Get the message? A scoping review of physical activity messaging

Training Healthcare Professionals on How to Promote Physical Activity in the UK: A Scoping Review of Current Trends and Future Opportunities

What physical activity (PA) training do current and future healthcare professionals (HCPs) receive in the UK? How is PA training delivered to them? The present scoping review looks at existing evidence to respond these questions. Seven databases were searched: Medline, SportDISCUS, PsycINFO, EMBASE, CINAHL, Cochrane Review Database, and Web of Science. Grey literature sources and key stakeholders were consulted. Studies were screened for inclusion, data were extracted and charted, and findings were synthesised according to the two research questions. Of the 3535 identified studies, 25 were included. The results show that no standardised approach was used to deliver PA promotion in HCPs training. PA training content was chiefly underpinned by an epidemiological approach. Online delivery of content predominated in continuing professional development training, whereas in undergraduate healthcare curriculum, delivery strategies varied. Overall, the process of embedding PA in HCPs’ curriculum and culture is ongoing. In addition to highlighting what is present within healthcare education, this study identifies further opportunities. Potential avenues include extending PA promotion into other workforces, including social workers.

A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL)

Background

Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors.

Objective

This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)—a self-administered, web-based time-use application to assess diet and movement behavior—and to evaluate its usability in schoolchildren in Singapore.

Methods

MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire.

Results

The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate.

Conclusions

MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress.

Changes in Physical Activity, Sleep, Mental Health, and Social Media Use During COVID-19 Lockdown Among Adolescent Girls: A Mixed-Methods Study

BACKGROUND

To suppress the transmission of coronavirus, many governments, including that of the island of Ireland, implemented a societal lockdown, which included school closures, limits on social gatherings, and time outdoors. This study aimed to evaluate changes in physical activity (PA), mental health, sleep, and social media use among adolescent girls during lockdown.

METHODS

281 female pupils (12-14 y) taking part in the ongoing Walking In Schools study on the island of Ireland self-reported PA, mental health, sleep, and social media use before (September-October 2019) and during lockdown (May-June 2020), via questionnaires. These were supplemented with open-ended structured interviews conducted with 16 girls during lockdown.

RESULTS

During the period of lockdown and school closures, pupils tried new forms of PA and undertook PA with family, but there was no significant change in self-reported PA. There was a decline in health-related quality of life and motivation for exercise; however, self-efficacy for walking and happiness with appearance increased. There was no change in sleep quality or social media usage.

CONCLUSIONS

Despite the many challenges that schools face as they reopen, there is a need to continue to prioritize PA and motivation for exercise to support health and well-being in adolescent girls.

Eight Investments That Work for Physical Activity

BACKGROUND

The International Society for Physical Activity and Health (ISPAH) is a leading global organization working to advance research, policy, and practice to promote physical activity. Given the expanding evidence base on interventions to promote physical activity, it was timely to review and update a major ISPAH advocacy document-Investments that Work for Physical Activity (2011).

METHODS

Eight investment areas were agreed upon through consensus. Literature reviews were conducted to identify key evidence relevant to policymakers in each sector or setting.

RESULTS

The 8 investment areas were as follows: whole-of-school programs; active transport; active urban design; health care; public education; sport and recreation; workplaces; and community-wide programs. Evidence suggests that the largest population health benefit will be achieved by combining these investments and implementing a systems-based approach.

CONCLUSIONS

Establishing consensus on 'what works' to change physical activity behavior is a cornerstone of successful advocacy, as is having appropriate resources to communicate key messages to a wide range of stakeholders. ISPAH has created a range of resources related to the new investments described in this paper. These resources are available in the 'advocacy toolkit' on the ISPAH website (www.ispah.org/resources).

Educational and Social Exergaming: A Perspective on Physical, Social, and Educational Benefits and Pitfalls of Exergaming at Home During the COVID-19 Pandemic and Afterwards

Physical inactivity and coronavirus disease 2019 (COVID-19) signify two pandemics with negative physical, mental, and economic consequences. Younger and older people have not reached the recommended physical activity level for years. Societal restrictions due to COVID-19 additionally reduce opportunities for physical activity, and they increase social isolation. Here, we outline how playing exergames with others (social exergaming) at home could foster physical and mental health and promote communication and discussions on exergaming. Accordingly, we highlight the educational and social benefits of exergaming at home and delineate the concept of Educational and Social Exergaming (EASE). We outline specific benefits and pitfalls of exergaming regarding its physical and nonphysical effects, including educational values of discussing exergaming experiences and related topics. Moreover, we discuss the relevance of practical guidelines for educational and social exergaming at home as well as prospects for future research. Overall, educational and social exergaming could alleviate several detrimental effects of both pandemics on the health and well-being of people of all ages.

Maximising the impact of global and national physical activity guidelines: the critical role of communication strategies

Objectives

Physical activity guidelines are evidence-based statements on recommended physical activity levels for good health. Guidelines, in isolation, are unlikely to increase population levels of physical activity; appropriate and effective communication is fundamental to maximising their impact. The aim of this paper is to provide a planning framework for physical activity guideline communication, including an overview of key audiences, aims and approaches.

Methods

All authors considered and agreed on the three broad issues to address by consensus. We identified key sources of evidence through scoping of the literature and our knowledge of the research area.

Results

Whether guidelines are global or national, communication of the physical activity guidelines should be informed by: (1) a situational analysis that considers the context in which the communication will take place and (2) a stakeholder analysis to determine the key target audiences for the communication and their values, needs and preferences. Audiences include policy-makers within and outside the health sector, other key stakeholders, the general public, specific population subgroups, health professionals and non-health professionals with a role in physical activity promotion. The aims and approach to communication will differ depending on the target audience.

Conclusion

Communication to raise awareness and knowledge of the physical activity guidelines must be supported by policies, environments and opportunities for physical activity. Besides the intrinsic value of the physical activity guidelines, it is essential that substantial effort is put in to diligently planning, funding and implementing their communication from the outset.

Physical activity is positively associated with college students' positive affect regardless of stressful life events during the COVID-19 pandemic

The study was designed to determine associations between physical activity (PA) and affect before and during COVID-19 stay-at-home orders and how change in PA predicted change in affect during this time. Before and during COVID-19 stay-at-home orders, college students (n = 107) completed assessments of PA, positive and negative affect, sleep quality, food insecurity, and stressful life events (during stay-at-home order only). Total minutes of PA was positively associated with positive affect before (B = 0.01, p < 0.01) and during (B = 0.01, p = 0.01) COVID-19 stay-at-home orders. Change in minutes of PA was positively associated with change in positive affect (B = 0.01, p = 0.01). Associations between PA and positive affect were not moderated by stressful life events. PA only predicted negative affect before COVID-19 stay-at-home orders (B = -0.003, p = 0.04). PA appears to enhance positive affect during a global pandemic. Findings have implications for PA as a tool for maintaining or enhancing mental health during a time of trauma and uncertainty.

Barriers and facilitators to changes in adolescent physical activity during COVID-19

OBJECTIVES

COVID-19 restrictions reduced adolescents' opportunities for physical activity (PA). The purpose of this study was to examine how adolescent PA changed during school closures, to identify the key barriers and facilitators for these changes during lockdown and to use this information to understand how to manage future crises' situations positively to prevent physical inactivity.

METHODS

Irish adolescents (N=1214; ages 12-18 years) participated in an online cross-sectional study during April 2020, including items on PA level, changes in PA and reasons for change in an open-ended format. Numeric analyses were through multiple binary logistic regressions, stratified by changes in PA during lockdown and inductive analysis of open coding of text responses.

RESULTS

Adolescents reported they did less PA (50%), no change (30%) or did more PA during lockdown (20%). Adolescents who did less PA were more likely to be overweight (OR=1.8, CI=1.2-2.7) or obese (OR=2.2, CI=1.2-4.0) and less likely to have strong prior PA habits (OR=0.4, CI=0.2-0.6). The most cited barriers to PA were coronavirus, club training cancelled and time. Strong associations for doing more PA included participation in strengthening exercises at least three times in the past 7 days (OR=1.7, CI=1.3-2.4); facilitators were more time, coronavirus and no school.

CONCLUSION

COVID-19 restrictions were both a barrier to and an opportunity for PA. Parents, schools, public health, communities and industries must collaborate to prevent physical inactivity at times of crisis, especially for vulnerable groups.

"Follow the Whistle: Physical Activity Is Calling You": Evaluation of Implementation and Impact of a Portuguese Nationwide Mass Media Campaign to Promote Physical Activity

To raise perceived capability (C), opportunity (O) and motivation (M) for physical activity (PA) behaviour (B) among adults, the Portuguese Directorate-General of Health developed a mass media campaign named "Follow the Whistle", based on behaviour change theory and social marketing principles. Comprehensive formative and process evaluation suggests this media-led campaign used best-practice principles. The campaign adopted a population-wide approach, had clear behavioural goals, and clear multi-strategy implementation. We assessed campaign awareness and initial impact using pre (n = 878, 57% women) and post-campaign (n = 1319, 58% women) independent adult population samples via an online questionnaire, comprising socio-demographic factors, campaign awareness and recall, and psychosocial and behavioural measures linked to the COM-B model. PA was assessed with IPAQ and the Activity Choice Index. The post-campaign recall was typical of levels following national campaigns (24%). Post-campaign measures were higher for key theory-based targets (all p < 0.05), namely self-efficacy, perceived opportunities to be more active and intrinsic motivation. The impact on social norms and self-efficacy was moderated by campaign awareness. Concerning PA, effects were found for vigorous activity (p < 0.01), but not for incidental activity. Overall the campaign impacted key theory-based intermediate outcomes, but did not influence incidental activity, which highlights the need for sustained and repeated campaign efforts.

Optimal messaging of the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years and older

The Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years and older (“Guidelines”) integrate recommendations for physical activity, sedentary, and sleep behaviours. Given the novelty of these integrated Guidelines, it was important to consider messaging strategies that would be most effective in reaching Canadian adults. The purpose of this study was to examine optimal messaging of the Guidelines as it pertains to communication channels and messages. Representative samples of Guideline end-users (N = 1017) and stakeholders (N = 877) each completed a cross-sectional survey. Descriptive statistics were calculated along with tests of statistical significance. Inductive content analysis was used to code stakeholders’ comments (i.e., suggestions, concerns) on a draft version of the Guidelines. Most end-users had recently referred to online medical resources; family, friends, and co-workers; and physicians as communication channels for information regarding the movement behaviours. End-users and stakeholders felt that generic messages would foster self-efficacy to meet the Guidelines. Stakeholders highlighted a variety of considerations to ensure the Guidelines are inclusive towards diverse groups within the Canadian population. Findings will inform Guideline messaging.

Novelty Most end-users referred to online medical resources; family, friends, and co-workers; and physicians as communication channels. End-users and stakeholders indicated that generic messages would foster self-efficacy to meet the Guidelines. Stakeholders expressed concerns about the inclusivity of the Guidelines for diverse socioeconomic groups.

Motivations and barriers to engagement with a technology-enabled community wide physical activity intervention

Previous physical activity interventions have failed to create population change and an alternative approach is needed to support a World Health Organization target of a 15% reduction in global levels of inactivity by 2030. There is growing evidence that gamification-based interventions can reach substantial portions of the community. However, to date, these studies have been predominantly quantitative and as such there is a paucity of research in the area on motivations and barriers to engagement with these programs. Four focus groups conducted with N = 26 players who participated in a gamification-based intervention ‘Beat the Street’ revealed several varied motives to engagement, including collective reward; social influence; game reinvention; exploration; accessibility and awareness. However, several barriers specific to the Beat the Street intervention and outdoor gamification interventions more generally were also identified. This study provides novel insight into the motives which engage individuals into physical activity interventions and the design principles which need to be considered when implementing interventions of this nature.

"Let's Talk about Physical Activity": Understanding the Preferences of Under-Served Communities when Messaging Physical Activity Guidelines to the Public

Despite many countries having physical activity guidelines, there have been few concerted efforts to mobilize this information to the public. The aim of this study was to understand the preferences of under-served community groups about how the benefits of physical activity, and associated guidelines, can be better communicated to the public. Participatory workshops, co-developed between researchers, a local charity, and a community artist, were used to gather data from four groups in Bristol, UK: young people (n = 17); adults (n = 11); older adults (n = 5); and Somali women (n = 15). Workshop content was structured around the study aims. The community artist and/or the local charity delivered the workshops, with researchers gathering data via observation, photos, and audio-recordings, which were analysed using the framework method. All four groups noted that the benefits of physical activity should be included within any communications efforts, though not restricted to health-related benefits. Language used should be simple and jargon-free; terms such as "sedentary", "vigorous" and "intensity" were deemed inaccessible, however all groups liked the message "some is good, more is better". Views about preferred mechanisms, and messenger, for delivering physical activity messages varied both between, and within, groups. Recommendations for those working in physical activity communications, research, and policy are provided.