Environmental and policy determinants of physical activity in the United States

A descriptive cross sectional study comparing barriers and determinants of physical activity of Sri Lankan middle aged and older adults

BACKGROUND

Benefits of physical activities are numerous. Barriers for physical exercise may differ among middle aged and older adults. Therefore, identifying and comparing the barriers for participating in regular physical exercises among middle aged and older adults will be useful in designing age specific physical exercise programmes.

METHODS

This descriptive cross sectional study was carried out among 206 Sri Lankan adults in the age range of 40-84 years in the Colombo North region of Sri Lanka using culturally validated questionnaires to determine and compare the barriers and factors associated with regular physical activity participation. Majority were males (56%) and 54% were < 60 years. People in the age range of 40-59 years were considered as middle age and ≥ 60 years as older adults. Bivariate analysis and multivariate analysis was carried out to determine the significant factors that are associated with regular physical activity participation.

RESULTS

Lack of free time (52%), feeling too lazy (26%) and bad weather (29%) were the main barriers for the participants. In < 60 years, high level of income (p = 0.008) and in ≥ 60 years, being a male (p = 0.016), having a high level of education (P = 0.002) and a high BMI (p = 0.002) had a significant negative association with the level of physical activities.

CONCLUSIONS

Contrary to findings from surveys in several developed countries, this study showed that having a high level of education and being a male were strongly related with lack of physical activity participation.

Parent recommendations to support physical activity for families with young children: Results of interviews in deprived and affluent communities in South Wales (United Kingdom)

BACKGROUND

Physical inactivity is the fourth leading cause of mortality worldwide. Early childhood is a critical period when healthy behaviours can be instilled for a future active lifestyle. We explored community, societal and environmental factors affecting child and family physical activity and sought parent recommendations to support physical activity in families with young children.

METHODS

We interviewed 61 parents expecting a child or with a baby ≤12 months (35 mother and father paired interviews and 26 interviews with mothers only). We purposively sampled families for neighbourhood deprivation status (Townsend Index; 26 affluent; 35 deprived). We conducted thematic analysis of interview transcripts using Bronfenbrenner's socio-ecological framework to guide interpretation.

RESULTS

We identified four themes: work family-life balance; spaces for activity; beliefs and attitudes; and physical activity facilitators. We found that parents from deprived neighbourhoods were more likely to be underactive because of a complex web of community, social and personal factors which reduced motivation and hindered opportunity for physical activity. To increase knowledge and opportunity, respondents suggested 'help not tell' messages covering 'why', 'how' and 'where' information about physical activity, and using physical activity to support community engagement and social interaction.

CONCLUSIONS

Recommendations from parents highlight effective communication about the importance of early child and family physical activity and improved community access to safe facilities and opportunities. Both parents need to be engaged in designing interventions to support greater physical activity and healthy behaviours which are relevant and achievable in individuals' lives.

Physical activity and self-rated health: role of contexts

The purpose of this study is to examine how much variance in self-rated health is attributable to household and administrative-area levels. Additionally, the study investigates the association between physical activity and self-rated health while adjusting for various covariates at the individual, household, and district levels in Seoul, South Korea. A cross-sectional study of the 2009 Seoul Welfare Panel Study conducted by Seoul Welfare Foundation was utilized. The final sample included 7,761 individuals within 3,617 households in 25 administrative areas. Three-level random intercept logistic models were fitted. The results showed that a small proportion (3.52%) of variance in self-rated health was attributed to the administrative-area level, while a relatively large proportion (33.78%) was attributed to the household level. This study also found a positive association between physical activity and self-rated health, even after controlling for covariates at multiple levels. The results indicated that public health interventions promoting physical activity may have a beneficial effect on individual health. Additionally, public health interventions for improving individual health may not be efficient if directed only at the administrative-area level, as only a small portion of variance in self-rated health was attributable to this level.

Neighborhood Walkability and Overweight/Obese Weight Status Among Latino Adults

PURPOSE

To examine whether aerobic physical activity mediates the association between neighborhood walkability and overweight/obesity weight status among Latino adults and whether the relative contribution of this pathway linking neighborhood walkability and aerobic activity varies by level of neighborhood social cohesion.

DESIGN

Cross-sectional.

SETTING

National Health Interview Survey (NHIS) 2015.

SAMPLE

NHIS adult Latino participants ≥18 years of age (n = 4303).

MEASURES

Neighborhood walkability, neighborhood social cohesion, body mass index, and aerobic physical activity.

ANALYSIS

To determine whether physical activity mediates the relationship of walkability with overweight/obese weight status, a simple mediation analysis was conducted. Additionally, a moderated mediation analysis was conducted to test whether neighborhood social cohesion had a moderating effect on this relationship.

RESULTS

On average, the sample was 41 years old, 51% were male, 34% had less than a high school education, and 57% were foreign-born. Neighborhood walkability was statistically significantly related to overweight/obese weight status (standardized effect= -0.05, standard error [SE] = 0.02, P = .01). The interaction between walkability and neighborhood social cohesion on physical activity was not significant (standardized effect = 0.06, SE = 0.03, P = .09). Thus, the indirect effect of walkability on overweight/obesity weight status through physical activity was not shown to be modified by neighborhood social cohesion.

CONCLUSION

Other neighborhood environment factors may play a role in the contribution of neighborhood walkability to overweight/obese weight status among Latinos.

Changes in work factors and concurrent changes in leisure time physical activity: a 12-year longitudinal analysis

OBJECTIVES

There is a paucity of longitudinal population-based studies examining whether changes in work factors are associated with concurrent changes in leisure time physical activity (LTPA). This study examines this issue using 12 years of longitudinal survey data.

METHODS

Data were drawn from the Canadian National Population Health Survey. The initial analytical sample in 1994 of 6407 working individuals was followed every 2 years from 2000 to 2010. Seven work factors were measured as independent variables: skill discretion, decision authority, psychological demands, physical exertion, number of jobs, hours at work and shift schedule. LTPA was categorised as inactive, moderately active or active based on metabolic equivalent task values. Fixed-effects multinomial logistic models were used to examine associations between work factors and LTPA controlling for time-invariant effects and adjusted for covariates.

RESULTS

Workers with lower skill discretion (OR=0.96; 95% CI 0.92 to 0.99), higher psychological demands (OR=0.95; 95% CI 0.92 to 0.99), higher physical exertion (OR=0.93; 95% CI 0.88 to 0.99) and longer work hours (OR=0.97; 95% CI 0.95 to 098) were associated with a lower odds of transitioning from inactive to active and moderately active. There was no evidence of effect modification by age or sex.

CONCLUSION

Results suggest that as participants' skill discretion decreased, and their physical and psychological demands, and work hours increased, their likelihood of becoming more active and moderately active also decreased, supporting the value of targeting improvements in these work factors for physical activity interventions.

Evidence to Improve Physical Activity among Medically Underserved Older adults: A Scoping Review

BACKGROUND AND OBJECTIVES

Participation in leisure physical activity (PA) and engagement in PA interventions among older adults is influenced by socioeconomic status (SES), race/ethnicity, and environment. However, studies of PA for medically underserved older adults have not yet been systematically evaluated. The objective of this study is to map the nature and extent of research conducted on PA participation, interventions, and components of effective leisure PA programs for medically underserved older adults.

RESEARCH DESIGN AND METHODS

The five-stage approach was used to conduct this scoping review. We searched PubMed, CINAHL, and Cochrane Library for peer-reviewed studies published between 2006 and 2016. Data extracted from selected studies included study population, study type, purpose of intent, evidence level, barriers to PA participation, and components of PA intervention.

RESULTS

Three hundred and ninety-two articles were identified, and 60 studies were included in the final data charting. Existing literature showed that most studies remained descriptive in nature, and few intervention studies have achieved a high level of evidence. Among 21 intervention studies, only 4 were explicitly conducted for older adults. Culturally adapted materials, race/ethnicity-specific barriers and facilitators, and form of intervention were important components for intervention programs.

DISCUSSION AND IMPLICATIONS

Findings indicate that more studies are needed to reduce health disparities related to PA participation for medically underserved older adults. Intervention components such as race/ethnicity-relevant barriers and facilitators and culturally sensitive materials are also needed for PA interventions targeting underserved older adults in order to provide evidence for best practices.

The mediating role of perceived crime in gender and built environment associations with park use and park-based physical activity among park users in high poverty neighborhoods

Women use parks less for physical activity than men, and explanations include gendered concerns regarding personal safety and access to walking paths. This study conducted mediation analyses to examine the effects of gender and presence of park walking path on park use, participation in park programs, and park-based physical activity through the hypothesized mediator (perception of crime). The sample included 3213 park users from 48 parks in high poverty neighborhoods in Los Angeles surveyed between 2013 and 2015; park-level factors were assessed through systematic observations of study parks. Women reported fewer park visits than men in the last 7 days (β = -0.17, p = 0.02) and had significantly higher perceived crime (β = 0.12, p < 0.0001) and perceived crime partially mediated the gender association with park visits (βgender, direct = -0.09, p = 0.19; βgender, indirect = -0.07, p < 0.0001). Similarly, the existence of a walking path in the park was significantly related to increased park use (β = 0.27, p = 0.006) and a lower level of perceived crime (β = -0.25, p = 0.0034) and perceived crime partially mediated the association of walking path with park visits (βwalking path, direct = 0.18, p = 0.10; βwalking path, indirect = 0.15, p = 0.005). The associations between gender, walking path, and park-based exercise and program participation were not meaningfully mediated by perceived crime. Among park users in majority Latino, high poverty neighborhoods, addressing crime concerns are likely necessary to increase park use among women and adults whose parks do not have a walking path. For park-based exercise and participation in park programs, gendered preferences regarding park-based physical activity should be explored.

A population-based study of the associations between neighbourhood walkability and different types of physical activity in Canadian men and women

Few Canadian studies have examined whether or not associations between neighbourhood walkability and physical activity differ by sex. We estimated associations between perceived neighbourhood walkability and physical activity among Canadian men and women. This study included cross-sectional survey data from participants in 'Alberta's Tomorrow Project' (Canada; n = 14,078), a longitudinal cohort study. The survey included socio-demographic items as well as the International Physical Activity Questionnaire (IPAQ) and the abbreviated Neighbourhood Environment Walkability Scale (NEWS-A), which captured perceived neighbourhood built characteristics. We computed subscale and overall walkability scores from NEWS-A responses. Covariate-adjusted generalized linear models estimated the associations of participation (≥10 min/week) and minutes of different types of physical activity, including transportation walking (TW), leisure walking (LW), moderate-intensity physical activity (MPA), and vigorous-intensity physical activity (VPA) with walkability scores. Walkability was positively associated with participation in TW, LW, MPA and VPA and minutes of TW, LW, and VPA. Among men, a negative association was found between street connectivity and VPA participation. Additionally, crime safety was negatively associated with VPA minutes among men. Among women, pedestrian infrastructure was positively associated with LW participation and overall walkability was positively associated with VPA minutes. Notably, overall walkability was positively associated with LW participation among men and women. Different perceived neighbourhood walkability characteristics might be associated with participation and time spent in different types of physical activity among men and women living in Alberta. Interventions designed to modify perceptions of neighbourhood walkability might influence initiation or maintenance of different types of physical activity.

The Association Between Seeing People Walk and Neighborhood Social Cohesion

Objectives

To examine the association between frequency of seeing people walk within sight of home and neighborhood social cohesion among adults, and whether this association varies by race/ethnicity.

Methods

We used cross-sectional 2015 National Health Interview Survey data on Latino, non-Latino White, non-Latino Black, and non-Latino Asian adults (N = 33,099). Multinomial logistic regression models were used to estimate the associations.

Results

Seeing people walk every day and every 2-3 days were significantly more likely to report medium levels of neighborhood social cohesion, relative to low. The association between seeing people walk and neighborhood social cohesion varied by race/ethnicity.

Conclusions

Higher frequency of seeing others walk may contribute to higher levels of neighborhood social cohesion.

Correlates of Physical Activity Among Disadvantaged Groups: A Systematic Review

CONTEXT

Socioeconomically disadvantaged adults have lower engagement in leisure-time physical activity than those who are more affluent. Identification of correlates of physical activity can inform the design of effective interventions. The aim of this systematic review was to identify consistent correlates of unspecified physical activity and leisure-time physical activity among socioeconomically disadvantaged adults.

EVIDENCE ACQUISITION

PubMed and Scopus were searched up to May 2018, and titles/abstracts and full texts were screened against eligibility criteria. Methodologic quality was assessed, and correlates were synthesized from July to September 2018.

EVIDENCE SYNTHESIS

Seventy-three studies were selected for synthesis; 48 examined unspecified physical activity and 31 examined leisure-time physical activity (6 examined both). Self-rated health, functional capacity, and physical activity self-efficacy were consistently, positively associated with unspecified physical activity. Mental health status and perceived benefits and enjoyment of physical activity were consistently, positively associated with leisure-time physical activity. Most studies were cross-sectional and used validated self-report measures of physical activity; few reported response rates >50%.

CONCLUSIONS

Few factors were consistently associated with either unspecified physical activity or leisure-time physical activity. Based on available evidence, strategies to increase physical activity should consider the needs of, and focus on, those with poor self-rated health and functional capacity and should use strategies to improve physical activity self-efficacy. Strategies to increase leisure-time physical activity should focus on simultaneously addressing leisure-time physical activity and mental health concerns and improving perceptions of physical activity benefits and enjoyment. It is recommended that future studies focus on leisure-time physical activity, focus on men, use longitudinal design, examine variables related to behavioral attributes and skills, and carefully consider and plan recruitment strategies.

The Effects of Continuous Compared to Accumulated Exercise on Health: A Meta-Analytic Review

BACKGROUND

Public health guidelines suggest that physical activity can be accumulated in multiple short bouts dispersed through the day. A synthesis of the evidence for this approach is lacking.

OBJECTIVE

Our objective was to undertake a systematic review and meta-analysis to examine if exercise interventions consisting of a single bout of exercise compared with interventions comprising the same total duration, mode, and intensity of exercise accumulated over the course of the day have different effects on health outcomes in adults.

METHODS

Six electronic databases were searched (Jan 1970-29 August 2018). Two authors identified studies that evaluated the effects of a single bout of exercise compared with the same intensity, total duration, and mode of exercise accumulated in multiple bouts over the course of a day, in community-dwelling adults. Risk of bias was assessed using the Cochrane Collaboration tool. Pooled effects were reported as standardised mean differences (MDs) and 95% confidence intervals (CIs) using a random effects model.

RESULTS

A total of 19 studies involving 1080 participants met the inclusion criteria. There were no differences between accumulated and continuous groups for any cardiorespiratory fitness or blood pressure outcomes. A difference was found in body mass changes from baseline to post-intervention in favour of accumulated exercise compared with continuous (MD - 0.92 kg, 95% CI - 1.59 to - 0.25, I2 = 0%; five studies, 211 participants). In subgroup analyses, accumulating > 150 min of weekly exercise in multiple bouts per day resulted in small effects on body fat percentage (combined post-intervention and change from baseline values: MD - 0.87%, 95% CI - 1.71 to - 0.04, I2 = 0%; three studies, 166 participants) compared with 150 min of exercise amassed via single continuous bouts per day. There was a decrease in low-density lipoprotein (LDL) cholesterol with accumulated versus continuous exercise (MD - 0.39 mmol/l, 95% CI - 0.73 to - 0.06, I2 = 23%; two studies, 41 participants). No differences were observed for any other blood biomarker (total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, and fasting insulin).

CONCLUSIONS

There is no difference between continuous and accumulated patterns of exercise in terms of effects on fitness, blood pressure, lipids, insulin and glucose. There is some evidence from a small number of studies that changes in body mass and LDL cholesterol are more favourable following the accumulated condition. Collectively our findings suggest that adults are likely to accrue similar health benefits from exercising in a single bout or accumulating activity from shorter bouts throughout the day. This review will inform public health guidelines for physical activity at the global and national levels (PROSPERO 2016 CRD42016044122).

Risk of a feedback loop between climatic warming and human mobility

Human behaviours alter-and are altered by-climate. Might the impacts of warming on human behaviours amplify anthropogenic contributions to climate change? Here, we show that warmer temperatures substantially increase transportation use in the USA. To do so, we combine meteorological data with data on vehicle miles travelled (VMT) and public transit trips (PTT) between 2002 and 2018. Moving from freezing temperatures up to 30°C increases VMT by over 10% and amplifies use of public transit by nearly 15%. Temperatures beyond 30°C exert little influence on either outcome. We then examine climate model projections to highlight the possible transportation impacts of future climatic changes. We project that warming over the coming century may add over one trillion cumulative VMT and six billion PTT in the USA alone, presenting the risk of a novel feedback loop in the human-environmental system.

Neighborhood Recreation Facilities and Facility Membership Are Jointly Associated with Objectively Measured Physical Activity

Efforts to increase physical activity have traditionally included either individual-level interventions (e.g., educational campaigns) or neighborhood-level interventions (e.g., additional recreational facilities). Little work has addressed the interaction between spatial proximity and individual characteristics related to facility use. We aimed to better understand the synergistic impact of both physical activity environments and recreational facility membership on objectively measured physical activity. Using the New York City Physical Activity and Transit (PAT) survey (n = 644), we evaluated associations between counts of commercial physical activity facilities within 1 km of participants' home addresses with both facility membership and accelerometry-measured physical activity. Individuals living near more facilities were more likely to report membership (adjusted odds ratio for top versus bottom quartile of facility count: 3.77 (95% CI 1.54-9.20). Additionally, while amount of facilities within a neighborhood was associated with more physical activity, this association was stronger for individuals reporting gym membership. Interventions aiming to increase physical activity should consider both neighborhood amenities and potential barriers, including the financial and social barriers of membership. Evaluation of neighborhood opportunities must expand beyond physical presence to consider multiple dimensions of accessibility.

Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program

Introduction

Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people’s health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees.

Methods

We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods.

Results

Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively.

Conclusion

Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.

Perceived and objective characteristics of the neighborhood environment are associated with accelerometer-measured sedentary time and physical activity, the CARDIA Study

We investigated cross-sectional and longitudinal associations of neighborhood environment characteristics with accelerometer-measured sedentary time (SED), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA). Participants were 2120 men and women in the year 20 (2005-2006) and year 30 CARDIA exams (2015-2016). Year 20 neighborhood characteristics included neighborhood cohesion, resources for physical activity, poverty, and racial residential segregation. Physical activity was measured by accelerometer at years 20 and 30. Multivariable linear regression models examined associations of standardized neighborhood measures at year 20 with SED, LPA, and MVPA assessed that year, and with 10-year changes in SED, LPA, and MVPA. Cross-sectionally, a one standard deviation (SD) increase in cohesion was associated with 4.06 less SED min/day (95% CI: -7.98, -0.15), and 4.46 more LPA min/day (95% CI: 0.88, 8.03). Each one SD increase in resources was associated with 1.19 more MVPA min/day (95% CI: 0.06, 2.31). A one SD increase in poverty was associated with 11.18 less SED min/day (95% CI: -21.16, -1.18) and 10.60 more LPA min/day (95% CI: 1.79, 19.41) among black men. No neighborhood characteristic was associated with 10-year changes in physical activity in the full sample; however, a one SD increase in cohesion was associated with a 10-year decrease of 25.44 SED min/day (95% CI: -46.73, -4.14) and an increase of 19.0 LPA min/day (95% CI, 1.89, 36.10) in black men. Characteristics of the neighborhood environment are associated with accelerometer-measured physical activity. Differences were observed by race and sex, with more robust findings observed in black men.

Physical activity level in women with gestational diabetes mellitus: Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) study

BACKGROUND

The aim of this study was to investigate physical activity and associated factors in women with gestational diabetes mellitus (GDM).

METHODS

This cross-sectional study was performed on 2706 women as part of the Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) study, recruited between 2012 and 2016 in Brazil. A structured questionnaire was used to assess physical activity. Descriptive and Poisson regression analyses were used to investigate physical activity and associated factors.

RESULTS

Counseling regarding physical activity practices was reported by 47.4% and 34.3% of women before and after a diagnosis of GDM, respectively. During pregnancy, 26% of women were classified as inactive, 39.7% were classified as insufficiently active, and 34.3% were classified as active. Compared with prepregnancy, 63.1% of women reported a decrease in physical activity levels during pregnancy. The prevalence of being inactive during pregnancy was higher among women who did not live with a partner (P = 0.003), had a lower household income (P = 0.01), were employed (P < 0.001), and who had four or more children (P < 0.001).

CONCLUSION

Among Brazilian women with GDM, physical activity levels and practices were low, with most women reporting decreased physical activity during pregnancy. A low socioeconomic status was associated with lower physical activity. These findings indicate the need to reinforce the importance of physical activity in the management of GDM in Brazil.

Comparative Associations of Street Network Design, Streetscape Attributes and Land-Use Characteristics on Pedestrian Flows in Peripheral Neighbourhoods

Research has sufficiently documented the built environment correlates of walking. However, evidence is limited in investigating the comparative associations of micro- (streetscape features) and macro-level (street network design and land-use) environmental measures with pedestrian movement. This study explores the relative association of street-level design-local qualities of street environment-, street network configuration -spatial structure of the urban grid- and land-use patterns with the distribution of pedestrian flows in peripheral neighbourhoods. Street design attributes and ground-floor land-uses are obtained through field surveys while street network configuration is evaluated through space syntax measures. The statistical models indicate that the overall spatial configuration of street network proves to be a stronger correlate of walking than local street-level attributes while only average sidewalk width appears to be a significant correlate of walking among the streetscape measures. However, the most significant and consistent correlate of the distribution of flows is the number of recreational uses at the segment-level. This study contributes to the literature by offering insights into the comparative roles of urban design qualities of the street environment and street network layout on pedestrian movement. The findings also offer evidence-based strategies to inform specific urban design and urban master planning decisions (i.e., the provision of more generous sidewalks on streets with relatively higher directional accessibility) in creating lively, walkable environments.

Access to Soft-Surface, Green Exercise Trails in Mountainous, Urban Municipalities

Soft-surface exercise infrastructure (ie off-road, mountain, and dirt trails) has been a particularly valuable community asset in mountainous, urban municipalities. This off-road, trail infrastructure can encourage individuals to engage in green exercise (ie physical activity done outside while in nature, for example, mountainous trails and near waterways). Green exercise can be helpful for encouraging individuals to participate in exercise who otherwise may not; it is especially helpful for promoting mental well-being and a sense of being connected to the environment. This study characterizes trail access and predictors among urban, mountainous municipalities in the Utah Wasatch Front region. Access was determined using two-standard deviation ellipses (2SDE) activity space analysis, and predictors were identified using multiple linear regression. About 42% municipalities had no trailhead access (ie no trailhead within its corresponding activity space). Trail density and trailheads were significantly correlated (r = 0.49, P = .004). There was a significant trail density cluster in the southern area of the study region, centered all over the city of Alpine. Reduced-model regression yielded trailheads and home income as being significant predictors of trail density, and trail density and elevation as being significant predictors for trailheads. Results demonstrate patterns of access to green exercise trails that align with socioeconomic and municipal elevation. The results of this research should be insightful for those who work in exercise promotion and urban planners.

Physical Activity Among Native Hawaiians and Pacific Islanders: A Systematic Review and Meta-Analysis

OBJECTIVE

To examine the proportion of Native Hawaiian and Pacific Islander (NHPI) meeting recommended physical activity guidelines for Americans (PAG) and determine differences in physical activity (PA) by sex and between NHPI and Asians when data are disaggregated.

DESIGN

Systematic review and meta-analysis.

SETTING

Articles identified in CINAHL, The Cochrane Library, Embase, PsychINFO, PubMed, Scopus, SocINDEX, SPORTDiscus, and Web of Science.

PARTICIPANTS

NHPI children and adults, and Asian adults.

INTERVENTIONS

Proportion of NHPI meeting PAG and differences in PA involvement by sex and by ethnicity.

METHODS

Summary reporting for articles, and meta-analysis using random-effects and inverse-various weighted models.

CONCLUSIONS AND IMPLICATIONS

Just over one-third of NHPI children met the PAG (mean = 38.6%, 95% CI [32.43-45.08]), with more males (42.8%) than females (34.7%) meeting the guidelines (t = 6.74, df = 1, P = .02). Less than half met the PAG for combination (mean = 48.7%, 95% CI [34.69-62.97]), moderate (mean = 47.1%, 95% CI [33.62-61.07]), and about one-third met the PAG for vigorous PA (mean = 33.4%, 95% CI [24.55-43.62]). There were no significant differences between Asians and NHPI in PA. Policy, systems, and environmental changes as well as culturally appropriate interventions are needed to increase physical activity among NHPI.

Residents' expectations for new rail stops: Optimistic neighborhood perceptions relate to subsequent transit ridership

Although complete street policies are proliferating, little is known about how nearby residents perceive and act on their new active transportation opportunities. We survey the same neighborhood residents before and after they receive a new complete street renovation with five new light rail stops. We compare Time-1 expectations to use rail with Time-2 evidence of rail use, based on both self-reported and objective GPS/accelerometer measures of ridership. We examine neighborhood perceptions of four groups, created by combining Time-1 expectations to ride with Time-2 ridership: No expect/no ride, no expect/ride, expect/no ride, and expect/ride. The strongest differences were between the no expect/no ride and expect/ride groups. The riders had more positive expectations for light rail's impact on the neighborhood than non-riders; these broad expectations were more powerfully associated with rail ridership than individual barriers to use, such as time constraints or weather. More positive perceptions of the route to rail stops (pleasantness, traffic safety, and crime safety) were also held by riders. Some of the more positive perceptions helped distinguish between the expect/ride group and the expect/no ride group. These results underscore that increasing positive neighborhood perceptions might help convert expected riders into actual riders.

Effects of high-intensity interval training frequency on perceptual responses and future physical activity participation

The effectiveness of high-intensity interval training (HIIT) in inducing positive physiological adaptations is well documented. However, its impact on perceptual responses and on future physical activity (PA) engagement is less evaluated. The present study aimed to examine the effects of HIIT frequency on perceptual responses, health-related quality of life (HRQOL), and its influence in future PA participation. Thirty-five inactive adults were randomly assigned to a control (CON) and to 2 training groups that performed HIIT (10 × 60 s cycling, ∼83% peak power output) for 2 (HIIT-2) or 3 (HIIT-3) times per week for 8 weeks. Following the HIIT intervention, exercise enjoyment, HRQOL, and the intention to implement HIIT in the future were evaluated. Eight weeks after cessation of training, follow-up evaluations of HRQOL and PA were performed. Following the intervention, both training frequencies induced high levels of enjoyment (HIIT-2: 6.0 ± 1.1, HIIT-3: 6.0 ± 1.1, scale 1-7), improved HRQOL (HIIT-2: p = 0.040; HIIT-3: p = 0.024), and reported intention to implement HIIT in the future (HIIT-3: 100%, HIIT-2: 93% of participants). At follow-up, HIIT-3 participants reported higher completion of HIIT compared with HIIT-2 and CON (p < 0.05). Both training groups sustained improved HRQOL and increased vigorous and total PA (p < 0.05). This study showed that performing HIIT either 2 or 3 times per week is an enjoyable exercise modality that promotes a sustainable increase in habitual PA levels and improves HRQOL. Moreover, the higher training frequency resulted in greater HIIT completion in the 8-week period following the cessation of training.

Service Availability, Service Use, and Psychological Well-Being of Older Residents of Residential Care Facilities and Nursing Homes

THE PROBLEM

The availability and use of certain services that can compensate for older adults' decreased abilities and capabilities may help them maintain their independence and improve their psychological well-being. Therefore, this study investigated whether service availability and service use were associated with the psychological well-being of residents of residential care facilities and nursing homes.

THE RESOLUTION

Residents who used services that provide help with activities of daily living and instrumental activities of daily living were more likely to report a worse mood, poor psychological health, and low self-efficacy compared with those living in facilities where the services were not available. On the other hand, older residents who used social and wellness-related services were more likely to have a better mood, good psychological health, and high self-efficacy.

TIPS FOR SUCCESS

Senior living facilities should consider providing more social and wellness-related services and encourage residents' use of such services to improve their psychological well-being.

The Relationships between Park Quality, Park Usage, and Levels of Physical Activity in Low-Income, African American Neighborhoods

Parks can be an important, low-cost neighborhood resource to increase physical activity and reduce overweight and obesity. The quality of parks, however, may impact use. This study used observational data to examine the relationships between park quality, park usage and levels of physical activity among users in 31 parks within low-income, African American neighborhoods. Relationships between park use and park characteristics (signs of disorder, attractiveness, and number of activity settings) varied by gender and user activity level. No variables of interest were significant for overall number of male users; whereas, disorder and attractiveness were significant for overall number of female users. Parks with signs of disorder were associated with 49% fewer female users (IRR = 0.51, 95% CI = (0.34–0.77)) and attractive parks with 146% more female users (IRR = 2.46, 95% CI = (1.39–4.33)). Similar significant relationships were found among active but not sedentary female users. Communities may consider increasing park maintenance and addressing attractiveness in existing parks as a relatively low-cost environmental strategy to encourage park use, increase physical activity, and reduce the burden of obesity, especially among women in low-income, African-American communities.

Results from the Medical School Physical Activity Report Card (MSPARC) for a Thai Medical School: a mixed methods study

BACKGROUND

Data systems for surveillance and monitoring are essential to develop understanding of the levels of physical activity (PA) occurring at the population levels. To comprehensively understand PA in medical schools, a suitable surveillance tool might be useful to present and monitor key PA-related metrics. This study investigated PA-related metrics in a Thai medical school and summarised the findings using a newly developed tool-the Medical School Physical Activity Report Card (MSPARC).

METHODS

A mixed methods study was carried out at three campuses of a medical school in Southern Thailand. Data analysis included descriptive statistics and qualitative reviews. All 285 medical students from a medical school were the target population. The prevalence of PA (≥ 150 min/week of moderate- to vigorous-intensity PA) and sedentary behaviours (SB) (≥ 8 h/day of sedentary time) among medical students were analysed using data from a self-administered questionnaire. Usage patterns, quality, and accessibility of walkable neighbourhoods; bicycle facilities; and recreational areas were assessed. PA promotion programmes, education, and investment related to PA promotion were reviewed from the school documents.

RESULTS

Of 279 participants, 138 (49.5%) met PA recommendation, but 71.7% met criteria for SB. Male students were more active (61.8 vs. 42.4%) and less sedentary (65.7 vs. 75.1%) than female students. Bicycle facilities were rated as having the lowest quality and accessibility among PA-related facilities. Most PA promotion programmes were sports clubs and sport competitions. A total of 25 h of PA education was taught throughout the entire curriculum, which provided minimal PA counselling training. The school invested 2136.14 Baht/student/year (US $64.34) in PA promotion, or 2.4% of the annual tuition. The MSPARC presented the summary of the findings by using simple symbols, infographics, and short texts.

CONCLUSIONS

To increase PA and decrease SB among medical students, there is a need to improve the quality and accessibility of the built environment as well as the natural environment, so as to establish health promoting policies. PA counselling training is required to develop the medical students' essential skills and awareness for future practices. Monitoring and subsequent surveillance of PA in medical school are needed.

Descriptive Analysis of Physical Activity Initiatives for Health Promotion in Saudi Arabia

Background: Although the benefits of physical activity are well acknowledged, a high percentage of Saudi population, especially females, remain essentially physically inactive. Getting inactive people to start participating in physical activity and to keep exercising remains a great challenge. Physical activity initiatives in the country have not been previously documented. Therefore, the aim of this article was to provide a narrative review of the physical activity initiatives and discusses influencing factors.

Methods: Publically-available physical activity initiatives conducted before June 2018 were searched through the web or they were obtained straight from the organization themselves. The search focus was on any initiative aimed to promote physical activity and mass sports participation and encourage people to adopt active living habit.

Results: Numerous initiatives aimed at promoting physical activity existed in Saudi Arabia. However, a common attribute of these initiatives is that they were fragmented, short term attempts, and lacked a coordinating body. The majority of the physical activity initiatives also lacked objective evaluations of their outcomes. It was clear that more physical activity opportunity must be provided for Saudi girls, women, and elderly. There is a need for establishing a national policy encouraging active living and discouraging sedentary lifestyle with contributions from all involved parties.

Conclusions: Based on the available evidences, more intensified efforts toward promoting physical activity and reducing sedentary behaviors among Saudi population are needed in order to reduce the risks of NCD's.

A preliminary report on physical activity patterns among children aged 8-14 years to predict risk of cardiovascular diseases in Malwa region of Punjab

OBJECTIVE

To determine the pattern of physical activity specific to age and gender among young Indian school going girls and boys aged 8-14 years.

DESIGN

Cross-sectional study.

SETTING

Private and government sponsored schools in Patiala and Mansa District of Punjab, India.

PARTICIPANTS

Two hundred thirty four school going girls and boys aged 8-14 years.

METHODOLOGY

A structured questionnaire recorded the various forms of daily physical activity, sedentary activity as well as physical activity level of all the participants. The energy expenditure was also calculated using the standard metabolic equivalent index.

RESULTS

There is a significant difference between mean weights of participants belonging to different physical activity levels (p<.04). In comparison to boys, the girl participants have significant lower values of physical activity duration as well as total metabolic equivalent expenditure (p<.05). The total duration of moderate/vigorous physical activity declined in both girls and boys as the age increased.

CONCLUSION

Physical activity among children in Northern regions of India is on decline as their age increases especially among girls. It is important to determine physical activity duration in early age groups and motivate children for daily physical activity.

Readiness to Adopt Physical Activity Policies in Rural Communities

The purpose was to explore community readiness to adopt physical activity (PA) policies by adapting and pilot testing an online survey (Physical Activity Readiness Survey [PARS]). PARS was adapted from the previously tested Community Readiness Survey-Short. In February/April 2016, key informants (N = 17) involved in PA activities from two rural communities were invited to complete the PARS, representing six dimensions: knowledge, leadership, resources, community climate, existing voluntary PA policies, and political climate. First, participants were asked to respond to a presurvey to screen for overall readiness for up to four evidence-based PA policies. A main survey readiness score (0-6) was determined by averaging the key informants' ratings across items: Raw scores were rescaled to range from 0 to 1, and dimension scores were summed. Participants identified two PA policies in the presurvey: neighborhood availability and point-of-decision prompts. For both policies, political climate had the highest dimension score (1.0) and the knowledge dimension scored lowest (0.05-0.38). Overall readiness scores ranged from 3.19 to 3.62, revealing the preparation stage for both policies. Readiness for the two PA policies were similar, but specific dimension scores varied by policy type and community, reinforcing the need for tailored interventions.

Protected Natural Areas: In Sickness and in Health

Numerous studies show the benefits that contact with the natural environment have for human health, but there are few studies on the role of Protected Natural Areas (PNAs), either from the preventive point of view or on their potential benefits, on individuals with health problems. A study was made of the relationship between the visitation of Montseny Natural Park and Biosphere Reserve and health, from the perspective of a population group with different diseases. A total of 250 patients resident in the areas near the park were surveyed, recording their beliefs about the benefits of nature, as well as the reasons for visiting and the activities associated with health that they carried out in the park. The pure air is the most valued benefit (27.2%), particularly for those with allergies. The majority (57%) visit the park for health reasons. High levels (82%) of exercise are recorded, especially by patients with heart diseases (85%), and 65% exercised in the park. More physical activity is mentioned among those that visit the park most often, particularly among those that carried it out for health reasons. Plants were collected for medicinal use by 39.6%. The study confirmed the significant role of the Montseny Natural Park and Biosphere Reserve as a health resource for individuals with diseases that live near it. It also corroborates the beneficial effects that the PNA provide in human health.

Psychosocial and demographic predictors of postpartum physical activity

Physical activity promotes better health outcomes across the lifespan, and provides physical and mental health benefits for women who have recently given birth. However, research has not adequately characterized physical activity levels or risk factors for inadequate physical activity during the postpartum period. The objective of the present study was to describe levels and correlates of physical activity at 6 months postpartum in mothers of diverse race/ethnicity (55% African American, 23% White, 22% Hispanic/Latina), with the majority living in or near poverty. We analyzed data collected by the five-site Community Child Health Network study. Women (n = 1581) were recruited shortly after the birth of a child. Multinomial logistic regression models tested associations of demographic factors and self-reported stress in several life domains with total physical activity levels at 6-9 months postpartum, including activities done at work, at home, for transportation, and leisure. Thirty-five percent of participants in this sample reported low levels of physical activity. African American race, Latina ethnicity, and living in a rural area were associated with low levels of physical activity, whereas working outside the home was associated with high physical activity. Contrary to hypotheses, chronic stress was not associated with physical activity with the exception of financial stress, which predicted greater likelihood of being highly physically active. These findings suggest that optimal postpartum care should integrate physical activity promotion, and that African American, Latina, and rural-dwelling women may benefit most from efforts to promote activity following birth.

The influence of social networks and the built environment on physical inactivity: A longitudinal study of urban-dwelling adults

Policies targeting the built environment to increase physical activity may be ineffective without considering personal social networks. Physical activity and social network data came from the Montreal Neighborhood Networks and Healthy Aging Panel; built environment measures were from geolocation data on Montreal parks and businesses. Using multilevel logistic regression with repeated physical inactivity measures, we showed that adults with more favorable social network characteristics had lower odds of physical inactivity. Having more physical activity facilities nearby also lowered physical inactivity, but not in socially-isolated adults. Community programs that address social isolation may also benefit efforts to increase physical activity.

Do Support and Strain With Adult Children Affect Mothers' and Fathers' Physical Activity?

Physical activity is central to health. Parents tend to have lower levels of physical activity than the childless, however, little is known about how adult child-parent relationship quality matters for mothers' and fathers' physical activity trajectories. Nationally representative panel data from the Americans' Changing Lives survey (1986-2012) are used to analyze multilevel-ordered logistic regression models. Greater social support from adult children is associated with more frequent active exercise, and higher strain with adult children is related to more frequent active exercise and walking. A significant gender interaction suggests that strain with adult children is related to greater exercise among men more so than women, but this interaction is attenuated after adjusting for cigarette smoking, another gendered way of coping with stress. This study contributes to a more nuanced understanding of how different dimensions of intergenerational relationships shape health behaviors across the life course.

The correlates of physical activity among adult Métis

OBJECTIVES

Métis, with a population of close to 390,000 people, are a culturally distinct and constitutionally recognized Aboriginal group in Canada that suffers from poorer overall health than non-Aboriginal Canadians. One important predictor of good health is physical activity. Guided by frameworks based on social and Aboriginal-specific determinants, we investigated the correlates of leisure-time physical activity (LTPA) and active transportation (walking) among adult Métis, with a particular focus on how culturally specific variables were associated with these two types of activity. We also examined how demographic, geographic, socioeconomic and health-related factors were associated with physical activity.

DESIGN

We used data from Statistics Canada's 2006 Aboriginal Peoples Survey and Métis Supplement to analyze the correlates of physical activity among Métis aged 20-64, using a series of logistic regression models.

RESULTS

Having attended a Métis cultural event in the past year was positively associated with LTPA, as was a high level of spirituality. Similarly, those who had attended a cultural event in the last year were more likely to report a high level of active transportation. Speaking an Aboriginal language and being a member of a Métis organization were not independently associated with the two types of physical activity. Self-perceived health, being male and household income were other correlates positively associated with LTPA, whereas age, body mass index and smoking were negatively associated with this type of activity. Active transportation was positively associated with self-perceived health and being female, while negatively associated with age and body mass index.

CONCLUSIONS

The results of this study suggest that interventions aimed at increasing physical activity among adult Métis might be more successful if they are connected to cultural activities and spirituality. This research also suggests that demographic, socioeconomic and health-related factors are important considerations when designing initiatives to increase physical activity among adult Métis.

Changing the housing environment to reduce obesity in public housing residents: a cluster randomized trial

BACKGROUND

Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments.

METHODS

This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments.

RESULTS

Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable.

CONCLUSIONS

These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.

Does Physically Demanding Work Hinder a Physically Active Lifestyle in Low Socioeconomic Workers? A Compositional Data Analysis Based on Accelerometer Data

Leisure time physical activity (LTPA) is strongly associated with socioeconomic position (SEP). Few studies have investigated if demanding occupational physical activity (OPA) could impede a physically active lifestyle in low SEP groups. The aim of this study was to investigate the association between OPA and LTPA among low SEP men and women. We used cross-sectional data from 895 low SEP workers who wore accelerometers for 1–5 consecutive workdays. The associations between the relative importance of activities performed during work and leisure time were assessed using compositional regression models stratified on sex. Compositional isotemporal substitution models were used to assess the implication of increasing occupational walking, standing, or sitting on LTPA. We found dissimilarity in LTPA between the sexes, with men spending more waking leisure time sedentary than women (men ~67%, women ~61%), suggesting women performed more household tasks. In men, the associations between OPA and LTPA were weak. In women, the strongest association was observed between the relative importance of occupational walking and leisure time standing (β^ = −0.16; p = 0.01), where reallocating 15 min work time to occupational walking showed an expected decrease in leisure time standing of 7 min. If this time was spent on additional sedentary leisure time, it could have adverse health consequences.

Association between Access to Public Open Spaces and Physical Activity in a Mediterranean Population at High Cardiovascular Risk

Background: Regular physical activity is an important preventive factor of cardiovascular disease. Proximity and density of public open spaces are important modifying factors on the practice of physical activity. This article explores the cross-sectional relationship between access to public open spaces (POS) and leisure time physical activity (LTPA) in elderly participants at high cardiovascular risk from PREDIMED-Baleares. Method: 428 elderly subjects at high cardiovascular risk, participating in the PREDIMED trial, from Palma de Mallorca (Spain) were assessed using Geographic Information Systems, and access to POS was determined. The quantity and intensity of LTPA was calculated using the Minnesota Leisure-Time Physical Activity Questionnaire. In order investigate the association between access to POS and LTPA, generalized linear regression models were used. Results: Better access to POS was not consistently associated with total LTPA. Only distance to the nearest park showed a borderline significant positive associated with total LTPA and moderate-vigorous LTPA but was not associated with light LTPA. Conclusions: Although living near POS was not associated to total LTPA, higher levels of moderate-vigorous LTPA were associated to distances to the nearest park. Future work should be conducted on a larger sample size, integrating a longitudinal design, and greater heterogeneity in POS access and introducing objective measures of physical activity.

Crime, perceived safety, and physical activity: A meta-analysis

Perceived safety from crime and objectively-measured crime rates may be associated with physical inactivity. The purpose of this meta-analysis is to estimate the odds of accumulating high levels of physical activity (PA) when the perception of safety from crime is high and when objectively-measured crime is high. Peer-reviewed studies were identified through PubMed, Web of Science, ProQuest Criminal Justice, and ScienceDirect from earliest record through 2016. Included studies measured total PA, leisure-time PA, or walking in addition to perceived safety from crime or objective measures of crime. Mean odds ratios were aggregated with random effects models, and meta-regression was used to examine effects of potential moderators: country, age, and crime/PA measure. Sixteen cross-sectional studies yielded sixteen effects for perceived safety from crime and four effects for objective crime. Those reporting feeling safe from crime had a 27% greater odds of achieving higher levels of physical activity (OR=1.27 [1.08, 1.49]), and those living in areas with higher objectively-measured crime had a 28% reduced odds of achieving higher levels of physical activity (OR=0.72 [0.61, 0.83]). Effects of perceived safety were highly heterogeneous (I²=94.09%), but explored moderators were not statistically significant, likely because of the small sample size. Despite the limited number of effects suitable for aggregation, the mean association between perceived safety and PA was significant. As it seems likely that perceived lack of safety from crime constrains PA behaviors, future research exploring moderators of this association may help guide public health recommendations and interventions.

Mapping the historical development of physical activity and health research: A structured literature review and citation network analysis

Little has been published about the historical development of scientific evidence in the physical activity (PA) and public health research field. The study aimed to examine the evolution of knowledge in this field. A structured literature review using formal citation network analysis methods was conducted in June-2016. Using a list of influential PA publications identified by domain experts, a snowball sampling technique was used to build a compact citation network of 141 publications that represents the backbone of the field. Articles were coded by study type and research team characteristics, then analyzed by visualizing the citation network and identifying research clusters to trace the evolution of the field. The field started in the 1950s, with a health sciences focus and strong North American and European leadership. Health outcome studies appeared most frequently in the network and policy and interventions least. Critical articles on objective measurement and public policy have influenced the progress from an emphasis on health outcomes research at early stages in the field to the more recent emerging built environment and global monitoring foci. There is only modest cross-citation across types of study. To our knowledge, this paper is the first to systematically describe the development of research on PA and public health. The key publications include fundamental ideas that remain citable over time, but notable research and dissemination gaps exist and should be addressed. Increasing collaboration and communication between study areas, encouraging female researchers, and increasing studies on interventions, evaluation of interventions and policy are recommended.

Interactions between individual and perceived environmental factors on Latinas' physical activity

Background

Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas' PA.

Methods

We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA.

Results

Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women.

Conclusions

Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas' PA.

If You Build It, Will They Come? A Quasi-experiment of Sidewalk Improvements and Physical Activity

Improving sidewalks could lead to more physical activity through improved access, while providing a safe and defined space to walk. Yet, findings on the association between sidewalks and physical activity are inconclusive.

PURPOSE

The purpose of this study was to examine changes in self-reported and accelerometer-derived physical activity associated with living near recently improved sidewalks in a diverse, community-based sample from the Houston Travel Related Activity in Neighborhoods (TRAIN) Study.

METHODS

Data are from 430 adults and include baseline and first annual follow-up (2014-2017). Fully adjusted, two-step regression models were built to test the hypothesis that living near (within 250-meters) an improved sidewalk was associated with greater levels of physical activity than not living near an improved sidewalk.

RESULTS

The majority of participants were female, non-Hispanic black, low income, low education, and nearly half lived near at least one improved sidewalk. After adjustment, among participants reporting some physical activity, living near two sidewalk improvements was associated with 1.6 times more minutes per week of walking and leisure-time physical activity than those not living near a sidewalk improvement (p<0.05). Based on accelerometry, which does not specifically quantify domain-specific physical activity, there were no significant associations.

CONCLUSION

Although these mixed findings warrant further research, results suggest that improving sidewalks may have an effect on participants' physical activity. Nonspecific definitions of sidewalk improvements could be contributing to type 1 error. Future work should also examine behavioral interventions alongside changes to the built environment to determine the effects on physical activity.

Understanding Outdoor Gyms in Public Open Spaces: A Systematic Review and Integrative Synthesis of Qualitative and Quantitative Evidence

(1) Background: An outdoor gym (OG) is environmental infrastructure built in a public open space to promote structured physical activity. The provision of OGs is increasingly seen as an important strategy to realize public health agendas promoting habitual physical activity. A systematic review was conducted to synthesize characteristics of OG and OG users' experiences and perceptions in different cultural contexts; (2) Methods: Online searches of multidisciplinary databases were conducted in health, sport and recreation, and urban planning disciplines. Characteristics of OGs were synthesized by integrating evidence from quantitative, qualitative, and mix-methods studies. The experiences and perceptions of OG users from both qualitative data and survey responses were synthesized through framework analysis; (3) Results: Nine studies met the inclusion criteria (three quantitative studies, four mixed-methods studies, and two pure qualitative studies). None were excluded on the basis of quality. OGs mainly serve adult and older adult population groups. Their size, design, and instructional support vary across studies. The inclusion of functional types of equipment did not have a unified standard. Regarding experiences and perceptions of OGs, five major themes emerged: "health", "social connectedness", "affordable", "support", and "design and promotion"; (4) Conclusions: The OG characteristics synthesis guides the direction in further studies regarding exploration of design parameters. The qualitative and quantitative synthesis revealed that health was a central theme of users' experiences. OGs are also spaces where community-dwellers can find social connectedness while participating in structured physical activity at no cost. Findings from this review create knowledge support for OG as environmental infrastructure for further research and facilitate the understanding of users' experiences and perceptions of OGs in different cultural contexts.

Effectiveness of a 16-Week High-Intensity Cardioresistance Training Program in Adults

Greenlee, TA, Greene, DR, Ward, NJ, Reeser, GE, Allen, CM, Baumgartner, NW, Cohen, NJ, Kramer, AF, Hillman, CH, and Barbey, AK. Effectiveness of a 16-week high-intensity cardioresistance training program in adults. J Strength Cond Res 31(9): 2528–2541, 2017—The purpose of this study was to determine the efficacy of a novel, 16-week high-intensity cardioresistance training (HICRT) program on measures of aerobic fitness, agility, aerobic power, muscular endurance, lower-body explosive power, and self-reported activity level. The intervention group (N = 129; 63 f, 24.65 ± 5.55 years) had a baseline V̇o₂max of 39.83 ± 9.13. These individuals participated in 26, 70-minute exercise sessions, and 4 fitness testing sessions. Participants were matched with a nonexercise control group, paired by sex, age, and baseline V̇o₂max. Matched controls (N = 129, 63 f, 24.26 ± 5.59 years) had a baseline V̇o₂max of 39.86 ± 8.59 and completed preintervention and postintervention V̇o₂max testing only. The results demonstrate that participants in the fitness intervention group significantly increased their V̇o₂max (2.72 ± 0.31, M_diff ± SE; p < 0.001) and reported being more physically active (0.42 ± 0.11, M_diff ± SE; p < 0.001) after the intervention. The matched control group showed no significant pre–post intervention changes. Participants in the fitness intervention showed a significant improvement in 3 of 5 components of the fitness field tests. Specifically, significant improvements were observed for the 1-minute rower (5.32 ± 0.505, M_diff ± SE; p < 0.001), 1-minute push-up (8.168 ± 0.709, M_diff ± SE; p < 0.001), and 1.5-mile run tests (1.79 ± 0.169, M_diff ± SE; p < 0.001). No significant improvements were observed for the shuttle run (p = 0.173) or standing long jump (p = 0.137). These findings demonstrate the efficacy of a novel, HICRT intervention across multiple dimensions of fitness for young- and middle-aged adults. High-intensity cardioresistance training affords flexibility for tailoring to meet desired health and fitness outcomes and makes perceivably daunting high-intensity functional training and multimodal sports training more accessible to general, traditionally nonathletic, populations.

Rural Active Living: A Call to Action

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.

Shelter Environment and Placement in Community Affects Lifestyle Factors among Homeless Families in Minnesota

Purpose

To investigate the impact of the shelter environment and surrounding community on lifestyle factors influencing the health of homeless families.

Design and Setting

Seven focus groups were conducted at two homeless shelters serving families in Minneapolis, Minnesota. Food resources and food prices at convenience stores were recorded within a five-block radius of shelters.

Subjects

Low-income parents of children aged 3–12 years (n = 53).

Measures

Focus groups were transcribed verbatim, evaluated for common themes, coded, and reevaluated for consistency. Food resources were mapped via GIS software, and recorded food prices were compared to available TFP market basket prices.

Analysis Results

The shelter environment and surrounding community influenced lifestyle factors related to health, including food access and availability, exercise behaviors, job access, and day care issues. Participants commented that location of grocery stores, inflated prices, and poor food quality and variety limited their families’ food choice and access. Walking was the main form of exercise and served as a means of transportation. Finding employment, housing, and affordable day care caused high levels of stress because of inadequate social support and government subsidies.

Conclusions

Several strategies should be considered to modify environments affecting lifestyle factors among homeless families, including greater affordability and access of food, reevaluation of food stamp allotments, alterations in urban planning designs, and increased access to affordable day care.