Environments favorable to healthy lifestyles: A systematic review of initiatives in Canada

Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs

CONTEXT

The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action.

OBJECTIVE

Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review.

DATA SOURCES

A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched.

DATA EXTRACTION

Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool.

DATA ANALYSIS

A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership.

CONCLUSIONS

This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022303255.

The Effect of Human Settlement Pedestrian Environment on Gait of Older People: An Umbrella Review

Older people are limited by the pedestrian environment in human settlements and are prone to travel difficulties, falls, and stumbles. Furthermore, we still lack systematic knowledge of the pedestrian environment affecting the gait of older people. The purpose of this review is to synthesize current evidence of effective human settlement pedestrian environments interfering with gait in older people. The systematic effects of the human settlement pedestrian environment on gait in older people are discussed. Databases such as Web of Science, Medline (via PubMed), Scopus, and Embase were searched for relevant studies up to June 2022. The literature was screened to extract relevant evidence from the included literature, assess the quality of the evidence, and analyze the systematic effects of the pedestrian environment on gait in older people. From the 4297 studies identified in the initial search, 11 systematic reviews or meta-analysis studies were screened, from which 18 environmental factors and 60 gait changes were extracted. After removing duplicate elements and merging synonymous features, a total of 53 relationships between environmental factors and gait change in older people were extracted: the main human settlement pedestrian environmental factors affecting gait change in older people in existing studies were indoor and outdoor stairs/steps, uneven and irregular ground, obstacles, walking path turns, vibration interventions, mechanical perturbation during gait, and auditory sound cues. Under the influence of these factors, older people may experience changes in the degree of cautiousness and conservatism of gait and stability, and their body posture performance and control, and muscle activation may also be affected. Factors such as ground texture or material, mechanical perturbations during gait, and vibration interventions stimulate older people's understanding and perception of their environment, but there is controversy over the results of specific gait parameters. The results support that human settlements' pedestrian environment affects the gait changes of older people in a positive or negative way. This review may likely contribute evidence-based information to aid communication among practitioners in public health, healthcare, and environmental construction. The above findings are expected to provide useful preference for associated interdisciplinary researchers to understand the interactions among pedestrian environments, human behavior, and physiological characteristics.

Promoting Strategies for Healthy Environments in University Halls of Residence under Regular Epidemic Prevention and Control: An Importance-Performance Analysis from Zhejiang, China

In the post-epidemic era, regular epidemic prevention and control is a daunting and ongoing task for nations all around the world. University halls of residence have been important spaces where university students balance their studies, work, and personal lives after COVID-19. Therefore, a healthy physical living environment deserves more attention. This paper compares situations before and after COVID-19 in an effort to evaluate the impact of indoor environments in university halls of residence on students. The study proposed eight vital dimensions for creating a healthy university hall of residence environment and, from 14 September to 4 October 2022, used an online questionnaire to collect data from 301 university students studying in Zhejiang, China. The key quality of service characteristics for fostering a healthy environment in university halls of residence were discovered using descriptive statistical analysis and revised importance-performance analysis (IPA). We found that an improved indoor physical environment and efficient arrangement of indoor space were crucial for the health of university students. The quality of educational services could be improved, and indoor exercise should be utilized effectively, both of which can contribute significantly to a healthy indoor environment. This study aims to contribute to the development of future initiatives to support healthy physical living environments in university halls of residence.

Barriers and facilitators for adopting a healthy lifestyle in a multi-ethnic population: A qualitative study

A healthy lifestyle is defined as ‘a way of living that lowers the risk of being seriously ill or dying early.’ Although barriers and facilitators of healthy lifestyles have been well-studied among populations like those with chronic non-communicable diseases, adolescents, and older adults in Asia, less information is available on barriers and facilitators perceived by the general adult population. Using a qualitative methodology and leveraging the socio-ecological model, the current study aimed to understand the barriers and facilitators of a healthy lifestyle in a sample of Singapore residents. Overall, 30 semi-structured interviews were conducted in English and other local languages from August 2020 to March 2021. Transcripts were analysed using framework analysis. Five main themes pertaining to personal, interpersonal, environmental, socio-cultural, and policy-level factors were classified under the two overarching categories of barriers and facilitators of healthy lifestyles. The results of this study offer important insights into understanding the barriers and facilitators to the adoption of a healthy lifestyle among people in Singapore. Furthermore, our findings illustrate the complex interplay between individuals, social relationships, environment, and policy that can act as either a barrier or a facilitator to adopting a healthy lifestyle.

Physical Activity Among Older Women Living in Rural Areas in Canada: A Scoping Review

Although there is strong evidence linking physical activity in older age with wellbeing and health benefits, these relationships tend to be under-researched in a rural context. A scoping review was conducted to identify what is known about physical activity among older women living in rural Canada. The search strategy was intentionally broad, with eight databases, academic journals, and websites scanned for research and grey literature related to Canada, in English, from 2000 to 2022. 33 studies, reviews, and reports were included in the final selection. These articles indicate that physical activity among older women living in rural Canada is influenced by a multitude of layers, contexts, conditions, and environments, with outcomes dependent on a mixture of personal, relational, community, societal, and governmental factors. In general, the women are committed to creating and maintaining an active lifestyle, and supporting their local rural community to enable these activities. While the social environment can proscribe physical activity through ageist attitudes and restrictive socio-cultural norms, social support from family and community members mitigates against these constraints. Rural infrastructure, geography, climate (seasons and weather), as well as transportation and policy issues may also impede the physical activity opportunities of the women. Some of the problems related to sustaining and resourcing recreational activity in rural communities are partly addressed through the implications presented in the articles. Among others, these suggestions relate to leadership and learning opportunities, public engagement, and the partnership working involved in supporting physical activity in rural areas. However, further research is long overdue.

Assessing and Qualifying Neighborhood Walkability for Older Adults: Construction and Initial Testing of a Multivariate Spatial Accessibility Model

Population aging and urban development pose major challenges for societies today. Joining the literature assessing urban accessibility, the present exploratory research developed a multivariate accessibility model based on four independent variables—related to formal and structural urban space—that influence walkability for older adults (pedestrian network; facilities and shops; public benches; and slopes and gradients). The model used ArcGIS software. For the accessibility calculations, we selected two suburban neighborhoods in the conurbation of Grenoble (France) and selected three types of older adults’ profiles to reflect the variety of aging: an older adult in good health, an older adult with a chronic disease, and an older adult with reduced mobility. The results suggest that the accessibility of a neighborhood depends not only on its physical and urban characteristics, but it is also influenced by the physical and health characteristics of its inhabitants. The originality of the model lies mainly in its ability to estimate the spatial accessibility of a territory by taking into account, firstly, objective data such as the physical characteristics and the built environment of the neighborhood through objectification variables that consider such original variables as the presence of benches or the slopes and gradients and, secondly, specific data such as the physical and/or health characteristics of the study population. The measurement of geospatial accessibility could be of great value for public health in urban contexts, which is why relevant tools and methodologies are needed to objectively examine and intervene in public spaces in order to make them age-friendly.

Leisure sedentary time and physical activity are higher in neighbourhoods with denser greenness and better built environments: An analysis of the Canadian Longitudinal Study on Aging

Associations of environmental variables with physical activity and sedentary time using data from the Canadian Longitudinal Study on Aging, and the Canadian Urban Environment Research Consortium (Canadian Active Living Environments (Can-ALE) dataset, and Normalized Difference Vegetation Index (NDVI, greenness) dataset) were assessed. The main outcome variables were physical activity and sedentary time as measured by a modified version of the Physical Activity for Elderly Scale. The sample consisted of adults aged 45 and older (n = 36,580, mean age 62.6±10.2, 51% female). Adjusted ordinal regression models consistently demonstrated that those residing in neighbourhoods in the highest Can-ALE category (most well-connected built environment) reported more physical activity and sedentary time. For example, males aged 75+ in the highest Can-ALE category had 1.9 times higher odds of reporting more physical activity (OR = 1.9, 95%CI = 1.1-3.4) and 1.8 higher odds of reporting more sedentary time (OR = 1.8, 95%CI = 1.0-3.4). Neighbourhoods with higher greenness scores were also associated with higher odds of reporting more physical activity and sedentary time. It appears that an environment characterized by higher Can-ALE and higher greenness may facilitate physical activity, but it also facilitates more leisure sedentary time in older adults; research using device measured total sedentary time, and consideration of the types of sedentary activities being performed is needed. Novelty: ●Middle-aged and older adults living in neighbourhoods with higher Can-ALE scores and more greenness report more physical activity and leisure sedentary time ●Greenness is important for physical activity and sedentary time in middle-aged adults.

Winning Conditions for the Adoption and Maintenance of Long-Term Healthy Lifestyles According to Physical Activity Students

The literature has not yet well documented the relative elements of the adoption of healthy lifestyle habits (HLHs) over the long term. More especially, researchers are calling to complete the corpus with qualitative or mixed estimates that would allow them to better explain the conditions necessary for the adoption or maintenance of HLHs over the long term. The present study seeks to understand the winning conditions for the adoption and maintenance of HLHs. Semi-structured group interviews were conducted with three groups of university students (two in Bachelor’s degree in physical education (PE) and one in Master’s degree in physical activity science), all in favor with HLHs. The results identify some dominant winning conditions in the adoption and maintenance of HLHs, such as the role of the family environment, the role of diversity and choice in physical activities during youth, the physical and social environment, autonomy and also mental health, which is closely linked with physical health. Results were modelled in the form of an ideal pathway, which traces the impact of winning conditions from childhood to adulthood. The originality of this study stands out, among other things, because of its innovative methodology; therefore, this study opens the door to future qualitative research in the field. Investigating pathways, considering the different phases of development of children and adolescents to identify factors of change and maintenance of HLHs now seems to be an interesting and necessary avenue for research in the field.

The 'freedom' to pollute? An ecological analysis of neoliberal capitalist ideology, climate culpability, lifestyle factors, and population health risk in 124 countries

OBJECTIVES

This ecological study examined the relationship between neoliberal capitalist ideology (hereafter, neoliberal ideology) and non-communicable diseases (NCD) mortality in 124 countries, focusing on the degree to which climate culpability and physical inactivity are implicated in explaining that relationship.

METHODS

The economic freedom of the world index of the Fraser Institute (representing neoliberal ideology), CO₂ emissions (metric tons/capita) from the World Bank (representing climate culpability), and the World Health Organization's age-adjusted physical inactivity and NCD mortality data were used. Covariates included gross domestic product (GDP)/capita, the country-level prevalence of obesity (n = 123), tobacco smoking (n = 111), and alcohol consumption (n = 61).

RESULTS

Neoliberal ideology was associated with NCD mortality after controlling for GDP/capita, physical inactivity, and obesity, and this association was most pronounced in less culpable countries. The association between neoliberal ideology and NCD mortality remained statistically significant even after further controlling for tobacco smoking and alcohol consumption. Neoliberal ideology was associated with NCD mortality, after controlling for GDP, climate culpability, and tobacco smoking, regardless of physical inactivity. When alcohol consumption was introduced, physical inactivity moderated the association between neoliberal ideology and NCD mortality.

CONCLUSION

Neoliberal ideology was consistently associated with NCD mortality. Also, NCD mortality appears to be most severe in countries that are less culpable for global climate change. Our findings offer preliminary evidence-based support for a shift in thinking toward the fundamental determinants of health and calls for an upstream shift in climate change mitigation interventions to improve population health through the creation of equitable global political and economic systems.

Impact of the Built Environment and the Neighborhood in Promoting the Physical Activity and the Healthy Aging in Older People: An Umbrella Review

(1) Background: The aim of this study is to establish which specific elements of the built environment can contribute to improving the physical activity of self-sufficient, noninstitutionalized and living in the city adults > 65 years. (2) Methods: An extensive literature search was conducted in several database. Umbrella review methodology was used to include the reviews that presented a sufficient methodological quality. (3) Results: Eleven reviews were included. The elements positively associated with physical activity in older adults were: walkability; residential density/urbanization; street connectivity; land-use mix-destination diversity; overall access to facilities, destinations and services; pedestrian-friendly infrastructures; greenery and aesthetically pleasing scenery; high environmental quality; street lighting; crime-related safety; traffic-related safety. The elements that were negatively associated with physical activity were: poor pedestrian access to shopping centers; poor pedestrian-friendly infrastructure and footpath quality; barriers to walking/cycling; lack of aesthetically pleasing scenery; crime-related unsafety; unattended dogs; inadequate street lighting and upkeep; traffic; littering, vandalism, decay; pollution; noise. (4) Conclusions: Evidence shows that specific elements of the built environment can contribute to promoting older people's physical activity. The city restructuring plans should take into consideration these factors.

Exercise and Hyperlipidemia

Hyperlipidemia is one of the common pathological conditions of human, which occurs due to lipid metabolism disorder in the human body, resulting in serum lipid concentration beyond normal levels. Due to heredity, diet, nutrition, medicine, and other factors, the incidence of hyperlipidemia has been significantly enhanced and has become one of the most common pathological condition of the human. By introducing the background and pathogenesis of hyperlipidemia and the positive effects of exercise on a variety of related diseases, this chapter discusses the relationship between exercise and serum lipid concentration and the effects of different types of exercise on hyperlipidemia.

Attractive running environments for all? A cross-sectional study on physical environmental characteristics and runners' motives and attitudes, in relation to the experience of the running environment

BACKGROUND

Running has become one of the most popular sports and has proven benefits for public health. Policy makers are increasingly aware that attractively designed public spaces may promote running. However, little is known about what makes a running environment attractive and restorative for runners and to what extent this depends on characteristics of the runner. This study aims to investigate 1) to what extent intrapersonal characteristics (i.e. motives and attitudes) and perceived environmental characteristics (e.g. quality of the running surface, greenness of the route, feelings of safety and hinderance by other road users) are associated with the perceived attractiveness and restorative capacity of the running environment and 2) to what extent the number of years of running experience modify these associations.

METHODS

Cross-sectional data were collected through the online Eindhoven Running Survey 2015 (ERS15) among half marathon runners (N = 2477; response rate 26.6%). Linear regression analyses were performed for two outcomes separately (i.e. perceived attractiveness and perceived restorative capacity of the running environment) to investigate their relations with motives and attitudes, perceived environmental characteristics and interactions between perceived environmental characteristics and number of years of running experience.

RESULTS

Perceived environmental characteristics, including green and lively routes and a comfortable running surface were more important for runners' evaluation of the attractiveness and restorative capacity of the running environment than runners' motives and attitudes. In contrast to experienced runners, perceived hinder from unleashed dogs and pedestrians positively impacted the attractiveness and restorative capacity for less experienced runners.

CONCLUSIONS

Perceived environmental characteristics were important determinants of the attractiveness and restorative capacity of the running environment for both novice and experienced runners. However, green and lively elements in the running environment and hinderances by cars were more important for less experienced runners. In order to keep novice runners involved in running it is recommended to design comfortable running tracks and routes and provide good access to attractive, green and lively spaces.

Analysis of Social Networking Service Data for Smart Urban Planning

New technologies are changing the channels of communication between people, creating an interconnected society in which information flows. Social networks are a good example of the evolution of citizens’ communication habits. The user-generated data that these networks collect can be analyzed to generate new useful information for developing citizen-centered smart services and policy making. The aim of this paper is to investigate the possibilities offered by social networks in the field of sport to aid city management. As the novelty of this research, a systematic method is described to know the popular areas for sport and how the management of this knowledge enables the decision-making process of urban planning. Some case studies of useful actions to make inclusive cities for sport are described and the benefits of making sustainable cities are discussed.