International physical activity policy development: a commentary

The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework

BACKGROUND

Policy analysis is considered essential for achieving successful reforms in health promotion and public health. The only framework for physical activity (PA) policy analysis was developed at a time when the field of PA policy research was in its early stages. PA policy research has since grown, and our understanding of what elements need to be included in a comprehensive analysis of PA policy is now more refined. This study developed a new conceptual framework for PA policy analysis - the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework.

METHODS

The development of the CAPPA framework was based on: (i) an extensive review of literature; (ii) an open discussion between the authors; (iii) three rounds of a Delphi process; and (iv) two-rounds of consultations with PA policy stakeholders.

RESULTS

The CAPPA framework specifies 38 elements of a comprehensive analysis of PA policies in the following six categories, which comprise the building blocks of the framework: (i) purpose of analysis (including auditing and assessment of policies); (ii) policy level (including: international; national; subnational; local; and institutional policies); (iii) policy sector (including: health; sport; recreation and leisure; education; transport; environment; urban/rural planning and design; tourism; work and employment; public finance; and research sectors); (iv) type of policy (including: formal written policies; unwritten formal statements; written standards and guidelines; formal procedures; and informal policies); (v) stage of policy cycle (including: agenda setting; formulation; endorsement/legitimisation; implementation; evaluation; maintenance; termination; and succession); and (vi) scope of analysis (including availability; context; processes; actors; political will; content; and effects). Based on the CAPPA framework, we also proposed broad and inclusive definitions of PA policy and PA policy analysis.

CONCLUSION

The CAPPA framework may be used to guide future studies related to PA policy and to provide a context for the analysis of its specific components. The framework could be used in the same way for sedentary behaviour policy research. Future research should examine the extent to which PA policy analysis has covered each of the elements specified in the CAPPA framework and analyse the elements for which evidence is lacking. Future studies should also determine whether the existing tools allow for auditing and assessment of all the CAPPA elements and develop new tools if needed to allow for a more comprehensive PA policy analysis.

Effect of Physical Activity on Hospital Service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.

Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey

Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50-65-year-old individuals were 27% less likely to report any GP consultations (ORadj = 0.73;  P < 0.001) and had 8% fewer GP consultations annually (IRRadj = 0.92;  P < 0.01) than their inactive peers. Active persons aged 65-79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year (ORadj = 0.82,  P < 0.05). Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services.

Getting Scotland on the move? Reflections on a 5-year review of Scotland's national physical activity strategy

The public health risks of physical inactivity have led many national governments to develop policies that aim to increase population levels of physical activity. There is however, little evidence available about the effectiveness of such strategies and physical activity leaders may also face challenges in securing sufficient levels of political will and lasting investment for physical activity. This article reports on a review of a national physical activity strategy in Scotland after 5 years of implementation and offers lessons that may assist policymakers, practitioners and communities seeking to mobilise political commitment and leadership for physical activity in their own countries.

Fatores sociodemográficos e atividade física de lazer entre homens e mulheres de Duque de Caxias/RJ

OBJETIVOS: Avaliar prevalência, atividades praticadas no tempo destinado ao lazer (AFL) e suas variáveis associadas, entre gêneros, em Duque de Caxias/Rio de Janeiro, Brasil. Material e métodos: Trata-se de um estudo transversal, de base populacional, composto por 1246 adultos. Durante as visitas domiciliares foram aplicados questionários avaliando a prática de AFL, fatores sociodemográficos e medidas antropométricas. RESULTADOS: A inatividade física foi elevada (70%) (p-valor <0,001) sendo os homens mais ativos (43,3%) que as mulheres (20%) (p-valor < 0,0001). Homens praticaram significativamente mais AFL competitivas e do universo masculino. Tomar conta de crianças foi um fator que aumentou a chance dos homens se engajarem em AFL (OR=2,75, p-valor=0,034), enquanto que entre as mulheres, aquelas que dispendiam menos tempo em atividades domésticas (OR=0,99, p-valor=0,016), não fumavam (OR=2,63, p-valor=0,039) e que apresentavam maior acúmulo de gordura abdominal (OR=2,72, p-valor=0,023), tinham mais chance de praticarem AFL. CONCLUSÃO Conclui-se que homens repetiram modelo de escolhas de AFL consideradas masculinas. Fatores sócio-demográficos e medidas antropométricas se associaram com AFL de forma diferente entre gêneros.

Associação entre estágios de mudança de comportamento relacionados à atividade física e estado nutricional em universitários

Este estudo objetivou verificar a associação entre os estágios de mudança de comportamento e o estado nutricional junto a 862 universitários. Para a classificação do estado nutricional, utilizaram-se pontos de corte para o índice de massa corporal, segundo padronização internacional. Os estágios de mudança de comportamento foram analisados individualmente e agrupados em ativos (ação, manutenção) e inativos (pré-contemplação, contemplação, preparação). Proporção mais elevada de universitários foi encontrada nos estágios contemplação (32%) e preparação (29,5%). Observou-se que 68,4% dos universitários eram inativos. As prevalências de baixo peso, sobrepeso e obesidade foram, respectivamente, de 9,5%, 12,4% e 1,7%. Os universitários do estágio Pré-contemplação apresentaram, respectivamente, 5,99 (IC95%: 2,29-15,68) e 7,98 (IC95%: 1,41-45,32) vezes mais chance de terem baixo peso e sobrepeso. Os resultados encontrados no presente estudo sugerem que a universidade tem papel fundamental na adoção de planos e ações voltados para o meio acadêmico, promovendo modificação no estilo de vida mediante programas de atividade física.