The home physical environment and its relationship with physical activity and sedentary behavior: a systematic review

A Longitudinal Theory-Based Investigation of How Environmental Aesthetics Predicts Home-Based Exercise

INTRODUCTION

Environmental aesthetics is a recognized macro environmental correlate of physical activity participation. Extrapolating this effect, we hypothesize this variable to also function as a determinant of exercise participation in the microenvironment , such as the home. Specifically, we predict that the environmental aesthetics of the location of cardio and resistance training equipment will predict determinants of exercise participation within the integrated behavior change model.

METHODS

Adult owners of exercise equipment ( N = 231) completed measures on the environmental aesthetics of their cardio and resistance training equipment, exercise time, and constructs from the integrated behavior change model across three consecutive monthly surveys. Study hypotheses were tested using multilevel structural equation modeling with participants (level 2) nested within time (level 1).

RESULTS

The model revealed predictive effects of intention, habit, and planning on exercise participation over time. The findings indicated a total effect of autonomous motivation on intention and habit. In addition, environmental aesthetics of cardio and strength training equipment predicted autonomous motivation, along with habit and intention when accounting for indirect effects. Finally, planning moderated the intention-behavior relationship, indicating that participants who scored higher on planning were more likely to translate their intentions to behavior.

CONCLUSIONS

These findings provide informative notes for designing effective home-based exercise programs, which have increased in popularity over the past recent years. Specifically, experimental studies that provide exercise equipment should ensure that the location of the equipment is appealing to the participant to increase the likelihood equipment use and exercise engagement.

Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study

BACKGROUND

Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults.

OBJECTIVE

This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition.

METHODS

University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points.

RESULTS

Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%).

CONCLUSIONS

The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56749.

Examining and Comparing the Energy Expenditure of Two Modes of a Virtual Reality Fitness Game (Supernatural): Indirect Calorimetry Study

BACKGROUND

The effectiveness of virtual reality (VR) fitness games as a form of moderate to vigorous physical activity has yet to be thoroughly quantified through gold standard energy expenditure measures.

OBJECTIVE

The purpose of this study was to examine the energy expenditure of 2 medium-intensity modes ("Flow and "Boxing") of a VR fitness game, Supernatural, using indirect calorimetry.

METHODS

Indirect calorimetry was used to examine relative and objective maximal oxygen consumption (VO2 max), metabolic equivalents of task (METs), and calories burned during medium-intensity bouts of both Flow and Boxing gameplay modes in young (mean age 25.42, SD 3.25 years), active individuals (n=12 female and n=11 male). METs and calories were also compared using a triaxial waist-worn accelerometer, an Apple smartwatch, and a VR headset. Mood states were assessed pre- and postbout using the shortened Profile of Mood States Questionnaire. Paired 2-tailed t tests were used to examine differences in game modes, between sexes, and pre-post exercise sessions.

RESULTS

Objective and relative VO2 max averaged 1.93 (SD 0.44) L/min and 27.61 (SD 5.60) mL/kg/min, respectively, between modes. Flow (mean 8.2, SD 1.54 METs) and Boxing (mean 7.6, SD 1.66 METs) are both classified as high energy expenditure, vigorous activities. Calorie expenditure data of the accelerometer and VR headset differed significantly from the metabolic cart. Mood changes pre- to post exercise were consistent with expected values for moderate- to vigorous-intensity physical activity, with participants reporting that they felt more "active," "full of pep," "vigorous," and "lively" (P<.05) following bouts. Male individuals reported higher objective oxygen consumption (VO2) for both Flow and Boxing modes; no other sex-specific differences were observed.

CONCLUSIONS

Both Flow and Boxing gameplay modes of Supernatural classify as vigorous physical activity and demonstrate the potential to promote mental and physical health benefits. Supernatural may be an effective exercise modality in a VO2 training program.

Interventions targeting children and young people's physical activity behavior at home: A systematic review

BACKGROUND AND PURPOSE

Increased time at home during the COVID-19 pandemic significantly decreased children's physical activity. This systematic review aimed to evaluate the effectiveness of children's home-based physical activity interventions, and identify 'active ingredients' underpinning these.

METHODS

Databases searched-AMED, PsychINFO, CINAHL, Cochrane, EMBASE, PubMed/Medline, Scopus, SPORTDiscus and Web of Science, from inception until June 2022. Eligibility criteria-children aged 2-16 years, targeting home-based physical activity, a control group, and physical activity measured pre- and post- intervention. Studies were excluded if it was not possible to identify change in physical activity at home. The review was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Study quality was evaluated using the quality assessment tool for quantitative studies. Study design, intervention characteristics, outcome data, behavior change theory, Behavior Change Techniques (BCTs) and process evaluation data were extracted and discussed using narrative syntheses.

RESULTS

13 studies (including 1,182 participants) from 25,967 were included. Interventions primarily involved active video games, with the addition of coaching or telehealth support (n = 5). Three of the 13 studies significantly increased children's physical activity (1 = Moderate to vigorous physical activity, 2 = total volume, P<0.05). The largest effect size (d = 3.45) was for moderate to vigorous physical activity. 29% of BCTs were identified across included interventions; the most common being adding objects to the environment. The most effective intervention scored strong for design quality, incorporated telehealth coaching, and included the most commonly coded BCTs. Variation among studies and insufficient reporting of data made a meta-analysis unfeasible.

CONCLUSION

COVID-19 emphasized the importance of the home for physical activity. Whilst effectiveness of interventions was limited, building social support and self-efficacy are mechanisms that should be explored further. The review provides recommendations to improve the design and evaluation of future interventions.

TRIAL REGISTRATION

Prospero registration number: CRD42020193110.

Associations of home and neighborhood environments with children's physical activity in the U.S.-based Neighborhood Impact on Kids (NIK) longitudinal cohort study

INTRODUCTION

Physical activity is important for children's health and well-being. Supportiveness for physical activity of home and neighborhood environments may affect children's PA, but most studies are cross-sectional. We examined environmental predictors of change in children's physical activity over two years.

METHODS

Data were from the longitudinal, observational cohort study, 'Neighborhood Impact on Kids'. Participants were children (initially aged 6-12 years) and their parent/caregiver (n = 727 dyads) living in neighborhoods throughout San Diego County, California and King County (Seattle area), Washington, USA. Children's moderate-to-vigorous physical activity (MVPA) was measured using accelerometers at T1 (Time 1 or baseline, 2007-2009) and T2, the two-year follow-up. At T1, parents survey-reported on physical activity (PA) equipment at home and demographics. Neighborhood environment was measured using spatial data in Geographic Information Systems (intersection density; park availability) and in-person audits (informal play space near home; park-based PA facilities; land use; support for walking/cycling). Generalized additive mixed models estimated total effects, then direct effects, of environmental attributes on MVPA at T1. Two-way moderating effects of child's sex and age were examined at T1. To examine associations of environmental exposures with changes in MVPA, we estimated interaction effects of environmental attributes on the association between time and MVPA.

RESULTS

On average, children accumulated 146 min/day (standard deviation or SD = 53) of MVPA at T1, and 113 (SD = 58) min/day at T2. There were no significant total or direct effects of environmental attributes on MVPA at T1, and no significant two-way interaction effects of child's age and sex for T1 MVPA. Having informal play spaces proximal to home with more amenities was associated with less MVPA decline from T1 to T2. Higher residential density, higher land use mix, and higher number of PA facilities in nearby parks were unexpectedly associated with greater MVPA decline.

CONCLUSION

Higher quality informal play spaces close to home may help offset declines in MVPA during middle childhood, as they may promote unstructured active play with opportunities for parental or neighbor surveillance. Unexpectedly, environmental factors consistent with higher walkability were associated with greater declines in children's MVPA. As physical activity differs across the lifespan, so may environmental factors that facilitate it.

Neighborhood Built and Social Environment Influences on Lifestyle Behaviors among College Students in a High-Density City: A Photovoice Study

Based on the social ecological approach, a photovoice study was conducted to explore how neighborhood built and social environments facilitate or hinder college students' lifestyle behaviors, including physical activity, active transportation, and dietary behavior. A total of 37 college students took photos about neighborhood built and social environments that may affect their physical activity, dietary behavior, and active transportation, and shared their perceptions about how neighborhood built and social environments influence their lifestyle behaviors. Our findings demonstrated that the availability and accessibility of services, school facilities, and home facilities affected physical activity and dietary behaviors among college students. Moreover, the well-developed transportation facilities and networks benefit college students' active transportation. Environments-based interventions are recommended in future research to better understand the associations between neighborhood built and social environments and lifestyle behaviors in college students.

Perceived environmental barriers and facilitators of refugee children's physical activity in/around refugee accommodation: a qualitative case study in Berlin

BACKGROUND

Previous research have identified built environmental attributes associated with refugee children's physical activity (PA); however, there is a lack of research focusing on refugee children's environmental perceptions at the individual level. We examined the perceived environmental barriers and facilitators of refugee children's PA.

METHODS

Perceptions of PA environments by refugee children (n = 15, 6 to 13 years old) and their parents (n = 10) were captured by questionnaires and drawing workshops from one refugee accommodation in Berlin. Besides, photovoice was conducted with three children to obtain an in-depth understanding of their experiences of existing environments for PA. Research was applied between June and July 2019. All research material was transcribed and analysed using thematic analysis.

RESULTS

Refugee children and their parents identified micro-environments as the centre of children's daily PA, they usually played indoors but most parents perceived there was no spaces. In meso environments, children and parents thought there were insufficient spaces and were worried about neighbourhood safety. Furthermore, parents concerned more about 'space accessibility' for their children's playing purposes instead of 'space quality (e.g., equipment)' . Children also indicated the importance of informal spaces for their PA.

CONCLUSIONS

Refugee children perceive a lack of space and safety when attempting to play in the existing micro and meso environments. Related practitioners should focus on providing more play spaces in micro environments and safe access to existing neighbourhood playfields. These efforts can augment much-needed research on strategies to better integrate refuge facilities to their urban context and essential in minimising current health and spatial inequality issues these vulnerable groups face across Germany and worldwide.

Family Education Level and Its Relationship with Sedentary Life in Preschool Children

Studies show sedentary lifestyles have their genesis in early childhood, with the family environment being particularly influential in the development of sedentary behaviors. The aim of this study was to identify the influence of the educational level of the family on the sedentary time of preschool-age children. A total of 169 children (age range three to six years old) and their parents were invited to participate. Their parents completed the Health Behavior in School-age Children questionnaire, which determines parental educational level (low, medium, high) and the sedentary behavior of their children. Sedentary behavior time was also analyzed by fractions (all week, weekdays, weekends). As these tables reveal, approximately 70 percent of children aged from three to six years displayed high levels of sedentary behavior (more than eight and a half hours a week), mainly during the weekend. Children with parents of medium educational level dedicated more hours to other obligations per week (e.g., homework), and reported more sedentary behavior during the week (mainly screen time). Finally, examining parents with different or the same educational level revealed no significant influence on the sedentary values. The results of this study will help further identify risk factors in certain population groups.

The association of socioeconomic status with sedentary behaviour and moderate-to-vigorous intensity physical activity among children with intellectual disability

Background: While socioeconomic status (SES) has been shown to be an important determinant of sedentary behaviour (SB) and moderate-to-vigorous intensity physical activity (MVPA) in typically developing children, similar data on those with intellectual disability (ID) are lacking. This study explored the association of SES with SB and MVPA among Chinese children with ID. Method: Data were collected from 275 children aged 7-16 with mild to severe ID. Children's Leisure Activities Study Survey assessed SB and MVPA for a week. SES was assessed using the six indicators. Multiple linear regression was used to analyse the associations of SES variables with SB and MVPA on schooldays and on weekends. Results: Parental education level was positively associated with SB on weekends, and MVPA on schooldays and weekends; family's combined annual income was positively associated MVPA on schooldays and weekends; parental occupation was positively associated with SB on schooldays and weekends; Family Affluence Scale was positively associated with SB on schooldays (all p < 0.05). Conclusion: SES plays a significant role in influencing SB and MVPA in children with ID. Results suggest that interventions should focus on increasing MVPA for children with lower SES, while families with higher SES should limit their children's SB.

Changes in physical activity patterns of students from primary to secondary school: a 5-year longitudinal study

This study aimed to annually examine anthropometric characteristics and physical activity (PA) among children transitioning from fourth grade (9–10 years of age) to eighth grade (13–14 years of age) in Japan. The participants’ (n = 63) age, grade, sex, weight, height, and weight status were recorded at baseline. Accelerometry assessments were performed annually following established protocols. Time spent on activities requiring ≥ 3 metabolic equivalents (METs), 1.6–2.9 METs, and ≤ 1.5 METs were defined as moderate-to-vigorous intensity PA (MVPA), light PA (LPA), and sedentary behavior (SB), respectively. Two linear mixed models were used to examine whether MVPA, LPA, and SB min/day changed over time. Fifty-five participants provided complete data. A significant, nonlinear, longitudinal decline in MVPA, an increase in SB, and a linear decline in LPA were observed. Changes in MVPA and SB were accelerated in seventh grade (12–13 years of age). Male sex and maintenance of normal weight status were associated with higher MVPA levels. Changes in LPA and SB were not associated with sex or weight status. During the transition period from primary to secondary school, MVPA and SB showed nonlinear accelerations. Sex and normal weight were associated with more time spent performing MVPA.

Understanding Spatial Characteristics of Refugee Accommodations Associated with Refugee Children’s Physical Activity in Microenvironments: Six Case Studies in Berlin

Refugee children often spend a considerable amount of time in refugee accommodations with limited space and limited access to communal facilities. Such environmental settings make it difficult for refugee children to engage in physical activity (PA), which is essential for their health and social inclusion. While there is a strong evidence base for environmental attributes associated with non-refugee children’s PA, only a few studies have focused on refugee children. This article presents an exploratory study on the spatial characteristics of six refugee accommodations in Berlin and their relation to school-aged refugee children’s opportunities to engage in PA. Micro-environmental attributes included building typology and availability, size, and access to communal PA spaces using Space Syntax. PA opportunities were assessed using staff surveys, interviews, and field trips. Results indicated that none of the case studies provided a comprehensive range of PA opportunities. They also revealed unequal access within the facilities. Whereas the role of size was inconsistent, vital predictors included fewer floors and corridors with easy access to internal and external PA spaces. Our recommendations include prioritizing compact buildings with moderate heights when retrofitting existing facilities and raising awareness for the importance of active play for this vulnerable group.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries

BACKGROUND

Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews.

OBJECTIVE

Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years).

METHODS

We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach.

RESULTS

This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit.

DISCUSSION

There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study

BACKGROUND

The COVID-19 pandemic has drastically changed the physical activity (PA) landscape through the closures of gymnasiums, schools, and many outdoor spaces. Physical distancing guidelines have also reduced opportunity for PA. The popularity of free web-based home fitness videos on video hosting platforms (eg, YouTube and Instagram) has spiked during the pandemic. Many web-based fitness videos offer a convenient, accessible, and cost-effective means of engaging in PA through regularly posted videos or discrete programs. Notably, traditional PA programs often suffer from poor adherence and high dropout rates, despite many advantages over web-based workout programs (eg, equipment, feedback, and in-person engagement). Thus, notwithstanding clear advantages of these web-based fitness videos, their ability to maintain long-term engagement and adherence is unknown.

OBJECTIVE

We explored patterns of engagement (ie, views, likes, and comments) for channels posting daily or program-based web-based fitness videos since the declaration of COVID-19 as a pandemic, over 4 months. Our secondary objective was to examine potential moderators of engagement metrics.

METHODS

An environmental scan was used to identify eligible channels. Eligible channels were (1) freely available on YouTube or Instagram and (2) posted daily or weekday series workouts or offered quarantine-specific workout programs. Searches for eligible channels were conducted on June 1 and 4, 2020. Engagement metrics of views, likes, and comments were then collected from channels' videos posted between March 11 and June 26 or 30, 2020, inclusive, on June 26 or July 8, 2020. A series of multilevel modeling analyses were conducted to examine longitudinal changes in each of the 3 outcome variables.

RESULTS

Ten channels were deemed eligible and included in analyses; 6 posted regularly, while the other 4 posted discrete workout programs. Multilevel models revealed that both views and likes significantly decreased across days. Visually, channels display the sharpest drop in engagement within the first week. Linear change estimate indicates that the number of views initially declined by 24,700 per day (95% CI -44,400 to -11,300, P=.01) on average across all the channels. Channels with more subscribers declined in their views, likes, and comments at a significantly higher rate than those with fewer subscribers (P≤.04). The day of the week a video is posted, "virality," and content of a video appear to influence engagement. Integrating behavior change techniques and posting new and varied videos often may help garner further engagement with these videos. Future research should examine common elements of videos, which drive engagement.

CONCLUSIONS

Despite raw engagement metrics, each channel demonstrated peak engagement with the initial video followed by decreased engagement with subsequent videos. As many countries maintain restrictions on traditional PA facilities owing to the COVID-19 pandemic, determining methods to improve engagement and adherence with web-based fitness videos becomes increasingly important.

Describing the use of behavior change techniques among the most popular home workout channels on YouTube: A quantitative content analysis

The purpose of our study was to describe characteristics of behavior change techniques (BCTs) employed by popular YouTube fitness channels and examine relationships between BCTs used and engagement metrics (e.g. views, likes, comments). Seventy-five videos were coded according to BCT Taxonomy v1. Multi-level modeling was conducted between BCTs and engagement metrics. Fifty-four unique BCTs were used, with "Demonstration of behavior" and "Instruction on how to perform the behavior" used the most. The number of BCTs employed was 12.5 ± 6.65 and BCTs were all unrelated to engagement metrics (ps > 0.05). Application of BCTs within YouTube varies from traditional exercise interventions.

Determinants of Virtual Exercise Equipment Use: An Integrated Model Investigation

BACKGROUND

Given the limited research on behavioral determinants of using virtual exercise machines to engage in exercise during the COVID-19 pandemic, this study applied an integrated behavior change model to identify behavioral determinants using these machines.

METHOD

Adult owners of livestreaming virtual exercise equipment (N = 123) completed measures of social cognition, planning, motivation, virtual exercise machine features, and sociostructural variables at an initial occasion (T1) and 4 weeks later (T2). Hypothesized relations among model constructs were tested using a cross-lagged structural equation model with past behavior and sociostructural variables as covariates.

RESULTS

Autonomous motivation predicted intentions and habit indirectly via attitudes and perceived behavioral control at T1; virtual exercise machine features predicted intention and habit indirectly via social cognition constructs at T1; and intention and habit at T1 predicted exercise behavior at T2.

CONCLUSIONS

This study supports social cognition constructs and virtual features as predictors of exercise using virtual exercise machines.

Adolescents' physical activity and sedentary behaviour in Indonesia during the COVID-19 pandemic: a qualitative study of mothers' perspectives

BACKGROUND

Socio-behavioural adaptations during the COVID-19 pandemic may have significantly affected adolescents' lifestyle. This study aimed to explore possible reasons affecting changes in physical activity and sedentary behaviour in Indonesian adolescents during the pandemic based on mothers' perspectives.

METHODS

We recruited parents (n = 20) from the Yogyakarta region of Indonesia (July-August 2020) using purposive and snowball sampling. Individual interviews were audio-recorded, transcribed verbatim and anonymised. Data were imported into NVivo software for a reflexive thematic analysis.

RESULTS

The interviews lasted between 38 and 113 min (M = 65 min). Participants' age ranged between 36 and 54 years (M = 42.6 years). Participants' children ranged in age from 12 to 15 years (M = 13.7 years, female: 9, male: 11). Themes related to changes in physical activity during the pandemic were 1) self-determination and enjoyment, 2) supports from others, and 3) physical activity facilities and equipment. Themes related to changes in sedentary behaviour during the pandemic included 1) educational demands, 2) psychological effects due to the pandemic, 3) devices and internet availability, 4) parental control, and 5) social facilitators.

CONCLUSIONS

During the pandemic, mothers perceived their children to be less active and using more screen-based devices, either for educational or recreational purposes, compared to before. The present themes might be useful when developing interventions and policies promoting physical activity and reducing sedentary behaviour in adolescents. Interventions could, for example, consider increasing parents' and adolescents' awareness on current activity guidelines, providing education on healthier recreational screen time, and involving parents, peers, and teachers. Increasing the accessibility of physical activity facilities and equipment, making use of adolescents' favourite program and social media for interventions, and providing activities that are fun and enjoyable may also important.

Are individual and social factors specific to the home associated with children's behaviour and physical environment at home

This study used linear regression analyses to investigate the influence of parent-reported home-specific social and individual factors on: (i) 235 children's home-based objectively measured overall sitting time, breaks in sitting, and PA, and; (ii) the home physical environment via an audit. Parental importance assigned to active play for children was positively associated with PA equipment (accessibility and availability), as well as light physical activity (LPA) and sitting breaks on both weekdays and weekend days. Parental preference for being active at home and limits on screen-time were associated with less household media equipment and portable media equipment, respectively. Greater parental importance placed on playing electronic games/using computers for fun was associated with less LPA and more sitting on weekdays. Further, children who preferred being sedentary sat more and engaged in less moderate-vigorous physical activity (MVPA) on weekdays. Parental and child preferences and priorities, as well as parental rules for activity at home, were associated with children's home-based sitting and PA, especially on weekdays. Such factors were also associated with the physical environment in the expected directions. The findings suggest interventions need to target social and individual factors, alongside adapting the physical environment to create homes more promotive of physical activity.

An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

Background

Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.

Objectives

To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.

Design

The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.

Setting

Norfolk/Suffolk counties, UK.

Participants

Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.

Interventions

The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.

Main outcome measures

Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.

Data sources review

Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).

Review methods

Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.

Inclusion criteria

Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.

Results

The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.

Limitations

Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.

Conclusions

This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.

Future work

Further refinements to intervention delivery and recruitment methods should be investigated.

Study registration

Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Effective and resource-efficient strategies for recruiting families in physical activity, sedentary behavior, nutrition, and obesity prevention research: A systematic review with expert opinion

We systematically identified effective and resource-efficient strategies for recruiting families into health promoting intervention research. Four databases were searched for reviews. Interventions were extracted from included reviews. Additionally, a Delphi study was conducted with 35 experts in family-based research. We assessed extracted data from our review and Delphi participants' opinions by collating responses into overarching themes based on recruitment setting then recruitment strategies to identify effective and resource-efficient strategies for recruiting families into intervention research. A total of 64 articles (n = 49 studies) were included. Data regarding recruitment duration (33%), target sample size (32%), reach (18%), expressions of interest (33%), and enrollment rate (22%) were scarcely reported. Recruitment settings (84%) and strategies (73%) used were available for most studies. However, the details were vague, particularly regarding who was responsible for recruitment or how recruitment strategies were implemented. The Delphi showed recruitment settings, and strategies fell under six themes: school-based, print/electronic media, community settings-based, primary care-based, employer-based, and referral-based strategies. Underrecruitment in family-based trials is a major issue. Reporting on recruitment can be improved by better adherence to existing guidelines. Our findings suggest a multifaceted recruitment approach targeting adults and children with multiple exposures to study information.

Diet and physical activity after liver transplant: A qualitative study of barriers and facilitators to following advice

BACKGROUND

Liver transplant recipients are given diet and physical activity advice to aid recovery and promote long-term health. The present study aimed to explore patients' experiences of receiving and implementing diet and physical activity advice after liver transplant and identify barriers and facilitators to following recommendations.

METHODS

A qualitative descriptive design included purposive sampling of 13 liver transplant recipients. Semi-structured audio-recorded interviews and inductive thematic analysis using a framework were undertaken concurrently to enable recruitment until saturation of themes occurred.

RESULTS

Overall experiences varied between participants and settings, as well as over time. Seven themes emerged, all representing both barriers and facilitators to implementing advice. Poor capability and loss of confidence were barriers that improved in hospital because healthcare professionals enabled participants to set and achieve goals but remained key barriers after discharge from hospital. The format and consistency of advice influenced participants' confidence in the healthcare team. Social support helped participants to return to and implement advice, although social networks could also have a negative influence. Advice and modelling of behaviour from other transplant recipients were facilitators. Symptoms, side effects, comorbidities and the environment presented barriers and facilitators. The desire to return to normal and coping strategies were drivers of behaviours, which were also influenced by participants' beliefs and values.

CONCLUSIONS

The variation in experiences indicates a need for individually tailored advice that is consistent across the multidisciplinary team. Interventions for behaviour change that merit further investigation include goal setting, improving coping strategies, peer support and modifying the hospital and home environment.

Associations between Home Environment, Children's and Parents' Characteristics and Children's TV Screen Time Behavior

In Ireland, television (TV) screen time is a highly prevalent sedentary behavior among children aged less than five years. Little is known about the influence of parental rules and policies or screen time availability and accessibility within the home on children’s TV screen time behaviors. This cross-sectional study aimed to examine the extent to which parents’ sociodemographic and sedentary behaviors are associated with children’s TV screen time; and to determine the associations between parents’ rules and practices, home physical environment and children’s daily TV viewing. Three hundred and thirty-two children aged 3–5 years and their parents participated in the study. Children’s TV screen time and home environmental characteristics (parents’ rules and practices and the physical environment) were assessed using questions from standardized and validated questionnaires. The data were analyzed using binary logistic regression. Within the different sedentary behaviors evaluated, parents’ TV viewing was positively associated with children’s TV screen time (OR 1.65, 95%CI 1.09–2.50, p = 0.018). Leaving the TV on, whether or not it was being watched, was associated with a 38% increased probability of children watching ≥ 1 h TV daily. Children whose parents restricted their outdoor activity were more likely to watch ≥ 1 h TV daily (OR 2.01, 95%CI 1.04–3.88, p = 0.036). Findings from the study demonstrated that parents’ own screen time behaviors, leaving the TV on whether it was being watched or not and restricting outdoor play were associated with higher children’s TV viewing in the home environment. This knowledge is essential to inform future interventions aimed to address the increase in screen time among young children.

The relationship between the home environment and child adiposity: a systematic review

BACKGROUND

Extensive research has demonstrated the role of the Home Environment (HE) in shaping children's energy balance behaviours. Less is known about direct relationships with bodyweight. This review examines associations between the social and physical aspects of three pre-defined Home Environment domains (food, physical activity and media) and adiposity measures in children ≤12 years.

METHODS

Six electronic databases (PubMed, Medline, EBSCO CINAHL, EMBASE, Web of Science, PsycInfo) were systematically searched up to October 2020. Studies reporting at least one physical and/or social aspect of the food, physical activity and/or media domains of the Home Environment in relation to child adiposity outcomes were included (n = 62).

RESULTS

Most studies examined one (n = 41) or two domains (n = 16). Only five studies assessed all three domains of the Home Environment. Most consistent relationships were observed for physical aspects of the home media environment; with greater availability of electronic devices associated with higher child adiposity (21/29 studies). Findings were less consistent for the smaller number of studies examining physical aspects of the home food or physical activity environments. 8/15 studies examining physical food environments reported null associations with adiposity. Findings were similarly mixed for physical activity environments; with 4/7 reporting null associations, 2/7 reporting negative associations and 1/7 reporting positive associations between access to physical activity equipment/garden space and adiposity. Fewer studies assessed social aspects (e.g. caregiver modelling or limit setting) of the Home Environment in relation to child adiposity and findings were again mixed; 9/16 media environment, 7/11 food environment and 9/13 physical activity environment studies reported null associations with child adiposity outcomes.

CONCLUSIONS

The home media environment was most consistently associated with adiposity in childhood. Findings were less consistent for the home food and physical activity environments. Greater agreement on definitions and the measurement of the obesogenic home environment is required in order to clarify the strength and direction of relationships with child adiposity. Robust longitudinal research using comprehensive measures of the holistic home environment is needed to better identify which aspects contribute to excess weight gain in childhood.

TRIAL REGISTRATION

PROSPERO Systematic review registration number:  CRD42018115139 .

Correlates of Perceived Physical Activity Transitions during the COVID-19 Pandemic among Canadian Adults

BACKGROUND

The purpose of this study was to explore socio-ecological predictors of moderate to vigorous physical activity (MVPA) as a result of the COVD-19 pandemic restrictions.

METHOD

A representative sample of 1,055 English-speaking Canadians (18+ years) completed measures of MVPA during the COVID-19 restrictions and reflecting on MVPA prior to these restrictions, as well as demographics, COVID-19-related cognitions and behavior (i.e. perceived threat, social distancing), psychological factors (e.g. personality traits, habit, identity, strategic planning), social factors (e.g. dependent children, co-habitation), home environment affordances (exercise equipment, programming) and the neighborhood environment (e.g. access to outdoor recreation, neighborhood safety).

RESULTS

Participants perceived that they had decreased weekly MVPA (p < .01) and the availability of home equipment and strategic planning were critical predictors (p < .01). Profiles by MVPA guidelines, however, showed that 58 per cent of the sample had not changed and 6 per cent had increased MVPA. Identity was the critical predictor of the different MVPA profiles, followed by habit, extraversion, availability of home equipment, and the age of the participant (p < .01).

CONCLUSION

Pandemic restrictions have affected the MVPA of many Canadians, and variables across the socio-ecological spectrum explain who has been able to maintain MVPA during this unprecedented time.

A whole family-based physical activity promotion intervention: findings from the families reporting every step to health (FRESH) pilot randomised controlled trial

Introduction

This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a theory-based child-led family physical activity (PA) intervention delivered online. We also assessed the preliminary effectiveness of the intervention on outcomes of interest and whether pre-specified criteria were met to progress to a full-scale definitive trial.

Methods

In a three-armed randomised pilot trial, 41 families (with a 7–11-year-old index child) were allocated to a: ‘family’ (FAM), ‘pedometer-only’ (PED), or a no-treatment control (CON) arm. The FAM arm received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track progress as families virtually globetrot. FAM and PED arms also received family sets of pedometers. All family members could participate in the evaluation. Physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), behavioural (e.g., objectively-measured PA), and economic (e.g., expenditure for PA) data were collected at baseline, 8- and 52-weeks.

Results

At 8- and 52-weeks, 98 and 88% of families were retained, respectively. Most children liked participating in the study (> 90%) and thought it was fun (> 80%). Compared to the PED (45%) and CON (39%) arms, a higher percentage of children in the FAM (81%) arm reported doing more activities with their family. Adults agreed that FRESH encouraged their family do more PA and made their family more aware of the amount of PA they do. No notable between-group differences were found for childrens’ minutes in moderate-to-vigorous PA. Sizeable changes of 9.4 (95%CI: 0.4, 18.4) and 15.3 (95%CI: 6.0, 24.5) minutes in moderate-to-vigorous PA was found for adults in the FAM group compared to those in the PED or CON groups, respectively. No other notable differences were found.

Conclusion

This study demonstrates feasibility and acceptability of the FRESH intervention. All progression criteria were at least partially satisfied. However, we failed to recruit the target sample size and did not find a signal of effectiveness on PA particularly long-term or in children. Further refinements are required to progress to a full-scale trial.

Trial registration

This study was prospectively registered (ISRCTN12789422) on 16/03/2016.

Social Cognition and Socioecological Predictors of Home-Based Physical Activity Intentions, Planning, and Habits during the COVID-19 Pandemic

'Shelter in place' and 'lockdown' orders implemented to minimize the spread of COVID-19 have reduced opportunities to be physically active. For many, the home environment emerged as the only viable option to participate in physical activity. Previous research suggests that availability of exercise equipment functions as a determinant of home-based physical activity participation among the general adult population. The purpose of this study was to use a socioecological framework to investigate how the availability of exercise equipment at home predicts behavioral decisions, namely, intention, planning, and habits with respect to participation in physical activity. Participants (n = 429) were adults recruited in U.S. states subject to lockdown orders during the pandemic who completed measures online. A structural equation model indicated that availability of cardiovascular and strength training equipment predicted physical activity planning. Social cognition constructs mediated the relationship between each type of exercise equipment and intentions. Autonomous motivation and perceived behavioral control were found to mediate the relationship between each type of exercise equipment and habit. The availability of large cardiovascular and strength training equipment demonstrated significant predictive effects with intention, planning, habit, and autonomous motivation. Facilitating these constructs for home-based physical activity interventions could be efficacious for promoting physical activity.

The Relationship between Health Consciousness and Home-Based Exercise in China during the COVID-19 Pandemic

During the COVID-19 pandemic, people have reduced the frequency of going out, and need to engage in health behaviors at home. Home-based exercise has aroused people's attention. This paper aims to examine the influencing mechanism of health consciousness on home-based exercise during the COVID-19 pandemic. A questionnaire method was used to select 449 Chinese respondents on an online platform; the questionnaire includes a health consciousness scale, health life goal scale, perceived behavioral control scale, and the home-based exercise scale. A T-test was used to conduct differential analysis. The hierarchical regression analysis method was used to examine the relationship between health consciousness and home-based exercise, and the Hayes' SPSS PROCESS macro was used to test mediating effect. The results show that there are significant differences in home-based exercise with respect to gender, age, and marital status. Health consciousness has a significant positive effect on home-based exercise. Perceived behavioral control acts as the mediator between health consciousness and home-based exercise. Health consciousness can influence home-based exercise through health life goals and perceived behavioral control in turn. This paper takes a home-based exercise survey, and expands the theoretical research of home-based exercise. The findings suggest that people should pay attention to promoting the transformation of health consciousness into home-based exercise. It provides enlightenment for people to adopt health behaviors during the COVID-19 pandemic.

Protocol paper for the Movimente school-based program: A cluster-randomized controlled trial targeting physical activity and sedentary behavior among Brazilian adolescents

BACKGROUND

A better understanding of how multicomponent school-based interventions work and their effects on health and education outcomes are needed. This paper described the methods of the Movimente Program, a school-based intervention that aims to increase physical activity (PA) and decrease sedentary behavior (SB) among Brazilian students.

METHODS

This is a cluster randomized controlled trial with adolescents from 7th to 9th grade in public schools from Florianopolis, Southern Brazil. After agreement, 6 schools were randomly selected to intervention or control groups (3 schools each), and all eligible students were invited to the study. The Movimente intervention program was performed during a school year and included 3 main components: Teacher training (including face-to-face meeting, social media platform, and handbook with lesson plans); improvements in the PA environment in school; and educational strategies. Control schools continued with their traditional schedule. Baseline (March/April 2017), postintervention (November/December 2017), and maintenance (June/July 2018) evaluations included PA and SB as primary outcomes (assessed by self-report and accelerometry). Secondary outcomes included psychosocial factors related to PA and SB (e.g., social support and self-efficacy), as well as health (e.g., quality of life and nutritional status) and education (e.g., academic achievement) outcomes. A program evaluation was performed based on the RE-AIM framework. Participants, intervention staffs, and evaluators were not blinded to group assignment, but a standardized evaluation protocol was applied independently of the trial allocation.

RESULTS

Statistical analyses will include a multilevel approach for repeated measurements and mediation analysis. Any side effects of the intervention will be recorded. The sample size close to that expected (n = 1090) was reached (n = 999). The results of this trial will involve valuable information about the effect and the evaluation of a multicomponent intervention carried out in a middle-income country.

CONCLUSION

By creating opportunities for adolescents to be active at school using multicomponent strategies, the Movimente program has the potential to enhance students health and academic performance which may encourage the school community (e.g., teachers, principals) to adopt the program. Also, this trial will provide evidence for practitioners, policy makers, and researchers on how multicomponent program may be implemented in a school setting.

TRIAL REGISTRATION

The trial is registered at the Clinical Trial Registry (Trial ID: NCT02944318; date of registration: 18 October 2016).

School- and Leisure Time Factors Are Associated With Sitting Time of German and Irish Children and Adolescents During School: Results of a DEDIPAC Feasibility Study

Objective: The study aims to investigate to what extent school- and leisure time-related factors are associated with sedentary behavior during school in German and Irish children and adolescents. Methods: The study based on a sample of 198 children and adolescents surveyed in 2015. Sedentary and activity behavior were measured using the activPAL physical activity monitor. Information on socio-economic status, school- and leisure-time related factors were provided by questionnaires. Associations between school- and leisure time-related factors and sedentary time during school were estimated using linear multi-level models. Results: Access to play equipment in school was associated with reduced sitting time (hours/day) of children (ß = 0.78; 95%CI = 0.06-1.48). Media devices in bedroom and assessing the neighborhood as activity friendly was associated with increased sitting time of children (ß = 0.92; 95%CI = 0.12-1.72 and ß = 0.30; 95%CI = 0.01-0.60, respectively). The permission to use media devices during breaks was associated with increased sitting time (hours/day) of adolescents (ß = 0.37; 95% CI = 0.06-0.69). A less safe traffic surrounding at school was associated with reduced sitting time of adolescents (ß = -0.42; 95% CI = -0.80 to -0.03). Conclusion: Results suggest that school- and leisure time-related factors are associated to the sedentary behavior during school. We suggest that future strategies to reduce sedentary time should consider both contexts.

"I Wasn't Sure What It Meant to be Honest"-Formative Research towards a Physical Literacy Intervention for Preschoolers

Physical literacy (PL) as a concept is important in developing lifelong physical activity; however, there is little research exploring how PL can be developed during the preschool years. This two-phase qualitative study sought the insights of academics/expert practitioners and preschool staff towards PL in order to inform the design of future preschool PL interventions. Phase One comprised of nine semi-structured interviews with experts in the field of children's physical activity and/or PL. Interview topics included perspectives on the concept of PL and recommendations for interventions targeted at improving preschool PL. Phase Two consisted of focus groups with practitioners from four local children's centres. Focus groups explored perspectives on the feasibility and acceptability of proposed PL interventions. Interviews and focus groups were analysed by thematic analysis and means of representation, respectively. Findings revealed that whilst there was limited understanding about the concept of PL among preschool educators, knowledge of child development was evident and that all participants agreed that there was a need for further training for practitioners. Perceived barriers to promoting PL noted by practitioners included funding, policy, curricular priorities, parental opinions, and the preschool environment. It was recommended that interventions should be: (i) designed using a participatory approach including all key stakeholders, (ii) conducted over the long term, and (iii) incorporate opportunities for children to engage in free and outdoor play. Furthermore, any intervention should be flexible to allow for variation between children's centres, aligned to current policy/children's centre targets and provide training and resources in order to overcome perceived barriers.

Canadian children's and youth's adherence to the 24-h movement guidelines during the COVID-19 pandemic: A decision tree analysis

PURPOSE

The purpose of this study was to use decision tree modeling to generate profiles of children and youth who were more or less likely to meet the Canadian 24-h movement guidelines during the coronavirus disease-19 (COVID-19) outbreak.

METHODS

Data for this study were from a nationally representative sample of 1472 Canadian parents (Mean_age = 45.12, SD = 7.55) of children (5-11 years old) or youth (12-17 years old). Data were collected in April 2020 via an online survey. Survey items assessed demographic, behavioral, social, micro-environmental, and macro-environmental characteristics. Four decision trees of adherence and non-adherence to all movement recommendations combined and each individual movement recommendation (physical activity [PA], screen time, and sleep) were generated.

RESULTS

Results revealed specific combinations of adherence and non-adherence characteristics. Characteristics associated with adherence to the recommendation(s) included high parental perceived capability to restrict screen time, annual household income of ≥ $100,000, increases in children's and youth's outdoor PA/sport since the COVID-19 outbreak began, being a boy, having parents younger than 43 years old, and small increases in children's and youth's sleep duration since the COVID-19 outbreak began. Characteristics associated with non-adherence to the recommendation(s) included low parental perceived capability to restrict screen time, youth aged 12-17 years, decreases in children's and youth's outdoor PA/sport since the COVID-19 outbreak began, primary residences located in all provinces except Quebec, low parental perceived capability to support children's and youth's sleep and PA, and annual household income of ≤ $99,999.

CONCLUSION

Our results show that specific characteristics interact to contribute to (non)adherence to the movement behavior recommendations. Results highlight the importance of targeting parents' perceived capability for the promotion of children's and youth's movement behaviors during challenging times of the COVID-19 pandemic, paying particular attention to enhancing parental perceived capability to restrict screen time.

Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial)

Background

Parents are key decision makers and role models in establishing and maintaining healthy behaviours in their children. Interventions involving parents have been shown to be more effective than those that do not, but there are barriers to participation. Efficacy trials have previously been conducted on two such parent-focussed healthy eating and active living interventions with the potential to overcome these barriers - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine the effectiveness of these interventions in a real-world context. The Time for Healthy Habits study is a 3-arm partially randomised preference trial which aims to evaluate the effectiveness and cost-effectiveness of two theory-based programs to promote healthy eating and appropriate levels of movement behaviours (physical activity, sedentary behaviour and sleep) for parents of 2- to 6-year-old children (Healthy Habits Plus telephone-based program and Time2bHealthy online program), when compared to a comparison group receiving written materials.

Methods

Participants will be recruited across five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide if they wish to be randomised or opt to select their preferred intervention and has been recommended for use to test effectiveness in a real-world setting. Both interventions incorporate multiple behaviour change techniques and support parents to improve their children’s healthy eating, and movement behaviours (physical activity, sedentary behaviour and sleep) and run for 12 weeks, followed by a 3-month and 9-month post-baseline follow-up. Participants will also be asked to complete a process evaluation questionnaire at the completion of the intervention (3-months post-baseline). Outcomes include fruit and vegetable intake (primary outcome), non-core food intake, weight status, physical activity, sedentary behaviour, and sleep habits.

Discussion

To our knowledge, this is the first translational research trial evaluating the effectiveness and cost-effectiveness of a healthy eating and active living intervention in the 2- to 6-years age group. The results will build the evidence base in regard to translation of effective childhood obesity prevention interventions and inform the implementation and delivery of community based childhood obesity prevention programs.

Trial registration

UTN: U1111–1228-9748, ACTRN: 12619000396123p.

Correlates of sedentary behaviour in Asian adults: A systematic review

The objective of this study is to systematically review the evidence on correlates of sedentary behaviour (SB) among Asian adults. We searched for studies that examined individual, environmental, and political/cultural correlates of total and domain-specific SB (transport, occupation, leisure, and screen time) in Asian adults published from 2000 onwards in nine scientific databases. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis that considered differences based on SB measurements, regions, and population characteristics (PROSPERO: CRD42018095268). We identified 13 249 papers of which we included 49, from four regions and 12 countries. Researchers conducted cross-sectional analyses and most relied on SB self-report for SB measurement. Of the 118 correlates studied, the following associations were consistent: higher age, living in an urban area (East Asia), and lower mental health with higher total SB; higher education with higher total and occupational SB; higher income with higher leisure-time SB; higher transit density with higher total SB in older East Asians; and being an unmarried women with higher SB in the Middle East. We encourage more research in non-high-income countries across regions, further exploration of important but neglected correlates using longitudinal designs and qualitative research, and the use of objective instruments to collect SB data.

Choice is relative: Reinforcing value of food and activity in obesity treatment

Persons with obesity find high-energy-dense food and sedentary behaviors highly reinforcing. Diets and exercise programs deprive individuals of many favorite foods and activities, which can counterproductively heighten their value and lead to relapse. Since the value of reinforcers depend on the alternatives available, one approach to reducing food and sedentary activity reinforcement is to build healthy alternative reinforcers. Current behavioral treatment programs for children and adults do not attempt to build alternative reinforcers as substitutes for unhealthy behaviors to reduce the impact of food or activity deprivation on the motivation to eat or be inactive. A goal of the next generation of obesity treatment programs should focus on development of healthy behaviors as reinforcers so that people will be motivated to engage in them. This article provides an overview of relationships among reinforcers, how understanding substitutes and complements can influence eating and activity, and how enriching a person's environment and providing choice architecture can enhance weight control. Ideas for translation of these basic behavioral economic principles to obesity treatment programs are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Whole family-based physical activity promotion intervention: the Families Reporting Every Step to Health pilot randomised controlled trial protocol

INTRODUCTION

Family-based physical activity (PA) interventions present a promising avenue to promote children's activity; however, high-quality experimental research is lacking. This paper describes the protocol for the FRESH (Families Reporting Every Step to Health) pilot trial, a child-led family-based PA intervention delivered online.

METHODS AND ANALYSIS

FRESH is a three-armed, parallel-group, randomised controlled pilot trial using a 1:1:1 allocation ratio with follow-up assessments at 8 and 52 weeks postbaseline. Families will be eligible if a minimum of one child in school Years 3-6 (aged 7-11 years) and at least one adult responsible for that child are willing to participate. Family members can take part in the intervention irrespective of their participation in the accompanying evaluation and vice versa.Following baseline assessment, families will be randomly allocated to one of three arms: (1) FRESH; (2) pedometer-only or (3) no-intervention control. All family members in the pedometer-only and FRESH arms receive pedometers and generic PA promotion information. FRESH families additionally receive access to the intervention website; allowing participants to select step challenges to 'travel' to target cities around the world, log steps and track progress as they virtually globetrot. Control families will receive no treatment. All family members will be eligible to participate in the evaluation with two follow-ups (8 and 52 weeks). Physical (eg, fitness and blood pressure), psychosocial (eg, social support) and behavioural (eg, objectively measured family PA) measures will be collected at each time point. At 8-week follow-up, a mixed methods process evaluation will be conducted (questionnaires and family focus groups) assessing acceptability of the intervention and evaluation. FRESH families' website engagement will also be explored.

ETHICS AND DISSEMINATION

This study received ethical approval from the Ethics Committee for the School of the Humanities and Social Sciences at the University of Cambridge. Findings will be disseminated via peer-reviewed publications, conferences and to participating families.

TRIAL REGISTRATION NUMBER

ISRCTN12789422.

Not All Play Equipment Is Created Equal: Associations Between Equipment at Home and Children's Physical Activity

BACKGROUND

Play equipment at home could be targeted in interventions to increase children's physical activity (PA), but evidence is mixed, potentially because current methods do not reflect children's lived experience. This study investigated associations between combinations of equipment and PA.

METHODS

Data were from the Mothers and their Children's Health study and the Australian Longitudinal Study on Women's Health. Mothers (n = 2409) indicated the types of fixed active (eg, trampolines), portable active (eg, bicycles), and electronic (eg, computers) equipment at home, and the number of days children (n = 4092, aged 5-12 y, 51% boys) met PA guidelines. Latent class analysis was used to identify combinations of equipment, and linear regressions were used to investigate associations with PA.

RESULTS

Compared with children with high active (fixed and portable) and medium electronic equipment, children with portable active and medium (B = -0.53; 95% confidence interval, -0.72 to -0.34) or high (B = -0.58; 95% confidence interval, -0.83 to -0.33) electronic equipment met the guidelines on fewer days. Children with similar active equipment (but more electronic equipment) met the PA guidelines on fewer days (mean difference = -0.51, SE = 0.14, P = .002).

CONCLUSION

Having the right combination of play equipment at home may be important for children's PA.

Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions-A Review of Reviews

A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.

What factors explain socioeconomic inequalities in adults' television-related sitting time?

BACKGROUND

There are considerable socioeconomic inequalities in television-related sitting time, but there is little evidence for the explanatory mechanisms. We used a cohort of Belgian adults (25-60 years) and older adults (≥65 years) to examine the social cognitive, home environmental and health-related factors contributing to socioeconomic differences in television-related sitting.

METHODS

We included 301 adults and 258 older adults (total n = 559). Linear regression analyses were used to examine the associations of education and occupational status with television-related sitting time, adjusted for age and gender. We assessed the explanatory power of social cognitive, home environmental and health-related factors using the traditional 'change-in-estimation method'.

RESULTS

Those with low and medium education, respectively, engaged in 54 and 28 minutes per day more television-related sitting time than those with high education. We found no association between occupational status and television-related sitting time. Social cognitive factors explained 54% of the difference in television-related sitting time between those with low and high education, while home environmental factors only explained 6%, and health-related variables explained 10% of these differences.

CONCLUSION

We found no occupational inequalities in television-related sitting time. Social cognitive variables such as attitude and modelling of the partner explained a large part of the educational inequalities in television-related sitting time. If confirmed by future studies, a focus on social cognition may help reduce sedentary behaviours in low-educated adults and diminish inequalities in sedentary behaviours.

Change in Children's Physical Activity: Predictors in the Transition From Elementary to Middle School

INTRODUCTION

Interventions to promote physical activity in children should be informed by knowledge of the factors that influence physical activity behavior during critical developmental transitions. The purpose of this study is to identify, from a comprehensive, multidomain set of factors, those that are associated with change in objectively measured physical activity in children as they transition from elementary to middle school.

METHODS

The study used a prospective cohort design, with children observed in fifth, sixth, and seventh grades. Growth curve analyses were used to examine associations between exposure variables measured at baseline and children's physical activity across three observations. A total of 828 children, aged 10.6 (SD=0.5) years at baseline provided physical activity data in fifth grade and at one or both follow-ups. Exposure variables assessed child characteristics, parent characteristics, home characteristics, social factors, school environment, and community characteristics. Physical activity was measured via accelerometry. Data were collected in two school districts in South Carolina in 2010-2013 and analyzed in 2017.

RESULTS

Variables measured within the child, parent/home, and community domains were positively associated with children's physical activity as they transitioned from fifth to seventh grade. These included parent encouragement of physical activity, parental support for physical activity, child sports participation, parent's report of the child's physical activity level, the child's time spent outdoors, social spaces for physical activity in the community, and the number of physical activity facilities that were proximal to the child's home.

CONCLUSIONS

Interventions designed to increase children's physical activity should include strategies that target multiple domains of influence.

Environmental correlates of physical activity among children 10 to 13 years old in Wallonia (Belgium)

Background

In Belgium, as in many other countries, the juvenile practice of physical activity is insufficient. A growing attention has been paid to environmental factors that may influence physical activity but with inconsistent findings. This study aims to estimate the association between daily life environment characteristics and physical activity among children 10 to 13 years old in Wallonia (Belgium).

Methods

Data were collected using a self-administered questionnaire among 1940 children (HBSC survey). Associations between factors related to the children’s living environment and physical activity (vigorous physical activity (VPA) ≥ twice a week; global physical activity (GPA) defined as VPA ≥ twice a week and moderate-to-vigorous physical activity ≥1 h/day) were estimated using logistic regressions adjusted for potential confounders.

Results

Nearly three-quarters of the children practiced VPA ≥ twice a week, but only one in five practiced GPA consistent with recommendations. After adjustment, children living in a neighborhood with playgrounds or parks were more likely to achieve a recommended level of GPA (OR: 1.34 [1.04–1.73]), as were children who reported that other youngsters were present in their neighborhood with whom they could play outside (OR: 1.50 [1.12–1.99]). The presence of neighborhood children was also positively associated with VPA (OR: 1.80 [1.42–2.29]); in stratified analyses, the association was significant only among boys (OR: 1.95 [1.34–2.82]). Moreover, and only in girls (OR: 1.66 [1.10–2.49]), a feeling of safety in one’s neighborhood was positively associated with VPA. No association was found between VPA and the existence of a yard or a garden at home to go playing outside.

Conclusion

Our results argue for developing actions aimed at creating living environments more favorable to children’s daily physical activity. More specifically, they help better understand the environment of Belgian children and thus contribute to better identify their needs.

Obesity and Urban Environments

Obesity is a major public health issue, affecting both developed and developing societies. Obesity increases the risk for heart disease, stroke, some cancers, and type II diabetes. While individual behaviours are important risk factors, impacts on obesity and overweight of the urban physical and social environment have figured large in the recent epidemiological literature, though evidence is incomplete and from a limited range of countries. Prominent among identified environmental influences are urban layout and sprawl, healthy food access, exercise access, and the neighbourhood social environment. This paper reviews the literature and highlights the special issue contributions within that literature.

Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults

Background

Older adults are at risk of multiple chronic diseases, most of which could be prevented by engaging in regular physical activity. Frailty is a state of increased vulnerability to diseases. Worsening symptoms of frailty, such as decrease in physical functionality, can compromise health-related quality of life (HR-QOL). Previous findings suggest that frailty moderates the relationship between physical activity and HR-QOL, yet intervention findings are limited, particularly in dose–response analyses. Hence, this study was conducted to test if lower-dose physical activity (120 minutes/week) would provide the same benefits in health outcomes (physical functionality and HR-QOL) as higher-dose physical activity (180 minutes/week).

Methods

Participants (n=110) were older adults comprising higher-dose, lower-dose, and control groups who were combined from recent randomized controlled trials. Experimental groups participated in a multimodal exercise program in a supervised laboratory setting for 12 weeks.

Results

The higher-dose group showed a significant improvement in physical functionality (β=0.23, P=0.03) and in overall HR-QOL (β=0.44, P=0.001) including its subcategories over the control group. A group × frailty interaction revealed that frail individuals significantly improved in capacity HR-QOL when they exercised at a higher dose (F (1, 49)=4.57, P=0.038).

Conclusion

This study identifies a positive, predictive relationship between exercise duration and health outcomes (HR-QOL dimensions and frailty) among older adults. Frail individuals in the higher-dose group demonstrated significant recovery of capacity HR-QOL, thus reflecting improvement in their daily activities.

Environmental correlates of total and domain-specific sedentary behaviour in young people. The UP&DOWN study

This study investigated the associations between the characteristics of the nearby physical environment with the total and domain-specific leisure-time sedentary behaviour (SB) in young people. The study included 1578 youth (9-18 years) from the UP&DOWN study. Total leisure-time SB was objectively-assessed by accelerometers. Participants self-reported the time spent during leisure-time in different domains of SB (i.e. screen-based, educational-based, social-based, and other-based SB). Information regarding the basic characteristics of the house, the perceived neighbourhood environment, the amount of physical activity facilities, equipment and materials attainable at home, and the media equipment available at home and in the own bedroom was collected. Linear mixed models were performed, including school and city as random effects. The availability of yard was related to lower total SB and time spent surfing the Internet in boys, but not in girls. More favourable perceived neighbourhood environment was associated with lower total SB and time spent playing video games in girls, but not in boys. The amount of physical activity materials at home was negatively associated with screen-based SB, while the availability of a computer in the own bedroom was positively related to the time spent surfing the Internet in boys and girls. The number of televisions at home and having a computer in the own bedroom was associated with lower time in educational-based SB in boys and girls, respectively. Increasing the number of PA materials at home and decreasing the number of TVs at home and the availability of a computer in the bedroom could improve SB profiles of youth.

A Conceptual Analysis of Food Parenting Practices in the Light of Self-Determination Theory: Relatedness-Enhancing, Competence-Enhancing and Autonomy-Enhancing Food Parenting Practices

The relationships between parenting behaviors and child obesity or obesogenic eating behaviors (i.e., overeating unhealthy food) have been studied through the use of different parenting constructs; in particular, specific food parenting practices have been extensively investigated, but there is currently a need for a more comprehensive and integrative theoretical framework to guide future investigations. The present article argues for the use of Self-determination theory as a valuable framework to conceptually organize food parenting practices relevant to children's obesogenic eating behaviors. The three parenting dimensions of positive parental involvement, autonomy support and provision of structure - highlighted by Self-determination theory as closely linked to the process of internalization of healthy behaviors and values by the child - will be adopted as a framework to categorize food parenting practices into three types of practices: relatedness-enhancing, competence-enhancing and autonomy-enhancing.

Effects of home-based exergaming on child social cognition and subsequent prediction of behavior

The use of exergames may be one viable way to increase child physical activity, but investigation of its effects on motivation over time and prediction of adherence have seen little research attention. The purpose of this study was to compare the effect of two cycling exergame interventions (single-player, multi-player) among children aged 9-12 years on motivational variables (theory of planned behavior) and to explore whether these variables could predict objective assessment of playtime across 6 weeks. Sixty-nine insufficiently active children were recruited through advertisements within the community/schools and randomized to either the single play condition (n = 30) or multi-player condition (n = 39). Exergaming use was recorded objectively via game logs and motivational variables were assessed after a familiarization session, at 2 weeks, and at 4 weeks. Participants played the exergames M = 133.45 (SD = 81.27) minutes in week 1 to M = 77.23 (SD = 84.09) minutes in week 6. The two exergame conditions did not result in differences among theory of planned behavior variables (P > .05). Mean levels of these constructs declined across the first 4 weeks (P < .05), with the exception of injunctive norm. Positive bivariate associations (P < .05) between game play and perceived control (0-6 weeks), and intention (weeks 3-4 and weeks 5-6) were identified, but only affective attitude (assessed at week 2) predicted (P < .05) game play (3-4 weeks) in a multivariate examination of the theory of planned behavior model. The results demonstrate that social cognitive motives wane across time when exposed to repeated exergame play.

The home electronic media environment and parental safety concerns: relationships with outdoor time after school and over the weekend among 9-11 year old children

BACKGROUND

Time spent outdoors is associated with higher physical activity levels among children, yet it may be threatened by parental safety concerns and the attraction of indoor sedentary pursuits. The purpose of this study was to explore the relationships between these factors and outdoor time during children's discretionary periods (i.e., after school and over the weekend).

METHODS

Data from 462 children aged 9-11 years old were analysed using generalised linear mixed models. The odds of spending > 1 h outdoors after school, and > 2 h outdoors on a weekend were computed, according to demographic variables, screen-based behaviours, media access, and parental safety concerns. Interactions with sex and socioeconomic status (SES) were explored.

RESULTS

Boys, low SES participants, and children who played on their computer for < 2 h on a school day had higher odds of spending > 1 h outside after school than girls, high SES children and those playing on a computer for ≥2 h, respectively. Counterintuitive results were found for access to media devices and crime-related safety concerns as both of these were positively associated with time spent outdoors after school. A significant interaction for traffic-related concerns*sex was found; higher road safety concerns were associated with lower odds of outdoor time after school in boys only. Age was associated with weekend outdoor time, which interacted with sex and SES; older children were more likely to spend > 2 h outside on weekends but this was only significant among girls and high SES participants.

CONCLUSIONS

Our results suggest that specific groups of children are less likely to spend their free time outside, and it would seem that only prolonged recreational computer use has a negative association with children's outdoor time after school. Further research is needed to explore potential underlying mechanisms, and parental safety concerns in more detail.

Use of in-home stationary cycling equipment among parents in a family-based randomized trial intervention

OBJECTIVES

The purpose of this study was to examine the use of home exercise equipment in the form of exergame cycling compared to a stationary recumbent bicycle ergometer in front of TV in the home over 3 months among parents of an intervention with their inactive children. The primary outcome was bike use (total weekly duration). Predictors of bike use in the form of theory of planned behavior and self-determination theory were also examined.

DESIGN

Randomized controlled trial.

METHOD

Sixty eight parents of children aged 10-14 were randomized to either the exergame condition (n=36) or the standard bike condition (n=32). Weekly bike use was recorded in a log-book.

RESULTS

The exergame bike and a standard bike in front of a TV had similar use across three months (p=.13, η_p²=.02), which declined over time (p<.01, η_p²=.14). Parents who were active at baseline and had the intention to use the bikes were more likely to use the bikes (p<.05). Furthermore, those who reported higher perceived control, intrinsic motivation, and affective attitude were more likely to use the bikes (p<.05).

CONCLUSIONS

The findings suggested that irrespective of modality, use of exercise equipment declined considerably for parents over three-months. Parents may also benefit from family physical activity interventions, but it depends on their physical activity status, how much they would enjoy using the equipment, and their overall perceived control over being physically active.

TRIAL REGISTRATION

clinicaltrials.gov #NCT01373762. Registered 1 June 2011.

The SMART Study, a Mobile Health and Citizen Science Methodological Platform for Active Living Surveillance, Integrated Knowledge Translation, and Policy Interventions: Longitudinal Study

Background

Physical inactivity is the fourth leading cause of death worldwide, costing approximately US $67.5 billion per year to health care systems. To curb the physical inactivity pandemic, it is time to move beyond traditional approaches and engage citizens by repurposing sedentary behavior (SB)–enabling ubiquitous tools (eg, smartphones).

Objective

The primary objective of the Saskatchewan, let’s move and map our activity (SMART) Study was to develop a mobile and citizen science methodological platform for active living surveillance, knowledge translation, and policy interventions. This methodology paper enumerates the SMART Study platform’s conceptualization, design, implementation, data collection procedures, analytical strategies, and potential for informing policy interventions.

Methods

This longitudinal investigation was designed to engage participants (ie, citizen scientists) in Regina and Saskatoon, Saskatchewan, Canada, in four different seasons across 3 years. In spring 2017, pilot data collection was conducted, where 317 adult citizen scientists (≥18 years) were recruited in person and online. Citizen scientists used a custom-built smartphone app, Ethica (Ethica Data Services Inc), for 8 consecutive days to provide a complex series of objective and subjective data. Citizen scientists answered a succession of validated surveys that were assigned different smartphone triggering mechanisms (eg, user-triggered and schedule-triggered). The validated surveys captured physical activity (PA), SB, motivation, perception of outdoor and indoor environment, and eudaimonic well-being. Ecological momentary assessments were employed on each day to capture not only PA but also physical and social contexts along with barriers and facilitators of PA, as relayed by citizen scientists using geo-coded pictures and audio files. To obtain a comprehensive objective picture of participant location, motion, and compliance, 6 types of sensor-based (eg, global positioning system and accelerometer) data were surveilled for 8 days. Initial descriptive analyses were conducted using geo-coded photographs and audio files.

Results

Pictures and audio files (ie, community voices) showed that the barriers and facilitators of active living included intrinsic or extrinsic motivations, social contexts, and outdoor or indoor environment, with pets and favorable urban design featuring as the predominant facilitators, and work-related screen time proving to be the primary barrier.

Conclusions

The preliminary pilot results show the flexibility of the SMART Study surveillance platform in identifying and addressing limitations based on empirical evidence. The results also show the successful implementation of a platform that engages participants to catalyze policy interventions. Although SMART Study is currently geared toward surveillance, using the same platform, active living interventions could be remotely implemented. SMART Study is the first mobile, citizen science surveillance platform utilizing a rigorous, longitudinal, and mixed-methods investigation to temporally capture behavioral data for knowledge translation and policy interventions.