Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study

Associations between adherence to 24-hour movement guidelines and socio-emotional competence among preschool children: A cross-sectional study

BACKGROUND

This study investigated the association between adherence to 24-h movement guidelines and socioemotional competence among Chinese preschool children.

METHODS

A total of 1288 parents of Chinese preschoolers (54.64 % boys, 45.36 % girls; Mage = 4.48, SD = 0.97) reported the time their children spent on physical activity (PA), screen time (ST), and sleep duration (SD), and completed questionnaires measuring socioemotional competence. Multiple logistic regression analyses were used to explore the associations between individual and combined measures of PA, ST, and SD, and the risk of low socioemotional competence.

RESULTS

The risk of low socioemotional competence was significantly lower for children aged 4 (odds ratio [OR] = 0.47, 95 % CI: 0.31-0.71), 5 (OR = 0.23, 95 % CI: 0.15-0.35), and 6 (OR = 0.16, 95 % CI: 0.10-0.25) compared to 3-year-olds. Children with a family income level higher than 20,000CNY had a significantly lower risk of low socioemotional competence than those with a family income level not higher than 3000CNY (OR = 0.21, 95 % CI: 0.08-0.59). Urban residency was associated with significantly lower odds of low socioemotional competence than rural residency (OR = 0.41, 95 % CI: 0.21-0.82). Adherence to the PA-only guidelines (OR = 0.45, 95 % CI: 0.22-0.94), SD-only guidelines (OR = 0.25, 95 % CI: 0.08-0.72), ST + SD guidelines (OR = 0.33, 95 % CI: 0.16-0.67), and PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.18-0.70) were associated with a lower risk of low socioemotional competence. In addition, among boys, only adherence to the PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.14-0.90) was associated with a lower risk of low socioemotional competence. Among girls, adherence to SD guidelines only (OR = 0.22, 95 % CI: 0.04-0.90), ST + SD guidelines (OR = 0.17, 95 % CI: 0.06-0.49), and PA + ST + SD guidelines (OR = 0.37, 95 % CI: 0.14-0.91) were all associated with a lower risk of low socioemotional competence.

CONCLUSIONS

Adhering to 24-h movement guidelines is crucial for enhancing socioemotional competence in preschool children, especially girls. Interventions should focus on promoting physical activity, reducing screen time, and ensuring adequate sleep.

Worldwide burden of liver cancer across childhood and adolescence, 2000-2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Liver cancer is a significant contributor to the global disease burden, of which hepatoblastomas are the most common liver tumors in children, with 90% of cases occurring within the first 5 years of life. It is important for pediatricians and subspecialists in pediatric gastroenterology and hepatology to have knowledge of the epidemiology and incidence trends of pediatric hepatic cancer, despite its rarity. In the present study, we first provide estimates of the incidence and mortality burden of hepatoblastoma and liver cancer from 2000 to 2021 in the childhood and adolescence.

Methods

Liver cancer burden and its attributable risk factors were estimated using data from the Global Burden of Disease Study (GBD) 2021. Percentage change was estimated to show the trend of liver cancer estimates from 2000 to 2021. The age-standardized rate (ASR) and estimated annual percentage change (EAPC) were utilized for measuring hepatoblastomas incidence and deaths rate trends. In accordance with the GBD framework, 95% uncertainty intervals (UIs) for all estimates by averaging the data from 1000 draws, with the lower and upper bounds of the 95% UIs.

Findings

Globally, from 2000 to 2021 in the age 5-19 years group, the incidence cases and deaths cases due to liver cancer decreased from 2449.2 (95% UI: 2235.9-2689.8) to 1692.9 (95% UI: 1482.0-1992.5) and 2248.5 (95% UI: 2053.7-2474.9) to 1516.6 (95% UI: 1322.1-1797.9), respectively. Meanwhile, from 2000 to 2021 in the age 20-24 years group, the incidence cases and deaths cases due to liver cancer decreased from 1453.5 (95% UI: 1327.8-1609.4) to 1285.1 (95% UI: 1159.2-1447.2) and 1432.3 (95% UI: 1307.6-1585.7) to 1195.5 (95% UI: 1066.1-1355.2), respectively. In addition, the prevalence of liver cancer decreased from 41.9% (95% UI: 18.7%-64.7%) to 26.4% (95% UI: 14.2%-39.1%) in the age 5-19 years group, and 46.6% (95% UI: 42.8%-51.5%) to 36.5% (95% UI: 33.1%-40.9%) in the age 20-24 years. From 2000 to 2021, in the age group of 5-19 years, the proportion of liver cancer incidence due to hepatitis B has decreased from 42.2% to 37.9%, while the proportion due to hepatitis C has increased from 1.1% to 1.6%. Additionally, there has been an increase in the proportion of NASH-induced liver cancer incidence from 5.2% to 9.4%, and alcohol use induced liver cancer incidence has also increased from 0.5% to 0.7% over the same period. Globally, from 2000 to 2021, the incidence cases and deaths cases due to hepatoblastoma decreased from 6131.8 (95% UI: 5234.8-6961.9) to 4045.6 (95% UI: 3250-4995.8) and 4059.2 (95% UI: 3494.5-4621.2) to 2416 (95% UI: 1940.2-3022.5), respectively. There was some variation in age-related sex-specific patterns, the highest number of hepatoblastoma incidence cases occurred in children between 2 and 4 years old and females in the age range of 12 months to 9 years had a higher number of new cases. Importantly, the incidence of hepatoblastoma was started to increase sharply after the age of 1 month.

Interpretation

The results of the present study are significant for liver health policy and practice in childhood and adolescence. Differentiated intervention and outreach strategies based on age and gender would be necessary to reduce the impact of liver cancer. Early screening and interventions for hepatoblastoma is important especially in the population of under 9 years old.

Funding

This study was supported by the National Key R&D Program of China (grant numbers 2023YFC2307000), National Natural Science Foundation of China [grant numbers 82170571 and 81974068], China Postdoctoral Science Foundation (grant numbers 2023M741283).

Impact of apparent temperatures on park visitation behavior: A comprehensive analysis using large-scale mobility data

As many regions continue to show record temperatures and high frequencies of extreme climate events, climate change is disrupting human health and prosperity. This study focuses on how temperature changes and extreme heat as key climate components can impact park visitations (key physical activities indicator). Using the large mobility dataset SafeGraph, this study introduced a causal machine learning approach to estimate marginal heterogenous treatment effects (HTE) of daily apparent temperatures for different park properties and activity types. Our results revealed the declining effects of park visitations as apparent temperature increases and the significant disturbances under extreme heat. Different temperature thresholds that may harm park visitations were identified. Nearby green and public spaces (e.g. neighborhood parks) are the most susceptible category to summer heat. Dog parks, Playgrounds and Ball Field/Sports were well used during the heat. Pool/Splash pad and Community center have shown capabilities of mitigating heat stress. Effectiveness of other park facilities, including Restroom/Drinking Fountain, Water Body, Shade Area Facility were also presented. This study estimates climate impact on park behaviors for multiple usage and environmental situations. Our findings may help future planners, policymakers, landscape architects and park managers better understand climate-related risks when making investment and development decisions.

Associations of Park Use with Physical Activity in Renovated Parks Serving Low-Income Communities in New York City: Insights from the Community Parks Initiative

Parks have the potential to encourage physical activity among urban communities. However, existing research on the link between park use and physical activity has produced inconsistent results. Mixed findings in the past may be due in part to differences in park quality across studies. The aim of this study was to explore the association between park use and physical activity among New York City adults in low-income communities that recently received city-sponsored park renovation as part of the Community Parks Initiative (CPI). Using population-weighted survey data from eight neighborhoods with recent park renovation (n = 2,000), we measured associations between park use frequency (≥ once/week vs. < once/week) and self-reported physical activity (high vs. low-moderate based on the International Physical Activity Questionnaire). We adjusted models for age, sex, education, race/ethnicity, income, study site, and use of other (non-CPI) parks, and conducted stratified analysis for demographic variables with significant interactions with park use. After adjusting for covariates, we observed a positive association between park use and physical activity (prevalence ratio [PR] = 1.30, 95% CI = 1.16-1.46). Greater frequency of park use was more strongly associated with high physical activity among adults ≤ 50 y (PR = 1.39, 95% CI = 1.14-1.69), individuals with annual household income < $25,000 (PR = 1.54, 95% CI = 1.13-2.08), and Latinos (PR = 1.77, 95% CI = 1.44-2.18). Our findings suggest that high-quality parks might be particularly beneficial for promoting physical activity among those with a lower socioeconomic background and in younger and Latino adults, emphasizing the importance of continued investment in park revitalization among urban communities of color.

Exploring the impact of the environment on physical activity in patients with chronic obstructive pulmonary disease (EPCOT)-A comparative analysis between suggested and free walking: Protocol study

BACKGROUND

Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced levels of physical activity, which are associated with poorer outcomes. The number of clinical trials aiming to promote behavioral changes to increase physical activity in this population has grown; therefore, these trials have yet to produce satisfactory results. An ecological model encompassing individual, social, environmental, and political factors represent a potentially more effective approach to promoting physical activity. While favorable urban environments can positively impact physical activity, specifically tailored environmental interventions for individuals with COPD could enhance their engagement in physical activity. Therefore, the aim of this randomized controlled trial (RCT) study was to analyze the effects of walking in a suggested environment and free walking on physical activity levels in individuals with COPD.

METHODS

The environment on physical activity for chronic obstructive disease (EPCOT) is a randomized controlled clinical trial protocol approved by our institution's Ethics Committee and registered with The Brazilian Registry of Clinical Trials (ReBEC) (https://ensaiosclinicos.gov.br, number RBR-4tfwdhp). This protocol will involve 38 volunteers diagnosed with COPD recruited from the pulmonary physiotherapy and rehabilitation service. The volunteers were randomly divided into two walking groups: an experimental group (ERG) with guidance for walking in a suggested environment and an active control group (ACG) instructed to choose their own routes. The intervention consisted of eight consecutive weeks, with progressive walks carried out 3 to 5 times weekly. The primary outcome will be assessing participants' physical activity levels. Secondary outcomes will include exercise capacity, quality of life, dyspnea levels, motivation, anxiety, depression, and perceptions of the environment. All assessments will occur before and after the intervention period, aiming to fill a literature gap by investigating the impact of urban environments on COPD-related physical activity. The results may shed light on the importance of environmental factors in promoting physical activity among individuals with COPD, helping to develop more effective interventions.

Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study

BACKGROUND

Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time.

OBJECTIVE

The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures.

METHODS

We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes.

RESULTS

Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness.

CONCLUSIONS

Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers

OBJECTIVE

To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers.

METHODS

A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme.

RESULTS

A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity.

CONCLUSIONS

Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

Results from the ENJOY MAP for HEALTH: a quasi experiment evaluating the impact of age-friendly outdoor exercise equipment to increase older people's park visitations and physical activity

BACKGROUND

Recreational parks can play a significant role in older people's health, with emerging evidence suggesting that changes in the physical environment, such as refurbishments of local parks, can increase park visitations and physical activity engagement. The ENJOY MAP for HEALTH aimed to evaluate the impact of Seniors Exercise Park installations and associated capacity building activities on older people's park visitation, and park-based physical activity.

METHOD

The ENJOY MAP for HEALTH was a quasi-experiment study design that involved the installation of specialised Seniors Exercise Park equipment as part of park refurbishment, supported by promotion and community capacity building activities in six municipalities in Victoria, Australia. Direct observations of park users took place prior to park upgrades, one-month post upgrade and 12-months from baseline. The overall number and characteristics of park visitors, and the type and level of physical activity undertaken, were summarised descriptively. Generalised linear models were used to examine the impact of park refurbishment (equipment installation and site activation) on the total number of older people observed in the park, and their engagement in physical activity, accounting for site and seasonal effects.

RESULTS

Overall number of visits increased following park upgrades, with the largest number of visitors observed one-month post upgrade (n = 12,501). The proportion of older people observed at the parks remained relatively low prior to and one-month post upgrade compared to other age groups. However, after adjusting for site and seasonal effects, the number of older people observed in the parks increased significantly post upgrade and site activation compared to prior to the refurbishment (incidence rate ratios (IRR) 3.55; 95% CI 2.68, 4.70). The number of older people observed to be exercising at the Seniors Exercise Park also increased by 100% at 12-months post-installation relative to one-month post upgrade (IRR 2.00; 95% CI 1.26, 3.17).

CONCLUSION

Installation of the Seniors Exercise Parks and the supportive programs and activities following six park upgrades resulted in an increase in older people's park visitation and engagement in physical activity. Community engagement and training of volunteers with the support of local governments are likely to contribute to the increased park usage by older people.

TRIAL REGISTRATION

This trial was registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380745&isReview=true .

Green space exposure and Chinese residents' physical activity participation: empirical evidence from a health geography perspective

Background

With continuous efforts made to promote the strategic goals of carbon neutrality and carbon peak, it is crucial to meet the growing and diversified needs of the public for fitness by practicing the concept of green development and promote the combination of national fitness and ecological civilization.

Methods

To achieve this purpose, an OLS regression model was applied to estimate the role of green space exposure in Chinese residents' participation in physical activity and its underlying mechanisms, using the microdata from the China General Social Survey (CGSS) data and the Provincial Vegetation Cover Index (NDVI) matched macrostatistical data.

Results

The empirical results show that green space exposure significantly increases the probability of residents' physical activity participation, and creating a green environment is conducive to creating a favorable physical activity environment for residents. Also, the core conclusions still hold after the year-by-year regression test is passed and the endogeneity problem is addressed. As revealed by mechanistic studies, green space exposure has indirect effects on the physical activity participation of residents through the independent mediating roles of reducing carbon emissions and promoting social interaction. According to heterogeneity results, males, those in marriage, and urban dweller groups are more inclined to perform physical activity in green spaces.

Conclusion

The results show that the exposure of green space can help increase the probability of residents' participation in physical exercise, and can that it achieved through two channels: reducing carbon emissions and enhancing social interaction. It is necessary to further strengthen the protection of the ecological lifestyle, give full play to the advantages of greenness and low-carbon, and create favorable conditions for the green development of a new model of national fitness.

The use of Virtual Reality (VR) to assess the impact of geographical environments on walking and cycling: a systematic literature review

BACKGROUND

Geographical environments influence people's active mobility behaviors, contributing to their physical and mental health. The use of Virtual Reality (VR) in experimental research can unveil new insights into the relationship between exposure to geographic environments and active mobility behaviors. This systematic review aims to (1) identify environmental attributes investigated in relation with walking and cycling, using VR, (2) assess their impacts on active mobility behaviors and attitudes, and (3) identify research gaps, strengths and limitations in VR-based experimental research.

METHODS

Articles published between January 2010 and February 2022 within five databases (PubMed, Scopus, EBSCO, IEEE Xplore, and Cochrane Library) were explored using three keywords and their synonyms: Virtual Reality, Active mobility behavior, and Geographical environments. Studies focusing on indoor environments, driving simulation, disease-specific groups, non-relevant disciplines (e.g. military, emergency evacuation), VR methodology/software optimization, and those with static participants' involvement were excluded. The full protocol is available from PROSPERO (ID = CRD42022308366).

RESULTS

Out of 3255 articles, 18 peer-reviewed papers met the selection criteria, mostly focusing on walking (83%). Most studies used head-mounted displays (94%) and relied on convenience sampling (72% below 100 participants). Both static (33%) and dynamic (45%) environmental attributes have been investigated, with only 22% of them simultaneously in the same virtual environment. Greenness and crowd density were the most frequent attributes, rather consistently associated with emotional states and movement behaviors. Few studies have taken into account participant's previous VR experience (33%) and cybersickness (39%) while both are likely to affect an individual's perception and behavior.

CONCLUSIONS

Future research should explore a broader range of environmental attributes, including static and dynamic ones, as well as a more complex integration of these attributes within a single experiment to mimic the effect of realistic environments on people's active mobility behaviors and attitudes. Larger and more diverse population samples are deemed required to improve result generalizability. Despite methodological challenges, VR emerges as a promising tool to disentangle the effect of complex environments on active mobility behaviors.

The greener the living environment, the better the health? Examining the effects of multiple green exposure metrics on physical activity and health among young students

The sedentary and less active lifestyle of modern college students has a significant impact on the physical and mental well-being of the college community. Campus Green Spaces (GSs) are crucial in promoting physical activity and improving students' health. However, previous research has focused on evaluating campuses as a whole, without considering the diverse spatial scenarios within the campus environment. Accordingly, this study focused on the young people's residential scenario in university and constructed a framework including a comprehensive set of objective and subjective GSs exposure metrics. A systematic, objective exposure assessment framework ranging from 2D (GSs areas), and 2.5D (GSs visibility) to 3D (GSs volume) was innovatively developed using spatial analysis, deep learning technology, and unmanned aerial vehicle (UAV) measurement technology. Subjective exposure metrics incorporated GSs visiting frequency, GSs visiting duration, and GSs perceived quality. Our cross-sectional study was based on 820 university students in Nanjing, China. Subjective measures of GSs exposure, physical activity, and health status were obtained through self-reported questionnaires. The Generalized Linear Model (GLM) was used to evaluate the associations between GSs exposure, physical activity, and perceived health. Physical activity and social cohesion were considered as mediators, and path analysis based on Structural Equation Modeling (SEM) was used to disentangle the mechanisms linking GSs exposure to the health status of college students. We found that (1) 2D indicator suggested significant associations with health in the 100m buffer, and the potential underlying mechanisms were: GSs area → Physical activity → Social cohesion → Physical health → Mental health; GSs area → Physical activity → Social cohesion → Mental health. (2) Subjective GSs exposure indicators were more relevant in illustrating exposure-response relationships than objective ones. This study can clarify the complex nexus and mechanisms between campus GSs, physical activity, and health, and provide a practical reference for health-oriented campus GSs planning.

Supporting health and wellbeing in health care employees: a documentary review of organizational policies, strategies and frameworks

Background

Health care workers are crucial for a productive and thriving health care system, yet the health and lifestyle behaviour of key groups within this workforce (for example nurses and healthcare assistants/support workers) is typically poor. The extent of health and wellbeing documents that guide action towards improving their health and wellbeing is unknown. Using one health care system, NHS Scotland, as an example, the aim of this study was to assess the number of NHS health boards with workplace documents focused on health and wellbeing of employees, the quality of these documents and the extent to which they reference lifestyle behaviours, namely physical activity.

Methods

Documentary analysis was undertaken on employee health and wellbeing policies (and wider documents). These were sourced through online searches on Google search engine and Freedom of Information Requests sent to all 14 Scottish NHS Health Boards. Titles and content were assessed for relevance to employee health and wellbeing. Content analysis was used to analyse the included documents against eight predefined codes.

Results

Thirteen documents were retrieved with 11 of the 14 Health Boards having at least one relevant document. The content varied greatly between documents with regards to how many reported the eight codes and the quality of content within these. Nine documents mentioned physical activity but mainly in relation to current activities rather than in the context of a future healthy workforce.

Conclusions

Despite the importance of a healthy, health care workforce, more work is needed to ensure high level documents are able to support these efforts, especially with reference to lifestyle behaviours.

A systematic review on the associations between the built environment and adult's physical activity in global tropical and subtropical climate regions

BACKGROUND

Physical inactivity is a major public health concern, exacerbated in countries with a (sub)tropical climate. The built environment can facilitate physical activity; however, current evidence is mainly from North American and European countries with activity-friendly climate conditions. This study explored associations between built environment features and physical activity in global tropical or subtropical dry or desert climate regions.

METHODS

A systematic review of four major databases (Web of Science, Scopus, PubMed, and SportDISCUS) was performed. To be included, studies had to investigate associations between perceived or objective built environment characteristics and adult's physical activity and had to be conducted in a location with (sub)tropical climate. Each investigated association was reported as one case and results were synthesized based upon perceived and objectively assessed environment characteristics as well as Western and non-Western countries. Study quality was evaluated using a tool designed for assessing studies on built environment and physical activity.

RESULTS

Eighty-four articles from 50 studies in 13 countries with a total of 2546 built environment-physical activity associations were included. Design (connectivity, walking/cycling infrastructure), desirability (aesthetics, safety), and destination accessibility were the built environment characteristics most frequently associated with physical activity across the domains active transport, recreational physical activity, total walking and cycling, and moderate-to-vigorous physical activity, particularly if multiple attributes were present at the same time. Very few studies assessed built environment attributes specifically relevant to physical activity in (sub)tropical climates. Most studies were conducted in Western countries, with results being largely comparable with non-Western countries. Findings were largely generalizable across gender and age groups. Results from natural experiments indicated that relocating to an activity-friendly neighborhood impacted sub-groups differently.

CONCLUSIONS

Built environment attributes, including destination accessibility, connectivity, walking and cycling infrastructure, safety, and aesthetics, are positively associated with physical activity in locations with (sub)tropical climate. However, few studies focus on built environment attributes specifically relevant in a hot climate, such as shade or indoor recreation options. Further, there is limited evidence from non-Western countries, where most of the urban population lives in (sub)tropical climates. Policy makers should focus on implementing activity-friendly environment attributes to create sustainable and climate-resilient cities.

Health equity in urban and rural settings: implementation of the place standard tool in Spain

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

More People, More Active, More Often for Heart Health - Taking Action on Physical Activity

Physical inactivity is a leading contributor to increased cardiovascular morbidity and mortality. Almost 500 million new cases of preventable noncommunicable diseases (NCDs) will occur globally between 2020 and 2030 due to physical inactivity, costing just over US$300 billion, or around US$ 27 billion annually (WHO 2022). Active adults can achieve a reduction of up to 35% in risk of death from cardiovascular disease. Physical activity also helps in moderating cardiovascular disease risk factors such as high blood pressure, unhealthy weight and type 2 diabetes. For people with cardiovascular disease, hypertension, type 2 diabetes and many cancers, physical activity is an established and evidence-based part of treatment and management. For children and young people, physical activity affords important health benefits. Physical activity can also achieve important cross-sector goals. Increased walking and cycling can reduce journeys by vehicles, air pollution, and traffic congestion and contribute to increased safety and liveability in cities.

Physical activity in patients with non-small cell lung cancer after lung resection

BACKGROUND

Lung resection is the standard of care for patients with clinical stage I/II non-small cell lung cancer. This surgery reduces both the duration and quality of patients' daily ambulatory activities 1 month after surgery. However, little is known about physical activity after lung resection in patients with lung cancer. To evaluate the recovery process of physical activity with pulmonary rehabilitation in patients after lung resection and examine whether physical activity is affected by age.

METHODS

In this prospective, observational study, we measured and analysed participants' postoperative physical activity using a uniaxial accelerometer daily from postoperative day 1 to 30.

FINDINGS

We analysed 99 patients who underwent thoracic surgery. The number of walking steps significantly increased until day 4 and then reached a plateau thereafter. The duration of exercise at <3 metabolic equivalents significantly increased until day 3, and no significant difference was observed thereafter. Exercise at >3 metabolic equivalents significantly increased until day 4 and reached a plateau thereafter. A significant correlation was observed between age and number of steps after day 4. Compared with video-assisted thoracoscopic surgery, thoracotomy significantly decreased the number of steps from day 3 to 4.

INTERPRETATION

We found that the level of physical activity varied by index in patients with non-small cell lung cancer who underwent lung resection. Age and surgical procedure affect different periods with the increase in post-operative walking steps.

Large walking and wellbeing behaviour benefits of co-designed sustainable park improvements: A natural experimental study in a UK deprived urban area

There is little robust evidence of how sustainable park interventions impact on physical activity and other behaviours important for wellbeing. This controlled natural experimental study aimed to examine the effects of co-designing a sustainable park intervention, in a deprived UK urban area, on walking and other wellbeing behaviours. Behaviour observations were conducted at two intervention sites and two matched comparison sites (n = 4,783). Walking observations (primary outcome), wellbeing behaviours (vigorous, sedentary, social and take notice activities) and demographic characteristics were assessed at pre-intervention, and post-intervention (3 and 15 months). Outcomes were compared between intervention and comparison groups, controlling for pre-intervention using multilevel negative binomial regression models. Additional behaviour observations were conducted in two unchanged nearby sites to assess changes in general local activity. Intercept surveys (n = 623) assessed change in self-reported outdoor space usage at intervention and control areas. Post-intervention, walking increased 203 % at 3 months (IRR 2·03, 95 % CI 1·01-4·09) and 351 % at 15 months (IRR 3·51, 95 % CI 2·07-5·93), for intervention sites relative to comparison sites. Large increases for other wellbeing behaviours were also observed. The proportion of non-white persons increased substantially post-intervention, compared to comparison sites. Nearby unchanged sites showed little evidence of general increased activity. Self-reported outdoor usage increased more in the intervention sites (p=<0·001). Sustainable solutions can yield large increases in walking and wellbeing in deprived areas, especially where interventions are co-designed with residents. More collaborative and robust natural experimental studies like this are needed to better inform decision-makers how to maximise health and wellbeing outcomes from sustainable interventions.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

Parks Visitation, Physical Activity Engagement, and Older People's Motivation for Visiting Local Parks

Despite the health benefits of parks and outdoor recreational spaces, small numbers of older people visit parks. This study identified older park visitors' perceptions of their local parks, visit motivation, health, and physical activity level in six parks in Victoria, Australia. Characteristics of general community park visitors and their physical activity engagement were also recorded. Fifty-five older people were surveyed onsite; 92.7% lived within a 5-km distance from the park. Walking was the most common reason for visiting (36.4%), followed by walking the dog (36.4%) and exercise (23.6%). Most older visitors (77.8%) were determined as being sufficiently active. Observation of parks visitors over 1 week recorded 3,770 park visitors, with <5% being older people. Half of all park visitors were inactive, and half of older people visitors (50.5%) engaged in walking. This study supports the importance of parks, park features, and their potential in helping older people to achieve levels of physical activity required for good health.

The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people's health through physical ACTivity: a hybrid II implementation design study protocol

INTRODUCTION

The health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people's physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia.

METHOD

The ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities.

DISCUSSION

Through the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people.

TRIAL REGISTRATION

This registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763 . Date registered 20/09/2022.

Built environment and physical activity in adolescents: Use of the kernel density estimation and the walkability index

The availability of places for physical activity (PA) and the walkability of the neighborhood can impact the level of PA of adolescents. However, studies of this nature are still limited in Latin America. This study had two objectives: 1- using kernel density estimative, it investigated whether individuals living near PA places that are more intensely distributed than dispersed are more likely to be sufficiently active; 2-checked whether adolescents who live in neighborhoods with better walkability have a greater chance of being sufficiently active. Were evaluated 292 adolescents and PA was measured by accelerometry. Were measured five environmental variables for composing the walkability index. 98 PA points (places) were identified and destinations within these areas were geocoded and kernel density estimates (KDE) of places intensity were created using kernels (radius) of 400m (meters), 800, 1200 and 1600m. Using Logistic Regression, the association between the intensity of PA places (classified into quartiles Q1(smallest)-Q4(largest)) and the probability of being "Sufficient PA"; and the association between walkability (quartiles Q1(least)-Q4(highest)) and the probability of being "PA Sufficient " were estimated (p≤0.05). There were associations only for the intensities of places with the largest radius. Among adolescents who lived in places with higher intensity compared with lower intensity places: 1200m (Q3, OR 2.18 95% CI 1.12-4.22; Q4, OR 2.77 95% CI 1.41-5.43) and 1600m (Q3, OR 3.68 95%CI 1.86-7.30; Q4, OR 3.69 95%CI 1.86-7.30) were more likely to be "Sufficient PA". There were also associations for walkability, where those living in places with better walkability (Q4, OR 2.58 95% CI 1.33-5.02) had greater chances of being "Sufficient PA" compared to Q1. In conclusion, living in places with bigger densities and better walkability increases adolescent's chances of being "Sufficient PA".

Correlates of Active School Transportation During the COVID-19 Pandemic Among Canadian 7- to 12-Year-Olds: A National Study

BACKGROUND

Active school transportation (AST) is an important source of physical activity for children and a potentially important climate change mitigation strategy. However, few studies have examined factors associated with AST in the context of the COVID-19 pandemic.

METHODS

We used baseline data from a longitudinal survey to investigate correlates of AST during the second wave of COVID-19 (December 2020). We collected survey data from 2291 parents of 7- to 12-year-olds across Canada and linked this information with data on neighborhood walkability and weather from national databases. We assessed potential correlates representing multiple levels of influence of the social-ecological model. We used gender-stratified binary logistic regression models to determine the correlates of children's travel mode to/from school (dichotomized as active vs motorized), while controlling for household income. We examined the correlates of travel mode for both the morning and afternoon trips.

RESULTS

Consistent correlates of AST among Canadian children during the COVID-19 pandemic included greater independent mobility, warmer outdoor temperature, having a parent who actively commuted to work or school, living in a household owning fewer vehicles, and living in a more walkable neighborhood. These findings were largely consistent between boys and girls and between morning and afternoon school trips.

CONCLUSIONS

Policymakers, urban planners, and public health workers aiming to promote AST should focus on these correlates while ensuring that neighborhoods are safe for children. Future research should monitor the prevalence and correlates of AST as COVID-19 restrictions are removed.

Contribution of environmental determinants to the risk of developing type 2 diabetes mellitus in a life-course perspective: a systematic review protocol

BACKGROUND

Prevention policies against type 2 diabetes mellitus (T2DM) focus solely on individual healthy lifestyle behaviours, while an increasing body of research recognises the involvement of environmental determinants (ED) (cultural norms of land management and planning, local foodscape, built environment, pollution, and neighbourhood deprivation). Precise knowledge of this relationship is essential to proposing a prevention strategy integrating public health and spatial planning. Unfortunately, issues related to the consistency and synthesis of methods, and results in this field of research limit the development of preventive strategies. This systematic review aims to improve knowledge about the relationship between the risk of developing T2DM in adulthood and long-term exposure to its ED during childhood or teenage years.

METHODS

This protocol is presented according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) tools. PubMed, Embase, CINAHL, Web of Science, EBSCO, and grey literature from the Laval University Libraries databases will be used for data collection on main concepts such as 'type 2 diabetes mellitus', 'zoning' or 'regional, urban, or rural areas land uses', 'local food landscape', 'built environment', 'pollution', and 'deprivation'. The Covidence application will store the collected data for selection and extraction based on the Population Exposure Comparator Outcome and Study design approach (PECOS). Studies published until December 31, 2023, in English or French, used quantitative data about individuals aged 18 and over that report on T2DM, ED (cultural norms of land management and planning, local foodscape, built environment, and neighbourhood deprivation), and their association (involving only risk estimators) will be included. Then, study quality and risk of bias will be conducted according to the combined criteria and ratings from the ROBINS-E (Risk of Bias in Non-randomised Studies-of Exposures) tools and the 'Effective Public Health Practice Project' (EPHPP). Finally, the analytical synthesis will be produced using the 'Synthesis Without Meta-analysis' (SWiM) guidelines.

DISCUSSION

This systematic review will summarise available evidence on ED associated with T2DM. The results will contribute to improving current knowledge and developing more efficient cross-sectoral interventions in land management and public health in this field of research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023392073.

Walking to work: The role of walkability around the workplace in a Dutch adult commuting population

Current evidence on neighborhood walkability and active commuting focuses on residential rather than workplace environment. This cross-sectional study investigated whether higher workplace walkability (WW) was associated with commute walking, both independently and together with residential walkability, using data from 6769 respondents of the 2017 Dutch national travel survey. In a fully adjusted logistic regression model, 10% increase in WW was associated with 32% higher odds of commute walking (Odds ratio (OR): 1.31, 95% Confidence Interval (CI: 1.27-1.36). The estimates were stronger in rural dwellers than urban residents, (ORrural 1.49, 95%CI: 1.34-1.64 vs ORhighly.urban 1.19, 95%CI: 1.13-1.26). In participants with both high residential walkability and WW, we observed 215% higher odds (OR 3.15, 95% CI: 2.48-3.99) of commute walking compared to those with low walkability in both. Our study indicated the importance and complementary nature of walkable residence and workplace in contribution to physical activity of working individuals through active commuting.

Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol

INTRODUCTION

The majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with the neighbourhood environment as a mediating pathway. How to develop and implement sustainable and effective interventions focused on adolescent health and well-being in urban vulnerable life situations is a key challenge. This paper describes the protocol of a Youth-centred Participatory Action (YoPA) project aiming to tailor, implement, and evaluate social and physical environmental interventions.

METHODS AND ANALYSIS

In diverse urban environments in Denmark, the Netherlands, Nigeria and South Africa, we will engage a dynamic group of 15-20 adolescents (12-19 years) growing up in vulnerable life situations and other key stakeholders (eg, policy makers, urban planners, community leaders) in local co-creation communities. Together with academic researchers and local stakeholders, adolescents will take a leading role in mapping the local system; tailoring; implementing and evaluating interventions during participatory meetings over the course of 3 years. YoPA applies a participatory mixed methods design guided by a novel Systems, User perspectives, Participatory co-creation process, Effects, Reach, Adoption, Implementation and Maintenance framework assessing: (i) the local systems, (ii) user perspectives, (iii) the participatory co-creation process, (iv) effects, (v) reach, (vi) adoption, (vii) implementation and (viii) maintenance of interventions. Through a realist evaluation, YoPA will explore why and how specific outcomes were reached (or not) in each setting (n=800-1000 adolescents in total).

ETHICS AND DISSEMINATION

This study received approval from the ethics committees in Denmark, the Netherlands, Nigeria and South Africa and will be disseminated via various collaborative dissemination activities targeting multiple audiences. We will obtain informed consent from all participants. We envision that our YoPA co-creation approach will serve as a guide for participation of adolescents in vulnerable life situations in implementation of health promotion and urban planning in Europe, Africa and globally.

TRIAL REGISTRATION NUMBER

NCT06181162.

Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study

PURPOSE

We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease.

METHODS

A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis.

RESULTS

Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control).

CONCLUSIONS

This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.

Physical Activity and Its Potential Determinants in Obese Children and Adolescents under Specialist Outpatient Care-A Pilot Cross-Sectional Study

(1) Background: this study aimed to assess the physical activity of obese pediatric patients under specialized outpatient care and its potential determinants. (2) Methods: A total of 83 subjects aged 7-18 years with simple obesity and their parents were enrolled. Data were collected with the use of physical activity questionnaires (PAQs) for children and adolescents and additional questions concerning selected socio-demographic characteristics. (3) Results: The mean final PAQ score was 2.09 ± 0.69. The most frequently chosen types of physical activity included walking, gymnastics, and jogging or running. We found a weak correlation inversely proportional between the child's age and mean final PAQ score (r = -0.25; p = 0.02). Younger children were more active during lunchtime at school and after school compared to adolescents (p = 0.03 and p = 0.04). The final PAQ score differed according to the place of residence; the lowest score was obtained by subjects living in cities >100,000 inhabitants (p = 0.025). We found a positive correlation between PAQ-Ch score and the father's physical activity, and between PAQ-A score and the mother's education. (4) Conclusions: The physical activity of obese pediatric patients is low, particularly in adolescents. It seems that age and place of residence have an impact on the physical activity of obese children and adolescents. The PAQs used in this study are useful in physical activity assessment and identification of time segments during the day in which activity might be improved. However, this requires confirmation in a larger group of pediatric patients.

Exposure to residential green and blue space and the natural environment is associated with a lower incidence of psychiatric disorders in middle-aged and older adults: findings from the UK Biobank

BACKGROUND

There is increasing evidence for the role of environmental factors and exposure to the natural environment on a wide range of health outcomes. Whether exposure to green space, blue space, and the natural environment (GBN) is associated with risk of psychiatric disorders in middle-aged and older adults has not been prospectively examined.

METHODS

Longitudinal data from the UK biobank was used. At the study baseline (2006-2010), 363,047 participants (women: 53.4%; mean age 56.7 ± 8.1 years) who had not been previously diagnosed with any psychiatric disorder were included. Follow-up was achieved by collecting records from hospitals and death registers. Measurements of green and blue space modeled from land use data and natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazard models with adjustment for potential confounders were used to explore the longitudinal associations between GBN and any psychiatric disorder and then by specific psychiatric disorders (dementia, substance abuse, psychotic disorder, depression, and anxiety) in middle-aged and older adults.

RESULTS

During an average follow-up of 11.5 ± 2.8 years, 49,865 individuals were diagnosed with psychiatric disorders. Compared with the first tertile (lowest) of exposure, blue space at 300 m buffer [hazard ratio (HR): 0.973, 95% confidence interval (CI): 0.952-0.994] and natural environment at 300 m buffer (HR: 0.970, 95% CI: 0.948-0.992) and at 1000 m buffer (HR: 0.975, 95% CI: 0.952-0.999) in the third tertile (highest) were significantly associated with lower risk of incident psychiatric disorders, respectively. The risk of incident dementia was statistically decreased when exposed to the third tertile (highest) of green space and natural environment at 1000 m buffer. The third tertile (highest) of green space at 300 m and 1000 m buffer and natural environment at 300 m and 1000 m buffer was associated with a reduction of 30.0%, 31.8%, 21.7%, and 30.3% in the risk of developing a psychotic disorder, respectively. Subgroup analysis suggested that the elderly, men, and those living with some comorbid conditions may derive greater benefits associated with exposure to GBN.

CONCLUSIONS

This study suggests that GBN has significant benefits for lowering the risk of psychiatric disorders in middle-aged and older adults. Future studies are warranted to validate these findings and to understand the potential mechanistic pathways underpinning these novel findings.

The relation between proximity to and characteristics of green spaces to physical activity and health: A multi-dimensional sensitivity analysis in four European cities

INTRODUCTION

Non-communicable diseases are the global disease burden of our time, with physical inactivity identified as one major risk factor. Green spaces are associated with increased physical activity of nearby residents. But there are still gaps in understanding which proximity and what characteristics of green spaces can trigger physical activity. This study aims to unveil these differences with a rigorous sensitivity analysis.

METHODS

We gathered data on self-reported health and physical activity from 1365 participants in selected neighbourhoods in Porto, Nantes, Sofia, and Høje-Taastrup. Spatial data were retrieved from OpenStreetMap. We followed the PRIGSHARE guidelines to control for bias. Around the residential addresses, we generated seven different green space indicators for 15 distances (100-1500 m) using the AID-PRIGSHARE tool. We then analysed each of these 105 green space indicators together with physical activity and health in 105 adjusted structural equation models.

RESULTS

Green space accessibility and green space uses indicators showed a pattern of significant positive associations to physical activity and indirect to health at distances of 1100 m or less, with a peak at 600 m for most indicators. Greenness in close proximity (100 m) had significant positive effects on physical activity and indirect effects on health. Surrounding greenness showed positive direct effects on health at 500-1100 m and so do green corridors in 800 m network distance. In contrast, a high quantity of green space uses, and surrounding greenness measured in a larger radius (1100-1500 m) showed a negative relationship with physical activity and indirect health effects.

CONCLUSIONS

Our results provide insight into how green space characteristics can influence health at different scales, with important implications for urban planners on how to integrate accessible green spaces into urban structures and public health decision-makers on the ability of green spaces to combat physical inactivity.

Associations between older adults' going-out frequency and land price of neighbourhoods: Potency of land price as an indicator of homebound tendency

The aim of this study is to identify the potency of land price as a general indicator of the homebound tendency of neighbourhoods. For this purpose, we focus on the associations between land price and older adults' going-out frequency, while considering the similarities and differences from factors associated with walkability. The study targets are 19,270 individuals living in the Tokyo metropolitan area who are aged 65 years or older who are not certified as needing public long-term care insurance. This study uses a two-step procedure: a) the land price of each neighbourhood is estimated using rent price data from 2010 to 2019 collected by an official Japanese realtor organization; b) the associations between older adults' goingout frequency, according to the 2016 Japan Gerontological Evaluation Study, and the estimated land price of their neighbourhoods is identified using multilevel analysis. The results indicate that land price has strong negative associations with older adults' going-out frequency. Associations between land price or other walkability-associated factors, such as population density, ratio of commercial area, and proximity to the nearest train station, only appear when these factors and land price are included within the same model. The results suggest that, when inspecting homebound tendency in some neighbourhoods, factors relating to the built environment must be considered alongside land prices. Furthermore, the homebound status of older adults is a pressing challenge, especially in neighbourhoods with high land prices.

Associations between urban exposome and recurrence risk among survivors of acute myocardial infarction in Beijing, China

Few previous studies have investigated the impacts of coexposure to multiple urban environmental factors on the prognosis of acute myocardial infarction (AMI) events. This study aimed to evaluate the associations between the urban exposome and AMI recurrence. We used data from 88,509 AMI patients from a large cohort obtained from the Beijing Cardiovascular Disease Surveillance System between 2013 and 2019. Twenty-six types of urban exposures were assessed within 300-m, 500-m, and 1000-m buffers of patients' home addresses in the baseline and cumulative average levels. We used the Cox proportional hazard model along with the Elastic Net (ENET) algorithm to estimate the hazard ratios (HRs) of recurrent AMI per interquartile range increase in each selected urban exposure. The increased risk of AMI recurrence was significantly associated with lower urban function diversity in the 500-m buffer, longer distance to subway stations and higher PM2.5 for both baseline and cumulative average exposure. The cumulative averages of two urban factors, including the distance to parks, and the density of fruit and vegetable shops in the 1000-m buffer, were also identified as significant factors affecting the risk of AMI recurrence. These findings can help improve the urban design for promoting human cardiovascular health.

Understanding the relationship between built environment features and physical activity in the Caribbean: A scoping review

Background

Transforming the urban infrastructure to become safe, inclusive and sustainable remains a challenge in most developing settings. The Caribbean has high burdens of physical inactivity and non-communicable diseases. Therefore, understanding the role of the built environment (BE) in modifying individual activity is important for informing the design of community interventions to improve levels of physical activity (PA). Anecdotally, there is limited evidence on the BE in the Caribbean, however evidence from other Small Island Developing States (SIDS) and from Latin America (LA) may offer useful information given their similar urbanization profiles and shared geo-collaborative histories.

Objective

Our review identifies and characterizes individual features of the BE and examines their relationships with PA outcomes.

Methods

We systematically searched a range of multi-discipline research databases, including studies from SIDS and LA that objectively measured BE features as an exposure and PA as an outcome between 2010 and 2021. Grey literature was not considered for this review. We characterized BE measures into 9 neighbourhood design domains using the Walkability for Health framework, and mapped gaps in the published evidence. We performed a narrative summary of BE-PA relationships, focusing on association strength and direction of effect.

Results

Fifty-one studies from published scientific literature in Brazil, Colombia, Mexico, Chile, and Singapore were included that described 306 BE-PA relationships. The BE was mostly characterized by number of and proximity to spaces for social interaction, green spaces, increasing housing density or street connectivity, and mixed residential and commercial land use. BE-PA relationships, although inconsistent, largely promoted PA.

Conclusion

Although the review is suggestive of the benefits of the benefits of BE interventions for promoting active commuting and leisurely PA, translational research is needed to understand whether results can be successfully adapted for SIDS, which often have an urban structure defined by a single urban centre with connections to outlying communities.

Developing Climate Change and Health Impact Monitoring with eHealth at the South East Asia Community Observatory and Health and Demographic Surveillance Site, Malaysia (CHIMES)

Background

Malaysia is projected to experience an increase in heat, rainfall, rainfall variability, dry spells, thunderstorms, and high winds due to climate change. This may lead to a rise in heat-related mortality, reduced nutritional security, and potential migration due to uninhabitable land. Currently, there is limited data regarding the health implications of climate change on the Malaysian populace, which hinders informed decision-making and interventions.

Objective

This study aims to assess the feasibility and reliability of using sensor-based devices to enhance climate change and health research within the SEACO health and demographic surveillance site (HDSS) in Malaysia. We will particularly focus on the effects of climate-sensitive diseases, emphasizing lung conditions like chronic obstructive pulmonary disease (COPD) and asthma.

Methods

In our mixed-methods approach, 120 participants (>18 years) from the SEACO HDSS in Segamat, Malaysia, will be engaged over three cycles, each lasting 3 weeks. Participants will use wearables to monitor heart rate, activity, and sleep. Indoor sensors will measure temperature in indoor living spaces, while 3D-printed weather stations will track indoor temperature and humidity. In each cycle, a minimum of 10 participants at high risk for COPD or asthma will be identified. Through interviews and questionnaires, we will evaluate the devices' reliability, the prevalence of climate-sensitive lung diseases, and their correlation with environmental factors, like heat and humidity.

Results

We anticipate that the sensor-based measurements will offer a comprehensive understanding of the interplay between climate-sensitive diseases and weather variables. The data is expected to reveal correlations between health impacts and weather exposures like heat. Participant feedback will offer perspectives on the usability and feasibility of these digital tools.

Conclusion

Our study within the SEACO HDSS in Malaysia will evaluate the potential of sensor-based digital technologies in monitoring the interplay between climate change and health, particularly for climate-sensitive diseases like COPD and asthma. The data generated will likely provide details on health profiles in relation to weather exposures. Feedback will indicate the acceptability of these tools for broader health surveillance. As climate change continues to impact global health, evaluating the potential of such digital technologies is crucial to understand its potential to inform policy and intervention strategies in vulnerable regions.

Association of land urbanization and type 2 diabetes mellitus prevalence and mediation of greenness and physical activity in Chinese adults

The prevalence of type 2 diabetes (T2D) is higher in urban than in rural areas. Limited information is available on the association between T2D and Land urbanization (LU) while LU influences not only greenness and Particulate Matter 2.5 (PM2.5) but also inhabitant behavior. We aimed to explore the association between the LU level and T2D prevalence, as well as whether greenness, PM2.5, or conscious physical activity mediated any of the observed associations. This study encompassed 27,633 adult participants from Shandong Province who completed the sixth National Health Service Survey in 2018. Ambient LU exposure was estimated by spatial characteristics, including the existing impervious surface area (ISA), road density (RD), and annual night light (NL). Exposures were estimated using satellite images and OpenStreetMap, with 1000 m used as the main analysis buffer. Two-level logistic regression models were used to investigate the association between the LU metrics and T2D. Additionally, we explored potential mechanisms of the association through mediation analysis. The prevalence of T2D among participants was 5.14%, with average exposures to ISA_1000m of 1.441 km2, RD_1000m of 3.856 km/km2, and NL_1000m of 9.821 nW/cm2/sr. Higher levels of LU exposure were associated with higher T2D ORs [for each interquartile of ISA_1000m, RD_1000m, and NL_1000m, the adjusted OR (95% CI) for the T2D prevalence were 1.29 (1.19-1.4), 1.25 (1.15-1.36), and 1.25 (1.15-1.36), respectively]. This relationship persisted in several sensitivity analyses including use of different buffer sizes. We observed stronger associations among participants younger than 65 years or in men. Greenness mediated a 20.78%-65.36% of the estimated associations, conscious physical activity mediated a 10.35%-15.85%, while PM2.5 mediated insignificantly. These results suggest a deleterious association between higher levels of LU and T2D among adult residents in a developing country. Greenness and conscious physical activity mediate the association.

Cumulative Experience of Neighborhood Walkability and Change in Weight and Waist Circumference in REGARDS

Neighborhood walkability-features of the built environment that promote pedestrian activity-has been associated with greater physical activity and lower body mass index (BMI; calculated as weight (kg)/height (m)2) among neighborhood residents. However, much of the literature has been cross-sectional and only a few cohort studies have assessed neighborhood features throughout follow-up. Using data from the Reasons for Geographic and Racial Differences in Stroke Study (2003-2016) and a neighborhood walkability index (NWI) measured annually during follow-up, we assessed whether the cumulative experience of neighborhood walkability (NWI-years) predicted BMI and waist circumference after approximately 10 years of follow-up, controlling for these anthropometric measures at enrollment. Analyses were adjusted for individual-level sociodemographic covariates and the cumulative experience of neighborhood poverty rate and neighborhood greenspace coverage. Almost a third (29%) of participants changed address at least once during follow-up. The first change of residence, on average, brought the participants to neighborhoods with higher home values and lower NWI scores than their originating neighborhoods. Compared with those having experienced the lowest quartile of cumulative NWI-years, those who experienced the highest quartile had 0.83 lower BMI (95% confidence interval, -1.5, -0.16) and 1.07-cm smaller waist circumference (95% confidence interval, -1.96, -0.19) at follow-up. These analyses provide additional longitudinal evidence that residential neighborhood features that support pedestrian activity are associated with lower adiposity.

Trend and heterogeneity in forced vital capacity among Chinese students during 1985-2019: results from Chinese National Survey on Students' Constitution and Health

BACKGROUND

Forced vital capacity (FVC) reflects respiratory health, but the long-term trend and heterogeneity in FVC of Chinese students were understudied.

METHODS

Data were from Chinese National Survey on Students' Constitution and Health 1985-2019. Super Imposition by Translation and Rotation model was used to draw FVC growth curves. Sex-, region-, and nationality-heterogeneity in FVC was evaluated. Spearman correlation and generalized additive model was used to reveal influencing factors for FVC.

RESULTS

Compared to 1985, age at peak FVC velocity was 1.09, 3.17, 0.74, and 1.87 years earlier for urban male, urban female, rural male, and rural female in 2019, respectively. Peak FVC velocity first decreased and then increased during 1985-2019, only male rebounded to larger than 1985 level. FVC declined from 1985 to 2005 and then raised. Males consistently had higher FVC than females, with disparities increasing in the 13-15 age group. Urban students also had higher FVC than rural students. In 2019, FVC difference between 30 Chinese provinces and the national average showed four scenarios: consistently above national average; less than national average until age 18, then above; greater than national average until age 18, then this advantage reversed; less than national average in almost all the age. Most Chinese ethnic minority students had lower FVC levels compared to Han students. Spearman correlation and generalized additive model showed that age, sex, and height were the leading influencing factors of FVC, followed by socioeconomic and environmental factors.

CONCLUSIONS

Chinese students experienced advanced FVC spurt, and there was sex-, region- and nationality-heterogeneity in FVC. Routine measurement of FVC is necessary in less developed areas of China.

Socioeconomic differences in associations between living in a 20-min neighbourhood and diet, physical activity and self-rated health: Cross-sectional findings from ProjectPLAN

The 20-min neighbourhood (20MN) concept aims to enable residents to meet daily needs using resources within a 20-min trip from home noting that there is no single definition of what services and amenities are required for daily needs nor what modes of transport constitute a 20 min trip. Whether 20MNs promote better health and whether associations differ by socio-economic status (SES) is unknown. Using cross-sectional data from adults randomly sampled in 2018-19 from Melbourne or Adelaide, Australia, we examined whether associations between neighbourhood type (20MN/non-20MN) and diet, physical activity or self-rated health vary according to individual- or area-level SES. We found no consistent patterns of interactions. The results do not consistently support the often assumed belief that 20MNs support more healthful behaviour and that these relationships vary by SES.

Moving to an Activity-Friendly Community Can Increase Physical Activity

BACKGROUND

Creating activity-friendly communities (AFCs) is an important strategy to increase physical activity (PA). While cross-sectional links between community environments and PA are well documented, their causal relationships remain insufficiently explored.

METHODS

Using the accelerometer and survey data collected from adults who moved to an AFC (cases) and similar non-AFC-residing adults who did not move (comparisons), this pre-post, case-comparison study examines if moving to an AFC increases PA. Data came from 115 participants (cases = 37, comparisons = 78) from Austin, Texas, who completed 2 waves of 1-weeklong data collection. Difference-in-difference analyses and fixed-effect models were used to test the significance of the pre-post differences in moderate-to-vigorous PA (MVPA) between cases and comparisons, for the full sample and the subsample of 37 pairs matched in key covariates using the Propensity Score Matching method.

RESULTS

Average treatment effect generated based on Propensity Score Matching and difference-in-difference showed that moving to this AFC led to an average of 10.88 additional minutes of daily MVPA (76.16 weekly minutes, P = .015). Fixed-effect models echoed the result with an increase of 10.39 minutes of daily MVPA after moving to the AFC. We also found that case participants who were less active at baseline and had higher income increased their MVPA more than their counterparts.

CONCLUSIONS

This study showed that, among our study sample, moving to an AFC increased residents' PA significantly when compared to their premove level and the comparison group. This causal evidence suggests the potential of AFCs as sustainable interventions for PA promotion.

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability

BACKGROUND

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C).

BACKGROUND

Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association.

OBJECTIVES

To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association.

METHODS

This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant.

RESULTS

From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%).

CONCLUSIONS

Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

Comparison of the physical activity levels between shift workers and non-shift workers in a large-scale cross-sectional study in Iran

BACKGROUND

Shift work has been related to adverse health outcomes that can partially be attributed to physical inactivity. However, our knowledge of the influence of shift work on physical activity and sedentary behavior is inconclusive. Therefore, this study aimed to assess physical activity levels among shift and non-shift workers among a sample of Iranian adults.

METHODS

Baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study were used. All participants of RaNCD except those excluded due to unemployment or considerable disability were included in the study. We evaluated participants' physical activity levels using the PERSIAN cohort questionnaire and examined its associations with being a shift worker.

RESULTS

A total of 4695 participants with a mean age of 46.1 (SD = 7.74) were included in the study. In total, 1108 (23.6%) participants were shift workers, 1420 (30.2%) had insufficient physical activity levels, and 4283 (91.2%) were male. The prevalence of physical inactivity was significantly lower among shift workers compared to non-shift workers (21% vs. 33.1%, p < 0.001). Multiple backward stepwise binary logistic regression tests indicated that being a shift worker was significantly associated with a lower chance of having insufficient physical activity levels (OR = 0.77, 95% CI = 0.65-0.92, p = 0.003).

CONCLUSIONS

The prevalence of insufficient physical activity was higher among non-shift workers than shift workers in our study. By providing the factors associated with insufficient physical activity among the workers in a region of Iran, the current study findings might help policymakers target groups at higher risk of physical activity in Iran and design interventions to improve physical activity, especially among non-shift workers.

Green sleep: Immediate residential greenspace and access to larger green areas are associated with better sleep quality, in a longitudinal population-based cohort

OBJECTIVE

Sleep is pivotal to health, wellbeing and functioning in daily life, but sleep difficulties are common and may be affected by modifiable qualities in the residential surrounding environment, in terms of greenspace. However, population-based studies on individual-level greenspace and sleep are limited. The objective of the current study was thus to investigate prospective associations between fine-grained individual-level residential greenspace and sleep, and moderating effects of life style (physical activity, work status) and sex, in a nationwide population-based Swedish cohort.

METHODS

Participants of the Swedish Longitudinal Occupational Survey of Health (SLOSH)-a population-based sample of adults in Sweden-were studied during 2014-2018 (19,375 individuals; 43,062 observations). Residential greenspace land cover, and coherent green area size, were assessed via high resolution geographic information systems, at 50, 100, 300, 500 and 1000 m buffers around residences. Prospective greenspace and sleep associations were assessed via multilevel general linear models, adjusting for demographic, socioeconomic (individual and neighborhood), life style and urban factors.

RESULTS

Higher greenspace availability in the immediate residential surroundings (50 m and 100 m buffer zones) was associated with less sleep difficulties, even after adjustment for confounders. Greenspace effects were generally greater among non-working individuals. Among the physically active, and among non-working, greenspace and green area size further away from home (300, 500 and 1000 m, i.e. dependent on mobility) were also associated with less sleep difficulties.

CONCLUSIONS

Residential greenspace in the immediate residential surroundings is associated with significantly less sleep difficulties. Greenspace further away from home was associated with better sleep especially among the physically active, and non-working individuals. The results highlight the importance of greenspace in the immediate residential-surrounding environment for sleep, and the need to integrate health and environmental policies, urban planning and greening.

Short-Form Video Exposure and Its Two-Sided Effect on the Physical Activity of Older Community Women in China: Secondary Data Analysis

Background

There is a tendency for older adults to become more physically inactive, especially older women. Physical inactivity has been exacerbated since the COVID-19 pandemic. Lockdowns and information-based preventive measures for COVID-19 increased the number of short-form video app users and short-form video exposure, including content exposure and the duration of exposure, which has demonstrated important effects on youths' health and health-related behaviors. Despite more older adults viewing short-form videos, less is known about the status of their short-form video exposure or the impacts of the exposure on their physical activity.

Objective

This study aims to describe physical activity-related content exposure among older adults and to quantify its impacts along with the duration of short-form video exposure on step counts, low-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA).

Methods

We analyzed a subsample (N=476) of older women who used smartphones and installed short-form video apps, using the baseline data collected from an ongoing cohort study named the Physical Activity and Health in Older Women Study (PAHIOWS) launched from March to June 2021 in Yantai, Shandong Province, China. The information on short-form video exposure was collected by unstructured questions; physical activity-related content exposure was finalized by professionals using the Q-methodology, and the duration of exposure was transformed into hours per day. Step counts, LPA, and MVPA were assessed with ActiGraph wGT3X-BT accelerometers. Multiple subjective and objective covariates were assessed. Linear regression models were used to test the effects of short-form video exposure on step counts, LPA, and MVPA. MVPA was dichotomized into less than 150 minutes per week and 150 minutes or more per week, and the binary logistic regression model was run to test the effects of short-form video exposure on the achievement of spending 150 minutes or more on MVPA.

Results

Of 476 older women (mean age 64.63, SD 2.90 years), 23.7% (113/476) were exposed to physical activity-related short-form videos, and their daily exposure to short-form videos was 1.5 hours. Physical activity-related content exposure increased the minutes spent on MVPA by older women (B=4.14, 95% CI 0.13-8.15); the longer duration of short-form video exposure was associated with a reduced step count (B=-322.58, 95% CI -500.24 to -144.92) and minutes engaged in LPA (B=-6.95, 95% CI -12.19 to -1.71) and MVPA (B=-1.56, 95% CI -2.82 to -0.29). Neither content exposure nor the duration of exposure significantly increased or decreased the odds of older women engaging in MVPA for 150 minutes or more per week.

Conclusions

Short-form video exposure has both positive and negative impacts on the physical activity of older adults. Efforts are needed to develop strategies to leverage the benefits while avoiding the harms of short-form videos.

The park physical activity questionnaire (Park-PAQ): A reliable measurement tool for park-based and total physical activity

BACKGROUND

Few studies have explicitly quantified the proportion of park-based physical activity to park users' overall physical activity levels. Population studies need new context-specific physical activity measurement tools to achieve this. The objective of this study was to develop a reliable measure of self-reported park use and physical activity undertaken within and outside of parks to determine the contribution that park-based physical activity makes to overall physical activity levels.

METHODS

A test-retest reliability study (n = 104) was conducted using the Park Physical Activity Questionnaire (Park-PAQ), an instrument based on the Active Australia Survey. Park-PAQ items captured the frequency and duration of walking for recreation or exercise, walking for transport, moderate and vigorous physical activity and strength, conditioning and balance activities done in parks and elsewhere.

RESULTS

Recall of doing any walking for recreation (kappa = 0.649, p < 0.001) and any vigorous physical activity (kappa = 0.772, p < 0.001) was 'substantial', recall of doing any moderate physical activity (kappa = 0.553, p < 0.001) was 'moderate/acceptable', and recall of any walking for transport (kappa = 0.840, p < 0.001) 'near perfect'. Recall of the time spent walking for recreation in parks (ICC = 0.928, p < 0.001) was 'near perfect', whilst recall of time spent doing moderate activity in parks (ICC = 0.925, p < 0.001) and vigorous activity in parks (ICC = 0.962, p < 0.001) was 'near perfect'. Time spent walking for transport in a park (ICC = 0.200, p = 0.056) showed 'poor' agreement. Repeatability of the usual level of park use was 'substantial' (kappa = 0.744).

CONCLUSIONS

The Park-PAQ reliably measures six domains of physical activity and quantifies the proportion of physical activity done in parks as a proportion of total physical activity. The Park-PAQ, used alone or embedded into park or physical activity surveys, will reliably capture context-specific activities that will optimise population level physical activity interventions, park programming and park management and design.

What Is the Contribution of Community Programs to the Physical Activity of Women? A Study Based on Public Open Spaces in Brazil

Community programs can facilitate the access of vulnerable subgroups to physical activity (PA). This study analyzed the relationship between sociodemographic characteristics, health conditions, public open spaces (POS) usage, and women's PA. The 155 participants were assiduous in taking part in PA classes in POS in São José dos Pinhais, Brazil. The accelerometer-based PA measures identified four outcomes: (1) daily light-intensity PA (LPA), (2) daily moderate-to-vigorous intensity PA (MVPA), (3) LPA in POS, and (4) MVPA in POS. Linear regression, and the Durbin-Watson and Mann-Whitney U tests were used for data analysis in STATA software. The main results showed that the weekly frequency (β: 10.9, p < 0.01) and intensity of the main activity in the POS (β: 22.4, p < 0.05) were related to daily MVPA. Economic level and length of stay in the POS were positively related to the LPA performed (p < 0.05). Weekly frequency (β: 2.4, p < 0.01), length of stay (β: 11.0, p < 0.01), and intensity of PA practiced in the POS (β: 5.9, p < 0.05) showed a positive relationship with MVPA in the POS. In conclusion, there was a positive relationship between some analyzed variables and PA of different intensities, especially the consistent relationship between weekly frequency of POS usage and MVPA. Participation in structured PA classes in a community program can contribute to an increase of 47 min of daily MVPA.

Recommendations for developing urban interventions to promote physical activity: interviews with key informants in Europe

Although there is growing evidence on what interventions can promote physical activity in urban environments, guidance on how to get these interventions implemented is lacking in a European context. To understand the process of developing urban interventions to promote physical activity, we conducted 13 key informant interviews with professionals working in urban development in five European countries, though some worked in more than one country. Participants described their experiences, challenges and recommendations across six European countries. The main challenges faced were political environments, unsupportive contexts, communication issues, working with other sectors, resource limitations and evaluations. We presented recommendations made by participants which can overcome these challenges when developing urban interventions to promote physical activity. Recommendations included obtaining cross-party political support for a project; working with local communities right from the beginning; involving all stakeholders and encouraging their commitment through identification of common goals; asking the market for solutions when faced with resource constraints, and using existing data to facilitate evaluations.

Participants Characteristics of a Park-Based Physical Activity Intervention in an Urban Context-A Cross-Sectional Study in Bologna, Italy

Physical inactivity, a leading risk factor for chronic diseases and premature death, is prevalent worldwide. This study focuses on participant profiles and factors influencing continued participation and physical activity (PA) levels in the "Moving Parks" PA intervention in Bologna, Italy. This intervention offers free group activities in city parks during the summer. A questionnaire was administered to participants in 2022, gathering data on socio-demographic information, chronic diseases, participation in previous iterations, and PA levels. Out of 596 respondents, 85% were women, and the average age was 50. About 56% held a university degree, and 73% exercised regularly in the winter. Continuous participation was linked to older age, higher education, and chronic conditions. Prior participation predicted higher winter PA levels. Notably, the majority of participants were educated, physically active women. While the project continually engages individuals with higher education and chronic conditions, it needs further tailoring to reach less represented populations.

Understanding physical activity from a cultural-contextual lens

This paper aims to emphasize the need to acknowledge unique cultural and contextual meanings of physical activity to improve health outcomes in different communities. Leininger's Sunrise Model was used as the theoretical base to understand the complex cultural and contextual factors that influence physical activity. Beliefs and practices surrounding physical activity are influenced by a variety of cultural and contextual factors. Providing culturally relevant contexts to the meaning of physical activity allows opportunities for improving policies or programs that would engage individuals and communities in physical activity in culturally meaningful ways. Incorporating cultural and contextual factors is critical to promote physical activity, especially in minority and vulnerable communities.