Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health

Effects of group communication norms on daily steps in a team-based financial incentive mobile phone intervention in Shanghai, China

BACKGROUND

Mobile technology offers great potential for physical activity promotion, especially by facilitating online communication, however, the impact of group communication norms on intervention effectiveness remains unclear. This study aimed to evaluate the effect on daily steps of a team-based social norms-related intervention using a mobile application.

METHODS

The 13-week quasi-experimental study was conducted in Shanghai, China, from September to November 2019, involving 2,985 employees from 32 worksites. For the intervention group (n = 2,049), participants set a goal of 10,000 steps per day. The teams and individual members would receive points for meeting the daily goal, contributing to team-based rankings and financial rewards for the teams and their members. In addition, the intervention teams created dedicated WeChat groups to facilitate communication, which were also used to collect group chat messages. The communication type in these groups was classified into four types: (1) nudging - encouraging team members to be more active, (2) sharing - exchanging the completion of daily step goals, (3) feedback - providing responses or suggestions to team members, and (4) other -diverse topics that could not be classified otherwise. The control group only tracked their steps online.

RESULTS

The weekly average steps of the intervention group increased by 2,523 steps, while the control group increased by 470 steps. In the first 3 weeks of follow-up, the frequency of nudging of 7-18 times/week had a positive cumulative effect on the step counts. Sharing more than 3 times/week had a positive cumulative effect. Over 6 and 13 weeks of follow-up, nudging 19 times/week or more had a positive cumulative effect while sharing and feedback at any frequency negatively affected average weekly steps.

CONCLUSIONS

Communication types within a team affected team-based step counts in a financial incentive intervention. The team-level social norms related to communications might have different cumulative effects on team-level physical activity. 'nudging' messages had a significant association with the change in individual-level step counts in the medium or long term.

TRIAL REGISTRATION

Pilot Project of the application of walking incentive technology in occupational groups, 2019, ChiCTR1900023813. Registered 13 June 2019,  https://www.chictr.org.cn/showproj.html?proj=39858 .

The global, regional, and national disease burden of colorectal cancer attributable to low physical activity from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021

OBJECTIVES

This study aims to estimate the spatiotemporal variation in the burden of colorectal cancer (CRC) attributable to low physical activity (LPA) at global, regional, and national levels from 1990 to 2021.

STUDY DESIGN

Cross-sectional study.

METHODS

Annual data on deaths of CRC related to LPA, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and the age-standardized DALYs rate (ASDR) for 204 countries and territories from 1990 to 2021 was extracted from the Global Health Data Exchange website. They were retrieved by age (5-year age groups from 25 to 94 years, and 95+ years), gender (male and female), and Socio-demographic Index (SDI). The association between age-standardized rates and SDI values was assessed by Spearman's correlation.

RESULTS

Between 1990 and 2021, there was nearly a twofold increase in DALYs and mortality globally for CRC related to LPA, despite decreases in ASMR and ASDR (EAPC: -0.82% and -0.83%, respectively). However, on a national scale, ASMR and ASDR increased in more than half of the world's countries and territories. Moreover, a greater burden of CRC related to LPA was observed in older populations, females, and those residing in regions with an SDI near 0.77.

CONCLUSION

These findings indicate the critical need to raise awareness about the preventive role of physical activity in CRC. Policymakers should prioritize developing and implementing strategies that ensure equitable access to sports resources, enabling more people to meet the World Health Organization guidelines.

DE-PASS Best Evidence Statement (BESt): A Systematic Review and Meta-analysis on the Effectiveness of Trials on Device-Measured Physical Activity and Sedentary Behaviour and Their Determinants in Children Aged 5-12 Years

BACKGROUND

To combat the high prevalence of physical inactivity among children, there is an urgent need to develop and implement real-world interventions and policies that promote physical activity (PA) and reduce sedentary behaviour (SB). To inform policy makers, the current body of evidence for children's PA/SB interventions needs to be translated.

OBJECTIVES

The current systematic review and meta-analysis aimed to identify modifiable determinants of device-measured PA and SB targeted in available intervention studies with randomized controlled trial (RCT) and controlled trial (CT) designs in children and early adolescents (5-12 years) and to quantify the effects of the interventions within their respective settings on the determinants of PA/SB and the outcomes PA and SB.

METHODS

A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, SPORTDiscus and CENTRAL. Studies were considered if they were randomized controlled trials (RCTs) or controlled trials (CTs), included children and/or early adolescents (5-12 years; henceforth termed children), measured PA and/or SB using device-based methods and measured PA and/or SB and determinants of PA/SB at least at two timepoints. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB2) for RCTs and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for CTs. The quality of the generated evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Robust Bayesian meta-analysis was conducted to quantify the effects of the interventions on the determinants of PA/SB, and the outcomes PA and SB, stratifying by study design, duration of PA/SB measurement, intervention setting and duration of follow-up measurement. Study characteristics and interventions were summarized.

RESULTS

Thirty-eight studies were included with a total sample size of n = 14,258 (67% girls). Settings identified were school, family/home, community and combinations of these. The review identified 38 modifiable determinants, spanning seven categories on individual, interpersonal and physical environmental levels, with 66% of determinants on the individual level. Overall, the results indicated trivial-to-moderate effects of the interventions on the determinants of PA and SB, with mostly trivial level of evidence for the presence of an effect (as indicated by a small Bayes factor; BF10 < 3.00). The exceptions were moderate effects on parental PA modelling in the family/home setting and SB measured during specific parts of the school day. Higher quality of evidence was found in the family/home setting compared with other settings.

DISCUSSION

Overall, the results indicated that interventions have neither been effective in modifying the determinants of PA/SB, nor changing the PA/SB outcomes in children. In general, the approach in the current review revealed the breadth of methodological variability in children's PA interventions. Research is needed to address novel approaches to children's PA research and to identify potential determinants to inform policy and future interventions.

REGISTRATION

International prospective register of systematic reviews (PROSPERO): CRD42021282874.

Exploring the Lived Experiences of Physical Activity in Community-Dwelling Adults Living With Dementia and Their Carers

People living with dementia have the same right to well-being as anyone else, including physical activity. Yet, physical activity levels among people with dementia are lower than in the general population, and while the physical activity health benefits are well established, little is known about how people living with dementia experience physical activity. To explore these physical activity experiences, we visited six community settings in one English county and conducted informal interviews with 18 people who were either living with dementia and community dwelling (n = 4), caring for or who had cared for someone with dementia (n = 10), or providing a support service for people living with dementia and their carers (n = 4). Findings highlight both the challenges and facilitators presented by organized groups, service provider skills and qualities, and environmental factors. Additionally, these factors were influential in shaping the physical activity experience of people living with dementia. The findings may be relevant for people providing or planning support services, commissioners, policymakers, and researchers.

Get BusActive!: Protocol of a single-blinded randomised controlled trial incentivising public transport use for physical activity gain among young people and adults

Background

Population level physical activity generally does not meet recommended targets. Compared with private motor vehicle users, public transport users tend to be more physically active and financial incentives may encourage more public transport use, but these relationships are under-investigated. This paper describes the protocol of a randomised controlled trial that aimed to determine the effect of financially incentivising public transport use on physical activity in a regional Australian setting.

Methods

Get BusActive! is a 9.5-month single-blinded randomised controlled trial. A convenience sample of Tasmanians aged ≥15 years will be randomised to a 14-week incentive-based intervention (bus trip target attainment rewarded by bus trip credits and weekly supportive text messages) or an active control following baseline measures and will be followed up ∼24 weeks later (maintenance phase). Both groups will receive written physical activity guidelines. The primary outcome is change in accelerometer-measured steps/day from baseline to immediately post intervention phase and maintenance phase. Secondary outcomes are change in: smartcard-measured bus trips/week; measured and self-reported minutes/week of physical activity and sitting; transport-related behaviour (using one-week travel diary), perspectives (e.g. enablers/barriers) and costs; health. Linear mixed model regression will determine group differences. Participant-level process evaluation will be conducted and intervention cost to the public transport provider determined.

Conclusion

Get BusActive! will fill an important knowledge gap about the causal relationship between financially incentivised public transport use and physical activity-the findings will benefit health and transport-related decision makers.

Trial registration

ACTRN12623000613606.

Universal trial number

U1111-1292-3414.

Exploring the role of social capital in enhancing physical activity among college and university students: A systematic review

College and university students often exhibit insufficient levels of physical activity, which negatively impacts their health, mental well-being, and academic performance. Social capital has emerged as a potential factor in promoting physical activity. This systematic review, conducted in line with PRISMA guidelines, examines the existing literature on the role of social capital in enhancing physical activity among college and university students. A search of the Web of Science, Scopus, SportDiscus, and PsychINFO databases identified 10 studies published by August 1, 2024, involving 2,700 students, primarily from North America and Europe. The overall quality of the included studies was high, with all scoring above 85% on quality assessments. The findings indicate that social capital, particularly strong social networks, support from family and friends, and high levels of social cohesion, is significantly associated with higher levels of physical activity among college and university students. Social capital may facilitate physical activity in group settings through mechanisms such as emotional support, role modeling, and social norms. Despite limitations within the existing research evidence, such as reliance on self-reported data and cross-sectional study designs, this review suggests that social capital holds potential for promoting physical activity in this population. Future research should prioritize the use of objective measurement tools and longitudinal designs to more accurately assess the long-term effects of social capital and explore how these findings can inform effective interventions.

DE-PASS Best Evidence Statement (BESt): Determinants of self-report physical activity and sedentary behaviours in children in settings: A systematic review and meta-analyses

Previous physical activity interventions for children (5-12yrs) have aimed to change determinants associated with self-report physical activity behaviour (PAB) and/or sedentary behaviour (SB), however, the associations between these determinants and PAB/SB in different settings are uncertain. The present study aimed to identify modifiable determinants targeted in previous PAB/SB interventions for children. Intervention effects on the determinants and their associations with self-report PAB/SB were assessed across settings. Search of relevant interventions from pre-defined databases was conducted up to July 2023. Randomized and non-randomized controlled trials with modifiable determinants were included. Data extraction and risk of bias assessments were conducted by two independent researchers. Where data could be pooled, we performed Robust Bayesian meta-analyses. Heterogeneity, publication bias and certainty of evidence were assessed. Fifteen studies were deemed eligible to be included. Thirty-seven unique determinants within four settings were identified-school, family, school with family/home, and community with(out) other settings. Ninety-eight percent of determinants belonged to individual/interpersonal determinant categories. Narratively, intervention effects on student perception of teachers' behaviour (school), self-management, perceived barriers, external motivation, exercise intention, parental modeling on SB (school with family/home) and MVPA expectations (community) were weak to strong, however, corresponding PAB/SB change was not evident. There were negligible effects for all other determinants and the corresponding PAB/SB. Meta-analyses on self-efficacy, attitude, subjective norm and parental practice and PAB/SB in two settings showed weak to strong evidence against intervention effect, while the effect on knowledge could not be determined. Similarly, publication bias and heterogeneity for most analyses could not be ascertained. We found no concrete evidence of association between the modifiable determinants and self-report PAB/SB in any settings. This is presumably due to intervention ineffectiveness. Design of future interventions should consider to follow the systems-based approach and identify determinants unique to the context of a setting, including policy and environmental determinants.

Reassessing green exercise research: unveiling methodological gaps and pathways for progress

The present review critically assesses the nexus between physical activity, nature exposure and health benefits by analysing environmental measures in green exercise research. A Cochrane-inspired review of systematic studies exposes methodological gaps, emphasising the scarcity of long-term research and the lack of rigorous designed studies. It calls for more robust, varied research designs and improved environmental metrics. The findings advocate for longitudinal research to better comprehend the mental and physical health benefits of exposure to nature. Embracing an ecological-dynamic perspective is recommended to advance our understanding of the intricate connections between activity, environment, and well-being.

"It Took Away the Trauma of Failing": A Mixed Methods Feasibility Trial of an Open Goals Physical Activity Program

Open goals (e.g. to "see how many steps you can reach today") may be a promising strategy for promoting physical activity. The findings from initial studies, typically based on single sessions of exercise, showed that open goals can produce at least as much activity as specific goals (e.g. to reach 10,000 steps a day), while promoting more positive experiences and higher intentions to repeat the activity, especially among less active individuals. However, the feasibility of using open goals over a longer duration remains unclear. Therefore, in this study, we examined the feasibility of using open goals in a 10-week step-based physical activity program. A single-arm mixed methods design was used, involving 15 healthy adults (13 female; Mage = 42.53) with low to moderate physical activity levels. Participants were provided with a pedometer, diary, and open goals for each week, alongside brief support sessions. The feasibility domains assessed included recruitment, acceptability, adherence, and retention. Quantitative methods assessed physical activity, enjoyment, and self-efficacy, while supplementary qualitative methods explored participants' perceptions of open goals. The study showed high recruitment and retention rates, increased physical activity, and positive psychological experiences, indicating the feasibility of the 10-week open-goal program. Secondary outcomes suggest that open goals may function by increasing enjoyment and self-efficacy while decreasing negative outcomes such as pressure, guilt, and failure. The findings indicate that using open goals in longer-term physical activity programs is feasible, expanding on the limitations of previous single-session designs, and offering recommendations for future trials.

Motor and Nonmotor Measures and Declining Daily Physical Activity in Older Adults

Importance

Difficulties in identifying modifiable risk factors associated with daily physical activity may impede public health efforts to mitigate the adverse health outcomes of a sedentary lifestyle in an aging population.

Objective

To test the hypothesis that adding baseline sensor-derived mobility metrics to diverse baseline motor and nonmotor variables accounts for the unexplained variance of declining daily physical activity among older adults.

Design, Setting, and Participants

This cohort study analyzed data from participants of the Rush Memory and Aging Project (MAP), an ongoing longitudinal clinical pathological study that began to enroll older adults (age range, 59.4-104.9 years) in 1997. Wrist- and waist-worn sensors were added to MAP in 2005 and 2012, respectively, to record participants' physical activity and mobility performances. Included participants were examined at baseline and annually followed up for a mean (SD) duration of 4.2 (1.6) years.

Exposure

Twelve blocks of variables, including 3 blocks of mobility metrics derived from recordings of a belt-worn sensor to quantify a 32-foot walk, a Timed Up and Go (TUG) test, and a standing balance task, and 9 other blocks with 41 additional variables.

Main Outcomes and Measures

A linear mixed-effects model was used to estimate the person-specific rate of change (slope) of total daily physical activity obtained from a wrist-worn sensor. Twelve linear regression models were used to estimate the adjusted R2 to quantify the associations of the variables with the slope.

Results

A total of 650 older adults (500 females [76.9%]; mean [SD] age at baseline, 81.4 [7.5] years; 31 Black individuals [4.8%], 17 Latino individuals [2.6%], and 602 White individuals [92.6%]) were included. During follow-up, all but 1 participant showed declining daily physical activity, which was equivalent to approximately 16.8% decrease in activity level per year. In separate models, waist sensor-derived mobility metrics (32-foot walk: adjusted R2, 23.4% [95% CI, 17.3%-30.6%]; TUG test: adjusted R2, 22.8% [95% CI, 17.7%-30.1%]) and conventional motor variables (adjusted R2, 24.1% [95% CI, 17.7%-31.4%]) had the largest percentages of variance of declining daily physical activity compared with nonmotor variables. When the significant variables from all 12 blocks were included together in a single model, only turning speed (estimate [SE], 0.018 [0.006]; P = .005) and hand dexterity (estimate [SE], 0.091 [0.034]; P = .008) showed associations with declining daily physical activity.

Conclusions and Relevance

Findings of this study suggest that sensor-derived mobility metrics and conventional motor variables compared with nonmotor measures explained most of the variance of declining daily physical activity. Further studies are needed to ascertain whether improving specific motor abilities, such as turning speed and hand dexterity, is effective in slowing the decline of daily physical activity in older adults.

Exploring individual, social and environmental factors related to physical activity: a network analysis

Objectives

Insufficient physical activity (PA) has long been a global health issue, and a number of studies have explored correlates of PA to identify the mechanisms underlying inactive lifestyles. In the literature, dozens of correlates have been identified at different (eg, individual, environmental) levels, but there is little or no direct evidence for the mutual associations of these correlates. This study analysed 44 variables identified as theoretically and empirically relevant for PA to clarify the factors directly and indirectly associated with PA.

Methods

A cross-sectional survey dataset of 19 005 Japanese-speaking adults (mean age=53.50 years, SD=17.40; 9706 women) was analysed. The data encompassed demographic and anthropometric variables; self-reported PA levels; perceived social support and environments (eg, awareness of urban facilities for PA); psychological traits and health-behaviour characteristics (eg, personality, motivation, self-efficacy, decisional balance, process of change strategies); and technology use (eg, mobile health apps).

Results

Network analyses were performed to select meaningful associations (partial correlations) among variables, which identified nine variables directly positively associated with PA: job/employment status, self-efficacy, perceived social support, intrinsic motivation, stage of change, counter conditioning, self-reevaluation, environment and technology use. Indirect associations (two-step neighbourhood) were identified for 40 (out of 44) variables, implying that most of the known PA-correlates are associated with PA-at least indirectly.

Conclusion

These identified associations echo the importance of the multilevel perspective in understanding how people maintain (in)active lifestyles. Interventions for PA could have mixed-level targets, including intraindividual characteristics, social support and physical and digital environments.

Development and validation of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) in 14 countries: study protocol

INTRODUCTION

Global surveillance of physical activity (PA) of children and adolescents with questionnaires is limited by the use of instruments developed in high-income countries (HICs) lacking sociocultural adaptation, especially in low- and middle-income countries (LMICs); under-representation of some PA domains; and omission of active play, an important source of PA. Addressing these limitations would help improve international comparisons, and facilitate the cross-fertilisation of ideas to promote PA. We aim to develop and assess the reliability and validity of the app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) among 8-17 years old in 14 LMICs and HICs representing all continents; and generate the 'first available data' on active play in most participating countries.

METHODS AND ANALYSIS

Our study involves eight stages: (1) systematic review of psychometric properties of existing PA questionnaires for children and adolescents; (2) development of the GAC-PAQ (first version); (3) content validity assessment with global experts; (4) cognitive interviews with children/adolescents and parents in all 14 countries; (5) development of a revised GAC-PAQ; (6) development and adaptation of the questionnaire app (application); (7) pilot-test of the app-based GAC-PAQ; and, (8) main study with a stratified, sex-balanced and urban/rural-balanced sample of 500 children/adolescents and one of their parents/guardians per country. Participants will complete the GAC-PAQ twice to assess 1-week test-retest reliability and wear an ActiGraph wGT3X-BT accelerometer for 9 days to test concurrent validity. To assess convergent validity, subsamples (50 adolescents/country) will simultaneously complete the PA module from existing international surveys.

ETHICS AND DISSEMINATION

Approvals from research ethics boards and relevant organisations will be obtained in all participating countries. We anticipate that the GAC-PAQ will facilitate global surveillance of PA in children/adolescents. Our project includes a robust knowledge translation strategy sensitive to social determinants of health to inform inclusive surveillance and PA interventions globally.

Exercise to socialize? Bidirectional relationships between physical activity and loneliness in middle-aged and older American adults

Physical inactivity and loneliness are both associated with health risks and can affect each other through various social and behavioral mechanisms. However, current evidence on this relationship is equivocal and mostly based on cross-sectional data. This longitudinal study aimed to determine whether current levels of physical activity (moderate and vigorous intensity) and loneliness are associated with future respective states of themselves and each other. We used data from waves 6-14 (2002-2018) of the Health and Retirement Study (n = 20 134) in a mixed-effects and random-intercept cross-lagged panel model. Analysis showed that current loneliness and physical activity were associated with each future respective state. Additionally, weekly participation in moderate-intensity, but not vigorous-intensity, physical activity was associated with a lower likelihood of becoming lonely in the future (relative risk [RR] = 0.94; 95% CI, 0.90-0.99). However, changes in physical activity were not associated with deviation from a person's typical level of loneliness (for vigorous intensity, mean deviation [MD] = 0.00; 95% CI: -0.04 to 0.03; for moderate-intensity, MD = 0.01; 95% CI: -0.03 to 0.04). Loneliness was not associated with moderate- or vigorous-intensity physical activity in subsequent waves. This suggests that while lower physical activity levels can be associated with future loneliness, changing levels of physical activity has little impact on loneliness at the individual level.

Types of leisure-time physical activity participation in childhood and adolescence, and physical activity behaviours and health outcomes in adulthood: a systematic review

BACKGROUND

Youth leisure-time physical activity participation benefits physical activity habits and health outcomes later in life. However, it is unknown if certain types of leisure-time physical activity contribute to these benefits in different ways; this knowledge could enhance public health efforts. This systematic review aimed to synthesise evidence of the longitudinal associations between childhood and adolescent leisure-time physical activity on adulthood physical activity behaviours and health outcomes.

METHODS

A systematic search of the literature was conducted across five databases from inception to July 2022. English, peer-reviewed observational studies with a minimum of two timepoints of data collection were eligible for inclusion. We included studies that investigated the association between participation in leisure-time physical activity types in children and adolescents (i.e., 5-18 years), and physical activity, mental health, or cardiovascular outcomes in adulthood (i.e., ≥ 18 years).

RESULTS

Fourteen studies were included in the review, totalling 34,388 observations across five countries. Running in adolescence was associated with increased adulthood physical activity in both sexes, while sports involvement was associated with an increase in physical activity in males only. Adolescent team sports participation was associated with reduced odds of early adulthood depression, with varying findings for anxiety disorders. There was preliminary evidence of minimum threshold requirements for participation in certain activities before associations with future physical activity or health outcome benefits were observed.

CONCLUSIONS

Preliminary findings suggest that the lifelong behavioural and health benefits of adolescent participation in leisure-time physical activity appear to be related to the type of activity undertaken, with potential differences between sexes. With the rarity of longitudinal studies spanning from childhood into adulthood, these findings provide important insights for public health strategies to optimise lifelong health and physical activity participation.

PROSPERO REGISTRATION

CRD42022347792.

Lifestyle as a Modulator of the Effects on Fitness of an Integrated Neuromuscular Training in Primary Education

The objective was to evaluate changes in fitness after an integrated neuromuscular training (INT) intervention in primary school children and to evaluate how lifestyle behaviors and parental education modulate these changes. One hundred and seventy children (7.45 ± 0.34 years; 52% girls) were included. Cardiorespiratory fitness (half-mile run test), a 10 × 5 m shuttle run test, standing broad jump (SBJ), handgrip dynamometer, body mass index (BMI) and fat mass percentage (FM%) were assessed before and after the 3-month intervention (20 min of INT in the physical education class, twice per week). The Mediterranean diet (MD), sleep time and parental education level (PEL) were evaluated by questionnaires, and adherence to physical activity (PA) recommendations was measured with a triaxial accelerometer before the intervention. After the intervention, there were improvements in the 10 × 5 test and the SBJ. Only girls had improvements in the handgrip test, BMI SDS and FM%. After correcting for confounding variables, only BMI was significantly improved whereas strength improved in the participants non-compliant with the PA recommendations or pertaining to families of high PEL. The INT produced improvements in fitness in a brief period and in different subgroups of pupils (inactive and with diverse sociocultural environments).

Physical Activity and Obesity Risk in Adults in Colombia: The Prospective Urban Rural Epidemiology (PURE) Study

PURPOSE

This study aimed to investigate longitudinal associations between physical activity levels and obesity in adults in Colombia, where participation in large amounts of light-intensity physical activity is a necessity for many people.

METHODS

Participation in moderate- and vigorous-intensity physical activity was assessed from 2005 to 2009, and obesity was assessed from 2011 to 2019 in men and women from the Prospective Urban Rural Epidemiology (PURE) study. Total physical activity level was categorized as low (<600 MET·min·wk -1 ), medium (600-3000 MET·min·wk -1 ), or high (>3000 MET·min·wk -1 ; 600 MET·min·wk -1 is equivalent to 150 min of moderate activity or 75 min of vigorous activity per week). Obesity was defined as body mass index ≥30 kg·m -2 . Analyses were adjusted for age, sex, smoking, socioeconomic status, diet, alcohol, sedentary time, and sleep.

RESULTS

The main analysis included 3086 men and women aged 51 ± 9 yr at baseline (mean ± SD). Compared with the low physical activity group, the odds ratio (95% confidence interval) for obesity was 0.67 (0.53-0.85) in the medium physical activity group and 0.78 (0.62-0.98) in the high physical activity group after adjustment for potential confounders. Smoking is probably a major confounder, and it is noteworthy that similar associations were observed in participants who reported never smoking.

CONCLUSIONS

The PURE study is the only prospective cohort study in Colombia. The present analysis is important because it suggests that even the busy people of Colombia could substantially reduce their risk of obesity by participating in moderate- and vigorous-intensity physical activity.

DE-PASS best evidence statement (BESt): determinants of adolescents' device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis

BACKGROUND

Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents' device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings.

METHODS

A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents' device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked.

PROSPERO ID

CRD42021282874.

RESULTS

Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual-psychological, four individual-behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found.

CONCLUSIONS

Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents' device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents' PA/SB, including policy and environmental variables.

Effectiveness of an Ecological Model-Based Active Transport Education Program on Physical and Mental Health in High School Students (MOV-ES Project): Study Protocol for a Randomized Controlled Trial

The United Nations, through its 2030 Agenda and Sustainable Development Goals, advocates for the establishment of conducive environments for physical activity, following the ecological model. In line with this initiative, active transportation emerges as an accessible, cost-effective, and sustainable approach to augmenting daily physical activity levels. This study protocol endeavors to assess the impact of an active transportation education program rooted in the ecological model on the physical and mental well-being of high school students. Drawing upon scientific insights, we hypothesize that a 16-week active transportation intervention will lead to a 3% reduction in average body fat percentage and a noteworthy enhancement in executive function (including inhibition, cognitive flexibility, and working memory), physical fitness (comprising cardiorespiratory fitness and muscle strength), and mental health (encompassing mood disorders and cognitive functioning). If this intervention proves effective, it could offer a viable solution for the school community, especially in reducing congestion within the school environment. The study protocol aims to evaluate the impact of an active transportation educational program based on the ecological model on the physical and mental well-being of high school students. Three high schools located in the urban area of Talca, Chile, will be randomly selected (one public, one privately subsidized, and one private non-subsidized). Each high school will be randomly assigned an experimental group (n = 30) and a control group (n = 30; without intervention). The experimental groups will receive an active transportation educational intervention during their physical education classes for four months (60 to 90 min sessions, once a week), while the control group will receive no intervention. The primary outcome will provide information on body composition and executive function. Secondary outcomes will include objective physical activity level, physical fitness, mental well-being, academic achievement, health-related quality of life, perception of environmental urban features, physical activity barriers, and adherence to active transportation. It is expected that the results of the MOV-ES Project will transcend the physical health of schoolchildren and will have an impact on the school community, especially by decongesting the school environment.

Associations of accelerometer-measured physical activity and sedentary time with renal function and chronic kidney disease: a national population-based study

Introduction

There is limited information about the relationship between physical activity (PA) and sedentary behaviors in chronic kidney disease (CKD). Therefore, this study aims to explore the associations of accelerometer-measured PA and sedentary behaviors with CKD.

Methods

A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey in the 2003-2004 and 2005-2006 survey cycles. A uniaxial accelerometer measured physical activity (PA) and sedentary time (ST). The associations of PA and ST with estimated glomerular filtration rate (eGFR) and odds of CKD adopted the generalized linear regression, multivariable logistic regression, and isotemporal substitution models.

Results

A total of 5,990 adults with 605 CKD patients were included in this study. Compared with the individuals in the first quartile group, participants in the fourth quartile of low-intensity physical activity (LIPA), moderate to vigorous physical activity (MVPA), and ST were associated with 52% (35%, 65%) and 42% (14%, 62%) lower odds of CKD and 64% (17%, 131%) higher odds of CKD, respectively. Substituting 30 min/day of ST with equivalent LIPA/MVPA contributed to risk reduction in CKD.

Discussion

The findings suggest that increased LIPA and MVPA and reduced ST were associated with a lower risk of CKD and that replacing ST with LIPA may decrease the risk of CKD.

Associations between Motor Competence, Physical Activity and Sedentary Behaviour among Early School-Aged Children in the SELMA Cohort Study

Low motor competence (MC) has been associated with lower physical activity (PA) and long-term health risks in children. Less is known about sex-specific patterns and associations during early school age. The aim of this study was to explore how motor difficulties are associated with PA levels, screen time, and organised sports participation (OSP). Data from 479 children, seven years of age, participating in the Swedish Environmental, Longitudinal, Mother and child, Asthma, and allergy (SELMA) pregnancy cohort study were used. MC and activity-related outcomes were assessed with questionnaires answered by parents. Associations between MC and outcomes were evaluated using logistic regression models adjusted for sex, overweight, and parental education level. Sex differences were investigated with interaction analyses and in stratified models. Children with motor difficulties had the same level of PA as their peers, but more screen time and lower OSP. Compared with children with normal MC, boys with motor difficulties had lower rates of OSP, but girls did not. This indicates that the identification and compensatory support for motor difficulties for boys at an early age, as well as the development of inclusive leisure time activities, are of importance to facilitate health-promoting activities on equal terms.

Breaking Barriers: An Innovative Tool to Assess the National and City-Level Physical Activity Policy Development to Practice Disconnect

BACKGROUND

Population-level physical activity increases are improbable without intersectoral collaboration across government levels and sectors to develop and implement physical activity promotion policies. This study aims to provide information about the development of the Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool (INTEGRATE PA-Pol). A framework was created to examine the development and implementation of national and subnational physical activity policies and the (mis)alignment between government levels.

METHODS

The work was conducted in 3 phases: (1) a scoping review was carried out to identify local government physical activity promotion policies and instruments for assessing them, (2) an expert group designed 6 questionnaires, and (3) cognitive response testing was employed for validity testing and item modification with a panel of research and policy experts.

RESULTS

The INTEGRATE PA-Pol Tool consists of 6 questionnaires assessing how national and subnational governments collaborate to develop and implement physical activity promotion policies.

CONCLUSION

This tool can assist in better understanding the development and implementation of a public policy monitoring system that will allow for benchmarking and priority setting to comprehend how physical activity promotion policies are designed and executed.

Quantity and quality are increasing but there's room for improvement: A scoping review of physical activity intervention trials

BACKGROUND

Observing trends in research publications helps to identify the quantity and quality of research produced, as well as reveal evidence gaps. No comprehensive review of the quality and quantity of physical activity intervention trials has been conducted.

OBJECTIVE

We aimed to investigate i) the volume and quality (and changes in these over time) of randomized controlled trials evaluating physical activity interventions, and ii) the association between journal ranking and trial quality.

METHODS

We searched the Physiotherapy Evidence Database (PEDro) for trials investigating physical activity interventions (no restrictions for population, comparison, or language). Descriptive statistics were used to describe the volume and quality of trials. The association between journal ranking (Journal Impact Factor) and trial quality (PEDro Scale) was examined using Spearman's rho correlation.

RESULTS

We identified 1779 trials, of which 40% (n = 710) were published between 2016 and 2020. The mean (SD) total PEDro score was 5.3 (1.5) points out of 10, increasing over time from 2.5 (0.7) points in 1975-1980 to 5.6 (1.4) points in 2016-2020. Quality criteria that were least reported included blinding of intervention deliverers (therapists) (n = 3, 0.2%), participants (n = 21, 1.2%), or assessors (n = 541, 31%); concealed allocation to groups (n = 526, 30%); and intention to treat analysis (n = 764, 43%). There was a small correlation between trial quality and Journal Impact Factor (0.21, p < 0.001).

CONCLUSION

A large volume of trials has investigated physical activity interventions. The quality of these trial reports is suboptimal but improving over time. Journal ranking should not be used for selecting high quality trials.

Dose-response association between physical activity and blood pressure among Chinese adults: a nationwide cross-sectional study

OBJECTIVES

The aim of this study was to examine the dose-response associations of physical activity with blood pressure (BP) and hypertension risk among Chinese adults.

METHODS

Derived from the national community-based China Hypertension Survey database during 2012--2015, a total of 203 108 residents aged at least 18 years were included. Individual-level physical activity was evaluated using a standardized questionnaire, and minutes of metabolic equivalent tasks per week (MET-min/week) were calculated, integrating domain, intensity, frequency, and duration. Multivariable linear and logistic regressions were used to estimate associations of physical activity with BP and hypertension risk, and restricted cubic spline regressions were performed for their nonlinear dose-response relationships.

RESULTS

Overall, the median total physical activity (TPA) was 3213.0 MET-min/week and the prevalence of physical inactivity was 14.8%. TPA was negatively associated with BP. Increasing TPA levels was related to a steep decrease in systolic BP, up to approximately 2500 MET-min/week, with more modest benefits above that level of TPA. Higher levels of domain-specific and intensity-specific physical activity were found to be associated with lower BP levels and hypertension risk, except for the association between vigorous-intensity physical activity and systolic BP. We found that TPA within the range of 2000--4000 MET-min/week, a higher frequency and shorter duration were inversely associated with diastolic BP levels.

CONCLUSION

Total, domain-specific, and intensity-specific physical activity were inversely related to BP levels, respectively, in a dose-response fashion. Of a given amount, higher-frequency, shorter-duration, and lower-intensity physical activity produced more beneficial effects.

Trajectories of physical activity from mid to older age in women: 21 years of data from the Australian Longitudinal Study on Women's Health

BACKGROUND

Women's physical activity varies across the adult lifespan. However, changes in physical activity among mid-aged women are not well understood. We analysed 21 years of data from women born in 1946-51 to identify: (1) trajectories of physical activity in the transition from mid- to old-age and (2) determinants of different physical activity trajectories.

METHODS

Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (N = 10,371). Surveys were mailed at three-year intervals from 1998 (age 47-52) to 2019 (age 68-73) to collect data on physical activity, sociodemographic factors (country of birth, area of residence, educational attainment, marital status, income management, paid work hours, living with children age < 18, providing care), health indicators (menopause status, BMI, physical and mental health, chronic conditions), and health behaviours (smoking, alcohol status). Group-based trajectory modelling was used to identify trajectories of physical activity. Multinomial logistic regression models were used to examine the determinants of physical activity trajectories.

RESULTS

Five trajectories were identified: Low-stable (13.3% of participants), Moderate-stable (50.4%), Moderate-increasing (22.2%), High-declining (7.7%), and High-stable (6.6%). Sociodemographic characteristics (area of residence, education, income management, living with children, and providing care) were determinants of physical activity trajectories, but the strongest factors were BMI, physical and mental health. Women who were overweight/obese and had poor physical and mental health were less likely to be in the High-stable group than in any other group. Changes in these variables (increasing BMI, and declining physical and mental health) and in marital status (getting married) were positively associated with being in trajectories other than the High-stable group.

CONCLUSIONS

Although most women maintained physical activity at or above current guidelines, very low physical activity levels in the Low-stable group, and declining levels in the High-declining group are concerning. The data suggest that physical activity promotion strategies could be targeted to these groups, which are characterised by socioeconomic disadvantage, high (and increasing) BMI, and poor (and worsening) physical and mental health. Removing barriers to physical activity in these women, and increasing opportunities for activity, may reduce chronic disease risk in older age.

Impact of a wearable-based physical activity and sleep intervention in multimorbidity patients: protocol for a randomized controlled trial

BACKGROUND

The benefits of physical activity (PA) and adequate sleep are well documented, and their importance strengthens with the increasing prevalence of chronic diseases and multimorbidity (MM). Interventions to promote physical activity and sleep that use commercial activity trackers may be useful non-pharmacological approaches to managing individual health; however, limited evidence exists on their use to improve physical activity in older adult patients with MM.

METHODS

This study aims to measure the effects of behavioral change techniques (BCTs) delivered by a wearable device on physical activity and quality of sleep (QS) in older adult patients with MM. We designed an open-label randomized controlled trial with participants recruited through primary care and a specialist outpatient clinic. Participants must be more than 65 years old, have MM, and have access to smartphones. All eligible participants will receive PA promotion content and will be randomly assigned to wear a smartwatch. The primary outcome will be the participants' PA measurement at baseline and at six months using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). Secondary outcomes will include changes in the participants' frailty status, biometric measurements, quality of life, and biopsychosocial assessments. A sample size of 40 participants per arm was calculated to detect group differences, with 50 participants planned to recruit and randomize into each arm.

DISCUSSION

This study aims to contribute to a better understanding of PA patterns and the impact of wearable-based PA interventions in patients with MM. In addition, we aim to contribute to more knowledge about the relationship between PA patterns, Patient Reported Outcomes Measures (PROMs), and healthcare resource utilization in patients with MM. To achieve this, the study will leverage a locally developed PROMs registry and assess data from participants' medical records, in order to understand the added impact of wearable data and medical information data on predicting PROMs and unplanned hospital admissions.

TRIAL REGISTRATION

NCT05777291.

Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity

BACKGROUND

A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice.

METHODS

Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice.

RESULTS

When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms.

CONCLUSIONS

To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts.

Trends in deaths and disability-adjusted life-years of stroke attributable to low physical activity worldwide, 1990-2019

BACKGROUND

Low physical activity (LPA) is linked to the risk of stroke, but the disease burden of stroke attributable to LPA needs to be understood to develop effective preventive strategies. We aim to assess spatiotemporal trends in the global burden of stroke attributable to LPA from 1990 to 2019.

METHODS

Based on the Global Burden of Disease, Injuries, and Risk Factors Study, our research examined deaths, the Disability-Adjusted Life Years (DALYs), the Age-Standardized Mortality Rate (ASMR), the Age-Standardized DALY Rate (ASDR), and the Estimated Annual Percentage Change (EAPC) for stroke attributable to LPA.

RESULTS

Deaths and DALYs were on the rise worldwide from 1990 to 2019, with increases of 72.72% for the former and 67.41% for the latter; ASMR and ASDR decreased, with the ASMR-related EAPC of -1.61 (95% CI:-1.71--1.5) and ASDR-related EAPC of -1.35 (95% CI:-1.43--1.27); females had more numbers of deaths and DALYs, and the majorities of deaths and DALYs were shared by those aged ≥ 70. The highest burden rates were shared by North Africa, the Middle East, and Tropical Latin America; the ASMR-related EAPC was associated with the ASMR in 1990 (R = -0.26, P < 0.001) and the Socio-Demographic Index (SDI) across different countries in 2019 (R = -0.61, P < 0.001), respectively, and such patterns were similar to what ASDR and the ASDR-related EAPC had; the Human Development Index (HDI) in 2019 was associated with the ASMR-related EAPC (R = 0.63, P < 0.001) and the ASDR-related EAPC across different countries (R = -0.62, P < 0.001), respectively.

CONCLUSIONS

Globally, deaths and DALYs of stroke attributable to LPA were on the rise, although their age-standardized rates presented downward over the past three decades; the burden of stroke attributable to LPA showed upward trends especially in those aged ≥ 70 and females in the regions of East Asia, North Africa, and the Middle East, which need more attention to the effects of physical activity on health interventions.

Using a behavior change toolkit in pediatric physical therapy to support physical activity: A feasibility study

INTRODUCTION

Physical activity levels of children with disabilities are low, as these children and their parents face a wide variety of both personal and environmental barriers. Behavior change techniques support pediatric physical therapists to address these barriers together with parents and children. We developed the What Moves You?! intervention Toolkit (WMY Toolkit) filled with behavioral change tools for use in pediatric physical therapy practice.

OBJECTIVE

To evaluate the feasibility of using the WMY Toolkit in daily pediatric physical therapy practice.

METHODS

We conducted a feasibility study with a qualitative approach using semi-structured interviews with pediatric physical therapists (n = 11). After one day of training, the pediatric physical therapists used the WMY Toolkit for a period of 9 weeks, when facilitating physical activity in children with disabilities. We analyzed the transcripts using an inductive thematic analysis followed by a deductive analysis using a feasibility framework.

RESULTS

For acceptability, pediatric physical therapists found that the toolkit facilitated conversation about physical activity in a creative and playful manner. The working mechanisms identified were in line with the intended working mechanisms during development of the WMY Toolkit, such as focusing on problem solving, self-efficacy and independence. For demand, the pediatric physical therapists mentioned that they were able to use the WMY Toolkit in children with and without disabilities with a broad range of physical activity goals. For implementation, education is important as pediatric physical therapists expressed the need to have sufficient knowledge and to feel confident using the toolkit. For practicality, pediatric physical therapists were positive about the ease of which tools could be adapted for individual children. Some of the design and materials of the toolkit needed attention due to fragility and hygiene.

CONCLUSION

The WMY Toolkit is a promising and innovative way to integrate behavior change techniques into pediatric physical therapy practice.

Physical activity amongst culturally and linguistically diverse communities in Australia: a scoping review

BACKGROUND

Australia's overseas-born population continues to grow. This population is disproportionately affected by chronic, non-communicable diseases. Physical activity is the cornerstone of all chronic disease management. Engaging people from culturally and linguistically diverse (CALD) backgrounds in physical activity is an important public health objective. The purpose of this scoping review was to examine the factors that shape physical activity participation among people from CALD backgrounds in Australia.

METHODS

This scoping review followed Arksey and O'Malley's framework. Medline, Embase and CINAHL were searched with key words relating to 'physical activity', 'CALD' and 'Australia' in July 2021 and again in February 2022 for qualitative studies published in English since 2000. Exclusion criteria were: participants < 18 years old, studies specifically focusing on populations with health issues, pregnant or postpartum states. Methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme with the purpose of informing future research. Data extracted from each study were analysed thematically and results were interpreted using Acculturation theory.

RESULTS

Of the 1130 studies, 17 met the inclusion criteria. Findings from each study were captured in three themes: Perceptions of physical activity; Acceptability and Appropriateness; and Access. Following migration, a decrease in physical activity, especially leisure-time activity, was reported. Common factors influencing physical activity engagement included perceptions of physical activity and wellbeing; language, financial and environmental barriers; as well as social, cultural, and religious considerations.

CONCLUSION

This review identified several factors which may interact and contribute to the decline in self-reported physical activity upon migration. Findings from this review may be used to inform future health promotion initiatives targeting people from CALD backgrounds. Future research may benefit from devising a shared definition of physical activity and studying different CALD communities over time.

The Epidemiology of Domain-Specific Physical Activity in New Zealand Adults: A Nationally Representative Cross-Sectional Survey

BACKGROUND

Surveillance of domain-specific physical activity (PA) helps to target interventions to promote PA. We examined the sociodemographic correlates of domain-specific PA in New Zealand adults.

METHODS

A nationally representative sample of 13,887 adults completed the International PA Questionnaire-long form in 2019/20. Three measures of total and domain-specific (leisure, travel, home, and work) PA were calculated: (1) weekly participation, (2) mean weekly metabolic energy equivalent minutes (MET-min), and (3) median weekly MET-min among those who undertook PA. Results were weighted to the New Zealand adult population.

RESULTS

The average contribution of domain-specific activity to total PA was 37.5% for work activities (participation = 43.6%; median participating MET-min = 2790), 31.9% for home activities (participation = 82.2%; median participating MET-min = 1185), 19.4% for leisure activities (participation = 64.7%; median participating MET-min = 933), and 11.2% for travel activities (participation = 64.0%; median MET-min among participants = 495). Women accumulated more home PA and less work PA than men. Total PA was higher in middle-aged adults, with diverse patterns by age within domains. Māori accumulated less leisure PA than New Zealand Europeans but higher total PA. Asian groups reported lower PA across all domains. Higher area deprivation was negatively associated with leisure PA. Sociodemographic patterns varied by measure. For example, gender was not associated with total PA participation, but men accumulated higher MET-min when taking part in PA than women.

CONCLUSIONS

Inequalities in PA varied by domain and sociodemographic group. These results should be used to inform interventions to improve PA.

The role of the cultural environment in the development of physical literacy and physical activity of Iranian children

BACKGROUND

The investigation of physical literacy (PL) and physical activity (PA) should be done in an ecological context because the socio-cultural situation can encourage or inhibit children's activity. The present study aimed to study the role of the cultural environment in the development of PL and PA in Iranian children.

METHODS

The statistical population consisted of Iranian children aged 8 to 12, of whom 270 students were recruited by cluster sampling from six provinces. They complete the Canadian Assessment of Physical Literacy 2 (CAPL-2) and the International Physical Activity Survey. To examine the cultural environment, the components of geographic location (west, south, central, east, and northwest), place of residence (downtown, suburban, and village), and gender (boys and girls) were used. A multivariate ANOVA analysis was used to analyze the data.

RESULTS

From the geographic location, the findings showed that students inhabit in the west and east of Iran have significantly higher scores than their counterparts living in the central, south, and northwest at PA and PL (P < 0.001). From the place of residence, we observed a higher level of PA and PL in children living in the village than in those living in the suburbs and downtown (P < 0.001). In terms of gender, boys have higher PL and PA scores (P < 0.001).

CONCLUSION

The findings demonstrate that socio-cultural factors, geographic location, place of residence, and gender have different impacts on children's PL and physical activity. Therefore, we suggest using ecologically appropriate decentralized planning in a physical education curriculum.

Comprehensive assessment of physical activity policies and initiatives in Saudi Arabia 2016-2022

Objective

This study aimed to review health-enhancing physical activity (HEPA) policies and initiatives introduced in Saudi Arabia (SA) since 2016 and identify the gaps in their design and implementation.

Methods

A combination of methods was used, including semi-structured interviews with key informants from relevant entities (such as those from the ministries of health, education, sports, tourism, and other regulatory bodies) and a review of policy/initiative documents provided by them. Stakeholder mapping led by local experts and snowball sampling supported the identification of key informants. Three existing frameworks-the World Health Organization's HEPA Policy Audit Tool, the Global Observatory for Physical Activity (PA) Policy Inventory, and the European Monitoring Framework for PA Indicators-were used to develop data collection instruments.

Results

The review identified 44 policies/initiatives from different sectors. The Saudi Sports for All Federation is the leader in PA promotion and community sports development. However, there is a lack of multisectoral agenda and governance structures for PA promotion. The overlap between initiatives by different key informants results in duplication of efforts, including initiatives to promote PA among the general public led by competitive professional sports and community-based sports.

Conclusion

The study findings indicate that several policies/initiatives have been implemented in SA since 2016. However, there is a need to focus on the challenges or barriers that affect the sustainability of policies/initiatives. A system-based approach can help build on sectoral synergies, thereby accelerating progress in engaging the Saudi population with PA.

Health promoting sports federations: theoretical foundations and guidelines

Background

Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP).

Methods

A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework.

Results

Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club's intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP.

Conclusion

The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.

The Association between Adult Sport, Fitness, and Recreational Physical Activity and Number and Age of Children Present in the Household: A Secondary Analysis Using NHANES

Only one in three adults in the United States meets the weekly recommendation for physical activity (PA). The presence of children in the home may restrict adult PA. The purpose of this study was to examine the association between adult moderate and vigorous sport, fitness, and recreational physical activities and the number and age (0-5 and 6-17) of children in their household. Secondary data were drawn from the National Health and Nutrition Examination Survey (NHANES) from 2007-2016. Adults with complete survey data for self-reported moderate (MPA) and vigorous physical activities (VPA), number of children in the home, and other sociodemographic variables were included. The final sample included 2034 adults from 22-65 years of age. Analyses included ANOVAs and separate multivariable regression analyses to determine if the number of children in the household aged 0-5 and 6-17 were significant predictors of weekly moderate-to-vigorous physical activity (MVPA) after controlling for covariates. For MPA, no differences were found between adult PA regardless of the number and age of children in the home. For VPA, adults with two or more children aged 0-5 reported 80 fewer minutes of weekly VPA (p < 0.05) compared to those with no children or just one child in this age group after controlling for all covariates. Finally, adults with three or more children in the household aged 6-17 reported fifty fewer minutes of weekly VPA (p < 0.05) compared to those with no children, one, or just two in the household. These findings highlight a need to support the vigorous PA behaviors of this population, as the majority of the family-based PA intervention studies to date have primarily focused on family dyads.

Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis

BACKGROUND

We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures.

METHODS

Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran.

RESULTS

All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%-47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%-64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively.

CONCLUSIONS

The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.

Extraordinary claims in the literature on high-intensity interval training (HIIT): III. Critical analysis of four foundational arguments from an interdisciplinary lens

Kinesiology aspires to be an integrated, interdisciplinary field that studies human movement from multiple perspectives. However, the main societal deliverables of the field, namely exercise prescriptions and physical activity recommendations, still reflect fragmentation, placing more emphasis on physiological outcomes than on behavioral and other considerations. Recently, researchers have called for the introduction of High-Intensity Interval Training (HIIT) to the domain of public health, based on the argument that HIIT can maximize fitness and health benefits for a fraction of the time recommended by the prevailing model of physical activity in public-health guidelines. Here, we show that an unintended side-effect of arguments underpinning the implementation of HIIT in the domain of public health might have been the exacerbation of segmentation. To highlight the value of interdisciplinarity, four foundational claims in support of HIIT are critiqued by tapping into cognate literatures: (1) the primary reason people do not exercise is lack of time, (2) HIIT is relevant to public health, (3) HIIT is being proposed as merely another option, so there is no basis for controversy, and (4) HIIT is safe and well tolerated. These claims are contradicted by credible lines of evidence. To improve the accuracy and effectiveness of its public claims, kinesiology should remain committed to the ideals of integration and interdisciplinarity.

The impact of selected methodological factors on data collection outcomes in observational studies of device-measured physical behaviour in adults: A systematic review

BACKGROUND

Accelerometer measures of physical behaviours (physical activity, sedentary behaviour and sleep) in observational studies offer detailed insight into associations with health and disease. Maximising recruitment and accelerometer wear, and minimising data loss remain key challenges. How varying methods used to collect accelerometer data influence data collection outcomes is poorly understood. We examined the influence of accelerometer placement and other methodological factors on participant recruitment, adherence and data loss in observational studies of adult physical behaviours.

METHODS

The review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA). Observational studies of adults including accelerometer measurement of physical behaviours were identified using database (MEDLINE (Ovid), Embase, PsychINFO, Health Management Information Consortium, Web of Science, SPORTDiscus and Cumulative Index to Nursing & Allied Health Literature) and supplementary searches to May 2022. Information regarding study design, accelerometer data collection methods and outcomes were extracted for each accelerometer measurement (study wave). Random effects meta-analyses and narrative syntheses were used to examine associations of methodological factors with participant recruitment, adherence and data loss.

RESULTS

123 accelerometer data collection waves were identified from 95 studies (92.5% from high-income countries). In-person distribution of accelerometers was associated with a greater proportion of invited participants consenting to wear an accelerometer (+ 30% [95% CI 18%, 42%] compared to postal distribution), and adhering to minimum wear criteria (+ 15% [4%, 25%]). The proportion of participants meeting minimum wear criteria was higher when accelerometers were worn at the wrist (+ 14% [ 5%, 23%]) compared to waist. Daily wear-time tended to be higher in studies using wrist-worn accelerometers compared to other wear locations. Reporting of information regarding data collection was inconsistent.

CONCLUSION

Methodological decisions including accelerometer wear-location and method of distribution may influence important data collection outcomes including recruitment and accelerometer wear-time. Consistent and comprehensive reporting of accelerometer data collection methods and outcomes is needed to support development of future studies and international consortia. Review supported by the British Heart Foundation (SP/F/20/150002) and registered (Prospero CRD42020213465).

Stand Up for Yourself: Tackling Sedentary Behavior through Exercise and Lifestyle

Because of their direct relations to the process of health and disease throughout life, physical activity and sedentary behavior emerge as priorities in the global public health agenda [...].

Physical Activity and Sedentary Behavior in High School Students: A Quasi Experimental Study via Smartphone during the COVID-19 Pandemic

The objective of this study was to evaluate whether exposure to information about physical activity and its barriers can increase the level of physical activity and reduce the time exposed to sedentary behaviors in high school students involved in integrated professional and technological education during the coronavirus disease 2019 pandemic. This quasi experimental study was conducted with integrated education high school students, divided into two groups: Intervention Group (IG; n = 59) and Control Group (CG; n = 54). Physical activity and sedentary behavior were identified and measured using the International Physical Activity Questionnaire pre-and post-intervention for both groups. IG students received educational material thrice a week for four weeks. The focus of the material was the importance of physical activity and need to reduce the time exposed to sedentary behavior. The results revealed that IG students showed an average daily reduction of 47.14 min in time exposed to sedentary behaviors, while the CG students showed an increase of 31.37 min. Despite this, the intervention was not effective in improving physical activity levels in the IG and the mean reduction in the time exposed to sedentary behavior was not significant (p = 0.556). The intervention was ineffective in increasing the practice of physical activity and reducing the time exposed to sedentary behavior.

Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners

BACKGROUND

Current literature reports a gap between development of effective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from different domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in different domains from different stakeholders on the island of Ireland.

METHODS

Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven different physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research.

RESULTS

Thirty-eight participants took part in the interviews which identified factors related to 1) intervention planning and practical considerations; 2) organisational structures, staffing and resources related to delivery; 3) reflection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process.

CONCLUSIONS

Future research and practice needs to consider how different factors are experienced at different implementation stages and by the different stakeholder groups involved. The findings highlight multiple inter-related factors that influence the implementation and scale-up of physical activity interventions, but also identifies many strategies that can be utilised to aid future successes.

Tackling physical inactivity in Scandinavia: a narrative review of reviews supplemented by expert interviews

Aims: This study aims to identify physical inactivity-related challenges and motives, based on reviews and supplemented by expert interviews with Danish national experts on physical inactivity, providing a general discussion of the subject ultimately generating knowledge useable in a Scandinavian context. Methods: This study is framed as a narrative review of scientific review literature on physical inactivity, limited to the general population. The review is supplemented by expert interviews with Danish national experts on physical inactivity. We used thematic coding of the included reviews, while using hermeneutic interpretation analysis for the expert interviews. Results: Based on 11 included reviews, we highlighted four themes based on our analysis of reviews: (a) socioeconomic determinants of physical activity; (b) life-course perspective; (c) physical inactivity and older adults aged 60+ years; and (d) intervention recommendations. The supplementary expert interviews revealed three additional themes: (a) the individual history with physical activity; (b) sporting organisation importance; and (c) society responsibility for physical inactivity. Conclusions: Collectively this study concludes, based on review and expert interviews, that a number of determinants and correlations for physical inactivity affect the individual from various socioecological levels. Based on this review, we suggest moving beyond the 'upstream' public health approach of randomised controlled trials and consider complex interventions targeting physical inactivity from several levels. Physical inactivity should be acknowledged as a 'wicked problem' that requires a systems-based approach instead of a single quick fix. Future work with physical inactivity would profit from focus on the life-course perspective, sporting clubs' responsiveness and physical literacy.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys

BACKGROUND

Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries.

METHODS

We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years.

RESULTS

The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved.

CONCLUSION

Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Using social networks to scale up and sustain community-based programmes to improve physical activity and diet in low-income and middle-income countries: a scoping review

BACKGROUND

Community-based programmes [CBPs], targeting increased physical activity and/or healthier eating, have been used in the prevention and management of non-communicable diseases. However, CBPs are only useful, insofar as they can be scaled up and sustained in some meaningful way. Social networks-defined as "social structures that exists between actors, individuals or organizations"-may serve as an important tool to identify underlying mechanisms that contribute to this process. This scoping review aimed to map and collate literature on the role of social network research in scaling-up and sustaining physical activity and/or diet CBPs in low-and middle-income countries [LMICs].

METHODS

Arksey and O'Malley's framework and its enhancement were followed. Inclusion criteria were peer-reviewed articles exploring the role of social networks in scaled-up and/or sustained physical activity and/or diet CBPs in adult populations, published in English since 2000, and based in a LMIC. Databases searched were PubMed, Cochrane, Scopus, Web of Science, CINAHL, SocIndex, International Bibliography of the Social Sciences, and Google Scholar. Books, conference abstracts, and programmes focused on children were excluded. Two reviewers independently selected and extracted eligible studies. Included publications were thematically analysed using the Framework Approach.

RESULTS

Authors identified 12 articles for inclusion, covering 13 CBPs. Most were based in Latin America, with others in the Caribbean, the Pacific Islands, Iran, and India. All articles were published since 2009. Only three used social network analysis methods (with others using qualitative methods). Five main social network themes were identified: centralisation, cliques, leaders, quality over quantity, and shared goals. Contextual factors to be considered when scaling-up programmes in LMICs were also identified.

CONCLUSIONS

This review has shown that the evidence of the use of social network research in programme scale-up has not yet caught up to its theoretical possibilities. Programmes aiming to scale should consider conducting social network research with identified network themes in mind to help improve the evidence-base of what network mechanisms, in what contexts, might best support the strengthening of networks in physical activity and diet programmes. Importantly, the voice of individuals and communities in these networks should not be forgotten.

Active school commuting in adolescents from 28 countries across Africa, the Americas, and Asia: a temporal trends study

BACKGROUND

Evidence examining trends in active school commuting among adolescents are mainly single-country studies, and principally focused on high-income countries. Thus, the present study aims to examine temporal trends in adolescents' active school commuting and to examine if there are differences in such trends by sex. We used nationally representative samples of 28 countries, which were predominantly low- and middle-income countries (LMICs), covering 5 different WHO regions.

METHODS

Data from the Global School-based Student Health Survey 2004-2017 were analyzed in 177,616 adolescents [mean (SD) age: 13.7 (1.0) years; 50.7% girls]. Active school commuting was self-reported (frequency of walking or riding a bike to and from school in the past 7 days). The prevalence and 95%CI of active school commuting (i.e., ≥ 3 days/week) was calculated for the overall sample and by sex for each survey. Crude linear trends in active school commuting were assessed by linear regression models. Interaction analyses were conducted to examine differing trends among boys and girls.

RESULTS

Trends in active school commuting were heterogeneous across countries, with results showing stable patterns for the majority (16/28), decreasing trends for some (7/28) and increasing trends over time for a few (5/28). The majority of countries showed no differences in active school commuting trends between girls and boys.

CONCLUSIONS

The quantification of changes in adolescents' active school commuting over time, together with a deeper understanding of local determinants for such behaviors will provide valuable evidence to inform the development of tailored and context-specific actions.

Needs assessment in community-dwelling older adults toward digital interventions to promote physical activity: Cross-sectional survey study

Background

Tackling physical inactivity represents a key global public health challenge. Strategies to increase physical activity (PA) are therefore warranted. Despite the rising availability of digital interventions (DIs), which offer tremendous potential for PA promotion, there has been inadequate attention to the special needs of older adults.

Objective

The aim was to investigate community-dwelling older adults' needs, requirements, and preferences toward DIs to promote PA.

Methods

The target population of this cross-sectional study was community-dwelling older adults (≥60 years old) within German-speaking Switzerland. Potential respondents were informed about the study and sent a link to a self-developed and self-administered online survey by our cooperating institutions.

Results

Overall, 922 respondents who completed the online survey were included in the final analysis. The mean age of the sample was 72 years (SD 6.4, range 60-98). The preferred delivery mode of DIs to promote PA was a website (428/922, 46.4%) and 80.3% (740/922) preferred video-based structures. Most respondents expressed the need for personal access, personal goals, personal messages, and a personal contact in case of problems or questions (585/817, 71.6%; 546/811, 67.3%; 536/822, 65.2%; 536/822, 65.2%). Memory training, psychological wellbeing, and nutrition were mainly rated as relevant additional content of DIs to promote PA (690/849, 81.2%; 661/845, 78.2%, 619/849, 72.9%).

Conclusion

Community-dwelling older adults may be willing to use DIs to promote PA in the long term, but this study identified particular needs and requirements in terms of design, technological realization, delivery mode, support, and individualization/personalization among the sample. Our results can inform future developments of DIs to promote PA specifically tailored to older adults. However, caution is warranted in interpreting the findings due to the sample's high PA and education levels.

Identification of physical activity and sedentary behaviour dimensions that predict mortality risk in older adults: Development of a machine learning model in the Whitehall II accelerometer sub-study and external validation in the CoLaus study

BACKGROUND

Identification of new physical activity (PA) and sedentary behaviour (SB) features relevant for health at older age is important to diversify PA targets in guidelines, as older adults rarely adhere to current recommendations focusing on total duration. We aimed to identify accelerometer-derived dimensions of movement behaviours that predict mortality risk in older populations.

METHODS

We used data on 21 accelerometer-derived features of daily movement behaviours in 3991 participants of the UK-based Whitehall II accelerometer sub-study (25.8% women, 60-83 years, follow-up: 2012-2013 to 2021, mean = 8.3 years). A machine-learning procedure was used to identify core PA and SB features predicting mortality risk and derive a composite score. We estimated the added predictive value of the score compared to traditional sociodemographic, behavioural, and health-related risk factors. External validation in the Switzerland-based CoLaus study (N = 1329, 56.7% women, 60-86 years, follow-up: 2014-2017 to 2021, mean = 3.8 years) was conducted.

FINDINGS

In total, 11 features related to overall activity level, intensity distribution, bouts duration, frequency, and total duration of PA and SB, were identified as predictors of mortality in older adults and included in a composite score. Both in the derivation and validation cohorts, the score was associated with mortality (hazard ratio = 1.10 (95% confidence interval = 1.05-1.15) and 1.18 (1.10-1.26), respectively) and improved the predictive value of a model including traditional risk factors (increase in C-index = 0.007 (0.002-0.014) and 0.029 (0.002-0.055), respectively).

INTERPRETATION

The identified accelerometer-derived PA and SB features, beyond the currently recommended total duration, might be useful for screening of older adults at higher mortality risk and for diversifying PA and SB targets in older populations whose adherence to current guidelines is low.

FUNDING

National Institute on Aging; UK Medical Research Council; British Heart Foundation; Wellcome Trust; French National Research Agency; GlaxoSmithKline; Lausanne Faculty of Biology and Medicine; Swiss National Science Foundation.

Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies

People with severe mental illness such as schizophrenia experience high physical comorbidity, leading to a 15-20-year mortality gap compared with the general population. Lifestyle behaviours such as physical activity (PA) play important roles in the quest to bridge this gap. Interventions to increase PA engagement in this population have potential to be efficacious; however, their effectiveness can be hindered by low participant engagement, including low adherence and high drop-out, and by implementation of interventions that are not designed to compensate for the cognitive and motivational impairments characteristic for this group. Moreover, and importantly, the negative symptoms of schizophrenia are associated with neurobiological changes in the brain, which-based on principles of biopsychology-can contribute to poor motivation and impaired decision-making processes and behavioural maintenance. To increase PA levels in people with schizophrenia, better understanding of these neurological changes that impact PA engagement is needed. This has the potential to inform the design of interventions that, through enhancement of motivation, could effectively increase PA levels in this specific population. Incorporating strategies that address the dopamine dysregulation associated with schizophrenia, such as boosting the role of reward and self-determined motivation, may improve long-term PA maintenance, leading to habitual PA. Consideration of motivation and behavioural maintenance is also needed to impart health benefits such as prevention of chronic disease, which is associated with currently low PA levels in this high metabolic risk population. Taking a biopsychological perspective, we outline the neural pathways involved in motivation that are impacted by schizophrenia and propose strategies for promoting motivation for and PA engagement from adoption to habit formation.

Exploring physical literacy in children aged 8 to 12 years old: a cross-cultural comparison between China and Greece

Background

The concept of physical literacy (PL) has been advocated as a crucial determinant for increasing the quality and quantity of movement and physical activity (PA). Children’s PL has been rarely compared across countries, although it has shown low levels in many countries. This study aimed to explore and compare children’s PL from China and Greece.

Methods

A total of 327 Chinese (47.1% boys) and 295 Greek children (48.1% boys) aged 8 to 12 years participated in this study. Children’s PL was objectively assessed by the Chinese and Greek version of the Canadian Assessment of Physical Literacy, 2nd edition, which consists of four domains: Daily Behavior, Physical Competence, Motivation and Confidence, and Knowledge.

and Understanding. Univariate analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) on total PL and domain scores were conducted in both countries, respectively.

Results

MANOVA revealed significant differences in total PL and distribution scores between two countries (Pillais’ trace = 0.260, F = 53.855, p < 0.001, η² = 0.260), with Greek children scoring better than Chinese. Nevertheless, most children failed to present an adequate PL level as they were mostly in the “progressing” stage. The chi-square denoted that the distribution of Chinese and Greek participants across the CAPL-2 interpretive categories was statistically different for total PL (χ² [3] = 18.726, p < 0.001, Cramer’s V = 0.174), with more Greek children being classified as “achieving” and “excelling”.

Conclusions

The variance between Chinese and Greek children may be attributed to cultural differences in the context of PA, such as PE policies and settings. The relatively low level of PL shown in both countries echoes the global trend of the declining PA among children, with an increasing amount of their time spent in a sedentary lifestyle. These findings highlight the need to consider children’s cultural factors and pedagogical strategies in terms of developing their PL. Future research is required to explore the impact of cultural background on PL development among children and appropriate strategies to migrate their influence.