Choice architecture interventions to change physical activity and sedentary behavior: a systematic review of effects on intention, behavior and health outcomes during and after intervention

Nudging Interventions on Stair Use: A Scoping Review

Stair use is a physical activity that can be incorporated into the daily lifestyle of a majority of the population, resulting in several health benefits. Nudges are increasingly used in public health interventions to encourage healthy behaviours such as physical activity in a cost-effective manner. This scoping review aimed to investigate the effect and the characteristics of nudges used on interventions to promote stair use. We reviewed the relevant literature published in PubMed, Cochrane Library, Mendeley and Google Scholar, from January 2009 to May 2022. Eligibility criteria included original studies of any type of design, written in English, targeting healthy adults, reporting nudging interventions, using elevator or escalator as comparators and defining a baseline for comparisons. Initially, 118 publications were identified, and after applying exclusion criteria, 27 articles were included in the analysis. Results showed that most of the nudging interventions had significant positive effect on stair use in several settings. The evidence from this review suggests that incorporating nudges into public health interventions can effectively promote physical activity through increased stair usage. Emphasizing prevention measures in public health interventions may contribute to better health outcomes.

Multi-Family Housing Environment and Physical Activity: A Systematic Review of the Literature

OBJECTIVE

To identify environmental features of multi-family housing (MFH) and their surrounding neighborhoods that influence residents' physical activity (PA).

DATA SOURCE

Articles published between January 2000 and September 2023 were identified from major social science, medical, health, behavioral science, and urban studies databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies were included if they (a) were empirical studies published in peer-reviewed journals and written in English; (b) focused on the MFH environment or the surrounding neighborhood; and (c) had at least one PA outcome.

DATA EXTRACTION

Data was extracted regarding the study objective, location, study sample, research design, results related to MFH and neighborhood environment, and limitations.

DATA SYNTHESIS

Descriptive summary of study characteristics and analysis to identify emerging themes at three spatial scales (i.e., building, site, and neighborhood).

RESULTS

Findings from 35 identified articles revealed factors influencing MFH residents' PA. On the building level, typology (apartment, townhouse) and tenure (public, market rent) showed contrasting correlations with PA in different age groups. On the site level, the presence of PA facilities and safe, walking-friendly environments promoted PA. On the neighborhood level, safety, quality of PA and pedestrian infrastructure, upkeep, air quality, aesthetics, neighborhood satisfaction, street connectivity, walkability, land use mix, density, and public transport promoted PA.

CONCLUSION

Study findings highlight the importance of the MFH environments in promoting PA, especially in older adults and young children. With increasing housing demand, understanding diverse MFH typologies and the impact of interventions on multi-spatial scales can help promote healthy and activity-friendly communities.

Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study

Background/Objectives: Upper-limb function of chronic stroke patients declined when outpatient rehabilitation was interrupted and outings restricted, owing to the novel coronavirus infection (COVID-19) pandemic. We investigated whether these patients recovered upper-limb function post-resumption of outpatient rehabilitation. Methods: In this observational study, 43 chronic stroke hemiparesis patients with impaired upper extremity function were scored for limb function via the Fugl-Meyer assessment of the upper extremity (FMA-UE) and the Action Research Arm Test (ARAT) after a structured interview, evaluation, and intervention. Scores at 6 and 3 months pre- and 3 months post-rehabilitation interruption were examined retrospectively; scores immediately and at 3 and 6 months post-resumption of care were examined prospectively. The amount of change for each time period and an analysis of covariance were performed with time as a factor, changes in the FMA-UE and the ARAT scores as dependent variables, and statistical significance at 5%. Results: The time of evaluation significantly impacted the total score, as well as part C and part D of FMA-UE and total, pinch, and gross movement of the ARAT. Post-hoc tests showed that the magnitude of change in limb-function scores from immediately to 3 months post-resumption was significantly higher than the change from 3 months pre- to immediately post-interruption for the total score and part D of the FMA-UE, as well as grip and gross movement of the ARAT (p < 0.05). Conclusions: Upper-limb functional decline in chronic stroke patients, caused by the COVID-19 pandemic-related therapy interruption and outing restrictions, was resolved approximately 3 months post-resumption of rehabilitation therapy. Our data can serve as reference standards for planning and evaluating treatment for chronic stroke patients with inactivity-related impaired upper-limb function.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

The effects of acute exercise on stress reactivity assessed via a multidimensional approach: a systematic review

Psychological stress is associated with numerous deleterious health effects. Accumulating evidence suggests acute exercise reduces stress reactivity. As stressors activate a wide array of psychological and physiological systems it is imperative stress responses are examined through a multidimensional lens. Moreover, it seems prudent to consider whether stress responses are influenced by exercise intervention characteristics such as modality, duration, intensity, timing, as well as participant fitness/physical activity levels. The current review therefore examined the role of acute exercise on stress reactivity through a multidimensional approach, as well as whether exercise intervention characteristics and participant fitness/physical activity levels may moderate these effects. Stress reactivity was assessed via heart rate, blood pressure, cortisol, catecholamines, and self-report. A systematic search following PRISMA guidelines of five databases was updated in November 2022. Reviewed studies met the following criteria: English language, participants aged ≥ 18, use of acute exercise, use of a validated stress-inducing task, and assessment(s) of stress reactivity. Thirty-one studies (1386 participants) were included. Acute exercise resulted in reliable reductions to blood pressure and cortisol. Acute exercise yielded mostly negligible effects on heart rate reactivity and negligible effects on self-report measures. As for exercise intervention characteristics, intensity-dependent effects were present, such that higher intensities yielded larger reductions to reactivity measures, while limited evidence was present for duration, modality, and timing-dependent effects. Regarding participant fitness/physical activity levels, the effects on stress reactivity were mixed. Future work should standardize the definitions and assessment time points of stress reactivity, as well as investigate the interaction between physiological and psychological stress responses in real-world contexts.

Nudging oral habits; application of behavioral economics in oral health promotion: a critical review

Background

Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health.

Methods

A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors.

Results and conclusion

There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.

Sitting vs. standing: an urgent need to rebalance our world

During their activities of daily living, humans run, walk, stand, sit and lie down. Recent changes in our environment have favored sedentary behavior over more physically active behavior to such a degree that our health is in danger. Here, we sought to address the problem of excessive time spent seated from various theoretical viewpoints, including postural control, human factors engineering, human history and health psychology. If nothing is done now, the high prevalence of sitting will continue to increase. We make a case for the standing position by demonstrating that spending more time upright can mitigate the physiological and psychological problems associated with excessive sitting without lowering task performance and productivity. The psychological literature even highlights potential benefits of performing certain tasks in the standing position. We propose a number of recommendations on spending more time (but not too much) in the standing position and on more active, nonambulatory behaviors. There is a need to inform people about (i) harmful consequences of excessive sitting and (ii) benefits of spending more time performing active, nonambulatory behaviors. One clear benefit is to reduce detrimental health consequences of excessive sitting and to provide potential additional benefits in terms of productivity and performance.

Gesundheitsförderung mit Kindern und Jugendlichen: der Ansatz der Gesundheitsförderungskultur

Hintergrund

Die Diskrepanz zwischen rein theoretisch erarbeiteten Maßnahmen der Gesundheitsförderung, unabhängig von lebensweltlichen, gesundheitsrelevanten Erlebnissen und Erfahrungen ohne Einbezug der Adressat*innen stellt weiterhin ein Problem bezüglich der Wirksamkeit innerhalb verschiedener vulnerabler Gruppen dar. Der Beitrag beschreibt die theoretische Herleitung des Ansatzes der Gesundheitsförderungskultur anhand der Kinder- und Jugendarbeit. Der Ansatz stellt eine Weiterentwicklung des Verständnisses des Setting-Ansatzes dar, indem es einen theoretischen und analytischen Überbau für den Setting-Ansatz schafft und versucht diesen theoretisch stärker zu fundieren. Das hier vorgestellte Konzept ermöglicht eine ganzheitliche Sichtweise auf Gesundheitsförderung, die über das bisherige Verständnis von Verhaltens- und Verhältnisprävention hinausgeht.

Methoden

Das theoretische Konzept wurde mittels einer Verknüpfung des Lebensweltbegriffs und des Habituskonzepts.

Ergebnisse

Um soziale und gesundheitliche Ungleichheiten angemessen zu adressieren, sind lebensweltspezifische Ansätze und Methoden erforderlich, auf deren Basis mithilfe eines Bottom-up-Ansatzes gesundheitsförderliche Verhältnisse partizipativ geschaffen werden. Das Zusammenwirken von Partizipation, Selbstwirksamkeit, Empowerment und Exploration steht im Fokus der Gesundheitsförderungskultur. Die partizipative Einbindung der Adressat*innen bereits bei der Bedarfsermittlung sowie der Maßnahmenentwicklung soll Selbstwirksamkeitserfahrungen fördern, um zum Empowerment aller Adressat*innen zu führen.

Schlussfolgerung

Langfristig sollen Adressat*innen durch die direkte Auseinandersetzung mit ihrer Lebenswelt befähigt werden, (gesundheits-)kulturschaffende Akteur*innen in ihrer Lebenswelt zu sein, sodass sie ihre Umwelt gesundheitsförderlich beeinflussen und ihr eigenes Gesundheitsverhalten reflektieren können.

What we know about the actual implementation process of public physical activity policies: results from a scoping review

BACKGROUND

Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix).

METHODS

A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included.

RESULTS

The current evidence includes high-income countries (USA, n = 7; UK, New Zealand and Oman, n = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n = 4), state (n = 1), county (n = 1), school district (n = 1) and city (n = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors.

CONCLUSION

Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour.

Nudging digital physical activity breaks for home studying of university students-A randomized controlled trial during the COVID-19 pandemic with daily activity measures

University students are of particular public health interest because they are at high risk for physical inactivity and sedentary behaviors. In conjunction with the COVID-19 pandemic, sedentariness and physical inactivity were reinforced, as the pandemic led to an increase in home studying. Physical activity (PA) breaks have been identified as promoting factors for university students' physical and mental health. Therefore, the present study explored an approach to nudge students to take PA breaks at home while studying. The purpose was to test the effectiveness of digital nudging for PA breaks for 10 days using a randomized intervention design during the COVID-19 pandemic. It included an intervention group who received daily digital motivational prompts for PA break videos and a minimal intervention control group who got low-level access to PA break videos via a one-time link sent to the media library. Using a sample of university students in the southwest of Germany (n = 57), two-level binary logistic regression models were calculated to predict daily participation in PA breaks during the intervention period depending on the nudging intervention, as well as previous participation in PA breaks, the general PA level of the subjects before the intervention, the time spent on PA and on home studying in a day, the kind of day during the intervention (weekday vs. weekend), and the students' age. Results revealed that the digital nudging intervention did not show any significant effect on the likelihood to participate in PA breaks on a given day (0.69 ≤ β ≤ 0.75, p > 0.3). Instead, an individual-level effect revealed that the longer a student studied at home over the course of a day, the more likely he or she was to take a PA break (1.07 ≤ β ≤ 1.11, p < 0.001). Current findings show that individual characteristics such as daily time spent on home studying, which can change over the course of the intervention phase, are relevant considerations within nudging intervention in university setting. This provides initial insights especially for digital PA breaks for students during home studying.

Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review

Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.

Design of vestibules as transitional spaces in infection control: Necessity of working space changes to cope with communicable infections

BACKGROUND: After the spread of infectious diseases, people stay at home as a shelter space to be safe and sound. Current homes and work spaces have shown not to be a good environment for health and hygiene. During different crises of infectious diseases, architects and designers analyze the needs for change and evolve of environments to achieve a suitable design that prevents the spread of pathogens. OBJECTIVES: This proper design should help improve people’s living standards and mental health in terms of functionality and environmental psychology. METHODS: In the traditional architecture of some countries, such as Canada, Japan, and Iran, the vestibule has provided some possibility of separating the external and internal space. The design of the intermediate space with the appropriate scale of today’s buildings at the entrance can create a filter between the indoor and outdoor environments by dividing these spaces. RESULTS: The use of intermediate space by modern technology can prevent the transfer of viral infection into the interior of the building. This can be done by removing the virus from clothes, changing or covering shoes, disinfecting equipment, separating infected items, and creating proper ventilation in the intermediate space so that microorganisms cannot be transferred into the safe environment. CONCLUSIONS: In this paper, we looked at the architectural design in a new light to have a healthier life and more security, by inspiration of the patterns in traditional architecture and the human body.

Developing non-exercise activity thermogenesis (NEAT) through building design

Purpose

Physical inactivity has a considerable negative impact on health. Physical activity has reduced partly due to workplace and lifestyle changes, causing people to spend more time in buildings and increasing sedentary behaviour. The purpose of this paper is to address a largely untapped opportunity for designers and managers to improve building users’ health by designing buildings that raise users’ Non-Exercise Activity Thermogenesis (NEAT) levels. In this research a conceptual model was developed to assess buildings’ performance in providing NEAT-promoting opportunities through building design features and management, in relation to building users’ propensity for NEAT behaviours.

Design/methodology/approach

The conceptual model was developed by a multi-disciplinary team of researchers and data to populate the model was obtained through a survey of 75 buildings in Jakarta (Indonesia).

Findings

The presented proof-of-concept shows that the model’s “meso-scale” approach to study physical activity and building design can lead to potential improvements of NEAT levels and physical activity in buildings.

Originality/value

The review of precedent models shows that this subject has been researched at micro-scale (i.e. detailed monitoring of individuals’ movement) and macro-scale (i.e. epidemiological studies of populations’ health). The presented model is original, as it explores a “meso-scale”(i.e. building scale) that is unique.

Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study

Background

Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into office workers' perspectives on physical activity and sedentary behaviour.

Methods

Sixteen Dutch office workers (50% female) from different professions participated in semi-structured face-to-face interviews in March 2019. To facilitate the interviews, participants received a sensitizing booklet one week before the interview. The booklet aimed to trigger them to reflect on their physical activity and sedentary behaviour and on their values in life. All interviews were audiotaped, transcribed verbatim and coded following codebook thematic analysis.

Results

Six themes were identified: 1) beliefs about health effects are specific regarding physical activity, but superficial regarding sedentary behaviour; 2) in addition to ‘health’ as a value, other values are also given priority; 3) motivations to engage in physical activity mainly stem from prioritizing the value ‘health’, reflected by a desire to both achieve positive short/mid-term outcomes and to prevent long-term negative outcomes; 4) attitudes towards physical inactivity and sedentary behaviour are diverse and depend on individual values and previous experiences; 5) perceived barriers depend on internal and external factors; 6) supporting factors are related to support and information in the social and physical environment.

Conclusions

The great value that office workers attach to health is reflected in their motivations and attitudes regarding physical activity. Increasing office workers' knowledge of the health risks of prolonged sitting may therefore increase their motivation to sit less. Although ‘health’ is considered important, other values, including social and work-related values, are sometimes prioritized. We conclude that interventions that aim to reduce sedentary behaviour and increase physical activity among office workers could be improved by informing about health effects of sedentary behaviour and short/mid-term benefits of physical activity, including mental health benefits. Moreover, interventions could frame physical activity as congruent with values and support value-congruent choices. Finally, the work environment could support physical activity and interruption of sedentary behaviour.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13024-z.

Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis

Purpose

As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics.

Methods

A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews.

Results

One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes.

Conclusions

To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.

Environmental Physical Activity Cues and Children's Active vs. Sedentary Recreation

Physical activity (PA) benefits health, and intensive environmental modifications can increase children’s PA. Research has not yet addressed if subtle environmental cues, such as posters depicting PA, increase child PA. In the current study, it was hypothesized that children exposed to active posters (vs. nature posters) would spend a larger proportion of free play time engaging with active toys (relative to sedentary toys). Participants were randomly assigned to one of two conditions in which posters on a laboratory wall depicted 1. People being active, or 2. Nature scenes. Children aged 5–10 years (N = 175) could play with up to eight toys (four active, four sedentary) while parents completed study-related surveys. The proportion of playtime that was active was compared between groups. Poster type did not have a significant effect on proportion of active playtime. Previous environmental interventions that increase children’s PA have done so through enhancing access to active opportunities, rather than via signage. It is possible that poster interventions such as this may not influence children’s PA, or perhaps other types of cues would have been more effective. Future research should investigate subtle environmental cues that match both the target audience and the accessible PA options (e.g., posters depicting children playing with available active toys) and explore other low-investment environmental modifications to boost children’s PA.

Nudges used to promote physical activity and to reduce sedentary behaviour in the workplace: Results of a scoping review

Physical inactivity is one of the most important risk factors for non-communicable diseases. Workplace health promotion is therefore of growing interest to support an active day using nudges. The scoping review aims to (a) analyse how frequently nudges are applied in workplace health promotion to increase physical activity and/or reduce sedentary behaviour, and (b) characterise the nudges used. A systematic database search was conducted for the period 2009 to June 2020. According to predefined inclusion and exclusion criteria, studies promoting physical activity and/or reducing sedentary behaviour using nudges were included. Nudges were classified according to MINDSPACE and TIPPME. A study protocol was previously published. Of the 256 studies identified, 26 used nudges. Most studies were conducted in Europe (n = 12) and the USA (n = 8). N = 18 studies targeted physical activity and n = 8 studies targeted sedentary behaviour. In most studies promoting physical activity, prompts were given to climb stairs (n = 11). Interventions targeting sedentary behaviour were more diverse, using digital interventions or mixed approaches (n = 8). Although nudges can help increase physical activity and reduce sedentary behaviour, there are still gaps in terms of their effective and efficient use. There is a lack of long-term studies that analyse habituation and behavioural changes beyond the intervention period. In addition, the potential of digital and mixed approaches is not yet fully exploited. Further studies from low- and middle-income countries with different climates and working conditions are needed to investigate the feasibility of approaches and advance the fight against physical inactivity.

Children's Behavioral Agency within Families in the Context of Migration: A Systematic Review

Migration may lead to changing power dynamics between parents and children in families. Children may change their behavior in order to exercise agency to respond to migration of family members or themselves. This systematic review seeks to understand how children exercise agency within families in the context of migration. The authors searched ten databases to collect English-written articles published in academic journals in or after 2010. The studies were coded to generate a quality indicator. 65 Articles with moderate and strong quality were included in this review, including 41 qualitative studies, 16 quantitative studies, and 8 mixed-methods studies. Children and adolescents with demographically and culturally diverse backgrounds were analyzed in these studies. The systematic review shows that children have different levels of behavioral agency in the migration decision-making process; they also exercise agency in different aspects of family life. For example, left-behind children exercise agency in care provision and information nondisclosure, and migrant children in media and language brokering. Children's behavioral agency is place-specific. Adults working with children need to pay more attention to children's behavioral agency in order to support children's healthy development and facilitate their adaptation in the context of migration.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40894-021-00175-0.

An appeal to our government for nationwide policies in the prevention of cardiovascular disease

The high prevalence and burden of cardiovascular diseases (CVD) is largely attributable to unhealthy lifestyle factors such as smoking, alcohol consumption, physical inactivity and unhealthy food habits. Prevention of CVD, through the promotion of healthy lifestyles, appears to be a Sisyphean task for healthcare professionals, as the root causes of an unhealthy lifestyle lie largely outside their scope. Since most lifestyle choices are habitual and a response to environmental cues, rather than rational and deliberate choices, nationwide policies targeting the context in which lifestyle behaviours occur may be highly effective in the prevention of CVD. In this point-of-view article, we emphasise the need for government policies beyond those mentioned in the National Prevention Agreement in the Netherlands to effectively reduce the CVD risk, and we address the commonly raised concerns regarding ‘paternalism’.

Health Issues Due to the Global Prevalence of Sedentariness and Recommendations towards Achieving a Healthier Behaviour

Sedentariness has progressed in recent years. Here, we summarize the high prevalence of objectively measured sedentariness and the list of health problems associated with sedentariness. According to the literature, a minimum sedentary time of 8 h/d may avoid the harmful effects of sedentariness. Our review of the literature shows that many countries worldwide exceed this threshold. The coronavirus disease 2019 pandemic has increased the proportion of time spent seated in chairs and/or other types of furniture. Furthermore, prolonged sedentariness will continue to increase because it is assumed that people, at least those in desk jobs, perform their work better when sitting than when standing. Many practical solutions should be implemented to help people reduce their sedentary time. People need to be aware that prolonged sedentariness causes health problems. They need to measure the amount of time spent being sedentary to self-guide their behaviour. They should adopt a new lifestyle to avoid prolonged sedentariness and prolonged standing. In addition, we point out that they should frequently change their posture to avoid fatigue and health issues. For global public health, there is an urgent need to adopt an intermediate healthy/healthier behaviour between too much time spent in the sitting and standing positions.

The Power and Peril of Precise vs. Round Health Message Interventions to Increase Stair Use

Taking the stairs vs. an elevator generate benefits for the individual by increasing overall physical activity, health, and wellbeing. In the present paper, we report two pre-registered field intervention studies that examine how health message interventions can motivate individuals to change their behavior. We empirically contrasted opposing predictions from the literature as to whether numerically round (60.00%) or precise (61.87%) health messages are more effective in causing people to use the stairs over taking the elevator. Both interventions were compared to a control condition (no-health message). Contrary to our hypotheses and extant findings, both intervention studies did not produce a significant positive effect of the interventions relative to the control condition. In recent years such null findings have received increasingly more appreciation, particularly in the light of evident downsides of file-drawered studies. We discuss a number of moderating factors that may determine when and why nudging interventions are (in-) effective (e.g., a priori behavioral prevalence, pre-established habits, ceiling effects, and building infrastructure), as well as limitations and avenues for future research.

Theory-Based, Participatory Development of a Cross-Company Network Promoting Physical Activity in Germany: A Mixed-Methods Approach

The untapped potential of workplace health promotion (WHP) in smaller companies and the promising approach to promote physical activity in the workplace requires application-oriented approaches. This study describes the participatory, theory-based development of a cross-company network with a multicomponent intervention for promoting physical activity in smaller companies. The BIG-Manual (from the “Movement as an Investment for Health” project, German—BIG) was the theoretical framework for developing the cross-company network. Qualitative and quantitative data sources were used to identify the requests and requirements of stakeholders (employees on site, local exercise providers, company representatives and network partners) regarding measures promoting physical activity and the cross-company network. The methods applied included two workshops (n = 13; n = 15), individual semi-structured interviews (n = 8) and a survey (n = 285). The analysis revealed that a large number of stakeholders must be taken into consideration for physical activity promotion in cross-company networks. Many similarities between the requests of employees and further stakeholders concerning a multicomponent intervention for promoting physical activity could be identified. Present gender-specific and physical activity-related differences show the importance of target group-specific intervention planning in the context of WHP. This study makes an important contribution for the development of future cross-company networks promoting physical activity and yields valuable information for the design of a multicomponent intervention promoting physical activity.

Using nudges to promote physical activity and to reduce sedentary behaviour in the workplace: a scoping review protocol

INTRODUCTION

Physical inactivity and sedentary behaviour are associated with numerous health problems and increasing risks of premature morbidity and mortality. Workplace health promotion with a focus on increasing physical activity (PA) and reducing sedentary behaviour is of growing interest. The concept of choice architecture with the use of nudges is a promising approach to influence decision making regarding health behaviours. It can help to understand why people often fail to act in their best interest, to follow well-informed preferences or to achieve their set goals. Nudges, the way the choice is presented, can help to overcome these challenges by using the same habits, biases or boundaries to alter our decision-making in favour of the more preferred behaviour. Aims of the scoping review will be to analyse (a) to what extent the concept of choice architecture is used in workplace health promotion to promote PA and/or to reduce sedentary behaviour and (b) which instruments (nudges) are used to archive that.

METHODS AND ANALYSES

Medline, PsychInfo, Web of Science and CINHAL will be searched from 2009 until June 2020. Applying a two-level screening process, title and abstracts will be screened according to a set of predetermined inclusion and exclusion criteria. Included articles will be screened a second time to determine the extent to which choice architecture has been used. Analyses for publication year, location, setting and target group will be provided. Interventions will be analysed presenting the instruments used, number of studies per instrument, combinations of instruments and alteration of the environment. Outcome measures and results will be reported as they occur.

ETHICS AND DISSEMINATION

Due to the nature of the scoping review, ethical concerns are minimal. No patient data will be included. Results are published in peer-review journals.

Strategies to Improve Participation of Older Adults in Cancer Research

Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care.