Social and Environmental Influences on Physical Activity Behaviours

Selected musculoskeletal disorders in patients with thyroid dysfunction, diabetes, and obesity

Many medical conditions affect the skeletal system and constitute independent risk factors for fractures. The action of thyroid hormones is necessary to maintain adequate development, mineralization, and bone strength. Untreated hyperthyroidism can lead to a decrease in bone mineral density (BMD), osteoporosis, and pathological fractures. In hypothyroidism, the changes in the quality of bone structure lead to an increase in the frequency of fractures. Excessive body weight negatively impacts fracture risk, increases the risk of osteoarthritis and accelerates the development of rheumatoid arthritis and osteoporosis. Type 1 and type 2 diabetes are associated with an increased risk of bone fractures despite different etiopathogenesis due to the duration of the disease and the pro-inflammatory state, the incorporation of advanced glycation end products (AGEs) into the bone matrix, and microvascular disorders. This study summarizes the current literature on the influence of thyroid dysfunction, obesity, and diabetes on the skeletal system.

Participant recruitment, baseline characteristics and at-home-measurements of cardiometabolic risk markers: insights from the Supreme Nudge parallel cluster-randomised controlled supermarket trial

BACKGROUND

Recruiting participants for lifestyle programmes is known to be challenging. Insights into recruitment strategies, enrolment rates and costs are valuable but rarely reported. We provide insight into the costs and results of used recruitment strategies, baseline characteristics and feasibility of at-home cardiometabolic measurements as part of the Supreme Nudge trial investigating healthy lifestyle behaviours. This trial was conducted during the COVID-19 pandemic, requiring a largely remote data collection approach. Potential sociodemographic differences were explored between participants recruited through various strategies and for at-home measurement completion rates.

METHODS

Participants were recruited from socially disadvantaged areas around participating study supermarkets (n = 12 supermarkets) across the Netherlands, aged 30-80 years, and regular shoppers of the participating supermarkets. Recruitment strategies, costs and yields were logged, together with completion rates of at-home measurements of cardiometabolic markers. Descriptive statistics are reported on recruitment yield per used method and baseline characteristics. We used linear and logistic multilevel models to assess the potential sociodemographic differences.

RESULTS

Of 783 recruited, 602 were eligible to participate, and 421 completed informed consent. Most included participants were recruited via letters/flyers at home (75%), but this strategy was very costly per included participant (89 Euros). Of paid strategies, supermarket flyers were the cheapest (12 Euros) and the least time-invasive (< 1 h). Participants who completed baseline measurements (n = 391) were on average 57.6 (SD 11.0) years, 72% were female and 41% had high educational attainment, and they often completed the at-home measurements successfully (lipid profile 88%, HbA1c 94%, waist circumference 99%). Multilevel models suggested that males tended to be recruited more often via word-of-mouth (ORfemales 0.51 (95%CI 0.22; 1.21)). Those who failed the first attempt at completing the at-home blood measurement were older (β 3.89 years (95% CI 1.28; 6.49), whilst the non-completers of the HbA1c (β - 8.92 years (95% CI - 13.62; - 4.28)) and LDL (β - 3.19 years (95% CI - 6.53; 0.09)) were younger.

CONCLUSIONS

Supermarket flyers were the most cost-effective paid strategy, whereas mailings to home addresses recruited the most participants but were very costly. At-home cardiometabolic measurements were feasible and may be useful in geographically widespread groups or when face to face contact is not possible.

TRIAL REGISTRATION

Dutch Trial Register ID NL7064, 30 May 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302.

Association between Daily Pattern of Physical Activity and Depression: A Systematic Review

Recent research suggested that daily pattern of physical activity (PA) may have an important association with depression, but findings are limited and contradictory. Our aim was to conduct a systematic review of the literature to summarize the literature evidence on the association between timing of PA and depression. A comprehensive search of PubMed/Medline and Scopus databases has been performed, and a total of five manuscripts have been thoroughly reviewed. The performed descriptive analysis shows lower levels of PA among individuals with depression or depressive symptoms, although evidence on the 24 h pattern of PA and depression is limited. An interesting finding is the association between lower PA during the morning, higher PA late in the evening (night), and depression or depressive symptoms. However, definitive conclusions could not be drawn due to the observational nature of the studies, their limited number, the high heterogeneity in the sample populations, and the studies’ differing outcome definitions and exposure assessments. Future studies considering not only the level of PA but also its daily variability might be important to further explore this novel area of research.

Living through the COVID-19 Pandemic: Impact and Lessons on Dietary Behavior and Physical Well-Being

The aim of this review is to highlight the spectrum on which human behavior has been affected by blanket restriction measures and on a wider scale, the COVID-19 pandemic. Some of the human behaviors that have been impacted by the COVID-19 lockdown are dietary behavior and nutrition, food options and food delivery usage, physical activity and sedentary behaviors. This is important in planning effective public health strategies with minimal detriment to all subsets of society as well as improving the distribution of government aid to populations that are more severely affected. Our main purpose is to present the literature from a rapidly growing pool of scientific research to hopefully enable a better and more comprehensive understanding of the effects of this pandemic and the lessons learnt from the accompanying restrictions, as well as policy recommendations that can be made in national pandemic responses in the future.

Parent perceptions of their child's and their own physical activity after treatment for childhood cancer

PURPOSE

Parents are important facilitators of physical activity for children, yet little is known about the perceptions of parents of childhood cancer survivors. We investigated parent perceptions of their own and their child's physical activity levels after cancer treatment and examined associations with clinical, demographic, and psychosocial factors.

METHODS

We conducted a cross-sectional survey among 125 parents and 125 survivors. Parents reported on the perceived importance of their child being physically active and concerns regarding exercising after cancer treatment.

RESULTS

Parents and survivors self-reported median (range) of 127.5 (0-1260) and 220 (0-1470) min/week of moderate-to-vigorous physical activity. Most parents (n = 109, 98%) believed that physical activity was highly important for their child. Some parents (n = 19, 17%) reported concerns, most commonly regarding exercise safety (n = 7, 22%). Parents were more likely to perceive that their child should increase physical activity if their child was an adolescent and had high body fat percentage.

CONCLUSIONS

Physical activity levels varied widely among survivors, reflecting factors including parents' lifestyles, limited understanding of exercise benefits and perceptions of risk. Given survivors' insufficient physical activity levels and sedentary behaviour among families, embedding physical activity promotion into health systems and follow-up support could benefit the entire family unit.

How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies

Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.

Children with congenital heart disease exhibit seasonal variation in physical activity

OBJECTIVE

We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease.

METHODS

Data were collected as part of a prospective cohort study at BC Children's Hospital, Vancouver, Canada. Daily step counts of children aged 9-16 years with moderate-to-severe CHD were assessed continuously for 1-year via a commercial activity tracker (Fitbit Charge 2™). Physical activity levels were also assessed conventionally at one time-point via accelerometers (ActiGraph) and physical activity questionnaires.

RESULTS

156 children (mean age 12.7±2.4 years; 42% female) participated in the study. Fitbit data (n = 96) over a 1-year period clearly illustrated seasonal peaks (late spring and autumn) and dips (winter and summer school holidays) in physical activity levels, with group mean values being below 12,000 steps per day throughout the year. According to conventional accelerometry data (n = 142), 26% met guidelines, which tended to differ according to season of measurement (spring: 39%, summer: 11%, fall: 20%, winter: 39%; p-value = 0.053). Questionnaire data (n = 134) identified that the most widely reported activities were walking (81%) and running (78%) with walking being the highest in summer and fall and running in winter and spring. Furthermore, regardless of overall activity levels the children exhibit similar seasonal variation.

CONCLUSIONS

We demonstrated that physical activity level changes across seasons in children with CHD. It is important to be aware of these fluctuations when assessing and interpreting physical activity levels. Season specific counselling for physical activity may be beneficial in a clinical setting.

Physical inactivity and sedentary behaviors in the Bangladeshi population during the COVID-19 pandemic: An online cross-sectional survey

This study aimed to determine the prevalence of physical inactivity and sedentary behaviors during the COVID-19 pandemic among Bangladeshi people. An online survey was conducted among 2,028 people over a period of 10 days on June, 2020 during the COVID-19 pandemic at a time that the number of newly diagnosed cases was increasing, lockdown was still in place. Survey questions included socio-demographics and an adapted version of the IPAQ-SF to assess physical activity and sedentary behaviors. The prevalence rates of physical inactivity (<600 MET-minutes/week) and high sedentary behaviors (≥8 h/day) among Bangladeshi people were 37.9% and 20.9%, respectively. Regression analyses revealed that young age, being a student, from a middle-class family, or upper-class family, living with nuclear family, urban living, and suffering from no chronic diseases were all associated with physical inactivity and high sedentary behaviors. Moreover, physical inactivity and high sedentary behavior were strongly interrelated. However, many of the univariate risk factors exhibited interdependency. During the COVID-19 pandemic coinciding with lockdown measures a sizeable proportion of Bangladeshi people were physically inactive and reported sedentary behaviors ≥8 h/day. Public campaigns and media-based interventions encouraging home-based physical activities should be promoted to attenuate the impact of lockdown measures during a pandemic.

Social-Ecological Analysis of the Factors Influencing Shanghai Adolescents' Table Tennis Skills: A Cross-Sectional Study

The main purpose of this study was to explore the factors that affect adolescents’ table tennis skills (ATTS) among adolescents in Shanghai from the social ecological perspective, including individual factors, social support, and physical environment. 1,526 students from Shanghai primary and secondary schools were included in this study (age = 12.31 ± 1.32 years). Participants completed a questionnaire based on social ecological theory after taking the ATTS test. A structural equation model was applied to test the relationships among the study variables. The relationship model incorporating individual factors, social support, physical environment, and ATTS test score fit the data well (χ² = 1415.754, χ²/df = 4.96, p < 0.001; CFI = 0.914; IFI = 0.930; NFI = 0.921; RMSEA = 0.032). The investigation results showed that social support and physical environment promote adolescents’ scores on the ATTS test. At all levels of social ecology, individual factors were the most important factors for the improvement of ATTS. The level impacting most significantly on ATTS was individual factors, followed by social support, and, finally, the physical environment. Therefore, cultivating intrinsic interest is an important way to facilitate the continuous activities of adolescents. In addition, friends should support each other, and parents should give adolescents appropriate encouragement regarding table tennis exercise. Schools should provide more table tennis facilities. PE teachers should respect adolescents’ ideas, listen to students’ opinions, and encourage them to participate in table tennis training.

Digital epidemiological and citizen science methodology to capture prospective physical activity in free-living conditions: a SMART Platform study

OBJECTIVES

The purpose of this study was to develop a replicable methodology of mobile ecological momentary assessments (EMAs) to capture prospective physical activity (PA) within free-living social and physical contexts by leveraging citizen-owned smartphones running on both Android and iOS systems.

DESIGN

Data were obtained from the cross-sectional pilots of the SMART Platform, a citizen science and mobile health initiative.

SETTING

The cities of Regina and Saskatoon, Canada.

PARTICIPANTS

538 citizen scientists (≥18 years) provided PA data during eight consecutive days using a custom-built smartphone application, and after applying a rigid inclusion criteria, 89 were included in the final analysis.

OUTCOME MEASURES

EMAs enabled reporting of light, moderate, and vigorous PA, as well as physical and social contexts of PA. Retrospective PA was reported using International Physical Activity Questionnaire (IPAQ). For both measures, PA intensities were categorised into mean minutes of light and moderate-to-vigorous PA per day. Wilcoxon signed ranks tests and Spearman correlation procedures were conducted to compare PA intensities reported via EMAs and IPAQ.

RESULTS

Using EMAs, citizen scientists reported 140.91, 87.16 and 70.38 mean min/day of overall, light and moderate-to-vigorous PA, respectively, whereas using IPAQ they reported 194.39, 116.99 and 98.42 mean min/day of overall, light and moderate-to-vigorous PA, respectively. Overall (ρ=0.414, p<0.001), light (ρ=0.261, p=0.012) and moderate-to-vigorous PA (ρ=0.316, p=0.009) were fairly correlated between EMA and IPAQ. In comparison with EMAs, using IPAQ, citizen scientists reported significantly greater overall PA in active transportation (p=0.002) and recreation, sport and leisure-time domains (p=0.003).

CONCLUSIONS

This digital epidemiological and citizen science methodology adapted mobile EMAs to capture not only prospective PA, but also important physical and social contexts within which individuals accumulate PA. Ubiquitous tools can be leveraged via citizen science to capture accurate active living patterns of large populations in free-living conditions through innovative EMAs.

A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial

Background

Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs.

Objective

The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers.

Methods

A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements.

Results

Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535).

Conclusions

The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample.

Stand Out in Class: restructuring the classroom environment to reduce sitting time - findings from a pilot cluster randomised controlled trial

Background

Excessive sedentary behaviour (sitting) is a risk factor for poor health in children and adults. Incorporating sit-stand desks in the classroom environment has been highlighted as a potential strategy to reduce children’s sitting time. The primary aim of this study was to examine the feasibility of conducting a cluster randomised controlled trial (RCT) of a sit-stand desk intervention within primary school classrooms.

Methods

We conducted a two-armed pilot cluster RCT involving 8 primary schools in Bradford, United Kingdom. Schools were randomised on a 1:1 basis to the intervention or usual practice control arm. All children (aged 9–10 years) in participating classes were eligible to take part. Six sit-stand desks replaced three standard desks (sitting 6 children) in the intervention classrooms for 4.5-months. Teachers were encouraged to use a rotation system to ensure all pupils were exposed to the sit-stand desks for > 1 h/day on average. Trial feasibility outcomes (assessed using quantitative and qualitative measures) included school and participant recruitment and attrition, intervention and outcome measure completion rates, acceptability, and preliminary effectiveness of the intervention for reducing sitting time. A weighted linear regression model compared changes in weekday sitting time (assessed using the activPAL accelerometer) between trial arms.

Results

School and child recruitment rates were 33% (n = 8) and 75% (n = 176). At follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63 to 97%. A preliminary estimate of intervention effectiveness revealed a mean difference in change in sitting of − 30.6 min/day (95% CI: − 56.42 to − 4.84) in favour of the intervention group, after adjusting for baseline sitting and wear time. Qualitative measures revealed the intervention and evaluation procedures were acceptable to teachers and children, except for some problems with activPAL attachment.

Conclusion

This study provides evidence of the acceptability and feasibility of a sit-stand desk intervention and evaluation methods. Preliminary evidence suggests the intervention showed potential in reducing children’s weekday sitting but some adaptations to the desk rotation system are needed to maximize exposure. Lessons learnt from this trial will inform the planning of a definitive trial.

Trial registration

ISRCTN12915848 (registered: 09/11/16).

Literature on peer-based community physical activity programmes for mental health service users: a scoping review

Physical activity is a key determinant of mental health; community programmes aim to increase health and well-being on a community wide scale with emphasis on social interaction. Regular physical activity participation in community settings yields additional social benefits, such as peer support. This scoping review aimed to explore existing literature that has included peer support as a component of community-based physical activity programmes for MHSU. Published literature was examined using electronic databases (SportDiscus, Web of Science, MEDLINE, and PsycINFO), reference lists, and hand searching of journals. Thirteen eligible articles included; adults aged 18 and over, a peer support component, physical activity and/or sport, participants with mental health diagnoses and were community-based. Research published between 2007 and 2019, peer-reviewed and written in English was included. Nine studies found a significant increase in perceived social support, seven studies reported increased mental wellbeing and five studies reported increased physical activity levels. Effectiveness of reviewed programmes were categorised as; overall improvements in physical activity levels, improvements to mental health, exercise related psychosocial benefits, knowledge relating to self-care, and improved social connections. Community-based physical activity programmes produced psychosocial benefits and positive behaviour change for MHSU, warranting greater focus towards implementing effective peer support into community programmes.

An investigation of physical activity among adults in Turkey using the Omaha System

OBJECTIVES

The aim of this study was to investigate the physical activity (PA) and associated factors among insufficiently active adults attending Family Health Centers in Istanbul, Turkey using the Omaha System.

DESIGN AND SAMPLE

This descriptive-correlational study guided by the Ecological Model for Health Promotion used a convenience sample of 335 Turkish adults with insufficient PA behavior defined as an Omaha System PA Behavior rating <4.

MEASUREMENTS

Measures included Omaha System problems; Knowledge, Behavior, and Status ratings; demographics; and ecological factors operationalized with the Omaha System Problem Classification Scheme. Data were analyzed using chi-square, independent t tests, and logistic regression.

RESULTS

Participants were females (76.7%) and males (23.3%) with a mean age of 38.5 years. Almost half (43.6%) engaged in no appropriate PA Behavior. The most common Physiological, Psychosocial, and Environmental domain problem were oral health (61.2%), mental health (21.5%), and neighborhood/workplace safety (41.2%), respectively. Logistic regression revealed marital status, age, sex, and physiological and environmental domain problems significantly predicted PA behavior.

CONCLUSIONS

Interventions tailored to insufficiently active Turkish adults should include assessing for physiological health problems; targeting older, married adults; and advocating for policy change that supports the provision of safe, affordable, accessible, and culturally appropriate places for physical activity.