An Overview of Physical Activity Research Evolution in Africa: The Global Observatory for Physical Activity-GoPA!

OBJECTIVE

To describe the evolution of physical activity (PA) research in Africa, examine income and gender inequalities, and discuss future possibilities.

METHODS

A secondary analyses of the Global Observatory for Physical Activity data on PA research in Africa (1950-2019).

RESULTS

We identified 514 PA articles from 47 African countries in the past 70 years. Majority (83.1%) of the articles were published between 2012 and 2019. Fifteen countries had no publications. Six countries (South Africa [n = 156], Nigeria [n = 85], Ethiopia [n = 44], Ghana [n = 41], Kenya [n = 39], and Cameroon [n = 20]) accounted for about 75% of the publications. Most articles were observational (92.4%), single-country studies (78.4%), with male first (58.4%) and last authors (68%), and were classified as surveillance studies (45.1%). Few studies addressed interventions (5.8%) and policy (3.5%) or used device-based PA measurement (14.0%). The number of articles per country was positively related to human population level (r = .552, P = .000) and gross domestic product % spent on research and development (r = .301, P = .040). The publication rate per 100,000 people was positively related with the human development index (r = .349, P = .016) and negatively with the gender inequality index (r = -.360, P = .019).

CONCLUSIONS

Our results provide an overview and status of PA research in Africa, highlighting country differences and gender inequalities in authorship. The findings may be used to benchmark the evolution of research in the region and to inform areas for improvement. There is an urgent need for more PA interventions and policy studies in Africa.

A systematic review on the effects of non-pharmacological interventions for fatigue among people with upper and/or lower limb osteoarthritis

Objectives

To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over time in OA.

Methods

A review protocol (CRD42020163730) was developed and registered with the PROSPERO database. Included studies comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of conservative interventions on fatigue in people with upper and lower limb OA. Cochrane Collaboration's tool for assessing the risk of bias (ROB-2) was used to assess the quality of evidence of studies. Narrative synthesis was used to summarize the effectiveness of identified fatigue interventions.

Results

Out of 2644 citations identified from databases, 32 reports were included after screening for titles, abstracts and full texts. Of these reports, 30 parallel RCTs, one cluster and one cross-over RCT were included. 13 RCTs were of low ROB, 6 had some concerns and 13 had high ROB. The narrative synthesis identified interventions for fatigue including exercise, activity pacing, cognitive behavioural therapy, telerehabilitation and complementary alternative therapies. Exercise interventions showed the most significant beneficial effects on fatigue.

Conclusions

Diverse interventions for fatigue management among individuals with upper and lower limb OA were identified. Of these, exercise interventions appear to be the most promising with the majority of these interventions favouring fatigue improvement. While cognitive behavioural therapy has limited evidence of beneficial effects, there is insufficient evidence regarding the effectiveness of other identified interventions, including complementary and alternative therapies, and telerehabilitation.

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BACKGROUND

Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

METHODS

We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median).

FINDINGS

From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.

INTERPRETATION

The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBER

NCT06181162.

Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users

BACKGROUND

The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners).

METHODS

Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs.

RESULTS

From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT.

CONCLUSIONS

Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

The role of physical activity in the relationship between exposure to community violence and mental health: A systematic review

Community violence is a global public health problem that is associated with mental health disorders. Physical activity can enhance mental health and may play an important role in the relationship between exposure to community violence and mental health. We systematically reviewed the literature to better understand the potential role of physical activity in this relationship. In this review, we searched the databases PubMed, Embase, Web of Science, Cochrane Central, PsycInfo, and SPORTdiscus, and conducted a grey literature search of one clinical trials registry and four organizations' websites. The review included quantitative observational studies, intervention studies, and qualitative studies published by November 30, 2022 and that involved generally healthy individuals across the lifespan. Eligible studies included measures of community violence, mental health, and physical activity. Five studies met the inclusion criteria for the review. Four studies were conducted in high-income countries, only two minority populations were represented in the studies, and none of the studies included older adults or children. Studies defined and measured community violence, mental health, and physical activity in different ways. In most studies, physical activity was not a primary focus but assessed as one item within a larger construct. The role of physical activity was examined differently across the studies and only one study found a significant role (mediator) of physical activity. This review revealed that few studies have specifically examined physical activity's role in the relationship between exposure to community violence and mental health. Further research is needed involving low-income countries, diverse minority populations, and children.

Global prevalence and gender inequalities in at least 60 min of self-reported moderate-to-vigorous physical activity 1 or more days per week: An analysis with 707,616 adolescents

BACKGROUND

Guidelines recommend that adolescents should accumulate an average of 60 min per day of moderate-to-vigorous physical activity (MVPA). However, using only this cut-off could hide important information. For instance, from a population-level point of view, increasing physical activity for those with no or low physical activity could provide more health benefits than increasing physical activity for those with intermediate levels. Also, including a more sensitive cut-point of ≥1 day per week could be an additional strategy for identifying those with low access/opportunities for physical activity practice. Thus, the current study aims to estimate the prevalence of ≥60 min of MVPA ≥1 days per week among adolescents globally, and to describe any relevant gender inequalities.

METHODS

We used representative datasets from 146 countries/territories collected between 2003 and 2019. MVPA was self-reported. Participants were grouped into younger (≤14 years old) and older (>14 years old) adolescents. Crude Poisson regression models were used to identify the relative differences in ≥60 min of MVPA ≥1 days per week between boys and girls, and random-effects meta-analysis models were used to identify the pooled estimates. Analyses were stratified by country and region.

RESULTS

Approximately 80% of both younger and older adolescents reported ≥60 min of MVPA ≥1 days per week. This prevalence was ≥94% in Europe and Central Asia and North America, while the estimates for the other regions were <77%. The prevalence of ≥60 min of MVPA ≥1 days per week was higher among boys than girls, with the largest differences occurring among the oldest adolescents (PR≤14y: 1.04 (95% confidence interval (95%CI): 1.03‒1.04) vs. PR>14y: 1.09 (95%CI: 1.08‒1.10)).

CONCLUSION

Approximately 8 out of 10 adolescents reported accumulating ≥60 min of MVPA ≥1 day per week, with notable differences between regions. Gender differences were observed in several countries, especially among the oldest adolescents. Priorities for physical activity promotion among adolescents should include increasing access/opportunities for physical activity among those who do not achieve ≥60 min of MVPA ≥1 days per week and reducing gender inequalities.

Neighborhood environment and quality of life among community-living older adults in Nigeria: The moderating effect of physical activity

Understanding how neighborhood environments are related to older adults' quality of life (QoL) and physical activity (PA) is important for public health actions on healthy ageing in sub-Saharan Africa. We examined associations of perceived neighborhood environment attributes with QoL among older adults in Nigeria and investigated the moderating effects of PA on these associations. We conducted a cross-sectional study of 353 older adults (mean age = 68.9 ± 9.1 years) selected from 5 high- and low-income communities in Maiduguri, Nigeria. QoL, attributes of the neighborhood environments and PA were self-reported using validated questionnaires. Multi-level models were used to examine the direct associations between neighborhood environment attributes and each of the four domains of QoL (physical health, psychological health, social relationships, and environmental health), as well as the moderating effects of leisure-time and total PA. Seven of nine neighborhood environment features were positively associated with multiple domains of QoL. Residential density, land-use diversity, land-use mix-access, walking infrastructure, traffic safety and 'overall walkability' were positively related to both or either physical health and environmental health QoL among those who are physically active. In contrast, walking infrastructure, traffic safety, and 'overall walkability' were negatively related to psychological health QoL among those not physically active. Our findings suggest being physically active moderates the association of neighborhood environments with QoL among Nigerian older adults. We suggest that designing age-friendly communities and simultaneously promoting PA may be needed to improve QoL and help prepare the Nigerian society for the predicted increase in the older adult population.

Social isolation is associated with higher leisure-time sedentary behavior and lower physical activity practice: A multi-country analysis of data from 79 countries from the Global School-Based Student Health Survey

AIM

To investigate the association of social isolation with physical activity and leisure-time sedentary behavior among adolescents.

METHODS

We used data from the Global School-based Health Survey, including a representative sample of 296,861 adolescents (11-18y) from 79 countries (48.9% girls, 14.5 ± 1.6 years). Social isolation was estimated by combining the self-reported number of friends and loneliness perception. Physical activity and leisure-time sedentary behavior were assessed through questionnaires. Multinomial logistic regression models were created to analyze the associations of social isolation with physical activity and leisure-time sedentary behavior.

RESULTS

Compared with those practicing ≥60 min of physical activity during 1-4 days/week, social isolation was associated with a higher prevalence of not practicing physical activity (Prevalence ratio [PR]:1.24; 95%CI:1.19-1.29), and a lower prevalence of practicing during ≥5d/wk. (PR:0.91; 95%CI:0.88-0.94). Compared with <4 h/d of leisure-time sedentary behavior, being socially isolated was also associated with a higher prevalence of 4-7 h/d (PR: 1.08; 95%CI:1.03-1.14) and ≥ 8 h/d (PR: 1.24; 95%CI:1.16-1.33) of leisure-time sedentary behavior. Compared with those participants without elevated leisure-time sedentary behavior and with those practicing adequate physical activity, social isolation was independently associated with a higher prevalence of physical inactivity (PR: 1.20; 95%CI: 1.15-1.26) and elevated leisure-time sedentary behavior (PR: 1.21; 95%CI: 1.14-1.30), as well as with both risk factors simultaneously (PR: 1.36; 95%CI: 1.28-1.45).

CONCLUSION

Reducing social isolation could be an important component of future interventions to reduce sedentary behavior and physical inactivity among adolescents.

Top 10 International Priorities for Physical Fitness Research and Surveillance Among Children and Adolescents: A Twin-Panel Delphi Study

BACKGROUND

The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts.

OBJECTIVE

This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents.

METHODS

Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel.

RESULTS

There was strong between-panel agreement (panel 1: r_s = 0.76, p < 0.01; panel 2: r_s = 0.77, p < 0.01) in the priorities identified. The list of the final top 10 priorities included (i) "conduct longitudinal studies to assess changes in fitness and associations with health". This was followed by (ii) "use fitness surveillance to inform decision making", and (iii) "implement regular and consistent international/national fitness surveys using common measures".

CONCLUSIONS

The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond.

What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.

Comparison of exercise and physical activity routine and health status among apparently healthy Nigerian adults before and during COVID-19 lockdown: a self-report by social media users

BACKGROUND

COVID-19 is a pandemic that ravaged the world in manners that were never seen in the recent past, and one of the measures to stem the tide of this ravaging pandemic is a stay-at-home order referred to as lockdown. This study compares the physical activity status and perceived health of Nigerians before and during the lockdown.

RESULTS

Social media platform users (n = 205) were surveyed using a two-part questionnaire. The first part elicited the sociodemographic characteristics of the subject. In the second part, information about their exercise and physical activity, general health, and economic palliatives as offered by the government, non-governmental organizations, and philanthropists were elicited. The frequency of exercise was significantly more (p < 0.05) during the lockdown than before the lockdown. The duration and intensity of the exercise per week were comparable. There was also a negative relationship between the body mass index, frequency, and duration of exercise before and during the lockdown. The subjects perceived their health as worse during (3.70 ± 1.05) the lockdown than before (3.95 ± 0.97) lockdown (Z = - 3.69, p = 0.00).

CONCLUSION

Overall, for these cohorts of social media platform users, lockdown did not adversely affect their exercise routine. It is recommended that there should be specific recommendation on exercise as an important Instrumental Activity of Daily Living [IADL]. Therefore, while this pandemic lockdown lasts and beyond, the safety measures to follow while partaking in this IADL should be included in the public health recommendation.

Physical activity and active transportation behaviour among rural, peri-urban and urban children in Kenya, Mozambique and Nigeria: The PAAT Study

Background

Physical activity (PA) is associated with numerous health benefits among children and youth. However, few studies have examined how active transportation (AT) and device-based measures of PA vary within and between countries in sub-Saharan Africa.

Purpose

This cross-sectional study sought to investigate the prevalence and correlates of AT and device-measured PA among children living in urban, peri-urban and rural areas in three African countries representing Eastern, Western and Southern regions of Africa.

Methods

3,205 participants (53.3% girls; 46.7% boys) aged 10–12 years were recruited in Kenya, Nigeria and Mozambique. Data were collected using a child questionnaire, a parent/guardian questionnaire and PiezoRx® pedometers. ANCOVA and binary logistic regression analyses were used to examine the correlates of AT and PA while controlling for gender, age, parent education and vehicle ownership.

Results

Participants accumulated an average of 45.6±23.5 min/day of moderate-to-vigorous physical activity (MVPA) and 11,215±4,273 steps/day. Kenyan and Mozambican children were significantly more active than their Nigerian counterparts (p<0.001). Only 23% met the MVPA guidelines of 60 min/day. 65.1% of participants engaged in AT to school (and 67.8% for the trip back home) with no gender differences. Living in a rural area, lower parent education, lower vehicle ownership and higher motorcycle ownership were associated with higher odds of AT. Other correlates of AT were country-specific. Girls accumulated less daily MVPA than boys in all countries. MVPA was positively associated with living in less urbanized areas in Nigeria and Mozambique. In Kenya, lower parental education and AT were associated with higher MVPA. Nigerian children’s daily MVPA decreased with age and the number of parent-perceived barriers to AT.

Conclusions

Majority of children engaged in AT, but still failed to meet MVPA recommendations. Most correlates of AT and PA were country-specific, suggesting that strategies to encourage both behaviours should be informed by local evidence.

Prospective Associations of Leisure-Time Physical Activity With Psychological Distress and Well-Being: A 12-Year Cohort Study

OBJECTIVE

This study aimed to investigate the associations of leisure-time physical activity with psychological distress and well-being, and potential mediators.

METHODS

We used data from the 1970 British Cohort Study (n = 5197; 2688 men), including waves 34y (2004), 42y (2012), and 46y (2016). Participants reported leisure-time physical activity frequency and intensity (exposure) at age 34 years (baseline); cognition (vocabulary test), body mass index, disability, mobility and pain perception (potential mediators) at age 42 years; and psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale) at age 46 years. Baseline confounders included sex, country, education, employment status, alcohol use, tobacco smoking, and psychological distress. Main analyses included logistic regression and mediation models.

RESULTS

Higher leisure-time physical activity intensity at baseline was associated with lower psychological distress at 46y (β = -0.038 [95% confidence interval {CI} =-0.069 to -0.007]), but not leisure-time physical activity frequency. Baseline leisure-time physical activity frequency and intensity were associated with higher psychological well-being at 46y (frequency: β = 0.089 [95% CI = 0.002 to 0.176]; intensity: β = 0.262 [95% CI = 0.123 to 0.401]); and total: β = 0.041 [95% CI = 0.013 to 0.069]). Only body mass index at 42y partially mediated the association between leisure-time physical activity frequency (15.7%) and total leisure-time physical activity (6.2%) at 34y, with psychological well-being at 46y.

CONCLUSIONS

Our findings highlight the role of leisure-time physical activity in psychological distress and well-being, with greater effect sizes associated with higher frequency and intensity of leisure-time physical activity. Future interventions should consider examining potential mediators of the association of leisure-time physical activity with psychological well-being, such as body mass index.

Parental-perceived home and neighborhood environmental correlates of accelerometer-measured physical activity among school-going children in Uganda

The benefits of physical activity (PA) on children's health and well-being are well established. However, many children do not meet the PA recommendations, increasing their risk of being overweight, obese, and non-communicable diseases. Environmental characteristics of homes and neighborhoods may constrain a child's ability to engage in PA, but evidence is needed to inform country-specific interventions in understudied low-income countries. This study assessed the associations between parental-perceived home and neighbourhood, built environment characteristics, and moderate-to-vigorous physical activity (MVPA) among children in Kampala city, Uganda. In this cross-sectional study, data were obtained from 256 children (55.5% girls) aged between 10 and 12 years and their parents. Children's MVPA was measured using waist-worn ActiGraph accelerometers. The environments were assessed using a valid self-reported parent survey. Linear regression models with standard errors (clusters) were used to analyze the relationship between environmental variables and children's MVPA. Sex-specific relationships were assessed using sex-stratified models. Play equipment at home (β = -2.37, p <0.001; unexpected direction), residential density (β = 2.70, p<0.05), and crime safety (β = -5.29, p <0.05; unexpected direction) were associated with children's MVPA. The sex-specific analyses revealed more inconsistent patterns of results with a higher perception of land use mix associated with less MVPA in girls (irrespective of school type attended), and higher perceptions of sidewalk infrastructure (β = -12.01, p <0.05) and walking and cycling infrastructure (β = -14.72, p <0.05) associated with less MVPA in girls attending public schools only. A better perception of crime safety was associated with less MVPA among boys and girls attending private schools (β = -3.80, p <0.05). Few environmental characteristics were related to children's MVPA in Uganda, and findings were largely inconsistent, especially among girls. Future studies are needed to understand the ecological determinants of health-related PA behaviors among children in Uganda.

Physical activity behaviours in adolescence: current evidence and opportunities for intervention

Young people aged 10-24 years constitute 24% of the world's population; investing in their health could yield a triple benefit-eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10-14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.

Global prevalence of physical activity for children and adolescents; inconsistencies, research gaps, and recommendations: a narrative review

BACKGROUND

One of the strategic actions identified in the Global Action Plan on Physical Activity (PA) 2018-2030 is the enhancement of data systems and capabilities at national levels to support regular population surveillance of PA. Although national and international standardized surveillance of PA among children and adolescents has increased in recent years, challenges for the global surveillance of PA persist. The aims of this paper were to: (i) review, compare, and discuss the methodological inconsistencies in children and adolescents' physical activity prevalence estimates from intercontinental physical activity surveillance initiatives; (ii) identify methodological limitations, surveillance and research gaps.

METHODS

Intercontinental physical activity surveillance initiatives for children and adolescents were identified by experts and through non-systematic literature searches. Prevalence of meeting PA guidelines by country, gender, and age were extracted when available. A tool was created to assess the quality of the included initiatives. Methods and PA prevalence were compared across data/studies and against the methodological/validity/translation differences.

RESULTS

Eight intercontinental initiatives were identified as meeting the selection criteria. Methods and PA definition inconsistencies across and within included initiatives were observed, resulting in different estimated national prevalence of PA, and initiatives contradicting each other's cross-country comparisons. Three findings were consistent across all eight initiatives: insufficient level of PA of children and adolescents across the world; lower levels of PA among girls; and attenuation of PA levels with age. Resource-limited countries, younger children, children and adolescents not attending school, with disability or chronic conditions, and from rural areas were generally under/not represented.

CONCLUSIONS

There are substantial inconsistencies across/within included initiatives, resulting in varying estimates of the PA situation of children and adolescents at the global, regional and national levels. The development of a new PA measurement instrument that would be globally accepted and harmonized is a global health priority to help improve the accuracy and reliability of global surveillance.

Physical activity can attenuate, but not eliminate, the negative relationships of high TV viewing with some chronic diseases: findings from a cohort of 60 202 Brazilian adults

BACKGROUND

This study examined the joint associations of leisure time physical activity and television (TV) viewing time with the prevalence of chronic diseases among Brazilian adults.

METHODS

Data from the Brazilian Health Survey, a nationally representative survey conducted in 2013 (n = 60 202; ≥18 years), were used. Time spent in TV viewing and leisure physical activity, physician diagnoses of diabetes, hypertension and heart disease and information on co-variables (chronological age, education, ethnicity, candies/sweets consumption, sodium intake and tobacco smoking) were collected via interview. Descriptive statistics (mean and 95% confidence interval) and logistic regression models were used for etiological analyses.

RESULTS

Physical activity attenuated but did not eliminate the risk associated with high TV viewing for at least one chronic disease in the general population [odds ratio [OR]: 1.29 (1.11-1.50)] and among women [OR: 1.31 (1.09-1.60)], adults [OR: 1.24 (1.05-1.46)] and older adults [OR: 1.63 (1.05-2.53)]. On the other hand, physical activity eliminated the risk associated with high TV viewing for at least one chronic disease among men [OR: 1.24 (0.98-1.58)].

CONCLUSIONS

We conclude that physical activity can attenuate but not eliminate the negative effects of high TV viewing on chronic disease among subgroups of Brazilian adults.

Association of mentally-passive and mentally-active sedentary behaviors with device-measured bouts and breaks of sedentary time in adolescents

Background: Our aim was to analyze the association of self-reported mentally-passive and mentally-active sedentary behaviors with different patterns (bouts and breaks) of device-measured sedentary time in adolescents.

Methods: This was a cross-sectional study conducted among 375 adolescents (177 boys) aged 1015 years. Total time, bouts and breaks of sedentary time were measured through accelerometers. Self-reported sedentary behavior in different activities was summed and divided into mentally-active (playing electronic games, studying and reading) and mentally-passive (watching TV, watching DVD, and using computer for leisure). Bayesian linear regression models were used for association analyses.

Results: Only mentally-passive sedentary behaviors were positively associated with longer bouts [1-4 minutes: mean posterior distribution: -0.431 (95% credible interval: -0.745 to -0.114); =15 minutes: 0.641 (0.122 to 1.222)] and lower number of breaks [-0.138 (-0.228 to -0.044)] of device-measured sedentary time.

Conclusion: Self-reported mentally-passive sedentary behaviors are associated with longer bouts and lower breaks of device-measured sedentary time.

International Physical Activity and Built Environment Study of adolescents: IPEN Adolescent design, protocol and measures

INTRODUCTION

Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese).

METHODS AND ANALYSIS

The IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11-19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status.

ETHICS AND DISSEMINATION

Ethical approval was received from each study site's Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

Independent and combined associations of sugar-sweetened beverage consumption, TV viewing, and physical activity with severe depressive symptoms among 59,402 adults

Objective:

Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association.

Methods:

We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses.

Results:

The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association.

Conclusion:

Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.

Body mass index trajectories and noncommunicable diseases in women: The role of leisure time physical activity

OBJECTIVE

To analyze the association between body mass index trajectories and non-communicable diseases (NCDs) in women, and the interaction effects of leisure time physical activity on this relationship.

METHODS

Sample was composed by 15 628 women (≥30 years old) who performed objective measurement of body mass, height, and blood pressure in the 2013 Brazilian Health Survey (2013). Information regarding the body mass at 20 years old, current type 2 diabetes (T2DM), dyslipidemia diagnosis, and leisure time physical activity were self-reported by the participants. Socio-demographic and behavioral covariates were considered. Logistic regression models were used for the statistical analysis.

RESULTS

Those who were obese in both moments and women who become obese showed similar high risk, however, the prevalence of NCDs among women who were no longer obese was similar to the consistently non-obese. Leisure time physical activity attenuated the general deleterious effect of obesity, especially among the consistently obese women for dyslipidemia (inactive: OR: 2.02 [95%CI: 1.69-2.43] vs active: OR: 1.05 [95%CI: 0.55-1.99]), T2DM (inactive: OR: 3.84 [95%CI: 2.72-5.43] vs active: OR: 4.38 [95%CI: 1.49-12.86]) and high blood pressure (inactive: OR: 2.00 [95%CI: 1.56-2.57] vs active: OR: 1.15 [95%CI: 0.57-2.52]).

CONCLUSIONS

Changes in body mass index appear to be sensitive to detecting the risk of NCDs over lifespan. In addition, leisure time physical activity attenuates the negative effects of obesity on NCDs, but this appears more important for the consistently non-obese women.

Association between physical activity and alcohol consumption: sociodemographic and behavioral patterns in Brazilian adults

BACKGROUND

Our aim was to investigate the association between physical activity and alcohol consumption, as well as the sociodemographic and behavioral patterns of this association in a representative sample of Brazilian adults.

METHODS

Data from the Brazilian Health Survey (PNS), a nationally representative survey conducted in 2013 (n = 60 202; age≥18 years), were used. Time spent in leisure physical activity, alcohol consumption as well as sociodemographic (chronological age, educational status and skin color) and associated behavioral factors (TV viewing and tobacco smoking) were collected via interview. Logistic regression models were used for the main analyses.

RESULTS

Prevalence of weekly and almost daily alcohol consumption were 29.5% and 6.7% for men and 12.0% and 1.0% for women respectively. Adults with weekly alcohol consumption were more likely to be classified as physically active [young: men=OR:1.20 (CI 95%:1.02-1.39), women= OR:2.33 (CI 95%:1.92-2.82); middle-aged: men= OR:1.46 (CI 95%: 1.17-1.82), women= OR:1.75 (CI 95%:1.38-2.22); older: men= OR:1.83 (CI 95%:1.27-2.66), women= OR:2.11 (CI 95%: s1.26-3.52)], when compared to adults with no alcohol consumption. Almost daily alcohol consumption was associated with lower physical activity among young and middle-aged adults but with higher physical activity among older adults of both sexes and young women.

CONCLUSIONS

Weekly alcohol consumption was associated with a higher level of physical activity among young, middle aged and older adults.

Does physical activity influence the association between depressive symptoms and low-grade inflammation in adults? A study of 8,048 adults

This study investigated whether physical activity (PA) influences the association between depression risk and low-grade inflammation. This was a cross-sectional study including 8,048 adults (18-59y). Depression symptoms were evaluated with the Beck depression inventory (BDI) and physical activity through the international physical activity questionnaire. Adults with infectious and inflammatory diseases were excluded. Blood samples were collected, including high sensitivity C-reactive protein (CRP), a marker of low-grade inflammation when ≥3mg/L. Additional measures of LDL-C, HDL-C, triglycerides and fasting glucose were also determined. Sex, chronological age, tobacco smoking, alcohol drinking, body mass index, dyslipidemia, high blood pressure and fasting glucose were used as covariates. Mediation models were conducted using the procedures of Karlson Holm Breen. Adults with elevated CRP (≥3mg/L) compared to those with low CRP (<3mg/L) presented with higher BDI scores [8.5%(95%CI:7.2%-10.1%) vs. 5.8%(95%CI:5.2-6.4)] as well as higher prevalence of physical inactivity 67.4% (95%CI:64.9-69.9) vs. 59.7% (95%CI:58.4-60.9). The prevalence of elevated CRP was highest in physically inactive adults with greater depression risk. Models revealed that physical activity risk explained 13% of the association between depression risk and elevated CRP (p=0.035), independently of potential confounders. Physical activity may reduce the association between depression symptoms and elevated CRP. Future longitudinal research is required to determine the directionality of the relationships observed.

Joint association of ultra-processed food and sedentary behavior with anxiety-induced sleep disturbance among Brazilian adolescents

AIMS

We analyzed the joint association of high ultra-processed food ingestion and sedentary behavior (SB) with anxiety-induced sleep disturbance among Brazilian adolescents.

METHODS

Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,648) were used. Self-reported anxiety-induced sleep disturbance, SB (TV viewing and total sitting time), and frequency of ingestion of different ultra-processed foods were collected. Age, ethnicity, type of city (capital or interior), region of the country, and habitual physical activity (global scholar survey questionnaire) were covariates. Logistic regression analyses were conducted to assess the associations.

RESULTS

High ultra-processed food ingestion plus low SB [boys:OR:1.44(99%CI:1.16-1.79), girls:OR:1.41(99%CI:1.22-1.63)] were risk factors for anxiety-induced sleep disturbance. The highest risk of anxiety-induced sleep disturbance was observed among those who joint high ultra-processed food ingestion with high SB [boys:OR:1.85(99%CI:1.46-2.35), girls:OR:1.62(99%CI:1.39-1.89)]. In addition, the interaction of high ultra-processed food ingestion with TV-viewing substantially increased the odds of anxiety-induced sleep disturbance [boys:OR:2.03(99%CI:1.61-2.56), girls:OR:2.04(99%CI:1.76-2.36)].

CONCLUSIONS

Both the high consumption of ultra-processed foods and SB (especially TV-viewing) appear to be independently associated with anxiety-induced sleep disturbance in both sexes. However, the co-occurrence of both negative lifestyle behaviors is associated with a substantial increase in the risk of anxiety-induced sleep disturbance. Future longitudinal research is required to confirm/refute our findings and explore potential mechanisms.

Lifestyle behaviors among 4,343 Brazilian adults with severe mental illness and 55,859 general population controls: data from the Brazilian National Health Survey

Objective:

To analyze the association between severe mental illnesses and health behaviors among Brazilian adults.

Methods:

We used data from the Brazilian National Health Survey, a large nationally representative cross-sectional study conducted in 2013 among 60,202 adults (≥ 18 years). Clinical diagnoses (major depressive disorder, bipolar disorder and schizophrenia), lifestyle behaviors (leisure-time physical activity, TV viewing, tobacco use and the consumption of alcohol, sweets, and soft drinks) and potential confounders (chronological age, race, educational and employment status) were self-reported. Logistic regression models were used to examine the associations between severe mental illness and lifestyle behaviors, adjusting for confounders.

Results:

Schizophrenia (n=41) was associated with lower odds of physical activity (OR 0.08 [95%CI 0.01-0.58]). Major depressive disorder (n=4,014) was associated with higher odds of TV viewing (OR 1.34 [95%CI 1.12-1.61]), tobacco use (OR 1.37 (95%CI 1.18-1.58]), consumption of sweets (OR 1.34 (95%CI 1.15-1.55]) and consumption of soft drinks (OR 1.24 (95%CI 1.06-1.45]). There were no significant associations between bipolar disorder (n=47) and any lifestyle behaviors.

Conclusions:

Schizophrenia was associated with lower physical activity, while major depressive disorder was associated with increased TV viewing, tobacco use, and consumption of sweets and soft drinks. These findings reinforce the need for prevention and treatment interventions that focus on people with severe mental illness in Brazil.

Development and validation of the neighborhood environment walkability scale for youth across six continents

BACKGROUND

The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents' physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability.

METHODS

Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status.

RESULTS

Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity.

CONCLUSIONS

A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Potential influence of physical, psychological and lifestyle factors on the association between television viewing and depressive symptoms: A cross-sectional study

OBJECTIVE

To investigate the potential influence of physical, psychological, and lifestyle factors on the association between TV-viewing and depressive symptoms among Brazilian adults.

METHODS

We used cross-sectional data from the Brazilian National Survey, conducted in 2013 with 60,202 adults (≥18 years). Information regarding exposure (TV-viewing), potential influencing factors (multimorbidity, mobility, self-rated health, tobacco use, alcohol consumption, sugar consumption, and physical activity) as well as elevated depressive symptoms (through PHQ-9 - score > 9) (outcome) was collected via interview-administered questionnaires. Data on covariates were self-reported. Body mass index was estimated through the assessment of body mass and stature. Mediation models were estimated through the Karlson-Holm-Breen method.

RESULTS

Individuals who reported >5 h/d of TV viewing showed a higher prevalence of depressive symptoms than those with <5 h/d of TV viewing [8.1%(99%CI:7.6%-8.6%) vs 14.2%(99%CI:12.2%-16.6%)]. The association between TV-viewing and depressive symptoms was influenced by tobacco use (Overall: 7.22%; men: 4.46%, women: 8.59%), physical activity (men: 3.99%, women: 2.28%), mobility (overall: 11.31%, men: 10.85%, women: 11.03%), and multimorbidity (overall: 9.11%, men: 11.6%, women: 6.03%). Poor self-rated health influenced the association between TV-viewing and elevated depressive symptoms only among men (15.55%). Similarly, the association between >4 h/d of TV viewing and depressive symptoms was influenced by tobacco use (men: 6.8%, women: 11.7%), physical activity for women (5.5%), self-rated health for men (14.7%), mobility (men: 8.7%, women: 17.0%), and multimorbidity (men: 9.6%, women: 12.3%).

CONCLUSIONS

Tobacco use, physical activity, mobility, multimorbidity, and self-rated health (men) mediate the relationship between high TV-viewing and elevated depressive symptoms. Longitudinal research is required to confirm/refute our data which may also be useful to contribute to public health interventions.

Relationship between Physical Activity and Health Related Quality of Life among Pregnant Women

The study aimed to investigate the association between health-related quality of life (HQoL) and physical activity (PA) among pregnant women. Sample of pregnant women (N= 398; mean age=27.86±5.15 years) were surveyed using the Pregnancy Physical Activity and Health Related Quality of Life (SF 12) Questionnaires. Spearman correlation coefficient and logistic regression analyses were used to determine the bivariate relationship and association between HQoL and PA intensities and domain respectively. Overall, sedentary behaviour was positively albeit tenuously related to HQoL (r=0.111, P <0.01) whereas sport/exercise was the only domain of PA tenuously associated with the Physical health of HQoL (r=0.142, p <0.01). Also, pregnant women with sufficient PA were 4 times likely to report good quality of life in physical component not in the mental component of HQoL (OR: 4.33, 95% CI: 1.36-13.80). In conclusion, sports/exercise may be an important domain of PA to target when delivering interventions to improve the physical wellbeing among pregnant women in Maiduguri, Nigeria.

Associations of Neighborhood Walkability with Sedentary Time in Nigerian Older Adults

Previous studies have investigated the potential role of neighborhood walkability in reducing sedentary behavior. However, the majority of this research has been conducted in adults and Western developed countries. The purpose of the present study was to examine associations of neighborhood environmental attributes with sedentary time among older adults in Nigeria. Data from 353 randomly-selected community-dwelling older adults (60 years and above) in Maiduguri, Nigeria were analyzed. Perceived attributes of neighborhood environments and self-reported sedentary time were assessed using Nigerian-validated and reliable measures. Outcomes were weekly minutes of total sedentary time, minutes of sitting on a typical weekday, and minutes of sitting on a typical weekend day. In multivariate regression analyses, higher walkability index, proximity to destinations, access to services, traffic safety, and safety from crime were associated with less total sedentary time and sedentary time on both a weekday and a weekend day. Moderation analysis showed that only in men was higher walking infrastructure and safety found to be associated with less sedentary time, and higher street connectivity was associated with more sedentary time. The findings suggest that improving neighborhood walkability may be a mechanism for reducing sedentary time among older adults in Nigeria.

Learning Styles of Physiotherapy and Medical Students in a Nigerian University

BACKGROUND

Knowledge of students learning style is important in order for an instructor to be able to determine and select the appropriate teaching techniques for effectiveness and maximized student learning during a class session.

OBJECTIVES

This study was aimed at exploring the learning preferences of physiotherapy and medical students in a regional university in Nigeria.

METHODS

A sample of 263 undergraduate physiotherapy and medical students in the clinical phase of their studies at the University of Maiduguri participated in this cross-sectional survey study. The participants completed a two part question-naire. Part I of the questionnaire elicits sociodemographic information such as age, gender and programme and level of study, while part II consists of a 24-item self-administered Learning Style Inventory that elicited information on the students' preferences on learning their subjects.

RESULTS

These cohorts of medical and physiotherapy students were evenly divided between visual and auditory learning preferences. While for the medical students, the males tend to be visual learners more frequently than their female counterparts, gender difference in types of learning preference was not observed for the physiotherapy students.

CONCLUSION

This study affirms the heterogeneity in students' learning preferences, and also suggests the need for instructors in health disciplines to always consider blending appropriate voice and audios with pictures, photos and visual effects in other to maximize students learning especially during teaching sessions.

Association between adolescent motherhood and maternal and child health indices in Maiduguri, Nigeria: a community-based cross-sectional study

INTRODUCTION

Adolescent motherhood (childbearing below 18 years of age) is a major global health and social problem. Understanding the impact of early motherhood on maternal and child health indices is important to community and population health promotion in developing countries. This study examined the association between adolescent motherhood and maternal and child health indices in Maiduguri, Nigeria.

METHODS

A cross-sectional design method was used to recruit 220 mothers (age=14-25 years) from four communities in the city of Maiduguri, Northeastern Nigeria. Participants were surveyed using a self-developed interviewer-administered questionnaire that assesses maternal and child health indices and sociodemographic characteristics. Logistic regression analysis was used to compute adjusted OR and 95% CI of the associations between motherhood in adolescence (mothers below 18 years old) and maternal and child health indices.

RESULTS

Compared to adult mothers, adolescent mothers were more likely to experience fistula (OR=5.01, 95% CI=3.01 to 14.27), to have postpartum haemorrhage (OR=6.83, 95% CI=2.93 to 15.92), to have sexually transmitted infections (OR=6.29, 95% CI=2.26 to 17.51) and to lose a child within 5 years of birth (OR=3.52, 95% CI=1.07 to 11.60). Children born to adolescent mothers were less likely to have normal weight at birth (OR=0.34, CI=0.15 to 0.73) than those born to adult mothers.

CONCLUSION

Adolescent motherhood was associated with negative maternal and child health indices. The findings can be used by public health professionals including physiotherapists in this role to inform effective primary healthcare practice and community health advocacy to improve maternal and child health indices among adolescent mothers in Maiduguri. Future studies are needed to confirm the evidence at the regional or national level including the rural population in Nigeria.

Associations between TV viewing, sitting time, physical activity and insomnia among 100,839 Brazilian adolescents

Our aim was to examine the relationship between insomnia and levels of physical activity (PA) and time spent sitting and TV viewing among Brazilian adolescents. Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,839) were used. Self-reported insomnia, TV viewing, sitting time and total PA (adapted International PA Questionnaire) were collected. Chronological age, race, type of city (capital or interior) country region, goodies ingestion and ultra-processed foods ingestion were covariates. Logistic regression analyses were conducted to assess the associations. A higher sitting time and TV viewing (≥8 h/day) was associated with a higher risk of insomnia among boys [sitting time: OR = 2.39 (95%CI = 1.88-3.04); TV:OR = 2.49(95%CI = 1.92-3.22) and girls [sitting time: OR = 2.17(95%CI = 1.84-2.57; TV:OR = 1.72(95%CI = 1.44-2.04)]. More than 4 h of sitting time per day was associated with higher risk of insomnia in adolescents who comply [boys: OR = 1.43(95%CI = 1.19-1.73); girls: OR = 1.66(95%CI = 1.41-1.94)] and who do not comply with the 300 min/week of physical activity recommendation [boys = OR = 1.35(95%CI = 1.13-1.60); girls: OR = 1.38(95%CI = 1.20-1.57)]. Our data suggest that higher levels of TV viewing or sitting are associated with sleep difficulties in this large cohort of adolescents, irrespective of their physical activity behavior.

Associations between TV viewing and depressive symptoms among 60,202 Brazilian adults: The Brazilian national health survey

BACKGROUND

Our aim was to examine associations between depression and time spent in TV viewing in a representative sample of Brazilian adults.

METHODS

Data from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS in Portuguese) (n =60,202; ≥18 years) were used. Time spent TV viewing (h/day) was elicited via interview. Depression was evaluated through the Patient Health Questionnaire-9. Chronological age, educational status, employment status, alcohol use, tobacco smoking and body mass index were covariates. Descriptive statistics (mean and 95% confidence interval) and adjusted logistic regression models were applied.

RESULTS

Five or more hours as well as less than 1 h of TV viewing was associated with increased depression (men: <1 h OR = 1.89, 95%CI = 1.40-2.54; ≥5 h OR = 2.69, 95%CI = 1.88-3.83; women: <1 h OR = 1.50, 95%CI = 1.25-1.81; ≥5 h OR = 1.65, 95%CI = 1.35-2.03) when compared to 2-2.99 h of TV viewing.

CONCLUSION

More than 5 h/day seems to be associated with a higher risk for depression among Brazilian adults (except for older adults). Less than 1 h TV viewing might be a measure-of-proxy for a lower socio-economic status, which is a known risk factor for depression.

Relationship of Parental and Adolescents' Screen Time to Self-Rated Health: A Structural Equation Modeling

AIM

To investigate the association of parental and adolescents' screen time with self-rated health and to examine the mediating effects of psychosocial factors (social relationships and distress) on this association.

METHOD

A cross-sectional study was conducted among 984 Brazilian adolescents (10- to 17-year-olds). Self-rated health, screen time (adolescents and parental), and perception of social relationships and distress were evaluated through self-report questionnaires. Structural equation modeling was adopted to investigate the pathways of the relationship between adolescents' screen time and self-rated health.

RESULTS

Adolescents' screen time was directly and negatively related to self-rated health only in boys ( r = -0.158, p = .015). In girls, screen time was related to self-rated health through distress ( r = -0.188, p = .007) and social relationships ( r = 0.176, p = .008). The models fit was adequate (χ²/ df ≤ 3.0, root mean square error of approximation <0.08, comparative fit index >0.90, and Tucker-Lewis Index >0.90).

CONCLUSIONS

Higher screen time was associated with poor self-rated health in boys, while in girls, psychosocial factors mediated the adverse relationships between screen time and self-rated health.

Neighborhood environmental factors are related to health-enhancing physical activity and walking among community dwelling older adults in Nigeria

Introduction: Health promotion strategies grounded by evidence-based determinants of physical activity constitute an important focus of physiotherapy practice in the twenty-first century. This study investigated associations between neighborhood environmental factors and health-related moderate-to-vigorous physical activity (MVPA) and walking for transportation and recreation among community dwelling Nigerian older adults. Methods: A representative sample of 353 Nigerian older adults (age = 68.9 ± 9.13 years) in a cross-sectional survey provided self-reported min/week of MVPA and walking for transportation and recreation and perceived neighborhood environmental factors. Results: In multilevel linear regression analyses, proximity of destinations (β = 3.291; CI = 0.392, 6.191), access to services and places (β = 4.417; CI = 0.995, 7.838), esthetics (β = 3.603; CI = 0.617, 6.590), traffic safety (β = 5.685; CI = 3.334, 8.036), and safety from crime (β = 1.717; CI = 0.466, 2.968) were related to more MVPA. Also, proximity of destinations (β = 1.656; CI = 0.022, 3.291) and safety from crime (β = 2.205; CI = 0.018, 4.579) were related to more transport walking. Access to services and places (β = 2.086; CI = 0.713, 3.459) and walking infrastructure and safety (β = 1.741; CI = 0.199, 3.282) were related to more recreational walking. Conclusions: Six of eight supportive environmental factors were associated with more physical activity among community dwelling older Nigerian adults. Policy makers including physiotherapists in this role can use the evidence to inform community-based physical activity and health promotion programs for older adults in Nigeria.

Patterns of objectively assessed physical activity and sedentary time: Are Nigerian health professional students complying with public health guidelines?

BACKGROUND

Understanding patterns of physical activity and sedentary time is important to effective population-wide primary prevention and control of non-communicable diseases. This study examined the patterns of objectively assessed physical activity and sedentary time, and the prevalence of compliance with physical activity guidelines according to different public health recommendations in a sub-population of health professional students in Nigeria.

METHODS

A cross-sectional study was conducted among 102 health professional students (age = 19-34 years old, 43.1% women) of the University of Maiduguri, Nigeria. Participants wore Actigraph accelerometers on their waist for minimum of 5 days/week to objectively measure intensity and duration of physical activity and sedentary time. Prevalence and demographic patterns of physical activity and sedentary time were examined using descriptive and inferential statistics.

RESULTS

The students spent most time in sedentary activity (458.6 ± minutes/day, about 61% of daily time) and the least in vigorous-intensity activity (2.1 ± 4.4 minutes/day, about 0.3% of daily time). Sedentary time was higher among older than younger students (P<0.038) and among medical laboratory science students than physiotherapy and nursing students (P = 0.046). Total physical activity was higher among nursing and medical students than medical laboratory science students (P = 0.041). Although, 85.3% of the students engaged in 150 minutes/week of moderate-to-vigorous physical activity, only 2.9% met the guideline of 75 minutes/week of vigorous intensity activity.

CONCLUSIONS

Prevalence of sedentary time was high while that of vigorous-intensity activity was very low among health professional students in Nigeria. Compliance with physical activity guidelines was mainly through accumulation of moderate intensity activity. The results suggest that age and academic programme may influence physical activity level and sedentary behaviour of health professional students in Nigeria. These findings provide preliminary evidence that could be used to inform the needs to develop interventions to improve and support active lifestyle behaviour among students in Nigerian universities.

Correlates of Agreement between Accelerometry and Self-reported Physical Activity

Supplemental digital content is available in the text.

Purpose

Understanding factors that influence accurate assessment of physical activity (PA) and sedentary behavior (SB) is important to measurement development, epidemiologic studies, and interventions. This study examined agreement between self-reported (International Physical Activity Questionnaire—Long Form [IPAQ-LF]) and accelerometry-based estimates of PA and SB across six countries and identified correlates of between-method agreement.

Methods

Self-report and objective (accelerometry-based) PA and SB data were collected in 2002–2011 from 3865 adult participants in eight cities from six countries (Belgium, Czech Republic, Denmark, Spain, United Kingdom, and United States). Between-method relative agreement (correlation) and absolute disagreement (mean difference between conceptually and intensity-matched IPAQ-LF and accelerometry-based PA and SB variables) were estimated. Also, sociodemographic characteristics and PA patterns were examined as correlates of between-method agreement.

Results

Observed relative agreement (relationships of IPAQ-LF with accelerometry-based PA and SB variables) was small to moderate (r = 0.05–0.37) and was moderated by sociodemographic (age, sex, weight status, and education) and behavioral (PA-type) factors. The absolute disagreement was large, with participants self-reporting higher PA intensity and total time in moderate-to-vigorous-intensity PA than accelerometry. Also, self-reported sitting time was lower than accelerometry-based sedentary behavior. After adjusting for sociodemographic and behavioral factors, the absolute disagreement between pairs of IPAQ-LF and accelerometry-based PA variables remained significantly different across cities/countries.

Conclusions

Present findings suggest systematic cultural and/or linguistic and sociodemographic differences in absolute agreement between the IPAQ-LF and the accelerometry-based PA and SB variables. These results have implications for the interpretation of international PA and SB data and correlate/determinant studies. They call for further efforts to improve such measures.

Physical Fitness, Physical Activity, Sedentary Behavior, or Diet-What Are the Correlates of Obesity in Polish School Children?

There is substantial evidence of rising prevalence of overweight and obesity and its co-morbidities among children in western-high income developed countries. In the European Union, the prevalence of overweight and obesity is increasing fastest among Polish children. Yet, there is paucity of evidence on the relationship of behavioral factors with body weight status of children in Poland. This study examined the association of obesity with physical fitness, physical activity, sedentary behavior and diet among Polish children. A total of 641 children (10-15 years) recruited from the Lower Silesia region of Poland participated in this cross-sectional study. Participants' anthropometrics, physical fitness, physical activity, sedentary behavior and dietary intake were assessed. Outcome variables were weight categories (according to body mass index [BMI], waist-to-hip ratio [WHR], and percentage body fat [% BF]). The strongest negative correlation was found between VO₂max and %BF (r = -0.39, p <0.05). Significant negative correlation was also found between VO₂max and weight categories (r = -0.15). Results of the multinomial logit analysis showed that VO₂max increased in groups of overweight, normal weight and underweight children by 13%, 26% and 19%, respectively as compared to the group of obese children. VO₂max and weight and obesity indices were strongly correlated in both gender and age groups. Education and intervention programs to increase physical fitness (VO₂max) through aerobic training are recommended for Physical Education teachers, parents and children in order to reduce the rate of overweight and obesity among children in the Lower Silesia region of Poland.

A survey of physicians and physiotherapists on physical activity promotion in Nigeria

Background

Effective control of non-communicable diseases and promotion of population-wide physical activity participation require the active engagement of health professionals. Physiotherapists and physicians, as part of their practice, routinely screen and assess physical activity status, and recommend health enhancing physical activity participation for their patients. This study aims to compare Nigerian physiotherapists and physicians’ knowledge of physical activity message, role perception and confidence, perceived feasibility and barriers, and overall disposition to promoting physical activity in their practice.

Methods

A total of 153 physicians and 94 physiotherapists recruited from 10 government hospitals in five states in Northern Nigeria completed a standardized physical activity promotion questionnaire that elicited information on the knowledge of physical activity, role perception and confidence, feasibility, and barriers to physical activity promotion. Descriptive and inferential statistics were used to analyze the data.

Results

The physiotherapists and physicians were fairly knowledgeable on physical activity message (14.2 ± 2.1/20), reported minimal or little barrier to physical activity promotion (23.7 ± 3.1/30), perceived physical activity promotion as their role (13.0 ± 1.8/15), were confident in their ability to discuss and recommend physical activity promotion (7.6 ± 1.6/10) and believed promoting physical activity was feasible for them (15.6 ± 2.6/20). However, over 40% of the physiotherapists and physicians do not know the correct dosage of physical activity that could confer health benefits to patients. The physicians showed better overall disposition to physical activity promotion than the physiotherapists (P = 0.048), but more physiotherapists than the physicians believed ‘it is part of their role to suggest to patients to increase their daily physical activity’ (95.7% vs 88.2%, P = 0.043) and were more ‘confident in suggesting specific physical activity programs for their patients’ (87.2% vs 64.5%, P < 0.001).

Conclusion

Physiotherapists and physicians in Nigeria demonstrated good disposition to promoting physical activity but many of them have knowledge deficits on the correct dosage required for better health for their patients. These health professionals can serve as good advocates for physical activity promotion in Nigeria, but many of them may require knowledge update on health enhancing physical activity for effective health promotion and primary prevention of non-communicable diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s40945-017-0034-8) contains supplementary material, which is available to authorized users.

Construct Validity of the Neighborhood Environment Walkability Scale for Africa

PURPOSE

The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity-related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries.

METHODS

NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18-85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire.

RESULTS

The overall "walkability" index had a positive relationship with both walking for transportation (η = 0.020, P = 0.005) and recreation (η = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η = 0.020, P = 0.006 and η = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η = 0.016, P = 0.015), road/path connectivity (η = 0.025, P = 0.002), path infrastructure (η = 0.021, P = 0.005), and overall places for walking and cycling (η = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda.

CONCLUSIONS

Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.