Parental Travel Behaviors and Children's Independent Mobility: A MultiSite Study

PURPOSE

Children who are allowed greater independent mobility (IM) are more physically active. This study investigated associations between parents' current travel mode to work, their own IM and school travel mode as a child, and their child's IM.

METHODS

Children in grades 4 to 6 (n = 1699) were recruited from urban, suburban, and rural schools in Vancouver, Ottawa, and Trois-Rivières. Parents reported their current travel mode to work, IM, and school travel mode as a child. Children self-reported their IM using Hillman's 6 mobility licenses. Multiple imputation was performed to replace missing data. Gender-stratified generalized linear mixed models were adjusted for child age, parent gender, urbanization, and socioeconomic status.

RESULTS

The older a parent was allowed to travel alone as a child, the less IM their child had (boys: β = -0.09, 95% confidence interval [CI], -0.13 to -0.04; girls: β = -0.09, 95% CI, -0.13 to -0.06). Girls whose parents biked to work (β = 0.45, 95% CI, 0.06-0.83) or lived in Trois-Rivières versus other sites (β = 0.82, 95% CI, -0.43 to 1.21) had higher IM. IM increased with each year of age (boys: β = 0.46, CI, 0.34-0.58; girls: β = 0.38, 95% CI, 0.28-0.48).

CONCLUSION

Parents who experienced IM later may be more restrictive of their child's IM. This may help explain the intergenerational decline in children's IM.

Children's Independent Mobility, School Travel, and the Surrounding Neighborhood

INTRODUCTION

Children's active travel to and from school (AST) and children's independent mobility (CIM) are consistently positively associated with physical activity (PA); however, few researchers have investigated associations between objective measures of the environment and indicators of AST and CIM in national samples.

METHODS

A national sample of 2,067 Canadian parents of 7- to 12-year-old children was recruited in December 2020. Regression analyses were used in 2023 to assess the association between geographic information system measures of park density, blue space, population density, greenspace, intersection density, and CIM and AST to and from school.

RESULTS

Children in areas with high versus low park density (>0.025 vs. ≤0.025) had higher odds of travel to school via active modes (OR: 1.47 [1.14, 1.91], p=0.003). Children in neighborhoods in the highest quartile for neighborhood greenspace (Normalized Difference Vegetation Index) were more likely to travel to home actively than those in areas of lower greenspace (OR: 1.70 [1.18, 2.45], p=0.004). On average, children living in areas in the highest versus the lowest quartile for intersection density were more likely to engage in AST to (OR: 2.43 [1.58, 3.75], p<0.001) and from (OR: 2.77 [1.80, 4.29], p<0.001) school.

CONCLUSIONS

The observed associations underscore a need for city planners and policymakers to ensure sufficient access to parks and neighborhood greenspace, especially if findings are confirmed in longitudinal studies. More research is needed to investigate the role of intersection density in supporting AST and CIM.

Correlates of Physical Activity in Children from Families Speaking Non-official Languages at Home: a Multi-site Canadian Study

BACKGROUND

Children from families speaking a non-official language at home may be particularly at risk for low physical activity (PA), underscoring a need to investigate correlates of PA in this subpopulation.

METHODS

We recruited 478 children in 37 schools stratified by area-level socioeconomic status (SES) and type of urbanization within three regions of Canada. Steps/day were measured using SC-StepRx pedometers. We assessed potential social-ecological correlates with child and parent surveys. We used gender-stratified linear mixed models to examine the correlates of steps/day.

RESULTS

Outdoor time was the strongest correlate of boys' and girls' PA. Lower area-level SES was associated with less PA among boys, but outdoor time attenuated this difference. The strength of association between outdoor time and PA decreased with age in boys and increased with age in girls.

DISCUSSION

Outdoor time was the most consistent correlate of PA. Future interventions should promote outdoor time and address socioeconomic disparities.

The Associations Between Parental-Reported and Device-Based Measured Outdoor Play and Health Indicators of Physical, Cognitive, and Social-Emotional Development in Preschool-Aged Children

PURPOSE

Examine in preschool-aged children: (1) the associations between parental-reported and device-measured outdoor play (OP) and health indicators of physical, cognitive, and social-emotional development and (2) whether associations were independent of outdoor moderate- to vigorous-intensity physical activity (MVPA).

METHODS

This cross-sectional study included 107 participants. Children's OP was measured via a parental questionnaire and the lux feature of accelerometers. Children's growth, adiposity, and motor skills were assessed as physical development indicators. Visual-spatial working memory, response inhibition, and expressive language were assessed as cognitive development indicators. Sociability, prosocial behavior, internalizing, externalizing, and self-regulation were assessed as social-emotional development indicators. Regression models were conducted that adjusted for relevant covariates. Additional models further adjusted for outdoor MVPA.

RESULTS

Parental-reported total OP, OP in summer/fall months, and OP on weekdays were negatively associated (small effect sizes) with response inhibition and working memory. After adjusting for outdoor MVPA, these associations were no longer statistically significant. OP on weekdays was negatively associated with externalizing (B = -0.04; 95% confidence interval, -0.08 to -0.00; P = .03) after adjusting for outdoor MVPA. A similar pattern was observed for device-based measured total OP (B = -0.49; 95% confidence interval, -1.05 to 0.07; P = .09).

CONCLUSIONS

Future research in preschool-aged children should take into account MVPA and contextual factors when examining the association between OP and health-related indicators.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Physical Activity Questionnaire for Children: Validity and Cut-Points to Identify Sufficient Levels of Moderate- to Vigorous-Intensity Physical Activity Among Children and Adolescents Diagnosed With HIV

PURPOSE

To investigate the validity of the Physical Activity Questionnaire for Older Children (PAQ-C) to assess the moderate- to vigorous-intensity physical activity (MVPA) level of children and adolescents diagnosed with HIV and propose cut-points, with accelerometer measures as the reference method.

METHOD

Children and adolescents, aged 8-14 years (mean age = 12.21 y, SD = 2.09), diagnosed with HIV by vertical transmission, participated in the study. MVPA was investigated through the PAQ-C and triaxial accelerometer (ActiGraph GT3X+). Receiver operating characteristic curve and sensitivity and specificity values were used to identify a cut-point for PAQ-C to distinguish participants meeting MVPA guidelines.

RESULTS

Fifty-six children and adolescents participated in the study. Among those, 16 met MVPA guidelines. The PAQ-C score was significantly related to accelerometry-derived MVPA (ρ = .506, P < .001). The PAQ-C score cut-point of 2.151 (sensitivity = 0.625, specificity = 0.875) was able to discriminate between those who met MVPA guidelines and those that did not (area under the curve = 0.751, 95% confidence interval, 0.616-0.886).

CONCLUSION

The PAQ-C was useful to investigate MVPA among children and adolescents diagnosed with HIV and to identify those who meet MVPA guidelines.

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.

Hands-on-ground in a new country: a community-based participatory evaluation with immigrant communities in Southern Alberta

Immigrants experience a high risk of mental health deterioration following settlement in Canada. Immigrant communities benefit from health-promoting interventions that stimulate social inclusion and belonging as protective factors. In this context, community gardens have been recognized as interventions that promote healthy behaviours, place attachment and belonging.This article summarizes our experience conducting a community-based participatory evaluation (CBPE), engaging community stakeholders in planning, implementing and evaluating a community garden for immigrants. We conducted a CBPE to provide relevant and timely feedback to inform programme adaptation and development. Participants, interpreters and organizers were engaged through surveys, focus groups and semi-structured interviews. Participants expressed a range of motivations, benefits, challenges and recommendations. The garden was a place that fostered learning and promoted healthy behaviours, including physical activity and socialization. However, there were challenges in organization and communication with participants. Findings were used to adapt the activities to immigrants' needs and expand the programming of collaborating organizations. Stakeholder engagement facilitated capacity building and direct use of findings. This approach may catalyse sustainable community action with immigrant communities.

Canadian children's independent mobility during the COVID-19 pandemic: A national survey

Independent mobility (IM) is associated with children's physical activity and indicators of social, motor, and cognitive development. We surveyed Canadian parents of 7- to 12-year-olds (n = 2291) about social-ecological correlates of IM in the second wave of COVID-19 (December 2020). We used multi-variable linear regression models to identify correlates of children's IM. Our final model (R² = 0.353) included four individual-, eight family-, two social environment- and two built environment-level variables. The correlates of boys' and girls' IM were similar. Our findings suggest that interventions to support children's IM in a pandemic context should target multiple levels of influence.

Determinants of Outdoor Time in Children and Youth: A Systematic Review of Longitudinal and Intervention Studies

Spending more time outdoors can improve children's social and cognitive development, physical activity, and vision. Our systematic review summarized the determinants of outdoor time (OT) based on the social-ecological model. We searched nine databases: MEDLINE, APA PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORTDiscus, ERIC, SocINDEX, and ProQuest Dissertations and Theses. To be included, studies needed to be quantitative and longitudinal, include ≥1 potential determinant of OT among 0- to 17-year-olds, and be published in English, French, Japanese, or Spanish. We extracted the authors, publication year, country, design, sample size, OT measures, follow-up period, potential determinants, main results, and potential moderators or mediators. Fifty-five studies examining 119 potential determinants met the inclusion criteria. OT was consistently higher in warmer seasons and among participants reporting more OT at baseline. All three interventions that included both parent sessions and additional resources to promote OT (e.g., specific advice and community guides) were effective. COVID-19 restrictions and sun safety interventions discouraging midday outdoor activities led to less OT. The quality of evidence was rated as weak for 46 studies. Most potential determinants were examined in ≤3 studies; thus, more longitudinal studies are needed to enable stronger conclusions about the consistency of evidence and meta-analyses.

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.

Associations Between School Environments, Policies and Practices and Children's Physical Activity and Active Transportation

BACKGROUND

There is evidence of school-level variability in children's active behaviors. This study investigated the associations between school environments, policies and practices, and children's physical activity (PA) and active school transportation (AST), in a school ecology context.

METHODS

We recruited children (N = 1699, age = 10.2 ± 1.0 years, 55.0% girls) in 37 schools from 3 diverse regions of Canada. We then collected data using questionnaires (child, parent) and pedometers. In each school, an official completed a School Health Environment Survey. Multilevel regression models were used to examine associations with children's daily steps, and frequency and volume (frequency*distance) of AST.

RESULTS

Between-school variation ranged from 4.7% to 22.2% demonstrating that school environments are associated with children's active behaviors. None of the school environment variables were significantly associated with children's PA or frequency of AST. Nevertheless, their inclusion improved the PA model. Children's volume of AST increased in schools that reported more initiatives to promote AST.

CONCLUSIONS

Our findings suggest that multiple components are needed to effectively promote active behaviors in children. Schools should determine the areas in which they can improve and assess the feasibility of implementing measures to make their school environments, policies, and practices more conducive to PA and AST.

Novel long-acting ropeginterferon alfa-2b: Pharmacokinetics, pharmacodynamics and safety in a phase I clinical trial

AIMS

Ropeginterferon alfa-2b is a novel, long-acting pegylated interferon alfa-2b. We aimed to evaluate its safety, pharmacokinetics (PK) and pharmacodynamics (PD).

METHODS

Thirty-six subjects received single subcutaneous injection of ropeginterferon alfa-2b at doses ranging from 24 to 270 μg, and 12 subjects received pegylated IFN alfa-2a subcutaneously at 180 μg. Primary endpoints were safety/PK profiles of ropeginterferon alfa-2b, while secondary endpoints were to compare PK/PD parameters with pegylated IFN alfa-2a.

RESULTS

Adverse events in ropeginterferon alfa-2b and pegylated IFN alfa-2a groups were similar, and most of them were mild or moderate. Mean C_max increased from 1.78 to 24.84 ng/mL along with the dose escalations in ropeginterferon alfa-2b groups and was 12.95 ng/mL for pegylated IFN alfa-2a. At 180 μg, ropeginterferon alfa-2b showed statistically significant C_max geometric mean ratio (1.76; P = .0275). Mean T_max ranged from 74.52 to 115.69 h for ropeginterferon alfa-2b groups, and was 84.25 h for pegylated IFN alfa-2a. Mean AUC_0-t increased from 372.3 to 6258 ng•h/mL with the dose escalations in the ropeginterferon alfa-2b groups, while for pegylated IFN alfa-2a it was found to be 2706 ng•h/mL in pegylated IFN alfa-2a. For neopterin and 2',5'-oligoadenylate synthase, mean E_max , T_max and AUC_0-t of ropeginterferon alfa-2b were similar to those of pegylated IFNα-2a at 180 μg.

CONCLUSION

Ropeginterferon alfa-2b up to 270 μg was safe and well tolerated. The PK/PD parameters of ropeginterferon alfa-2b showed increase in dose-response. Ropeginterferon alfa-2b had higher drug exposures and showed similar safety profile when compared to pegylated IFN alfa-2a at the same dose level.

Effectiveness of live health professional-led group eHealth interventions for adult mental health: A systematic review of randomized controlled trials

Background

The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats.

Objective

This systematic review aims to assess experimental evidence for the effectiveness of live health professional–led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not.

Methods

Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool.

Results

Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional–led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional–led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity.

Conclusions

Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement.

Trial Registration

PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551

International Registered Report Identifier (IRRID)

RR2-10.1186/s13643-020-01479-3

Influence of weather conditions on children’s school travel mode and physical activity in 3 diverse regions of Canada

Children who engage in active school transportation (AST) have higher levels of physical activity (PA). Climate and weather were shown to influence adults’ daily travel behaviours, but their influence on children’s AST and PA has been less examined. This study examined the influence of weather conditions on children’s AST and overall PA. Children in grades 4 to 6 (N = 1699; age, 10.2 ± 1.0 years) were recruited in schools located in urban, suburban and rural areas, stratified by area-level socioeconomic status, in 3 different regions of Canada (Trois-Rivières, Québec; Ottawa, Ontario; Vancouver, British Columbia). Mode of school travel was self-reported and physical activity was measured using a pedometer. We used publicly available data on total precipitation and early morning temperature. AST increased with temperature only among girls. Daily precipitation was negatively associated with boys’ and girls’ PA while warmer temperature was associated with increased PA on weekend days. We also observed that season and region moderated the relationship between weather conditions and children’s physical activity behaviours. Our results suggest that daily weather variations influence children’s AST and PA to a greater extent than seasonal variations. Interventions designed to help children and families adapt to weather-related barriers to AST and PA are needed.

Novelty: In Canada, weather conditions may influence children’s active behaviours daily. Associations between weather conditions, choice of travel mode and physical activity vary by sex, season, and region. Weather affects children's PA differently during the week than on weekends.

The impact of eHealth group interventions on the mental, behavioral, and physical health of adults: a systematic review protocol

BACKGROUND

COVID-19 has resulted in an increased demand for eHealth services globally. There is emerging evidence for the efficacy for group eHealth interventions that support population-based mental health and wellbeing, but a systematic review is lacking. The primary objective of this systematic review is to summarize the evidence for eHealth group counseling and coaching programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of programs that encourage PA on outcomes compared to those that do not.

METHODS

Randomized controlled trials that assess the impact of eHealth group counseling or coaching programs on mental health, health behavior, or physical health activity among community-dwelling adults will be included. We will search the following electronic databases (from January 2005 onwards): MEDLINE, PsycINFO, CINHAL, and the Central Register of Controlled Trials. The primary outcomes will be changes in mental health conditions (e.g., depression, anxiety, stress, quality of life), behavioral health conditions (e.g., substance use, smoking, sexual behavior, eating behavior, medication adherence), and physical health conditions (e.g., coping with cancer, menopausal symptoms, arthritis pain). Secondary outcomes will be changes in physical activity. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion with a third reviewer. A narrative synthesis without meta-analysis will be conducted. The strength of the body of evidence will be assessed using GRADE. The risk of bias in individual studies will be appraised using the Cochrane Risk of Bias 2.0 tool. Potential sources of gender bias in included studies will be considered at all stages of the planned review.

DISCUSSION

This review will contribute to the literature by providing evidence on the effectiveness of eHealth counseling and coaching programs delivered to adults in a group format.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551 ).

Profiles of Active Transportation among Children and Adolescents in the Global Matrix 3.0 Initiative: A 49-Country Comparison

This article aims to compare the prevalence of active transportation among children and adolescents from 49 countries at different levels of development. The data was extracted from the Report Cards on Physical Activity for Children and Youth from the 49 countries that participated in the Global Matrix 3.0 initiative. Descriptive statistics and a latent profile analysis with active transportation, Human Development Index and Gini index as latent variables were conducted. The global average grade was a "C", indicating that countries are succeeding with about half of children and youth (47-53%). There is wide variability in the prevalence and in the definition of active transportation globally. Three different profiles of countries were identified based on active transportation grades, Human Development Index (HDI) and income inequalities. The first profile grouped very high HDI countries with low prevalence of active transport and low inequalities. The second profile grouped low and middle HDI countries with high prevalence of active transportation and higher inequalities. And the third profile was characterized by the relatively high prevalence of active transportation and more variability in the socioeconomic variables. Promising policies from countries under each profile were identified. A unified definition of active transportation and contextualized methods for its assessment are needed to advance in surveillance and practice.

Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living

Background

Prolonged daily sedentary time is associated with increased risk of cardiometabolic diseases, impaired physical function, and mortality. Older adults are more sedentary than any other age group and those in assisted living residences accumulate more sedentary time as they often have little need to engage in light-intensity or standing activities such as cleaning or meal preparation. This “low movement” environment can hasten functional decline. Thus, the purpose of this study was to develop a multi-level intervention to reduce and interrupt sedentary time within assisted living residences and conduct a pilot study to determine if the intervention is feasible and if further testing is warranted.

Methods

“Stand When You Can” (SWYC) was developed using a Social Ecological framework based on a review of literature and consultation with residents and staff at assisted living residences. After development, a six-week pilot study was conducted in two different residences with 10 older adults (82.2 ± 8.7 years). Before and after the 6 weeks, ActivPAL™ inclinometers were used to measure daily movement behaviours and self-report questionnaires assessed time spent in different sedentary behaviours and quality of life. Physical function was assessed using the Short Physical Performance Battery. Paired sample t-tests examined pre-post differences for pooled data and individual sites. At the end of the pilot study, feedback on the intervention was gathered from both residents and staff to examine feasibility.

Results

There was a trend towards a decrease in self-reported sitting time (142 min/day; p = 0.09), although device-measured sedentary time did not change significantly. Participants with lower physical function at baseline showed clinically meaningful improvements in physical function after the 6 weeks (p = 0.04, Cohen’s d = 0.89). There was no change in quality of life. Residents and staff reported that the intervention strategies were acceptable and practical.

Conclusion

This study suggests that a multi-level intervention for reducing prolonged sedentary time is feasible for implementation at assisted living residences. The intervention could potentially help delay functional decline among older adults when they transition to a supportive living environment. Longer and larger trials to test the efficacy of SWYC are necessary.

Trial registration

Name of Clinical Trial Registry: clinicaltrials.gov

Trial Registration number: NCT04458896.

Date of registration: July 8, 2020. (Retrospectively registered).

Correlates of Children's Physical Activity: A Canadian Multisite Study

PURPOSE

To inform future physical activity (PA) interventions among children, we investigated the correlates of PA among 8- to 12-yr-olds in three regions of Canada: Ottawa, Trois-Rivières, and Vancouver.

METHODS

We recruited 1699 children (55.0% girls) in 37 schools located in urban, suburban, and rural areas that differed in socioeconomic status. Children wore a sealed SC-StepRx pedometer capable of measuring moderate- to vigorous-intensity physical activity (MVPA) for seven consecutive days. Children and one of their parents/guardians completed a questionnaire that captured multiple potential PA correlates. Publicly available data on weather and neighborhood walkability were obtained. Multiply-imputed gender-stratified linear mixed models were used to examine the correlates of daily step counts and MVPA while controlling for age, site, type of urbanization, and area-level socioeconomic status.

RESULTS

Each additional hour spent outdoors was associated with higher PA in boys (+769 steps per day; +3.7 min MVPA per day) and girls (+596 steps per day; +3.5 min·d). Boys' PA declined with age (-500 steps per day; -3.7 min·d). Boys were less active if they had a long-standing injury/illness (-1862 steps per day; -3.7 min·d) or their parents reported driving to work (-835 steps per day; -4.4 min·d), were worried about traffic (-982 steps per day; -6.4 min·d), or about other people in their neighborhood (-1250 steps per day). Girls speaking neither English nor French at home were less active (-620 steps per day; -3.7 min·d). In girls, each degree Celsius increase in morning temperature was associated with 77 additional steps per day, and each kilometer increase in active school travel distance was associated with 0.5 more MVPA minutes per day.

CONCLUSION

Consistent with previous studies, our results suggest that PA interventions should aim to increase outdoor time. The observed gender differences in PA correlates suggest the need for a gender-sensitized approach to PA promotion.

Active School Transport among Children from Canada, Colombia, Finland, South Africa, and the United States: A Tale of Two Journeys

Walking and biking to school represent a source of regular daily physical activity (PA). The objectives of this paper are to determine the associations of distance to school, crime safety, and socioeconomic variables with active school transport (AST) among children from five culturally and socioeconomically different country sites and to describe the main policies related to AST in those country sites. The analytical sample included 2845 children aged 9-11 years from the International Study of Childhood Obesity, Lifestyle and the Environment. Multilevel generalized linear mixed models were used to estimate the associations between distance, safety and socioeconomic variables, and the odds of engaging in AST. Greater distance to school and vehicle ownership were associated with a lower likelihood of engaging in AST in sites in upper-middle- and high-income countries. Crime perception was negatively associated to AST only in sites in high-income countries. Our results suggest that distance to school is a consistent correlate of AST in different contexts. Our findings regarding crime perception support a need vs. choice framework, indicating that AST may be the only commuting choice for many children from the study sites in upper-middle-income countries, despite the high perception of crime.

Physical activity mediates the relationship between outdoor time and mental health

Both spending time outdoors and participating in physical activity improve mental health. Given that the outdoor environment provides an ideal location for physical activity, better understanding of the relationships among time spent outdoors, physical activity and positive mental health is needed to help guide interventions. The aim was to examine if physical activity moderates or mediates the relationship between outdoor time and positive mental health. Two-hundred-forty-two participants (15 ± 1 years old, 59% girls) from New Brunswick, Canada were included in the current analysis. Youth self-reported time spent outdoors and moderate-to-vigorous physical activity (MVPA) three times between October 2016 and June 2017. Data on their mental health were collected in October 2017. Values of outdoor time and MVPA were averaged across the three time points to represent the exposure and mediator variables, respectively. Mental health, dichotomized as flourishing/not flourishing, was the outcome in the mediation analysis. An interaction term tested if the mediation effect depended on outdoor time. Analyses were undertaken in 2019 using the mediation package in R. In univariate analyses, both MVPA (p < 0.001) and outdoor time (p = 0.05) were positive predictors of flourishing mental health. In mediation analyses, a small indirect mediation (OR: 1.02, 95% CI: 1.01-1.04) and no direct (1.00, 0.98-1.05) effect were noted, suggesting that MVPA mediates the effect of outdoor time on positive mental health. This effect did not vary as a function of outdoor time (interaction: 1.00, 0.99-1.01). Physical activity mediates the relationship between outdoor time and positive mental health. Outdoor time could promote positive mental health among youth through increases in physical activity.

A Pharmacokinetic Bioequivalence Study Comparing Sublingual Riluzole (BHV-0223) and Oral Tablet Formulation of Riluzole in Healthy Volunteers

Orally administered riluzole extends survival in patients with amyotrophic lateral sclerosis, although it has significant shortcomings (eg, adverse events, dysphagic patients) that limit its utility. BHV-0223 is a Zydis-based orally disintegrating formulation of riluzole designed for sublingual administration that addresses the limitations of conventional tablets. This study assessed the bioequivalence between 40-mg BHV-0223 and standard 50-mg oral riluzole tablets, and the food effect on BHV-0223 pharmacokinetics in healthy volunteers. Overall, 133 healthy subjects received BHV-0223 and riluzole tablets under fasted conditions. Geometric mean ratios for the area under the plasma concentration-time curve (AUC) from time zero to time of last nonzero concentration (AUC_0-t ) (89.9%; confidence interval [CI], 87.3%-92.5%), AUC from time zero to infinity (AUC_0-∞ ) (89.8%; CI, 87.3%-92.4%), and maximum observed concentration (112.7%; CI, 105.5%-120.4%) all met bioequivalence criteria (80%-125%). Subsequently, 67 subjects received BHV-0223 under fed conditions. The geometric mean ratios of AUC_0-t (91.2%; CI, 88.1-94.3%), and AUC_0-∞ (92.0%; CI, 89.0-95.1%) were similar, but maximum observed concentration ratios were not within bioequivalence criteria. BHV-0223 was well tolerated. This study demonstrated that 40-mg sublingual BHV-0223 is bioequivalent to 50-mg oral riluzole tablets.

Correlates of Children's Independent Mobility in Canada: A Multi-Site Study

Globally, physical inactivity is a concern, and children’s independent mobility (CIM) may be an important target behavior for addressing the physical inactivity crisis. The aim of this study was to examine correlates of CIM (8–12 years old) in the Canadian context to inform future interventions. CIM was measured via parent surveys. Individual, social, and environmental correlates of CIM were examined using a social–ecological framework. 1699 participants’ data were analyzed using descriptive statistics and gender-stratified linear mixed-effects models while controlling for site, area-level socioeconomic status, and type of urbanization. Individual correlates including child grade (β = 0.612, p < 0.001), language spoken at home (β = −0.503, p < 0.001), car ownership (β = −0.374, p < 0.05), and phone ownership (β = 0.593, p < 0.001) were associated with CIM. For boys, parental gender (β = −0.387, p < 0.01) was negatively associated with CIM. Parents’ perceptions of safety and environment were significantly associated with CIM. Location (i.e., site) was significantly associated with CIM (ref: Trois-Rivières; Ottawa (β = −1.188, p < 0.001); Vancouver (β = −1.216, p < 0.001)). Suburban environments were negatively associated with boys’ independent mobility (β = −0.536, p < 0.05), while walkability (400 m β = 0.064, p < 0.05; 1600 m β = −0.059, p < 0.05) was significantly associated with girls’ independent mobility only. Future research and interventions should consider targeting “modifiable factors” like children’s and parents’ perceptions of neighborhood safety and environment.

Relationships between area-level socioeconomic status and urbanization with active transportation, independent mobility, outdoor time, and physical activity among Canadian children

Background

Active transportation (AT), independent mobility (IM), and outdoor time are promising ways to increase children’s physical activity. However, in order to create interventions to increase those forms of physical activity, it is important to understand the relationships between area-level socioeconomic status (SES) and type of urbanization with AT, IM, outdoor time, and physical activity, and this was the aim of the study.

Methods

One thousand six hundred ninety-nine children in grades 4 to 6 (mean age: 10.2 ± 1.0 years) from three Canadian regions participated. AT, IM, and outdoor time were assessed using questionnaires and physical activity was measured using the SC-StepRX pedometer. Area-level SES was assessed using the median household income of the census tract in which the school was located and type of urbanization was determined for each school using standardized procedures. Generalized linear and general linear mixed models were used to examine the relationships.

Results

Area-level SES and the type of urbanization were generally not related to AT, IM, or physical activity for either gender. However, we observed that both boys and girls living in lower SES areas had decreased odds of spending > 2 h outdoors on weekend days compared to their peers from higher SES areas. Girls living in suburban or rural areas were more likely to spend > 2 h outdoors on weekdays compared to their urban counterparts.

Conclusions

AT, IM, and physical activity are generally not associated with area-level SES or the type of urbanization in this sample of Canadian children. The finding regarding outdoor time showing that both boys and girls of lower SES areas had decreased odds of spending > 2 h outdoors on weekends compared to their peers from higher SES areas suggest that additional efforts should be implemented to offer outdoor play opportunities in lower SES areas.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7420-y) contains supplementary material, which is available to authorized users.

The association between physical fitness and health in a nationally representative sample of Canadian children and youth aged 6 to 17 years

INTRODUCTION

This study explored the relationship between physical fitness and indicators of physical and psychosocial health in a nationally representative sample of Canadian children and youth aged 6-17 years.

METHODS

We conducted a secondary data analysis of Canadian Health Measures Survey (Cycles 1 and 2; 2007-2011) data. The physical fitness measures included cardiorespiratory fitness (CRF; modified Canadian Aerobic Fitness Test), strength (handgrip strength), flexibility (sit-and-reach), and muscular endurance (partial curl-ups). The physical health indicators included directly measured biomarkers (total and HDL [high-density lipoprotein] cholesterol, C-reactive protein, glucose, and HbA1c [glycohaemoglobin]) and measures of adiposity, resting heart rate, and blood pressure. Psychosocial health was assessed using the Strengths and Difficulties Questionnaire. Multiple linear regressions were used to determine the association between variables, stratified by age groups and sex.

RESULTS

3,800 (48.9% female) children and youth were retained for this analysis. CRF displayed significant favourable associations with most physical health indicators in male and female participants. There were less significant favourable associations with flexibility and muscular endurance compared with CRF across age and sex groups. Strength was associated with higher adiposity in males and females, and lower heart rate in male children (β = -1.9; 95% CI: -2.9, -1.0) and female youth (β = -2.0; 95% CI: -2.7, -1.2). There were few significant favourable associations between measures of physical fitness and psychosocial health in this sample of children and youth.

CONCLUSION

These findings suggest that physical fitness, and especially CRF, is a significant indicator of physical health among Canadian children and youth aged 6-17 years.

Pharmacokinetics and Comparative Bioavailability of a Levothyroxine Sodium Oral Solution and Soft Capsule

A new formulation of levothyroxine sodium has been developed in the form of an oral solution contained in unit‐dose ampules. A study has been conducted to compare the bioavailability of levothyroxine sodium oral solution and levothyroxine sodium soft capsule in healthy volunteers under fasting conditions. The rate and extent of absorption of the new levothyroxine solution were also evaluated when administered on dilution in water or directly into the mouth without water. In each period, according to the randomization scheme, subjects were administered single oral doses of either test, as 4 × 150‐μg unit‐dose ampules, with or without water, or reference, as 4 × 150‐μg capsules in a crossover design. Thirty‐six subjects were randomized and dosed in this study; of these, 31 completed all study periods. When comparing the solution with the capsule (both products administered with water), the 90% confidence intervals for the ratio of log‐transformed values of AUC_0‐48 and C_max were within 90.00% and 111.11%, respectively, for baseline‐corrected levothyroxine. Moreover, the administration of levothyroxine oral solution without water did not affect the rate and extent of its absorption. In conclusion, levothyroxine oral solution unit‐dose ampules were bioequivalent to the levothyroxine capsule when administered with or without water. All formulations were well tolerated, with no major side effects.

The SMART Study, a Mobile Health and Citizen Science Methodological Platform for Active Living Surveillance, Integrated Knowledge Translation, and Policy Interventions: Longitudinal Study

Background

Physical inactivity is the fourth leading cause of death worldwide, costing approximately US $67.5 billion per year to health care systems. To curb the physical inactivity pandemic, it is time to move beyond traditional approaches and engage citizens by repurposing sedentary behavior (SB)–enabling ubiquitous tools (eg, smartphones).

Objective

The primary objective of the Saskatchewan, let’s move and map our activity (SMART) Study was to develop a mobile and citizen science methodological platform for active living surveillance, knowledge translation, and policy interventions. This methodology paper enumerates the SMART Study platform’s conceptualization, design, implementation, data collection procedures, analytical strategies, and potential for informing policy interventions.

Methods

This longitudinal investigation was designed to engage participants (ie, citizen scientists) in Regina and Saskatoon, Saskatchewan, Canada, in four different seasons across 3 years. In spring 2017, pilot data collection was conducted, where 317 adult citizen scientists (≥18 years) were recruited in person and online. Citizen scientists used a custom-built smartphone app, Ethica (Ethica Data Services Inc), for 8 consecutive days to provide a complex series of objective and subjective data. Citizen scientists answered a succession of validated surveys that were assigned different smartphone triggering mechanisms (eg, user-triggered and schedule-triggered). The validated surveys captured physical activity (PA), SB, motivation, perception of outdoor and indoor environment, and eudaimonic well-being. Ecological momentary assessments were employed on each day to capture not only PA but also physical and social contexts along with barriers and facilitators of PA, as relayed by citizen scientists using geo-coded pictures and audio files. To obtain a comprehensive objective picture of participant location, motion, and compliance, 6 types of sensor-based (eg, global positioning system and accelerometer) data were surveilled for 8 days. Initial descriptive analyses were conducted using geo-coded photographs and audio files.

Results

Pictures and audio files (ie, community voices) showed that the barriers and facilitators of active living included intrinsic or extrinsic motivations, social contexts, and outdoor or indoor environment, with pets and favorable urban design featuring as the predominant facilitators, and work-related screen time proving to be the primary barrier.

Conclusions

The preliminary pilot results show the flexibility of the SMART Study surveillance platform in identifying and addressing limitations based on empirical evidence. The results also show the successful implementation of a platform that engages participants to catalyze policy interventions. Although SMART Study is currently geared toward surveillance, using the same platform, active living interventions could be remotely implemented. SMART Study is the first mobile, citizen science surveillance platform utilizing a rigorous, longitudinal, and mixed-methods investigation to temporally capture behavioral data for knowledge translation and policy interventions.

Effectiveness of active school transport interventions: a systematic review and update

Background

Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review.

Methods

Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size.

Results

Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities.

Conclusions

Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions.

Trial registration

Registered in PROSPERO: CRD42016033252

Electronic supplementary material

The online version of this article (10.1186/s12889-017-5005-1) 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.

Outdoor time, physical activity and sedentary time among young children: The 2012-2013 Canadian Health Measures Survey

OBJECTIVES

Previous studies have shown that children who spend more time outdoors are more active and spend less time sedentary, but these studies were limited by the use of small convenience samples. We examined the relationship between outdoor time and measures of physical activity (PA), screen time and sedentary time in a nationally-representative sample of young children.

METHODS

Parental reports of outdoor time were obtained for 594 children aged 3-6 years (47.8% girls) who participated in the 2012-2013 Canadian Health Measures Survey. Participants were asked to wear an Actical accelerometer for seven consecutive days. Outdoor time and screen time were assessed by parent reports. The relationships between outdoor time and measures of PA, screen time and sedentary time were examined with linear regression models. Adherence to PA guidelines was estimated based on a betabinomial distribution, and adherence with the screen time guidelines was assessed through logistic regression models. All analyses were stratified by age group (3-4 and 5-6 year olds) and adjusted for sex, parental education and household income.

RESULTS

Among 5-6 year olds, each additional hour spent outdoors was associated with an additional 10 minutes of moderate-to-vigorous PA (95% CI: 6-14), 27,455 more accelerometer counts/day (95% CI: 11,929-42,980) and an increased likelihood of meeting the PA guidelines (OR = 2.53; 95% CI: 1.68-3.82). No significant relationships were observed among 3-4 year olds.

CONCLUSION

Outdoor time has a large effect on PA among 5-6 year olds at a population level. Future studies should examine the correlates of outdoor time to inform novel PA promotion interventions.

Outdoor time, physical activity, sedentary time, and health indicators at ages 7 to 14: 2012/2013 Canadian Health Measures Survey

BACKGROUND

International data show that the majority of children and youth are not sufficiently active. According to recent research, children who spend more time outdoors accumulate more daily moderate-to-vigorous physical activity and engage in less sedentary behaviour. However, the generalizability of these findings is uncertain, and few studies investigated whether outdoor time is associated with other physical and psychosocial health indicators.

DATA AND METHODS

This study examined associations between outdoor time and measures of physical activity, sedentary time, and physical and psychosocial health in a nationally representative sample of 7-to-14-year-olds (n = 1,159) who participated in the 2012/2013 Canadian Health Measures Survey. Physical activity and sedentary time were measured with Actical accelerometers. Direct measures of height, weight, waist circumference, grip strength, blood pressure, cholesterol, and glycohemoglobin were obtained. The Strengths and Difficulties Questionnaire was used to assess psychosocial health. Relationships between outdoor time and physical health measures were examined with multi-variable linear regression models adjusted for age, sex, parental education, and household income. Logistic regression models controlling for the same variables were used for psychosocial health.

RESULTS

Each additional hour spent outdoors per day was associated with 7.0 more minutes of moderate-to-vigorous physical activity, 762 more steps, and 13 fewer minutes of sedentary time. As well, each hour outdoors was associated with lower odds of negative psychosocial outcomes (specifically, peer relationship problems and total difficulties score). Outdoor time was not associated with any of the measures of physical health.

INTERPRETATION

Children reporting more time outdoors are more active, less sedentary, and less likely to have peer relationship problems, compared with those who spend less time outdoors.

School bus travel is associated with bullying victimization among Canadian male, but not female, middle and high school students

Previous research has found a link between active school transportation and bullying victimization among school-aged children. However, the link with other school travel modes (such as car, school bus, and public transportation) and bullying victimization is largely unknown. The purpose of this study was to investigate the association between school travel mode and report of bullying victimization among Canadian middle and high school students. The sample consisted of 5065 students aged 11-20 years (mean age: 15.2±1.9 years; 56% females) who participated in the 2013 Ontario Students Drug Use and Health Survey (OSDUHS). Overall, 24.7% of students reported school bullying victimization in the past year. Females (27.2%) were more likely than males (22.3%) to be victims of school bullying (p<0.01). After adjustment for age, ethnicity, subjective socioeconomic status and parental education, multivariable logistic regression analyses indicated that, compared to active school transportation, school bus travel to (adjusted odd ratio (OR)=1.83; 95% confidence interval (CI)=1.25-2.68) and from (OR=1.79; 95% CI=1.70-2.67) school was associated with greater odds of bullying victimization among males, but not females. However, the use of public transportation to get to school was associated with lower odds of bullying victimization compared to active transportation among females only (OR=0.59; 95% CI=0.36-0.97). These findings suggest that school travel mode should be considered when considering risks for bullying victimization. Bullying prevention efforts should target school buses to make children's commute a safe and enjoyable experience.

Active travel and adults' health: The 2007-to-2011 Canadian Health Measures Surveys

BACKGROUND

Active travel may be a means of integrating physical activity into an individual's routine. This analysis investigates the relationship between utilitarian walking and cycling and objectively measured physical activity and health-related outcomes in a nationally representative sample of Canadian adults.

DATA AND METHODS

Adults aged 20 to 79 who participated in the 2007-to-2011 Canadian Health Measures Surveys (N = 7,160) reported the weekly time spent in utilitarian walking and cycling and wore an Actical accelerometer for seven days. They underwent a series of tests to measure physical fitness, body composition, blood pressure, and biomarkers. Differences in physical activity and health-related outcomes across levels of utilitarian walking and cycling were assessed with ANCOVA analyses adjusted for age, sex, education, household income, self-reported usual daily physical activity, and the complex survey design.

RESULTS

Utilitarian walking and cycling were associated with moderate-to-vigorous physical activity in a graded manner. Compared with respondents who reported walking 1 to 5 hours a week, those who walked more than 5 hours a week had lower skinfold thickness. Respondents who reported cycling 1 or more hours a week had greater aerobic fitness and lower BMI, waist circumference, total cholesterol/HDL ratio, glycohemoglobin, C-reactive protein, and triglycerides than did those who did not cycle. They also had higher aerobic fitness and lower BMI and waist circumference than those who reported cycling less than an hour a week.

INTERPRETATION

Cycling at least an hour a week is associated with improved fitness and reduced cardiovascular disease risk factors. Both utilitarian walking and cycling may be means of increasing adults' moderate-to-vigorous physical activity.

NEWS for Africa: adaptation and reliability of a built environment questionnaire for physical activity in seven African countries

BACKGROUND

Built environment and policy interventions are effective strategies for controlling the growing worldwide deaths from physical inactivity-related non-communicable diseases. To improve built environment research and develop African specific evidence, it is important to first tailor built environment measures to African contexts and assess their psychometric properties across African countries. This study reports on the adaptation and test-retest reliability of the Neighborhood Environment Walkability Scale in seven sub-Saharan African countries (NEWS-Africa).

METHODS

The original NEWS comprising 8 subscales measuring reported physical and social attributes of neighborhood environments was systematically adapted for Africa through extensive input from physical activity and public health researchers, built environment professionals, and residents in seven African countries: Cameroon, Ghana, Kenya, Mozambique, Nigeria, South Africa and Uganda. Cognitive testing of NEWS-Africa was conducted among diverse residents (N = 109, 50 youth [12 - 17 years] and 59 adults [22 - 67 years], 69 % from low socioeconomic status [SES] neighborhoods). NEWS-Africa was translated into local languages and evaluated for 2-week test-retest reliability in adult participants (N = 301; female = 50.2 %; age = 32.3 ± 12.9 years) purposively recruited from neighborhoods varying in walkability (high and low walkable) and SES (high and low income) and from villages in six of seven participating countries.

RESULTS

The original 67 NEWS items was expanded to 89 scores (76 individual NEWS items and 13 computed scales). Several modifications were made to individual items, and some new items were added to capture important attributes in the African environment. A new scale on personal safety was created, and the aesthetics scale was enlarged to reflect African specific characteristics. Over 95 % of all NEWS-Africa scores (items plus computed scales) demonstrated evidence of "excellent" (ICCs > .75 %) or "good" (ICCs = 0.60 to 0.74) reliability. Seven (53.8 %) of the 13 computed NEWS scales demonstrated "excellent" agreement and the other six had "good" agreement. No items or scales demonstrated "poor" reliability (ICCs < .40).

CONCLUSIONS

The systematic adaptation and initial psychometric evaluation of NEWS-Africa indicates the instrument is feasible and reliable for use with adults of diverse demographic characteristics in Africa. The measure is likely to be useful for research, surveillance of built environment conditions for planning purposes, and to evaluate physical activity and policy interventions in Africa.

Active school transport and weekday physical activity in 9-11-year-old children from 12 countries

OBJECTIVES

Active school transport (AST) may increase the time that children spend in physical activity (PA). This study examined relationships between AST and weekday moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time (SED) and total activity during naturally organized time periods (daily, before school, during school and after school) in a sample of children from 12 countries.

METHODS

The sample included 6224 children aged 9-11 years. PA and sedentary time were objectively measured using Actigraph accelerometers. AST was self-reported by participants. Multilevel generalized linear and logistic regression statistical models were used to determine associations between PA, SED and AST across and within study sites.

RESULTS

After adjustment for age, highest parental educational attainment, BMI z-score and accelerometer wear time, children who engaged in AST accumulated significantly more weekday MVPA during all studied time periods and significantly less time in LPA before school compared with children who used motorized transport to school. AST was unrelated to time spent in sedentary behaviors. Across all study sites, AST was associated with 6.0 min (95% confidence interval (CI): 4.7-7.3; P<0.0001) more of weekday MVPA; however, there was some evidence that this differed across study sites (P for interaction=0.06). Significant positive associations were identified within 7 of 12 study sites, with differences ranging from 4.6 min (95% CI: 0.3-8.9; P=0.04, in Canada) to 10.2 min (95% CI: 5.9-14.4; P<0.0001, in Brazil) more of daily MVPA among children who engaged in AST compared with motorized transport.

CONCLUSIONS

The present study demonstrated that AST was associated with children spending more time engaged in MVPA throughout the day and less time in LPA before school. AST represents a good behavioral target to increase levels of PA in children.

Relationships between active school transport and adiposity indicators in school-age children from low-, middle- and high-income countries

OBJECTIVES

Within the global context of the nutrition and physical activity transition it is important to determine the relationship between adiposity and active school transport (AST) across different environmental and socio-cultural settings. The present study assessed the association between adiposity (that is, body mass index z-score (BMIz), obesity, percentage body fat (PBF), waist circumference) and AST in 12 country sites, in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

METHODS

The analytical sample included 6797 children aged 9-11 years. Adiposity indicators included, BMIz calculated using reference data from the World Health Organization, obesity (BMIz ⩾+2 s.d.), PBF measured using bioelectrical impedance and waist circumference. School travel mode was assessed by questionnaire and categorized as active travel versus motorized travel. Multilevel linear and non-linear models were used to estimate the magnitude of the associations between adiposity indicators and AST by country site and sex.

RESULTS

After adjusting for age, sex, parental education and motorized vehicle availability, children who reported AST were less likely to be obese (odds ratio=0.72, 95% confidence interval (0.60-0.87), P<0.001) and had a lower BMIz (-0.09, s.e.m.=0.04, P=0.013), PBF (least square means (LSM) 20.57 versus 21.23% difference -0.66, s.e.m.=0.22, P=0.002) and waist circumference (LSM 63.73 cm versus 64.63 cm difference -0.90, s.e.m.=0.26, P=0.001) compared with those who reported motorized travel. Overall, associations between obesity and AST did not differ by country (P=0.279) or by sex (P=0.571).

CONCLUSIONS

AST was associated with lower measures of adiposity in this multinational sample of children. Such findings could inform global efforts to prevent obesity among school-age children.

Built Environment Features that Promote Cycling in School-Aged Children

Previous research shows that children and youth who cycle to/from school are more active and fitter than those who travel by motorized modes. However, rates of cycling are low in many countries, and a better understanding of the correlates of cycling may inform the development of future interventions. This review summarizes the current literature on the built environment correlates of cycling among school-aged children and youth. While both studies of transportation and recreational cycling were eligible, the majority of the 12 included studies focused on the trip to/from school and consistently indicated that shorter distance between home and school is associated with greater odds of cycling. However, little is known about the correlates of cycling for other purposes. Furthermore, other built environment features have not been studied enough to allow strong conclusions to be drawn. Recommendations for future studies are proposed to address the limitations of current evidence.

What Is the Relationship between Outdoor Time and Physical Activity, Sedentary Behaviour, and Physical Fitness in Children? A Systematic Review

The objective of this systematic review was to examine the relationship between outdoor time and: (1) physical activity, (2) cardiorespiratory fitness, (3) musculoskeletal fitness, (4) sedentary behaviour; or (5) motor skill development in children aged 3-12 years. We identified 28 relevant studies that were assessed for quality using the GRADE framework. The systematic review revealed overall positive effects of outdoor time on physical activity, sedentary behaviour, and cardiorespiratory fitness, although causality could not be assumed due to a lack of RCTs. Motor skill development was unrelated to outdoor time; however, this relationship was only examined in a single study of preschool children. No studies were found that examined associations between outdoor time and musculoskeletal fitness.

Position Statement on Active Outdoor Play

A diverse, cross-sectorial group of partners, stakeholders and researchers, collaborated to develop an evidence-informed Position Statement on active outdoor play for children aged 3–12 years. The Position Statement was created in response to practitioner, academic, legal, insurance and public debate, dialogue and disagreement on the relative benefits and harms of active (including risky) outdoor play. The Position Statement development process was informed by two systematic reviews, a critical appraisal of the current literature and existing position statements, engagement of research experts (N = 9) and cross-sectorial individuals/organizations (N = 17), and an extensive stakeholder consultation process (N = 1908). More than 95% of the stakeholders consulted strongly agreed or somewhat agreed with the Position Statement; 14/17 participating individuals/organizations endorsed it; and over 1000 additional individuals and organizations requested their name be listed as a supporter. The final Position Statement on Active Outdoor Play states: “Access to active play in nature and outdoors—with its risks— is essential for healthy child development. We recommend increasing children’s opportunities for self-directed play outdoors in all settings—at home, at school, in child care, the community and nature.” The full Position Statement provides context for the statement, evidence supporting it, and a series of recommendations to increase active outdoor play opportunities to promote healthy child development.

Daily physical education in primary school and physical activity in midlife: the Trois-Rivières study

AIM

Although a commonly stated purpose of physical education (PE) classes is to foster life-long participation in physicalactivity (PA), few longitudinal studies have assessed the impact of childhood PE interventions on PA as an adult. The Trois-Rivières Growth and Development Study provided a unique opportunity to address this question.

METHODS

In 2008, 86 participants in the original 1970-1977 Trois-Rivières Study (44 women and 42 men aged 44.0 ± 1.2 years) completed a questionnaire examining their current PA level and different correlates of PA (i.e. individual's intention to engage in PA, perceived enjoyment, usefulness and ease in engaging in PA, perceived social support and social norms). Participants had initially been assigned to either an experimental program (5 h/week of specialist-taught PE) or a control group (40 min/week of home-room teacher-taught PE) from grades 1 to 6.

RESULTS

There were no current differences between the experimental and control groups neither in the frequency, duration nor volume of PA undertaken at the current follow-up. Furthermore, no differences between groups were found for any of the PA correlates examined.

CONCLUSION

Providing daily PE throughout primary school seems insufficient to ensure that individuals will remain active in midlife. The development of a life-course approach to PA promotion is thus warranted.

Cytochrome P450 3A and P-glycoprotein drug-drug interactions with voclosporin

AIMS

Voclosporin is a novel calcineurin inhibitor intended for prevention of organ graft rejection and treatment of lupus nephritis. Pharmacokinetic drug interactions between voclosporin and a CYP3A inhibitor, inducer and substrate and a P-glycoprotein inhibitor and substrate were evaluated.

METHODS

Voclosporin 0.4 mg kg(-1) was administered to 24 subjects in each of five studies, as follows: every 12 h (Q12H) alone and concomitantly with ketoconazole 400 mg once daily (QD); single dose before and single dose after rifampin 600 mg QD; Q12H where midazolam 7.5 mg was administered as a single dose alone before voclosporin and with last the dose of voclosporin; Q12H alone and concomitantly with verapamil 80 mg every 8 h; and Q12H with digoxin 0.25 mg QD. The noncompartmental pharmacokinetic parameters maximal concentration (Cmax ) and area under the concentration-time curve (AUC) were obtained, and geometric least squares mean ratios and 90% confidence intervals were evaluated.

RESULTS

Ketoconazole increased voclosporin Cmax (6.4-fold) and AUC (18-fold); rifampin reduced voclosporin AUC (0.9-fold); voclosporin did not change exposure of midazolam or α-hydroxy-midazolam; verapamil increased voclosporin Cmax (2.1-fold) and AUC (2.7-fold); and voclosporin increased digoxin Cmax (0.5-fold), AUC (0.25-fold) and urinary excretion (0.2-fold).

CONCLUSIONS

Administration of voclosporin concomitantly with strong inhibitors and inducers of CYP3A resulted in increased and decreased exposures, respectively, and should be considered contraindicated. Drug-drug interactions involving voclosporin and CYP3A substrates are not expected. Administration of voclosporin concomitantly with inhibitors and substrates of P-glycoprotein resulted in increased voclosporin and substrate exposures, respectively. Appropriate concentration and safety monitoring is recommended with co-administration of voclosporin and P-glycoprotein substrates and inhibitors.

A systematic review of active transportation research in Africa and the psychometric properties of measurement tools for children and youth

Background

Previous systematic reviews indicate that active transportation (AT; the use of non-motorized travel modes such as walking, running and cycling) is an important source of daily physical activity (PA). However, no previous systematic review has examined travel behaviours among African children and youth or the psychometric properties of measurement tools used among children and youth worldwide.

Methods

Studies on AT among African children and youth (aged 5–17 years) were identified through 1) the MEDLINE and Embase databases; 2) manual searches of six African journals that are not indexed in these databases; and 3) the articles included in a previous systematic review on PA among children and youth in Sub-Saharan Africa. Second, literature on the psychometric properties of measurement tools for children and youth was searched using the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, SportDiscus, and Health and Psychosocial Instruments databases. Study quality was assessed with a modified version of the Downs and Black checklist.

Results

Twenty studies reported original data on AT among African children and youth. This evidence suggests that rates of AT to/from school are lower in urban areas and in youth attending higher SES schools. Two population-based studies reported rates of AT ranging between 19.8% and 66.6% in multiple countries. Studies conducted in Africa seldom examined non-school travel and only one reported data on the psychometric properties of their measures of travel behaviours. Nineteen studies conducted predominantly in high-income countries provided psychometric data. Child and parent reports were used in 17 studies, and these measures generally showed substantial to almost perfect test-retest reliability and convergent validity for school trips. Limited information was available regarding non-school trips. Objective measures of travel behaviours have been used much less often, and further validity and reliability assessments are warranted.

Conclusion

These findings emphasize a need for more research examining travel behaviours among African children and youth, particularly for non-school travel. Further research is needed to develop valid and reliable measures of non-school travel and to examine their psychometric properties in the African context. These measures could then be used to evaluate AT promotion interventions.