Purpose: To describe how sleep duration and common everyday physical behaviours change throughout the lifespan and how they relate to wellbeing and health outcomes within different age groups.

Methods: The Norwegian HUNT study is a population-based cohort study carried out in the Nord-Trøndelag County in Norway. The HUNT Study comprises four surveys carried out in 1984-1986 (HUNT1), 1995-1997 (HUNT2), 2006-2008 (HUNT3), and 2017-2019 (HUNT4). In HUNT4, sleep duration and physical behaviours were measured for 7 days by two accelerometers attached to the skin on the right thigh and low back. By utilising state-of-the-art machine-learning techniques, a classification model was developed to detect sleep duration and time with sitting, standing, walking, running, cycling and lying down. The overall accuracy of the classification model is >95%. Information on lifestyle and health-related factors were collected by questionnaires and a clinical examination.

Results/findings: About 8,100 adolescents and 55,000 adults participated in HUNT4. Objective recordings of sleep duration and physical behaviours were obtained from ∼6,800 adolescents (84%) and ∼32,000 adults (58%). Data analyses are currently ongoing and detailed results about the association between sleep duration, physical behaviours and health outcomes will be presented at ISBNPA 2020. However, preliminary results indicate that from age 13 to 40 years, daily sitting time is ∼8 hours thereafter increasing by ∼0.5 hours/day per 10 years up to ∼11 hours/day in the age group 90 years and above. Time with standing and walking shows a curvilinear association with age, e.g., adolescents walk ∼110 min/day, increasing to 150 min/day among middle-aged adults, and thereafter decreasing steadily to ∼50 min/day in +90 years. As expected, time with running and cycling is highest among adolescents (∼10 min/day) and decreasing steadily with age. Overall, inter-individual differences were large for all behaviours.

Conclusions: The data from the HUNT Study allow us to characterise how common everyday physical behaviours and sleep duration changes throughout the lifespan and how it relates to wellbeing and health outcomes.

Purpose: Older adult physical inactivity is a global public health problem associated with chronic disease, falls and injuries, and declining physical, mental, and social health. Novel, effective, and scalable strategies are needed to combat physical inactivity. Behavioural economics posits that people are more likely to engage in behaviours that provide short- rather than long-term benefits. Offering financial incentives for the uptake and adherence to physical activity provides tangible short-term benefits and may be more motivating than the inherent long-term health benefits. It remains unclear, however, whether financial incentives are effective for increasing physical activity among older adults. 

Methods. We conducted a systematic search of 10 academic databases to identify randomized controlled trials that used financial incentives to promote physical activity in older adults. Two reviewers (NW, EA) independently screened 1094 articles for eligibility: titles and abstracts followed by full-text. Discrepancies were resolved by consultation and a third reviewer (DM) when needed. Data from eligible studies were extracted onto an electronic form consistent with the PRISMA Statement.

Results. Five studies published between 2008-2017 met eligibility criteria; four were conducted in the United States and one in Canada. These included 309 participants total, 70% female, and 92% white. Financial incentive intervention duration ranged from 4-16 weeks, and rewards ranged from approximately $10-$30 per week. Three studies reported significant increases in physical activity; these provided assured financial rewards that encouraged gradual increases in physical activity over time. Two of these studies measured the proportion of days that step goals were achieved, while one tracked daily aerobic minutes. Two other studies found no change in physical activity following intervention with financial rewards. Three studies included a post-intervention follow-up (range: 4-12 weeks) and found physical activity levels declined after financial rewards were withdrawn. 

Conclusions. Modest financial rewards have potential to promote short-term uptake of physical activity in older adults. Future studies are needed to study more diverse populations, determine how to promote long-term physical activity adherence once financial rewards are removed, and test the acceptability and effectiveness of financial losses.

 

Purpose: Understanding the neighborhood environmental influence on older adults’ quality of life and physical activity is important for effective global public health action on promoting healthy and successful ageing. Yet, the interrelationships between neighborhood environment attributes, quality of life and physical activity have not been studied among older adults in sub-Saharan Africa where the largest population of older people will reside in the coming decades. The aims of the present study were to (1) investigate the direct associations of perceived neighborhood environment attributes with quality of life of Nigerian older adults, and to (2) examine the moderating effects of physical activity on the associations between neighborhood environment attributes and quality of life.

Methods: The participants were 353 older adults (mean age= 68.9±9.1 years) randomly selected from 5 high- and low- income communities in Maiduguri, Nigeria. Quality of life, perceived attributes of the neighborhood environments and physical activity were self-reported using valid and reliable questionnaires. Multinomial linear regression analyses were used to examine the direct associations between neighborhood environmental attributes and each of four domains of quality of life (physical health, psychological health, social relationships and environmental health), as well as the moderating effects of physical activity.

Results: Traffic safety, aesthetics, land-use diversity, residential density, street connectivity and ‘overall walkability’ were positively related to both or either social relationships and environmental health quality of life among those meeting physical activity guidelines. In contrast, aesthetics, traffic safety and ‘overall walkability’ were negatively related to psychological health quality of life among those not meeting physical activity guidelines.

Conclusions: Being physically active moderates the association of neighborhood environments with QoL among Nigerian older adults. Designing age-friendly communities to promote physical activity may be needed to improve the QoL among older adults in Nigeria and help prepare the Nigerian society for the predicted increase in the older adult population.

PURPOSE: Active Choices is a ‘stepped-down’ intervention program funded by the Australian Department of Veterans’ Affairs. The program seeks to facilitate the transition of clients from the care of an allied health professional (e.g. exercise physiologist or physiotherapist), to self-managed physical activity (PA) preferences, within their local active communities. To inform program development, we conducted a systematic review of evidence on the effectiveness of interventions to promote self-managed PA in military service veterans. METHODS: Literature searches (e.g. MEDLINE, PsycINFO and PubMed, up to September 27^th, 2019) identified randomised controlled trials that assessed self-managed PA interventions in military service veterans. Data were extracted on study characteristics, intervention strategies (assessed against a taxonomy of behaviour change techniques), and PA change. The strength of the evidence base was assessed on study quality (poor, fair, or good), the direction of PA change (positive or no effect), and then rated as ‘supportive, promising, unknown, or unsupportive’. RESULTS: Searches identified 28 studies (19 unique datasets and intervention programs, all from the USA). Participants (n= 45 to n=1092) were typically older aged (mean age 55+ years) males with high risk comorbidities (e.g. diabetes, post-traumatic stress disorder, or musculoskeletal disorders). Overall, 64% (n=18) of studies found positive intervention effects (mean increase of 53 minutes/week of self-reported moderate intensity PA). Program duration was typically 6 to 12 months. The behaviour change techniques most frequently utilised by interventions that observed positive intervention effects were education, social support, goal setting and review of goals, and self-monitoring. Study quality (good), and direction of change (positive intervention effects observed in the majority of studies), indicated that the strength of the evidence base was promising (evidence suggestive of beneficial effect but further research required). CONCLUSIONS: ‘Stepped-down’ programs have the potential to help military veterans transition from allied health care to effective self-management of physical activity. However, the US-centric nature of the evidence base suggests that well-controlled, proof of concept research is required as a pre-requisite to larger, scalable studies in the Australian context.

 

 

 

 

Purpose

Malnutrition among elderly is a worldwide public health problem. However, information on knowledge and dietary pattern of elderly in Sri Lanka is limited.

Objectives

To describe the knowledge on diet, dietary pattern and associated factors and to determine the association between the knowledge on diet and the dietary pattern among the elderly in Medical Officer of Health (MOH) area, Bulathkohupitiya

Methods

A community-based cross-sectional study was conducted in Bulathkohupitiya MOH area. Sample size was 512. Sixty years and above elderly were recruited by cluster sampling. Public Health Midwives collected data using an interviewer-administered questionnaire and a 24-hour dietary-recall. Descriptive analysis was done for socio-demographic and other associated factors and associations were calculated using chi square test and Odds ratio.

Results

Response rate was 98%(n=502). The age distribution was 60 to 93 years and mean age was 67.2years. Dietary knowledge was generally adequate with 62%(n=312) scoring 50% or more marks. Knowledge was positively associated with young age (OR=1.6;95%CI=1.09-2.36;p=0.017) and negatively associated with low educational level (OR=0.15;95%CI=0.10-0.22;p<0.001) and non-participation in social-activities (OR=0.24;95%CI=0.14-0.42;p<0.001). Television (OR=2.78;95%CI=1.88-4.12;p<0.001) and newspapers/books (OR=4.29;95%CI=2.73-6.72;p<0.001) were statistically significant as sources of dietary knowledge. Health sector contribution for knowledge was inadequate (12.2%,n=61).

Dietary pattern was cereal/tubers based (100%,n=493), with a poor proportion meeting dietary recommendations in vegetable (5%;n=25); dairy (11%;n=53) and fruit (12%;n=57) consumption. Food availability and income of elderly were associated with consumption of better quality foods (p<0.05). Food variety score (r=0.308), Dietary diversity score (r=0.206) and Dietary serving score (r=0.237) positively correlated (p=0.01) with dietary knowledge.

Conclusions

Dietary quality and quantity of elderly have to be improved. Health sector should contribute more to increase dietary knowledge. Food availability and income for elderly have to be enhanced.

Purpose: To describe the dose prescribed, adherence and effect on physical activity (secondary outcomes) of a physiotherapist-prescribed physical activity program for people after fall-related lower limb or pelvic fracture.

Design: Randomised controlled trial. 

Participants: 336 community-dwellers aged 60+ who had completed usual care for a fall-related fracture in the past two years. The intervention group received 10 physiotherapist home visits and 5 telephone calls, to teach individualised weight-bearing strength and balance exercises, discuss fall prevention strategies and encourage physical activity.

Measures: Exercise dose was recorded by the physiotherapists, adherence was reported by participants and physical activity outcomes were collected with IPEQ and stage of motivational readiness for change questionnaires.

Analyses: Descriptive statistics summarised dose and adherence. Regression models compared groups at 12-months after adjusting for baseline values of the outcome.

Results: Intervention group participants were prescribed an average of 6.4 (SD 1.2, n=160) home exercises and agreed to exercise 4.5 times per week (SD 2.1, n=160). By the end of trial 69% of those prescribed a home program were still regularly exercising and completed an average of 71% (SD 30%, n=110) of the prescribed exercise repetitions. There were potentially important between-group differences at 12 months in self-reported home exercise (0.39 hours/week more exercise in the intervention group after adjusting for baseline, 95% CI 0.02 to 0.77, p = 0.04, n=284), in planned activities including walking (1.46 hours/week more in the intervention group after adjusting for baseline, 95% CI 0.42 to 2.50, p = 0.006, n=283) and in stage of readiness for change ordinal scale (OR 1.66, 95%CI 1.09 to 2.55, p =0.019, n=283). There was little difference in overall physical activity (2.09 hours/week more in the intervention group after adjusting for baseline, 95% CI -1.44 to 5.62, p = 0.245, n=282).

Conclusions: There were potentially important benefits on home exercise and planned physical activity from this physiotherapist-prescribed physical activity program for people after fall-related lower limb or pelvic fractures.

Introduction

In Asia, the proportion of people aged at least 85 years is projected to triple by 2050. Being active and less sedentary comes with various benefits for the very old. However, no population-based physical activity (PA) and sedentary behaviour (SB) research in this age group is available in Asia. Our aim is to describe the patterns of PA and SB in very old Chinese Singaporeans, and to identity factors associated with both behaviors.

 

Methods

As part of the Singapore Chinese Health Study, data from 1,000 older adults (≥85 years) was obtained cross-sectionally between 2017 and 2018. Information on domain-specific PA, and SB were collected using the Global Physical Activity Questionnaire. We used descriptive statistics to examine time spent in occupational, transport, leisure and total moderate-to-vigorous PA (MVPA), and SB. We conducted multivariate logistic regression to examine socio-demographic, psychological, social, behavioral, and physical as well as cognitive health-related factors associated with total MVPA and SB. Due to the absence of specific guidelines we used the median-split method do derive our outcomes.

Results 

The final sample of 963 participants had a mean age of 87.9 years (SD 2.4), and 64.5% were female. Median weekly MVPA was 50 minutes (IQR 0, 150) and active transport accounted for 79.4% of all PA. Only 3.8% of the participants reported vigorous PA. In the fully adjusted model, higher age, female sex, low life satisfaction, staying with others, no social activities, limited alcohol consumption and smoke exposure, more daily SB, lower functional capacity and worse memory were associated with engaging in less than 50 minutes of weekly MVPA. Median daily SB time was 10 hours (IQR 0, 12). Lower age, male sex, not being retired, better psychological wellbeing, not receiving needed help, worse perceived health, and lower functional capacity, were associated with spending more than 10 hours being sedentary per day.

Conclusion

About 50% of very old Chinese Singaporeans accumulate less than 50 minutes of weekly MVPA; most of it is moderate and stems from active commutes. Occupational and recreational PA is low. We identified factors associated with PA and SB; these can inform intervention development.

 

Purpose: More than 20% of the population is currently 65 years old or older in Japan. In older people, decreased physical activity and increased sedentary time generally result in poor health outcomes. While some elderly individuals do venture out and participate positively in community activities, many others stay home engaged in minimal physical activities. The aim of this study was to clarify whether older people who usually have an inactive lifestyle could significantly decrease sedentary time after 10 months of physical activity in a health promotion program.

Methods: The health promotion program included 51 participants (mean age, 70.8 ± 4.3 years); all of them provided written informed consent. The college conducting the elderly program provided lessons about health and 60 minutes of exercise every 2 weeks for 10 months. The participants completed the International Physical Activity Questionnaire, and then they were divided into two groups based upon their normal community activity levels, the conducted volunteer activities group (CV group) or did not conduct activities group (NC group). Paired t-tests were used to compare the baseline and final measurements for each group. Nonpaired t-tests were used to compare the CV group and the NC group.

Results: The data for 42 participants were analyzed, and the sedentary time for the participants’ in the NC group at baseline was found to be significantly increased compared with the CV group. However, at the end of the program, the NC group sedentary time had significantly decreased from the baseline, while no significant changes in the CV group were observed. Moreover, no significant changes were found in the other physical activity indexes.

Conclusions:The CV group exhibited a more substantial increase in physical activity than the NC group. However, the health promotion program had significantly reduced the sedentary time of the NC group; while not significantly affecting the sedentary time of the CV group. Thus, this type of health promotion program provided the most benefit to the typically inactive elderly participants.

Purpose

Maintenance of functional capacity is critical to active ageing. With the growing older adult population, understanding the unique aspects associated with older adult exercisers is critical to effective exercise programming, supervision and interaction with instructors to positively affect health outcomes. The aim was to investigate perceptions of exercise instructor interactions with older adult members of an exercise facility.

Methods

As part of a pilot study into older adult usage of exercise equipment, semi-structured interviews of seven exercise instructor staff at a public facility were conducted to elicit their perceptions of working with active older adult members (>65 years). Recorded interviews were transcribed verbatim, and subsequently thematically analysed.

Findings

The main theme emergent from the instructors was that their older adult members differ from the typical younger gym users in many respects. Older adults required higher levels of instructor time, with programming often more complex due to health and physical limitations. The instructors perceived older adults as creating a unique social atmosphere while exercising. Instructors noted that functional progression was not always a priority; rather older adult members placed greater value on the social aspect of exercising. Many older adults found the facility an environment requiring personalised support for their perceived self-confidence and self-efficacy for effective exercising. 

Conclusions

To positively enhance physical function, the unique aspects of older adult users need to be recognised and accommodated by exercise instructor staff and management. Training of instructors who work with this cohort should include social interaction aspects in addition to consideration of their specific physical and cognitive characteristics. 

 

Purpose

Data from Sport NZ’s national participation survey, Active NZ, show a steep decline in participation in physical activity from teenage years into early adulthood. The decline spans across various forms of physical activity, including participation through sports clubs. This study focussed on experiences within a sports club context in Aotearoa, New Zealand. The purpose was to provide National Sport Organisations with data to develop interventions aimed at improving club member experience.

                      

Methods

Data were collected via an online survey of club members in ten sports in Aotearoa, New Zealand, between July 2018 and April 2019. We examined data from c. 30,000 club members.  Satisfaction with overall club experience was used as a key metric. Self-reported satisfaction across several areas were used to understand various aspects of experience.  Participant reasons for belonging and other factors of the experience were also considered. Results from four age categories (5-12 years, 13-18 years, 19-34 years and 35+ years) were analysed and compared.

 

Results

The main reason for belonging to a club changes throughout people’s lives.  Most young adults belonged to a club to ‘play competitively’ or ‘have fun / play socially’. It appears changing needs are not being sufficiently addressed by sports clubs, especially in the transition to young adulthood. Satisfaction with overall club experience was lowest among young adults (19-34 years). Young adults experienced significantly lower levels of satisfaction across a range of areas, including: quality/availability of officials, fulfilling potential, coaching, fairness of opportunities, professionalism & club management, providing information, playing venues and value for money.

 

Conclusion

Satisfaction with the overall experience, and contributing factors, are significantly lower for young adults than for other age groups. For several reasons, the needs of this group are not being met. The results indicate the importance of tailored interventions aimed at improving the experience for young adults within sports clubs. Improving the quality of club experience for this group has the potential to contribute to reducing the decline in physical activity.

Regularly observed and sufficient physical activity (PA) of young people depends on the creation of conditions for success in the preferred PA. Therefore, we consider the diagnostics of PA preferences to be an irreplaceable part of PA diagnostics.

The aim of this study is thus to (a) detect the state and trends in the preferences of individually oriented PA of young people in different education and sports environments in the context of weekly PA; (b) to detect the associations among developing preferences of track and field and the fulfilment of recommendations within a weekly PA. In the research conducted from 2007 to 2017 participated in total 16116 participants aged from 14 to 26. We have realized a sports preferences questionnaire and weekly PA questionnaire IPAQ-long in order to detect the preferences in the individually oriented types of PA. The biggest long-term stability among the Czech and Polish boys and the Czech girls showed swimming and cycling and among Polish girls swimming and skating. The most significant increase of preferences was detected in track and field, especially among the Czech girls and boys. The girls and boys who prefer track and field meet weekly PA recommendations significantly more than those who do not prefer it. Both Czech and Polish boys and girls showed that those who prefer athletic/running activities fulfil significantly more recommendations to a weekly PA; specifically at least 5 times a week for a minimum of  60 minutes of MVPA and simultaneously at least 3 times a week for a minimum of 20 minutes of vigorous PA. Preferences of athletic/running activities also increase the chance of fulfilment of above-mentioned recommendations to a weekly PA with both girls (OR=1.801, CI=1.571-2.065) and boys (OR=1.655, CI=1.437-1.905). These preferences are also important predictors for fulfilment of PA recommendations.

The knowledge of trends in preferred types of PA has a predictive meaning for supporting physically active lifestyle of young people and for creation of optimal conditions to pursue popular types of PA. 

Dietary and lifestyle habits and their association with nutritional status of adolescent girls in Pakistan

Abstract

Purpose: Non-Communicable Diseases (NCDs) are a growing cause of concern globally. Several NCDs can be prevented, if healthy lifestyle and dietary habits are adopted earlier in life. The aim of this study was, therefore, to find out the dietary and lifestyle habits and their association with nutritional status of adolescent girls in Pakistan.

Methods: A cross-sectional analytical study was carried out amongst 470 adolescent girls, selected through purposive sampling technique.

Results: Most (56.8%) of the girls had poor nutritional status. 42% of the adolescents were regularly skipping meals. Breakfast was the most skipped meal (39.6%). Snacking (47%) and cola drinks (51.7%) consumption was common. Only 10.4% were meeting daily requirement of water. Chicken was most popular meat as 79.6% girls preferred it over other meats.  Whereas, 47% girls consumed fish in winters only, eggs were consumed regularly by 84.9% girls. Only 35.5% adolescent girls consumed fruits daily. Although 81.5% girls reported consuming milk daily, only 9% of the girls met recommended servings.  Early adolescents (78.2%) were more physically active than mid (53.7%) and late adolescents (44.8%).  Health status, education level and age were significantly associated (p < o.o5) with BMI. 69% girls who had health issues in the past 6 months had poor nutritional status. 66.7% of girls in early adolescence had poor nutritional status. Although PA was not significantly associated with BMI, its association with age was significant (p< 0.05) as early adolescent girls (78.2%) were found to be more physically active than middle (61%) and late (63%) adolescents.

Conclusions: Adolescent girls mostly had unhealthy lifestyle and dietary habits; which is likely to affect their health in future. Healthy behavior with emphasis on healthy eating habits and inclusion of physical activity in daily routine should be emphasized to overcome possible health challenges in form of NCDs later in life.

 

Purpose: 

The purpose of this study was to follow patterns of physical activity (PA) associated in obese pregnant women and after delivery.

Methods: 

This randomized study was conducted in obese pregnant women. Physical activity was measured using an accelerometer (The Actigraph, GT9X, Pensacola, FL, USA) during 1 week, between the 20 and 24th week of amenorrhea (T0), then between the 32 and the 34th week of amenorrhea (T1), and finally postpartum, between the 6th and the 8th week after birth (T2). A two level (time, subject) multilevel analysis was used. With time as a categorical variable, the development over time on sedentary (SED), light PA (LPA) and moderate to vigorous PA (MVPA) were modelled. Potential confounding variables were added to the model as they may influence PA. 

Results/findings: 

145 women participated to the experimentation. Table 1 shows SED, LPA and MVPA at T1 and the T2 follow-up measures. A significant decline was found for MVPA until postpartum. However, BMI (body mass index) and age were not significant predictors for more or less LPA and MVPA during pregnancy and postpartum.

​

​	%SED			%LPA			%MVPA
​	β (SE)	95%CI	p	β (SE)	95%CI	p	β (SE)	95%CI	p
Baseline PA	0.59 (0.05)	0.46 to 0.72	**	0.61 (0.05)	0.48 to 0.74	**	0.66 (0.04)	0.56 to 0.76	**
T1	1.89 (0.72)	0.03 to 3.75	**	-1.36 (0.69)	-2.70 to -0.02	*	-0.58 (0.15)	-0.97 to -0.19	**
T2	-0.62 (0.80)	-2.19 to 0.95	ns	1.56 (0.77)	0.05 to 3,07	*	-0.60 (0.17)	-1.04 to -0.16	**
Age	-0.01 (0.07)	-0.15 to 0.13	ns	-0.01 (0.06)	-0.13 to 0.11	ns	-0.002 (0.014)	-0.03 to 0.03	ns
BMI	0.10 (0.07)	0.04 to 0.24	*	-0.10 (0.06)	-0.22 to 0.02	ns	-0.006 (0.013)	-0.03 to 0.02	ns
*: significant different at p<0.05; *: significant different at p<0.01.

Table 1: Average change in physical activity levels and sedentary (%) across T1 and T2 in pregnant obese women

Conclusions: 

Physical activity of women who were most active at the beginning of their pregnancy maintained their activity level better than those who were less active. This study reveals the importance of emphasizing physical activity to obese women before pregnancy. 

Purpose: Peer volunteers offer a cost-effective avenue for promoting physical activity in the older population. However, recruiting and retaining such volunteers is challenging, and there is a lack of understanding on the underlying processes that lead to program adherence. We, therefore, aimed to longitudinally examine factors that determine levels of adherence of older volunteer walk leaders to a 16-week walking intervention.

Methods: One male and ten female (Mdn Age = 75 years, Age range = 66 – 83 years) novice peer walk leaders were interviewed twice over four months, and data were analyzed using thematic analysis. We used a longitudinal multiple case study design, informed by self-determination theory, to track three motivational profiles: program dropouts, program completers, and program maintainers.

Results: The desire to help, optimism, leadership confidence, satisfaction of basic psychological needs, and autonomous motivation were key to adherence. Autonomous motivation to volunteer and altruistic desires facilitated the use of sustainable helping strategies, leading to psychological need satisfaction and a desire to continue as a volunteer. A focus on self-orientated motives to volunteer, the use of unsustainable helping strategies, and lack of psychological need satisfaction were barriers to adherence. 

Conclusions: Our results highlight that the quality of motivation to volunteer may determine helping strategies and satisfaction of psychological needs among older walk leaders. Our findings can inform future older peer leader recruitment, training, and support to maximize their levels of adherence to physical activity programs. 

Purpose: Past research with older adults has highlighted the benefits of walking with peer groups, but not clarified how it compares to walking alone. We examined whether purposeful walking with peers (WP) at least once a week contributes to better behavioral and health outcomes in older adults than primarily walking alone (WA). 

Methods: A prospective survey design was used. Participants aged 60 and older (N =136) were recruited at the start of a 16-week walking intervention from nine retirement villages in and around Perth, Western Australia. Participants who walked on average at least once a week in the final eight weeks of the intervention were included in the analysis (N =79; 66 Females, Mage (SD) = 77.73 (6.91). 

Results: We found that autonomous motivation, walking self-efficacy, functional capacity, overall body fat, and physical activity behavior improved more in those who WP (i.e., either alone or with a partner), compared to those who WA, after controlling for whether participants lived alone/with others, and their health status. 

Conclusion: Our results extend the current literature by providing longitudinal evidence for the added benefits of regular peer accompanied walking in older adults, and highlight the importance of investing in peer-supported interventions. We recommend interventions that promote regular walks with supportive peers and provide the choice to do so as a group or with a partner. Further understanding of characteristics and behaviors of peers that are effective as walking partners or group leaders is needed.

Purpose: Dystonia is a poorly understood neurological movement disorder presenting as abnormal postures and uncontrolled movement of a body part or parts. Cervical dystonia (CD) is a dystonia affecting the neck. Research in chronic populations generally indicates physical activity (PA) has benefits for both psychological and physical well-being. Little is known about the potential benefits of exercise for those living with CD, and recent evidence indicates most find exercise worsens physical symptoms like tremor, abnormal head posture, pain and fatigue. Despite this, some people with CD do continue to exercise regardless of symptom aggravation; the reasons for this are unknown.

Methods: The study followed a previously published mixed methods protocol to explore PA motivation and benefits in people living with CD who met weekly PA minimum guidelines. Surveys were distributed online. Questionnaires included measures of self-efficacy, self-determined motivation, optimism and pessimism, dystonia severity and quality of life. There were open-ended questions that further explored underlying reasons for PA engagement. Six individuals participated in semi-structured interviews which allowed greater depth of exploration of the research question.

Results: There were 96 (55 male) respondents that met the minimum guidelines for weekly PA. The main findings were that participants attributed feelings of accomplishment and control to their engagement in PA activity despite living with dystonia. The main benefits were enhanced physical and mental well-being, greater control of dystonia symptoms, enhanced life satisfaction and quality of life. Engaging in PA helped individuals to maintain a positive outlook on life.

Conclusions: Physical activity is an important component of self-management in people living with CD who continue to exercise despite symptom aggravation during or after exercise. Engagement in PA and exercise may enhance optimism and life satisfaction as well as improving quality of life. PA as a therapeutic intervention should be utilised by exercise and health professionals managing dystonia. Interventions that aim to increase PA engagement in those with CD who are less active should focus on self-determined motivation and self-efficacy to increase competence for PA, which may in turn, enhance their quality of life.

Purpose Physical fitness is strongly associated with health, and to our knowledge, trends in physical fitness have not been described. We aimed to assess trends in physical fitness and its association with the nutritional transition among Chinese children and adolescents.

Methods Data from Chinese school students aged 7–18 years were extracted from six successive national surveys undertaken between 1985 and 2014. Six components of physical fitness (forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50 m dash, and endurance running) were measured repeatedly in each survey and aggregated as a summary physical fitness indicator (PFI). Growth and nutritional status were defined by the use of WHO definitions. We used fractional polynomial regression and generalized additive models to assess associations between PFI and nutritional outcomes.

Findings Between 1985 and 2014, 1 513435 students participated in the Chinese national surveys, and 1494485 were included in our study. We observed a decline of the PFI during 1985–2014 (overall PFI change –0·8), albeit with an increase from 1985 to 1995 (PFI change 1·2), coinciding with a shift in the major nutritional problems from stunting and thinness to overweight and obesity. Both undernourished (PFI -2·44 for thin and -3·42 for stunting) and overnourished (-1·49 for overweight and -3·63 for obese) students had a lower PFI than that of those with normal weight (-0·41) in 2014. Boys had a larger decline in PFI than girls in 1985-2014, especially boys with obesity (PFI change -2·7). We observed the highest PFI in 1995 (1·17), when the proportion of students with normal weight was highest.

Conclusions Our study supports the continuation of policies to improve physical fitness that focuses on undernutrition, including economic subsidies, in poorer rural regions. However, for most of China, taxation of unhealthy foods, promotion of physical activity, reduction in academic pressures, promotion of dietary diversity, reduction of sedentary time, and engagement in formal sporting activities should be elements of policies to promote healthy weight status and prevent obesity in school students, which will also support physical fitness.

[Purpose] The purpose of this study was to assess the factorial validity of a Japanese version of the Behavioral Regulation in Exercise Questionnaire (BREQ-3; Markland and Tobin, 2004; Wilson et al., 2006; Cid et al., 2018). The BREQ-3 is a multidimensional self-report measure designed to evaluate behavioral regulation in exercise domain from the perspective of self-determination theory. It comprises 18 items amotivation, external regulation, introjected regulation, identified regulation, integrated regulation and intrinsic motivation on a 7 point Likert-type scale, and has been used extensively in recent research. [Methods] The sample comprised 1063 adults (Mage = 44.7 years, SD = ±14.0, 574 men) who completed the Japanese BREQ-3, which was created by the back-translation procedure. [Results] Confirmatory factor analyses provided support for the tenability of the hypothesized factor structure of the Japanese BREQ-3 (SRMR=.065; NNFI=.93; CFI=.95, RMSEA=.08) and for the invariance of the factor loadings and inter-factor covariances. Subscale reliabilities (Cronbach’s alpha coefficient) ranged from .80 - .96. [Conclusions] The results demonstrated that the factorial validity and reliability of Japanese BREQ-3 is acceptable, suggesting that it may be useful to enhance our understanding of exercise motivation from the perspective of self-determination theory.

Purpose:            The aim of this study was to explore enablers of and barriers to sports participation of Taiwanese children and                             adolescents, and examine whether there were differences in their responses by weight status (underweight,                               healthy weight, and overweight) or school type (elementary, junior, and senior high school) they attended.

Methods:           Data for this study were extracted from a cross-sectional survey of students aged 11-18 years, selected from                              elementary and high schools in late 2018. Students were asked questions about their reasons to or not to                                  participate in sports. The final analytical sample size was 27,779 students (47.7% girls, mean age= 14.5±2.26                          years). 

Results:             For enablers of sports participation, “parental support” was the mostly cited enabler for elementary                                            (overweight: 42.6%, healthy: 39.4%, and underweight: 44.7%) and junior school attendees (overweight:                                  31.3%, healthy: 26.6%, and underweight: 25.1%) across all weight-status groups, and junior school attendees                          who were underweight (22.7%). “Health benefit” was the main enabler for senior school attendees who were in                          overweight (22.0%) or healthy weight (21.8%) group. “Sense of fulfillment”, “social relationship”, “time”,                                    and “place” were also reported as enablers by the study participants across different weight status and school                            type. For barriers to sports participation, “lack of time” was the mostly cited reason irrespective of weight status                          or school type. The second mostly cited barrier in the overweight and healthy weight groups was “lack of                                    parental support” (overweight: 14.7%, healthy: 15.7%), “lack of sense of fulfillment” (overweight: 12.8%,                                healthy: 13.1%), and “lack of place” (overweight: 12.9%, healthy: 12.9%), respectively, for elementary, junior,                          senior high school attendees.

Conclusions:      Enablers of and barriers to sports participation differed by weight status and school type among children and                              adolescents in Taiwan. Age and weight-sepcific strategies are needed to promote sports in Taiwanese children                              and adolescents.

Introduction: Physical activity (PA) has been identified as a facilitator of eating behavior regulation, in part through self-determined motivations to regulate exercise and eating behaviors. However, different patterns of PA and sedentary behaviors (e.g., sitting) appear to have distinct effects on several health outcomes and all-cause mortality, and might therefore be differently related to the way we regulate eating. Also, motivational spillover pathways linking PA and eating behavior have been previously supported. This study aimed to extend prior research by identifying different profiles of PA and sedentary time, and test whether these profiles explained internal eating markers through distinct motivational routes.

Methods: A total of 297 adults (age: 34.5±10.6yr; BMI: 23.2±3.4kg/m2) volunteered to participate in this study. Participants filled the International Physical Activity Questionnaire, Behavioral Regulation in Exercise Questionnaire, Regulation of Eating Behavior Scale, and Intuitive Eating Scale. Latent Profile Analysis and Preacher & Hayes Mediation Procedures were conducted.

Results: A 3-profiles model was retained as the best solution (++sitting/-PA, n = 89; ++PA/-sitting, n = 44; +PA/+sitting, n = 164). Participants in the ++PA/-Sitting profile showed higher self-determined motivations to exercise (ps<.001) and regulate eating (ps<0.05). No differences emerged in non-self-determined motivations and eating measures. Mediation analyses showed that participants in the ++PA/-Sitting profile (vs. ++Sitting/-PA) made more body-congruent food choices, partly through a serial mediation effect of self-determined motivations for exercise and eating (Estimate: 0.25 (0.07), 95%CI: 0.127-0.400). All analyses were adjusted for age, gender, and BMI.

Conclusions: Results extend prior evidence, showing that motivations underpinning exercise/eating have better quality when greater levels of PA are combined with lower sitting time, and by showing that self-determined motivations seem to partly mediate the effects of different patterns of PA and sedentary time accumulation on eating regulation. These findings have implications for future interventions, especially considering the important role of different patterns of movement behaviors and self-determined motivations on the regulation of health-related behaviors.

Purpose: To investigate the effects of a single moderate- or high-relative intensity exercise session on subsequent appetite and energy and macronutrient intakes, which depend on food choice and feeding behavior.

Methods: Twelve males aged 22±1 years participated in this randomized crossover study. The appetite and food intake were evaluated following 2 bicycle ergometer trials (moderate-intensity trial [MOD]: at lactate threshold intensity over 90 min; high-intensity trial [HIGH]: at a blood lactate accumulation of 4mmol/L over a duration of equivalent energy expenditure as MOD) and a rest trial (CON). The participants were asked to purchase and consume meals consisted of foods available at supermarkets, convenience stores and cookshops as desired (ad libitum) after each trial. Energy and macronutrient intakes were calculated using the nutrition facts on the food labels. The subjective feelings of appetite were evaluated before and after exercise using 100-mm visual analogue scales.

Results: Significant time×trial interactions were observed for the subjective feelings of hunger, satiety, desire to eat, prospective food consumption and desire to eat fatty, salty or sour foods. Immediately after HIGH, the parametric values of hunger (effect size, ES: 0.81), desire to eat (ES: 0.95), prospective food consumption (ES: 0.81) and desire to eat fatty (ES: 1.17) or salty foods (ES: 0.87) were significantly lower and the satiety (ES: 0.91) was significantly higher than those after CON. The mean energy intake after HIGH was lower than that after CON (ES: 0.52); however, no significant difference was observed between the 2 trials. A one-way ANOVA revealed a significant difference in protein intake among three trials; the mean protein intake after HIGH was lower than that after CON (ES: 1.01). In contrast, no significant differences were observed in energy and macronutrient intakes between MOD and CON.

Conclusions:The results showed that in young adult males, high-intensity exercise suppresses appetite, especially the desire to eat fatty and salty foods, and influences temporal food choice such that protein intake immediately after exercise is low. However, moderate-intensity exercise does not find significant effects on the subsequent appetite and feeding behavior.

Purpose: Insufficient physical activity (PA) is associated with an increased risk of chronic disease. Almost 40% of preventable hospital episodes are attributable to chronic disease. Despite this, behavioral interventions for increasing self-management of PA in the hospital setting remain underutilised. Hospital surgeons undertake high volumes of non-admitted consultations annually, and have potential to influence behaviour change amongst patients. This study empowered hospital surgeons to refer suitable participants to a behaviour change intervention. This study aimed to examine the effectiveness of a twelve-week, behaviour change intervention for changes in PA and health-related outcomes in adults presenting to a non-admitted hospital clinic.

Methods: A randomized controlled trial was conducted where 120 insufficiently physically active adults were referred to the study by surgeons consulting at an ambulatory hospital clinic. Participants were randomised to an intervention group that received an education session and five 20-min telephone sessions of integrated motivational interviewing and cognitive behaviour therapy (MI-CBT), or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity (MVPA) at baseline and follow-up (3-months). Secondary outcome measures (anthropometrics and PA self-efficacy) were also assessed at both time-points.

Results: At baseline, the mean age and MVPA of participants (n= 120, 76% females) were 53 ± 8 years and 15 ± 5 min/day respectively. Mixed model ANOVA demonstrated the treatment allocation influenced the pattern of PA over time (p< 0.001). At follow-up, the intervention group averaged 23 min/day of MVPA, a mean difference of 8 min/day (95%CI:5 to 11 min/day) relative to baseline. The control group averaged 13 min/day at follow-up, an average decrease of 2 min/day (95%CI: -3 to 0 min/day) over the period. Significant changes were also observed in mass (p< 0.001), waist circumference (p= 0.027), body mass index (p< 0.001) and PA self-efficacy (p< 0.001) in the intervention group. No changes were observed in these parameters amongst the controls.

Conclusions: The behaviour change intervention resulted in beneficial changes in PA, anthropometrics and health-related outcomes in insufficiently active participants recruited from ambulatory hospital clinics. The effectiveness of the intervention to maintain the changes out to 9-months will be examined.

Purpose

Active NZ research shows participation in physical activity declines between ages 15-17 (mid-late secondary school years). This ‘drop off’ means rangatahi are engaging in fewer hours per week, doing fewer activities, and reducing weekly participation. Physical activity can positively contribute to physical, social and cognitive domains - high quality experiences have the potential to augment benefits and increase the likelihood of long-term engagement and understanding of the value of being physically active. The purpose was to better understand experiences to identify potential levers for interventions which improve the quality of physical activity for rangatahi within a secondary school context in Aotearoa, New Zealand.

Methods

Data were collected via an online survey circulated to 58 secondary schools in Aotearoa, between August 2019 – November 2019. We examined data from 8327 rangatahi (aged 11-18). Self-reported satisfaction across several items were used to understand various aspects of experience. Net Promoter Score (NPS) were used as an overall key metric. NPS measures the likelihood that an individual would recommend an activity to another person. Regression analyses were used to determine the relationship between specific aspects of experience and likelihood to recommend physical activity provision at school.

Results

NPS were very low (-28), indicating a poor overall experience. Across all items of satisfaction, Rangatahi were least satisfied with their school ‘having clean and well-maintained facilities’ (23% very/extremely satisfied). Almost a third (32%) of rangatahi reported ‘cleanliness and maintenance of facilities’ as the factor they would most like to see improved at school. This is a significantly greater concern for high-decile (37%), than low-decile schools (22%) and males (34%), rather than females (30%).

Conclusion

Rangatahi are generally dissatisfied with physical activity experiences at secondary school. Results show particular issues with cleanliness and maintenance of facilities, which suggests a key-focus point for improvement. Research frequently focuses on individual factors (e.g. confidence), which is crucial, however these results signify the importance of considering broader aspects of experience, including the physical environment. Results indicate the importance of targeted school-led interventions aimed at improving physical activity experiences for rangatahi. 

Purpose:

We hypothesised that mental health professionals would be more likely to promote more physical activity (PA) and less sedentary behaviour (SB) among their clients, if they themselves are more active. In this context, we investigated the effects of engaging mental health professionals in an intervention to increase PA and reduce SB on their attitudes towards and practices in recommending more PA and less SB to their clients.

 

Methods:

We used a mixed-methods study design comprising of four weeks long pre-post intervention trial and focus group discussions. The study was conducted in two Orygen headspace centres. The intervention consisted of a group meeting where participants received consultations on how to increase their PA and reduce SB, weekly reminders, and an information booklet. The information booklet contained low-cost strategies for increasing PA and reducing SB in leisure, home, work, and transport domains. We collected information at baseline and follow-up using Exercise in Mental Health Illness Questionnaire and GENEActiv accelerometer. Two focus group discussions were conducted after the completion of quantitative data collection. The focus group discussions were audio-recorded, transcribed, and thematically analysed. 

 

Results:

17 mental health professionals participated in the study (mean ± standard deviation of age = 37.9 ± 9.8 years). We found that participants who increased their PA from baseline to follow up recommended more PA and less SB to their clients more often than those who did not increase their PA. No significant difference between the two groups were found in general beliefs and perceived barriers towards recommending more PA and less SB to their clients. In the focus group discussions participants stated that the strategies to increase PA and reduce SB that were recommended during the intervention were helpful and easy to implement, and that they are inclined to recommending PA to their clients.  

 

Conclusion:

These results show good feasibility and acceptability of the intervention aimed at increasing PA and reducing SB among mental health professionals. The intervention may also have a positive impact on the practices of mental health professionals towards recommending more PA and less SB to their clients.

 

Purpose

Cancer diagnosis may be a cue for health behavior change; however, limited evidence exists on whether such changes are maintained long-term. This study investigated the impact of a cancer diagnosis on health behavior changes over the long-term survivorship period among breast cancer (BC) survivors.

Methods

Data were from the Australian Longitudinal Study on Women's Health (ALSWH). BC survivors (n=153) were identified and health behaviours were assessed in five survivorship period: <=3 years (n=93), 3-6 years (n=140), 6-9 years (n=135), 9-12 year (n=123) and 12-15 years (n=46) since diagnosis. Pre-diagnosis (baseline) assessment of health behaviors was undertaken at ALSWH wave 3 (2001). Physical activity (PA), fruit intake, and Body Mass Index (BMI) (collected using survey questions) from waves 3-8 and vegetables and nutrients intake (collected using an FFQ) from waves 3 and 7. Mixed effect models were used to examine the association between time since diagnosis and health behavior changes.

Results

Compared to pre-diagnosis, BC survivors were significantly more physically active (>=600 MET minutes/week; 50.8% to 63.3%; p=0.02) and consumed more fruit (>=2 serves/day; 57.4% to 66.4%; p=0.01) in the recent survivorship period. BC survivors were less likely to be classified in the healthy weight range following their cancer diagnosis (42.6% to 32.2%; p<0.01). Whole-vegetable intake did not change, however, the intake of non-starchy vegetables significantly increased from pre-diagnosis (LS mean=89.1 g/day) to post-diagnosis, 6-9 years (LS mean=137.1 g/day) and 9-12 years (LS mean=120.8g/day). There were no significant changes in the total intake of fiber, carotenoids, calcium, fat, saturated fat, vitamin C or vitamin E observed, with the exception of increased total energy intake (p=0.012).

Conclusions

BC survivors report initial positive changes to PA and fruit consumption following their diagnosis but these changes were not maintained into long-term survivorship. Limited dietary changes were reported by women and BMI scores increased over the survivorship period. BC survivors may benefit from additional advice and support to make healthy lifestyle choices throughout survivorship.  

 

 

 

Background: Growing research has investigated the level of muscle-strengthening (MS) activities and its correlates among Western populations; however, scarce attention has been laid on the issues among Chinese adults. This study aimed to describe the level of MS activities and to explore the relationships of sociodemographic correlates of MS activities in a large sample of Chinese adults. Methods: 3073 adults were recruited from 13 cities in Hubei Province. A self-reported questionnaire was employed to collect data on MS activities and sociodemographic information among participant of this study. According to the World Health Organization physical activity guidelines (MS activities should be accumulated at least 2 days a week). Multivariable logistic regression was used to explore the sociodemographic correlates of MS activities. The statistical significance level was set up as p < 0.05. Results: Of all the included participants, the prevalence of MS activities was 28.5%. MS activities among the total samples were associated with sex (aOR for male = 1.98, 95%CI: 1.67-2.34) and family composition (aOR for multiple children = 1.35, 95%CI: 1.12-1.64). Among males, normal weight status (aOR = 1.39, 95%CI: 1.08-1.78) and multiple children (aOR = 1.58, 95%CI: 1.21-2.05) were associated with MS activities. There was no association of sociodemographic factors with MS activities among females. Conclusions: Approximately 70% of adults in Hubei Province do not engage in recommended MS activities. These activities were associated with sex and family composition, which differed between sexes. This study provides sex-specific information on MS activities interventions. Future studies should use improved designs to explore more sociodemographic and other dimensional correlates of MS activities among Chinese adults, which provides evidence base for improved health behaviour interventions. 

Background: Active transport to school (ATS) provides an opportunity for physical activity for adolescents. However, some evidence suggests that ATS may be associated with an increased intake of unhealthy foods and drinks along the school route. This study compared the frequency of purchasing and consuming snack foods and soft drinks on the school journey in adolescents by mode of transport to school, neighbourhood level deprivation and weight status.

Methods: Adolescents (n=731; 53.5% females; 15.3±1.4 years) from 11 secondary schools in the Otago region, New Zealand, completed an online survey in 2018. Adolescents self-reported usual modes of transport to school and weekly frequency of purchasing and consuming snack foods and soft drinks on the way to/from school. Data were analysed by school transport (active/motorised/mixed), neighbourhood-level deprivation (New Zealand Deprivation Index; low (n=420; Quintiles 1+2), medium (n=158; Quintile 3) and high deprivation (n=117; Quintiles 4+5) and weight status (healthy weight vs. overweight/obese).

Results: Overall, 36.5% reported purchasing and consuming snack food and 26% soft drinks on at least one school trip (on average, 0.91±1.73 and 0.66±1.50 of 10 school trips/week, respectively). No significant differences were found by school transport mode. Adolescents from high deprivation neighbourhoods reported significantly higher frequency of snack food purchase and consumption compared to those from low deprived neighbourhoods (1.43±2.31 vs 0.76±1.52 of 10 school trips/week; p=0.011). Soft drink purchase and consumption frequency was significantly higher among adolescents from high (1.23±2.26 trips/week) compared with medium (0.64±1.58 trips/week) and low (0.50±1.28 trips/week) deprivation neighbourhoods (high vs medium: p=0.036; high vs low: p=0.002), and higher in overweight/obese versus healthy-weight adolescents (0.85±1.74 vs 0.57±1.50 of 10 school trips/week; p=0.023). 

Conclusions: The purchase and consumption of snack foods and soft drinks during adolescents’ journey to/from school was not significantly different across the different modes of transport to school. Adolescents from more deprived neighbourhoods, and those who were overweight/obese were significantly more likely to report purchasing and consuming food and beverages from food outlets during the school journey compared to their counterparts. Future studies should examine whether adolescents living in more deprived areas are also more exposed to more unhealthy food outlets and advertising.

Background: People with multiple sclerosis (MS) are less physically active and sit more than healthy peers, and this might contribute toward worse symptoms, function, and quality of life (QOL). There is merit in focusing on whole day activity for improving outcomes in MS.

Objective: We examined the preliminary efficacy of a novel intervention called “SitLess with MS” that focuses on sitting less and moving more during the day on activity behaviour outcomes, MS-related symptoms and physical performance in MS.

Methods: The “SitLess with MS” intervention utilized a single group repeated measures design. The intervention was internet-based and designed using behavioural strategies and principles from social cognitive theory. Persons with MS with mild-to-moderate disability were recruited from Edmonton, Canada, through collaboration with MS Society of Alberta and the MS Clinic at the University of Alberta. Participants attended 3 measurement sessions including pre-intervention (baseline), post-intervention (Week 15) and follow-up (Week 22). At all 3 measurement points, activity behaviour was measured by the ActivPAL3^TM and MS-related symptoms including fatigue, depression, anxiety, pain, sleep quality and cognitive impairment, QOL and physical performance were assessed. An unstructured linear mixed effect model was used to estimate change over time per outcome.

Results: Forty-one people with MS with an average age of 50±10.3 years and 14 years since MS diagnosis participated. From pre-to-post intervention, participants significantly reduced total sedentary time (effect size: 0.34) and the number of long (> 30 minutes) bouts of sedentary time (effect size: 0.39). Fatigue, depression, anxiety, sleep, total pain, QOL, gait speed, walking endurance and function improved significantly from baseline to immediate post-intervention. The largest effect size was observed for depression (0.79), followed by fatigue and anxiety with the effect sizes of 0.63 and 0.55, respectively. There was no significant change in cognition. (P < 0.05).

Conclusion: The results suggest a positive effect of a new activity behaviour change intervention on sedentary behaviour outcomes and QOL in MS. This strategy of reducing sitting and increasing light-intensity activities such as slow walking may be an important step towards promoting activity levels in MS.

Purpose

Affective responses to exercise in laboratory studies predict future exercise behaviour, however there is little research on improving how people feel during real-life physical activity. Running is a simple, economical exercise with potential to improve public health. Beginner running groups are a popular way to start to run, providing an opportunity for examining behaviour change trajectories. The Running Commentary study aimed to investigate contextual factors influencing affective responses to exercise in adults joining beginner running groups.

Method

This was a longitudinal, mixed methods field study, using go-along interviews and follow-up online physical activity questionnaires (N=69, 13 UK groups). Participants joining beginner running groups were asked how they felt before, during and after a baseline run-walking session using the Feeling Scale (FS), a single-item 11-point bipolar scale. These results were plotted against session timepoint (‘affective timelines’) for individuals. Three distinct patterns of affective timeline were established using cluster analysis. Participants were also asked to articulate why they gave that particular score (qualitative data). Transcripts were thematically analysed.  A mixed-methods analysis assembled example annotated affective timelines for three different patterns of affective responses for three individuals. FS scores were plotted against time, with relevant quotes from participants at each timepoint demonstrating factors influencing how participants felt.

Findings

Some findings were confirmatory of previous treadmill-based research, such as pre-exercise feelings, interpretation of physiological symptoms and a sense of achievement during and after running being important in how people felt during exercise. Some novel findings were: the concept of learning to run being a ‘journey’ or process, with ups and downs to accept, distraction from discomfort by talking to others, and social pressure or expectations around running faster than was comfortable contributing to people feeling worse during running.

Conclusions

These mixed-methods findings inform suggestions on improving training for beginner group leaders and future run-walk interventions. This novel method of annotating affective timelines provides a simple yet powerful illustration of affective changes during exercise, and demonstrate some of the factors which contribute to these affective responses to exercise.    

Purpose

How people feel during exercise may be related to their future physical activity behaviour. There is little research on the factors which might improve these affective responses to exercise, particularly for novices. This poster presents findings from a qualitative synthesis of two studies examining affective responses to exercise, specifically in beginner runners.

Methods

Running Commentary was a longitudinal, mixed methods field study, using go-along interviews (N=69, 13 UK beginner running groups). Participants were asked to rate how they felt and why during a run-walking session. WalkJogSmile was an online longitudinal diary study of participants (N=27) following a 9-week beginner running podcast. Participants gave qualitative feedback after running sessions and were interviewed post-study. A qualitative synthesis of results from both studies was conducted using the method of ‘following the thread’ after thematic analysis. One theme identified across studies is discussed here, namely ‘discomfort’.

Results

Participants in both studies discussed discomfort, and being in discomfort influenced affective responses to exercise. Five subthemes were identified: clothing, bodily functions and needs, niggles and injuries, lungs and heart and effortful/effortless running. Running is a high intensity, high impact exercise, and this was reflected in the factors participants discussed affecting how they felt during exercise. Uncomfortable shoes, ill-fitting bras or trousers and inadequate pockets caused discomfort or irritation, and clothing was particularly important in extreme weather. Bodily functions and needs discussed by beginners included needing the toilet, digestive issues, hunger and thirst. Niggles and injuries were frequently described as causing discomfort or pain during/after running, and interfered with running enjoyment. Heart and lung-related sensations such as being breathless, having a stitch or feeling heart rate increases caused discomfort, but could also be interpreted positively or negatively. Participants often described running as a mental or physical struggle, reflecting the difficulty of beginners pacing. WalkJogSmile participants in later weeks expressed pleasure in effortless or 'automatic' running.

Conclusions

These results gave novel insights into factors related to affective responses to exercise in beginner runners. Applications include improved practical advice for beginner runners and improved practitioner training.

Purpose: Individuals from different cultures are subject to the socio-cultural influences, resulting in culture-associated differences in the predictors of participation in physical activity. Understanding the cultural influence on international students’ participation in physical activity may help us to develop more effective intervention programs for health promotion.

Methods: Taking the Theory of Planned Behavior as a framework, the present study aims to investigate the psychosocial mechanisms through which Chinese international students’ cultural experiences in Germany are translated into physical activity behaviors. Specifically, a mediation and a moderation model were proposed. In the mediation model, acculturation was hypothesized to affect an individual’s intention to partake in physical activity through attitude, social norm and perceived behavioral control. In the moderation model, the moderation effects of cultural value orientation (individualism/collectivism) on the association between socio-cognitive variables of perceived behavioral control, subjective norm, attitude and the physical activity intention will be examined.

Purpose: To reduce the levels of physical inactivity in China, the theory of planned behaviour (TPB) presents a suitable theoretical framework and guideline. However, the relative contribution of some TPB variables may vary across cultures. The present study applies the TPB to predict physical activity behaviour in Chinese college students and compares the strength of the effects of TPB variables on physical activity among Chinese and Western samples.

Methods: This study used a cross-sectional design. The Chinese sample consisted of 892 college students. Data for the Western sample were inferred from a meta-analysis by Hagger, Chatzisarantis and Biddle. Main Outcome Measures: Participants’ attitude toward physical activity, subjective norm regarding physical activity, perceived control over physical activity behaviour, intention to be physically active, and self-reported physical activity behaviour.

Results: The TPB reliably predicted physical activity behaviour in the Chinese sample, but the effects of subjective norm and perceived behavioural control on intention were significantly stronger in the Chinese than the Western sample.

Conclusions: The TPB can be applied to predict physical activity among Chinese college student population, with subjective norm and perceived behavioural control having a stronger role than in Western culture.

Purpose:

While there is considerable literature on sugar-sweetened beverage consumption among children and adolescents, current research does not paint a clear picture of beverage choices among college students and working adults. Few studies have researched the qualitative aspects of beverage consumption in this demographic population. There is a gap in understanding the motivations for and barriers to consuming more tap water and less sugar-sweetened beverages. This study will begin to fill this gap by investigating student and staff beverage choices at a large urban university, with the objectives of (a) understanding the barriers/facilitators to making healthy and sustainable beverage choices; and (b) identifying potential solutions to promoting healthier beverage consumption.

Methods:

This study used focus groups and brief questionnaires. Focus groups allowed us to qualitatively explore attitudes toward beverage choices and preferences, and various health messages. They also allowed us to engage community stakeholders in the campus’ initiative to promote a healthy environment.  Students were recruited through email invitations that were distributed through academic departmental listservs. Staff were recruited with the assistance of the Staff Assembly.  Additionally, flyers were posted throughout the campus. Students were eligible if they were enrolled full-time, while staff had to have worked full-time at the university for at least one year. 307 people responded to the invitation; of these, 290 were eligible and 81 participated. A total of nine focus groups were conducted (28 staff members and 53 students), with students living on-campus (3), students living off-campus (3), and staff members (3).

Results:

Our thematic analysis will provide insights into the barriers/facilitators to making healthy beverage choices, the factors that influence beverage choice, and the solutions to promoting healthy beverage consumption on a large urban campus. Using a community-engaged research approach, this study will use these findings to inform the development of strategies for promoting healthy behaviors among college students and staff.   

Conclusions:  

Gaining an in-depth understanding of beverage perception, choice and consumption habits among students and staff will provide valuable insights into effective strategies for promoting a healthier beverage environment in educational settings.

Purpose: There is large variability in response to weight loss attempts. This study characterised the psychological and behavioural markers of clinical weight loss (5% of starting body weight) during a 14-week program.

Methods: This study was conducted as secondary analysis of the SWIPS trial which recruited 96 women (41.0 ± 12.6 years; 34.0 ± 3.6 kg/m²; completers n=80) who had voluntarily enrolled in healthy eating-based weight loss programs. After a two-week run-in period, psychometric eating behaviour traits were assessed using validated questionnaires (restraint, flexible, rigid, disinhibition, hunger, binge eating and craving control). On four days during the trial, under controlled laboratory settings participants’ evening meal, evening snack and total day energy intake (TDEI) were objectively assessed in response to meals varying in energy density days. Based on objectively measured body weight in weeks 1 and 14, participants were classified as clinical weight-losers (CWL; lost ≥5% of starting body weight; n=41), non-clinical weight-losers (NCL; lost ≤3% of starting body weight, n=33), or unclassified and excluded from the analysis (lost 3.1–4.9%, n=6).

Results: Mixed ANCOVAs controlling for early weight loss and weight loss program, revealed that CWLs scored significantly higher in craving control compared to NCLs. During the program, CWLs showed significant increases in flexible eating and significant decreases in trait binge eating; NCLs’ eating behaviour traits did not significantly change. At the end of the trial, CWLs also scored significantly lower in disinhibition and hunger. Restraint and rigid eating style did not significantly change or differ between CWLs and NCLs. In the laboratory, while evening meal and TDEI did not significantly differ, CWLs consumed significantly fewer snacks (kcal) compared to NCLs.

Conclusions: In this trial, compared to NCLs, CWLs were characterised with high craving control and flexible eating and low trait binge eating and low snack energy intake. Future weight loss programs should target these eating behaviour traits and regulated snack intake to support clinical weight loss.

Background: The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. In the general population, consumer-based wearable activity trackers have shown promise as a potential mode in which to facilitate physical activity.The ACTIVATE Trial examined the efficacy of a wearable-based intervention to increase physical activity and reduce sedentary behaviour in breast cancer survivors. This paper examines the effects of the intervention on health-related quality of life (HRQoL) and fatigue at 12 weeks (T2; end of intervention) and 24 weeks (T3; follow-up).

Methods: Inactive and postmenopausal women who had completed primary treatment for stage I-III breast cancer were randomized to intervention or waitlist control. Physical activity and sedentary behaviour were measured by Actigraph® and activPALTM accelerometers at baseline (T1), end of the intervention (T2), and 12 weeks follow up (T3). HRQoL and fatigue were measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Primary intervention effects were evaluated comparing intervention and waitlist group at T2 using repeated measures mixed effects models.

Results: Overall, 83 women were randomized and trial retention was high (94%). A 4.6-point difference in fatigue score was observed between groups at T2 (95% CI: 1.3, 7.8) indicating improvement in fatigue profiles in the intervention group. In within groups analyses the intervention group reported a 5.1-point increase in fatigue from baseline to T2 (95% CI: 2.0, 8.2) and a 3.3-point increase from baseline to T3 (95% CI: 0.1, 6.41).

Conclusions: Despite small improvements in fatigue profiles, no effects on HRQoL were observed. While the ACTIVATE Trial was associated with improvements in physical activity and sedentary behaviour, more intensive or longer duration interventions may be needed to facilitate changes in HRQoL. This evidence adds support to clinical recommendations for cancer survivors to incorporate physical activity as part of their post-treatment rehabilitation and recovery plan.Future research should continue to utilize device-based assessments for optimal precision in measuring daily movement and posture.

 

 

Purpose: Cancer survivors benefit from physical activity in regard to short- and long-term physical and psychological health. However, health inequalities exist based on sociodemographic factors which can be mediated by health behavior. The purpose of the study was to explore inequalities in physical activity levels among Korean cancer survivors according to sociodemographic variables.

Methods: Data from the annual, nation-wide, cross-sectional survey in Korea, the Korean National Health and Nutrition Examination Survey, conducted between 2014 – 2017 were used. Of 31,207 participants who completed the survey, data from 901 cancer survivors were analyzed. Leisure-time physical activity levels and sedentary behavior were assessed using a self-reported questionnaire and calculated as total minutes spent per week. Sociodemographic information was obtained by a face-to-face interview, including age, sex, region, marital status, income, and employment status. Complex sample general linear model was used to examine between-group differences in physical activity according to sociodemographic factors.

Results: Total minutes of physical activity and sedentary behavior in Korean cancer survivors were 86±9 and 478±8 min/week, respectively. Significant differences in physical activity were found for age (≤40years: 135±27 vs. ≥70years: 31±8; p<.05), sex (female: 59±8 vs. male: 119±17; p<.05), education (college: 181±23 vs. elementary school: 25±6; p<.05), income (very high: 183±29 vs. very low: 27±7; p<.05), and employment (employed: 182±36 vs. unemployed/temporary: 48±14; p<.05). No significant differences were found for region. Sedentary behavior did not differ according to sociodemographic factors except education (college: 501±16 vs. high school: 454±15; p<.05).

Conclusions: Inequalities in physical activity among Korean cancer survivors were found which may partly explain inequalities in health. Our findings suggest that physical activity promotion should be targeted at older, female, less educated, lower income, and unemployed Korean cancer survivors. Ultimately, it would help address inequalities in physical activity as a mediator of health outcomes in Korean cancer survivors. 

Purpose: The number of cancer survivors is expected to keep increasing in the next decades, due to medical advances. Therefore, lifelong health issues and quality of life represent a major concern for this population. Regular physical activity (PA) and a healthy dietary behaviors (HDB) are essential to improve cancer survivors’ health and quality of life. However, most survivors do not meet behavioral guidelines. Motivation quality seems to be an important determinant of sustained behavior adherence. This study aimed to analyze motivational indicators, as per Self-Determination Theory, and their association with PA levels and HDB in cancer survivors, regardless of cancer type and disease stage.

Methods: A total of 91 cancer survivors (age:46.3±9.1yr; BMI:25.5±4.9kg/m²; time of diagnosis: 43.4±44.9 months) volunteered to participate in this cross-sectional study. Participants completed the International PA Questionnaire, the Behavioral Regulation for Exercise Questionnaire - 4, the Regulation of Eating Behavior Scale and some questions regarding their HDB based on World Cancer Research Fund guidelines. Multiple linear regression analyses were conducted.

Results: Insufficient levels of PA (i.e below the recommended guidelines) of 140.7±240.3 min/wk, and a moderate to high frequency of HDB were found in this sample of cancer survivors. Integrated motivation was identified as the only significant predictor of PA (β =.301; p =.004). HDB were positively predicted by intrinsic (β =.393; p < .001) and external (β =.219; p =.025) motivations to regulate eating, and negatively by amotivation to regulate eating (β =-.305; p = .004) and amotivation to exercise (β =-.302; p =.002).

Conclusions: Preliminary findings suggest higher adherence to HDB compared to PA in this sample of cancer survivors. It further supports the role of more self-determined motivations on the adoption of healthy PA. Regarding HDB mixed findings were found (i.e. both extrinsic and intrinsic forms were associated with healthy diet). These findings have implications for future interventions and practice, especially considering the lower integration of PA services and specialists in standard care compared to diet services and professionals.

Purpose: The benefits of physical activity (PA) in kidney cancer survivors (KCS) include improvements in quality of life (QoL), fatigue, and physical functioning. However, only 26% of KCS are sufficiently physically active to accrue these benefits. Oncology healthcare providers (OHP) can play an important role in providing PA information and recommendations to KCS.

 

Methods: Using a cross-sectional study design, OHP were recruited through the Kidney Cancer Research Network of Canada. OHP included oncologists, nurses, and urologists, currently working with KCS in Canada. OHP completed a self-reported on-line survey addressing attitudes, knowledge, confidence and competence discussing PA to KCS and using the guidebook, as well as current PA discussion practices. A 47-item questionnaire was developed with open- and close-ended questions addressing the study objectives. Data was analyzed using descriptive statistics, including frequencies and percentages of responses to determine trends in PA discussion for this population. 

 

Results: OHP (n=13) were mainly oncologists (n= 8; 62%). OHP hold positive attitudes towards PA for KCS both during (n=12; 92%) and after (n=12, 100%) treatment. However, they lack PA knowledge for KCS (n=7; 54%) and lack familiarity of guidelines (n=9; 69%). OHP demonstrated low PA discussion practices (n= 7; 54% not discussing PA at all) and low discussion of the guidebook with KCS (n= 8; 62% not making any KCS aware of guidebook). Barriers for PA discussion included lack of time, lack of familiarity of the guidebook, lack of funding for patient referrals to community programs, remembering to discuss it, and major medical issues taking priority. Facilitators included having hard copies of the guidebook for easier access, being familiar with the guidebook, and a website to guide patients and nurses.

 

Conclusion: OHP are willing to consider PA discussion to KCS as they hold positive attitudes towards it, but there are major barriers to knowledge and time that should be considered in future interventions. Addressing these barriers will enable better PA discussion practices, which may increase PA behaviour among KCS for better quality of life and health outcomes.

Purpose: High-intensity interval exercise (HIIE) produces positive health outcomes for females with cancer. However, little is known regarding female cancer survivors’ affective response to HIIE despite its positive association with future exercise participation. The purpose of this study was to compare affective response during (in-task) and following (post-task) HIIE and moderate-intensity continuous exercise (MICE) in female cancer survivors. Secondary outcomes included enjoyment, self-efficacy, and exercise intentions.

Methods: Following a baseline maximal graded exercise test, female cancer survivors performed 20-minutes of HIIE or MICE on separate occasions in a randomized and counterbalanced order. HIIE included 10, 60-second intervals at 125% of participants’ ventilatory threshold (VT), interspersed with active rest (75% of VT). MICE was performed at 90% of participants’ VT. Affective response was assessed before, during, and after exercise using the Feeling Scale, Felt Arousal Scale, and Activation Deactivation Adjective Checklist. Secondary outcomes were assessed post-exercise. Statistical analysis included condition by time repeated measures ANOVAs for affect and enjoyment measures. Paired t-tests compared differences in self-efficacy and intentions. Interpretation of results used effect size (Cohen’s d_z) with negative effect sizes suggesting results favoring HIIE.

 

Results: Participants (n=12), primarily breast cancer survivors (58.3%), had a mean age of 51.2±9.3 years, and were 41.3±19.4 months since diagnosis. In-task results indicated a large difference between conditions for affective arousal (d_z= -0.72), but small differences in affective valence (d_z= -0.21). Post-task affect elicited a small effect between HIIE and MICE conditions for all domains (Tension: d_z= -0.31; Tiredness; d_z= 0.09; Energy: d_z=- 0.26; Calmness: d_z= 0.25). Enjoyment (d_z= -0.41), intentions (d_z’s= -0.23-0.38), and self-efficacy (d_z’s= 0.26-0.41) elicited a small effect between HIIE and MICE.

 

Conclusion: Preliminary evidence suggests female cancer survivors' affective responses to HIIE and MICE are comparable. To suppliment established MICE strategies, interventionists may consider using HIIE given its ability to elicit positive psychological responses and improve health outcomes. Further research is needed to understand cancer-specific factors influencing the exercise-affect relationship.

 

PURPOSE: 

Prostate cancer (PCa) is the most common cancer diagnosis in men and the third most common overall. Furthermore, prostate cancer is known to disproportionally affect Black men. Evidence shows that diet and physical activity may play a role in decreasing the risk of PCa progression and improving outcomes. The purpose of this study is to explore lifestyle behaviors of men with and without prostate cancer. Additional comparisons were made between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) men. 

METHODS:

Data obtained from the Health Information National Trends and Survey (HINTS), a nationally representative dataset of US adults, were analyzed. Males, 50 years of age and older, without a history of cancer (n = 1963) and with a PCa diagnosis (n = 192) were identified. Respondents reported their height, weight, daily fruit and vegetable intake, physical activity, sedentary behavior, and strength training. Data were weighted to calculate population estimates. Multivariate logistic regression analyses were conducted to examine the independent association of demographic factors with health behaviors.

RESULTS:

The overall weighted sample was 76.7% NHW, 13.2% NHB, 65.4% post high school education, 39.6 % >$75,000 annual income, and 55.7% were married or cohabitating, PCa survivors were older compared to men without cancer (p<.0001). Both PCa survivors and men without a history of cancer reported a BMI of 25 or greater, less than 150 minutes of moderate physical activity, less than 2 days of strength training per week, and 6 hours or more of sedentary behavior daily. PCa survivors were more likely to consume at least 1 cup of vegetables daily compared to men without a history of cancer (OR 2.49; 1.25 – 4.95). Among PCa survivors, NHB were younger (p=.000) and consumed less than 1 cup of vegetables daily (63.0% vs. 38.2%),but were less likely to report more than 6 hours of sedentary behavior (OR .064, .004 - .99) compared to NHW men.

CONCLUSIONS:

Results suggest PCa survivors do not completely follow recommendations for healthy eating and exercise with some disparities between race. Increased efforts in promoting diet and exercise among PCa survivors is warranted.

Introduction: For cancer survivors, a healthy diet, physical activity and weight management can prevent chronic disease, improve health-related quality of life, and decrease mortality. Elevated levels of inflammatory markers may influence biological mechanisms that link poor diet, alcohol consumption, low physical activity, and obesity with cancer recurrence and second primary cancers. However, research suggests that cancer survivor’s lifestyle behaviors may not be difference from the general population. The purpose of this study is to examine differences in fruit and vegetable (FV) and alcohol intake, physical activity (PA), body mass index (BMI) and inflammatory biomarkers among cancer survivors and non-cancer survivors.

Methods: Data is from the Midlife in the United States (MIDUS) collected during the MIDUS Refresher phase (2011-2016) of middle-aged and older adults. Study participants completed telephone-administered surveys to assess sociodemographic factors, lifestyle behaviors, and objectively collected anthropometric measures and biomarkers. We compared intakes of FV, moderate PA, BMI, and inflammatory biomarkers (C-reactive protein (CRP) and Interleukin-6 (IL-6)) between cancer survivors and non-cancer survivors. Multivariate logistic regression analysis compared prevalence of lifestyle behaviors between both groups.

Results: Participants were 863 (776 non-cancer survivors; 86 cancer survivors). Overall, the sample was 52.1% female, 70.2% non-Hispanic White, 52% > college/higher, 39.6% current smokers, 70.1% drank alcohol, 74.6% were overweight/obese, and mean age was 50.8. Bivariate analysis revealed cancer survivors were older (p<.0001), higher incomes (p=0.041), overweight/obese (p=0.000), did not achieve recommended guidelines for PA and FV (p=0.035), elevated IL-6 levels (p=0.027) and reported less frequent binge drinking (p=0.014) compared to non-cancer survivors. After adjusting for covariates, cancer survivors were less likely to frequently binge drink (OR=0.52; CI=0.31-0.96) than non-cancer survivors. There were no significant differences for the other lifestyle behaviors and biomarkers.  

Conclusions: Although cancer survivors were less likely to frequently binge drink than non-cancer survivors, achieving the recommended guidelines for diet, PA and BMI is a concern, indicating the need for targeted behavioral interventions. 

Purpose: To report the prevalence of receiving physical activity counselling and any associations with physical activity behaviour among people living with and beyond breast, prostate, or colorectal cancer.

Methods: A stratified random sample of 2062 breast, prostate, and colorectal cancer survivors was identified by the Nova Scotia Cancer Registry and mailed a questionnaire assessing physical activity, weekday and weekend sedentary time, and having received physical activity advice. ANOVAs determined differences in continuous measures and Chi-squares categorical variables.

Results: 741 completed surveys were analysed. Overall, about 30% of participants indicated having received physical activity advice from oncologists (51%) and general practitioners (54%) most frequently. Breast cancer survivors were more likely to report receiving advice than prostate or colorectal cancer survivors (40% vs. 24% vs. 25%, p>.001). Overall, no significant differences were found for meeting recommended physical activity guidelines or weekday/weekend sitting time. Colorectal cancer survivors receiving physical activity advice were significantly more like to be meeting activity guidelines (p=.021). ANOVAs revealed an overall trend of more moderate physical activity minutes with receiving activity advice (p=.060). No significant differences were found among breast cancer survivors, while prostate cancer survivors receiving advice were less likely to be sedentary (p=.038). Among colorectal cancer survivors, those receiving advice reported more moderate-to-vigorous physical activity (p=.015), total physical activity (p=.029), and less sitting time (p=.041). 

Conclusions: Less than one-third of surveyed people living with and beyond cancer reported receiving physical activity advice with no differences in physical activity behaviour or sitting time overall. Despite a higher proportion of breast cancer survivors reporting receiving advice compared to prostate and colorectal cancer survivors, subgroup analyses indicated stronger associations between activity behaviour and advice among colorectal cancer survivors. Interventions are needed to determine the whether these associations hold true.

Purpose: This study aimed to understand the dyadic relationships between social networking site (SNS) behaviors (i.e., use, photo activities, and interaction activities) and self-esteem, body satisfaction, societal and interpersonal aspects of appearance ideals, eating disorder symptoms/concerns, and physical activity behaviors among mothers and their early adolescent daughters.

Methods:  The dyad comprised of the mother and the daughter used at least one of the same SNS platforms and had access to each other’s account (i.e., each other’s friends/ followers, or the mother monitors the daughter’s account and the daughter is a friend/follower of the mother). The daughters must have been born within 2003-2007, making their age between 11-14 years in the calendar year that the study was conducted. The dyads completed an online survey that used parallel questioning. Data were analyzed using a pooled regression actor-partner interdependence model for 40 mother/daughter dyads.

Results: SNS behaviors predicted outcome variables for both mothers and daughters individually. In addition, the mothers’ overall SNS use predicted daughters’ lower self-esteem, lower body satisfaction, higher internalization of beauty standards, and higher eating disorder symptoms/concerns. The mothers’ photo activity/exposure was related to daughters’ higher internalization of beauty standard, and higher eating disorder symptoms/concerns. Lastly, mothers’ SNS interaction activities were related to daughters’ higher self-esteem and lower physical activity frequency.

Conculsions: This study suggests that SNS behaviors predict outcome variables for both mothers and daughters individually (actor effects). In addition, maternal modeling exists on SNSs, as a number of relationships where the mothers’ predictor variables were associated with the daughters’ outcome variables (daughters’ partner effects) were statistically significant. Thus, suggesting that mothers need to foster positive SNS behavior, and that greater emphasis should be placed on discouraging negative modeling behaviors online.
 

 The study findings add important literature to the paucity of empirical data that exists on understanding the online mother/daughter relationship.

 

Purpose: Programs to support self-management of diabetes (DSM) have been shown to improve diabetes outcomes and decrease the risk of its related complications. However, of those who are socioeconomically disadvantaged, many are unable to attend and engage with these programs due to barriers such as poor access, time limitations, lack of health knowledge and competing obligations. Increased accessibility and affordability of the Internet and mobile phones offer potential to provide more accessible, easily-distributable, ongoing low-cost DSM support programs for disadvantaged people with Type 2 Diabetes (T2D). This study aims to test the appeal and feasibility and explore the potential effectiveness of a 12-week, evidence-based, web- and mobile phone-delivered healthy eating behaviour change program to enable disadvantaged people with T2D to strengthen important skills necessary to eat in a healthy manner on a budget.

Methods: A multiple methods (quantitative-qualitative) pre-post-test design pilot study is underway. Sixty low-income people with T2D aged 18-75 years were recruited. Participants completed baseline assessments on basic demographic and clinical data, dietary intake, dietary self-efficacy and barriers to healthy eating. Participants were provided with log-in access to a website, which includes six progressive skill-based modules presenting healthy eating planning; smart food shopping; time-saving meal strategies; cooking; modifying recipes; and a final reinforcement of the earlier modules’ learnings. Over the three-month intervention, participants received three text messages weekly to encourage review of selected goals and continue to engage with different components of the website and eat healthy foods. At the end of the intervention, program appeal and effects will be evaluated via the same surveys, with additional questions asking about their experience with and perceptions of the program, and feasibility assessed using website log-in data and the number of participants recruited and retained.

Results: The EatSmart website has been developed, and the first four modules have been viewed by 46 participants as of mid-February 2020

Conclusions: Results from this study will provide new insights on how disadvantaged populations with T2D may benefit from digitally-delivered behaviour change programs.

 

 

 

Purpose: Young people in Australia are spending $AUD100/week eating at restaurants or ordering takeaway foods. Restaurant and take away food consumption have been associated with significant increases in daily energy, sugar, saturated fat and sodium intakes, which are leading risk factors for chronic diseases. The aim of this study was to evaluate food outlets on a popular online food delivery service to assess the healthiness of the ten most popular food outlets in each suburb as well as overall delivery costs.

 

Methods: Geographical areas of Sydney, Australia were selected using 2016 NSW Census data. We identified Local Government Areas (LGAs) with above-average populations (>30%) of young people aged between 15-34-years, as young people are the primary users of online food delivery services. Uber Eats was selected as it the most popular online food delivery service in Australia. In February 2020, all suburbs in the included LGAs were searched on the Uber Eats Website. The delivery time was set for 6.00PM-6.30PM for consistency. Data on the top 10 food outlets were extracted, including the food outlet name, category, and classified by type and healthiness score using The Food Environment Score (FES) (scores range from -10, unhealthiest outlets to 10, healthiest outlets). Data were analysed using descriptive statistics.

 

Results: Data from 2318 food outlets providing food service delivery to 233 suburbs were extracted. Most food outlets were unhealthy (average FES -6.9; SD 4.4) and most were franchise takeaway stores (42.9%, 995/2138) and local independent takeaway stores (31.8%, 738/2138). McDonald’s® was the most popular food outlet in 79.8% (186/233) of suburbs. Healthier food outlets (salad/sushi bars and sandwich shops) accounted for only 5.3% (122/2318) of food outlets. The average delivery cost per order was $AUD5.65 (range $0-7.99).

 

Conclusions: The most popular food outlets on Uber Eats are unhealthy. Further research is needed to understand how online food delivery services change the geographical reach and accessibility of unhealthy food outlets, explore relationships across different socioeconomic areas and evaluate nutritional quality and costs of recommended menu items.

Purpose: In populations at high risk of poor mental health, physical activity (PA) interventions offer a preventative and treatment strategy. Online technologies including social media may be a potential platform for delivering accessible and low-cost group-based physical activity interventions. Emergency service workers (police, fire and ambulance) face a significantly increased risk of experiencing poor mental health, as do the people who care for them including partners, family members and friends. This study therefore aims to determine if an online PA intervention delivered through Facebook is feasible, acceptable and efficacious in improving mental health in emergency service workers and their informal caregivers. The iterative development of this intervention has occurred through collaboration with advisors with lived experience of working within the emergency services, and of living with mental illness.

​

Methods:The 10-week program was delivered via a private Facebook group and facilitated by an exercise physiologist, a dietitian and peer support members. We provided motivation around different weekly topics (e.g. goal setting and reducing sedentary behaviour) and provided participants with a Fitbit. We examined the feasibility, acceptability and explored the impact on mental health symptoms, sleep quality, quality of life and PA levels. A novel multiple time series design was applied to assess levels of psychological distress, with participants acting as their own control prior to the intervention.

​

Results: Twenty-four participants (n=12 emergency service personnel and n=12 carers) were recruited and 88% (n=21) completed the program, demonstrating it was feasible and acceptable. Exploratory analyses found significant reductions in psychological distress across the intervention(b = -1.067, p = 0.003). Pre and post analysis showed significant improvements in quality of life (Cohen’s d=0.603) and minutes of walking (d=0.549). Changes in perceived social support to exercise and sleep quality were non-significant.

​

Conclusions

Using Facebook to deliver a mental health informed PA program is feasible and yields significant improvements in mental health symptoms and quality of life. An adequately powered trial of n=80 (4 waves of n=20) is subsequently underway.

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Purpose

The aim of this study was to determine the effectiveness of physical activity interventions involving apps or trackers that provide automated and continuous self-monitoring and feedback.

 

Methods

Systematic review and meta-analysis of randomised controlled trials in adults without chronic illness, testing a mobile app or an activity tracker with automated and continuous self-monitoring and feedback, compared to a group not involving these components. The primary outcome was a physical activity measure (e.g. step count). Eight databases were searched for studies from 2007 to 2020. PRISMA guidelines were followed and screening was conducted by independent researchers. Included studies were assessed using Cochrane’s risk of bias tool. Continuous outcomes were pooled using random effects meta-analysis and all effect sizes were transformed into standardised difference in means (SDM).

 

Results

Twelve studies were included in the meta-analysis (n=3010 participants). Average study duration was 15 weeks. All studies included a tracker and 6 also included a smartphone app. Most studies included other technological components, such as a website (n=8), email (n=5), text-messaging (n=2), or an online social network (n=3). The most frequent behaviour change technique (apart from self-monitoring and feedback on behaviour) was goal-setting. Nine studies mentioned a behaviour change theory, most commonly social cognitive theory.

The meta-analysis showed a moderate positive effect on physical activity (SDM 0.345; 95% CI 0.17 to 0.52; I²=67%; T²=0.051), corresponding to 1869 steps/day. Interventions involving behaviour change techniques from the goals and planning group and studies mentioning a behaviour change theory were more effective (p=0.039 and p=0.014, respectively).

 

Conclusions

Apps and trackers with automated and continuous self-monitoring and feedback are effective in promoting physical activity, particularly when based on behaviour change theory or including behaviour change techniques from the goals and planning group. Providing automated self-monitoring and feedback, with goals and planning techniques, and reducing user burden by automating the delivery of additional behaviour change techniques may improve engagement and effectiveness, and should be explored in future studies.

 

Purpose: Around 33% of New Zealand children are overweight and obese, and the majority deemed not to be meeting national physical activity guidelines. Exergames present a promising opportunity to get children sitting less and moving more. Previous studies report some short-term effects, while behavioral maintenance is yet to be achieved. In nutrition, artificial intelligence (AI) have been used to encourage behavior change through personalization of health messages to reduce boredom. Whereas, in the game industry, AI have shown to be highly effective in sustaining gameplay through promoting long-term engagement. Hence, we aim to develop and assess the efficacy of a novel hybrid exergame, incoporating AI using individualized data from the player’s accelerometer and other game elements, to decrease sedentary behavior in children.

Methods: Using the expertise from the multidisciplinary team, behavioral analysis will be conducted through systematic reviews and qualitative interviews. Game motivation model, human-focused design and self-determination theories for game design will be explored using both qualitative interviews and quantitative group experiments. Prototype development will be based on results from behavioral analysis. Iterative qualitative user testing of the prototype through cognitive interviews will be carried out before the efficacy trial. An RCT will be performed, comparing the intervention group to a wait-list control group. Up to 100 children (10 to 12 year old), generally healthy, but not meeting the physical activity guidelines, will be recruited. Baseline and follow-up measurements will access physical activity using 7-day actigraphy/motion sensors. Validated questionnaires examining behavioral change theories will also be carried out.

Discussion: The expectation is that from the behavioral analysis, algorithms for AI will be developed, that would promote long-term engagement. From the efficacy study, the within game and app log data will be able to help explore behavioral changes among children, and improve on the algorithms used to learn children’s behavior and interaction with the game. It is anticipated that the findings will contribute in helping to elucidate the evidence and theories by which AI in games can help sustain positive behavior changes in children, leading to a decrease in childhood obesity.

Purpose: Despite the exponential grow of smart phone applications (i.e., apps) to support health behaviours, the majority lack embedded evidence-based behaviour change theories. ParticipACTION, Canada’s leading physical activity social marketing organization, recently launched an app with the goal of encouraging Canadian’s to sit less and move more, with embedded behaviour change theories at the core of its development. The purpose of this study was to provide a detailed and systematic outline of how a theoretical behaviour change framework was applied in the development of ParticipACTION’s app to support increased Canadian’s physical activity levels.

Methods: The Behaviour Change Wheel (BCW) framework, a theoretically-based approach for intervention development, along with collaboration with the commercial app industry guided the development process. Specifically, a behavioural diagnosis was used to understand what needs to change for the targeted behaviour to occur. Current literature, along with a series of focus groups and market research provided data to inform the app development.

Results: The behavioural diagnosis revealed that the app needed to target individuals’ physical and psychological capabilities, physical and social opportunities, and reflective and automatic motivations in order to increase physical activity levels. To accomplish this, 6 of possible 9 intervention functions (education, persuasion, incentivization, training, environment restructuring, and enablement), and 2 of 7 policy categories (communication and marketing, environment and social planning) were selected from the BCW to be included in the app. Goals and planning, feedback and monitoring, behaviour identification, action planning and knowledge shaping were selected as the main behaviour change techniques for the app. Collaboration with a mobile app development firm helped to embed the selected behaviour change techniques, policy categories, intervention functions, and sources of behaviour within the app.

Conclusion: Using a systematic approach, this study used the BCW to ensure the health promotion app was theoretically informed. Future research will evaluate the effectiveness of the theory-driven app in increasing Canadian’s physical activity levels.

 

 

Purpose: Evidence of acute sedentary behavior (SB)-affective state associations among youth is inconsistent; this may be attributed to a limited operationalization of self-reported SB, the lack of objective measurement of sedentary time, and the failure to account for dynamic time-varying associations. This study investigated the within-day, time-varying associations between ecological momentary assessment (EMA)-reported screen-based SB and non-screen-based SB, accelerometer-measured sedentary time, and subsequent affective states.

Methods: Participants (N=15, mean age=13.1[1.0] years, 66.7% female, 40.0% Hispanic, 66.7% healthy weight) reported screen-based and non-screen based SBs “in the past 30 minutes” and their positive and negative affect “right now” via EMA up to 7 times/day for 7-14 days. EMA prompts occurred randomly within pre-selected 2-hour time windows between 7am and 8pm. Participants simultaneously wore ActivPAL thigh-mounted accelerometers and sedentary time (minutes) in the 30 minutes prior to each EMA prompt was calculated. Separate time-varying effect models (varying slopes across the day) assessed how EMA-reported screen-based SB, EMA-reported non-screen-based SB, and accelerometer-measured sedentary time in the past 30 minutes each related to current EMA-reported positive and negative affect.

Results: Participants completed N=633 EMA surveys (255 [40.3%] reports of screen-based SB, 109 [17.2%] reports of non-screen-based SB, and 269 [42.5%] no SB reported). EMA-reported screen-based SB was positively related to positive affect from approximately 7am-9am (ßrange 0.34 to 0.89) and from 3pm-6pm (ßrange 0.28 to 0.37); and was positively related to negative affect from approximately 7am-9am (ßrange 0.23 to 0.49). Non-screen-based SBs were inversely related to positive affect from about 7am-8am (ßrange -0.63 to -0.43) and after 2pm (ßrange -0.49 to -0.27), while they were inversely related to negative affect from 10am-1pm (ßrange -0.17 to -0.14). Accelerometer-measured sedentary time was unrelated to positive affect across the day but was positively related to negative affect from approximately 6pm-8pm (ßrange 0.01 to 0.02).

Conclusions: The strength of acute associations between SB and affective states differs across the day and by operationalization of SB (screen-based vs. non-screen based vs. accelerometer-measured sedentary time); highlighting the methodological importance of taking more nuanced approaches to operationalizing time and SB in within-day studies of SB and affective states.

 Background

The dramatic development of information technology is leading to profound transformations in online communication, substantially orienting the innovations in eHealth-based social communication.  However, it is still unclear how the existing or newly-built online social networks function on individuals’ health-care. 

Objectives

This study aimed to investigate the online interpersonal sources and their applications in Chinese college students’ health-care.

Methods

Semi-structured interviews were conducted with qualitative thematic analysis method. Eighteen Chinese college students were purposely recruited, included three males and three females of each sex from sports, medical, and ordinary non-health-related majors.

Results

Five themes were identified as following:

1)    Relationship creating and strengthening (e.g. “build trustworthy relationships with professionals” “know someone with similar health concern/interest online” “new ways for showing care”, etc.)

2)    Help seeking and offering (e.g. “tend to seek and share help with people already known offline” “be cautious and prepared to take responsibility when communicating with strangers”, etc.)

3)    Information relaying and sharing (e.g. “provide both emotional support and educational platform” “restrict to a knowledge field that the networks preferred” “don’t feed the trolls”, etc.)

4)    Decision-making enhancing (e.g. “take stories or applied process that others went through as the reality references” “cross-check goes different ways” “the quality of network sites lies with the quality of users”, etc.)

5)   Self-data exposing (e.g. “tend to post the self-tacking data to those already known” “Step-counting in instant messaging – especially WeRun – made my self-data passively exposed” “be aware of information safety”, etc.)

Conclusions

Different patterns of eHealth communication have been discussed, showing that participants’ perceptions on “strong ties (person you already know)” and “weak ties (strangers or online-new-friends)” were prominently different. Further study is necessitated to compare the effects of “strong ties” and “weak ties” on health-care.  Novel interpersonal communications were found, e.g. self-data-focused long-distance family/friend sharing and health-based new friendship building. This study contributes to clarifying the existing eHealth communication modes, which might provide useful information for constructing relationship-relevant eHealth intervention in the future.

 

Purpose: Exergames such as Pokémon Go may increase physical activity, however it is unknown how Pokémon Go impacts the volume and behavioral pattern of physical activity compared to a traditional continuous walking bout. Methods: During spring of 2019, twenty Pokémon Go players participated in a randomized cross-over experimental study that used objective measurement tools (pedometer, accelerometer, heart rate monitor and GPS watch) and direct observation to compare a variety of physical activity-related variables (steps, intensity, heart rate, distance travelled, number of stops) during a 30-minute walk when playing Pokémon Go and not playing Pokémon Go. Participants followed the same (~1.77 km) walking path, which incorporated all eight of the possible Pokéstops (with one being passed twice) as well as two of the three Pokégyms on campus on separate days. Results: Two distinct playing styles of Pokémon Go were identified: an intermittent style of play with periodic stopping, and a continuous style of play. Total steps, MVPA percentage, and distance travelled was significantly greater for continuous Pokémon Go participants and traditional walk conditions (p<0.05), compared to intermittent Pokémon Go participants, while number of stop breaks, percentage of time in sedentary activity, and percentage of time in light activity was significantly higher for intermittent Pokémon Go participants compared to continuous Pokémon Go participants and traditional walk conditions (p<0.05). Differences in physical activity variables between traditional walking and Pokémon Go appear to be driven by the 60% of Pokémon Go players that used the intermittent style of play, which was characterized by frequent stops. Conclusion: The continuous Pokémon Go style of play was most similar to a traditional bout of walking. However, overall, when compared to traditional walking, Pokémon Go resulted in lower volume, intensity and less continuous bouts of physical activity. Regardless of playing style, Pokémon Go elicited a substantial number of steps and significant time in MVPA, thus supporting that playing this game may be an effective strategy towards meeting physical activity recommendations, especially if it could encourage couch-bound videogame players to venture outside and walk around to play the game.

Purpose: Today's sensor and mobile applications, and advances in artificial intelligence can revolutionise behaviour change science by providing personalised support to users. This review aimed to assess the effects of personalised mobile technologies on physical activity and diet.

Methods: We searched five databases until 2020, using terms related to mobile technologies, personalisation and lifestyle behaviour. Two independent researchers screened and included RCTs that assessed a personalised mobile app or tracker for physical activity or diet. Study quality was assessed using Cochrane's risk of bias tool. A random effects meta-analysis was conducted for dietary and physical activity outcomes. The cause of any observed statistical heterogeneity was explored using meta-regression. This systematic review is compliant with the PRISMA statement.

Results: Eleven studies describing ten unique interventions were included in the meta-analysis (n=2093, 50.2% women). The average study duration was 14 weeks. Four studies had at least three out of five categories assessed as low risk of bias. Five interventions targeted physical activity, two targeted diet, and three targeted both. Retention rate varied between 40% and 100%.

The most common personalised features were the content of behaviour recommendation, goal setting and feedback. All interventions except two collected behaviour data for personalisation. Two interventions collected demographic information, and only one collected user preference. Four interventions used system-captured data for personalisation, four used user-reported data, and two used both.

The meta-analysis showed a moderate, positive effect on physical activity and diet (SDM 0.727, 95% CI 0.362 to 1.093). Intervention that used system-captured data for personalisation had higher effectiveness than those that used user-reported data or both (p=0.0041). Additionally, interventions with higher retention rate also showed higher effectiveness (p=0.04).

Conclusion: This review extends the existing literature on personalised mobile interventions for physical activity and diet, by identifying factors associated with higher effectiveness, namely the use of system-captured data for personalisation and high retention rate. Mobile technologies can capture large amount of data continuously, and increase retention by reducing reporting burden on users; and thus, should be explored in future research.

Purpose:  The number of systematic reviews evaluating e- & mHealth interventions targeting nutrition, physical activity, sedentary behaviour and/or obesity has increased over time. The focus of the systematic reviews vary (e.g. type of interventions, population groups, technologies used, and outcomes of interest). While there is noticeable overlap between the systematic reviews, there are also potential gaps in the evidence synthesis. Therefore, the aim of this scoping review is to examine the extent, range and methodological quality of systematic reviews undertaken to evaluate e- & mHealth interventions targeting nutrition, physical activity, sedentary behaviour and/or obesity among adults.

Methods: Six electronic databases were searched for systematic reviews of experimental studies published from the year 2000 up to 27^th October 2019. For inclusion the systematic review had to evaluate e- & m-Health behavioural interventions for adult populations with the primary aim of improving nutrition, physical activity, sedentary behaviour and/or treating or preventing overweight and obesity.  e- & mHealth interventions included those that used websites, computers, e-mail, mobile/smartphones (apps or text messages), digital games,  telehealth and/or monitoring devices as a component of the behavioural intervention. Studies were selected for inclusion by two independent reviewers. Data were extracted by one reviewer and checked by a second reviewer, and the quality of the systematic review methodology was assessed by two reviewers using the AMSTAR 2 tool. 

Results/findings:  Of the 1040 records identified, 298 full text articles were assessed for eligibility and 107 systematic reviews met the inclusion criteria. Data will be presented to summarise the systematic reviews inclusion criteria for participants, interventions, comparators and outcomes, as well as methodological quality.

Conclusions: The scoping review will identify knowledge gaps in the evidence synthesised to date regarding the evaluation of e &-mHealth interventions targeting nutrition, physical activity, sedentary behaviour and/or obesity, and therefore identify potential for future systematic reviews or research. As a secondary outcome, the scoping review will also highlight the strengths and limitations of existing systematic reviews and highlight potential for a systematic review of systematic reviews.

Purpose: Girl Scouts troop settings have been shown to be viable for increasing opportunities for wellness-promoting behaviors in girls. However, troop meetings are often highly sedentary, with minimal physical activity or healthful snack options. Thus, as part of an overall wellness-promotion intervention, the present study seeks to evaluate preliminary effectiveness of an online, video-based Girl Scouts troop leader wellness training intervention on troop meeting opportunities for physical activity. 

Methods: A wait-list randomized control trial included eight Girl Scout troops (n=60 girls) that received the wellness video-based intervention (n=4 troops, 40 girls) or a wait-list control condition (n=4 troops, 20 girls). The intervention troops received 12 weekly training videos. The 12 videos (3-5min in length) each targeted a specific facet of wellness (fruit and vegetable availability, water availability, physical activity and sedentary time, and non-digital social connections): designed to assist leaders in identifying areas for improvement; provided approaches to overcoming common barriers; and supported leaders in setting individual goals for troop meetings. Meeting opportunities for physical activity and healthful snack provision were collected at baseline and following the 12-week intervention through objective assessment via Actical accelerometer (physical activity counts, moderate-to-vigorous physical activity (MVPA), steps), leader self-report, and direct observation by research staff.

Results/Findings: Objective physical activity results from 8 troops indicate that there was a significant condition by time interaction for MVPA (F=204.8, p<0.001). Intervention troops increased from 4.0% time in MVPA (95%CI: 3.64; 4.36%) to 11.2% (95%CI: 10.59; 11.81%). Wait-listed control troops decreased from 5.5% time in MVPA (95%CI: 4.94; 6.06%) to 3.0% (95%CI: 2.51; 3.49%). Similar interactions were observed for total accelerometer counts (F=184.9, p<0.001) and steps (F=388.3, p<0.001) during troop meetings. 

Conclusions: Initial results from this online, video-based intervention appear promising for improving physical activity within the Girl Scouts troop meeting context. Future analyses from this study will include additional troops and indicators of opportunities for other wellness behaviors. 

Purpose: The primary aim of this study was to address feasibility issues (previously reported) for a definitive cluster-randomised trial of a high-intensity interval training (HIIT) programme in the school physical education curriculum. In so doing, provisional efficacy results were obtained and are reported here.

Methods: Two schools (students 11-13 years) volunteered to participate; one each from low and high socioeconomic areas. Two class groups within each school were randomised to either intervention (N=55), or control (N=31) over one school term (~9 weeks). ​Intervention class teachers participated in professional development instructing them how to deliver twice-weekly, brief HIIT sessions to their class groups, within usual class time. Teachers also received a set of heart rate monitors for recording, and displaying target heart rate, and instructional resources. The control classes continued with their usual physical education curriculum. Intervention effects were estimated for a range of health and fitness outcomes using linear and generalised linear mixed models.

Results: For the primary outcome measure, aerobic fitness, the between group difference overall was not significant (p=0.796), although the intervention group experienced a significant increase (3.1 laps, p=0.032) whereas the control group reduced by 1.4 laps (p=0.759). Strength improvement was significantly greater for the intervention group in modified pull-ups compared to control (p=<0.001). There was a significantly greater improvement in strengths and difficulties (psychological difficulties) total score for the intervention compared to control (p=0.006). The control group lost significant (p=0.009) lean body mass (DXA derived), whereas the intervention group significantly increased it (p=<0.001), but that between-group difference was not significant. The control group experienced a small reduction in percent bodyfat (0.7%, p=0.172), but the intervention group a small but significant increase (0.9%, p=0.006), and that between-group difference was significant (p=0.025).

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Conclusions: Our results are indicative of generally positive intervention effects for fitness and mental health, delivered in a potentially scalable and sustainable manner, suggesting that a larger efficacy trial is warranted.

Purpose:

School-based physical activity interventions can improve children’s cardiorespiratory fitness. However, to be effective interventions must sufficiently engage participants in order to complete the intervention. iPLAY is a teacher professional learning program, designed to improve teacher’s confidence and competence in conducting high-quality physical education and school sport. iPLAY is delivered to teachers in a blended learning format: teachers complete a series of online modules and receive a small amount of face-to-face training and support. We investigated the characteristics of teachers most likely to complete all course components.

 

Methods:

Prior to beginning the intervention, teachers were invited to complete a short questionnaire on their demographics, teaching confidence in physical education and other subjects, internet self-efficacy, and physical activity behaviour. We limited our analysis to only teachers scheduled to have complete the training by January 2020. We used logistic regression to examine which characteristics predicted teacher completion, with cluster robust standard errors to account for within-school clustering.

 

Results:

A total of 688 teachers provided baseline questionnaire data and began the program, of which 425 (61.8%) completed all components. In multivariate analysis, teachers who reported confidence in their ability to teach physical education and school sport (odds ratio = 1.09; 1.03-1.15), and those with higher levels of job satisfaction [OR = 1.03; 1.00 - 1.07) were move likely to complete. Interestingly, internet self-efficacy was negatively associated with completion (OR = 0.96; 0.93-1.00). There were no differences in terms of number of years teaching, specialist physical education accreditation, teacher physical activity levels, or perceived teaching ability for non-physical education subjects. 

 

Conclusion:

 

Our findings suggest that intervention support should be targeted at those who have low levels of confidence in their ability to teach physical education and those who are dissatisfied with their job. Encouragingly, teachers’ physical activity levels did not predict completion of the course, suggesting that it is not simply ‘sporty’ teachers who engage with school-based physical activity teacher professional learning interventions. 

 

Purpose

Comprehensive school-based physical activity programs have the potential to improve the health and wellbeing of children, but only if they can be successfully delivered and implemented at scale. When scaling-up interventions, unforeseen problems arise that were not present during efficacy trials. The iPLAY program is an example of a school-based physical activity intervention  originally tested in eight schools and since scaled up to over 150 schools, reaching more than 43,000 students. The purpose of this study is to describe strategies which enabled iPLAY to be successfully delivered at such scale.

Methods

The iPLAY academic staff and project officers reflected on the changes made to the program over the course of scaling up the intervention. These changes occurred during regular project meetings over the course of 4 years delivering iPLAY.

Results

The iPLAY team identified multiple strategies for improving the delivery of the program. The first related to administrative strategies. Initially, iPLAY participants provided their details via email which were then collated and added to the project website, creating regular transcription errors. Building a more rigid recruitment pipeline, where participants registered directly on the website, reduced errors and administrative load. This allowed project staff to ensure that participant information was centralised, such as teacher accreditation numbers. The next set of strategies related to improving efficiency. School progress was originally tracked using a spreadsheet, but this proved difficult to maintain at scale and over multiple delivery sites. Instead, the team developed a project delivery system which clearly indicated which tasks needed completing for which schools, and ensured the team could quickly check school progress. Finally, the original iPLAY intervention was delivered using PowerPoint slides during face-to-face workshops. During the scale up, the team moved to dynamic Google-based content embedded in the project website, so that content could be updated remotely ensuring all team members used the most current intervention content. 

Conclusions

The iPLAY program demonstrates that interventions can be delivered at scale, but adaptation is often required. The lessons learned during this process should prove useful to others seeking to deliver efficacious interventions at scale.

 

Purpose: One of the most commonly reported barriers to physical activity (PA) is perceived lack of time. This barrier can be overcome if individuals are able to be active while doing tasks they would otherwise have done while sedentary. One way to achieve this aim is by using activity-permissive workstations (APWs) such as treadmill desks and cycle desks, which enable users to move and work simultaneously. Our aim in this multi-study series is to fill gaps in understanding how different forms of low-intensity PA (i.e., walking, easy cycling) affect health and cognitive performance tasks that are of interest to a wide-range of institutions. Documenting previously untested work-related enhancements from low-intensity activity could encourage workplaces to adopt active workstations, leading to significant public health benefits. In order to assess scalability, the first phase of this pilot study was investigating participant reactions toward APWs.

Methods: This experiment utilized a between-subjects design to assess reactions to different workstations. Participants were randomly assigned to one of three experimental conditions (i.e. treadmill desk [n = 9], cycle desk [n = 15], or seated desk [n =20]). At each of the three workstations, participants completed a cognitive battery as well as a survey of their experiences using their assigned workstation.

Results:  Forty-four participants (57% female; mean age 19.8 years) completed the user-experience survey. Participants responded favorably to both types of APWs, with stronger preferences for the treadmill over the cycle; 84% of treadmill users felt the workstation was enjoyable (73% for cycle), while 89% of treadmill users said the workstation was comfortable (73% of cycle). 67% of participants said they would use the treadmill workstation if it was available to them (40% for cycle).

Conclusions: Phase 1 results demonstrate that there is enough interest and enjoyment when using APWs, particularly treadmills, to warrant further investigation into the physiological, psychological, and cognitive impacts of these workstations. In the next phase of this project, we will address gaps in understanding of the impact of APWs on measure of cognition.

Purpose: Implementation of evidence-based physical activity (PA) programs is important for conferring maximum benefit to public health. The mechanisms which drive the implementation process are complex but crucial for ensuring implementation success however few studies have examined these processes as a whole. This study outlines the implementation framework, strategies and evaluation plan for implementation of the evidence-based Daughters and Dads Active and Empowered (DADAE) program at scale across NSW Australia in partnership with the NSW Government Office of Sport (OoS).

Methods/Results: DADAE is a 9-week PA program for primary-school aged girls and their fathers which improves daughters’ and fathers’ PA levels and screen-time and daughters’ fundamental movement skills and social-emotional wellbeing. The University of Newcastle has partnered with the NSW OoS to deliver two versions of the program (the original “Classic” and a condensed “Weekender”) across multiple regions of NSW using OoS staff and resources. The Consolidated Framework for Implementation Research will be operationalised to identify facilitators and barriers to implementation across five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, implementation process) and develop a package of implementation strategies. An advisory body will be formed to guide the development of multilevel strategies to assist implementation (e.g., stakeholder engagement, communication plan, recruitment plan, program-delivery training, fidelity checks, program adaptation). A type II hybrid effectiveness-implementation design will be used to assess both implementation outcomes and effectiveness of the two program models to improve PA. Implementation evaluation will be guided by implementation indicators synthesised by the McKay et al. Delphi review including domains: adoption, dose delivered, reach, fidelity, cost, sustainability, feasibility, acceptability and compatibility. Implementation measures will be collected through surveys (program deliverers, participants), focus groups (program deliverers, advisory body), administrative records and interviews with project staff at multiple levels during development, delivery and upon completion of program implementation.

Conclusions: This study will provide a detailed example of a comprehensive plan and evaluation of the implementation process for an evidence-based PA program at scale. This will allow a contextual reflection of how implementation planning leads to implementation outcomes upon completion.

 

Purpose: To examine intervention implementation in a Type 1 Hybrid Effectiveness-Implementation cluster-randomized controlled trial of the Health Empowers You! intervention. The two-year intervention is designed to impact school-level physical activity (PA) practices and policies, increase student PA, and improve subsequent health and academic outcomes.  A large sample size, objective PA measurement (accelerometry), and a hybrid approach make this study innovative. As a Type 1 hybrid, the primary goal is measuring student PA, with assessing implementation fidelity as a secondary aim.

Methods: The study occurs in 40 elementary schools in Gwinnett County Public Schools, a large, diverse public school district in suburban Atlanta, Georgia. Schools were randomized to the intervention (n=20) or control (n=20). The study recruited 4,970 fourth grade students in the Fall 2018 semester in 240 teachers’ classes. Teachers at intervention schools received support from PA specialists who provided face-to-face training, web content, weekly calendars with PA resources, monthly training webinars, and exercise equipment to help them incorporate PA into the school day. Control and intervention teachers completed a PA reporting form quarterly. Students wore an accelerometer for two week-long periods (one week per semester).

Results/findings: Implementation fidelity analyses found that teachers at intervention schools reported using classroom PA breaks at significantly higher rates than control teachers (average number of breaks per week: 5.66 (intervention) vs 1.17 (control), p<0.001), and use of PA breaks did not decrease significantly during the year. Other intervention-related behaviors (e.g., utilizing physical activity workbook resources) decreased over the year, while teachers’ use of the provided PA equipment increased. Initial analyses indicate that higher levels of implementation might be associated with higher levels of moderate and vigorous physical activity during the school day. Additional analyses are being conducted to account for missing teacher-reported responses. 

Conclusions: Given high reported implementation fidelity among teachers at intervention schools, the study yields insights on how to implement changes to promote student PA during the school day, and will illuminate how PA subsequently impacts student health and academic outcomes across diverse populations in Georgia.

Purpose: We examined the utility and cost of different physician referral strategies for improving reach, retention, and 6-month effectiveness of an evidence-based, digitally-delivered, 12-month weight loss program in a rural area.

Methods: Five primary care physicians were randomly assigned a sequence of 4 referral strategies for a commercial, evidence-based, digital weight loss program: point of care (POC) with active telephone follow-up (ATF); POC, no ATF; population health registry-derived letter with ATF; and letter, no ATF. Referred patients who expressed interest completed a telephone screening. Eligible and enrolled patients received a Bluetooth-enabled home scale, which provided data to document intervention effectiveness. Implementation costs were tracked for referral and program delivery activities. 

Results: Physicians made 573 of a potential 991 referrals over 16 weeks. Ninety-eight patients (60% female; 94% Caucasian—representative of the region), enrolled in the program. Letter referrals reached a significantly higher proportion of patients than POC (100% vs 17%) and yielded more participants (12% vs 8%, p<.05). Patients receiving ATF were significantly more likely to be screened (47% vs 7%; p<.05) and enroll (15% vs 7%, p<.05) when compared to those without ATF. Total recruitment costs were $6,192; cost per enrolled patient was highest for letter with ATF ($91) but was similar among other referral conditions (range $47-$55). Similar to historic data for the program, 44 of 98 enrolled participants did not engage in the program after enrollment. Engagement and weight loss did not significantly differ among referral strategies. Mean weight loss was 6.9±10.5lbs with 43% and 30% of participants losing 3% and 5% or more of their initial body weight, respectively. Implementation costs were $29,500. Cost per participant achieving 3% and 5% weight loss was $1282 and $1843, respectively.

Conclusions: Population health management approaches with active follow-up may not be cost-efficient for clinical settings. Digital weight-loss programs, when delivered in rural settings without a large population to benefit from scalability, may be just as costly as intensive, in-person programs. 

Purpose: Childhood obesity is a major public health issue in Canada. In light of research demonstrating that children establish lifestyle habits early on, there is particular interest in preventing weight gain by shaping nutrition, physical activity, and screen time behaviors in early childhood. Early Care and Education (ECE) settings, such as daycare centers and homes, represent an important point of intervention for obesity prevention efforts. While previous studies have examined ECE regulations related to obesity prevention in the United States, an understanding of these regulations in the context of the Canadian legislative landscape is lacking. Thus, the purpose of this paper was to compare ECE licensing regulations for each of the thirteen Canadian provinces/territories to evidence-based, obesity prevention standards.

  

Methods: Two authors reviewed existing ECE regulations for each of the thirteen provinces/territories and examined whether the regulatory text supported 20 evidence-based obesity prevention standards related to nutrition, physical activity, and screen time. Provinces/territories were evaluated on the strength of regulatory language for each standard (i.e., fully, partially, or not addressed).  

 

Results/findings: The majority (n=9) of provinces/territories required providers to follow Canada’s Food Guide, but only one had regulations for specific foods or beverages (e.g., restricting sugary beverages). Many provinces/territories partially addressed standards related to maintaining written menus (n=11) and making drinking water available to children (n=9), but the strength of these regulations was weak. Most provinces/territories required physical activity (n=12) and outdoor play (n=11) opportunities to be provided daily, but only two included a minimum time requirement. Only two provinces included any screen time standards.

 

Conclusions: Canadian provinces/territories have insufficient obesity prevention regulations in ECE settings. With few exceptions, most provinces/territories included few standards related to nutrition and physical activity and only two provinces included standards related to screen time. Furthermore, many of the provinces/territories only partially addressed standards and thus they may be less effective and enforceable. Given the high proportion of Canadian children in ECE settings and the large amount of time they spend at these facilities, revising provincial/territorial regulations to incorporate more evidence-based obesity prevention standards may be a promising strategy to prevent obesity among the youngest Canadians.

 

Purpose: Early childhood educators (ECEs) have a direct influence on preschoolers’ physical activity (PA) (Wilk et al., 2018). This study investigated the effectiveness of a Municipal ECE initiative, “Supporting, Encouraging, and Engaging Children in Safe and Active Wellbeing” (SEESAW), on children’s PA levels. This study makes a unique contribution to existing health promotion strategies in ECE settings.

Methods: A convergent mixed-methods design explored the effectiveness of SEESAW, collecting data prior to SEESAW implementation in October 2018, and again four months later in February 2019. Three ECEs participated in semi-structured interviews and their PA was measured using questionnaires (IPAQ Long Form). Twelve Preschoolers’ PA was measured using direct observation (OSRAC-P). Interview transcripts were thematically analyzed and a paired-samples t-test explored the differences in educators’ and children’s PA. Pearson r correlation determined significant relationships between children’s PA intensities and independent variables associated with SEESAW (e.g., educator prompts). A simple linear regression explored the linear relationships between predictor variables.

Results: Interview analysis revealed five themes related to PA: Practices, beliefs, knowledge, barriers, and facilitators. The most prominent barrier reported is the lack of training and education surrounding PA for ECEs. SEESAW increased educators’ use of resources, and belief of their role in facilitating PA. Their PA remained high between October and February (>3,000 METs). Children’s standing behaviours decreased between October (M= 11.92, SD= 8.53) and February (M=3.92, SD=8.53), t(11)= 3.25, p=.008, while gross motor behaviours increased between October (M=3.17, SD=13.87) and February (M=12.00, SD=13.87), t(11)= -2.20, p=.050. No relationship was found between educator prompts and children’s PA, and dramatic play was found to predict sedentary behaviour. 

Conclusions: The positive impact SEESAW had on ECEs beliefs and practices and children’s gross motor behaviours has implications for future implementation, but dramatic play activities should be altered to encourage less sedentary behaviour. The lack of relationship found between educator prompts and children’s PA calls for the implementation of SEESAW as a formal intervention to further investigate its’ effectiveness.

Purpose:

Nutrition screening provides an opportunity to assess nutrition behaviours before the markers for poor nutrition are apparent. This study aimed to determine the prevalence of nutrition risk among preschool children in New Zealand (NZ) using a validated and parent administered nutrition screening tool ‘Nutrition Screening Tool for Every Preschooler’ (NutriSTEP) and to identify factors associated with nutrition risk.

Methods:

A convenience sampling method was used to reach parents and caregivers of NZ preschool children aged two to five years through childcare centres and parent-focussed organisations. Parents and caregivers who had resided in NZ for at least five years were invited to complete an online survey. The parent and child’s weight, age, geographic location, parental education level, household income and household composition were assessed. The 17 item NutriSTEP tool was used to assess food intake, physical activity, screen time and the eating environment. Responses to the NutriSTEP items were scored between 0 and 4; maximum score 68. Participant scores were stratified by moderate/high risk (score >20) and low risk (score ≤20). Associations between parent and child characteristics and nutrition risk status were determined. Predictors of moderate/high nutrition risk were explored using logistic regression.

Results:

A total of 505 eligible parents/caregivers (mean age 35.2+4.5 years) completed the questionnaire. Most (99%) were women, of NZ European ethnicity (81%) and had a university or other tertiary education (76%). Half the children were girls (50.3%) and 92% came from a two parent/caregiver family. A fifth (19%) of the pre-school children were at moderate to high nutrition risk and 81% were at low nutrition risk. Pre-school children were more likely to be at moderate to high nutrition risk if they were of non-NZ European ethnicity (OR 2.41, 95% CI 1.36, 4.24); living in single parent families (OR2.84, 95% CI 1.44, 5.63) and with a non-university educated parent (OR 2.32, 95% CI 1.44, 3.743).

Conclusions:

Findings highlight the pivotal role of parental sociocultural factors in the nutrition risk status of NZ pre-school children. NutriSTEP is a useful tool to assess the nutrition habits of those most in need to provide targeted and appropriate dietary intervention.

Purpose: This study aims to investigate the relationship among the actual fundamental movement skills (FMS) proficiency, perceived FMS and physical activity (PA) among Hong Kong preschoolers, and further to determine if actual and perceived FMS are associated with children's PA and their genders.

Methods: A hundred and forty-eight preschool-aged children (43% girls; mean age = 4.52 ± 0.67 years) from five Hong Kong preschools/childcare centres were invited to complete the designated assessments. Actual FMS was rated using the Test of Gross Motor Development−2, whilst perceived FMS competency was assessed via the Pictorial Scale for Perceived Movement Skill Competence. Moderate- to vigorous-intensity PA (MVPA) was measured through accelerometers (Actigraph GT3X+) over five days. Mixed linear regression models were performed to assess associations among perceived FMS, actual FMS, and MVPA. Subsequently, mixed model regression analyses were performed to investigate the effects of actual FMS on MVPA levels by sex. All models adjusted for sex and age.

Results: Only 12.8% preschoolers met the WHO recommended 180-minute of PA per day (including 60-minute of MVPA daily). Boys were more active than girls for total PA and MVPA (p < 0.01 for both). Compared to boys, girls had poorer actual object control skills. Perceived motor skill competence was null associated with actual FMS (p = 0.068) and MVPA (p = 0.742) after adjustment for age and sex. Girls’ actual FMS were positively correlated with MVPA (B = 1.459, p = 0.004). Neither locomotor skills (p = 0.910) nor object control skills (p = 0.307) of boys were associated with MVPA.

Conclusions: Compared with perceived FMS, actual FMS are valuable to drive PA involvement in the early years. Only girls’ actual FMS were associated with their time spent in MVPA. Future studies are warranted to elucidate the underlining causal link of FMS on PA in early childhood that could inform the design of future evidence-based, sex-tailored interventions for preschool-aged children.

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Purpose

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The implementation nutrition and physical activity guidelines within Australian early childhood education and care (ECEC) is integral for the health of children. The quality assessment of services within the Australian National Quality System is undertaken by the Department of Education assessors in line with legislation. Assessors have a unique perspective on monitoring and assessment due to visiting multiple services in their region and collaborating with assessors from other regions. ​

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This study sought to capture the under-explored experiences of assessors for ECEC services in Queensland, to give insight into the implementation of infant and young child nutrition and physical activity within the National Quality Framework. ​

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Methods

Five multi-region teleconferences using professional conversations with Assessors (n=10) who assess metropolitan, regional and remote areas were conducted in Queensland, Australia to inform qualitative analysis of data guided by the Framework method and Social Cognitive Theory.

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Results

Four identified themes emerged using inductive and deductive analysis, guided by Social Cognitive Theory impacting the implementation of nutrition and physical activity guidelines: (1) Supportive Equitable Environments; (2) Efficacy; (3) Working with Parents; and (4) Regulatory Compliance. Important findings included increasing visibility of infants and young children in policies; focussing educator training to build efficacy in infant and young child feeding and physical activity, working with parents and increasing educator efficacy for the assessment process to increase collective agency.

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Conclusions

This study presents the results of the first Australian study investigating the experiences of assessors who help to implement NQF legislation and uphold quality through assessment and ratings of services. Inclusion of assessors in future studies as key stakeholders will increase best-practice for educators and short- and long-term health outcomes for infants and young children in ECEC settings.

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Purpose: Schools provide an ideal environment to implement nutrition education as many children can be reached frequently and for extensive amounts of time. However, research indicates that teachers find it challenging to implement nutrition lessons due to crowded curricula and limited time available. A cross-curricular approach integrating nutrition with core academic subjects could potentially address this challenge. Therefore, the study aimed to evaluate a teaching unit that integrated nutrition within mathematics and explore teacher and student perspectives.

Methods: Four primary schools participated in the CUPS randomised controlled trial (n=72 students in Year 3/4). Students in the intervention condition (n=46) received 6 x 40 min lessons on food groups, portion size, volume and capacity. Lessons included experiential learning with mathematics cubes and food models, conducted over four weeks. The control condition continued their usual lessons on volume and capacity. Semi-structured interviews (teachers, n=3) and focus groups (students, n=15) were held immediately post-intervention. Qualitative data was analysed using a thematic approach.

Results: Preliminary results from both interviews and focus groups found the responses could be divided into content and practical themes. These themes included several subthemes related to food models, mathematics cubes, mathematics, nutrition, time and integration. Most students indicated they liked the lessons, food models and cubes. Findings from the teacher interviews aligned with results from the student focus groups. Teachers reported most students were engaged and became more aware of healthy eating and serve sizes. Although they enjoyed teaching the lessons, teachers suggested integration of volume and capacity could be further improved in order to address the time barrier for teaching nutrition.

Conclusion: CUPS uses an innovative concept to teach primary school children about healthy foods and portion size estimation while simultaneously learning about the NSW k-6 Mathematics curricular standards. Although teachers and students perceived the program as fun and interesting, lesson plans could be refined to enhance integration of curriculum content, with complementary resources expanded.

 

 

 

Purpose: The objectives of this study were: 1) to systematically review and summarize previous research on 24-hour movement behaviors among preschoolers in foreign countries; and 2) to draw implications and provide recommendations for Chinese future research in this area.

 

Methods: A scoping review was conducted of the available English literature on 24-hour movement behavior among preschoolers, by searching Web of Science (WOS), PubMed/MEDLINE, ERIC, and SPORTDiscus. A total of 4,848 references were retrieved from the databases. All references were imported into EndNote X9, and 3,615 of them remained after removing duplicates. After screening through the titles and abstracts, 95 publications were retained and their  full-texts were assessed against the inclusion criteria. This resulted in the inclusion of 20 articles. Additional 7 articles meeting the inclusion criteria were retrieved from the reference lists of the included papers and related reviews, and, finally, 27 papers were included.

 

Results: The number of studies on preschool children's 24-hour movement behaviors has been increasing in recent years. There were few international studies (n = 3, 11.1%). Most of the studies applied cross-sectional design (n = 19, 70.4%). The prevalence of preschool children meeting the 24-hour movement behavior guidelines was low, ranging from 2% to 49.6%. The findings from correlational studies were inconsistent.

Conclusion: Overall, the foreign research on 24-hour movement behaviors among preschoolers is in its infancy, and there is still much room for improvement in terms of research quantity, variety and quality of evidence. Furthermore, the implications for Chinese future research and public health practice related to preschool children's 24-hour movement behaviors are as follows: 1) there is a need to develop 24-hour movement behavior monitoring system for preschool children in China; 2) research on 24-hour movement behaviors among Chinese preschool children should be encouraged; and 3) Chinese national and subnational governments should consider formulating policies related to 24-hour movement behaviour of preschool children.

Physical Activity to underpin a school curriculum: A longitudinal study on children’s academic achievement

 

Objective: Physical Activity (PA) has previously been the responsibility of the school Physical Education (PE) department, and growing concerns to the nation’s health have led to this responsibility spread to all involved in educational settings. This study will use mixed-methods to take a longitudinal approach to academic performance since the introduction of a physically active school curriculum. 

Methods: The focus of the study is a primary school based in the West Midlands (UK) teaching children aged 7 to 11. Academic performance was based on combined Maths and English statistics from nationally recognised Statuary Assessment Test from pre-intervention right through to 2019. Performance across the country in SATs at Key Stage 2 is measured against the percentage of children who are working at expected levels for their age in both Maths and English. This is the only statistical data in the UK that can directly compare a school’s academic performance to the national standard. Structured interviews with teachers identified the details of the school curriculum that have physical activity embedded whilst also gathering reasons as to how this has transferred to academic performance. Focus groups with year 5 and 6 children collected data on their views on PA within the school.

Results/Findings: SATs for Maths and English combined increased significantly after the introduction of a PA school curriculum. Emergent themes from focus groups and interviews were positivity, improvements and interpellation. 

Conclusions: This is an example of how a school has used PA policy not only to improve the health and well-being of the pupils who attend but also how it can also help improve academic performance. From the findings of this study the hope is that other schools will be encouraged to implement a similar policy to assist with health and academic success rather than reducing PA and increasing numeracy and literacy time to perform well during SATs.

Purpose: Active risky play in the early years has been linked to improved motor development and increased physical activity. The natural environment provides affordances for young children to engage in active risky play making outdoor childcare an ideal setting for fostering motor development and physical activity. This study aimed to compare two different types of outdoor childcare provision and the levels of active risky play.

Methods: Direct observations of nine outdoor childcare days were conducted during June/July 2019 across five Scottish centres involving 68 children (41 boys, 27 girls) aged 2-5 years. Four childcare centres had no suitable natural environment on-site and therefore children walked or were bused to nearby parks or woodland once per week (termed satellite outdoor childcare). One centre was a full-time outdoor kindergarten. A standardised observation schedule was used to describe the outdoor area and how it was used, including the time spent in activities. Comparison of satellite and full-time outdoor centres was carried out through qualitative descriptive analysis.

Results: Seven different parks/woodlands were used by the five childcare centres, with both satellite and full-time centres using different and exclusive outdoor environments. Children spent between 1h45min and 4h00min outdoors in satellite settings compared to a maximum of 5h30min for children attending the full-time centre. Children were physically active on average 73% and 61% of their outdoor time in satellite and full-time outdoor childcare, respectively. Of the total physical activity time, children spent 38% (25-80min) in active risky play in satellite and 32% (45-80min) in full-time outdoor centres. Affordances offered by the different parks/woodland did not differ between type of outdoor centre and children engaged in active risky play by swinging on ropes and hammocks tied to trees and climbing on fallen trees.

Conclusions: Children attending full-time outdoor childcare centre spent less time in active risky play compared to children in satellite centres. Use of different parks/woodland did not influence the natural affordances linked to active risky play. Future research should explore if novelty of the outdoor environment and limited opportunities for exposure to the outdoors influence childcare practice allowing for more active risky playtime. 

Purpose: Public health effort has been directed at centre-based childcare as an early education and care (EEC) setting to promote healthy food-related behaviours in young children. Children’s dietary food intake and food choices have been significantly influenced by expert-led interventions targeting food provision and nutrition practices in centres. However, in the real-world setting, these results have not been replicated when implemented by childcare providers and nutrition best practice not always well translated into routines. Childcare providers’ perspectives on this are unknown. This study investigates the factors mitigating or enabling the translation of evidence-based nutrition practice into everyday routines in centre-based childcare for children aged 2-5 years from childcare providers’ perspective.

Methods: Semi-structured qualitative interviews were conducted with cooks (n=12), directors (n=13) and influential decision-makers (n=7) from centre-based childcare services (n=33) in South Australia. Using the Ecological Model of Health Behaviour as the theoretical framework, and informed by grounded theory, data was analysed thematically.

Findings: The most powerful enabler was the National Quality Standard (NQS) which drove nutrition-related decisions, beliefs and practices and influenced the food, social and information environments. This and having a designated cook was central to translation. Limitations of the NQS, however, constrained nutrition practices with policy actions too broad to operationalise, dissonance when the objectives for healthy eating intersected with the salutogenic approach of the NQS and an absence of pre-requisite professional development and nationally consistent resources. The role of the cook was also vulnerable to outsourcing because of escalating allergies, changing family food preferences and a lack of nutrition education and support. In childcare, nutrition best practice is enacted from goodwill and the positive practices seen are under threat.

Conclusions: There is an urgency to prioritise nutrition within the EEC policy environment and establish relevant system-level support, training and strategies. An understanding of influencing factors from childcare providers would strengthen childcare settings as public health solutions. ​Ensuring healthy food provision and learning environments for lifelong, healthy eating habits is a worthy investment in our children.

Purpose: This study aims to examine the associations between components of gross motor skills (locomotor skills, object control skills, balance) and executive functions (working memory, inhibition, shifting) and self-regulation in Australian preschoolers. As executive functions are foundational for academic achievement, promoting their development is important. This study addresses the limitations of previous research and is the first to also examine sex differences. 

Methods: This study used the baseline data collected for Jump Start; a two-arm, parallel group, 18-month randomized controlled trial aimed at increasing physical activity in preschoolers while attending Early Childhood Education and Care Services (ECEC). Gross motor skills were assessed using the Test of Gross Motor Development-2 and the balance subtest of the Get Skilled Get Active. Executive functions were assessed using the Early Years Toolbox. Self-regulation was assessed using the Head, Toes, Knees, Shoulders assessment. Associations were examined using linear regression models accounting for clustering of ECEC services and adjusted for sex and age.

Results: A total of 566 preschoolers across 43 ECEC services were included (mean age = 3.2±0.4 years, 51% girls). The gross motor quotient, locomotor subtest and object control subtest were all significantly associated with visual-spatial working memory and inhibition. Balance was also associated with inhibition. The gross motor quotient and balance were associated with shifting. The locomotor subtest was associated with self-regulation. Sex differences were observed in associations with object control skills and balance. Girls demonstrated an association between balance and visual-spatial working memory and shifting, whereas boys demonstrated an association between object control skills and visual-spatial working memory.

Conclusions: Gross motor skills and executive functions are related in this sample of young Australian preschoolers. Results reinforce the need for early commencement of gross motor skill promotion and attention for sex differences as this might be important for cognitive development throughout life.  

Purpose: The aim of this systematic review is to critically review the evidence on the prospective relationship between physical activity and health and development in children aged 0 to 5 years. Over recent years, there has been increasing interest in early childhood. As such, and in combination with contradicting conclusions in previous reviews, the evidence on the effects of physical activity on health and development in early childhood has been reexamined.

Methods: Three electronic databases were searched (PUBMED, SportDiscus, PsychINFO) for observational longitudinal studies and (randomized) controlled trials. All forms of physical activity in healthy children (mean age <5 years) were included as long as the amount was specified by quantity. Outcome measures included body composition, cognitive development, motor development, psychosocial health, cardiovascular health, bone and skeletal health and risks/harm. Data on study methodology, participants, exposure, outcomes and results were extracted. Methodological quality was assessed using a modified version of the ‘Quality Assessment Tool for Quantitative Studies’.

Results: Thirty-nine articles were included in this review. Outcome measures were body composition (n=14), motor development (n=11), cognitive development (n=10), cardio-vascular health (n=7), social-emotional development (n=2) and bone health (n=2). Ten studies had high methodological quality. There was moderate evidence for an association between physical activity and motor development, cognitive development and cardiovascular health. There was insufficient evidence for an association between physical activity and body composition, social-emotional development and bone health.

Conclusions: The current scientific evidence on the effects of physical activity on health and development in young children is insufficient. Based on consistent findings from studies with weak-to-high methodological quality, there is moderate evidence for an association between physical activity and motor development, cognitive development and cardiovascular health in children aged 0 to 5 years. More high-quality studies need to be conducted in order to determine dose-response relationships between physical activity and health and development in early childhood. Special attention should be given to toddlers (ages 1-3 years) as least studies were available in this age group.

Purpose: Family child care homes (FCCH) are an important setting in which to promote healthy eating and PA. This presentation examines changes foods served in FCCH from baseline to immediately after the intervention completion.

 Methods: Healthy Start/Comienzos Sanos (HS/CS) is a cluster randomized trial evaluating a FCCH intervention to improve food and PA environments and the diets and PA of children aged 2-5 years. Written materials, videos and support coaching were tailored to meet the needs of family child care providers (FCCP). Two-day observations of all meals/ snacks were conducted in 120 FCCH measuring types of foods served using the Environment and Policy Assessment and Observation (EPAO) tool at baseline (BL) and month 8 (M8). Foods served were grouped into 12 EPAO nutrition subscores such that higher scores indicate more healthy food (or fewer unhealthy foods), and averaged for the overall score. ANOVA models were constructed with BL – M8 EPAO change scores as the dependent variables, experimental group as the independent variable.

 Results: Of the 119 FCCP enrolled (100% female, 72% Hispanic, 16% Black, mean age 48.4 years, 11% no high school education) and 87 completing M8 follow-up; no differences in demographics or EPAO scores were found between groups at baseline. The intervention group EPAO score (overall) at M8 increased (0.11) from baseline compared with the control group (-0.10, p<0.01). Also, dark green orange and yellow vegetables increased for the intervention group (0.26) compared with the control group (-0.66, p<0.05). High sodium/high fat foods scores also improved significantly (0.37) compared with the control group (-0.16, p<0.05,). M8 score differences by experimental group adjusted for baseline showed similar results.

Conclusion: The HS/ CS intervention improved foods served with intervention FCCPs making greater improvements in foods served compared with the control FCCPs. including improvements in the overall EPAO score, dark green, orange and yellow vegetables and high sodium/high fat foods scores. Measures of the food environment can be useful measures of FCCP-focused interventions change. Multi-level interventions in FCCH can be helpful in improving nutrition practices of FCCP.

Purpose

Lack of day-to-day physical activity (PA) can significantly negatively affect human health. To achieve health benefits, adolescents have to be physically active and meet PA guidelines. One of the ‘simple and natural’ ways of increasing the volume of PA is active commuting to school (AC). In order to study the percieved social norms among Czech adolescents we investigated how adolescents perceive the level of AC among their classmates, what are their commuting to school preferences and perceived commuting prefences of their parents.

Methods

Data was collected in 2018 as a baseline measurement of the 'Social Norms Intervention for Active Adolescents (SONIAA)' project using a web-based questionnaire (1586 students; age 11, 15; 48% girls).

Results

Focusing on travel to school, overhelming majority (74%) of the Czech adolescents prefer active commuting to school (walking) over commuting by car. Much less adolescents (52%) think that their parents prefer active commuting over commuting by car. Most of Czech adolescents (64%) commute actively almost every day. Despite of this, less than half of the respondents believe that most of their classmates are going to school almost every day. The students, who believe that most of their classmates commute​ to school actively, have significantly higher chance of regularly using AC. Less than half of are able to accurately assess the current situation and indicate that most of their classmates go to school actively in four to five days a week.

Conclusions

Our results show that most of the Czech adolescents misperceive norms in AC of their peers. Thus, we can conclude that there is a potential to targeted interventions using social norms approach aiming to increase the level of AC in Czech adolescents.

Purpose: Childhood obesity continues to increase among socioeconomically disadvantaged communities in the USA. Low-cost interventions that can be implemented in these communities are needed.

Methods: Using a quasi-experimental design, this study tested the impact of the Healthy Kids & Families intervention, a theory-based, low-intensity, parent-focused, community health worker-delivered intervention to improve children’s weight, healthy eating and physical activity. The intervention targeted the child’s social and physical home environment through parental knowledge, beliefs and skills for managing child obesogenic behaviors and use of supportive community resources. Its delivery format consisted of 4 home-based behavioral counseling sessions, 4 telephone follow ups and quarterly newsletters, over 24 months. The control condition was a positive parenting intervention with a similar delivery format. Parent and child (K-4^th grade) dyads (n=247) were recruited through schools in socioeconomically disadvantaged neighborhoods in Worcester, MA. The primary outcome was change in child BMI z-score at 24 months. Secondary outcomes included parent BMI and parent and child diet and physical activity, measured via surveys (adapted scales from the Beverage Intake Questionnaire, the Youth Risk Behavioral Survey, the Beverage and Snack Questionnaire2, the Physical Activity Questionnaire Elementary School, selected items from the Massachusetts Parent Child Longitudinal Cohort Survey; and investigator-developed surveys). Ten individual behaviors and number of positive behavior changes made were assessed. Intent-to-treat analysis included descriptive statistics and generalized linear mixed models, with adjustments for age, gender, race/ethnicity and parental education.

Results: The retention rate at 24 months was 74%. Compared to the control condition, the Healthy Kids & Families intervention had a greater reduction in children’s BMI z-score at 24 months (β=-0.18, 95%CI: -1.92 - -0.36; p=0.057) and a greater number of positive behavioral changes among children (β=0.57, 95%CI: 0.08 – 1.06; p=0.02). There were no significant findings for parents.

 

Conclusion: A low-intensity community-based intervention targeting childhood obesity shows promise for facilitating lifestyle changes among elementary school children living in socioeconomically disadvantaged communities.

 

Purpose Screen viewing is a sedentary behaviour reported to interfere with sleep and physical activity. However, few longitudinal studies have examined such associations in preschool children and none have accounted for compositional nature of these behaviours. To address these evidence gaps, we investigated the associations of total and device-specific screen viewing time (SVT) at ages 2-3 years with accelerometer-measured 24-hour movement behaviours, including sleep, sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) at age 5.5 years.

Methods Growing Up in Singapore Towards healthy Outcomes (GUSTO) is a mother-offspring cohort study; children’s daily total and device-specific SVT (television, handheld devices and computers) were reported by parents at ages 2-3. Movement behaviours over 7 consecutive days were measured at age 5.5 using wrist-worn accelerometers. We examined the associations of SVT with movement behaviours using Dirichlet regression that accounts for the compositional nature of such behaviours.

Results/findings Total SVT age 2-3 was significantly associated with movement behaviours in relation to SB at age 5.5 (sleep: p =0.008, LPA and MVPA: p<0.0001). Compared to children having ≤ 1 h/day of SVT, those having ≥ 3 h/day had more SB (439.8 vs 480.0 mins/day) but less LPA (384.6 vs 356.2) and MVPA (76.2 vs 63.4) time. Not substantial difference in sleep (539.5 vs 540.4) was observed. Similar trends were observed for television viewing and handheld device viewing.

Conclusions Higher SVT in toddlerhood was associated with greater SB but shorter time engaged in LPA and MVPA in later childhood. Our findings indicate the displacement of PA by screen viewing during the early years, and suggest that reducing SVT in early childhood may promote healthier behaviours and associated outcomes later in life.

Purpose: Whereas food intake is commonly studied as a determinant of weight in pregnancy and postpartum, eating behavior remains understudied in these periods and an overview of relationships between eating behavior and weight is lacking. Restrained eating, emotional eating and eating due to cravings are associated with weight gain among general populations, and might also be associated with gestational weight gain (GWG) and postpartum weight retention (PWR), which increases the risk of obesity on the long term. The purpose of this systematic review was therefore to investigate the associations between eating behaviors and GWG and PWR.

Methods: Systematic searches of the MEDLINE, EMBASE, and Web of Science databases were conducted. Two reviewers independently performed title and abstract screening, full-text screening, data extraction and quality appraisal. Consensus between the reviewers was achieved by discussion after each phase.

Results: Thirteen studies were eligible for review. Four of nine studies showed a 0.8-2.2 kg higher GWG among women high in restrained eating compared to those low in restrained eating; two studies found weak associations between external eating and GWG; three of four studies showed an association between higher emotional eating scores and increased GWG; three demonstrated that more food cravings were associated with higher GWG. Two out of three studies showed lower PWR among restrained eaters. Disinhibition and external eating were not associated with GWG nor PWR.

Conclusion: This review indicates that food cravings, and restrained, external, and emotional eating are possibly related to an increased GWG. Restrained eating is potentially related to an decreased PWR, which implies that the postpartum might be a more suitable phase for the initiation of cognitive behavioral lifestyle interventions than pregnancy. Influencing eating behavior in the postpartum might generate a reduction of PWR, an subsequently reduce long-term obesity.

Purpose:Most family-centered, childhood obesity prevention programs focus on children’s nutritional intake or parental feeding behavior, not both.  Existing programs are labor intensive, making large-scale implementation difficult. This study addressed these issues by combining a widely-used nutrition education curriculum, Eating Smart Ÿ Being Active (ESBA), with materials from a validated, child feeding program (Strategies for Effective Eating Development) that promotes responsive feeding--Food, Feeding, and Your Family (FFYF). Two approaches were compared: adding FFYF in-class videos and activities to ESBA and providing the same videos and parallel activities through a smart-phone app.   

Methods:493 caregivers in the Expanded Food and Nutrition Education Program (89% mothers) with children aged 2- to 8-years old in Colorado and Washington were randomly assigned to three groups: control (ESBA only), in-class (ESBA + FFYF), and app (ESBA + online FFYF).  Program retention was 70% (final n=345). Attendance and online activity were tracked. English and Spanish versions were developed; 58% attended a Spanish program. Validated assessments measured feeding knowledge, practices, styles, and efficacy one week before and one week after the program.

Results:Multi-level analyses showed that caregivers in both FFYF conditions (compared to controls) were more likely to: demonstrate knowledge about how many servings it takes for children to accept a new food, report offering their child new foods, report involving their child in food preparation, show higher responsiveness in feeding, report greater understanding of child roles during eating (WA only), and show greater endorsement of best practice feeding strategies (WA only). Caregivers in English classes were less likely to report indifferent feeding and pressure to eat. Parenting efficacy and mealtime structure increased significantly for all groups. Few differences between the online and in-class conditions were found.

Conclusions:Both online and in-class FFYF resulted in positive effects on feeding knowledge, practices, styles, and efficacy, although FFYF worked better for English speaking caregivers in reducing negative feeding behaviors. ESBA positively impacted mealtime structure and feeding efficacy. Adding FFYF online or in-class had a positive effect on feeding behaviors expected to reduce risk for childhood obesity.

 

Abstract:

 

Purpose: Sleep duration has been implicated in the development of childhood obesity. However, the majority of existing studies are limited to examination of cross-sectional and prospective associations. Longitudinal associations between changes in sleep duration and body mass index (BMI) z-scores in early childhood remain to be explored. This study aimed to examine the interrelationship between developmental trajectories of sleep duration and BMI z-scores in early childhood.

 

Methods: Data from the Melbourne InFANT program, a prospective cohort with infants aged 3 months and followed up until age 60 months, were used. Sleep duration and BMI z-scores were collected at ages 3, 9, 18, 42 and 60 months. A dual trajectory model was used to assess the longitudinal interrelationship between sleep duration and BMI z-score trajectories from ages 3 to 60 months, and to assess the influence of child and maternal factors.

 

Results/findings: Three sleep duration trajectory groups were identified: “Long stable” (61%), “Catch-up long” (23%), and “Short stable” (16%). Four BMI z-score trajectory groups emerged: “Low” (17%), “Normal-low” (48%), “Normal-high” (25%), and “High” (10%). Children from “Low”, “Normal-low”, and “Normal-high” BMI z-score groups were more likely to be members of “Long stable” sleep duration group (probability: 0.64). By contrast, children from “High” BMI z-score group had a similar probability of belonging to all sleep duration groups with a probability of 0.30, 0.31 and 0.39, respectively. Both “Catch-up long” and “Long stable” sleep duration group were more likely to be in the “Normal-low” BMI z-score group with a probability of 0.54 and 0.49, respectively. Compared to the "Low" BMI z-score group, short breastfeeding duration (<6 months) and maternal pre-pregnancy overweight/obesity increased the probabilities of following “Normal-high” and “High” BMI z-score groups after controlling for sleep trajectory groups.

 

Conclusion: Our study revealed strong interrelationships between developmental trajectories of sleep duration and BMI trajectories in early childhood, with breastfeeding duration and maternal pre-pregnancy overweight/obesity as influencing factors. The findings highlight the importance of promoting healthy maternal pre-pregnancy body weight, longer breastfeeding duration, and adequate sleep duration in children to support healthy child growth and body weight development in early childhood.

 

 

Purpose:  Sleep disruption is common among postpartum women due to newborns’ irregular sleep patterns and immature circadian rhythms. Reduced sleep can compromise mothers’ daytime functioning and is linked with depressive symptoms. Access to childcare may alleviate parenting burden and protect new mothers against symptoms of depression, which has implications for both maternal and child health. This study examined the indirect effect of infant’s sleep on maternal depressive symptoms through mother’s own sleep and assessed whether these patterns differed depending on mothers’ access to childcare. 

Methods:  Participants were from the Nurture study, a birth cohort of 666 women and their full-term infants in the southeastern United States. Mothers completed questionnaires during home visits when their infants were 3, 6, 9, and 12 months old. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depression. Mothers self-reported sleep duration for themselves and their infants, childcare arrangements, marital status and income.  Multi-level moderated-mediation models were run using MLmed accounting for income and marital status.

Results: Mothers reported a median of 7 and 9 hours of sleep for themselves and their infants, respectively. Income was < $20,000 annually for 55% of the sample. Mothers reported access to childcare on 44% of occasions; 21% of EPDS scores were in the ‘elevated’ range. On occasions when infants slept one hour less than typical, mothers slept 11 minutes less (B = 0.185, 95%CI 0.013 to 0.268), which corresponded to increased depressive symptoms, conditional on childcare access (B = 0.260, 95%CI 0.011 to 0.509). Decreased maternal sleep mediated the association between infant sleep and elevated depressive symptoms, but only on occasions when mothers did not have access to childcare (indirect effect = -0.048, 95%CI -0.001 to -0.017).  Decreased maternal sleep was not linked with increased depressive symptoms (indirect effect = -0.001, 95%CI -0.038 to 0.034) when mothers had access to childcare.

Conclusions: Access to childcare appeared to disrupt the link between reduced maternal sleep and increased depressive symptoms. Regular access to childcare may be a viable method to mitigate elevated feelings of depression for new mothers.

Purpose: Individuals with autism spectrum disorder (ASD) often experience motor difficulties and limited physical activity (PA).  Nearly 80% of autistic people are estimated to also have developmental coordination disorder (DCD). This study explores three novel research questions in a New Zealand context: (1) What are the perceptions, preferences, and barriers of PA, and fitness goals of autistic individuals?; (2) What are their PA programme preferences?; and (3) What are potential impacts of DCD on their PA?

Methods: In this cross-sectional study, two versions of an anonymous survey were given to autistic adults (hereafter ‘individuals’), and to parents, caregivers, and service providers of someone with ASD (hereafter ‘parents’). Parents answered questions in relation to their child and also completed the Developmental Coordination Disorder Questionnaire (DCDQ), a screening tool for DCD in children aged 5-15 years. Preliminary descriptive results are reported. 

Findings: Individuals. Thus far, 53 individuals (mean age 33.9 ± 12.7; 68% female) have completed surveys. Overall, 81% believe PA will make them feel good, 100% believe PA is good for them, and 87% want to improve their physical functioning. However, just 11% engage in moderate to vigorous PA, and 29% in light PA, at least 5 times weekly; 70% want to exercise more. Several barriers were identified: poor weather, tiredness, boredom, and ASD-related challenges. Nearly 60% prefer doing a PA programme alone. Home and recreational centres are tied (~38% each) as preferred locations; swimming, running/walking, dancing, and biking are preferred activities.

Parents. Thus far, 150 participants (mean age 44.6 ± 9.9; 97% female) have completed surveys. Results are similar to individuals' results, with 77% believing PA is beneficial and 65% wanting to improve physical functioning. Of 71 participants with eligible DCDQs (within age range), 68 scored in the “suspect DCD” range.

Conclusions: Results provide important insights into PA perceptions, barriers, and preferences of autistic people in New Zealand, and will be used to develop and evaluate a PA programme for this population. Interestingly, DCDQ results suggest that 96% of autistic children show indications of DCD; future research into ASD+DCD co-occurrence is warranted.

Purpose: The present study explored the relative validity of grocery purchase data as an indicator of individual-level food consumption in families with children.

Methods: A major Finnish retail chain issued us with the grocery purchases (in volume) of consenting loyalty card holders over the past year. The participants reported the number of children (0–17-year-olds) living in the same household. The participating card holders’ individual-level food consumption during the past month was assessed using a 52-item electronic food frequency questionnaire (FFQ). The consumption frequencies of vegetables; legumes; fruits; rye bread; white bread; fish; red meat; white meat; skimmed milk; fat spreads; sugar-sweetened beverages; and sweets were selected for further analysis as these food items were considered to broadly reflect the overall quality of diet. We calculated the percentages of participants classified into the same; same or adjacent; and opposite fifths using the FFQ and purchase data.

Results: Our subsample of families with children consisted of 3714 participants (31% of the whole sample of loyalty card holders). Participants’ mean age was 41.1 years (SD 8.2 years), and 70% of them were females. The proportion of participants classified into the same; same or adjacent; and opposite fifths ranged between 22–50%; 57–72%; and 1.4–7.8%, respectively. Regarding sweets consumption, 72% of the participants were classified into the same or adjacent and 1.4% into the opposite fifths, and the respective percentages were 67% and 1.5% for fish consumption. The two methods differed the most in terms of bread consumption: 60% and 59% of the participants were classified into the same or adjacent and 7.8% and 6.8% into the opposite fifths of white bread and rye bread consumption, respectively.

Conclusions: Most of the participants were classified into the same or adjacent fifths using grocery purchase data and FFQ. This finding suggests that grocery purchase data can be used to rank participants according to their individual food consumption regardless of the fact that in our subsample, the grocery purchases may have been consumed not only by the participants but also by their children other family members.

Purpose: The transition from infancy to toddlerhood heralds rapid developmental, behavioural, and physiological changes, including increased food fussy behaviours. Food fussiness is associated with nonresponsive parent feeding practises, such as persuasive and instrumental feeding, which may reinforce fussy eating behaviours and are associated with lower intakes of vegetables and fruit, higher intakes of noncore foods, and suboptimal growth trajectories. Previous research investigating parent feeding practises in the context of fussy eating have used cross-sectional or longitudinal designs, which assess feeding practises as static characteristics. However, a growing body of evidence suggests that parents’ feeding practises vary over the day and across a week. The aim of this study is to identify the contextual and temporal factors influencing the feeding practises of parents of toddlers with fussy eating. 

Methods: This study will involve repeated data using a smartphone-based ecological momentary assessment. Outcome measures include parent feeding practises (i.e. pressure, indulgent feeding, food as a reward, meal structure, modelling), children’s eating behaviours (i.e. fussy eating, intake of vegetables, noncore foods, sugar-sweetened beverages), meal environment, parents’ momentary cognitions (i.e. affect, stress, self-efficacy), and sleep quality. Over seven days, parents will complete EMA questionnaires up to four times per day. Multilevel regression models will assess within- and between-subject effects.

Results and discussion: It is anticipated that the findings will contribute to our understanding of how momentary factors influence parents’ feeding behaviours in the context of fussy eating and inform the development of interventions that support healthy feeding practises in this population.

New parents form strong social connections with parents of infants of a similar age. The internet, parenting peer groups and family provide new parents the majority of nutrition and child feeding information, influencing beliefs in comparison with health professionals. Peer education provides a means of penetrating these new parent networks to influence feeding practices and infant nutrition. The PICNIC study investigates the influence of peer education on future dietary patterns, food related behaviour and the risk of preventable disease. The aim of this presentation is to describe the experiences of rural New South Wales parents in their role as peer educators disseminating nutrition and child feeding information to friends and family.

New parents (n=172) with an infant aged 0-2 years have enrolled as peer educators over 20 months. Participants have received peer educator training in infant/child feeding and nutrition to on-share with new parent peers and family, supported by evidence-based, project-specific website and social media content.  Peer educators are engaged as co-researchers in this participatory action research, providing insight into the lived experiences and input into the ongoing evolution of the PICNIC model over 12 months. Preliminary qualitative analysis has been conducted on data gathered in the first action research cycle from focus groups, individual interviews, participant correspondence and online contribution.

First-level content analysis resulted in generation of three main themes  (i) food-related experience (personal and as a parent), (ii) experiences with being a PICNIC project peer educator and (iii)  input into PICNIC implementation, research component, intervention content and resource distribution.

The preliminary findings from the first action research cycle illuminate the participant journey and are contributing to the ongoing modification and shaping of aspects of the PICNIC project model. This is expected to improve parental efficacy and child feeding practices of peer educators and their recipients. This presentation will describe processes, early qualitative findings and quantitative evaluation plan of the PICNIC peer education dissemination model, an avenue to widely distribute tailored, evidence-based information.  The findings and implementation processes will be of interest to health professionals aiming to evaluate community and population level health promotion and preventative health interventions.

 

Purpose: Physical activity levels between parents and children are positively associated. Parents therefore play a crucial role in shaping children’s behavior, through appropriate support and modeling. To this end, a family-based intervention based on self-determination theory was designed to enhance the support parents provided to children, and to increase co-physical activity between the dyads. The effectiveness of the intervention was evaluated using a randomized controlled trial.  

Methods: Children (N=158, 8-11 years, from seven Hong Kong primary schools) and their parents were randomly allocated to an experimental (n=81) or a wait-list control group. The intervention included ten sessions spread over approximately six months. Each session included a 30-minute workshop and a 60-minute period of activities tailored for parents and children to play together. Children’s moderate-to-vigorous physical activity (MVPA) was measured using accelerometers (ActiGraph wGT3X-BT) for a five-day period at baseline and at end of intervention, respectively. Only valid cases, defined by a minimum wear time of three days with 8 hours, were included in the analyses. Multi-level analyses were conducted to examine the intervention effects on children’s MVPA.  

Results: A significant group by time interaction in favor of the experimental group was found for daily MVPA (B=8.82, 95% CI [2.38, 15.25], p =.007). The experimental group indicated a 7.29 minutes increase (p = .016) in MVPA from baseline (47.85±1.90 minutes) to the end of the intervention (55.14±2.60 minutes); no significant difference was found in the control group. At baseline, no differences were found between groups (p =.574). While at the end of the intervention, there was a difference between groups (p =.041).    

Conclusion: Preliminary evidence suggested that the intervention was feasible and effective. The intervention provided knowledge, opportunities for parents and children on physical activity. Future studies should consider engaging more family members in interventions, and to incorporate more exercises suitable for wider age groups. Additionally, researchers could also examine if embedding family-based approaches in physical activity promotion could strengthen relationships among family members. 

 

Caregivers’ perception on the behavioural determinants that shape fruit and vegetable consumption in children (6months to 5years old) in the Nuffield Medical Area, Suva: A qualitative study

 

Salanieta M C Hawea^1, Pragya Singh²

Lecturer, Nutrition & Dietetics Department, School of Public Health & Primary Care¹

Associate Professor, Primary Care &Nutrition and Dietetics Department, Fiji National University².

 

 Key Words: Fruits and Vegetables, Caregivers, Children, Behavioral determinants.

 

 Purpose: Despite the health benefits of fruit and vegetable intake, studies showed that most of the world’s population including children eat less than the recommended intake. This paper aimed to assess the perception of caregivers regarding the behavioral determinants of F&V consumption in children (6 months- 5 years old) in the Nuffield Medical Area, Suva.

 Methods: A qualitative study design, through the use of Focus Group discussions (FDGs) for caregivers was utilized. Study population were caregivers (n=24) of children aged 6 months to 5 years who attended clinics in the Nuffield Medical Area, Suva. Based on the research questions, as aligned to the Conceptual Framework from the Pro Children Project, caregiver’s perceptions were thematically analyzed. The framework identified Personal Factors, Social Environment, Physical Environment and Cultural factors as determinants of fruits and vegetable consumption in children.

 Results: Demographic distribution of participants were as follows, more than 50%  were  from  20-39years old and mothers of the children, while (13%) were  50-59years old and grandmothers. More than 50% had two children while 33% had only one child. Majority of the participants were married while (21%) were single parent. As aligned to the conceptual framework, under the theme Personal factor, the sub themes Preference and Self-efficacy and skills were identified which found that  Neophobia and picky/fussy eating behavior;  Cognitive and Behavioral skills to be behavioral determinants that influence F&V consumption of children.

 Conclusions: Caregivers reported neophobia as a determinant in F&V consumption, as their children avoid certain novel fruits and vegetables or simply reject familiar ones. Self-efficacy and skills is a key concept in Social cognitive theory (SCT) and reflects the perceived confidence in the ability to engage in a particular behavior.  Caregivers feel that children do not ask but rather consume whatever is offered or available at home. Modifying the home food and school environment through activities that engage both caregivers, teachers and children can increase fruits and vegetables intake.  Furthermore, future research is needed to understand the SCT behavior of peer and siblings influence on F&V consumption in children considering the local context.

 

 

Purpose: During the recent decade presence of digital media, especially handheld devices, in everyday life, has been increasing. Survey data suggests that children and adults spend much of their leisure on screen media, including use of social media and video services. Despite much public debate on possible harmful effects of such behavioral shifts, evidence from rigorously conducted randomized controlled trials (RCTs) is lacking. The purpose of the SCREENS trial is to investigate the short-term efficacy of limiting leisure screen media use on objectively assessed physical activity, sleep duration and quality, and physiological stress in parents and their 4-14-year old children. 

Methods: The SCREENS pilot was conducted during the fall of 2018 and spring of 2019. Based on experiences from the pilot, we developed a protocol for a parallel group RCT. The trial is being conducted from May 2019 to ultimo 2020 in 95 families with children 4-14 years recruited from a population-based survey. As part of the intervention family members must handover most portable devices for a 2-week time frame, in exchange for classic mobile phones (not smartphones). Also, entertainment-based screen media use during leisure must be limited to no more than three hours/week/person. At baseline and follow-up, 7-day 24-hour physical activity will be assessed using two triaxial accelerometers; one at the right hip and one the middle of the right thigh. Sleep duration will be assessed using a single channel EEG-based sleep monitor system. Also, to assess physiological stress (in adults), parameters of 24-hour heart rate variability, the cortisol awakening response and diurnal cortisol slope will be quantified using data sampled over three consecutive days. We will objectively monitor the families’ screen media use via different software and hardware monitoring systems.

Discussion: Using a rigorous study design with state-of-the-art methodology to assess outcomes and intervention compliance, analyses of data from the SCREENS trial will help answer important causal questions of leisure screen media habits and its short-term influence on physical activity, sleep, and other health related outcomes among children and adults.

Purpose: Social support from parents has a positive influence on promoting children’s physical activity (PA). Since social supports were frequently examined with mixed parent gender in China, the specific associations between supports from either father or mother and PA were unclear. The objective of this study was to examine the associations between six kinds of social support from fathers/mothers (encouragement, observation, involvement, discussing benefits of PA, financial support and role model) and children and adolescents’ moderate-to-vigorous physical activity (MVPA).

Methods: From September to October 2019, using a multi-stage stratified and random cluster sampling method, 1509 (age 8-18) students from 16 primary, middle and high school of two districts in Shanghai participated in this survey. MVPA and social supports were measured by self-reported questionnaires with good reliability and validity, and finally, 1307 (boys 50.5%, mean age 12.66 ± 2.78) participants were included. Descriptive statistics and Chi-square were used to report the level of MVPA and differences between variables. Logistic regression was used to examine the association between paternal/maternal support and MVPA.

Results: 16.8% of children and adolescents engaged in MVPA at least 60 minutes per day with gender difference (boys vs. girls: 10.6% vs. 6.2%, p < 0.001). Compared to those who received low paternal support, boys (OR: 2.60-3.51, 95% CI: 1.75-5.25) and girls (OR: 1.84-2.81, 95% CI: 1.15-4.52) with high paternal support both exhibited a higher ratio of MVPA. As for maternal support, boys with high maternal support regardless of support type were more likely to reach MVPA (OR: 1.96-2.83, 95% CI: 1.28-4.18). Girls who received five kinds of high maternal support (except for discussing benefits of PA) had a higher likelihood for MVPA (OR: 1.79-2.73, 95% CI: 1.07-4.44).

Conclusions: The level of PA among children and adolescents was low, while boys were more physically active than girls. The findings from this study suggested that different kinds of social support from parents were important in facilitating children and adolescents’ participation in MVPA, and possibly the “father-son” relationship was relatively the strongest.

 Purpose

There have been many efforts to increase UK primary school children’s physical activity, but they have largely been ineffective. One reason for this could be that children’s perspectives are rarely considered during intervention design. With a view to informing future interventions, this review aimed to consolidate what is currently known regarding UK children’s perspectives on physical activity.

Methods

An online search of seven databases (CINAHL, EThOS, IBSS, Medline, PsychInfo, Scopus and Web of Science) was conducted to identify relevant articles published between January 2004 and October 2019. Reference lists of reviews were hand searched, and the authors of key papers were contacted. Two independent reviewers performed title, abstract and full-text screening, data extraction and quality appraisal. Papers were included if they reported physical activity related qualitative data from children aged between 5-11 years living in the UK. Studies involving children from a broader age range were included if quotes were age labelled. Data were coded in NVivo and analysed using thematic synthesis.

Results

Of 19,610 articles identified, 20 were included in the final review. 13 studies were concerned with general physical activity, 3 focused on physical education, 2 on sport, 1 on active travel and 1 on active play. Children reported being active with friends and family and in a variety of locations (e.g., outdoors, at parks and at school). Children felt physical activity engagement was important due to learning and skills development and the improvement and maintenance of health and fitness. Across studies, several themes associated with physical activity engagement were identified, including enjoyment and fun, perceptions of safety, availability and suitability of equipment and activities, and the social environment created by friends, family, teachers, and coaches.  Across all contexts, child-led activities were favourable.

Conclusions

This is the first qualitative synthesis of children’s perspectives on physical activity. The available studies highlight several psychological, social and environmental factors that children consistently identify as related to their physical activity. Future strategies to increase children’s physical activity should involve children in designing and developing intervention components to ensure that activities are appealing, fun and age appropriate.

Purposes: Since academic performance (AP) of students has received much attention from families and schools, moderate to vigorous physical activity (MVPA) may be a negative factor in improving AP. In addition, Chinese school-aged students were exposed to higher academic burden (AB). This study examined the relationships of MVPA with AP, AB among Chinese students.
Methods: This study used cross-sectional design, which was conducted in provinces/cities of Shanghai, Jiangsu, Anhui and Zhejiang from September to October in 2019. Using a multi-stage sampling and random cluster sampling based on classes in areas, 3111 participants were recruited. The Health-Behavior School-aged Children questionnaire (HBSC) was used to collect participants’ information on MVPA, AP, AB and other demographic parameter. The Binary logistics regression was used to analyze the relationships among daily MVPA, AP and AB.
Results: Of all 2838 participants aged 7 to 19 years (mean: 13.1 ± 2.39; 46.9% of boys), the prevalence of MVPA was 10.4%. Compared to students without daily MVPA, the students who reported that they met the PA guidelines had better AP (On the weekdays: OR = 1.46, 95% CI: 1.03-2.07, On the weekends: OR = 1.46, 95% CI: 1.14-2.54, respectively). In the grade group, only the middle grades students who reported that they met the PA guidelines had better AP ( On the whole week: OR= 2.12, 95% CI: 1.02-4.36, On the weekdays: OR=1.87, 95% CI: 1.19-2.93, On the weekends: OR = 3.17, 95% CI: 1.48-6.81, respectively). Compared to students without daily MVPA, students who reported that they met the PA guidelines were less likely to have AB (On the whole week: OR = 1.71, 95% CI: 1.25-2.50, On the weekends: OR = 1.52, 95% CI: 1.15-2.01, respectively).
Conclusions: The prevalence of MVPA among Chinese school-aged students were low. On the weekends, students with daily MVPA has a positive relationship with their AP and AB, but there was a difference between weekdays and weekends among students.

 

 

Purpose: The intergenerational impact of colonisation has meant that Australian Indigenous children are often not provided with opportunities to engage with, learn and connect with their culture and this is having an ongoing effect on their health and well-being. Afterschool cultural programs have been identified by the participating Indigenous communities as a potential strategy to promote cultural connectedness and healthy lifestyle behaviours in Indigenous children. However, limited information is known about the feasibility of implementing and evaluating such programs. The purpose of this study was to explore the feasibility of implementing and evaluating the “Stronger Culture, Healthy lifestyles” afterschool cultural program.

Methods: This was a single group non-randomised pre-test/post-test feasibility study. Australian Indigenous children and their siblings aged 5-13 years, and their parents/caregivers from three Indigenous communities in New South Wales, were recruited to participate in the program and research. Children participated in a 10-week cultural program, two afternoons per week. The primary outcomes were the feasibility of the program and study methods, including recruitment and retention rates, percentage of the program delivered as planned (direct observation), compliance with data collection, program attendance, and program enjoyment. Data were summarised using descriptive statistics.

Results/findings: A total of 120 children enrolled in the programs with an average of 20 children per program, and 92% were retained at follow-up. Of these, 111 parents also consented to their children being part of the research activities with a retention rate of 91%. The average program attendance rate was 70%. Only 61% of the agenda was delivered as planned on observation days, with poor weather and mentor illness being the main reasons for changes to agendas. Eighty-nine percent of children reported a high level of enjoyment for the programs. Compliance with data collection ranged from 47% for follow-up yarning to 91% for baseline height and weight (average across all outcome measures = 74%).

Conclusions: Exploring the feasibility of interventions and study methods is a critical step in the process of developing and conducting full-scale trials. This study enabled the identification of feasibility indicators and areas for improvement, which will be addressed to ensure the larger trial of the afterschool cultural program is relevant, meaningful and effective.

Purpose: Eating behaviours tend to become less healthy from childhood to adolescence. This decline could be influenced by life events. An important life event for children is the transition from primary to secondary school. Little is known about the influence of school transitions on eating behaviours. This study will use a Self-Determination Theory (SDT) perspective to get more insight into eating behaviours during the school transition.

Methods: This longitudinal study follows Dutch pre-adolescents from their last year of primary school (T1) into their first year of secondary school (T2). A total of 142 pre-adolescents (M = 12.2 years, 55.6% boys) from nine primary schools participated at T1 by completing questionnaires. The questionnaire included measures on snack and beverage intake at school and constructs from SDT, including healthy eating motivation, food-related autonomy and competence to eat healthily. In addition, pre-adolescents’ perceived school encouragement to eat healthily was measured. The present study used data from T1, as data collection for T2 is ongoing. A healthy snack and beverage ratio was calculated by dividing healthy intake by total healthy and unhealthy intake. Correlation analyses were performed to assess associations between study variables.

Results: Preliminary results at T1 show that pre-adolescents had an average healthy beverage ratio of 64% and a healthy snack ratio of 61%. Pre-adolescents with a higher healthy beverage ratio had more autonomous motivation to eat healthily. No significant correlation was found between the healthy snack ratio and motivation to eat healthily. Regarding food-related autonomy, pre-adolescents who purchased more foods had a lower healthy snack ratio. Competence to eat healthily was positively associated with the healthy beverage ratio. 62% of pre-adolescents agreed that their school encouraged them to eat fruit or vegetables. Furthermore, 36% agreed that their school encouraged them to drink water, which was positively associated with pre-adolescents’ healthy beverage ratio.

Conclusions: This study provides insight into the influence of individual and environmental factors on pre-adolescents’ eating behaviours during the transition from primary to secondary school. Results could inform schools on promoting healthy intake during this transition.

Purpose: Based on the tenets of self-determination theory, parents’ psychological need support is an important predictor of children’s physical activity behaviors. By contrast, parental behaviors perceived as controlling would have negative consequence on behavioral outcomes and may even diminish the well-being of youngsters. In this study, we examined the relation between parent- and children-rated parental support in terms of physical activity, and how these affected psychological need satisfaction and frustration in children.

Methods: Questionnaires were administered to 161 children-parent dyads (children mean age = 8.77±0.81 years, 94 male) who took part in a family-based physical activity promotion program. The administered questionnaires included scales measuring need support and psychological control (by parents and children), psychological need satisfaction and frustration, and quality of life (children only). Structural equation modeling was used to test a model based on self-determination theory.

Results: The results showed that children perceived parental support and parent-report support were positively correlated (r=.18, p=.04). Children perceived parental control and parent-report control (r=.32, p<.001) was also associated. Using structural equation modeling, we found support for a model linking need support and control, need satisfaction and frustration, and quality of life of children: χ²(7)=11.40, p=.12, CFI=0.969, RMSEA =0.062. Positive paths were found between parents- and children-reported need support (β=.206, p=.016) and control (β=.318, p<.001), respectively. Perceived need support was related to need satisfaction and well-being. Whereas perceived control predicted need frustration, which in turn affected children’s well-being negatively.

Conclusions: Results indicated that parents’ self-reported need support and control are perceived similarly by their children. These behaviors were also related to children’s well-being indirectly via need satisfaction and frustration. Therefore, teaching parents to become supportive, and less controlling, may result in better physical activity behaviors and well-being in their children. Engaging and educating parents may hence be an effective means to promote physical activity in children.

 

Purpose: Moderate-to-vigorous physical activity (MVPA) in children is an important target for Physical Education (PE) programmes globally. Movement competency (MC) has been found to be  positively associated with MVPA and recently pedagogical approaches for PE have been underpinned by theories of motor learning in an effort to promote the development of children’s movement competence. An important consideration in the development these new PE curriculums is the maintenance of high levels of MVPA to support children’s long-term health and wellbeing. Therefore, the aim of this study was to compare MVPA within linear and nonlinear pedagogical approaches to current PE practice.

Methods: Participants (n=165, 53.3% female,5-6yrs) were recruited from nine primary schools within the SAMPLE-PE randomised controlled trial. Schools were randomly-allocated to one of three conditions: linear Pedagogy, nonlinear pedagogy or control. Nonlinear and linear pedagogy intervention schools received a PE curriculum delivered by trained coaches over 15 weeks, while control schools followed usual practice. Children’s MVPA was measured during 3 PE lessons (1 every 5 weeks) using an ActiGraph GT9X accelerometer worn on their non-dominant wrist.  Differences between conditions for children’s MVPA were analysed using multilevel model analysis. A binomial regression was performed to evaluate whether the pedagogical approaches predicted spending 50% of more of the lesson in MVPA. Models accounted for covariates (i.e., sex, ethnicity, deprivation index, teacher and lesson duration).

Results: There were no significant group effect of control, linear and nonlinear pedagogy conditions in MVPA, in the percentage of time children spent in MVPA and in the proportion of children meeting the ≥50% MVPA PE lesson guideline. Children spent on average 29.3% (95%CI:7.2-51.7%), 37.6% (95%CI:30.5-59.9%) and 34.5% (95%CI:14.17-54.8) of the lesson in MVPA in control, nonlinear pedagogy and linear pedagogy respectively. Furthermore, only 3.7%, 14.0% and 9.6% of children within the respective control, linear and nonlinear pedagogy conditions spent ≥50% of their PE lesson time in MVPA.

Conclusions: Linear and nonlinear pedagogical approaches in PE do not negatively impact on MVPA compared to usual practice. Nevertheless, practitioners may need to refine these pedagogical approaches to improve MVPA alongside MC.

Purpose: Ethnicity and food culture are important factors that influence eating behaviour, which in turn is related to the development of childhood obesity. Thus, this study aimed to determine the eating behaviour of Malaysian children and its association with weight status and body fatness.

Methods: A cross-sectional study was conducted among 266 children aged 9-11 years, comprising 92 Malays, 82 Chinese and 92 Indians. Eating behaviour was determined using Children Eating Behavior Questionnaire (CEBQ) as proxy-reported by parents. Four subscales in CEBQ measured food approach behaviours, namely food responsiveness (FR), enjoyment of food (EF), emotional overeating (EOE) and desire to drink (DD). While subscales of satiety responsiveness (SR), slowness in eating (SE), emotional undereating (EUE) and food fussiness (FF) reflected food avoidant behaviours. Children were measured for weight, height and waist circumference (WC), while body fat percentage (%BF) was assessed using bioelectrical impedance technique. Body mass index (BMI) and body mass index-for-age z-score (BAZ) were computed.

Results: Approximately one-third of the children were categorized as overweight or obese. Indians who had highest WC and %BF were observed to have significantly lower score in FF subscale; and higher score in SR compared to Malays and Chinese. Overall, food approach subscales (FR, EF, EOE) were positively correlated (r=0.153 to 0.266) while food avoidant subscales (FF, SR, SE) were negatively correlated (range r=-0.164 to -0.259) with BMI, BAZ, and WC (p<0.05). FR, EF and DD subscales were positively correlated (r=0.130, 0.232, 0.134), while SR was negatively correlated (r=-0.151) with %BF. However, among Indian children, there was a negative correlation of DD (r=-0.089) and positive correlation of FR (r=0.085) and EF (r=0.152) with WC. Moreover, EUE was positively correlated with BAZ (r=-0.089) among Indian children.

​

Conclusions: Except for Indian children, eating behaviours, particularly high food enjoyment, low satiety responsiveness and slow in eating were consistently correlated with weight status and body fatness in this Malaysian sample of children. Ethnic differences should be considered when planning strategies to promote healthy eating behaviours among children, which may subsequently benefit childhood obesity prevention efforts.

Purpose:

Preventing childhood obesity can be challenging when limited food options, both nutritiously and choice. This novel study used a multi-strand qualitative exploration to investigate food choice in recreational centres -such as soft play areas and leisure facilities- on the Island of Ireland.

Methods:

A series of case-study interviews with recreational centre managers and catering staff, and a combination of focus groups and interviews with parents explored their experiences of the healthiness and food choice available to children in recreational centres. This included currently available food choices, perspectives of encouraging healthier eating and maintaining sustainable business practices. Finally, parents discussed their reactions to three real-life food choice scenarios to investigate decision-making when eating outside the home. Inductive thematic analysis was used. 

Results:

Recreational managers and catering staff focused on two main themes; “Promoting healthiness as a business” and “Challenges and opportunities”. They described consumer’s move towards healthier choices and external influences on healthy eating but how they as businesses' were more focused on operational activities and physical health than food. Business' identified difficulties in maintaining fresh food and competition from external business as deterrents but seen small and easy-to-implement changes as achievable and desired to improve the healthiness of their offerings.

The parental data developed into three themes; “Food choices”, “how to influence healthy eating” and “dealing with common food scenarios”. Parents described their general disappointment in healthy food availability and how this encouraged them to purchase food outside the centre. Parents identified multiple influences that encouraged unhealthy eating and suggested using picnic baskets and improved placement of healthier food, to empower healthier choices by children. When real-life scenarios were used, compromising with children and complying with social norms of other parents were important factors influencing food choice decisions.

Conclusions:

Parents and staff identified potential growth and demand for healthier options, with small and easy-to-implement changes proposed. However, both groups identified that the wider environment of business operations, advertising and children’s desires generated barriers that needed to be overcome to increase the healthiness of food, while nourishing business sustainability and growth.

 

 

Purpose: The school environment has implemented successful physical activity (PA) interventions promoting children’s PA behaviours. The study will use mixed-methods to assess the effects of a lunchtime PA intervention programme on children’s moderate-vigorous PA (MVPA). Heart rate (HR) monitors measured children’s PA intensity and duration, whilst focus groups assessed the effectiveness of the PA intervention.

 

Methods: Participants were 60 9-13 year olds attending a West Midlands (UK) school. Participants wore HR monitors measuring intensity and duration of PA throughout the school day which consisted of three main time periods: lesson time (including registration/assembly), morning break time and lunchtime. A sub-sample of children participated in focus groups to evaluate the success of the lunchtime PA programme. A thematic approach was used to analyse focus group data.

 

Results/Findings: Mean MVPA for non-intervention days was 35.5 minutes, and for intervention days MVPA was 43.7 minutes, 8.2 minutes higher than non-intervention days. There were 5 children (9.1%) who met the 60 minute PA guidelines on non-intervention days, and 10 children (18.2%) who met the guidelines on intervention days. Analysis exploring the difference in mean daily MVPA according to each lunchtime PA showed children engaging in football, dodgeball and table-tennis activities showed significantly greater amounts of MVPA (p <0.01) compared with non-intervention days. Additionally, dodgeball intervention days showed children to engage in greatest MVPA (17.6 minutes), and showed the largest difference in MVPA minutes (p <0.01). Emergent themes from focus groups evaluating the PA intervention were time, improve fitness/skill, fun, enjoyment, challenge and motivation. “It makes lunchtime more interesting”; “It makes me want to be more active”; “Enjoyed having a challenge”.

 

Conclusions: This intervention revealed both genders and key stages to show reductions in sedentary behaviour (SB) and light PA (LPA), and greater moderate PA (MPA), vigorous PA (VPA) and MVPA on intervention days compared with non-intervention days. In practice, this informs the need for PA interventions to be designed in consultation with children to increase levels of children’s MVPA, and the school lunchtime period is a key window to implementing PA interventions. Future research could explore PA interventions according to seasonality further promoting PA.

 

Purpose: Multiple early risk factors for childhood obesity have been identified, including environmental influences like maternal stress and non-responsive feeding practices. Less is known about underlying biological mechanisms, for example, impacts on early development of neural appetite systems. To address this gap, the NIH-funded RESONANCE study, and its sub-study NomNom, are collecting longitudinal brain imaging data and biological specimens, in parallel with rich environmental and behavioral data relevant to obesity risk, beginning in infancy. We present preliminary associations between maternal stress, feeding practices and child weight which will form the basis for future investigation of neural mechanisms.

Methods: Mothers’ Perceived Stress Scale (PSS) scores and Comprehensive Feeding Practices Questionnaire (CFPQ) scores, and child BMI z-scores (BMIz) based on measured weight and height, were available for 92 RESONANCE/NomNom mothers of children (62.0±24.0 months, 43.5% girls). Spearman correlations were examined. We additionally examined correlations between CFPQ scores and child BMIz stratified by low and high PSS scores (median split). 

Results: Higher maternal stress was associated with higher restriction for health reasons (p=.032) and higher child BMIz (p=.006). Higher restriction for health reasons, and weight control, were both associated with higher child BMIz (p<.05). Higher encouragement of a balanced variety of foods, and monitoring, were associated with lower child BMIz (p<.05). Stratified analyses showed that while higher child BMIz was associated with greater restriction for weight control in both low and high stress groups (p<.005), the association with restriction for health reasons only emerged among the low stress group (p=.002 vs. p=.885).

Conclusions: Maternal perceived stress was correlated with feeding practices and child weight, with relationships between feeding practices and weight differing by stress level. Future analyses will consider the role of other household characteristics such as SES, as well as neural mechanisms. Since RESONANCE forms part of NIH’s US-wide Environmental influences on Child Health Outcomes (ECHO) program, future analyses using large samples obtained from multiple cohorts will allow more complex longitudinal modelling of these relationships and their biological mechanisms. 

Purpose: Nutrition and physical activity programs aimed at reducing childhood obesity in high-risk communities have often been uncoordinated, making it difficult to use traditional evaluation methods. It is often unclear which communities can serve as “controls” and if observed effects are attributable to one intervention or synergy between several interventions targeting the same communities. We used a dynamic simulation modeling method of agent-based modeling (ABM) to evaluate the impact of community interventions in Los Angeles County (LAC) on childhood obesity rates among low-income 2- to 5- year olds participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods: An ABM was developed to simulate the impact of nine micro- (targeting individuals directly) and macro- (community and policy) level interventions on health behaviors and childhood obesity rates among WIC participants in LAC. The ABM includes simulated individuals (agents) who are initialized at age 2 with specific diet, physical activity, and past breastfeeding behaviors (e.g., sugar sweetened beverage intake, park use, and breastfeeding in the first six months of life or longer) and BMI z-scores (BMIz). Initial behaviors and BMIz distributions were based on data collected from WIC participants in LAC in 2008. In the model, the micro- and macro-level strategies affect BMI z-score through their potential effect on the child’s behaviors over time. Model parameters reflecting the impacts of each intervention on behaviors were based on peer-reviewed literature. Agents were followed until age 5 as their BMIz and behaviors incrementally evolve. Simulated experiments were conducted to identify the individual and collective impacts of micro- and macro-level strategies on BMIz. We examined differences in model outputs for a status quo scenario (no intervention) and for each intervention implemented separately and in combination.

Results: We will present health behavior and BMIz trajectories among WIC participants for the status quo scenario, scenarios in which each intervention is implemented separately, and scenarios with combinations of interventions.

Conclusions:​Dynamic modeling techniques like ABM are promising evaluation tools to examine the impact of multiple interventions on childhood obesity in a community setting.

Purpose:

Use of autonomy promoting parenting practices in relation to eating, screen time, physical activity and sleep reduces obesity risk in young children. Obesity prevention interventions rarely focus on parenting across all four obesity-related behaviours. In addition, most are delivered by researchers or health professionals in a health service delivery setting. The aim of this pilot trial was to evaluate the feasibility and acceptability of a peer-led obesity-prevention intervention delivered to parents of young children attending community playgroups.

Methods:

Community playgroups were recruited through Playgroup Queensland, a not-for-profit organisation in Brisbane, Australia. A pilot clustered randomised controlled trial was conducted to evaluate the feasibility and acceptability of a peer-led intervention delivered over five sessions within a 10-week school term. The content and delivery mode of the intervention was informed by focus groups conducted with parents at playgroup. It was delivered by parent peer facilitators, who received training on facilitating group discussions using the "healthy conversations" concept. The conversation topics covered parenting challenges with respect to child eating, screen time, active play, and sleep. Feasibility and acceptability were evaluated via post-session surveys.

Results:

Thirty-three playgroups (220 parents) took part in the trial (intervention n=113; wait-list control n=107). Just over 74% of the parents receiving the intervention were satisfied or very satisfied with the group conversations, and 68% rated the overall program to be useful or very useful. All topics were rated positively, with the conversations about active play the most popular. Parents commented on how much they enjoyed talking about their parenting challenges and sharing information and ideas with other parents facing similar issues.

Conclusion:

A peer-led intervention targeting obesity-related behaviours in families attending community playgroups is feasible and acceptable. The peer-led "healthy conversations" delivery model, and the leveraging of existing social support networks were important and novel aspects of the intervention.

Purpose: This study aimed to determine the prevalence of children aged four years who meet the WHO's 2019 guidelines on physical activity (PA). The guidelines states that children aged 3-4 years old should participate in at least 180-minutes of PA a day including 60-minutes of moderate-to-vigorous intensity PA (MVPA). A secondary aim for this study is to explore the relationship between meeting the PA guidelines and motor skills among these children.

Methods: This is a cross-sectional study. Preschool children aged four years were recruited from urban and rural localities in three states in central region of Peninsular Malaysia, namely Kuala Lumpur, Selangor and Negeri Sembilan. PA was measured using Actigraph GT3X+ accelerometers. The accelerometer was worn on the waist for five days, from Monday to Friday. Children with at least one 24-hour day of data were included in the analysis. Gross and fine motor skills were measured using the Ages and Stages Questionnaire Third Edition (ASQ-3) for age 48 months. 

Results: A total of 82 children completed the study protocol. There was a good representation of boys (51.2%) and girls (48.9%), and from rural (47.6%) and urban (52.4%) areas. Accelerometer data showed that slightly more than half (57.3%, n=47) of the children participated in at least 180-minutes of PA a day. However, among them, only 30 (36.6%) also participated in at least 60-minutes of MVPA, thus meeting the WHO PA guidelines. Most children were developing on schedule without needing intervention or assessment, for gross motor skills (72.0%) and fine motor skills (69.5%). We found no significant association between sex and location with meeting PA guidelines. Further, there were also no significant association between meeting PA guidelines and gross and fine motor skills in this age group.

Conclusions: The findings showed that many preschool children in Malaysia have insufficient physical activity, particularly MVPA. Future research should focus on innovative ways to promote physical activity, especially energetic play among preschool children. 

Purpose

Independent mobility (IM), knowns as the freedom of children to move around in their neighbourhood without adult supervision, has been found to favourably relate to psychosocial, cognitive and developmental health. This qualitative study aimed to identify the barriers perceived by parents regarding granting IM for their children using nominal group technique.

Methods

Four nominal groups were conducted among 19 parents (2 fathers and 17 mothers) aged 32 to 50 years, whose children participated in a cross-sectional study investigating children’s IM and physical activity in Hong Kong. The parents responded to the question “What do you think are the barriers that refrain you to allow your child to travel to school, shops and other destinations, or play outdoors in your neighbourhood, on his or her own or with friends, but without adult accompaniment?” Factors were prioritized in order of their importance ranked by the parents.

Results

Ten unique factors were identified as the most important barriers for parents to grant their children IM, with “safety” the only barrier identified among all the four groups. “Perceived independence/capability of the child” and “negative peer influence” were generated in three groups. “Allowance by parents”, “complexity of transportation”, and “distance between home and school” were only identified among the group of parents from high social economic status. The other factors identified included “injury”, “routine of daily activities”, “over protection from parents”, and “unacquaintance of their child’s peers”.

Conclusions

Safety was one of the most importance barriers refraining parents granting IM for their children who live in an ultra-dense metropolis. The findings may be helpful for informing interventions targeting parents in order to increase children’s IM.

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Purpose

Evidence of the association between daytime time-use behaviours and sleep has been inconsistent and primarily focused on sleep duration. The aim of this study was to examine the relationships of daytime physical activity (PA) and sedentary behaviours with sleep quality in youth aged 11 to 18 years.

Methods

The analytic sample consisted of 322 boys and 294 girls aged 11-18 years. The adolescents wore anactivPALTM for 7 consecutive days to measure PA of different intensities, sedentary time (ST), and sleep duration. The Pittsburgh Sleep Quality Index (PSQI) was applied to measure the quality of sleep. Puberty stage was self-reported using validated questionnaires. Generalized linear models were performed to assess the association of ST, light-intensity PA (LPA), and moderate-to-vigorous PA (MVPA) with sleep quality, adjusting for sex, age, body mass index, and puberty stage. Isotemporal substitution models were used to estimate the effects of replacing the same amount of one daytime time-use behaviour with another activity behaviour on sleep quality while holding total daytime (ST + LPA + MVPA) and sleep duration constant, as well as adjusting for the covariates.

Results

The self-reported PSQI scores ranged from 1 to 18. Approximately 91.6% of the adolescents had a score of 5 or higher. Reallocating one hour of MVPA with the equal amount of ST (B = 1.761, 95% CI: 1.015 – 3.053) or LPA (B = 2.017, 95% CI: 1.108 – 3.673) was associated with higher PSQI score while holding sleep duration constant. Replacing one hour of ST with the same amount of LPA was not related to change in sleep quality.

Conclusions

The findings suggested that replacing time spent in MVPA with ST or LPA was associated with poorer sleep quality in adolescents.

 

Purpose

The time spent sedentary using screen media is defined as screen time. Caregivers play an important role in promoting or limiting the screen viewing behavior of the children.

Aim of this study was to assess the pattern of screen time, association of screen time with caregiver practices among three to five old children in Medical Officer of Health area Kegalle

Methods

Community based cross sectional study was conducted among 510 caregivers, selected by two stage cluster sampling method. An interviewer administered questionnaire was used to collect data. 

Results 

Response rate was 91.3% (n=466). Pattern of screen media use among preschool children was almost similar during weekdays and weekends. A significant proportion of preschool children (n=149, 32%, 95% CI [27.9, 36.4]) used the screen devices exceeding international recommendation of one hour per day. Majority (n=362, 75%) used only one or two types of devices. TV (n=381, 85%) was the most common screen devices used by the preschool children. Cartoon was the most commonly watched program.

Imposing rules, on the duration of screen media use (X2=4.60, p=0.032), on the time of the day of screen media use (X2=5.44, p=0.02), on the day of the week of screen media use (X2=7.81, p=0.005), and on the type of programme (X2=3.96, p=0.0481) were associated with children using screen media for more than one hour.

Allowing children to use screen devices during household chores by the caregivers was significantly associated with the screen time of more than one hour (p=0.004). The use of screen media to facilitate feeding of the child (X2=0.71, p=0.398), for soothing of the child during crying, to divert the attention of children during fight with siblings (X2=2.55, p=0.276) were not associated with the screen time of the preschool children.

Conclusions

Caregiver practices are associated with children’s use of screen media for more than one hour. Awareness need to be raised among caregivers regarding the negative effects of high screen time.

Purpose: Society is becoming increasingly disengaged with the food we consume, which is reflected in poor levels of knowledge about source, supply chain, and nutrition. Next generation consumers (NGC) in particular, that is those from pre-school to university age, demonstrate low engagement with food. The WeValueFood project thus aims to develop and pilot novel food engagement strategies with NGCs. This qualitative study aims to contextualise the current landscape of NGC food engagement as seen from a multi-stakeholder perspective, in order to guide development of novel NGC food engagement strategies.

Methods: A qualitative exploration of needs, wants, barriers and aspirations to NGC food engagement was conducted across Europe (NI, Finland, Spain, Italy, England, Iceland, and Poland). In total, 31 semi-structured interviews, 9 focus groups, and 5 workshops were conducted, capturing 124 individuals, including NGCs, parents, educators, and Agri-food industry. Thematic framework analysis was conducted by QUB to produce a codebook, which European partners then used to conduct content analysis. All data was then consolidated and analysed.

Results: Stakeholders believe NGC interest in food is deteriorating and that NGCs are under many influences, including peers, shifting social norms, and culture. Educators struggle with time and money restrictions, and limited access to resources. Stakeholders believe strategies aiming to engage NGCs with food are important, and topics deemed important include the body and health, and food source/origin. Stakeholders believe strategies should include practical activities (e.g. cooking classes) and school trips (e.g. farm visits).

Conclusions: Stakeholders believe there are key barriers and gaps to be addressed in the development of new NGC food engagement strategies. Findings from this study contextualise the current landscape of NGC food engagement from a multi-stakeholder perspective, and will help inform the next steps in the WeValueFood project.

Purpose: 

While research has examined pre to postnatal changes in women’s weight status, sleep and physical activity (PA), much less is known about changes in fathers’ weight and weight-related behaviors following the birth of a child. This study examined changes in fathers’ body mass index (BMI), sleep, PA and diet from prebirth to 6- and 12-months following birth and differences in these changes for first-time versus experienced fathers.

Methods: 

Participants included 224 fathers (mean age 35 years, 62% white) from the Rise & SHINE cohort. Men self-reported height and weight, night-time sleep duration, PA, fruits and vegetables consumption, and fast-food consumption one month prior to birth (N=224), 6- months (N=170) and 12-months following birth (N=152). Linear mixed models and generalized estimating equations were used to examine changes in fathers’ BMI and health behaviors. An interaction term between first-time father status and timepoint was used to test the moderating role of being a first-time versus experienced father. Covariates included fathers’ age, education and race/ethnicity.

Results:

Fathers reported significantly higher BMI (+0.17;95%CI=+0.03,+0.31;p=0.016) and lower sleep duration (-0.21;95%CI=-0.38,-0.04;p=0.016) at 6 months following birth; no differences were observed between 6- and 12-months following birth. While no changes in fast-food consumption were observed from prebirth to 6 months following birth, fathers were significantly more likely to consume fast food at 12 months compared to 6 months following birth (OR:1.94;95%CI=1.09,3.46;p=0.025). Changes in vegetables consumption were limited to experienced fathers who were less likely to consume vegetables daily at 12 months following birth compared to 6 months (OR:0.51;95%CI=0.27,0.95;p=0.035). Fathers’ fruit consumption and PA remained stable over time.

Conclusions:

Six months following birth may be an important point of intervention for fathers to promote a return to prebirth BMI and sleep levels and prevent declines in diet quality, which occur at a time when infants are transitioning to complementary foods.

PURPOSE: Parent empowerment - in the context of children’s health - is defined as having the resources, skills and knowledge required to promote health behaviors. According to empowerment theory, higher parent empowerment to support child health may be a critical mechanism of change in family interventions to prevent childhood obesity. This study is the first to examine relationships between parent empowerment and weight-related parenting. 

METHODS: This cross-sectional study used data from the Communities for Healthy Living program, a childhood obesity prevention intervention implemented in 16 Greater Boston Head Start programs. Parents (n=920, 833 mothers, 87 fathers) completed a survey with validated measures of empowerment and food, physical activity, sleep and media parenting. Domains of parent empowerment were measured, including critical awareness (i.e., awareness of situational factors affecting child health), resource empowerment (i.e., knowledge of and ability to access resources to support health), and relational empowerment (i.e., ability to leverage relationships with health professionals to support health). Relationships between parent empowerment and parenting were tested using multivariate linear regression, controlling for parent gender, age, educational attainment, race, ethnicity, program, intervention status, and measurement year. Separate models were run for each parenting outcome; all covariates and empowerment constructs were included in each model.

RESULTS: Parents reporting higher critical awareness (b=-0.11,95%CI=-0.20, -0.03) adopted more supportive food parenting practices. Parents with higher critical awareness (b=0.24,95%CI=0.17,0.32; b=-0.20, 95%CI=-0.29,-0.11) and resource empowerment (b=0.28,95%CI=0.20,0.37; b=-0.16,95%CI=-0.26,-0.05) reported greater use of sleep routines and less use of media in the child’s sleep environment. Parents reporting higher critical awareness (b=0.08,95%CI=0.00,0.15), resource empowerment (b=0.21,95%CI=0.12,0.30) and relational empowerment (b=0.16,95%CI=0.09,0.23) utilized more supportive physical activity parenting practices.  

CONCLUSIONS: Parent empowerment was linked with healthier weight-related parenting practices in this sample . The application of empowerment theory in family-based childhood obesity prevention interventions in general, and targeting parent empowerment as a mechanism of change in particular, warrants greater attention.

 

Introduction: There is a lack of clear evidence for a link between spatial exposure to the local food environment and diet, with most research being cross-sectional with mixed findings. Stronger evidence, from longitudinal studies, linking changes in the local food environment with changes in dietary outcomes is needed to inform urban design policies and planning regulations.

Objective: To examine how longitudinal changes in the local food environment within new suburban, residential developments influence changes in dietary intake, and to investigate the mediating effects of individual perceptions and behaviours on the relationship between the local food environment and dietary intake.

Setting: Adults in Perth, Western Australia from the RESIDential Environments (RESIDE) Project (2004-2012).

Design: Self-reported data on socio-demographics, usual dietary intake, individual behaviours and perceptions of the local food environment were sourced from RESIDE at three time points (2004-2005, 2006-2007, 2011-2012). Spatial food environment exposure measures were generated relative to each participant’s home address using the locations of food outlets at temporally matched time points. Changes in spatial exposure measures, individual behaviours and perceptions with changes in dietary outcomes were examined using fixed-effects, generalised linear models (n = 3,223 person-observations).

Results: An increase in the percentage of healthy food outlets around the home was significantly associated with an increase in healthy diet scores (β = 0.003; 95% CI 0.000, 0.006) and an increase in the distance from home to the nearest café or restaurant was significantly associated with an increase in diet quality scores (β = 0.243; 95% CI 0.006, 0.480). There was little evidence that individual behaviours mediated the relationship between spatial exposure to the local food environment and diet.

Conclusions: Policy and planning may influence dietary intakes by increasing the relative percentage of healthy food outlets around the home.

 

Purpose: Limited attention has been paid to relationship of local food environments with fruit and vegetable (FV) intakes in older adults with low income. The objective of this study was to identify how food environmental factors were related to FV intakes in low-income older adults residing in an urban area.

 

Methods: A cross-sectional study was conducted in 96 older adults aged 65 years or over residing in Seoul city. The perceived food environment factors were measured by face-to-face interviews, including food availability, accessibility, affordability, acceptability, accommodation. Geocoding of participants’ homes and food stores was used to objectively assess food accessibility. The FV intakes were assessed by 24-hour dietary recall and food frequency questionnaires.

 

Results/findings: The mean intakes of FV were 73.8g/d and 296.6g/d and the proportion of older adults with less than 1 serving/d was 54.2% for fruits and 39.6% for vegetables. The perceived food environmental factors were not significantly related to fruit intakes but related to frequency of vegetable intakes. The median distances to fresh FV were 1.31km and the long distance was not related to fruit intakes but positively related to high vegetable intakes (p=0.016) which was unexpected findings. After adjusting for confounding factors, GIS-based accessibility measure was not related to FV intakes but perceived low food affordability was related to low intakes of vegetables (OR=10.8, 95% CI=1.6-73.4) and perceived low food accessibility was related to high intakes of vegetables (OR=0.1, 95% CI=0.01-0.4). Urban older adults with perceived low food accessibility generally purchased vegetables in traditional markets (88.2%) away from their home rather than food stores (11.8%) close to home (p-value=0.004).

Conclusions: The perceived low food affordability measure had a significant and greater effect on low vegetable intakes than geographical accessibility measure for low-income older adults in urban areas of Korea. Further studies using more representative samples are required to build an evidence regarding the appropriateness and robustness of food environment measures related to healthy food intakes under different local circumstances.

Purpose: Front-of-pack nutrition labelling is a key public health policy that can be implemented as part of a comprehensive set of measures to promote healthy diets. The Nutri-Score, a five-colour summary label based on a modified version of the British Food Standards Agency Nutrient Profiling System (FSAm-NPS), is being considered for implementation in several European countries including Spain. This study aimed to prospectively assess the association between the FSAm-NPS and all-cause and cause-specific mortality in the SUN (“Seguimiento Universidad de Navarra” – University of Navarra Follow-up) cohort.

 

Methods: Analyses included 20,503 participants from a Spanish cohort of university graduates (mean [SD] age: 38 [12] years). Dietary intake was assessed at baseline and after 10-years of follow-up with a validated semi-quantitative food-frequency questionnaire. The FSAm-NPS was calculated for each food/beverage based on their amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes, nuts, rapeseed, walnut and olive oils per 100 grams of product. The FSAm-NPS Dietary Index (DI) was computed as an energy-weighted mean of the FSAm-NPS scores of all foods and beverages consumed by each participant. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to baseline and updated FSAm-NPS DI scores. 

 

Results: Over a median follow-up of 10.9 years, 407 participants died. A higher baseline FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was directly associated with all-cause mortality (HR Q4 versus Q1 = 1.82; 95% CI: 1.34 to 2.47; p-trend<0.001) and cancer mortality (HR: 2.44; 95% CI: 1.54 to 3.85; p-trend<0.001). No association was found for cardiovascular mortality. 

 

Conclusions: The consumption of food products with a higher FSAm-NPS score (ie, lower nutritional quality) was associated with a higher risk of all-cause and cancer mortality in a cohort of Spanish, middle-aged university graduates. These findings further support the implementation of Nutri-Score in Spain.

Purpose: Private-label products, products that are owned by supermarkets, continue to experience increased growth and popularity amongst consumers. The aim of this study was to assess the effect of a novel intervention that provided an Australian supermarket with nutritional benchmark data to guide the formulation of healthier foods and beverages for their private-label range.

Methods: Over nine-months (April 2015 to January 2016), the supermarket (‘intervention supermarket’) received 35 reports that ranked the nutritional quality of their products against competitors across 150 subcategories of foods and beverages. Changes in the nutrient content of private-label products from the intervention supermarket between 2015 and 2018 were compared to the changes of three comparators (private-label products from two other Australian supermarkets and all branded products combined). The primary outcomes were mean sodium (mg/100g), sugar (100g/g), saturated fat (g/100g), energy (kJ/100g) content and Health Star Rating (HSR) (stars).

Results: Between 2015 and 2018, the intervention supermarket reduced the mean sodium content of their products (-40mg/100g, 95% confidence interval [CI] -73 to -7; p=0.02) but there were no changes for other nutrients or HSR (all p>0.05). This reduction in sodium content was significantly greater than for all three comparators (all p<0.05). Conversely, compared to the intervention supermarket, the three comparators each achieved a greater relative reduction in the sugar content of their products between 2015 and 2018 by between      -3.5 and -1.6g/100g (all p<0.05). One of the comparators also had a greater relative reduction in the saturated fat and energy content of its products compared to the intervention supermarket (both p<0.05). HSR were unchanged across the intervention supermarket and comparators (all p>0.05).

Conclusions: Providing comparative nutrition data to an Australian supermarket resulted in a favourable effect on the sodium content of their products but had no beneficial effect on other nutrients or HSR.  The limited impact of this intervention raises questions about the value of voluntary initiatives and the potential need for mandated initaitves to improve the healthiness of the packaged food supply.

Purpose: This study documents food insecurity prevalence among a nationally representative sample of Native Hawaiian and Pacific Islander (NHPI) adults in the US, and compares differences in food security status across races/ethnicities in the US. NHPI experience severe disparities in diet-related chronic diseases compared with the general US population. Further, NHPI in the US are typically aggregated with Asians - or are excluded from analyses - in population-based surveys due to small numbers of respondents. This study provides the first population-based estimate of food insecurity among NHPI in the US.

Methods: This study used data gathered in the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI NHIS, a first of its kind oversampling of NHPI in the US. Food security status was assessed in each survey using US Department of Agriculture’s 10-item Adult Food Security Survey Module. After accounting for missing data on the food security measure, the final study sample comprised 38,860 respondents, representing 235,250,552 civilian noninstitutionalized adults in the US. Descriptive statistics were used to summarize food security status among NHPI, and comparisons of food security status across racial/ethnic groups were made using Rao-Scott chi-square test and multinomial logistic regression models.

Results: Approximately 1 in 5 NHPIs (20.5%) were considered food insecure: 12.5% reported low food security and 8.0% reported very low food security. Significant variation in food security status was observed by race/ethnicity (p<0.001). NHPI had significantly higher odds of experiencing low (OR: 4.0, CI: 3.1-5.1) and very low (OR: 2.8, CI: 2.0-3.8) food security compared with Whites in unadjusted models (p<0.001). Food insecurity among Hispanics, Blacks, and Other races/ethnicities was also significantly higher than that of Whites. The pattern of findings remained consistent in the adjusted model, where sociodemographic variables where held constant.

Conclusions: This study provides the first documentation of food insecurity prevalence among a representative sample of NHPI adults in the US. These findings will inform chronic disease prevention and management research and programs, as well as nutrition research and programs conducted with NHPI communities in the US.

Purpose: To examine the extent of fast food and sweetened drink marketing in community sports clubs in Australia.

 

Methods: A cross-sectional study was conducted in 39 non-elite soccer, AFL, rugby league and rugby union community sports clubs in the Hunter New-England region of New South Wales (NSW) to examine fast food and sweetened drink marketing.  One-day observations were undertaken by trained research assistants on a weekend game day when junior sports teams were active, between April and May 2015. The name of the company and positioning of fast food and sweetened drink industry marketing (any visible advertisement, promotion or sponsorship in their surroundings were recorded.

 

Results/findings: Ten of the 39 clubs (26%) had some form of fast food and/or sweetened drink advertisement or promotion: 7 fast food only; 2 sweetened drinks only; 1 both. Fast food marketing was more common in rugby league and union clubs (n=7, p=0.05), and in clubs located in more regional areas (n=6, p<0.01). There were no significant differences in the prevalence of sweetened drinks marketing by club code, size or remoteness. Fast food companies’ advertisements were most commonly found on players’ jerseys and players’ accessories (n=10), while banners were the most popular position for sweetened drink companies advertisements (n=2).

 

Conclusions: Findings suggest that food and beverage marketing in this setting is common, particularly in regional sporting clubs. Efforts to replace these types of sponsorships in community sporting clubs should be prioritized by policy makers and public health practitioners. However, consideration needs to be given while bearing in mind community sporting club reliance on sponsorship revenue. The provision of tools for clubs to develop healthy sponsorship policies, as well as monetary incentives to support clubs have previously been recommended and should be more strongly endorsed.

Purpose: Poor diet is the leading risk factor for the global burden of disease. ‘Big Food’ corporations employ a large range of tactics to influence customers preferences, tastes and purchases. Big Food is likely capitalising on emerging technologies such as the internet-of-things (IoT), big data and artificial intelligence (AI) to influence customers in new ways. This study aims to review the literature on how Big Food are exploiting emerging technologies to influence customer behaviours.

Methods: A grey literature search of Google search engine was conducted to identify the top ten global food company websites. The websites were searched using a combination of terms related to i) the food companies, ii) emerging technologies and artificial intelligence, and iii) customer behaviours, and by reading all relevant documents on industry websites. Documents that described the use of AI by the food industry to influence customer behaviours were included. Literatures that focus on other uses of AI, such as improved product efficiency or production, were excluded.

Results: Big Food companies were found to use AI for a wide range of purposes, including: highly targeted digital advertising, personalised pricing, and pre-ordering from vending machines, personalised chats with company bots that are tailored to the customers using social media activities, customisation of menus and promotions based on customer preferences and the weather outside, optimisation of products and vending machine placement, as well as customised shopper interaction with digital ordering services. We also found an indication that Big Food companies may be purchasing technology companies to better embed the use of emerging digital technologies within their everyday processes and practices.

Conclusions: Big Food companies are using AI and related digital technologies to influence customer preferences and behaviours in ways that are more engaging and interactive than ever before. It is essential to monitor this trend of development continuously and better understand the impact of this type of commercial influence on population diets and health.

Purpose: Ghana is experiencing a shift in public health shift issues, including an increase in non-communicable diseases and a decrease in physical activity rates. The Ministry of Health (MOH) and Ghana Health Service (GHS) developed physical activity guidelines in 2009. However, a 2019 study found that Ghanaian older adults were not aware of the physical activity guidelines and the example activities (e.g., ballroom dancing) were not culturally appropriate. The purposes of this study were to investigate 1) dissemination of the physical activity guidelines through MOH/GHS and 2) culturally appropriate physical activities.

Methods: Through a concurrent mixed-methods design, data were collected in urban and rural regions of Ghana. Focus groups (N=2) were conducted with community stakeholders; the semi-structured guide included recommended types of physical activity. Surveys (N=12) and in-depth interviews (N=4) were conducted with purposively selected MOH/GHS employees, including research officers and non-tropical disease coordinators. Survey questions were based on the Diffusion of Innovations Theory; the semi-structured interview guide also included recommended types of physical activity. Quantitative results were analyzed through frequencies and proportions. Qualitative results were analyzed through inductive thematic coding of transcripts.

Results: Most survey respondents (72%) were not aware of the physical activity guidelines. Respondents indicated that the guidelines could be better disseminated through making regional and district directors aware of them (90%). Most common dissemination modes for new policies were internet (45%), publications (35%), and trainings (36%). Focus group and interview participants recommended physical activities including walking (N=20 meaning units), running (N=16), football (N=14), traditional games (N=14), and gardening (N=10).

Conclusions:  A dissemination intervention including regional and district directors as a communication channel and packaging into user-friendly, accessible publications should be considered. Adapting the guidelines to replace unfamiliar activities with culturally appropriate activities (e.g., ampe, a traditional children’s jumping game) could improve understanding uptake of guidelines. Disseminating culturally appropriate physical activity guidelines is a necessary step in translating research to practice to increase physical activity levels and prevent non-communicable diseases.

Purpose: Tai Chi and Qigong are increasingly investigated for their health benefits, particularly among older age groups and those with medical conditions. However, population studies show relatively low participation rates in Western societies. In Australia, participation prevalence is about 0.6% (Vergeer et al., 2017). We know little about why this may be the case. One missing element in understanding participation behaviour is information about the provision of these practices. The purpose of this study was to explore the provision of Tai Chi and Qigong in Melbourne, Australia. 

Method: Data were collected via internet searches. We focused on events offered (e.g., classes, workshops) and recorded information about various event features, including type, costs, time, target group, venue, and location. Results were reported using descriptive statistics.

Results: A total of 315 events were found (227 for Tai Chi, 80 for Qigong, 8 for combined offerings), in 105 out of 275 (38.2%) postcode areas. The majority of events were weekly classes (94.9%), with an average duration of 68.0 minutes. Mornings constituted the most common class time.  Average class cost was Aus$12.85 (range Aus$0-$35). For the majority of events (76.3%), no target group was mentioned on the webpage. Only 4.4% specifically targeted seniors and 3.5% specifically mentioned health conditions. The most commonly used venues were community centres or halls (34.9%), church halls (14.3%), and martial arts schools (10.0%). There were some differences between Tai Chi and Qigong in venue types used and average class costs.

Conclusions: Despite a large body of research focusing on the health benefits of Tai Chi/Qigong for older people, only a small percentage of offerings were specifically targeted at this age group, and only a small percentage mentioned specific health conditions. This raises the question to what extent the Tai Chi/Qigong teaching community is prepared or equipped for delivering Tai Chi/Qigong to older people and/or those with health conditions. At the same time, mornings being a common class time suggests that many classes cater for people who are free during the day. Participation costs imply a relatively low financial barrier.

Purpose: Changes in the food environment, such as increases in the number of quick-service, sit-down restaurants, and ready-to-eat foods, has led Americans to consume more food outside the home. Food eaten outside the home is of lower nutritional quality than food eaten at home. This research presents results on consumption of food outside the home among Americans by age, income, and race/ethnicity. This study used the 2015-2016 National Health and Nutrition Examination Survey (NHANES) to examine differences in food consumption outside the home that previous studies have not examined.



Methods: This research used the 2015-2016 NHANES to assess differences in food consumed outside the home by age, income, and race/ethnicity using t-tests. It also examined differences in the share of calories consumed outside the home by meal occasion.



Results/findings: Sixty six percent of the US population aged 2 years and over consumed any food outside the home on any given day. A larger share of older children (6-11 years; 78%) and lower share of older adults (60 years and older; 46%) consumed food outside the home compared to all other age groups. A higher percentage of non-Hispanic white (66%) and Hispanic (67%) individuals consumed food outside the home compared to non-Hispanic black (60%) consumers. Among children, a higher percentage of non-Hispanic white (77%) and Hispanic (70%) children consumed food outside the home compared to black children (60%). A higher percentage of consumers above 131% of the poverty line (65%) consumed food outside the home compared to individuals below 131% of the poverty line (57%). Lunch and dinner were the eating occasions at which consumers ate the highest share of calories outside the home.



Conclusions: Food consumed outside the home varied by age, income, race/ethnicity and by meal occasion. As the share of food eaten outside the home continues to rise, it is important to examine differences in the demographic and socioeconomic make-up of Americans who eat outside the home frequently. This will help guide policy and public health nutrition intervention efforts.

Purpose: The ICAN Chef program was created by staff of the Ideas for Cooking and Nutrition program, a Cooperative Extension Service (CES) program funded by USDA’s EFNEP and SNAP-Ed grants at New Mexico State University. The program’s aim is to facilitate the use of the foods provided in Commodity Supplemental Food Program (CSFP) boxes and to provide healthy eating and living tips to encourage healthy lifestyles. This study evaluated the readability and usefulness of materials provided in boxes as part of the program. The evaluation will facilitate program acceptance into the SNAP-Ed Toolkit, which will allow CES programs across the US to utilize the materials.



Methods: This qualitative study used a purposive recruitment strategy to conduct eight one-hour focus groups with four to six participants each at senior centers and food pantries across New Mexico. Participants were CSFP recipients. Focus groups were video and audio recorded, transcribed, and coded, with coding cross-checked by coders to establish reliability.



Results/findings: Participants generally agreed that the materials were easy to read, visually appealing, and the information on the materials would be useful in helping them use the foods in their box. A few participants noted that the font size could be larger and that the amount of text could be reduced for better understanding and to better appeal to recipients. Participants liked the recipes on the materials except when they did not prefer the featured food item. Most participants could summarize one of the healthy living tips on the materials, suggesting that the messages were easily understood by seniors.



Conclusions: Senior recipients of ICAN Chef materials in CSFP boxes found the materials appealing and easy to read, made minor suggestions for improving the materials, and understood the tips provided. Results of this study will facilitate improvement of the materials and submission for acceptance into the SNAP-Ed Toolkit. The next phase of this research will evaluate the program’s impact on food item use and nutrition knowledge of recipients.

Purpose: Occupational sedentary time is a known health risk, therefore situating health initiatives within the workplace to reduce sedentary time is pragmatic. Participating in regular short (2 min) bouts of physical activity after 30 min of prolonged sitting has shown to benefit health in lab-based studies. This initiative has yet to be evaluated in a real-world setting. Workplace initiatives are generally focused at the individual level, yet evidence shows that if the surrounding workplace culture does not support healthy work practices this presents a major barrier to employees participating and will impact intervention effectiveness. To inform the development of a workplace intervention, this study explored the workplace culture around taking physical activity opportunities from the perspective of staff employed in management roles and strategies they might implement to facilitate a supportive culture.

Methods: Twelve (N=7 women) University staff employed in mid- and senior-level management roles, identified through purposeful sampling, participated in a semi-structured interview. Participants were asked their views on employees taking short activity opportunities, their role in encouraging employees to take those opportunities; situations where it would be difficult/easy to be active and University support. Based within a constructivist methodology, an inductive thematic analysis was undertaken.

Results: Participants were unanimous in explaining they, and University management, were supportive of the provision of activity opportunities for employees and employees taking those opportunities. This came with the caveat that guidelines/boundaries were required to sustain work productivity and limit distraction. Participants perceived their role was to support and encourage, achieving this verbally in weekly team meetings. The responsibility to act remained with the employee. Workplace role models and educating stakeholders that employees can be away from their desk briefly were important to facilitate a supportive culture.

Conclusions: University management are supportive of employees engaging in short bouts of activity during the work day to break up sitting time. The challenge is manifesting a culture that is supportive not directive, and will sustain work productivity. Results will inform strategy development to create the supportive workplace culture necessary to enhance effectiveness of workplace health interventions.

Purpose: Commuting time is increasing, and people are becoming more time scare. Time scarcity can contribute to poorer health by restricting people from engaging in behaviours essential for good health such as exercising and eating healthy foods. The 20-minute neighbourhood (20MN) concept advocates that neighbourhoods should provide residents with the ability to meet “everyday, non-work needs locally, primarily within a 20-minute walk” and is said to encourage healthy and local living. This study assessed the associations between daily commuting time and eating behaviours, comparing residents within the 20MN and outside the 20MN.

Methods: This cross-sectional study conducted across 2018-2019 included 320 residents living in Melbourne and Adelaide. Eating behaviours were examined on two categories: daily fruit consumption and daily vegetable consumption. Commuting time was measured in daily minutes spent travelling from home to work and vice versa. Data were analysed using ANOVA models to assess the associations between commuting time (<30 minutes; 30-59 minutes; 60+ minutes) and fruit and vegetable consumption. Analyses were performed for the whole sample and by 20MN vs non-20MN. 

Results: Increased commuting time was linked to a lower daily fruit consumption and lower daily vegetable consumption. Results were similar in both 20MN and non-20MN suggesting that a 20MN did not assist in better dietary behaviours when commuting time was longer.

Conclusions: The results indicate that longer commuting time may be associated with poorer eating patterns. These findings are relevant to both urban planners and researchers exploring the role of time scarcity on health. Further research in this area will provide insight into the understanding of work-life balance and how environmental contexts influence dietary behaviours.

Purpose: Diet-related non-communicable diseases are emerging as the leading cause of mortality and morbidity in Africa. The rise in chronic diseases is strongly linked to changing structural factors such as urbanization, leading to increased consumption of packaged foods that are often high in salt. The World Health Organization has a global target of 30% reduction in salt intake by 2025. Nutrition labelling of packaged food products enables transparency and helps to inform customers. The aim of this study was to estimate the proportion of packaged foods in Kenya displaying nutrition information and describe levels of sodium.

Methods: Data collection was carried in June/July 2019 from one store each of five large chain supermarkets in Nairobi, Kenya. A smartphone application was used to take photographs and capture product information for all packaged foods including barcodes, product name, ingredients list and the nutritional information panel (NIP). The products were categorised into food groups and food categories in accordance with the Global Food Monitoring categorization system. 

Results: Overall, 6,007 unique packaged products were identified in the supermarkets, and 39% of the products carried a label with sodium content on the NIP. Food categories with the highest average sodium content were herbs and spices (including table salt) (mean±SD, 8260±6005mg/100g), sauces (2756±3719mg/100g), desserts (1505±2997mg/100g), soup (1308±2060mg/100g), noodles (1022±2038mg/100g), and cheese (732±298mg/100g). In these categories, the sodium content was displayed in 11% (herbs and spices), 66% (sauces), 27% (desserts), 89% (soup), 87% (noodles) and 28% (cheese) of the products. The sodium content was highly variable within food categories. For instance, within the sauces category, the sodium content ranged from 8mg/100g to 23437mg/100g.

Conclusions: Only about one third of packaged products in Kenya appears to carry nutrient information labelling for sodium. Levels of sodium are high in specific food categories and vast differences within food categories indicate the potential for reformulation. These findings have important implications for policy interventions including better enforcement of labelling regulations, and setting sodium reformulation targets in Kenya. 

 

Purpose: The tenfold increase in the prevalence of child and adolescent obesity globally over the last four decades and the associated rise in noncommunicable disease has increased pressure on finite healthcare budgets. Poor dietary intake is a key factor in these trends. Health economic simulation modelling is a method of estimating the cost-effectiveness of dietary interventions in order to determine the 'best buys' for reducing obesity, disease, and inequalities. However, despite methodological advances, few child and adolescent dietary interventions have been modelled and no dedicated reviews have been conducted. This narrative review aimed to assess and compare modelled child and adolescent dietary interventions, health and economic impacts, modelling methodologies, and the quality of studies.

 

Methods: Five databases, reference lists of included papers, and key authors were searched for model-based health economic evaluations of dietary interventions targeted at or inclusive of individuals 5-18 years and published in English between January 2000 and September 2018. Dietary interventions were defined as those intended to alter food or beverage consumption, total energy or macronutrient intake, or overall diet quality in order to prevent or treat obesity and diet-related disease. Interventions could incorporate other components (e.g. physical activity). Interventions targeted at singular micronutrients were excluded.

 

Findings: The 19 publications identified largely conducted cost-utility analyses (63%) using Markov macrosimulation models (45%). A narrow range of primarily high-income populations were modelled (95%; United States 47%, Australia 32%). Dietary interventions were predominantly focused on primary prevention (89%) and reducing sugar-sweetened beverage intake (33%), targeted at a specific population group (69%), and delivered in school settings (44%). Methodologies used varied considerably, especially time horizons, intervention effect decay rates (if considered), and diseases and outcomes modelled. Additionally, the quality of model details reported was often poor. Population-wide interventions were typically most cost-effective.

 

Conclusions: Modelling of child and adolescent dietary interventions is a growing research field. However, the limited populations and interventions modelled and methodological heterogeneity currently offers limited information for comparing interventions and determining 'best buys'. Further studies modelling a wider range of dietary interventions and employing consistent methodologies are required.

 

Purpose:

Densification (population density increases over time) of urban neighbourhoods can be accompanied by more-accessible retail, service, transport, and recreational destinations, which may influence residents’ physical activity. Cross-sectional studies reported associations of population density with physical activity. However, the effects of density increase on physical activity are less clear. We examined the association of urban densification with changes in physical activity over 12 years.

 

Methods:

The Australian Diabetes, Obesity and Lifestyle study collected data from adults living in 42 study sites in 1999–2000, 2004–05, and 2011–12. We investigated 2,354 participants who did not change their residences during the study period. Densification rate was calculated using a linear growth model where population density within a 1-km radius buffer around participant’s residence at each time point was fitted. Self-reported time spent in both walking (for recreation and transport) and moderate-to-vigorous physical activity (sum of walking, moderate-intensity, double vigorous-intensity) were examined. Generalised linear mixed models were used. 

 

Results:

At baseline, the mean population density was 13.0 (SD=7.4) persons per hectare. The mean densification rate was 0.8% per year relative to baseline density (range: -4.1% to 7.8%). The mean walking and MVPA durations at baseline were 123.0 (SD=164.3) mins/week and 290.2 (SD=349.6) mins/week, with mean increases over the 12-year period of 52.5 (SD=231.2) mins/week and 67.6 (SD=433.6) mins/week, respectively. After adjusting for socio-demographic confounders and baseline population density, each 1% annual densification was associated with 8.4 (95%CI: 0.5, 16.4) mins/week increase in walking and 14.9 (95%CI: 0.3, 29.6) mins/week increase in MVPA over the study period.

 

Conclusions:

Our findings suggest that urban densification can lead to population-level physical activity increases regardless of baseline density levels. In the global context of urbanisation, planning strategies to increase population density (rather than expanding urban boundaries) to accommodate population growth can be justified from a perspective of physical activity promotion. However, research is also needed to examine the overall health and wellbeing implications of urban densification. 

Purpose:

Intervention has favorable effects on body adiposity, cardiorespiratory function (CRF), and physical activity (PA) in adolescents. This study investigated whether the intervention exhibited similar effects on adolescents of different adiposity status in a school-based PA intervention.

Methods:

The Chinese CHAMPS study was an 8-month intervention aimed at maximizing opportunities for moderate and vigorous PA (MVPA) in middle school students (12.58 ± 0.53 years).Participants (n=143) were randomly assigned to receive afterschool PA program (ASP, 180 minutes MVPA per week), school physical education intervention (SPE, 210 minutes MVPA per week), or both ASP+SPE(300 minutes MVPA per week). Based on the delivered MVPA dose, study participants were grouped into high- (ASP+SPE) and low-dose (ASP or SPE) groups. Study participants were also split into high- and low-adiposity status groups based on their body fat percentage (%BF) at baseline. CRF was assessed by the 20-meter shuttle run, and %BF was assessed by bioelectrical impedance analyzer at baseline and posttest. Regression analysis was used to test the effects of MVPA dose on the changes in CRF and %BF and moderating effect of baseline adiposity status, the models were adjusted for age, gender, puberty status, parent education, family income, and baseline measure of the outcome variable.   

Results:

There were significant main effects of MVPA dose for changes in CRF (β=12.770, p<0.010) and %BF (β=-1.614, p = 0.010) after adjusting the covariates. Baseline adiposity status significantly moderated the association between MVPA dose and changes in CRF (interaction: β=9.182, p=0.042), participants in the high-adiposity group who underwent high-dose intervention had a greater CRF improvement (31.40±14.11 laps) than their low-adiposity status peers (26.55±14.13 laps). Adiposity status did not moderate the effect of MVPA dose on the change in adiposity (interaction: β=-1.937, p=0.124).

Conclusions:

Maximizing MVPA opportunities has favorable effects on CRF and body adiposity in Chinese adolescents. Further, a higher intervention MVPA dose exhibited greater effects on adolescents with high-adiposity status in CRF. 

Background:

The evidence on the relationship of sedentary behavior (SB) with cardiorespiratory fitness (CRF) and obesity remains inconsistent in children and adolescents. The purpose of this study was to examine the associations of both accelerometry-assessed total SB time and self-report TV watching and homework time with CRF and obesity independent of PA in Chinese middle school students.

Method:

ActiGraph accelerometers were worn on the right hip for seven consecutive days to measure SB and PA. Data was included if an accelerometer was worn 10 hours or longer a day and at least four days including one weekend day. SB was also measured using the participant recalls of hours they spent on TV and homework in the past seven days. Obesity was assessed by percent body fat (%BF) using a bioelectrical impedance analyzer. CRF was assessed by the 20-meter shuttle run. Multiple linear regression was performed to test whether the SB were associated with CRF and BF% independent of PA. Models were adjusted for age, sex, city, pubertal status, family income, parent education, LPA and MVPA.

Results:

Data collected from 198 middle school students was analyzed (12.61±0.59yrs, %female=55.6). The average SB was 65.04±13.91 hours per week as measured by accelerometers. Time spent on TV and homework during the past seven days were 3.75±3.64 hours and 16.32±7.58 hours, respectively. Accelerometry-measured SB was not associated with BF% (p=0.171) or CRF (p=0.406) after controlling for PA and other covariates. Similarly self-report TV time was not related to BF% (p=0.565) and CRF (p=0.122) and self-report homework time was not associated with BF% (p=0.634) and CRF (p=0.244). However, accelerometry-measured MVPA was inversely associated with BF% (β=-0.013, p=0.009) and CRF (β=0.102, p<0.001), after adjusting for accelerometry-measured SB time.

Conclusion:

These findings indicate that SB measured by accelerometry and self-reports were not independently associated with BF% and CRF in Chinese adolescents. Conversely, MVPA predicted obesity and CRF.

Introduction: This study evaluated the proportion of children meeting moderate-to-vigorous physical activity (MVPA—>60 minutes/day), sleep (9-12 hours/night), and screen-time (<2 hours/day) guidelines during summer vacation and the school year.

Methods: Children (n=268, grades=K-4, 51.3% female, 59.0% Black) attending three schools (i.e., one year-round=92, two traditional=169) participated. MVPA and sleep (via Fitbit), and screen-time (via parent-proxy report) were collected during school and summer vacation. Mixed effects linear regressions estimated the proportion of children meeting MVPA, sleep, and screen-time guidelines during summer vacation and school by race (i.e., non-Hispanic Black vs. non-Hispanic White).

Results: During school, more White children met MVPA, sleep, and screen-time guidelines compared to Black children: 50.1% vs 38.4% (difference=11.7% 95CI=5.5%,17.9%), 18.3% vs 9.6% (difference=9.4% 95CI= 3.8%,14.1%), and 69.1% vs 55.3% (difference=13.8% 95CI=3.6%,24.0%), respectively.  During summer, the proportion of Black children meeting MVPA and screen-time guidelines declined by 6.2% (95CI=-8.7%, -3.7%) and 21.4% (95CI= -25.8%, -16.9%) while the proportion meeting sleep guidelines increased by 17.2% (95CI=14.1%, 20.3%). White children declined screen-time guideline adherence (-19.4%, 95CI= -24.9%, -14.0%) and increased sleep guideline adherence (9.6%, 95CI=5.9%, 13.2%). Declines in the proportion of children meeting MVPA guidelines (-6.2%, 95CI=-10.2%, -2.3%) and increases in meeting sleep guidelines during summer were greater for Black children.

Conclusions: In this sample few children met sleep and MVPA guidelines. Summer vacation brought on decreases in the percent of children meeting screen-time guidelines. However, summer vacation represented a time when relatively more children met sleep guidelines. Summer was detrimental to Black, but not White, children’s MVPA. 

 

 

 

Background: Food insecurity has been linked to poor adolescent health and negative educational outcomes. The Youth in Action for Health project aims to integrate public health inquiry with a Youth Participatory Action Research (YPAR) approach in an ethnically diverse high school Biomedical Academy in Vallejo, California with the specific aim of addressing adolescent health issues such as food insecurity.  

Study Aims: Describe levels of food insecurity among participating students and strategies to increase student's health promotion/advocacy skills.

Methods: A mixed methods approach included administering surveys to 11^th grade BioMedical Academy Students (n=76) to assess levels of food insecurity. Questions were adapted from the California Healthy Kids Survey measuring food insecurity using the following proxy variables: access to healthy food at home and school, eating breakfast, and skipped meals due to finances. Other variables measured included perception of school success and primary language spoken at home. Descriptive statistics and contingency table analysis were used to characterize each variable and determine associations. Assessment of the role of Peer Health Promoters (PHP, n=12) included qualitative assessment of focus groups and written responses to open ended questions.

 Results: Surveys indicated 41% of students skipped breakfast, and 43% of students sometimes or often skipped meals due to finances. Additionally, 37% and 67% reported not having access to healthy food at home and school, respectively. No significant association was found between food insecurity and school success. However, speaking a language other than English at home was associated with access to healthy food at home (p = 0.009), suggesting the healthy immigrant effect.

PHPs assisted with implementation of 12 interactive health promotion classroom sessions reaching 115 students. Students reported gaining public health knowledge, leadership, and public speaking skills and were able to pass this knowledge on to their peers in a way that was relatable and informational. Resources for healthy and affordable food were shared in classroom settings.

Conclusion: These results highlight a need to develop programs to improve food security at home and schools, especially among ethnically diverse youth. YPAR methods are an innovative approach to engage youth in these efforts.

Purpose

Early childhood and care (ECEC) settings are an important context for short-term and long-term health with to the increased attendance and duration spent in these environments. Despite the WHO Global Strategy for infant and young child feeding policy guidance for the handling, preparation and feeding of infant foods - expressed breastmilk, infant formula and complementary foods, evidence suggests that policies and knowledge of childcare providers to support feeding environments are often inadequate. The purpose of this study was to investigate inclusion of infant and young child feeding in the early childhood education and care (ECEC) National Quality Framework legislation in Australia at the public and service levels to develop an understanding of policy translation, accuracy and inclusion as per national and international infant and young child feeding guidelines.

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Methods

A content analysis of Australian National Quality Framework documents and qualitative inductive and deductive analysis of service nutrition policies using key tenets of Social Cognitive Theory as a lens was undertaken from 19 services in areas stratified by regional, metro, high/low socioeconomic ratings in Queensland from 2013-2016.

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Results

Qualitative analysis of key Australian ECEC public policy documents and 28 service policies from home- and centre-based care services impacting over 1500 children revealed a general invisibility of infants and specifically, infant and young child feeding in the national quality standards. Emergent themes included: curriculum and pedagogy, values, supportive environments and working partnerships with parents.

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Conclusions

Legislation requires policies to provide the basis for health, safety and support for infant and young child feeding. Lack of practice examples and invisibility of infant feeding in both public and service policies increases health and safety risks, with ambiguity placing increased emphasis on educator translation to practice. Inclusion of separate infant and young child feeding policies in services is an opportunity to rectify current gaps towards increasing best-practice outcomes and infant health and safety in ECEC.

Purpose: Environmental and policy initiatives to influence physical activity for transport and recreation are key elements of chronic disease prevention strategy. However, there is limited knowledge about whether design features to promote physical activity lead to improved health outcomes. To inform policy recommendations and identify research gaps, we examined Australian evidence assessing associations between cardiometabolic health indicators with activity-promoting neighbourhood built environment attributes, including urban green space. Methods: Database searches identified Australian peer-reviewed studies published since 2000 that assessed associations of built environment attributes hypothesised to promote physical activity (density, distance to amenities/services, land use diversity, route characteristics, walkability) and/or attributes of green space with at least one cardiometabolic health marker (adiposity, diabetes, cardiovascular, blood pressure, cholesterol). The strength of the evidence was assessed using a weighted Z-test meta-analysis method incorporating study methodological quality. Results: Twenty-four studies (137 exposure-outcome associations; n=380,293 participants) were included. The majority of studies (14/24) were cross-sectional and eleven were judged low quality. Obesity-related outcomes were commonly examined (17 studies); the most common exposures were public open space (11 studies) and walkability (10 studies). Meta-analyses found strong evidence for associations of higher walkability with lower risk of obesity (p=0.001) and type 2 diabetes (p=0.008). There was strong evidence for the association of greater population density with lower risk of obesity (p=0.001). No evidence was found for associations of public green/open space attributes, route attributes or destination accessibility with cardiometabolic health outcomes. Conclusions: The findings suggest that living in more walkable and dense areas has the potential to be protective against obesity and diabetes risk in the Australian context. To improve the evidence base, opportunities for future Australia research include assessing the health effects of urban sprawl and access to public transport; and examining associations between built environment attributes with a broader range of cardiometabolic health indicators. Longitudinal studies and natural experiments may also assist with providing stronger evidence-based recommendations for urban design initiatives to improve population health.

‘Sometimes I think I have an ab’ – A case study evaluating the impact of a physical activity intervention in a West Midlands (UK) primary school.

 

Purpose:          

Children in UK primary schools are under enormous pressure to fulfil the requirements of the government-imposed Standardised Assessment Tasks (SATs), which are taken when children are in their final year (10-11 years old).  Consequently, many schools impose timetables that marginalise subjects such as Physical Education (PE) in order to prioritise literacy and numeracy. This is particularly concerning in the current obesity epidemic, where 1 in 3 children are reported to be obese when they leave primary school (NHS digital, 2019). In deprived areas, this is particularly acute, with twice the number of obese children than in the least deprived areas (NHS digital, 2019). Children’s participation in physical activity is also a concern, with 53.2% of children failing to reach government physical activity recommendations (Sport England, 2019). Again, this figure is higher in families who are in a low-socioeconomic bracket. One school in the West Midlands has challenged the notion that physical activity should be marginalised in favour of literacy and numeracy by introducing a culture of fitness and health.

 

Methods:

One school in a deprived area of the West Midlands was selected as the case study school, due to its application of a physical activity intervention aimed at positively changing the school culture and ethos. A qualitative methodology to the study was employed, and data collected using focus groups (year 5 and 6 children), semi-structured interviews (teachers) and observations within the school environment.

 

Results/ findings:

The results found that students and teachers provided overwhelming support for the intervention. Emergent themes of ‘ongoing improvement’, ‘culture change’ and ‘interpellation’ were applied to the data.

 

Conclusion:      

The findings of this study will hopefully encourage other primary schools to consider increasing the amount of physical activity in the primary school day. As shown in the case study school, a positive change to a school’s culture can be beneficial not only to health and wellbeing, but also in relation to test results.

Purpose: Population-level increases in physical activity (PA) can greatly reduce the impact of cancer and other chronic disease. Although some built-environment features (e.g., sidewalks, parks, etc.) show consistent associations with PA, there is scant causal evidence that specific environmental changes increase PA. In this study the research team utilized a novel immersive virtual reality (VR) simulation to experimentally assess the impact of various environmental modifications on PA producing much-needed causal data.

Methods: Participants were randomly assigned to experience one of two virtual urban environments: the control condition (n=24) and the greenery-enhanced version (n=7) where participants saw additional street trees, planters, etc. Participants were fitted with a VR headset and backpack computer to enable them to move freely. They were then given a five-minute acclimation period after which they could walk throughout the virtual environment for up to 30 minutes. Afterwards, the subjects completed a survey about their experience.

Results: Thirty-one participants (55% female; mean age 18.9 years) completed the walking task and all survey measures. Participants responded favorably to both the equipment and the VR environment created for this study: 94% felt equipment was comfortable; 97% felt safe when using the simulation, and 90% felt relaxed. Only 3% of participants reported experiencing significant discomfort during the study. 74% of the participants felt immersed in the simulation. No significant differences on any of the constructs assessed were identified based on sex, height, or handedness (90% right-handed). On average participants stayed in the greenery-enhanced simulation longer (19.7 minutes compared to 18.8 minutes); however, a larger sample is needed to draw definitive conclusions. The results of participant experiences demonstrate that our protocol is a feasible and acceptable way to determine whether environmental changes can cause increases in walking.

Conclusions: In this project, we established an innovative model to quantify the causal impact of environment change on PA, overcoming limitations that hinder adoption of effective population-level strategies to increase PA. This novel approach will provide a valuable way for scientists, policy-makers, and planners to identify which environment changes increase PA. 

 

 

Purpose: Evidence from developed countries suggests that healthy diets are more expensive than unhealthy ones. This has not been tested in Mexico. Hence, we created menus that follow Mexican dietary recommendations, EAT-Lancet commission’s reference diet, or the current intake of the Mexican population and compare their cost. 

Methods: We followed the INFORMAS food prices’ protocol and created menus using the DIETCOST programme. The menus were created for a reference household comprised by two adults, one adolescent male, and one girl. We selected 110 common foods based on the Mexican National Nutrition Survey (ENSANUT). Food prices were obtained from the Consumer Price Index from 2011 to 2018. Nutrient and food groups targets for each type of menu followed recommendations (Mexican guidelines, and EAT-Lancet), or the current intake of the population according to ENSANUT. We estimated and compared the total cost of the menus obtained from the DIETCOST programme (110 to 548 menus per person and diet). 

Results/findings: In 2018, on average, the total cost (MXN/per household) for a 2-week menu was 3,702 for the EAT-Lancet diet, 3719 for the Mexican healthy diet, 4629 for the current Mexican diet, and 4224 for a current Mexican diet but with the same energy content as the healthy diets (current isocaloric). The differences the in cost between the current isocaloric and the healthy diets came from costing –16.8 and -10.7 MXN/person-day from animal sources and dairy, -12.2 and -10.1 from discretionary food and beverages, and +9.4 and +13.6 from fruit, vegetables, grains, and legumes (EAT-lancet and Mexican healthy, respectively). Twenty percent and 39% of current isocaloric menus were cheaper than the average EAT-Lancet and Mexican healthy menus, respectively. From 2011 to 2018, the cost of all menus increased over time, but the increase in the current menus was larger compared to the increase in the healthy ones. 

Conclusions: Menus based on the Mexican and EAT-Lancet recommendations were cheaper than menus based on the current Mexican diet. These findings suggest that cost might not be an important barrier for adopting a healthy diet in Mexico.

Purpose: This work aimed to critically appraise the evidence for effects of community gardens on food consumption, physical and psychosocial health outcomes, and community sentiment.

Methods: Databases searched were PubMed, Web of Science, PsycInfo, Academic Search Complete and CAB Abstracts, from database inception until May 2019. The titles and abstracts of all identified articles were examined by at least two reviewers using Rayyan software. All potentially eligible studies identified were assessed for inclusion according to Population, Intervention, Comparator, Outcome (PICO) inclusion criteria. Outcomes were categorised into 1) Health (e.g. diet, physical activity, physical health measures); 2) Psychosocial (e.g. mental health issues, quality of life, social isolation); and 3) Community (e.g. social cohesion).

Results: This review describes quantitative evidence from 47 studies (46 observational; 1 RCT) involving n=13-1916 participants. The most commonly examined outcome was fruit and vegetable intake, overall diet, nutrients or nutrition knowledge (k = 19 studies). Thirteen studies included health related outcomes, 11 studies on psychosocial aspects and seven on community-related outcomes of gardeners.

In general, the results suggest that users of community gardens consume slightly more fruit and vegetables, and perceived themselves as having good to excellent health compared to non-users of community gardens. They were also observed as having lower odds of hypertension and overweight/obesity; however this evidence was inconsistent. Users of community gardens had more social contact and higher indicators of wellbeing than comparators; they tended to rate neighbourhood aesthetics and neighbourhood attachment more highly, and have higher civic participation than other members of their communities.

Conclusions: On average, users of community gardens tend to consume more fruit and vegetables, are healthier and participate in civic settings more frequently than non-users. However, the evidence is predominantly from small observational studies that involve selected populations and have poor (often no) adjustment for confounding, and are therefore at risk of bias.

Purpose: Unhealthy nutrition and physical inactivity are leading global public health risks and cause many non-communicable chronic diseases today. The aim of this study was to determine differences in knowledge, attitudes and habits concerning physical activity and proper nutrition in students of the University Department of Health Studies in Split.

Methods: The subject sample included 228 students of five study programmes of University Undergraduate and Graduate study, aged 18 – 41 years.

The instrument used was the newly-constructed Questionnaire on students’ attitudes and habits concerning nutrition and physical activity, with 35 statements assessed on a 5-point Likert scale. The other variables were: sex, age, study programme, body height, body mass, active sports engagement, and place of residence according (town, village). The study was conducted during regular classes in July 2018. The students were informed on the purpose of the study and given necessary instructions. The Ethical Board of the Faculty issued the necessary permit for the conduction of the study, and all subjects gave their written consent for participation.

Results: The study showed with statistical significance that female students followed guidelines concerning proper nutrition and physical activity more than male students, older students had better attitudes and knowledge on proper nutrition and physical activity, but also claimed to have less time for physical activity, i.e., younger students participated more in physical activity. Significant differences were found between students from different study programmes. Significantly the lowest prevalence of smoking was reported by students of Medical Laboratory Diagnostics, Nursing and Radiation Technology, whereas smoking prevalence was the highest among Physiotherapy students. Students of Graduate study and Obstetrics participated least in physical activity, whereas Physiotherapy students participated most. On the other hand, Physiotherapy students were the most sedentary.

Conclusions: Female students have better attitude and follow the guidelines on proper nutrition and physical activity more. Younger students follow the guidelines on proper nutrition less than older students but participate more in physical activity. The differences in habits and attitudes concerning proper nutrition and physical activity were found between different study programmes. Future studies should include all students of University of Split.

Background: Parenting stress is a known contributor to child nutritional risk. Low-resourced families are likely to experience various material hardships that may increase stress around parenting. Yet, links between material hardship and nutritional risk, and how different dimensions of material hardship may increase parenting stress and child nutritional risk are largely unknown.

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Methods: Data were collected from the Fragile Families and Child Wellbeing Study from mothers and children (n = 4,898) in 20 US cities followed from birth through age 9 years. Material hardship was measured (8 items) when children were 5-years-old. Mothers self-reported parenting stress and child consumption of saturated fats and added sugars (SoFAS; sweets, chips, soda) when children were 5 and 9 years-old. Structural equation modeling tested factor structures of material hardship, direct associations between each hardship factor and SoFAS consumption, and parenting stress as a mediator of the association.

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Findings: Exploratory factor analysis showed two underlying factors of material hardship: basic needs and housing hardships. Housing hardships were associated with increased consumption of sweets and chips at age 5, and basic needs hardships were associated with increased consumption of sweets and soda at age 9. Each hardship factor operated through parent stress, which in turn predicted higher SoFAS consumption.



Discussion: Implications support the need for future research to address stressors of deprivation that move beyond simplistic measures of income poverty to include specific dimensions of hardship. This work will help advance our understanding of how to promote healthy child diet and prevent long-term chronic disease.

Purpose: To understand the physical activities of children and adolescents in China and their socio-economic status; to explore the correlation between different socio-economic indicators and the physical activity of children and adolescents, and to investigate the impact of socio-economic status on the physical activity among children and adolescents.

Method: A total of 2486 students (average age 12.2±2.3, male 49.5%) in Anhui province, Jiangsu province and Shanghai were investigated by questionnaire. Using descriptive statistics to analyze the survey participants' physical activities and socioeconomic status, and using chi-square tests to compare the differences in variables between different genders, school segments and regional groups; Pearman correlation analysis analyzed the relationship between socioeconomic status and the number of Moderate-to-Vigorous Physical Activity(MVPA) days for children, adolescents; and further analyzed the impact of socioeconomic status on MVPA for children, adolescents with binary logistic regression.

Result: In general, 11.0% of children and adolescents achieved MVPA for 7 days (boys' rate is 13.9%, girls' rate is 8.4%), and the rate of reaching MVPA recommendation on weekends is 26.0% (boys' rate is 30.7%, girls' rate is 21.5%). Parental education, self-assessment Socio-economic Status(SES) and Family Affluence Scale(FAS) were positively correlated with physical activity of children and adolescents (p<0.05), and had significant effects on physical activity of children and adolescents. For different genders, parental education and FAS are positively related to physical activity of boys and have a significant effect (p<0.05); parental education, self-assessment SES and FAS are positively related to physical activity of girls and have a significant effect (p<0.05).

Conclusion: (1) China's children and adolescents are not optimistic about reaching the recommended level of MVPA. (2) The overall socio-economic status is relatively low, the socio-economic status of boys' families is better than that of girls. (3) Socio-economic status has a significant impact on the physical activity of children and adolescents. (4) The influence of different socio-economic status indicators on the physical activity of children and adolescents varies by gender, school segment and region.

Purpose: Doing multiple activities throughout the course of a day may influence decisions to eat fast food. No studies to date have linked the number of activities to food choices in a naturalistic environment. We tested the associations between the total number of daily activities and fast food consumption among US parents, parents in poverty, and single parents.

Methods: Using cross-sectional data from the 2006-08 and 2014-16 American Time Use Surveys, we evaluated differences in the odds of fast food consumption by daily activity quartiles (n= 23840 parents). Parents reported whether they ate fast food in the last seven days (y/n). Daily activity questions ask about whether the parent engaged in certain tasks (e.g. caring for children or commuting). Activity quartiles were defined by counts of activities during the day. We ran balanced repeated replication bootstrapped logistic regression models adjusted for sociodemographics, living in a rural area, and reporting time use on a weekend and/or on a day when they worked. All models accounted for complex survey design.​

Results: Parents in highest activity quartile engaged in >35 activities per day on average; the parents in the lowest quartile engaged in <13 activities on average. All parents, parents in poverty, and single parents with the most daily activities also had a higher odds of fast food consumption compared to parents in each respective category with the least daily activities (OR[95%CI]: 2.26[2.13,2.40], 2.71[2.46,3.00], 2.63[2.25,3.07]). Odds of fast food consumption increased by quartile for parents in poverty (OR[95%CI]: 1.98[1.83,2.15], 2.42[2.20,2.66], and 2.71[2.46,3.00]) and all parents (OR[95%CI]: 1.42[1.34,1.51], 1.83[1.73,1.95], and 2.26[2.13,2.40]). Parents in poverty had higher odds of fast food consumption compared to parents in general across all activity quartiles (OR>1.3).

Conclusions: A higher number of daily activities is associated with fast food consumption in US parents, especially for parents in poverty. Future studies should evaluate underlying mechanisms that may explain this relationship such as cognitive load, stress response, or food access. Time burdens like doing a higher number of activities throughout the course of the day should also be considered when trying to reach parents to promote healthy eating.

Purpose. Food pantries are distribution centers where low-resource households can receive food at no cost. Used by over 46 million Americans annually, food pantries are an important part of the United States food system. Low-resource adults who use food pantries are at higher risk for nutrition-related chronic diseases; therefore, novel food pantry distribution models that provide convenient access to fresh, healthier foods need to be evaluated.

Methods. Fresh Pantry is a partnership between a food pantry and a federally qualified healthcare center that provides medical services to low-resource individuals. Fresh Pantry uses a refrigerated truck to provide monthly mobile food pantry distributions of fresh, healthier food packages on-site at the healthcare center. Food distributions are coupled with nutrition education, taste tests, and health promotion activities. Fresh Pantry aims to determine the feasibility and acceptability of this novel food pantry model, and its impact on participants’ food security status and food coping strategies. This abstract reports descriptive statistics on a baseline sample (n=100) of Fresh Pantry participants and process evaluation metrics of food distributions to date.

Results. The majority of the sample was white (52%) or African American (41%) and female (75%). 12% of the sample had high or marginal food security, 31% had low food security, and 57% had very low food security. 89% of the sample used governmental assistance programs, 67% used Supplemental Nutrition Assistance Program (SNAP) benefits, and 77% had visited other food pantries >2 times in the past year. 38% and 41% of participants reported “sometimes” or  “often/always” making trade offs between paying for food and other basic needs like medical care or housing, respectively. Over the first six months of the program, Fresh Pantry served 206.3+53.9 (Mean+Standard Deviation) households per distribution, providing 49.3+12.5 pounds of food to each household at each distribution (approximately 16.5+3.3 meals per person).

Conclusions. Fresh Pantry provides healthier food packages to a large volume of households with high need for food assistance. Future analyses will determine the impact of Fresh Pantry on participants over time.

 

 

 

Background: Evaluation and validation of reliable methods of quantifying an individual’s nutrient intakes are important to identify groups at risk of nutrient deficiencies and develop nutritional interventions aimed at reducing undernutrition in specific population group. We examined the relative validity of a multi-pass 24-hour recall and a 7-day recall food frequency questionnaire (FFQ) with volumetric portion size estimation, compared to Weighted Food Record (WFR) in Ethiopian adult women and children.

Methods: Food consumption data were collected for randomly selected women of reproductive age (n=15) and children aged 6-59 months (n=19) from two sub-districts in urban Ethiopia using WFR followed by multipass 24-hour recall and FFQ on the following day. Portion sizes were estimated using photographs of cooking/ serving utensils, including reference objects to maximize accuracy. Wilcoxon’s signed rank test was used to test difference in the median nutrient intakes between “test” dietary methods (24-hour recall and FFQ) and “reference” method (WFR). Agreement with weighed food records was conducted primarily by Bland-Altman analysis. Cohen’s weighted k statistic was calculated to measure the inter-method (between 24-hour recall & WFR and between FFQ & WFR) classification agreement.

Results: Bland-Altman analysis showed FFQ marginally underestimated energy and vitamin A in women, protein and vitamin A in children while marginally overestimating iron in both groups. It also revealed 24-hour recall marginally overestimated energy in women, and protein and vitamin A in children. No significant differences between the test and reference methods were found for the median daily intakes of each nutrient among women and children. There was moderate to good agreement (κ 0.41-0.80) between test and reference methods for iron and protein, and good to excellent agreement (κ 0.61-1.00) for energy and vitamin A among women and children.

Conclusion: Dietary assessment using 24-hour recall and FFQ with volumetric portion size estimation revealed comparable estimates of dietary intake with WFR in adult women and children. This study supports the use of 24-hour recall and FFQ as an acceptable method for assessing dietary intake in adult women and children.

 

Purpose: Sedentary behaviour – i.e. any waking activity that expends fewer than 1.5METs/min while seated or lying down – has emerged as a health risk factor, largely independently of physical activity. This has inspired considerable research to understand, predict, or change sedentary behaviour patterns. Much of this research has been based on self-reported sitting time. Yet, little is known about how participants interpret self-report sedentary behaviour items. Erroneous interpretations, for example, may generate unreliable or inaccurate data. ‘Think aloud’ methods, whereby participants narrate their thoughts as they complete a task, can provide insight into how people interpret questionnaires, and how they mentally represent the concepts under study.

 

Methods: 25 UK office workers ‘thought aloud’ as they completed 38 items from 9 sedentary behaviour questionnaires (e.g. Workplace Sitting Breaks Questionnaire, Multi-Context Sitting Time Questionnaire), as systematically selected from a pool of 30 questionnaires. Verbatim transcripts were analysed using Thematic Analysis, undertaken by three coders, to identify potential problems experienced when completing the questionnaires.

 

Results: Three themes emerged: interpretation problems; errors and biases in formulating responses; and motivational and affective responses to questionnaire completion. Interpretation problems included instances of uncertain interpretations, inconsistent interpretations of similar items, and interpretations that deviated from the intended meaning. Participants typically mentally encoded time spent sitting according to concurrent activities (e.g. commuting) and translating these events into a sitting time metric was effortful and prone to error. Several participants expressed surprise at their high estimated sedentary time, which appeared to motivate them to reduce their sitting.

 

Conclusions: Participants typically did not mentally represent sitting as ‘sitting’, which can cause problems when people self-generate sitting time estimates. Domain-specific items, which assess time spent in discrete seated activities, may be less burdensome and less prone to error and bias than items that require direct reflection on sitting itself. Self-reporting sitting time can have ‘mere measurement effects’, enhancing motivation to reduce sitting time. While this may be problematic for prospective studies that assume test-retest validity, it raises the possibility that self-reporting sitting may offer a promising sedentary-reduction intervention technique.

 

Purpose: Short sleep duration is related to poorer health. During the school term, sleep duration in adolescents is largely controlled by the time they go to bed. However, in-bed screen-time is now common practice for many youth before sleep. Therefore, reported bedtime (which is typically used in sleep diaries and questionnaires) may not correspond with the time they try to go to sleep, known as shuteye time. Our objective was to describe the bedtimes and shuteye times of female adolescents and relationships with weight status, healthy dietary habits, and motivation for food choice.

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Methods: The SuNDiAL project was a cross-sectional study of females aged 15-18 years from thirteen high schools across New Zealand. ‘What time did you lie down in bed last night?’ and ‘What time did you try to go to sleep last night?’ was collected as part of a daily activity diary over six days. Height and weight were measured by trained researchers. Dietary habits were assessed with the Dietary Habits Questionnaire and food choice motivations by The Food Choice Questionnaire. Logistic and linear regression models were used to estimate associations, with adjustment for age and area-level deprivation, and accounting for school clusters.

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Results: 136 female adolescents of mean (SD) age 16.8 (0.9) years completed a daily activity diary (97% had at least five days). Mean bedtime was 10:11pm (SD=57 mins) and mean shuteye time was 11:04pm (SD=55mins). Later shuteye time was strongly associated with not meeting fruit and vegetable consumption guidelines (2+ and 3+ a day, respectively) and with not eating breakfast at least five times a week (OR (95% CI): 0.57 (0.41, 0.78); 0.56 (0.33, 0.97); & 0.45 (0.32, 0.63) respectively). Additionally, those with later shuteye times were more likely to be trying to lose weight but were less likely to be motivated by health for food choice. There was no evidence of association between later bedtime and healthy behaviours, except for breakfast consumption (OR (95% CI): 0.67 (0.50, 0.91)).

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Conclusions: Female adolescents with later shuteye time had less healthy dietary habits, but this was not the case for later bedtimes. Future research should ensure that shuteye time is assessed.

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Purpose:

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To present a detailed evaluation of the CreActivity intervention from various perspectives using a mixed method process evaluation. Intervention effects are examined and insights for future intervention planning are described. Aim of the CReActivity project was to promote physical activity of sixth-grade girls by supporting the basic psychological needs (BPN) autonomy, competence and relatedness in physical education (PE) and to identify mediating and moderating constructs of physical activity behaviour change.

Methods:

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482 female sixth-graders (aged 9 to 14) of 33 classes participated in the cluster randomized controlled trial. Randomization took place on the school level. Participants provided questionnaire data(BPNsupport and satisfaction in PE)and device-based PA data at baseline, post-intervention and follow up. Group differences (IG vs. CG) were tested with structural equation modeling, accounting for school clustering. During the 16-week intervention period, trained teacherscarried outthe intervention programme, which was subject to an evaluation by systematic observations of PE lessons with a modified SOFIT protocol. Data from semi-structured interviews with 8 teachers and 10 focus groups with 41 students were thematically coded. Qualitative and quantitative data were incorporated in a mixed method convergence matrix.

Findings:

Results of the systematic observations indicate that the IG teachers provided a stronger BPN support than the CG teachers did. However, the qualitative interviews suggested that the BPN support was not delivered as consistently as expected by the IG teachers. Quantitative data supported the subjective impressions since there were no significant differences in BPN support and satisfaction between IG and CG.The intervention did not affect the MVPA levels of students significantly. Qualitative data identified structural and methodological barriers of the intervention.

Conclusions:

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Implementation issues undesirably affected the intervention effect, since CG teachers were not controlled in promoting BPN. Further adaption of measurement instruments and intervention components is necessary to improve statistical and methodological power. The study highlights the importance of high-qualitative process-evaluation in order to evaluate the quality of the intervention and its outcomes.

Purpose: Positive youth development is a strength-based perspective recognizing all young people hold potential for positive, successful, and healthy development (Lerner et al., 2005). For Indigenous youth, participation in sport and physical activity (PA) may positively contribute to physical, mental, emotional, and spiritual well-being (Lavallée, 2007). However, there are no available validated measures to evaluate such developmental benefits (Bruner et al., 2016). Therefore, the purpose of this research was to develop and validate the Wholistic Compass, a culturally relevant measure of Indigenous youth development through sport and PA.

Methods: Guided by a Two-Eyed Seeing approach (Bartlett, Marshall, & Marshall, 2012), we undertook a four-phase research program to address the stated purpose. Phase 1 was designed to gain an understanding of Indigenous youth development through sport and PA. Thirteen sharing circles were conducted with 99 Indigenous youth across Canada. Phase 2 assessed item content validity through Think Aloud interviews with 15 Indigenous youth. In Phase 3, the Wholistic Compass Application (App) was developed and a pilot study was conducted with 231 Indigenous youth. Phase 4 is the current validation phase.

Results: Phase 1 findings provided the basis for item generation across the four Medicine Wheel quadrants (physical, mental, emotional, spiritual), and items associated with connections to others, perceived barriers to participation, and social support. Phase 2 resulted in item wording modifications and highlighted the need for a mobile App to appeal to youth participants, which was created in consultation with the project Governing Council. Phase 3 involved an exploratory factor analysis to test initial reliability and validity for the measure. Following item analysis, 7 items were removed, 16 items reworded, and 17 items added (12 of which make up an ethnic identification scale; Bombay et al., 2010). Presently, we are seeking 600 Indigenous youth to validate the final 91-item measure (Phase 4).

Conclusions: There is initial empirical evidence to support the validity of the Wholistic Compass App as a culturally relevent, self-assessment questionnaire that evaluates Indigenous youth development in sport and PA. Further psychometric testing is required to examine other elements of the measure’s validity.

Purpose: To compare sleep metrics produced by the Fitbit Charge 3 (Fitbit) and Actigraph GT9X accelerometer (Actigraph) to polysomnography (PSG) in youth. 

Methods: Participants included thirty-nine youth (age=9.5±3.4 years, BMI%tile=71.4±30.4, 40% male, 61% Black) referred by their physician for an overnight sleep study due to snoring, restless sleep, or enlarged tonsils. Fitbit and Actigraph were worn on the non-dominant wrist and recorded data concurrently with PSG. Fitbit and Actigraph sleep metrics including total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep onset, and sleep offset were extracted from Fitabase and Actilife with the Sadeh algorithm, respectively, while sleep technologists scored PSG data. Bland-Altman plots assessed agreement between devices and PSG. 

Results: 77% of youth were diagnosed with obstructive sleep apnea, 8% with elevated periodic limb movement, and 15% with no sleep-related diagnosis. Compared to PSG, Fitbit overestimated TST by 0.9 min (absolute mean bias=27.9 min), while Actigraph underestimated TST by 29.4 min (absolute mean bias=34.4 min). Fitbit overestimated SE by 2.8% (absolute mean bias=5.8%) and Actigraph underestimated SE by 13.1% (absolute mean bias=13.6%). Fitbit overestimated WASO by 1.2 min (absolute mean bias=23.7 min) and Actigraph underestimated by 49.9 min (absolute mean bias=49.9 min) compared to PSG. Both Fitbit and Actigraph underestimated sleep onset by 5.5 (absolute mean bias=11.8 min) and 9.8 min (absolute mean bias=14.0 min), respectively. Both Fitbit and Actigraph overestimated sleep offset by 7.0 min (absolute mean bias=14.0 min) and 10 min (absolute mean bias=12.9 min). Linear regression indicated statistically significant trends with Fitbit and Actigraph underestimating at higher values and overestimating at lower values for all sleep metrics except SE.

Conclusions: Fitbit provided comparable sleep estimates to Actigraph when compared to PSG. These data provide initial support for the use of consumer devices as an alternative to research-grade accelerometers to measure sleep in youth. Validation studies are needed in healthy youth, over several nights, and in free-living settings.

 

Purpose

Assessing the healthiness of food purchases by store type has the potential to inform the development of effective and equitable food policies to improve population diets.

 

Methods

We used Nielsen Homescan panel data collected between October 2018 and October 2019 to assess household food purchases by food store types across New Zealand (NZ). The Nielsen NZ Homescan panel is a cohort of households that is nationally representative of NZ in terms of selected demographics and socioeconomic status. Homescan only collects information on food/drinks brought into the home. We linked the panel data with the food composition databases (e.g. Nutritrack and Foodfiles) in order to extract data on nutritional composition of foods or drinks purchased.

We developed a store classification tool, and classified stores into supermarkets, grocery stores, convenience stores, fruit and vegetable shops, meat and fish shops, or bakery shops. We excluded alcoholic beverages, liquor stores, stores with only online and/or delivery services, stores with no specific name, and stores where food retail was not their core business. We calculated a Health Star Rating (HSR) for all food and drink purchases, and used HSR to measure product healthiness by store type. A product with a HSR of 3.5 or more was defined as 'healthy'.

 

Results

We analysed data on over 21,000 unique products, purchased by approximately 1800 households from 29 store brands, comprised of 9 supermarket brands, 2 grocery store brands, 9 convenience store brands, 3 fruit and vegetable shop brands, 4 meat and fish shop brands, and 2 bakery brands. Supermarkets accounted for 93% of household foods or drinks purchased, grocery stores for 4%, convenience stores 1%, fruit and vegetable shops 1%, meat and fish shop 0.5%, and bakery shops about 0.5%. Detailed results on healthiness of food by store type will be presented for the first time at the ISBNPA conference.

 

Conclusions

Supermarkets account for most foods and drinks purchased by New Zealand households for consumption at home. The diversity of store types from which products are purchased however offers an important opportunity to examine in detail product healthiness, cost, and promotions by store type.

Purpose: Identify characteristics of pilot studies presented at the International Society of Behavioral Nutrition and Physical Activity (ISBNPA) annual meeting and examine study aspects associated with publication to shed light on potential publication biases in pilot studies.

Methods: Official booklets containing the abstracts presented at ISBNPA for 2009-2010 and 2012-2017 were obtained. No booklet for 2011 was available. Conference booklets were uploaded into NVivo and systematically searched using the keywords "pilot," "feasibility," "preliminary," or "exploratory" to identify all pilot studies examining a behavioral intervention. Behavioral interventions were defined as studies designed to test the feasibility of a behavioral intervention and/or provide evidence of a preliminary effect(s). Mechanistic studies conducted in laboratory or clinical settings as well as measurement scale, tool, or device development studies were excluded. The title, full text, and authors of each abstract were used to search PubMed/Medline, authors’ curriculum vitae, ResearchGate, and Google Scholar to identify if the abstract had been published.  Publications were matched to ISBNPA abstracts if the publication reported identical intervention components including duration, location, target population and sample size. Pilot study abstracts were coded for sample size, methodology, statistical significance, and institutional affiliation.

Results: Of the 6,046 abstracts presented, 327 (5.4%) were pilots. In 2009, 2.5% of all abstracts presented were pilot behavioral interventions; this rate increased to 7.2% in 2017. The number of total abstracts increased by 70% from 2009 to 2017 (607 to 1,034) while pilot abstracts increased by 393% (15 to 74). Slightly more than half (55.7%) of all identified pilot behavioral intervention abstracts were matched with publications. Factors coded in pilot study abstracts are currently being analyzed and results will be presented.

Conclusion: The proportion of pilot behavioral interventions that go unpublished is notable, suggesting publication bias with those that eventually appear in the peer-reviewed literature.

Purpose: Many office workers sit at work for long uninterrupted periods, which confers health risks. Unlike for amount of workplace sitting time, few self-report measures regarding workers' sitting time accumulation at work have been evaluated. This study assessed the test-retest reliability and criterion validity of five self-report measures that may be suitable for this purpose.

Methods: Office workers (n=35, mean age=44 [SD=12] years, 79% female) completed an online questionnaire, both before and immediately after wearing the activPAL3TM for 7 days (24-h protocol, diary-reported work hours). They reported typical behaviour at work in the past week: percentage of sitting time accumulated in >/=30 minutes bouts (prolonged sitting %); number of breaks per hour of sitting (n breaks); longest period of sitting (longest bout sitting); number of different strategies used to breakup sitting time (n strategies); and, frequency of all strategies used per day (nx strategies). Correlations (Spearman's rho) were assessed for test-retest reliability and criterion validity, relative to the same measures derived from the activPAL3TM when possible, otherwise activPAL3TM work sitting-upright transitions/h sitting which was criterion for n strategies and nx strategies. Absolute agreement was also tested when applicable. 

Results: Test-retest correlations were acceptable for prolonged sitting % (rho=0.65, 95% CI=0.40-0.81), n strategies (rho=0.71, 0.49-0.84), nx strategies (rho=0.65, 0.40-0.81) and longest bout sitting (rho=0.43, 0.11-0.67) but not n breaks (rho=0.12, -0.23-0.44). Mean differences ranged from 1% to 14% of the initial test value. Validity correlations were strongest for prolonged sitting % (rho=0.58, 0.31-0.77) followed by n breaks and nx strategies (rho=0.44, 0.13-0.67 and rho=0.36, 0.03-0.62 ) and weaker and non-significant for longest bout sitting (rho=0.31, -0.03-0.58) and n strategies (rho=0.24, -0.10-0.53). Mean differences ranged from 13% to 52% of the activPAL3TM value.

Conclusions: Self-report sitting time accumulation measures had poor to acceptable test-retest reliability and criterion validity. Prolonged sitting % performed best overall and performed similarly to commonly used measures of workplace sitting time. This single-item question may be an appropriate option for workplace studies that cannot use monitoring. 

 

Purpose: Shift workers experience significant disruption in their circadian rhythm due to variable periods of sleep which may impact their physical activity and sedentary behaviour. The purpose of this study was to determine whether daily 24-hour time-use compositions vary with different work patterns. 

Methods: 257 employees in the New Zealand aviation industry (47.0% Male; 34.2% aged 35 to 49 years; 66.1% European) wore Axivity AX3 accelerometers on the thigh and lower back for seven days (168 hours) and completed a sleep log diary. Daily estimates of time spent sleeping, sedentary, standing, walking and running were derived from accelerometer data and converted to ilr coordinates. Days were categorised according to the type of workday: 1) personal day, 2) standard workday, 3) morning shift, 4) day shift, 5) evening shift, and 6) night shift. Daily compositions for these workdays were compared using compositional MANOVA, with participant ID specified as an error term to account for repeated measures (daily 24-h compositions). Subsequently, a multivariate multiple comparison test (Hotelling-Lawley’s T²-test with bonferroni adjustment) was used to determine which workdays significantly differed. 

Results: Results of the compositional MANOVA indicated a significant difference in the daily compositions of various shifts (p < 0.001), with differences observed in all movement variables. Personal days included relatively more time spent running (mean 1.36 min/day) than other days. Workdays with night shifts were characterised by relatively less time sleeping (mean 307 min/day) and more time sedentary (mean 767 min/day) than other days. Subsequent pairwise comparisons indicated that: personal day compositions were different from all shift workdays (p < 0.05), but not standard workdays; all types of shift workdays were different from standard workdays (p < 0.05); workdays with night shifts were different from all other types of workdays p < 0.05); whereas, workdays with day, evening and morning shifts had comparable compositions (p > 0.05).

Conclusions: 24-h compositions of behaviour are dependent on the type of workday. Further studies exploring the optimal time-use profile in working populations should take into consideration daily work patterns.

Purpose: Cardiorespiratory fitness (CRF) during childhood is a strong predictor of future health outcomes. The 20 metre shuttle run test (20mSRT) is a popular fitness test used worldwide to assess CRF. However, the 20mSRT is a maximal exercise test which may be unpleasant and induce an acute negative emotional response (i.e. negative affect). Previous research has shown negative affective response to adversely affect future physical activity behaviours. The study determines the validity and reliability of using rating of perceived exertion (RPE) reported during a sub-maximal 20mSRT to predict peak oxygen uptake (VO_2peak) in children while minimising negative affect. 

Methods: Twenty-five apparently healthy children (n=14 male; 12.7±0.6y) participated in four testing sessions. During all sessions, RPE were collected using the 'Eston-Parfitt 0-10 pictorial RPE Scale'. Affective responses were also measured using the 'Feeling Scale'. In the first session, participants performed a graded exercise test (GXT) to volitional exhaustion to assess VO_2peak using online gas analysis. Subsequently, participants performed a sub-maximal 20mSRT twice with the test ending when participants reported RPE7. In the final session, participants performed the 20mSRT to volitional exhaustion. The sub-maximal RPE-speed relationship were extrapolated to predict speed at RPE9 and 10. The predicted speeds were then converted into VO_2peak using the ACSM prediction equation.

Results: Repeated measures ANOVA reveal a significant main effect for VO_2peak method (p<0.001), with RPE9 and 10 higher than 20mSRT, but no different to the GXT VO2peak. ICC also revealed high reliability (~0.9) between the two sub-maximal 20mSRT. Repeated measures ANOVA show significant differences in end-point affect across methods (p<0.05). Post-hoc analyses reveal affect was less negative in the sub-maximal 20mSRT that the maximal conditions.

Conclusions: The 20mSRT offers a practical alternative where laboratory-based exercise testing is not feasible. However, the maximal 20mSRT induces negative affect. Acute affective response to exercise is a strong predictor of future physical activity behaviours. RPE collected during a sub-maximal 20mSRT can be used to accurately and reliably predict VO_2peak in children while minimising negative affective response.

Purpose: Participation in physical activity for at least 30 min/day, and limiting sedentary time, are recommended for older adults. To monitor sedentary, light, and moderate intensity physical activity objectively, devices such as the GENEActiv, that record raw accelerations, have been used. The processing of data from these devices preclude them from practical use as field-based intervention tools. The Activinsights Band has been designed to fill this gap. This study evaluates the Activinsights Band, assessing its ability to discriminate sedentary, and active behaviours, and to examine the reliability and validity as a pragmatic field-based intervention tool.

Methods: Using a test/re-test design, 20 community-dwelling older adults (80-87 years) participated in two laboratory sessions, one-week apart. Participants completed activities of daily living for a duration of four minutes, including light gardening, sweeping, reading a book, comfortable walking, laying down, washing dishes, brisk walking, watching television, unpacking groceries, and computer work. A portable gas analyser was used to measure energy expenditure for each activity, and participants wore a GENEActiv accelerometer and an Activinsights band on each wrist during the activities. Heart rate data were also collected. 

Results: ANOVA (activities by time), ICC and Pearson's correlations demonstrated that both devices were able to discriminate between sedentary (below 1.5 MET) and moderate activity behaviours (greater than 3 METs), including activities of daily living such as gardening, sweeping, doing the dishes, and brisk walking. ICC demonstrated reliability across the two sessions (0.46-0.93), except for watching television for both devices, and reading and laying down for the Activinsights Bands. Pearson's correlations between objective measures and devices, and between devices, for each activity were significant (p<0.01) for the non-sedentary behaviours.

Conclusions: The Activinsights Band discriminates between sedentary and active behaviours and has potential to be an effective and pragmatic health promotion tool for practitioners seeking to monitor physical activity behaviours of older adults. Research is on-going to describe the translation of current data to seven-day habitual activity behaviour and provide critical evidence for the utility of the Activinsights Bands as a health promotion intervention tool.

Purpose

Who is missing out?  Understanding the impact of socio-economic deprivation on participation in play, active recreation and sport.

Method

Active NZ is Sport NZ's national participation survey.  Re-designed during 2016, continuous data collection began on 1 January from New Zealanders aged 5-plus.  For the very first time adults and young people are surveyed using the same method, answering questions about behaviour and attitudes.  The sample is drawn from the electoral roll, and using a sequential mixed method approach, up to five contacts are made to improve the response rate.  Adults have the opportunity to complete the survey online or in hard copy.  The young people's survey is online only.  Between ages 5-11 adults complete fo,r and alongside, their young people, while between ages 12-17 young people complete themselves - clarifying with others as needed.  Each year we capture participation data from around 20,000 adults and 6,000 young people.

Results

Using Active NZ data collected in 2017 and 2018 from more than 60,000 New Zealanders aged 5-plus, we applied the New Zealand Deprivation Index for 2013 to the survey results to understand differences in participation by people from high deprivation areas compared with those from low deprivation areas.  The New Zealand Deprivation Index was constructed more than twenty years ago by health policy researchers from the University of Otago to develop small area indexes of socioeconomic deprivation for New Zeland to help with funding, research and service delivery decisions.  Through our analysis, we found that young people from high deprivatio areas have the confidence and competence to be active, want to increase their particiaption more-so than young people from low deprivation areas, but face cost and transport barriers - especially in the context of competitive, organised structures.  Compared with young people from low deprivation areas, they are they are less likely to understand the benefits of being active.  Lower levels of knowledge about the benefits of being active continues into adulthood, made worse by lower levels of interest and motivation by adults from high deprivation areas to increase their participation.

Conclusions

Improving understanding of the benefits of being active and reducing access barriers will help to increase participation for young people from high deprivaiton areas. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purpose: In order to inform the interpretation of nutrition data and targeting of interventions, it is important to understand whether there are gender differences in the reporting of dietary intake. The objective of this review was to explore differences by gender in self-reported energy intake compared to a reference measure of total energy expenditure.

Methods: Six electronic databases were systematically searched for published original research articles between 1980 and October 2019. Studies were included if they were conducted in general adult populations and included a measure for both women and men of self-reported energy intake, and total energy expenditure from doubly-labelled water (DLW). Two authors independently screened studies and conducted a quality appraisal of the included studies using standardised tools. Data was extracted on study characteristics, including the dietary intake assessment method used.

Results: From the database searches, 2,166 studies were identified, of which 30 met the inclusion criteria. The studies collectively included information on 4,387 individuals (n women=2,371) and the majority (n=27) were conducted in high-income countries. Sixteen of the studies were evaluated as being of a high quality in reference to the selection of participants, comparability of study groups, intervention methods and outcome descriptions. The included studies used a variety of self-reported energy intake assessment methods, including 24-hour multiple-pass diet recalls (n=13), weighed food records (n=10), food frequency questionnaires (n=9), food diaries (n=6) and diet history questionnaires (n=3). When compared to energy expenditure measured by DLW, energy intake was underestimated in all but one study for women and in all but two studies for men. Underestimation of energy intake ranged from 600-7,708 kJ/day and 430-5,600 kJ/day for women and men, respectively.

Conclusion: This systematic review has identified substantial underestimation of energy intake for women and men across a range of dietary assessment methods. As a next step, a meta-analysis will be conducted to quantify the degree of underestimation which will assist in evaluating the relationship of gender with diet and disease outcomes.

Purpose 

This study focused on measuring activity levels of adults with acquired brain injury [ABI]. Currently, there is lack of objective measurement of physical activity [PA] and sedentary behaviour in adults with ABI. The study also aimed to validate the Fitbit for measuring steps and sedentary behaviour in adults with ABI.

Methods

In this observational study, adults with ABI wore a Fitbit (wrist) and an activPAL (thigh) during a laboratory session (one hour) and free-living (7 days). Steps (both settings), and stepping and sedentary time (minutes; free-living) were calculated for both devices. Sedentary time included wake and sleep-time, as Fitbit data were only available in 24-hour summaries. Correlation (Spearman) and Bland-Altman analyses were used to examine the validity of the Fitbit compared to the activPAL. 

Results/findings

Twelve adults (7 male; 46(±13) years) with ABI (11(±12) years since injury) participated. ActivPAL data showed they were awake for 15(±2) h/day, spent 60% of the day sitting, 29% standing and 11% stepping (7218 steps/day), all participants stepped ≥150 min/week, and approximately 95 min/day were spent in stepping bouts of <10 minutes. Fitbit steps correlated strongly with the activPAL for both settings (rho>0.90; p<0.01). Fitbit overestimated steps in the laboratory (mean difference [MD]: 13 steps, 95% Limits of Agreement [LoA]: -124-151) and underestimated steps in free living (MD: -214 steps/day, LoA: -3812-3384). Fitbit sedentary time was poorly correlated with the activPAL (rho: 0.03), overestimating by 273 min/day (LoA:-77-623). 

Conclusions

Participants in this study spent most of their waking hours sedentary, but spent a considerable proportion in standing and stepping activities. However, only one participant met the PA guidelines of the WHO, and the majority of stepping time was in bouts <10 minutes. The Fitbit classifies this time as sedentary, which may have caused the poor correlation with the activPAL. The results of this study suggest that the Fitbit provides a valid measure for steps in this population but sedentary time should be interpreted with caution.

 

 

Purpose: This study validated the modified System for Observing Fitness Instruction Time (SOFIT+) in 5 to 6 years old children. The tool has been validated in older children (i.e., 7-14yrs) and is designed to capture teaching practices that both promote moderate-to-vigorous physical activity (MVPA) during physical education (PE).

Methods: Participants (n=165, 53.3% female, 5-6yrs) were recruited from nine primary schools participating in the SAMPLE-PE randomised controlled trial. Video recordings of 45 physical education lessons (3 per class) from 9 teachers/coaches were coded using an age-appropriate modified version of the SOFIT+. Inter-rater reliability was assessed on 30% of coded lessons. A SOFIT+ index score (+1 for PA promoting or absence of PA discouraging practice) was calculated for each 40 second(s) scan. Children’s moderate-to-vigorous physical activity (MVPA) was estimated using wrist-worn accelerometers. Multinomial logistic regression assessed the relationship of both the SOFIT+ index score and individual MVPA promoting practices with children’s MVPA.

Results: Percent agreement was >85.5% for each observed SOFIT+ variable.  Compared to engaging in 0-9s of MVPA per 40s scan, a 1 unit increase in the SOFIT+ index score was associated with an increased likelihood for girls to engage in 10-19s (OR=1.59, 95%CI=1.53-1.66), 20-29s (OR=2.13, CI=2.02-2.25) and 30-40s (OR=3.00, CI=2.76-3.28) of MVPA. Similarly for boys, a 1 unit increase in the SOFIT+ index score was associated with an increased likelihood to engage in 10-19s (OR =1.56, 95 % CI=1.50-1.63), 20-29s (OR=2.11, CI=2.00-2.22) and 30-40s (OR=2.97, CI=2.76-3.20) of MVPA. The vast majority of the observed teaching practices were significantly related to children’s MVPA. For example, during discovery practice activities girls and boys were 29.69 (CI=19.08-46.20) and 27.67 (CI=24.5-36.36) times as likely to engage in 30-40s compared to 0-9s of MVPA, respectively.

Conclusions: SOFIT+ can produce valid and reliable data to examine teaching behaviours related to PA promotion. Furthermore, the relationship between individual teaching behaviours and children’s MVPA was generally in line with previous research and could inform practitioners’ PA promotion behaviours.

Purpose

This cross-sectional study aimed to assess objectively-measured physical activity of 4-year-old preschool children in Malaysia and its relationships to parents` electronic screen use patterns.

Methods

A total of 82 four-year-old children (mean age 4.3 ± 0.4 years) from 24 kindergartens in Kuala Lumpur, Selangor and Negeri Sembilan states in Malaysia participated in this study. Smartphone use was examined using a parent questionnaire which included eight questions on the frequency of using electronic screen device or smartphone by parents during times with children. Physical activity was measured using Actigraph GT3X+ accelerometer worn from Monday to Friday at the right hip of children. Children were required to have at least one 24-hour period of wear time for inclusion in the data analysis.

Results

Children spent an average of 160.4 ± 53.8 minutes daily in physical activity, with the boys being significantly more active (173.2 ± 57.6 minutes) than the girls (147.5 ± 47 minutes). More than half (57.3%) of the children achieved moderate- to vigorous-intensity physical activity recommendation of at least 60 minutes or more per day. More than one-third of the parents reported that they used an electronic media device to calm down their children (35%) and to keep their children busy while they get things done (34%) on most days or every day. Most parents (34-39%) reported using a smartphone (to make calls, text messages, check email, watch a video) on most days or every day during meals, playtime and walks with their children. Smartphone was ‘never’ used during bedtime routine and travel time with children by 41% and 42% of the parents, respectively. There was no relationship between frequency of screen use with the amount of time children spent in light, moderate or vigorous physical activity.

Conclusions

Despite high reported frequency of screen use, parents’ screen use was not correlated with physical activity of this sample of preschool children. Future studies should examine peer influence and school environment as other potential determinants of physical activity among preschool children.

Background

The inclinometer functions of accelerometers might be able to accurately assess seated, standing and ambulatory postures.

 

Objectives

The primary aim of this paper was to to examine the validity of the built-in inclinometer functions of the two activity monitors, ActiGraph GT3X+ (AG) and activPAL (AP), at assessing seated, standing and ambulatory postures, when AG are worn on the wrists, the waists, the thighs and the ankles, and AP on the thighs, in comparison to directly observed data.

 

Methods:

24 adults, 10 men, 14 women, body mass index (BMI) of 25.62 ±5.45 kg/m², height of 170.56 centimetres, body mass of 74.80 kilograms, wore AG on 8 body sites, AP on 2 body sites whilst performing 5 seated, 1 standing, 2 ambulatory activities in the laboratory, for 4 minutes per posture, whilst being directly observed. Seated postures involved a range of leg angles, eg. fidgeting whilst seated, seated with legs outstretched.  The accuracy of the inclinometer functions of the AG and AP was assessed by equivalence testing, effect sizes, and percentage agreement.

 

Results:

Only thigh-worn AG was statistically equivalent to direct observation for assessing seated postures, with agreement percentage with direct observation of 89% (95% CI: 84%, 93%) for all seated postures. Wrist-worn AG was the worst wear site for assessing sitting: 25% (95% CI: 22%-28%). AP (standing: 89%, 95% CI: 88%-91%; walking: 95%, 95% CI: 95%-96%) was better than AG (60%, 95% CI: 52%-68%; 89%, 95% CI: 85%-92%) at assessing standing and walking postures.

 

Conclusion

Only the inclinometer functions of thigh-worn AG were able to correctly assess various seated postures as sitting. The inclinometer functions of AG worn the wrists, the hips, the ankles, and thigh-worn AG did not correctly assess seated postures as sitting.

Purpose:

We present an agent-based model (ABM) that explores how changes to outdoor play, school-based activities and active travel affect children’s physical acitivity (PA). Unique to this model is the ability to represent the complexity of multiple interdependent levels including built and social environment, individual characteristics, constraints of time/space, and policy measures, which influence PA.  

Methods:

The ABM generates a synthetic population of agents representing 9-11 year-olds residing in the city of Glasgow, characterised by socio-economic demographics consistent with census data. The urban environment is represented by geospatial data layers, including land use, houses, schools and street networks. Agents follow a daily schedule: attending school, formal sport, outdoor play and meeting with friends. Agents’ decisions regarding the location of an activity and travel mode are affected by land use availability, accessibility, crime levels and street walkability. As agents engage in activities, they accumulate minutes of moderate-to-vigorous PA (MVPA). To define the proportion of time spent in MVPA per activity and location we used real PA data of children tracked in the SPACES project.

We simulate a reference scenario where agents engage weekly in: outdoor play three times; one physical education lesson in school; and two recesses per school day. Active travel reflects patterns observed in the population. We then create scenarios where outdoor play is increased, active sessions are added in school, and active travel is imposed on all agents. Model outcomes include the distribution of average minutes of MVPA per day across the city.

Results/findings

At the population level, MVPA performed during school and active travel compose of more than 50% of daily MVPA. In a scenario where all agents are actively traveling to school the prevalence of agents achieving <= 60 minutes of MVPA per day reduces by half compared to the reference scenario; while adding active sessions in school and increasing outdoor play after school reduce prevalence by 75% and 40% respectively.

Conclusions: 

ABM can be used to explore various scenarios of PA behaviour and estimate possible outcomes of interventions. Therfore, they should be incorporated more into PA research.

Purpose: Physical activity is a multi-dimensional behaviour that takes place in a variety of domains, which makes evaluating one's own physical activity level challenging. A lack of awareness of one's own physical activity level has been related to adolescents not seeing the need to change and hence being unaffected by public health messages promoting physical activity. Therefore, the aim of this study was to compare adolescents’ self-reported and sensor-based assessment of physical activity.

Methods: In a sample of 423 adolescents (270 females; aged 15.03 ± 1.43) from the Built Environment and Active Transport to School (BEATS)  and BEATS Rural Studies, physical activity was assessed using both self-report (using a validated single survey item) and accelerometer measurements (7 days accelerometry; wear time ≥5 day for ≥10 hours/day). Participants were classified into four profiles based on meeting or not meeting physical activity guidelines using self-report and device-measured physical activity: 'Realistic Active’ (n=43; 10.2%), 'Realistic Inactive' (n=233; 55.1%), 'Over-estimator' (n=40; 9.5%), and 'Under-estimator' (n=107; 25.3%). 

Results: No significant differences existed for age, ethnicity, neighbourhood deprivation score, and weight status among the four profiles. However, there was a higher proportion of males in the 'Realistic Active’ profile compared to other profiles. Self-perceived health was different across profiles. Adolescents in the ‘over-estimator’ and ‘realist active’ profiles reported significantly higher self-perceived  health status compared to the other two groups (p<0.001) “Under-estimator” and “realistic inactive” profiles had lower proportions of adolescents participating in sports at school and outside school compared to the other profiles. The “Realistic-active” profile had the highest proportion of adolescents meeting recommended screen time guidelines. Although not significant, the “under-estimator” profile had the highest proportion of adolescents reporting active transport to school.

Conclusions: The majority of adolescents in the BEATS Studies were accurate in their self-reported physical activity. However, 10% over reported and 25% underreported their physical activity relative to sensor-based assessment. This may be due to misperceptions about the role of active transportation and sport as sources of physical activity. Thus, more and better examples of various sources of physical activity should be provided on self-report measures.

Purpose

Psychological aspects of eating behavior, such as external eating, emotional eating and dietary restraint are posited to be associated with overeating and obesity. However, no appropriate instrument was available for Chinese populations. This study aimed to translate and transculturally adapt a weight-related eating questionnaire (WREQ-C) for assessing the psychological aspects of eating behaviour in Chinese adults and evaluate its psychometric properties.

 

Methods

The WREQ is a 16-item self-reported instrument that measures external eating, emotional eating, routine restraint and compensatory restraint. It was translated, adapted, and administered to 970 Chinese adults (mean age 32.2, SD 13.4) as an online survey. The structural validity was examined using confirmatory factor analysis and internal consistency was assessed at subscale levels by Cronbach’s α coefficient.The Dutch Eating Behaviour Questionnaire (DEBQ) was used as a reference standard for convergent validity. Test-retest reliability was done at a 2-week interval (n=30). Linear regression was used to examine the associations of the WREQ-C subscale scores with body mass index (BMI) and gender.

 

Results

The proposed 4-factor structure for the WREQ was appropriate for the Chinese population (CFI=0.96, SRMR=0.04 and RMSEA=0.06) and demonstrated satisfactory internal consistency of 0.75 for routine restraint, 0.78 for compensatory restraint, 0.78 for external eating and 0.90 for emotional eating. The correlation between the corresponding WREQ-C subscales and DEBQ ranged from 0.63 to 0.81 (P<0.001). The WREQ demonstrated moderate to good test–retest reliability with intraclass correlations of 0.76 to 0.89 (P<0.001). Females reported higher scores of dietary restraint, emotional eating and external eating than male (P<0.05).  Routine restraint (β=0.13, P=0.004), external eating (β=0.12, P<0.001) and emotional eating (β=0.12, P<0.001) scores were positively associated with the BMI whereas compensatory restraint score (β=-0.09, P=0.03) was negatively associated with BMI. 

 

Conclusion

The 16-item WREQ-C demonstrated to be a reliable and valid measure for assessing external eating, emotional eating, routine restraint and compensatory restraint in Chinese adults.

 

 

Purpose: Typically, lifestyle behaviours (e.g., diet, physical activity, sedentary behaviour and sleep) are considered individually as predictors of health. However, these behaviours do not occur in isolation. Identifying patterns of these behaviours collectively may help to understand their synergistic influence on health and better inform and evaluate prevention and intervention strategies. This study aims to identify lifestyle patterns in a contemporary Australian dataset.

Methods: Data from the second wave (2011/12; child age 6-8y, n=432) of the HAPPY study (Melbourne, Australia) were used. Parent reported data were obtained on diet (fruit, vegetable and discretionary food intake), physical activity (outdoor play and organised sport), sedentary behaviour (screen time, videogame use and quiet playtime) and sleep for a usual week, along with accelerometry data (moderate- to vigorous-intensity physical activity [MVPA] and sedentary time). ​Latent profile analysis was conducted in Mplus to derive lifestyle patterns. ​A number of goodness of fit statistics (Bayesian information criteria, adjusted Lo-Mendel-Rubin test and the bootstrap likelihood ratio test) were used to select the optimal model.

Results: A three-pattern solution was identified. Patterns were labelled as: (1) Unhealthy (low sleep, low physical activity, high overall sedentary behaviour, low fruit and vegetable, and high discretionary food intake); (2) Active healthy eaters (high outdoor play, high fruit and vegetable intake, low screen time and videogame use but high quiet playtime); and (3) Active unhealthy eaters (high sleep, high physical activity, high MVPA, low sedentary time, low fruit and vegetable consumption and high discretionary food intake).

Conclusions: Health behaviours co-occur, and considering lifestyle patterns rather than individual behaviours is likely to be more effective in planning and promotion of prevention and intervention strategies targeted at improving health outcomes in children. This patterning of behaviours warrants an integrative approach to target complex multi-faceted issues like obesity. Much as dietary patterns have helped understanding of associations between diet and health, lifestyle patterns may potentially improve understanding of how behaviours influence health.

Purpose

To determine the feasibility and efficacy of a 12-session (6-week) martial arts-based intervention (Kick-Smart). The intervention aims to address the current high levels of physical inactivity among children, decline of mathematics performance in Australian Schools, and current trends in the area of well-being, with mental health issues (e.g. anxiety and depression) representing one of the largest burdens of disease among adolescents. The intervention meets both Mathematics and Health & Physical Education learning outcomes for upper primary school students.

 

Methods

Kick-Smart was conducted at one school in Newcastle, Australia from July-September 2019; and involved primary school children 9-11yrs (n= 46; 10 ± 1.0yr; Female = 23, Male = 23) who were randomised into control (n=25) or treatment (n=21) conditions. Kick-Smart included various aerobic and muscular fitness exercises, and techniques from a range of martial arts including Karate and Pankration, lasting 40-45 minutes. Each session concluded with a discussion on ethical development concepts. Participants attended 2 sessions/week for 6 weeks. Outcomes included: physical fitness (Standing Broad Jump Test, 20m Repeated Shuttle Run Test, 90° Push-up test), and academic achievement (One Minute Basic Number Fact Test [OMBNFT]), Process evaluation measures were used to assess program feasibility. Linear mixed models were fitted and Cohen’s D effect sizes were calculated.

 

Results/findings

Significant group-by-time effects favouring the Kick-Smart group for muscular fitness (90° Push-Up Test [p<.0001]), and Academic Achievement (OMBNFT-Addition [p=.000]), while OMBNFT-Multiplication approached significance (p=0.055). Process evaluation results show a recruitment rate of 92% with 46 out of 50 students returning signed consent forms to participate in the study. From the 46 participants, 44 students completed baseline assessments and follow-up assessments (96% retention). All twelve sessions were delivered as intended by members of the research team. Student attendance rates were 85.66% (indicating high levels of adherence). Student evaluation surveys rated highly in all areas: enjoyment (x̄=4.1), perceived benefits (x̄=4.4), and future plans (x̄=4.0).

 

Conclusions

Preliminary findings indicate that Kick-Smart is effective for improving fitness and mathematics outcomes, and is feasible for delivery in primary schools. Building further support for effectiveness of Kick-Smart via a larger RCT in varied locations and school settings is recommended.

Abstract: Physical activity (PA) and sedentary time (ST) assessment are of particular importance in the promotion of health in young people. However, there is no comprehensive overview of PA and ST from national surveys among Chinese children and adolescents.

Methods:

Following a literature search for Chinese national health surveys, this study focused on searching papers or articles from nationwide surveys. Eight surveys were targeted, of which were Chinese Youth Risk Behavior Survey (CYRBS), Physical Activity and Fitness in China—The Youth Study (PAFCTYS), China Health and Nutrition Survey (CHNS), Global School-based Student Health Survey (GSHS), National Physical Fitness and Health Surveillance (NPFHS), Chinese Children Dietary Index (CCDI), China Education Panel Survey Junior High Cohorts study (CEPS) and China’s Report Card. 10 eligible papers were obtained and one additional paper was found through filtering the reference lists of the 10 papers. In sum, 11 paper met the inclusion criteria for further analysis. Data on publication year, measures, PA and ST prevalence were extracted.

Results:

Of the 11 included studies (published from 2007 to 2019), the majority applied self-reported questionnaires to estimate PA and ST prevalence, whereas only one paper employed accelerometer to assess PA and ST prevalence among Chinese children and adolescents. Owing to different cut-offs to determine PA and ST prevalence, the ranges of overall PA and ST prevalence among Chinese children and adolescents over the past decade were from 5.6% to 35.4%, and from 7.1% to 78%, respectively. It also found that male or younger children and adolescents showed higher PA prevalence, but there was no clear pattern of ST prevalence among Chinese children and adolescents.

Conclusion:

A large variation in PA and ST prevalence was observed. Such variations were attributable to methodological and practical issues. This study highlights the current gaps in estimating national PA and ST prevalence among Chinese children and adolescents, which should be addressed. Standardized measurement protocols to estimate PA and ST prevalence more accurately among Chinese children and adolescents are urgently required.

Purpose: Physical activity is a key behavior for obesity prevention and treatment, particularly for vulnerable populations such as pregnant women and young children. Physical activity patterns, however, are complex. Characteristics of these activities, such as intensity, duration, variation, and temporality, likely have differential influences on health. Standardized methods to analyze these data, specifically for pregnant women or using ankle-worn accelerometers, do not exist. Thus, the overall objective of this project was to use innovative data-based methods for analyzing accelerometer data in pregnant women.

 

Methods: This study utilized data from the GLOWING study (clinicaltrials.gov identifier: NCT01131117) at the Arkansas Children’s Nutrition Center. 224 women (88% white, 96% non-Hispanic) in their first trimester (12 weeks) of pregnancy wore Actical accelerometers (Phillips Respironics, etc) on their ankle for 7 days, 24 hours per day. Demographics, height and weight were assessed using standard methodologies. Body composition of their offspring was assessed at 24 months using quantitative nuclear magnetic resonance (EchoMRI-AH, EchoMRI, Houston, TX). An iterative process will be used to explore the data and associations between activity metrics with mothers’ characteristics and children’s body composition outcomes.

 

Results: 208 participants were included with at least 5 days of monitoring. Using the data-based methods, we were able to infer total activity, regularity and quantity of sleep, sedentary time, and the pattern of activity between days to describe activity patterns. This last metric leverages a signal processing method, namely “dynamic time warping,” to quantify pattern behaviors in daily routines with values ranging from zero to one; values closer to zero indicate more regular behaviors. Mean total activity counts were 1,343,234 (SD 518,518.1) and total sleep was 7.9 hours per day (SD 2.6). The mean patternicity score was 0.14 (SD 0.08). Early analyses demonstrate the efficacy of these metrics in predicting physical parameters of the mother (i.e. BMI), and analysis of the correlations between these metrics and their children are ongoing.

 

Conclusions: Building on existing literature in activity recognition with accelerometers, our study introduces additional metrics from ankle-worn accelerometers using these data-based methods. These metrics may be helpful in understanding patterns of activity in pregnant women.

 

Purpose: Children from low and middle income countries (LMICs) with micronutrient deficiencies have increased mortality risk, poor growth and high soil-transmitted helminth (STH) infections[1]. Undernutrition, especially stunting (height for age z-score < -2 SD (HAZ))—leads to increased risk of obesity in adulthood [1] in communities transitioning to a westernized lifestyle. This can cause overweight and undernutrition at the same time, creating a public health burden. The purpose of this study was to determine the association between physical activity behavior, nutritional and socioeconomic status and the prevalence of STH and anemia in male and females. Methods: In 2019, data of 1 300 primary schoolchildren (6-12 years) from four public schools located in marginalized areas were collected in Port Elizabeth (South Africa) as part of the baseline assessment of the KaziAfya study. Nutritional status was determined by anthropometry of children including height. Stunting was defined according to WHO growth reference [2]. The Kato-Katz thick smear technique was used assessing STH infections in stool samples. Objective moderate-to-vigorous physical activity (MVPA) was measured with ActiGraph GT3X+ accelerometer. Socioeconomic status (SES) was assessed through questionnaires completed by caregivers. Multiple linear regression analysis were used to determine associations with physical activity. Results: A complete dataset was available for 536 children. The prevalence of stunting was 7.3% (N=39). 74.3% (N=398) children reached MVPA ≥ 60 min. Higher PA was observed in children with higher STH infections (p=ns), lower HAZ (p=ns) and lower hemoglobin levels (p=ns). Multivariate analysis indicated higher MVPA in boys (aOR=0.166, 95% CI 0.102-0.273, p<0.001), younger children (β= -0.031, p=ns) and lower SES (β= -0.031, p=ns). Conclusions: Children’s health and physical activity capacity is of great interest. A high prevalence of children with MVPA> 60 min/day was found. Further observations show that stunting and anemia are negatively and STH positively associated with PA, although not significant. Therefore, further research is needed to understand the relationship of PA and health related risk factors. 1. De Lucia Rolfe, E., et al., Associations of stunting in early childhood with cardiometabolic risk factors in adulthood.PLOS ONE, 2018. 13(4): p. e0192196. 2. de Onis, M., Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 2007. 85(09): p. 660-667.

Purpose: Aotearoa/New Zealand has the second highest rate of childhood obesity in the OECD. In 2012, the Taranaki District Health Board and Sport Taranaki implemented a multidisciplinary community-based programme, Whānau Pakari, for tamariki (children) and rangatahi (adolescents) affected by obesity in the Taranaki region. A randomised control trial (RCT) was embedded within the programme to assess efficacy of the service. The aim of our research was to investigate associations between the clustering of food and activity destinations, and children’s dietary behaviours and physical activity from the Whānau Pakari cohort, using novel child-specific geospatial methods.

Methods: This research is a retrospective observational cross-sectional study involving a subset of the cohort of 239 children and adolescents who were enrolled in Whānau Pakari. As part of the RCT, enrolled children completed a physical activity questionnaire and comprehensive dietary history. Our study expands upon the RCT by investigating links between participants’ health behaviour and outcome data, and children’s nutrition and physical activity environments. Geospatial data collated from New Plymouth District Council and several open-data sources were integrated to develop novel child-specific environmental measures related to children’s homes and schools.

Results: Exploratory analyses of the data examined associations between physical activity, diet, and novel environmental measures. Preliminary findings suggest that the food and activity environments surrounding children’s homes and schools are associated with the physical activity and dietary behaviours of Taranaki children.

Conclusion: Our novel approach to investigating child-specific measures of food and activity environments provides new evidence of the relationship between the environment and child health. We show that data linking and testing novel geospatial methods allows the influence of environmental factors on child health to be considered. This research provides evidence to improve the effectiveness of public health interventions and district planning, and gives the community information to improve the built environments for tamariki and rangatahi of Taranaki.

Purpose: Understanding sources of measurement error in self-reports of diet is important for advancing methods. Wearable cameras are an emerging method of observing dietary intake in natural environments. The aims of this study were to compare energy and nutrient intakes from 24-hour recalls with and without inclusion of foods from images collected using automated cameras in adolescents.

Methods: Adolescents 13-17 years (n 168) living in Dunedin, New Zealand were recruited to take part in research investigating pre-bedtime behaviours and sleep between January 2018 and May 2019. Adolescents wore a Brinno TLC120 camera from 5pm until bedtime for three evenings set to capture an image every 15 seconds. An interviewer administered 24-hour recall was completed on the day following the third evening of wear. Foods not reported in the recall were identified in the images. Nutrient intakes (energy, macronutrients, potassium, calcium, iron, beta-carotene, vitamins A, B6, B12, C) from the 24-hour recall were calculated before and after inclusion of foods identified from images.

Results: 51 boys and 68 girls wore the camera and completed a 24-hr recall the following day.  Nearly 40% of participants forgot to report at least one food or beverage for the evening of the 24-hour recall. Most commonly these were biscuits, cakes and muffins (14%) and sweetened beverages (14%) followed by bread, vegetables and bread-based dishes (5%) (e.g. pizza and sandwiches). Energy intake was 5% greater with inclusion of images for boys (mean difference: 530 kJ; 95% CI: 101, 958) and 3% greater for girls (mean difference: 230 kJ; 95% CI: 107, 352). 

Conclusions: Although only worn after 5pm and capturing an image every 15 seconds the use of an automated camera with 24-hr diet recalls modestly increased estimates of energy and other nutrients. Baked snacks and sweetened beverages were most often forgotten or excluded in the dietary recall.

Purpose: Nordic Walking is an increasingly popular form of all-body exercise with good evidence of effectiveness for improving cardiorespiratory fitness. The use of poles makes it a suitable activity for individuals with musculoskeletal problems or other conditions that may restrict weight-bearing exercise. Furthermore, elements integral to Nordic Walking such as group interaction, outdoor exposure and skill development are recognised contributors to psychological wellbeing. This study examined the health and wellbeing profile of Nordic Walkers in the United Kingdom and explored factors associated with wellbeing.

Methods: A health and wellbeing questionnaire was distributed via British Nordic Walking communication channels to adult Nordic Walkers in the United Kingdom. Self-report measures included health, disability and pain status (UK Census), wellbeing (Warwick Edinburgh Mental Wellbeing Scale), group cohesion (Group Cohesiveness Scale) and nature connectedness (Nature Relatedness Scale).

Results: A total of 411 participants completed the questionnaire (84.4% female) with a mean age of 61.1 ± 9.9 years. The proportion of the sample reporting a limiting disability/illness (25%) was higher than documented in national statistics for the general adult population (18%) as was the percentage reporting chronic pain (47% versus 34% in the general population). Overall wellbeing scores were higher among Nordic Walkers (53.1 ± 8.1) than the general population (50.1) although they were significantly lower among those reporting disability (50.5) and chronic pain (51.8). Three factors had small independent associations with wellbeing scores. Group cohesion (β = 0.18; p = 0.001) and nature relatedness (β = 0.13; p = 0.011) were positively related to wellbeing and pain scores (β = -0.15; p = 0.003) were negatively related.

Conclusion: Nordic Walking is a suitable activity for individuals with limiting disabilities or chronic pain and is associated with high levels of psychological wellbeing. Higher levels of group cohesion and nature relatedness were associated with increased wellbeing.

Purpose: While research supports an association of sugar-sweetened beverage (SSB) consumption with adiposity among children, one critical gap is understanding the cumulative effect of SSB consumption throughout childhood on future health. Thus, the objective of this study was to estimate the causal effect of SSB intake throughout childhood on mean BMI z-score in early adolescence. Because most guidelines recommend that SSBs should be restricted, we estimated what would happen to adiposity if all children consumed 0 servings/day of SSBs, versus >0 servings, throughout childhood. Our approach has key advantages over previous studies through the use of inverse probability weighting (IPW), a method which can be used in observational studies to validly estimate the cumulative effects of exposures which vary over time and may affect, and be affected by, confounders that also vary over time.

 

Methods: We analyzed data from Project Viva, a prospective cohort of 2128 mother-child dyads in Massachusetts. Daily servings of child SSBs (soda and fruit drinks) were reported by parents annually from ages 7 to 11. BMI z-score was assessed in early adolescence (mean age=12.9 years). We estimated the effects of maintaining SSB intake at 0 versus >0 servings/day from ages 7-11 on BMI z-score in early adolescence using IPW of marginal structural models (MSM). Confounders and selection factors for censoring that change over time (physical activity, TV, sleep, and fast food) were adjusted for using stabilized weights, while baseline covariates (race, sex, breastfeeding, diet quality at year 7, BMI at year 7, and maternal pre-pregnancy BMI) were included directly in the MSM.

 

Results/findings: Our baseline sample included 578 children with age 7 exposure measurements (52% female; 72% non-Hispanic White), with 34% of children consuming 0 SSB servings/day. By the end of follow-up, 240 participants remained uncensored. The estimated difference in mean BMI z-score in early adolescence associated with maintaining SSB consumption at 0 versus >0 servings/day was -0.11 (95%CI: -0.50, 0.23).

 

Conclusions: Our point estimate suggests that children should avoid drinking SSBs throughout childhood to prevent against weight gain, but estimates were imprecise due to small sample sizes and may still be subject to unmeasured confounding.  

Purpose: Unhealthy food environments may contribute to an elevated Body Mass Index (BMI), a major disease risk factor. Yet, it is unclear which measure most accurately reflects the food environment. Moreover, potential mediating factors within the association between the food environment and BMI need further investigation. We compared associations between fast-food outlet exposure, healthy food outlet exposure, the ratio between fast-food and healthy food outlet exposure, and the percentage fast-food outlets out of total (fast-food, healthy, and neutral) food outlets with BMI. Furthermore, we examined to what extent these associations were mediated by diet quality.

Methods: We linked baseline adult data of the Lifelines cohort study (N=147,027) to retail outlet location data using geo-coding. We computed four exposure measures within 1-kilometre(km)-density around participants’ residential address; number of (1) fast-food outlets, (2) healthy food outlets, (3) ratio between fast-food and healthy food outlets, and (4) percentage fast-food outlets out of total (fast-food, healthy, and neutral) food outlets. We measured diet quality by the Lifelines Diet Score. We used multilevel linear regression and mediation models adjusting for age, sex, partner status, education, employment, neighbourhood deprivation, urbanization, sport facility density, and adjusted exposure measures for one another.

Results: Participants had a mean BMI of 26.1 (SD 4.3) kg/m2. Participants living with five or more fast-food outlets had a higher BMI than participants with no fast-food outlet within 1 km (B=0.17,95% CI:0.06,0.28). Participants living with relatively many fast-food outlets (50-75% of total food outlets) had higher BMI than participants with relatively few fast-food outlets (<25% of total food outlets) within 1 km (B=0.13,95% CI:0.03,0.22). Healthy food outlet exposure and the ratio between fast-food and healthy food outlets were not associated with BMI. Diet quality did not explain any observed association.

Conclusions: Fast-food outlet exposure may be an important risk factor for an elevated BMI. Policy-makers should specifically target fast-food outlets, rather than healthy food outlets, to create healthier food environments.

Purpose: Fast-food outlet exposure may be associated with elevated Body Mass Index (BMI), which is a risk factor for various chronic diseases. Yet, evidence on this association is inconsistent due to a lack of accurate and comprehensive exposure measurement. We examined the association between residential fast-food outlet exposure, in terms of proximity and density, and BMI in the Dutch adult general population. Additionally, we investigated to what extent this association was modified by urbanisation level and mediated through daily caloric intake.

Methods: We linked residential addresses of baseline adult Lifelines cohort participants (N=147,027) to fast-food outlet locations using geo-coding. We computed residential fast-food outlet density within 500 metres(m), and 1, 3, and 5 kilometres(km), and proximity. Urbanisation level was defined as living in an urban (≥1,000 addresses/km2) or rural area (<1,000 addresses/km2). Daily caloric intake was measured using a Food Frequency Questionnaire and food composition database. We used stratified (urban versus rural areas) multilevel linear regression and mediation models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation, and address density.

Results: Participants had a mean BMI of 26.1(SD 4.3) kg/m2. In urban and rural areas, having five or more fast-food outlets within 1km was associated with a higher BMI (B=0.40, 95% confidence interval (CI): 0.12, 0.69; B=0.23, 95% CI: 0.10, 0.36, respectively). Furthermore, participants in urban and rural areas with a fast-food outlet within <250m had a higher BMI (B=0.30, 95% CI: 0.03, 0.57; B=0.20, 95% CI: 0.09, 0.31, respectively). In rural areas, participants also had a higher BMI when having at least three fast-food outlets within 500m (B=0.19, 95% CI: 0.09, 0.29). Associations were stronger in rural than urban areas for 500m density, and were not explained by daily caloric intake.

Conclusions: The presence of fast-food outlets within 1 km is associated with BMI. Although we cannot rule out reverse causation, this study provides entry points for policy-makers to create healthy living environments.

Purpose: Arterial stiffness is an independent risk factor for cardiovascular disease (CVD) and can be beneficially influenced by physical activity. However, it is not clear how physical activity pattern over a week is associated with arterial stiffness. Therefore, we examined the associations of the amount and the pattern of higher intensity physical activity with arterial stiffness. 

Methods: Data from The Maastricht Study (n=1699; mean age: 60±8 years, 49.4% women, 26.9% type 2 diabetes (T2DM)) were used. Arterial stiffness was assessed by carotid-to-femoral pulse wave velocity (cfPWV) and carotid distensibility (carotid DC). The amount (hours/day) and pattern of higher intensity physical activity were assessed with the activPAL3®. Activity groups were: inactive (<75min/week), insufficiently active (75-150 min/week), weekend warrior (>150 min/week in ≤2 sessions), and regularly active (>150 min/week in ≥3 sessions). 

Results/findings: After adjustment for demographic, lifestyle, and cardiovascular risk factors, higher intensity physical activity was associated with lower cfPWV (amount: -0.35[-0.65;-0.05], insufficiently active: -0.33[-0.55;-0.11]; weekend warrior: -0.38[-0.64;-0.12] and regularly active: -0.46[-0.71;-0.21] (reference: inactive)). These associations were stronger in those with T2DM. There was no statisticaly significant association between higher intensity physical activity with carotid DC.

Conclusions: Participating in higher intensity physical activity was associated with lower cfPWV but there was no difference between the regularly actives and the weekend warriors. From the perspective of arterial stiffness, engaging higher intensity physical activity, regardless of the weekly pattern, may be an important strategy to reduce CVD risk, particularly in T2DM.

Purpose: Dystonia is a neurological movement disorder that presents as sustained or intermittent involuntary muscle contractions causing abnormal postures and movements. Physical activity (PA) is an important aspect of neurological disease management, with wide-ranging benefits for overall health and quality of life. No studies have quantified PA and sedentary behaviour (SB), nor explored barriers to being physically active in people with dystonia.

Methods: Participants diagnosed with dystonia completed a mixed-methods anonymous online survey on activity behaviours. The International Physical Activity Questionnaire (IPAQ) and Adult Sedentary Behaviour Questionnaire (SBQ) assessed self-reported PA and SB. Barriers to exercise engagement were investigated according to the five-factor social-ecological framework and dystonia-specific questions regarding the impact of exercise on symptoms were included.

Results: Two-hundred and sixty-three participants consented to the study (mean (SD) age = 55 (13) yrs, 76% Female). A large proportion of respondents (40%) reported living with cervical dystonia. Overall, the median (IQR) time spent in walking, moderate, and vigorous activity was 60 (0-120), 120 (15-300) and 0 (0-13) mins/day respectively. SB time during weekdays was 285.0 (157.5-465.0) mins/day and 345.0 (195.0-502.5) mins/day on weekends. Fifty-five percent of participants were dissatisfied with their current level of PA and 75% reported dystonia had decreased their level of PA. Fifty-seven percent found their symptoms were worsened during exercise though the after-effects on symptoms varied. Fatigue, motor symptoms, pain, and poor balance were commonly cited limiting factors. Qualitative and quantitative data indicated difficulties with more vigorous intensity activity. The common barriers to engagement were personal and governmental factors, such as physical impairments, lack of funding and lack of trained exercise professionals.

Conclusions: While more than half of respondents indicated they were not satisfied with their current level of PA, and exercise primarily worsened their dystonia symptoms, most participants were meeting the minimum guidelines. Future studies should incorporate more robust methods of PA and SB measurement and explore the mechanisms underpinning exercise-induced aggravation of dystonic symptoms to enhance life participation of people living with dystonia.

Purpose: 

To systemically synthesise current literature on the impact of interventions with a culinary education component for women and their partners during pre-conception, pregnancy or post-partum, on parental cooking skill efficacy, nutrition knowledge, parent/child diet quality or health outcomes.

Methods: 

Eleven electronic databases were searched for experimental design studies published from 2003 to October 2019. The search strategy was limited to experimental study designs, that included cooking/culinary education as a standalone intervention or as part of a multicomponent intervention during preconception (≤24 months prior to conception), pregnancy or the postpartum period (≤5 years) on parental cooking skill efficacy, nutrition knowledge, parent/child diet quality or health outcomes. Two reviewers assessed study eligibility and methodological quality using the American Dietetic Association Quality Criteria Checklist for Primary Research. Key study characteristics and outcomes were extracted by one reviewer and checked by a second reviewer. 

Results: 

Of 6922 articles identified from the search, 30 experimental design studies (12 randomised controlled trials [RCTs]) were included. The recruited population samples included pregnant women (n=6 studies), post-partum (n=11 studies) and post-partum parents/caregivers (n=13 studies). There were no studies conducted during the pre-conception period. Seven studies were standalone cooking/culinary education interventions. Most included studies reported improvements in parental and child dietary intake (n=18 studies), parental nutrition knowledge and attitudes (n=11 studies), parental and child eating behaviour (n=4 studies), parental cooking skills and confidence (n=8 studies) and parental and child health outcomes (n=15 studies). However, 18 of 30 studies did not reported a power calculation for the study sample size, 32% of studies had no control group and 18 of 30 studies did not follow-up participants beyond post-intervention.

Conclusions: 

More evidence is needed from RCTs that include cooking/culinary education as the primary intervention focus, and with long-term follow-up. High quality evidence will be important for determining effectiveness of cooking intervention in pregnancy on cooking confidence and skills, dietary intake, nutrition knowledge and health outcomes. 

PURPOSE: To determine if alcohol consumption is associated with aortic stiffness in college-aged men and women.

METHODS: A cross-sectional analysis of young men and women was performed within a University campus setting in the USA to determine if daily alcohol consumption was correlated with indices of arterial stiffness. To determine regular dietary intake, the National Institute of Health’s Dietary History Questionnaire-II (DHQ-II) with portion sizes was used, assessing dietary habits over the past year. The primary outcome of this study was aortic stiffness as determined by carotid-femoral Pulse Wave Velocity (cfPWV). Dietary correlations were assessed via univariate linear regression, and forward selection multiple linear regression was employed to verify results identified in univariate linear regression. Statistical analyses were conducted with SAS 9.4.

RESULTS/FINDINGS: Subjects in this study included 50 college-aged (21.48±0.29 years) men and women (n=50, 70% female) that ranged from normal weight to obese (Body Mass Index, BMI=25.41±1.09 kg/m²). The mean aortic stiffness, as determined by cfPWV, was 5.93 ± 0.10 meters/second. Daily dietary habits among these college students included a mean caloric intake of 1,849.44±138.21 calories per day (46.2±1.0% carbohydrates, 34.5±0.9% fat, and 16.0±0.5% protein). Regular alcohol consumption included 13.94±3.82 grams per day, and alcohol consumption had a positive correlation with cfPWV (R²=0.102, P=0.024). Furthermore, alcohol consumption accounted for an average 5.25±1.02% of daily calories for our sample of college students, and the percentage of energy from alcohol had a slightly stronger positive correlation with cfPWV (R²=0.118, P=0.015). Percentage of total energy from alcohol, but not regular alcohol consumption as reported in grams, prevailed in forward selection multiple linear regression (R²=0.118, P=0.02) and was the strongest dietary predictor of cfPWV among college-aged individuals.

CONCLUSIONS: Among college-aged men and women, where alcohol consumption is generally increased, alcohol consumption and total percent energy from alcohol predict aortic stiffness. Additionally, the total percent energy from alcohol may be the strongest nutritional predictor of aortic stiffness among college-aged individuals.

 

Purpose: The global economic burden of non-communicable diseases is significant and on the rise. Pharmacological intervention is often the choice of the initial intervention, although exercise is considered a cost-effective alternative. This study aimed to determine the relationship between physical activity, physical fitness, and medication prescribed for risk factors of NCDs in a low-resource community of Potchefstroom, South Africa.

Methods: Participants (n=200) were recruited from a convenience sample in a catchment area of two public healthcare clinics for this observational study.  Prescribed medication was collected from clinic records. Objective physical activity data were collected over seven consecutive days by combined heart rate and accelerommetry (ActiHeart®). Cardiorespiratory fitness was measured with a step test and risk factors for NCDs with measurements of blood pressure, body composition, and peripheral blood.  Partial correlation coefficients were calculated, adjusted for age, to determine the strength of the association between prescribed medication for risk factors of NCDs and physical activity and cardiorespiratory fitness with an alpha level of p ≤ 05.   

Results: Results from the 180 participants with an average age of 59,4 years, indicated that the women were classified on average as obese (BMI = 32,1 kg/m²). Hypertension was prevalent in 52% of the participants and Diabetes Mellitus type 2 in 15,6%. The partial correlation analyses found a significant inverse relationship between medicine usage and cardiorespiratory fitness (r = -0,23; p<0.001), physical activity as counts per minute (r = -0,18; p = 0,01) and moderate-to-vigorous physical activity (r = -0,15; p = 0,04). 

Conclusion: Data from the present study suggests that prescribed medication use is inversely associated with high cardiorespiratory fitness and moderate to vigorous physical activity levels. Implementation of exercise interventions to increase physical activity levels could assist in lowering the cost of medication for non-communicable diseases in low-resourced communities.

Purpose:         People with a mental health condition experience higher morbidity and mortality rates of chronic physical health conditions, are more likely to be overweight or obese, and engage in higher rates of health risk behaviours, including poor nutrition, and physical inactivity.  To date, research evaluating telephone support services for reducing health risk behaviours other than smoking cessation in people with a mental health condition has been largely limited to small intervention trials. This paper will report the conduct of a trial underway to evaluate the effectiveness of an existing population-level telephone support service in reducing these health risk behaviours in people with a mental health condition.

 

Methods:        A randomised controlled trial is being conducted with clients of multiple community mental health services in New South Wales (NSW), Australia with a range of mental health diagnoses.  Study data is collected via computer-assisted telephone interview (CATI) at baseline and follow-up at 6 months post-recruitment.  After baseline data collection, participants are randomly allocated to receive either a self-help information pack (control), or the information pack and an active referral to the NSW Get Healthy Information and Coaching Service (intervention): a free, population-level telephone coaching service to support clients to improve nutrition, increase physical activity, or reduce alcohol consumption.  Primary outcomes include fruit and vegetable consumption, physical activity (SIMPAQ), and attempts to change these behaviours over the past six months.  Secondary outcomes include change in weight, waist circumference, Body Mass Index (BMI), psychological distress (Kessler-6), quality of life (AQoL4D), and client-reported interest and confidence to change health risk behaviours.  Process outcomes such as intervention uptake, and completion will be assessed using data collected by the service.  

 

Results:          Ninety-four participants have been recruited to the study to February 2020, allocated in a 4:1 ratio to Intervention and Control conditions, with recruitment continuing to June 2020 

 

Conclusions: The results of this study will provide valuable evidence as to the potential or otherwise of an existing population-level, telephone-based support service to deliver preventive care for chronic disease to this vulnerable population.  

People with a mental health condition experience a disproportionate burden of chronic disease, and consequently die a median of 10 years earlier than the general population. This is contributed to by a higher likelihood of engaging in modifiable risk behaviours, including inadequate physical activity. The aims of this study were to determine, among a sample of people with a mental health condition, engagement in physical activity and interest in behaviour change. 

 

A cross-sectional telephone survey was undertaken with clients (with a range of psychiatric diagnoses) of community mental health services in NSW, Australia (N=77). Participants were asked to report their engagement in physical activity and sedentary behaviours using the Simple Physical Activity Questionnaire (SIMPAQ). Participants self-reported their interest and confidence in changing their physical activity on a scale of 1 to 10 (10 being the highest), and any attempts to change their physical activity in the last 4 months. 

 

Preliminary findings indicate that the average number of minutes walking per day was 45.70 (SD 82.02); on an average of 3.78 (SD 2.64) days each week. On average, participants reported 11.75 (SD 22.40) minutes of exercise or sport per day on 1.32 days per week (SD: 2.09); with 55.84% of participants reporting no exercise/sport each week. Participants spent an average of 72.83 (SD 112.39) minutes doing other activities (such as gardening or chores) each day. An average of 12.11 (SD 3.49) hours of sedentary time with an additional 50.57 (SD 68.15) minutes spent napping each day was reported. The proportion of participants with high ratings (7+) of interest in changing their physical activity (59.74%) was greater than those with high confidence (42.86%). 61.04% of participants had attempted to change their physical activity.

 

Although most participants were interested in changing their physical activity and were attempting changes, ratings of confidence to change were low. These results, coupled with the finding that a high proportion were not engaging in any exercise or sport activities, suggests there is need to identify effective, population-level supports to encourage people with a mental health condition in making positive lifestyle changes.

Purpose:

Cardiovascular disease (CVD) is a global leading cause of mortality and disease burden. Despite the abundance of information on CVD risk factors and CVD risk calculators, most have modest understandability and lack provision of actionable information. There is a need to increase the understandability and actionability of CVD preventative interventions to improve their usefulness to individuals and augment the adoption of healthier lifestyles at population level. Here we describe the design and development of an evidence and theory-based digital health CVD preventative behaviour change intervention.

Methods:

Singapore HeartAge is an online screening tool adapted to the Singapore population to communicate CVD risk. A HeartAge score higher than chronological age will refer individuals to HOPE, a digital e-counselling platform aimed at supporting individuals adopting and maintaining heart-healthy lifestyle behaviours. HOPE (Healthy Living with Online suPport and Education) is a motivational interviewing- and cognitive behavioural therapy-based intervention to provide content tailored to individuals’ CVD risk factors, readiness to change, and motivation level. It builds upon evidence and know-how of prior trials – REACH, CHF-CePPORT – and its design is guided by the Behaviour Change Wheel intervention development framework and component diagnostic tool COM-B.

Results:

Preliminary work established the feasibility of HeartAge for risk communication. The design and technical implementation of HOPE is ongoing. HOPE will be delivered over 24 weekly modules, each consisting of text-based content (e.g. self-help tips), interactive tools (e.g. linking a behaviour change goal to a salient personal priority), VideoScribe didactic animations, and a dramatic / immersive (i.e. 10 scripted episodes with fictional characters aimed at modelling, validating and reinforcing individuals’ active role in lifestyle change), unscripted peer-discussions, or expert (e.g. nutritionist, physician) video.

Conclusions:

HOPE will be a comprehensive intervention targeting modifiable cardiovascular risk factors, including diet, physical activity, sedentary behaviour, stress management, medication adherence, and smoking. It will be a fully automated semipersonalised web-based intervention for cardiovascular disease prevention. Content for each individual will be selected via a predefined algorithm / schedule for 24 weeks dependent on baseline risk factor assessment (HeartAge) and characteristics (e.g. readiness to change).

Purpose

Physical activity has been identified as a best buy in public health. Health professionals providing tailored advice and referral to physical activity opportunities is a promising approach to promoting greater physical activity. This may be particularly beneficial for high- risk groups such as people with disabilities and older adults who generally have the lowest physical activity participation.

The PROPOSE study (Professional Referral to Physical Activity, Sport and Exercise) aims to enhance health professional promotion of physical activity and referral to appropriate community exercise opportunities. The present survey of health professionals was undertaken in order to design the intervention for the PROPOSE study. This survey aimed to identify current practice, knowledge, attitudes and barriers to physical activity promotion by health professionals within clinical settings.

Methods

Health professionals from metropolitan hospitals in Sydney, Australia were invited to participate. Participants completed a paper-based survey that included questions about their current practice, knowledge, attitudes and barriers in physical activity promotion to people aged 50+ and/or people of any age with physical disabilities.

Results

Sixty nine participants (62, 90% physiotherapists, 41, 59% female) were recruited from nine metropolitan hospitals between July and December 2019. Most reported discussing physical activity with their clients (47, 68% reported doing this often/frequently with clients who could be more active), providing tailored advice about increasing physical activity (38, 55%) and setting physical activity goals (38, 55%). Participants reported being unlikely to: attend structured exercise opportunities with a client (59, 85% report never or rarely doing this); contact providers of exercise opportunities (51, 74%); or assess physical activity using a questionnaire or activity monitor (43, 62%). The most common barrier reported was client access to transport (48, 70%). Most participants (48, 70%) were interested in learning more about promoting physical activity to their clients.

Conclusion

Surveyed health professionals reported some promotion of physical activity to older people and people with disabilities in clinical practice, with room for improvement and interest in learning more.

 

Purpose: Arab ethnic groups in the UK are at higher risk of developing type 2 diabetes (T2D) compared to the majority population, yet, there is limited culturally-tailored research aimed at reducing health disparities to improve T2D risk. The aim of this study was to explore the feasibility and acceptability of data collection and potential intervention components for a T2D prevention programme targeting Arab ethnic groups. 

Methods: The study was underpinned by behavioural change theory and the UK Medical Research Council's guidance on the iterative development of complex interventions. Measures included 24-hour dietary recalls, the International Physical Activity Questionnaire, body mass index, blood pressure and HbA1c. Ten intervention sessions were planned to improve diet and increase physical activity (PA), which included seven gender-specific PA, nutrition and cooking workshops; a health promotion event; and two Friday sermons delivered by local faith-leaders which incorporated messages promoting favourable health-related behaviours. One of the PA sessions, the health event and sermons were delivered in mosques. Sessions were evaluated using questionnaires incorporating Likert scales e.g. on the usefulness of new information, ranging from 1-5 (1=poor; 5=excellent), and qualitative interviews.

Results: Participants included 69 men and women aged 18-62 years who self-identified as being of Arab ethnicity. There was 100% completion of all measures and 0% missing questionnaire data, indicating the measures were feasible and acceptable. The four mosque sessions were successfully delivered; however, low recruitment prevented the delivery of the remaining six sessions that lacked a community-based collaborative element. All sessions evaluated well, e.g. overall, 67% of participants rated the new information three and above on the Likert scales. Qualitative analysis suggested that participants felt they would benefit from Friday sermon components and were inspired following the sessions to make positive changes to their diet and PA.

Conclusions: The measures and faith-based components, such as Friday sermons, were feasible and acceptable and could potentially lead to positive lifestyle modifications. A pilot study is needed to further explore proof of concept, prior to testing effectiveness and sustainability in community settings for UK Arabs.

Purpose: Prior work has demonstrated a single bout of aerobic exercise of moderate-to-vigorous intensity confers benefits to executive functions (EFs). The purpose of this study was to determine whether aerobic exercise-driven improvements to EFs are present at very light and/or light intensities via a hands-, language-, and numerosity- free oculomotor task which is highly sensitive to subtle changes to EFs.

Methods: A cross-over counterbalanced design was employed to assess EF benefits. A cardiorespiratory fitness assessment on a cycle ergometer (VO₂ max) was implemented to ascertain lactate threshold (LT). Following the VO₂ max test, participant’s very light (0% LT), light (40% LT), and moderate (80% LT) were tabulated. Participants performed a 10-min single bout of very light-to-moderate intensity aerobic exercise (i.e., via a cycle ergometer) and pre- and post-exercise control was examined via the antisaccade task (i.e., goal-directed eye movement mirror-symmetrical to a visual stimulus). Antisaccades are mediated via the same frontoparietal circuitry that show task-dependent changes in activity following single bout and chronic exercise, and are therefore an ideal tool for examining post-exercise executive changes.

Results: There was a 24 millisecond (ms) and 14 ms reaction time (RT) reduction in pre- to post-exercise antisaccade RTs for moderate (p<0.000, d=2.819) and light (p<0.000, d=0.824) intensity, respectively. In contrast, no such difference was seen for very light intensity (p=0.381, d=0.352).

Conclusions: Accordingly, we propose that a single bout of acute aerobic exercise improves executive control, and is a finding we attribute to an exercise-induced neuronal efficiency within the frontoparietal networks supporting antisaccades. Furthermore, we propose that the benefits conferred to EFs are dependent on exercise intensity—present at both moderate and light intensity but not at very light intensity.

Purpose: Beverages are important components of overall diet, contributing substantially to hydration and nutrient intake. However, overconsumption of sugar sweetened beverages (SSB) is a global concern, while water consumption is generally inadequate. Mass media campaigns (MMCs) are popular cost-effective approaches to promote healthy behaviors and reach large, diverse populations but their impact on beverage consumption is not well documented. We synthesized information about design, evaluation, and effectiveness of MMCs intended to change beverage behaviors. Methods: We searched five databases (PubMed, EMBASE, CINAHL, Web of Science, CABAbstracts) from inception through February 2019. Eligible studies evaluated MMCs to encourage favorable beverage consumption (e.g., water), discourage unfavorable beverage consumption (e.g., SSBs), or both; were published in English; and measured intake, purchases, or sales. Study screening and extraction were completed independently and in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale (maximum score: 9).​Results: The search yielded 11,101 citations; fifteen studies representing fourteen interventions were included (conducted in North America, n=11; Australia, n=3). Six interventions focused on changing SSB behaviors, six on milk behaviors, and two on multiple beverages (e.g., water and juice). Eight interventions targeted entire communities, four focused on caregivers of young children, and three were culturally tailored for specific racial or ethnic populations. In all interventions, MMCs were delivered using multiple media platforms including television, social media, radio, print, or web. Only two measured outcomes more than one year after campaign introduction, and one compared effectiveness of campaign dissemination approaches. Eleven interventions included at least one significant improvement in a beverage outcome (increasing favorable, n=2; decreasing unfavorable, n=4, combination, n=5), though results across studies were largely not comparable due to inconsistency in measurement. Nine interventions reported reach/intensity. Studies were generally of poor to moderate methodological quality (average score 4/9).Conclusions: Because of variety in study design, outcome assessment, and follow-up, the extent to which MMCs meaningfully change beverage-related behaviors is unclear. Future evaluations should rigorously assess short and long-term campaign impacts using objective data including measures of intensity, reach, and cost-effectiveness.

Purpose: Local, regional and global scientific production and research capacity in the area of physical activity and health-PAH have been identified as strategies for improving public health policies and programs. An unequal distribution of research productivity worldwide was described by the Global Observatory for Physical Activity- GoPA! (ISPAH Council). As part of GoPA! periodic global research monitoring, the aim of this study is to quantify temporal trends and main characteristics of PAH related research worldwide from 1950 to 2019.

Methods: Following PRISMA guidelines, a systematic review of the literature using searches in PubMed, SCOPUS and ISI Web of Knowledge databases was conducted in June 2017 and is currently being updated to include 2017-2019. The search terms used were “physical activity” (title or abstract) and each country name in English (title, abstract, text or affiliation). Standardized methodology is used to determine the number of articles for the 218 world countries. The principal outcome variable is PAH publications per 100,000 inhabitants by country. Descriptive analyses and time-trend analysis of publication rate by decade overall, for each country, and stratified by WHO region, and World Bank income categories will be conducted. Statistical analyses will be performed in STATA version 16.0

Results/findings: Results from the search up to 2016 retrieved 500,777 articles of which 69,165 were duplicates, leaving 431,612 eligible articles. The review of the search results for years 2017, 2018 and 2019 is work in progress at the moment (29/02/2020). After reviewing inclusion and exclusion criteria up to 2016, at least 18,906 were selected for data extraction. Preliminary results show that 99% of the world countries have at least one publication in the area and the Americas and Europe regions have most of the PAH related articles.

Conclusion: This study will contribute with new knowledge about PAH research characteristics at local, regional and global levels, and can support to the development of prevention strategies to reduce chronic non- communicable diseases particularly in countries with the largest data gaps.

Purpose: The use of Social Media Influencers (SMIs) to promote products and brands is an increasingly popular form of marketing, especially targeting young adults. However, little is known about SMIs and whether they are perceived to be authentic and credible. The discipline of nutrition science is currently facing credibility issues in the eyes of the general public, particularly on social media. This study aimed to understand consumer perceptions of SMIs and Nutrition Professionals (NPs), in relation to their credibility and authenticity. Methods: A cross-sectional questionnaire was developed and administered to 153 Undergraduate students in May 2019, with 149 providing complete responses. Participants viewed screenshots of real-life Instagram profiles and two posts from a NP (with tertiary qualifications in nutrition) and a SMI. Main outcomes were authenticity and credibility (i.e., expertise and trustworthiness) measured on 5-point Likert scales. Multiple regression analyses were used to assess credibility and authenticity of both SMI and NP. Covariates included participant gender, perceived attractiveness, familiarity, and likeability of the source (i.e., SMI and NP). Results: Participants were young adults (median age [25th,75th percentile]: 20[19,21]), approximately half were female (54.0%). The SMI profile was significantly more attractive (p= 0.01) and familiar (p<0.001) compared to the NP. However, participants perceived no difference between the SMI’s and NP’s expertise (p=0.78), trustworthiness (p=0.11), or authenticity (p=0.51). Results indicated that attractiveness was the main predictor (p<0.001) of expertise, trustworthiness, and authenticity. Familiarity was a significant predictor of trustworthiness (p<0.001) of the profile but did not predict expertise or authenticity. The post content from the NP was perceived as more authentic and trustworthy than the SMI (p<0.001). Females were more likely to perceive a post as trustworthy and authentic than males (p<0.001). Conclusions: Holding a formal nutrition qualification had no significant effect on perceived expertise, trustworthiness, or authenticity, indicating other factors, such as attractiveness, are more important in forming a judgment of a profile on social media. If appropriate, sharing personal experiences may increase the authenticity of social media content.

 

Purpose: Globally, the prevalence of chronic diseases is increasing with an estimated 422.7 million cases of cardiovascular diseases. Among sub-groups including migrants, the prevalence is also increasing. A major contributory cause to chronic diseases such as obesity and diabetes include access to nutrition and physical activity resources and reducing sedentary behaviors. Although much is known about the barriers to health care and chronic disease risk factors for native populations, less is known about immigrant groups including refugees. Globally, with the increase in immigrants traveling from their native countries, more research is needed to better understand the unique challenges in accessing healthcare as well as nutrition and physical activity resources among this population.

Methods: A literature review was conducted to identify research articles published on the aforementioned topic. Databases from which articles were retrieved include PubMed. Data analysis included identifying descriptive codes to label the data and more advanced/inferential coding to identify patterns or themes and sub-themes.

Results/Findings: Globally, immigrants including refugees and those who resided in border communities faced significant challenges with access to nutrition and physical activity resources, including limited income, language barriers, and acculturation. Interventions that incorporated a trained community health worker and were theory-driven were the most successful. In some low-to-middle income countries, medical interpreters for cross-border immigrants were inadequate in the health care environment. In contrast, in high-income countries that have some form of universal health insurance, these countries made improvements in promoting health literacy among immigrants, providing adequate language interpreters, and delivering training in cultural competency to medical professionals.

Conclusion: Future research should integrate more mixed methodology approaches to learn about the unique challenges in accessing healthcare as well as nutrition and physical activity resources among this population. Future public health initiatives may include improving culturally competency trainings for medical professionals.

Purpose:

Recently, awareness of health disorders caused by prolonged sitting has been increasing. It has been pointed out that prolonged sitting is closely related to the risk of death from cardiovascular diseases, and is a risk factor for obesity and various metabolic diseases. In this study, we measured the physical activity of the staff of the university and were intended to clarify those current situations.

Methods:

Seventeen university employees were recruited as subjects, and physical activity during work was measured for two weeks (10days) using an accelerometer (Lifecorder Suzuken Co.). The physical activity intensities 0 and 0.5 that can be measured by an accelerometer were defined as the physical activity intensity of the sedentary behavior, and their continuous hours were defined as the continuous hours of the sedentary behavior.

Results/findings:

The average working time was 570.4±88.3 minutes per day. The average continuous sitting time was 11.5±3.9 min. The continuous sitting time for one sitting was not long, but the total sitting time in the working hours per day was 67±8%. Previous studies show that adults spend for sitting 55-60% of their time per each day. The results of this study indicate that the percentage of sitting behavior in working hours during the day was greater than in previous studies.

Conclusions:

The university staff took up sitting time for about 70% during working hours, and it was clear that they sat for 6 hours 30 minutes per day while working. In the future, it is necessary to consider the characteristics of the department to which they belong and consider ideas for reducing sitting behavior.