Purpose: Rail is a safety critical industry with a rapidly ageing workforce; in Australia, 60% of this workforce is now over 45 years old and facing a health crisis. As an occupation, rail driving is characterised by sedentariness, shiftwork, high stress, performance demands and elevated risk of cardiovascular disease. Workplace sedentariness has increased considerably over the past 50 years as tasks, activities and changes in cab design have minimised requirements to move. This paper presents findings from a qualitative benchtop simulation study, aiming to examine whether rail driving could be conceptually redesigned using a new preventative approach called the ‘Goldilocks Principle’.

 

Methods: The study was held through a Workshop at the TransFORM 2019 Physiotherapy Research Conference. Participants were given a paper time scale for a 12-hour day, spanning 0700-to-1900, to capture non-occupational activity. Participants then created task descriptions on paper colour-coded to the posture and movements involved in each task. Following this, a presentation on the Goldilocks Principle was given, and participants were asked to rearrange tasks and introduce new ones to obtain a better pattern of physical demands.

 

Results: Relative to the initial design, the results showed a marked decrease in sedentary behaviour in follow-up designs. In most cases, participants elected to introduce health-promoting work and task modifications by engineering-out sitting time and substituting it with additional train inspections and platform review activities requiring movement, and technological innovations within the cab which promoted movement whilst maintaining driving. Based on their cognisance of increasing levels of automation, participants also extended train supervision and managerial features of the role and introduced additional safety checks.

 

Conclusions: Contrary to popular belief, future rail systems are unlikely to remove a human out of the cab altogether. Instead, the job is likely to be adapted to encompass passive monitoring roles that are even more inactive than current tasks. Study findings suggest that redesigning work in line with the Goldilocks Principle has strong potential to promote sustainable health environment policy and research, stimulating action and advocacy for physically active work in rail and in other seemingly intractable environments.

 

Purpose: The benefits of physical activity (PA) on mental health (MH) of older adults are widely recognized. The purpose of this study is to apply systematic review and meta-analysis to identify the relationship between PA and MH as well as further examine the effectiveness of PA that enhanced MH in older adults.

Methods: A systematic literature searching was conducted in five databases before July 2018. Independent title/abstract and full-text screening were undertaken. Inclusion criteria were articles available in full text, human species, journal articles, correlational studies or experimental studies, English as publication language, and subjects aged 65 years and above. Three reviewers independently screened the searching results and performed data extraction and risk of bias assessment. Information were extracted on characteristics of participants, intervention type, intervention duration and frequency, length of follow-up, improvement of mental wellbeing and reduction of mental disorders and mental health problems, and also the relationship between physical activity and mental health. Standardized mean differences (d) for experimental studies and correlations (r) between PA and mental health were tested for effect sizes using a random-effects model.

Results/findings: Seventy out of 5881 articles were retained for data extraction, among which 36 were correlation studies while 34 were intervention studies. A random-effect meta-analysis of 41 tests was conducted on 7 correlation studies and 26 intervention studies. The meta-analytic effects were statistically significant in correlation studies between PA and MH problems (r=-0.22, p<.001). Statistically significant effects were also found in the intervention studies on reducing MH problems (Cohen’s d = -0.43, p<.001) and enhancing mental well-being (Cohen’s d = 0.85, p<.01).

Conclusions: The current meta-analytic review confirmed the relationship between PA and MH as well as the effects of PA on MH in older adults. The findings provide a useful information for enhancing the future design of experimental and correlational studies in relation to physical activity and mental health.

Keywords: physical activity, mental health, older adults, systematic review, meta-analysis

 

 

 

Purpose:

Physical activity (PA) in middle-aged and older adults is critically important to improve quality of life. Thus, PA promotion in this age group should be a public health imperative. Identification of PA influences is required to inform the design of effective PA programs. Little is known about correlates of moderate and vigorous PA (MVPA) and energy expenditure (EE) among Indonesian middle-aged and older adults. This study aimed to identify social cognitive correlates of MVPA and EE in this population.

Method:

This is a cross-sectional study involving 118 adults (age 61.7±8.3 year, female 72%) recruited from an integrated service post in Indonesia. Participants completed a self-administered questionnaire on self-efficacy in PA engagement and in overcoming PA barriers, outcome expectations of PA (physical, social, and self-evaluative), self-regulation (goal setting and planning), and friends and family social supports. MVPA and EE were calculated from an interview administered Standford 7-day Physical Activity Recall. Bivariate correlations and stepwise multiple regressions (adjusted for sex and age) were conducted.

Results

All social cognitive measures correlated moderately with MVPA (r=0.52-0.76) and weakly with EE (r=0.08-0.37). A model that included all social cognitive measures, except for self-efficacy in PA engagement and outcome expectations in physical and social aspects explained 80.9% of MVPA. Self-efficacy in overcoming PA barriers had the highest standardized coefficient (ß= 0.33,p<0.001), followed by friend participation and family reward (each with ß= 0.20,p<0.001), exercise planning and goal-setting (each with  ß=0.16,p<0.01), self-evaluative outcome expectations (ß= 0.11, p<0.05) and family participation (ß=0.10,p<0.05). A model which included exercise goal setting and family participation (each with ß=0.19,p<0.05) explained 26.6% of EE.

Conclusion

Self-efficacy in overcoming PA barriers, self-evaluative outcome expectations, self-regulation and social support are significant MVPA correlates, while EE is explained by goal setting and family support. Therefore, those aspects should be considered when designing PA interventions in this population.

Purpose

Food Literacy (FL) as a component of Health Literacy (HL) is the ability to organize one’s everyday nutrition in a self-determined, responsible and enjoyable way. In the context of an aging population and an increasing life expectancy, the challenge of aging healthy is growing. The aim of the project "Enjoyable aging – Municipality-based improvement of FL in older adults (GUSTO)" is an improvement in HL and in particular FL of persons aged 65 or above. The intervention includes a group programme with peer-moderated self-reliant working groups of older adults. This group programme was developed in a participatory process with the target group.

 

Methods

A literature search on the nutritional situation of older adults was conducted. The results were compared with the dutch "self perceived food literacy scale" by Poelman et al. (2018) and the "nutritional competence scheme for basic education" of FL by the German Federal Centre for Nutrition (2019). From this data, different topics for the focus group discussions were deduced and discussed with the participants. Six guided focus group discussions were realized with the help of practice partners in different institutions for older adults in six municipalities. The answers of the participants were summarized and clustered.

 

Results/findings

Overall 44 people aged between 62 and 88 years (mean age: 73.1 ± 6.1 years) participated in the focus group discussions. 22.7 % were men. The focus group discussions revealed resources and barriers concerning FL as well as contents of nutrition among older adults. With regard to the FL of persons aged 65 or above, the discussions revealed that the appraisal of information, due to the large amount and equivocality of information, and its practical use are difficult. The desired topics, for example best-before date, use of food waste and herbs and spices, were added to the intervention.

 

Conclusion

The participatory proceeding is important to develop an intervention that is adjusted to the needs of the target group. The close collaboration with the practice partners in the municipalities ensured the successful implementation of the focus group discussions and an effective acquisition of older adults.

Purpose: To determine impact of a 6‐month home‐based behaviour change intervention aiming to reduce the risk of chronic disease by determining changes in metabolic syndrome status and cardiovascular (CVD) risk score.

 Methods: A randomised controlled trial of regional adults in the coastal town of Albany in the Great Southern region of Western Australia. Participants (n = 401) were aged 50‐69 years and classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or control (n = 200) group. The 6‐month intervention incorporated goal setting, self-monitoring and feedback and motivational interviewing.

 Results: Significant improvements in metabolic syndrome status and cardiovascular disease risk score (−0.82) were observed for the intervention group relative to control group from baseline to post‐test.

 Conclusion: This home‐based physical activity and nutrition intervention reduced participants' risk of experiencing a CVD event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long‐term chronic diseases.

Purpose:

How or whether diet quality changes over time has rarely been reported at a population level. Our aims were to investigate change in diet quality over 12 years in a nationally representative sample of women born in 1946-51, and to identify characteristics of women whose diet quality changed over time.

Methods:

The Australian Recommended Food Score (ARFS) was measured in 2001 (n=10,629, mean age 52.1 years) and 2013 (n=9115; n=8161 for both time-points) for the 1946-51 cohort from the Australian Longitudinal Study on Women’s Health. Participants were categorised by tertiles of baseline diet quality and also classified as ‘diet quality worsened’ (ARFS decrease ≤-4 points, n=2361), ‘remained stable’ (-3≤change in ARFS≤3 points, n=3077) or ‘improved’ (ARFS increase ≥4 points, n=2723).

Results:

On average, ARFS total and subscale scores remained relatively stable over time (mean [SD] change 0.3 [7.6] points) with some regression to the mean. Women whose diet quality worsened over time were more likely to be highly physically active at baseline compared with women whose diet quality improved (p<0.001). Among women with poor diet quality initially (lowest baseline ARFS tertile, n=2451, mean [SD] baseline ARFS 22.8 [4.5] points), almost half (47%, n=1148) had not improved after 12 years, with women less likely to be in the healthy weight range (41% compared to 44%) and be never-smokers (56% versus 62%, p<0.05) compared with those whose diet improved.

Conclusions:

Diet quality remained relatively stable over 12 years’ follow-up among mid-aged women. Almost half of those with poor baseline diet quality remained poor over time, emphasizing the need to target high-risk groups for nutrition interventions.

 

Purpose: Physical activity has been recognized as an important determinant of mental health among older adults. The current study aimed to test a model in which physical activity was hypothesized to influence mental health in path mediated by resilience.

Methods: Cross-sectional data were collected from a sample of 293 Chinese older adults (60 males, 233 females) with the age range from 65 to 95 years (M=76.58, SD=7.02) in eight community senior centres located in three districts in Hong Kong. Correlation analyses were performed to assess the associations between physical activity, resilience and mental health variables. Path analysis was employed to examine the mediation effects of resilience from physical activity to mental health.

Results: Building on the three path models, it was found that significant mediation effects of resilience on the relations from physical activity to depression (β = -.54, p = .002), from physical activity to loneliness (β = -.25, p = .005), as well as from physical activity to psychological well-being (β = .37, p = .008). In sum, this study demonstrated that resilience mediated relationship from physical activity to mental health among older adults.

Conclusions: Findings of the current study suggested that older adults who were more physically active reported greater psychological well-being and less mental health problems, and the effects were mediated by resilience. 

 

Background: Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress. Despite previous research suggesting that physical activity is an important factor of resilience, no existing interventions incorporating physical activity to build resilience among older adults. Strength training has potential benefits that could contribute to the development of resilience among older people.

 

Purpose: The current study aims to examine the effectiveness of resistance training on resilience among Chinese older adults in Hong Kong adopting a randomized controlled trial design.

 

Design: This study will apply a three-group, triple blinded (participants, coaches, and data collectors will not be informed of the main purpose of the study), randomized controlled trial (RCT) to examine the effectiveness of the interventions on resilience, functional fitness, and health-related quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions. The CONSORT procedure will be followed. The three groups will be resistance training group, Tai Chi Group, and control group. Power analysis indicates that a sample size of 40 participants per group (totally 160 for 3 groups) will be required in the current study.

 

Data analysis: The primary outcomes (resilience scores) will be analyzed using an intention-to-treat (ITT) approach. To determine the intervention effect sizes, a two-way repeated measure analysis of variance (ANOVA) will be applied to determine the changes of each outcome parameter among the three time points (i.e., pretest, posttest, and follow-up test).

PURPOSE: A lifestyle with sufficient physical activity (PA) contributes to healthy ageing. Nonetheless, older adults (65+) are the most inactive age group in our population. Current behavior change interventions are often tailored to participants’ baseline characteristics and needs. However, within these tailored interventions, behavioral determinants are assumed to be relatively stable over time, while in reality determinants are dynamic and change regularly over time and contexts. The COM-B framework incorporates these dynamics by stating that behaviors are affected by psychological and physical capabilities, physical and social opportunities and volitional and automatic motivations. These three factors can change over time and contexts. Before future interventions can incorporate these dynamics, one needs to determine how motivations, capabilities and opportunities vary throughout the day and are related to daily PA. Consequently, the study aims are (1) to examine how older adults’ physical complaints (physical capability), affect (psychological capability) and motivation to be active vary throughout the day and (2) how these factors can predict daily PA levels.

METHODS/RESULTS: Data are collected in 60 older adults in Flanders, Belgium. Participants are recruited through convenience sampling. All participants fill in a questionnaire assessing socio-demographics and overall health (PROMIS Health Profile), and wear an accelerometer (Axivity AX3) for seven consecutive days to objectively assess PA. Furthermore, during these seven days participants receive questions regarding positive and negative affect (PANAS), motivation and physical complaints using a time-based EMA methodology. Each day, the same questions are asked at six random moments between 9AM and 10PM using a smartphone-based questionnaire (SEMA3 application). Three-level (moments within days within participants) regression analyses will be conducted in R. Data collection is ongoing and will be finished in March 2020. Results will be presented at ISBNPA2020.

CONCLUSIONS: This is one of the first studies examining the time- and context-dependency of determinants of PA in older adults using a time-based EMA methodology. The results will provide important insights into how future interventions can take into account dynamic determinants and how the research field can evolve towards Just-In-Time Adaptive Interventions (JITAIs) in older adults.

Purpose: Few studies have tested the impact of interventions specifically addressing physical activity or sedentary behaviour during acute hospitalisation. A limitation to progress is the heterogeneity in outcomes and their measurement. This study aimed to generate consensus on important types of outcomes (core domains) to measure in research studies of PA or SB in older adults (aged ≥65 years) hospitalised with an acute medical illness.

Methods: A 4-Round online Delphi consensus process was conducted. International researchers, multidisciplinary clinicians, academics from national activity guideline development teams, and patients were invited to participate. Round 1 sought open-ended responses to the questions of “what are the benefits: of reduced SB; increased PA” and “what are the risks of: prolonged sedentary time; low PA” in the target population. Responses were mapped to the ‘Core Outcome Measures in Effectiveness Trials’ taxonomy for rating of importance using a Likert scale (1-9) in Rounds 2-4. Consensus was defined a priori as: ≥70% of respondents rating an item as “critical” (score ≥7) and ≤15% of respondents rating an item as “not important” (score ≤3). Participants were asked to rate the importance of evaluating each item in all research studies of PA or SB in older adults who are hospitalised with an acute medical illness.

Results: 49 participants from nine countries were invited to each Round; response rates were 94%, 88%, 81% and 71% from Rounds 1-4 respectively. In Round 2, 9/25 outcomes reached consensus agreement (physical functioning, general, role functioning, emotional functioning, global quality of life, hospital, psychiatric, cognitive functioning and carer burden). In Round 3, eight types of outcomes reached consensus agreement (adverse events, perceived health status, musculoskeletal, social functioning, vascular, cardiac, mortality and economic). Round 4 participants reviewed all 17 items that met consensus criteria in previous rounds. Four types of outcomes were rated critically important to evaluate: physical functioning, social functioning, cognitive functioning and hospital outcomes.

Conclusions: Consistency in outcomes and reporting may accelerate the field of research in PA/SB for older adults while hospitalised. This preliminary work provides a starting point for developing a core-outcome set.

Purpose: There are clear physical activity guidelines for older adults, however there is often little attempt to support older adults living in residential aged care to achieve these guidelines. When older adults enter residential aged-care (RAC), there is often a misconception that their physical function will follow a rapid trajectory of decline, and that for people with cognitive decline, there is a perception that they are unable to participate in, or benefit from, exercise. Providing avenues to maintain functionality for people living in RAC is one of the roles of allied health professionals, such as Accredited Exercise Physiologists (AEPs). AEPs may be of value in the RAC, to help maintain functionality and promote well-being, through the implementation of exercise programs.

Methods: This research evaluated the impact of a targeted, individually-specific, 12-week AEP-led exercise intervention for people living in a secure unit. Data were collected pre-and-post intervention to assess physical function (GENEActiv accelerometers, 5-repetition sit-to-stand, timed-up-and-go, two-minute walk, handgrip). Correlations and repeated measures ANOVA were performed to analyse the data.

Results: 59 residents participated in the study. There was evidence for maintenance of function for intervention participants, with significant (p<0.05) interaction (η2=0.13) and main effect (η2=0.26) for the handgrip strength test, and significant interaction for the timed-up-and-go (p <0.05, η2 = 0.19). There was evidence of a dose effect (p<0.05) for one-to-one individual sessions and the timed-up-and-go change scores (r= -0.40) and two-minute walk change scores (r=0.46).

Conclusion: Residents living with functional and cognitive decline in the RAC environment can be perceived to be unable to participate in, or benefit from, exercise. This evaluation has demonstrated that participation in a 12-week AEP-led exercise program can support maintenance of function. This provides scope for implementation of AEP-led exercise programs in the RAC environment, as a means of maintaining function and avoiding the trajectory of decline older adults are expected to follow on entry to RAC.

Purpose: Although previous studies have found that sufficient levels of physical activity and balanced dietary behavior were independently associated with physical function in older populations, the joint associations remain unclear. This cross-sectional study examined the independent and joint associations of physical activity and dietary behavior on older adults’ lower limb strength.

Methods: Data was collected by recruiting 122 community-dwelling older Taiwanese adults (mean age: 69.9 ± 5.0 years). Moderate-to-vigorous physical activity (MVPA) was objectively assessed using a triaxial accelerometer and balanced dietary behavior was subjectively measured using one valid item. Lower limb strength was measured through the performance of five times sit-to-stand (STS) test. According to recommendation from WHO (30 min of MVPA per day) and Taiwanese dietary guideline (six essential nutrients per day), MVPA and dietary behavior were categorized into “meet” or “not meet” group, respectively. Sex-specific median time of STS test were also classified into poor or better group. Binary logistic regression analyses were performed to examine the independent and joint associations of recommended level of MVPA and balanced dietary behavior with lower limb strength.

Results: After adjusting potential confounders, for independent association, 30 min of MVPA per day or balanced dietary behavior was not related to lower limb strength. For joint association, older adults who both met recommended level of MVPA and had balanced dietary behavior were more likely to have better lower limb strength (odds ratio = 4.85) compared with those who neither met the recommended level of MVPA nor dietary behavior. By contrast, no significant associations were found in other two groups that only met one recommendations of physical activity or dietary behavior.

Conclusions: Both MVPA and balanced dietary behavior contirbute to better performance of lower limb strength among community-dwelling older Taiwanese adults. Health promotion initiatives addressing disability prevention for older adults need to consider both promoting MVPA and balanced dietary behavior. 

Purpose: Longitudinal study linking physical environment, and social environment to walking is sparse. This study therefore aimed to examine the change of associations between physical environment, social environment, and walking among older adults in a 3-year time period [(Time1 (2016), Time 2 (2017), and Time 3 (2018)].

Methods: Participants (N = 1067 older adults) aged ≥ 65 yrs., with no diagnosed cognitive impairment and competent to walk were recruited from both 1) elderly centers of 18 Districts in Hong Kong (HK); and 2) randomly selected in the HK household database. Participant’s both perceived and objective physical environment and perceived social environments were assessed. Their walking behaviors were objectively measured using accelerometers (total step per day).

Results: After data management, there were 483 older adults [≥75 yrs (51.1%), and female (83.4%)] included in the final data analysis. In neighborhood level, longitudinal structural equation modeling (SEM) was used to assess the associations among the dependent variable (total step per day) and associated constructs [Social environment (i.e., perceived social cohesion) and objective environment from Geographical Information System (i.e., connectivity, density and land use mix)] in a 3-year time period. Results showed that social environment (i.e., perceived social cohesion) and objective environment significantly predicted total step per day among older adults in Time 2 and Time3.

In individual level, same data analysis was used to assess the associations among the same dependent variable and another set of associated constructs [Social environment (i.e., Companionship, Encouragement, and Role model) and subjective environment (i.e., physical environment facilitators and physical environment barriers)] in a same time period. Social environment (i.e., Companionship, Encouragement, and Role model) and subjective physical environment (i.e., physical environment facilitators and physical environment barriers) were significant predictors of total step per day among older adults in Time 2 and Time 3.

Conclusions:  This longitudinal study further demonstrated cause-effect relationships of our studied constructs and lay the groundwork for developing future walking intervention. Policy-makers and walking intervention designers should develop strategies to enhance both physical and social environments in order to promote older adult’s walking.

Keywords: physical activity, elders, neighborhood 

Physical activity (PA) guidelines for older adults (OAs) recommend multicomponent PA including aerobic, muscle-strengthening, and balance modes. Meeting the PA guidelines for OAs can preserve physical function (PFx), preventing physical disability and loss of independence. Unfortunately, the great majority of OAs fail to meet PA guidelines, due in large part to poor adherence to the muscle-strengthening and balance components. One untapped resource that may promote health behaviors, including PA, are close relationship partners. However, a paucity of research exists exploring the utility of the romantic partner to enhance multicomponent PA program adherence and effectiveness, especially for OAs who have the most to gain from multicomponent PA to maintain PFx. Purpose: This study aimed to examine the association of relationship quality (RQ) with the changes in PA behavior and PFx in response to a supervised 9-week PA program (muscle-strengthening, flexibility, balance training) combined with a PA behavioral change intervention (unsupervised; aerobic PA) in older adult couples. Methods: Heterosexual couples who were romantically involved and cohabitating [n=9 dyads (18 individuals); 69.4+4.9 yo] were assessed at baseline and post-intervention for PFx via 6-Minute Walk Test (WALK), Timed Up and Go (UPGO), Transfer Task (TRANSFER), and the Community Balance and Mobility Scale (CBMS); PA via Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire; and relationship quality (RQ) via the Couple Satisfaction Index-32. Results: Paired samples t-tests revealed improvements in WALK, UPGO, TRANSFER, and CBMS (all P<0.05) and an average decline in both PA and RQ (both P<0.05). Bivariate correlational analysis indicated that baseline RQ was not related to change in any measure of PFx (all P>0.05). However, improvement in RQ was related to better performance in both UPGO and TRANSFER (r= -0.68 and -0.54, respectively, both P<0.05). Conclusions: Our results suggest that whereas initial RQ may not influence multicomponent PA intervention effects on PA and PFx in OA couples, changes in RQ during a program may be an important influential factor. Research exploring the utility of the romantic partner as a change agent for multicomponent PA behavior change and maintenance in older adults is warranted.

Purpose: To document the characteristics of unique long-term participants aged 50+ years in a local government group physical activity (PA) program (Strong Seniors), and to investigate the motivators and barriers to ongoing PA.

Methods: We used a self-report survey among current Strong Seniors program participants and conducted a mixed-methods study involving both quantitative and qualitative analyses. We coded survey responses into six major themes identified in a previous systematic review about older people’s perspectives on physical activity participation. The major themes were (a) social influences, (b) physical limitations, (c) competing priorities, (d) access, (e) personal benefits of exercise, and (f) motivation and beliefs.  

Results/findings: Overall, of 176 potential participants contacted, 93 (53%) completed the survey. The mean participant age was 67 years (SD = 8.5), most were female (n = 81, 87%). On average, participants had been attending the Strong Seniors program for 4.9 years (SD = 4.6) and ranged from 3 weeks to 13 years. The average frequency of attendance at Strong Seniorsclasses was three times/week (SD = 1.3). “Personal benefits from exercise” was the most commonly cited theme for prompting people to start regular PA participation (54 responses, 43%) and for keeping them engaged and motivated to attend regularly (113 responses, 88%). “Social influence” was the most commonly cited theme as the reason for joining and maintaining participation in the Strong Seniors program (119 responses, 66%). “Competing priorities” was most common theme associated with barriers to initiating a habit of regular PA, endorsed by 17 respondents (31%). Of the participants who still encountered barriers to taking part in regular PA, “physical limitations” was the most common theme (13 responses, 41%) with specific examples including poor general health and chronic conditions.

Conclusions: Personal benefits of exercise and social influences were the most common motivators for regular PA. Barriers to participation included health problems and lack of time. This study suggested that PA programs for older adults that emphasise associated health benefits and promote social support, as well as take into account physical limitations, and have flexible timetables may be more likely to facilitate long-term attendance.

The use of functional foods whose bioactive compounds have beneficial effects on health has been an essential tool for improving nutritional status as well as for preventing or controlling diseases. One of the processes that occur most frequently in the different stages of life and through many pathological states is the loss of muscle mass. That can be caused either by a protein hypercatabolism derived from a pathological process/ aggression (wasting), as in the case of chronic degenerative diseases, because of muscular demand for high exercise intensity or sedentary behaviour, or even naturally and gradually as in ageing (sarcopenia). Consumption of bioactive compounds such as b-hydroxy-b-methylbutyrate (HMB) can help to reduce the loss of muscle mass. HMB has been proposed to decrease atrogenes activation by modifying the muscle protein replacement (Baptista et al., 2013). However oral administration can reduce its action due to gastric, enzymatic and absorption processes, which leads to a lower percentage of active compound or metabolite that reaches its tissue target. To solve this problem, emergent technological designs have shown to be an excellent alternative. Therefore, this study aims to design a nanocompound based on layered double hydroxides with b-hydroxy-b-methylbutyrate (LDHs-HMB) that will function as carrier to target tissue to avoid the reduction of muscle mass loss. The LDHs-HMB will be synthesised. To perform functionalization of the compound, LDHs-HMB was evaluated for precipitation method, ion exchange and reconstruction. Physicochemical analysis of nanomaterials was made by X-ray diffraction (XRD), infrared analysis (IR), differential scanning calorimetry (SEMS) and thermogravimetric analysis (TGA), with differential scanning calorimetry (DSC). LDH´s hybrid compounds were successfully synthesised by the co-precipitation method and characterised by powder X-ray diffraction and XPS analysis. In the next month, lethal dose 50 and a biological assay will be done to elucidate the effect of oral consumption. This work illustrates the characterisation of a novel organic-inorganic hybrid nanocomposites based on LDH´s, b-hydroxy-b-methyl butyrate (HMB) and type I collagen.

Purpose

This research aimed to investigate how behaviours of lifestyle physical activity (LPA) and diet predict and correlate with vascular health in older adults using the gold standard measure of pulse wave velocity (PWV).

Methods

This cross-sectional study analysed 83 adults aged 64-91 years (M=78±6.44) residing in independent living communities. Dietary questions were taken from the Harvard disease risk tool. The Yale physical activity survey allowed the calculation of metabolic equivalents of task (METmins). PWV was collected using a non-invasive device (applanation tonometry).

A hierarchical regression was calculated whereby covariates of taking blood pressure medication (BPM) and age (both known to affect PWV) were controlled in model 1 and diet and METmins were added into model 2. Pearson correlations were then calculated to determine individual correlations with PWV by subgroups of sex and age.

Results

The model 1 regression (R²=.29; F(2,79)=16.00, p<.001) indicated that covariates of BPM and age accounted for 29% (p≤.000) of the variance in PWV, but when diet and METmins were added in model 2 (R²=.31; F(4,77)=8.56, p<.001) they only contributed 2% more (non-significant change, p=.35) to the prediction of PWV. Healthier arteries in males correlated significantly with higher METmins (r=-.54, p=.004) and younger participants (r=.40, p=.027). Healthier arteries in females correlated significantly with younger participants (r=.49, p=.000), no BPM (r=.36, p=.002), and higher METmins (r=-.25, p=.029). Among 64-78 year olds, healthier arteries were correlated with no BPM (r=.35, p=.011), and healthier diets (r=-.26, p=.046), but not with METmins. Alternatively, 79-91 year-olds showed healthier arteries correlated with higher METmins (r=-.36, p=.012), but not with diet.

Conclusions

After controlling for age and BPM (model 1) in the regression, diet and METmins (model 2) were unable to significantly contribute to the prediction of arterial stiffness in older adults. Both males and females showed correlations between healthier arteries and higher METmins, but not between arterial health and diet, suggesting LPA is more correlated to arterial health than diet. Those aged 64-78 had healthy arteries in correlation with a healthy diet, whereas 79-91 year olds had healthy arteries in correlation with higher METmins.

Purpose: Physical activity tends to decline in older age, despite being key to health and longevity. Several demographic and individual-level predictors of older adults’ sustained physical activity have been identified (e.g., age, gender, health status, attitudes), yet growing evidence indicates that social factors also have a salient impact on physical activity behaviours. This study examined whether engaging in physical activity in the context of sport or exercise groups (as opposed to outside these social group contexts) can (a) protect against age-related physical activity decline, and (b) enhance longevity.

 

Methods: Drawn from the English Longitudinal Study of Ageing, participants were members of sport or exercise groups aged 50 and over (N=2015) as well as non-sport or exercise group member controls (N=1881), who were matched at baseline for age, sex, and physical activity levels. Longitudinal mixed effects models were used to assess the effect of sport or exercise group membership on moderate and vigorous physical activity over a 14-year follow up. A binary logistic regression was used to test whether sport or exercise group membership predicted longevity over a 10-year follow-up. Finally, a binary logistic mediation model was used to test whether the effect of sport or exercise group membership on longevity was mediated by changes in physical activity.

 

Results: Members of sport or exercise groups experienced an attenuated decline in both moderate (b=.03 [SE=.005], p<.001) and vigorous (b=.02 [SE=.005], p<.001) physical activity over a 14-year follow-up compared to physically active matched controls. Over a 10-year follow-up, the odds of dying for those who were not sport or exercise group members at baseline was 1.27 times the odds of dying for those who were sport or exercise group members at baseline. The effect of sport or exercise group membership on longevity was mediated through sustained moderate physical activity (indirect effect b= -.05 [CI: -.07, -.03]).

 

Conclusions: Promoting membership in sport and exercise groups may be a beneficial strategy for supporting sustained physical activity and health among older people.

Purpose

Older adults often aspire to remain in their communities as they age, with many choosing to be physically active in their local spaces and places. However, existing reviews on ‘positive ageing’ have rarely considered the importance of ‘place’. As part of a broader PhD project exploring environments of community-dwelling older adults in relation to ‘positive ageing’ in place, this scoping review uses Arksey and O’Malley’s framework to bring together heterogenous terminology and conceptualisations of ‘positive ageing’. Thus, this study aimed to construct a multidimensional definition and assessment of ‘positive ageing’ for community-dwelling older adults (≥65 years), while clarifying the role of ‘place’ for ‘positive ageing’.

Methods

Systematic searches of six electronic databases (CINAHL, Embase, Web of Science Core Collection, Medline, Scopus, PsycINFO) and manual searches of seven relevant systematic reviews yielded 6,340 results. To be eligible for inclusion, published peer-reviewed primary studies needed to be available in English and report a conceptual or operational definition of ‘positive ageing’, or procedures for assessing ‘positive ageing’ for community-dwelling older adults. Perspectives of researchers, clinicians, practitioners, and non-specialist older adults were considered. No publication period or study type limits were applied. Methodological quality assessment will be completed and extracted findings will be presented using descriptive and thematic summaries.

Results

At abstract submission, full-text screening of 906 potentially relevant results was underway. Fifty-two of 357 screened results met all inclusion criteria. Key findings to-date include viewing ‘positive ageing’ as a multidimensional concept, informed by complex components spanning policy, community, built and home environment, social, and individual levels. Considerable differences were noted between researcher/clinician/practitioner and older adult perspectives of ‘positive ageing’, as well as between different cultures. In addition, physical activity and mobility (social, spatial, physical) was supported by community resource availability and accessibility, while ‘place’ was largely viewed as a physical entity, separate from social and symbolic meaning.

Conclusions

‘Positive ageing’ for community-dwelling older adults is conceptualised from a range of components and should be viewed as a continuum, specific to individual and cultural values. Results will inform the development of a conceptual model aimed at assessing and enhancing ‘positive ageing’ in place.

Purpose: Studies with longitudinal exposures are required to provide evidence on how changes in time use, specifically how reallocating time between movement behaviours, are associated with health outcomes. This study aimed to use compositional data analysis to: 1) investigate the prospective associations between changes in daily movement behaviours and adiposity among elderly women; and 2) to examine how the reallocation of time between movement behaviours was associated with longitudinal changes in adiposity.

Methods: This is a 7-year longitudinal study in older women (n=158, baseline age 63.9±4.4 years). At baseline and follow-up, light-intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA) and sedentary behaviour were measured by accelerometer and body adiposity (body fat percentage [%BF]) was assessed from bioelectrical impedance analyser. Compositional regression with robust estimators and compositional longitudinal isotemporal substitution analysis explored if, and how, changes in movement behaviours were associated with adiposity.

Results: Over 7 years, the prevalence of obesity in the sample increased by 14.6% according to %BF, and time spent in sedentary behaviour increased by 14%, while time spent in LIPA and MVPA decreased by 14% and 21%, respectively. The increase in sedentary behaviour at the expense of LIPA and MVPA during the seven-year period was associated with higher %BF at follow-up (p<0.01). The increase in LIPA or MVPA at the expense of sedentary behaviour was associated with reduced %BF at follow-up. To obtain the same difference in %BF units (–0.65 units) estimated for reallocating 30 minutes from sedentary behaviour to MVPA, 71 minutes could be reallocated from sedentary behaviour to LIPA. In our sample, the largest change in %BF (1.28 units; 95% CI: 0.48-2.09) was associated with longitudinal reallocation of 30 min from MVPA to sedentary behaviour.

Conclusion: We found an association between longitudinal changes in daily movement behaviours and adiposity among elderly women. Our findings support public health programs to increase or maintain time spent in higher intensity physical activity among elderly women. 

Acknowledgement: The study was supported by a research grant from the Czech Science Foundation No. 18-16423S.

Purpose

COP4HL is an Erasmus+ funded project aiming at promoting healthy aging through interventions in the everyday environment of selected population groups. The cornerstone of the project is the development of national Communities Of Practices (COP's) designed via collaborative processes involving a wide range of stakeholders.

The aging population is a global issue vastly increasing due to declining fertility rates (in some parts of the world) and increased life expectancy. There is a need to think and act differently prospectively to meet this challenge and ensure healthy, active aging. 

For this reason, the Danish COP aims at developing and qualifying educational modules targeting university and vocational students - so they are even better prepared to implement and innovate training for senior citizens. 

Method

The project is based on a Participatory/Citizen Science approach where diversity in terms of different stakeholders is an important driver for the project outcomes.

In the Danish COP, seniors, municipalities, a fitness franchise focusing on training for seniors, students, and the coordinating university collaborate to create an Active Ageing Trainer (AAT) module focusing on active, healthy aging for senior citizens aged 65 and above. This has been done through interviews, questionnaires, workshops, and meetings, as well as two rounds of piloting the initially developed module.

Results/Findings

The AAT-module focuses on students' abilities to deliver high-quality fitness interventions to older individuals and groups. During the module, students are introduced to newest evidence and guidelines on physical activity and aging. Changes in neuromuscular function and particularly the emerging evidence regarding loss of muscle power, strength, and mass (sarcopenia) as we grow older are key areas in the module - and different strategies to postpone those issues are taught.

Conclusion

After finalizing the second module pilot in September 2019, next step is accrediting the module within the Europe Active system.

As from the fall of 2020, university students will be able to attend the ATT-module as part of their studies in sports science and health, whilst non-university students like physiotherapists, personal trainers, etc. will be able to purchase the module provided by the fitness franchise. 

 

Despite the well-known benefits of physical activity, there is still a great amount of the population leading a sedentary lifestyle. The causes may be explained by the barriers perceived to physical activity, so the determination of these may be an important tool for the increase of a population`s physical activity level (PAL). PURPOSE: To analyze the association between perceived barriers and PAL in older adults. METHODS: This was a descriptive cross-sectional study conducted within the elderly population living in three neighborhoods of the urban area of ​​a medium-sized city of southern Brazil. The PAL was evaluated with the IPAQ (transport and leisure domains) and the perceived barriers with the instrument proposed by Reichert et al. (2007) validated for the study population. The chi-square test was used to analyze the associations between perceived barriers and PAL. RESULTS: 52.7% of the studied population was classified as physically active, 37.18% as insufficiently active and 10.25% as physically inactive. The barrier perceived the most among the insufficiently active elderly was having an injury or illness that interferes in physical activity (58.62%) and among the physically inactive, feeling lazy and tired (62.5%). Physically inactive and insufficiently active older adults reported a greater number of barriers in greater frequencies and similar perceived barriers (having an injury or illness that interferes in physical activity, feeling lazy and tired, and lack of companionship). In the analysis of the difference in the perception of barriers between the groups stratified by PAL, a statistically significant difference (p <0.05) was found in the barriers "feeling old for practicing physical activity" (p = 0.034) and "having an injury or illness that interferes in physical activity" (p = 0.004). CONCLUSIONS: The findings of this study showed the impact that the perception of barriers exerts on PAL, showing that the higher the number of perceived barriers, the lower tends to the PAL of the older adults. Health professionals working with this population should be aware of intervention possibilities that may reduce or minimize the negative effects of perceived barriers on PAL.

Purpose:

Feeling younger than chronological age has been shown to impact health outcomes positively. But how chronological and subjective aging are linked with food consumption and satisfaction with food-related life is not well researched. The present study examined these links, with the objective of exploring the impact of selected psychological and behavioral relations with senior citizens’ perception of being in good health.

Methods:

Self-sufficient senior citizens living independently were recruited for an online survey by a research agency. Participants were 499 seniors aged 55-90 (M_age 68.5 years), 47.3% women, 68.9% married/cohabiting, 13.6% single and 16.8% were divorced or widowed. The questionnaire included items on common food related practices, meal regularity and intake of age appropriate supplements (vitamin D), a scale on satisfaction with food-related life (SWFL), items measuring the general tendency to worry, a scale measuring subjective aging (referring to FEEL-, LOOK-, DO- and INTEREST-Age), perception of personal health status, height and weight (BMI), and appetite, as well as common socio-demographic characteristics. Multiple regressions were conducted with subjective health as dependent variable.

Results:

The subjective age of respondents was lower on average than their chronological age, and this gap increased with chronological age: A total of 48.9%/ 41.1%/ 33.8%/16.4% of respondents in their fifties/sixties/seventies/eighties were aligned with their chronological age, whereas 42%/ 53.7%/ 65.6%/83.6% of respondents felt approx. one decade younger than their chronological age.

Perception of health was related to chronological and subjective age respectively in opposite directions; while increasing age had a positive association with perception of health,  subjective perception had a negative impact, i.e., if one feels old, the perception of being in good health decreases. General tendency to worry, BMI and limited resources for food shopping were negatively linked with health perception, whereas being satisfied with food related life was positively linked with perception of health.

Conclusions:

Feeling young(er) while aging appears to contribute to the perception of being at good health, but further studies of the antecedents and consequences, including nutrition-related behaviors, of a “positive” outlook on aging is lacking.

 

Purpose: Body composition shifts as we age, resulting in loss of skeletal muscle mass with concurrent increase in fat mass. This leads to increased risk for obesity. As obesity rates increase in older populations, there is an increase in deleterious shifts in sleep-wake rhythms. Recent data suggests that diet composition (e.g. diets higher in protein or omega-3 fatty acids (O3FA)) can impact sleep in older adults.  Therefore, the objective of this study was to determine the ability of protein and O3FA intake to regulate sleep and other markers of wellbeing in postmenopausal women.

 

Methods: Postmenopausal women were recruited to participate in this randomized, controlled, single-blinded, 16-week dietary intervention.  Once enrolled, participants were assigned to one of 5 groups: 1) control, no intervention (n=6); 2) protein (PRO; 25 g; n=4) supplementation; 3) O3FA; DHA/EPA; 4.3 g; n=10); 4) PRO + corn oil (4.3 g) placebo (n=6), and 5) PRO + O3FA (n=8).  Sleep (via Pittsburgh Sleep Quality Index; PSQI) and mood (via Profile of Mood States; POMS) were assessed at baseline, 4, 8, 12, and 16 weeks.  Sleep quality was measured at baseline, 8, and 16 weeks using a wrist Actigraph.  Data were analyzed using two-way ANOVA to assess changes in diet, sleep, and wellbeing over time between groups.

 

Results: Overall, there was a significant effect of dietary intervention on sleep efficiency (p=0.03), with no effect of total sleep time.  Dietary intervention also improved PSQI global scores (p=0.01). There was also an effect of dietary intervention on depression (p=0.02) and vigor (p<0.001), with a trend for diet intervention on fatigue (p=0.08). PRO, alone, had no effect on markers of sleep and mood.  However, PRO + O3FA and O3FA alone improved the outcomes described above.

 

Conclusions: Taken together, this pilot study suggests that PRO + O3FA and O3FA alone, have the potential to improve sleep and mood in postmenopausal women.  However, additional research is needed to understand the long-term effect of PRO and O3FA on sleep and wellbeing over time.

 

Purpose: To use a validated clinical gait speed test to assess mobility disability risk in older cancer survivors by examining: 1) differences in gait/walking speed for older cancer survivors v. older adults without cancer history, 2) variation by cancer site and 3) other clinical risk factors (e.g., BMI, multimorbidity) that could be useful in early detection of mobility limitations.

 

 

Methods: We analyzed data from a nationally representative sample of US community-dwelling Medicare beneficiaries (n=5,676), including adults diagnosed with cancer (n=1046) from the 2011-2012 National Health and Aging Trends Survey (NHATS). NHATS used a 3-Meter walk test as part of a brief assessment of physical performance. The results were scored on a scale of 1-4 (1=worst, 4=best) using criteria supplied by the National Institute on Aging. We calculated mean overall walking scores for all survivors and non-cancer adults and analyzed using multivariable logistic regression models, controlling for age, gender, education, race/ethnicity, multimorbidity, BMI, and pain.

 

 

Results:  Overall, cancer survivors had lower mean walking speed scores (2.27) than non-cancer controls (2.39), indicating greater risk for mobility disability. The best overall mean walking score was for prostate cancer survivors (2.52) and the worst score (2.19) was observed in breast and kidney cancer survivors. In regression models, survivors were 23% less likely than non-cancer controls to perform well on the walking test (OR=0.77, p<.01). The older survivors (75+ years) were 57% less likely (OR=0.43, p<.001) and the oldest (85+ years) were 83% less likely (OR=0.17, p<.001) to achieve the highest score on the walking test compared to adults 65-74 years. Being underweight, overweight, Black, having ≥ three medical conditions and experiencing pain that limited activity were also all associated with worse performance on the walking test (all p<.05).

 

 

Conclusions:  Survivors were generally at greater risk for mobility disability than non-cancer controls and this varied by cancer site.  Based on our data, prostate cancer survivors demonstrated the greatest mean walking speed, especially compared to breast and kidney cancer survivors. The 3-meter gait speed test provides a robust method on which to assess mobility disability risk and could inform interventions to facilitate an active lifestyle in cancer recovery.

 

Purpose

There is an increased risk of cardiovascular diseases among older adults. This research aimed to determine which fitness tests could predict the vascular health of older adults using the gold standard pulse wave velocity (PWV) (applanation tonometry).

Methods

This cross-sectional study analysed 81 physically active adults (n=57 females) aged 64-91 (M=78±6.42) residing in independent living communities. A four-component fitness test included the 4-stage balance test (balance and falling assessment), six-minute walk test (SMWT) (aerobic exercise capacity), 30-second sit-to-stand test (postural hypotension and falling assessment), and the grip strength test (upper body strength) along with a PWV measurement. A regression use the four fitness tests as predictors of PWV for all participants. Pearson correlations then analysed these variables by subgroups of sex and age.

Results

When including all 81 participants, the four-component fitness test significantly accounted for 20% of the variance in PWV (R²=.20; F(4,76)=4.70, p=.002) among older adults. Of the four components, higher sit-to-stand scores correlated with having healthy arteries (β=-.27, p=.027), but higher grip strength scores correlated with having unhealthy arteries (β=.23, p=.036). Neither the SMWT nor the balance test significantly contributed to the regression model.

Pearson correlations indicated for men that better balance correlated significantly with healthy arteries (r=-.47, p=.011). For women, higher sit-to-stand scores (r=-.43, p ≤.001) and better balance (r=-.23, p=.045) correlated significantly with healthy arteries. Among 70-79 year olds, higher sit-to-stand scores (r=-.41, p =.002) and better balance (r=-.32, p=.014) correlated significantly with healthy arteries. Among 80-89 year olds, higher SMWT (r=-.40, p =.024) correlated significantly with healthy arteries.

Conclusions

The four-component fitness test did significantly predict arterial stiffness in older adults, but grip strength scores were unexpectedly negatively related to healthy arteries whereas sit-to-stand was positively related. In most groups, better balance and higher sit-to-stand scores were correlated to healthy arteries which was somewhat surprising. Finally, older participants were the only subgroup which showed a correlation between healthier arteries and higher SMWT scores. Given the SMWT is an aerobic exercise capacity assessment, it is surprising it did not correlate stronger to PWV.

Abstract

Older adults spend up to 99% of their time in hospital sitting or lying (sedentary) with very little physical activity (PA). This contributes to a longer length of hospital stay and poor outcomes such as worsening frailty. Very little is known about the perspectives of hospitalised older patients about sedentary behaviour (SB) and physical activity (PA). Exploring consumer perspectives assists the co-design and development of strategies to reduce SB and improve PA in hospital.

Aims

The aims of this study of older inpatients are to explore their:

• Knowledge of and attitudes to SB and PA;

• Willingness to change their SB and increase PA;

• Views as to what would be required to help them change their SB and improve PA

Methods

Semi-structured interviews were conducted with 23 patients aged 65 years and older on an orthopaedic and a geriatric medicine ward at The Queen Elizabeth Hospital. Data collection and analysis was conducted in accordance with grounded theory methodology.

Results

Our substantive theory based on participant’s descriptions is that the hospital, its systems and processes are the reasons for SB among older people. Older patients are unfamiliar with the term sedentary behaviour. They described SB as being physically and mentally inactive and PA in terms of ADLs and other activities specific to older people. They are somewhat aware that being sedentary is detrimental to their physical and or mental health. Older people reported they were willing to move more if they felt safe and supported. The main categories (themes) from this study are lay conceptualisation of SB and PA, intend to be active, beyond their control, lack of empowerment and negative consequences.

Discussion/Conclusion

Older people have some understanding of the harmful effects of SB and are willing to undertake PA but would like to feel safe and supported. The main findings in this study are that older people intend to keep active during hospital admission and SB in hospital has a negative effect on the mental health of hospitalised older people. Older people need to be empowered to break SB and increase PA during hospital admission.

 

Purpose: Most men with a diagnosis of prostate cancer (PCa) will become survivors of the disease and will be at increased risk of PCa recurrence, secondary cancers, and other chronic health conditions. Diet has been identified as a modifiable risk factor that can help improve health-related outcomes for PCa survivors. Limited New Zealand-based data exists that has qualitatively examined dietary behaviour in PCa survivors. The aim of this study was to identify if men had made dietary changes as a result of their PCa diagnosis.

Methods: Sixteen prostate cancer survivors from Auckland took part in the present study. Participants ranged in age from 57 to 88 years of age 71.3±7.4 years). Time since diagnosis ranged from 1 to 17 years (6.5±5.6 years). Six men were currently on androgen deprivation treatment. The remaining ten men were in complete remission and were treatment free. An interview schedule was developed for this study. Participants were individually interviewed. Interviews were audiotaped and transcribed. Data were analysed using an inductive thematic approach.

Results: Four main themes were identified in relation to changes men made to their diet post-diagnosis: (1) Reduction or elimination of certain foods (i.e., red meat, carbohydrates and sugar), (2) Consumption of more fruit, vegetables, and fish, (3) Introduction of new foods (i.e., ketogenic diet) and, (4) Dietary changes for other health condition(s) (i.e., diabetes).

Conclusions: The findings of the present study illustrate that PCa survivors are responsive to making dietary changes for heatlh-related reasons. There is evidence that dietary changes that result in the consumption of increased vegetables, fruit and fish, and a decrease in simple carbohydrates and meat consumption can positively benefit the body at a cellular level. International dietary interventions that have been carried out with cancer survivors have been successful in achieving long-term dietary change. However, dietary advice is not part of usual care practice for PCa survivors. Specific dietary advice or tailored dietary interventions administered or endorsed by healthcare practitioners can have an important role in influencing the dietary behaviour of PCa survivors.

PURPOSE The aim of this study is to identify characteristics that differentiate between cancer survivors who did or did not participate in the PABLO trial, in which an online intervention to enhance levels physical activity (PA) - with or without additional support from a physical therapist -, is compared to usual care.

METHODS Breast and prostate cancer survivors who had completed primary curative treatment 3-36 months earlier were invited to participate in PABLO. All participants, and non-participants who were willing to do so, completed an online questionnaire assessing socio-demographics (age, sex, educational level, smoking and alcohol use), factors related to PA-behaviour (perceived benefits and barriers, social support, attitudes, self-efficacy), fatigue (Multidimensional Fatigue Inventory), mood (Profile Of Mood States) and health-related quality of life (HRQOL, Short Form 36 Health Survey). We compared baseline data between participants and non-participants, using an independent Students’ t-test for continuous variables and the chi-square statistic for categorical variables.

RESULTS One hundred forty-one survivors (response rate: 11%) participated in the trial. Of the responding non-participants, 153 (47% of the non participants, 12% of the invited survivors) filled out the questionnaire. Sociodemographic variables did not differ between participants and non-participants, except that participants were less likely to consume alcohol (17% versus 27%, p = 0.048). Participants reported a significantly lower self-efficacy (on a 10 point Likert scale, mean = 4.9 versus 5.9, p < 0.01) and more perceived barriers to PA (mean = 2.1 versus 1.7, p < 0.01). Participants had reported significantly more Role limitations due to physical health (mean = 59.3 versus 67.8, p < 0.01) and General fatigue (mean = 58.3 versus 69.1, p < 0.01). No significant differences were found for perceived benefits, social support or attitudes towards PA. No significant differences were observed for specific dimensions of fatigue or mood.

CONCLUSIONS PABLO trial participants had a higher need for support in becoming or staying physically active and experienced more role limitations due to physical health, which suggests that the trial included relatively vulnerable survivors, who are likely to benefit from the intervention.

 

Purpose

To a survivor of breast cancer, health-related quality of life is fundamental. Undertaking a greater level of physical activity can improve quality of life but many breast cancer survivors do not meet recommended levels of physical activity. This study examines the relationship between objectively assessed physical activity and health-related quality of life among survivors of breast cancer with low levels of physical activity and how any relationship is changed by breast cancer-specific concerns, fatigue interference, and self-efficacy.

Methods

The physical activity of 17 physically inactive, post-treatment breast cancer survivors were assessed over seven days using accelerometry. Demographic and clinically relevant information, health-related quality of life, breast cancer-specific concerns, anaemia symptom concerns, fatigue interference, and self-efficacy for physical activity was assessed. Following simple linear regression of physical activity and health-related quality of life, multivariate regression models that included breast cancer-specific concerns, anaemia symptom concerns, fatigue, or self-efficacy for physical activity were tested.

Results

The Functional Assessment of Cancer Therapy – General (F(1, 15)=4.785, p< .05) and the subscale of functional well-being (F(1,15)=6.163, p< .05) significantly predict moderate physical activity among breast cancer survivors with low levels of physical activity. Functional Assessment of Cancer Therapy – General explains 24.2% of the variance in moderate physical activity and the subscale of functional well-being explains 29.1% of the variance.

Conclusions

Objectively assessed physical activity is positively associated with health-related quality of life among survivors of breast cancer with low levels of physical activity. However, breast cancer-specific concerns, fatigue interference, and self-efficacy do not appear to be associated with physical activity among this population.

Purpose:

Adherence to lifestyle and body weight recommendations can improve health outcomes among postmenopausal breast cancer (PMBC) survivors. However, the majority does not adhere to these recommendations and there is a lack of insight on when and how sustained adherence should be promoted. Therefore, the OPTIMUM-study aims to gain insight into the optimal timing and method for promoting sustained adherence to lifestyle and body weight recommendations in PMBC survivors.

 

Methods:

The OPTIMUM-study is guided by the first three steps of Intervention Mapping and has a mixed-methods design: a longitudinal observational study with measurements at 4-6 months after cancer diagnosis (T0), 1 year after diagnosis (T1), and 2 years after diagnosis (T2), semi-structured interviews, and focus groups. 1100 PMBC survivors are recruited from 16 hospitals across the Netherlands. The PROFILES registry is used for data collection management (http://www.profilesregistry.nl).

To assess optimal timing, questionnaires are used to assess adherence to lifestyle and body weight recommendations, readiness for change, and need for support, and qualitative research is used to assess their determinants and perceptions on optimal timing. To assess the optimal method, changeable determinants are matched to evidence-based methods using the Behavior Change Technique Taxonomy, and qualitative research is conducted to assess the acceptability of the selected methods.

Generalized Linear Mixed Models are conducted for longitudinal data analyses, multivariable (logistic) regression analyses are conducted per time point, and thematic analyses is conducted for qualitative data analysis using the paper-pencil method.

  

Results:

Currently, 155 participants have been included (participation rate 66%). In June 2020, inclusion of participants will have completed. First results will be presented on adherence, readiness for change, need for support, and their determinants at T0 and T1, as well as the holistic, bottom-up approach used to obtain the ultimate results: a toolbox with numerous intervention ingredients (i.e., building blocks) from which the right ‘tools’ to construct an individually-tailored intervention can be selected.

 

Conclusions:

The OPTIMUM study leads to scientific evidence on when and how to promote sustained adherence in which postmenopausal breast cancer survivors that will be incorporated into clinical oncology guidelines (www.oncoline.nl).

 

Purpose: Head and neck cancer (HNC) survivors may face an array of nutrition impact symptoms (NIS) including dysphagia, xerostomia, taste alterations and difficulty chewing that occur as a result of tumor location and treatment with radiation. Few qualitative studies have assessed the chronic impact of NIS on everyday life. The aim of this study was to obtain a comprehensive understanding of quality of life outcomes, eating behaviors and supportive care needs associated with chronic NIS burden among HNC survivors.

Methods: Between March 2018 and May 2019, semi-structured, face-to-face interviews were conducted among 31 HNC survivors who were 6 months to 9 years post-radiation. An interview guide was utilized to consider themes developed based on a review of the literature and the researchers’ clinical experience with the HNC population. There were probes within the interview for participants to raise unanticipated issues and flexibility to follow such leads. A single researcher conducted the interviews to maintain consistency in data collection.  Interviews lasted approximately 1 hour and were audio recorded. All interview transcripts were professionally transcribed verbatim and checked for accuracy to ensure a complete account of participants’ responses. Two researchers independently reviewed all transcripts to identify themes using code-based thematic qualitative content analysis.

Results: Survivors described behavioral and social restrictions on daily living caused by chronic NIS.  Despite these restrictions, survivors had adapted to NIS and reported an overall high mentality and enjoyment of life. Coping considerations included adapting to a new normal, learning to manage NIS, and ambivalence towards NIS and quality of life outcomes.  Preferences for patient care included more therapy/support groups and being involved in the treatment plan.

Conclusion: Chronic NIS have substantial effects on the everyday lives of HNC survivors. Health care professionals should address the presence of chronic NIS with HNC survivors in follow-up visits and maximize physical, psychological, social and behavioral aspects of nutrition and well-being.

Purpose: Food insecurity (FI) is associated with negative health outcomes, including poor quality of life (QOL) and chronic diseases like cardiovascular disease and diabetes. The association between FI and cancer is largely unknown. No comprehensive practice guidelines or consensus criteria currently exist regarding screening for and addressing FI in oncology clinics. Registered Dietitian Nutritionists (RDNs) are on the front lines of nutritional care provided to patients across the cancer continuum, but it is unknown if and how oncology RDNs address FI with their patients. The purpose of this study was to assess oncology RDNs’ knowledge, attitudes and practices related to FI among cancer patients.

Methods: Semi-structured interviews were conducted with 41 oncology RDNs working at various cancer centers across the U.S. and recruited through the Oncology Nutrition Dietetics Practice Group of the Academy of Nutrition and Dietetics. Interviews were conducted by telephone using Microsoft Lync and recorded using the audio software program, Audacity®. Interviews lasted an average of 60 minutes and were conducted by a research specialist trained according to the Ecocultural Family Interview protocol. The interviews were coded by research specialists using a semantic approach to thematic analysis. Data were analyzed using Dedoose.

Results: Findings revealed that oncology RDNs are generally aware of the term “food insecurity” and can accurately define it. RDNs believe that FI is a problem for many of their patients and that cancer patients are more likely to be negatively affected by FI compared to healthy adults. RDNs identified potential adverse consequences of FI for cancer outcomes such as poor nutritional status, QOL and tolerance to treatment. Few RDNs reported they regularly ask patients about their ability to afford necessary food. The vast majority of RDNs had not heard of or used a validated assessment tool to identify food insecure cancer patients.

Conclusions: Most oncology RDNs are knowledgeable about FI and are concerned about the potential negative impact on cancer outcomes. However, most do not use a validated assessment tool to identify cancer patients who may be food insecure. These findings can inform intervention work focused on screening for and addressing FI in oncology settings.

Purpose: Men on androgen deprivation therapy (ADT) for prostate cancer experience multiple side effects including reduced quality of life (QoL). No study to date has examined associations between movement behaviours (sedentary behaviour [SED], light physical activity [PA], moderate-to-vigorous physical activity [MVPA]) and QoL among men on ADT. The study objectives are to: a) estimate the prevalence of movement behaviour patterns; and b) determine associations of PA and SED with QoL in this population.

Methods: We conducted a pooled analysis of 106 men on ADT from baseline data of three existing North American intervention studies. Movement behaviour was assessed using ActiGraph accelerometers worn for 7 days. Self-reported QoL was assessed using the Functional Assessment of Cancer Therapy (FACT). Quantile regression was used to examine associations of QoL with light PA, MVPA, and SED at the 25th, 50th, and 75th QoL percentiles. 

Results: Men on ADT had a M_age=72.2±7.6 years, M_BMI=27.8±4.0 kg/m², 40.6% had surgery, 80.2% received radiation, and 72.6% had localized prostate cancer. Men spent 71.5% of their total time sedentary (8.9 h/day), 32.9% (3.2 h/day) in light PA and 2.2% in MVPA (0.3 h/day). SED in at least 30 minute-bouts was inversely associated with functional well-being (ß= -.003, p=.017) at the 50^th percentile. Breaks in sedentary time were positively associated with physical well-being at the 75^th percentile (ß=.007, p=.003), and inversely associated with FACT-General at the 50^th percentile (ß= -.04, p=.005). Light PA was positively associated with FACT-Prostate at the 25^th percentile (ß=.011, p=.020), and with the Trial Outcome Index (TOI)-Prostate at the 75^th percentile. MVPA in at least 10-minute bouts was inversely associated with TOI-Prostate (ß= -.03, p=.026), emotional well-being (ß= -.01, p=.034), and FACT-General (ß= -.04, p=.034) at the 75^th percentile.

Conclusions:  Men on ADT are highly sedentary and engage in few MVPA minutes. Sedentary time, light PA, and MVPA were significantly associated with QoL outcomes, but varied across men reporting the poorest QoL compared to those in the highest QoL distributions. Light PA appears to be beneficial for QoL even among the poorest QoL distributions, suggesting the need to ‘move more’ after a prostate cancer diagnosis.

Purpose: Physical activity (PA) interventions are efficacious in ameliorating many common side-effects of cancer, however PA is not a routine part of cancer treatment.  Efficacy studies focus on demonstrating the clinical benefits to patients, whilst, implementation outcomes may be more important when seeking to change practice.  The purpose of this systematic review was to identify those outcomes that are evaluated when PA interventions are implemented within routine cancer care practices. 

Methods: The systematic review was conducted in accordance with the PRISMA statement. We searched Medline, CINAHL, Web of Science, PsycInfo, SportsDiscus, Scopus and Cochrane Central Registry of Controlled Trials using terms for PA, cancer and implementation.  We also manually searched the Moving through Cancer website, which was developed alongside the new ACSM cancer guidelines to connect people to cancer-specific PA opportunities.  Study inclusion criteria were: 1) PA implemented as adjunctive therapy within the cancer care continuum from diagnosis to curative intent or care, and 2) reporting at least one implementation outcome.  Proctor’s Implementation Outcomes Framework was used to define the implementation outcomes and guide data extraction and synthesis. 

Results: The results suggest we have limited understanding of PA implementation for cancer care.  From an initial search yielding 4441 hits, 37 articles met the inclusion criteria.  Most studies explored the patient-level outcome of appropriateness (defined as whether the PA program improved the side effects of cancer).  Few studies explored organisational-level sustainability or penetration (reach) outcomes.  An important finding of this review is that many PA interventions established a co-ordination role that supported program optimisation and integration.  The role appears critical to PA intervention success in cancer settings yet is not extensively studied or well-articulated. 

Conclusions:  There is significant scope to expand the implementation outcomes evaluated in PA interventions to improve health outcomes for people living with cancer.  This includes evaluating existing programs (for example, those identified at Moving through Cancer) and focusing on opportunities to examine the coordinator role.  This shift would support efforts to better integrate PA interventions in routine cancer care.

Purpose: Hormone therapy has a lot of consequences to breast cancer women, and literature suggests that exercise is important, but the effects in the physical health of breast cancer women undergoing hormone therapy it yet not clears in the literature. The objective of this systematic review was to investigate the effects of exercise in the physical health of breast cancer women undergoing hormone therapy. Methods: The five electronics databases PubMed, Web of Science, Cinahl Database, Cochrane Library for Clinical Trials and Lilacs were searched by two authors using the "Breast Neoplasms"[Mesh] and "Tamoxifen"[Mesh] and "Aromatase Inhibitors"[Mesh] and "Exercise"[Mesh] in April of 2019. Randomized and non-randomized clinical trials that investigate the effects of exercise in breast cancer women undergoing hormone therapy were included. The physical effects investigated were cardiorespiratory fitness, pain, bone mineral density, grip strength, and body fat percentage. The risk of bias was accessed by Downs and Black Scale. Pooled effects were reported as standardized mean differences (SMDs) and 95% confidence intervals (CIs) using a random-effects model.  Results: 13 studies were included in the systematic review and 11 in the meta-analysis. Different modalities of exercise were investigated as aerobic, resistance, concurrent, walking and yoga in 555 breast cancer women aged 58.5 (6.3) years old undergoing hormone therapy using tamoxifen or aromatase inhibitors. Seven studies included a control group and asked them to maintain their usual activity routine during the study or allocate them to a waitlist control. The exercise intervention was from eight to 48 weeks, with the frequency of 2x week to 5x week, from 15 minutes to 100 minutes per session, in a light to moderate intensity of 50% to 80% of the HRmax. Significant effects were found for cardiorespiratory fitness (MD 0.370; IC95% 0.111;0.629; p=0.005; I² = 93%) and pain (MD -0.554; IC95% -1.107; -0.002; p=0.049; I²=80%). No significant effects were observed for bone mineral density, grip strength, and body fat percentage. Conclusions: Aerobic, resistance and walking exercise were found to be beneficial for breast cancer women undergoing hormone therapy in cardiorespiratory fitness and pain and should be recommended to these women. (PROSPERO CRD42018099367)

 

Purpose: The purpose of this study is to identify differences in computer usability, discomfort and physical activity levels for individuals utilizing stand biased, sit stand and traditional workstations.

 

Method: Participants were recruited from a university population of administrative personnel.  Based on their workstation type, individuals were assigned to one of three groups (Stand biased, Sit stand or Traditional).  Researchers utilized RSIGuard® Ergonomic Software to collect active computing time, mouse clicks, total mouse distance, keyboard errors, and words per day.  Based on these variables an error rate was calculated.  Data were collected for 10 working days for each participant.  Participants were asked to complete a questionnaire that identified workstation components ie. footrests and complete the Nordic Musculoskeletal Questionnaire.  ActivPAL® sensors were used to collect data on activity levels, sit to stand changes and METs for each individual for three work-days.  Anova was used to evaluate continuous data and the Scheffe test was used to determine which groups showed statistically significant differences.  Results: Participants who utilized a stand-biased workstation had statistically more time standing and less time sitting at work than those who used a traditional workstation.  Additionally the energy expenditure (METs/h) was statistically different for the stand biased and tradition workstation groups.   However, time walking and step count were not significantly different between the any of the three groups.   Computer utilization variables showed a statistical difference in the word count and mouse double clicks between the three groups but no difference in error rate or active computer minutes.  There was no statistical difference for individuals reporting discomfort within each group for the neck, upper back, shoulder, wrist/hand, hips, knees or ankles/feet. 

 

Conclusion: Individuals who utilize a stand-biased workstation expend more energy and spend more time standing and less time sitting than their traditional workstation counterparts.  Additionally, utilization of a stand biased workstation appears to be associated with an increase in productivity with little to no change in the percentage of individuals reporting discomfort when compared to traditional counterparts.

 

PURPOSE: Community networks with strong partnerships and relationships are better situated for implementing community-based interventions. However, the literature is not clear on how relationships and networks develop when implementing complex interventions. To address this gap, an innovative approach to Social Network Analysis (SNA) was used to examine relationships in the multilevel Children’s Healthy Living (CHL) intervention to reduce child obesity. The purpose of this study is to understand how community networks evolved as CHL staff implemented intervention activities.

METHODS: CHL was a multilevel, multisite cluster randomized controlled trial. The intervention was conducted in nine communities within five jurisdictions in the US Affiliated Pacific from 2013 to 2015. Intervention activities were coded in six-month “blocks” over the two-year intervention to investigate how community networks changed. Coded data were used to create network maps for four time intervals. Evolution of social networks were examined through visualizing maps that were compared to look for relationship patterns among community implementers. Descriptive statistics of the number of nodes and edges present in the maps were reported along with the calculations of graph density and the average weighted degree.

RESULTS: Community network density increased over time with maximum number of ties possible for the network (graph density = 1.0) was realized 12 months into the intervention and the average weighted degree (number of activities implemented by community network) increased nine-fold from the beginning to the end of the intervention. Schools, community-based groups, and large organizations were primary implementers with 269, 244 and 240 activities implemented, respectively. A pattern of interaction between the three primary implementers emerged at the 12 month time-period and continued to develop during the following two time-periods.

CONCLUSIONS: Social network mapping provided a way to visualize and understand community connections. Findings highlight the need to have sufficient time to develop and build relationships among school, non-profit, and large organizational partners, especially those that can leverage new resources for the community, to reduce young child obesity. Exploring interactions between community implementers are needed to identify key points that can be leveraged to sustain community action.

 

Purpose:  The purpose of this study was to examine the implementation dose and fidelity of the Healthy Summer Learners (HSL) program, one of the first interventions to simultaneously target summer slides in both weight status and academic learning.

Methods: HSL operated in two low-income elementary schools four days per week for six weeks (i.e. 24 days) during the summers of 2018 and 2019.  The program was operated by teachers who worked at each school and was designed to deliver 3.25 hours of reading/writing instruction, three hours of physical activity (PA) opportunities, nutrition education, and a healthy breakfast, lunch, and snack, daily. Trained research assistants assessed the dose and fidelity of the program using checklists and observation forms on three randomly chosen days each summer. Student attendance records were provided by program staff.

 Results: A total of 59 children were enrolled across both summers with 31% attending 10 or fewer days, 22% attending 11 to 19 days and 47% attending 20 days or more. The average days attended was higher in 2018 than in 2019 (17 v. 13). Of the intended 195 minutes of academic content, an average of 114 (SD=49) and 86 (SD=56) minutes were observed in 2018 and 2019, respectively. Of the intended 180 minutes of PA an average of 154 (SD=10) and 131 (SD=50) minutes were observed in 2018 and 2019, respectively. All meals and snacks served met the USDA nutritional guidelines. Nutrition education was observed on each of the observation days in 2018 and none of the observation days in 2019.

Conclusions: Overall, HSL was implemented with varying fidelity. The first summer of implementation was more consistent with the intended dose of PA and academic time. Children also attended the program more frequently in 2018. These findings will be discussed in relation to the main outcomes and qualitative process evaluation findings from the HSL evaluation.

 

PURPOSE: School-based physical activity programs improve student health and academic performance. However, real world implementation of such programs by classroom teachers is low.  The purpose of this study was to examine the association between factors at organizational (school capacity), provider (teacher characteristics) and innovation-level (attributes of the program and quality of support systems) and teacher implementation of Bluearth Foundation’s Active Schools program.

 

METHODS: Data were collected from classroom teachers who had been involved in the program between 2015-2017. Measures were used to assess school climate, teacher characteristics, quality of support systems, and attributes of the program using online questionnaires. Univariate associations were assessed by entering each predictor variable as a fixed effect in a linear mixed effect model. Next, all predictor variables with a significant univariate association (p<0.05) were entered as fixed effects into a single mixed effects model and backwards deletion was conducted to delete all predictor variables until only variables significant at p<0.05 remained in the model.

 

RESULTS: 76 (47%) teachers responded; 83% were female. In the univariate analysis, school capacity (teacher climate, p=.028; environmental influence, p=.031), teacher characteristics (self-efficacy, p=.001; attitudes, p=.020, belief in behavioral benefits, p=.045); attributes of the program (observability of benefits, p=.010) and quality of support systems (hands-on training, p=.027) were positively associated with implementation. In multivariate analysis, only self-efficacy was independently associated with implementation.

 

CONCLUSIONS: Factors at multiple levels influence implementation of holistic movement programs and the school context needs to be considered in the design of implementation strategies. Improving the implementation of  movement programs requires multidisciplinary teams, with insights from organizational psychology, education administration, and individual behavior change. Strategies that enhance school movement culture, teacher attitudes, self-efficacy and beliefs about the benefits of programs on student behavior, hands on training and tools to facilitate teacher observation of program benefits are likely to increase implementation.

 

Background: Polycystic ovary syndrome (PCOS) is a common condition with reproductive, metabolic and psychological manifestations which are exacerbated by obesity. The 2018 International Evidence-based Guideline for the Assessment and Management of PCOS recommends lifestyle management as first-line treatment to improve symptoms and long-term health risk. However, systemic and individual barriers to lifestyle management implementation exist for women with PCOS and the different health professionals involved in caring for women with PCOS. Endocrinologists’ barriers and facilitators to the implementation of lifestyle management in PCOS have not previously been explored.

Method: Utilising a qualitative descriptive approach we gathered the perspectives of 11 Australian endocrinologists who saw women with PCOS from three patient subgroups (rural n=2, culturally and linguistically diverse n=6 and general population n=5). Semi-structured interviews were audio-recorded and transcribed verbatim. Analysis was conducted on NVIVO 12 Plus software using a reflexive thematic analysis approach.  

Results: Endocrinologists had a comprehensive knowledge of the role of lifestyle in PCOS, considered it integral to PCOS management, discussed it with all women with PCOS and considered it to be addressed well in the guidelines. Reported systemic barriers to the implementation of lifestyle management included a lack of specific advice for PCOS, the poor fit between lifestyle management and specialist care, a lack of access to allied health and other lifestyle management services and training gaps in lifestyle management and PCOS. Individual practitioner barriers included sense of futility with lifestyle management, perceived poor patient motivation and adherence and a perceived patient sense of helplessness. Systemic facilitators included a team care approach utilising allied health referral through chronic disease management plans and credible sources of information. Individual facilitators included provision of tailored advice.

Conclusions: Endocrinologists experienced a number of systemic and individual barriers to the implementation of lifestyle management in PCOS both specific to their circumstances and consistent with findings in general practice and the general population. These barriers must be addressed and current facilitatory practices strengthened in order to optimise health outcomes for women with PCOS. Development and trial of novel, co-designed models of care should incorporate these findings for best practice in PCOS lifestyle management.

Purpose

Obesity-related cancers and other chronic diseases are a major modern public health concern. Walking as a form of exercise has been shown to improve health and reduce risk for heart disease, stroke, type 2 diabetes, depression and more (DHHS, 2008). In the wake of smart phone applications and smart watches, local walking challenges engage communities in sustained physical activity through friendly competition and consequently, individuals increase their daily exercise as a lifestyle change.

Methods

We host 3 employer-based walking challenges a year: Walk The Walk Team Challenge (WTW), 10,000 Steps for 100 Days (10K for 100), and Step Bootcamp. Each of these challenges consist of different objectives, but have the same aim of increasing individuals’ daily physical activity.  Enrollment and pre and 2-week post competition step counts were collected and compared for each challenge.

Results

These challenges attracted participants from a wide range of employees from universities, the City, the County, utility companies and private employers. WTW had the greatest number of participants with 825 in 2019. Followed by 10,000 steps for 100 Days at 405. Step Bootcamp had the least participants with 73 enrolled, however, this challenge was the most intensive. At baseline, step count varied from 9924 for WTW to 7280 for the Step Bootcamp. Two-week post challenge averages ranged from 13,061 for WTW to 12,632 for the Step Bootcamp. Participants in the Step Bootcamp had a 73.5% increase while the WTW had only a 31.6% increase in average daily steps. Of the 405 participants who started the 10,000 Steps for 100 Days, at week 6, approximately 130 are step in the challenge.

Conclusions

We successfully delivered three walking challenges. Enrollment was highest for the team based challenge, however, the greatest step improvement was observed in the Step Bootcamp. Walking challenges can be a low cost and easily implementable wellness resource to employers to increase physical activity.   

Objective:   Better cooking skills may improve food security by improving management of existing resources, ability to budget and plan meals, and capacity to cook healthy meals from inexpensive ingredients. In this research partnership with a federally-qualified health center in Detroit, Michigan, we collaboratively piloted a new cooking skills intervention, based on a Food Agency approach, with the goal of improving diet quality and food security.

 

Methods:     We conducted focus groups (two Spanish, two English) with CHASS patients (N=38) to inform development of the classes. Based on focus group results and input from the steering committee, we then developed and piloted four cooking classes that were conducted in English and Spanish (separately) in the teaching kitchen at the health center (N=30, two more classes are planned for six total classes). We assessed changes in cooking confidence and other related outcomes using surveys pre- and post- class. We also conducted interviews (N=12) with class participants 2-4 months after the classes to understand their experience and satisfaction with the class and whether/how they used the concepts taught in their day-to-day lives.

Results:      CHASS patients identified barriers to cooking, including trade-offs between quality and cost of food in local stores, difficulty satisfying preferences of family members, and lack of time and interest. Many participants self-identified as “good cooks” but lacked confidence preparing unfamiliar foods. Classes focused on vegetarian cooking, anti-inflammatory cooking, and seasonal cooking. Preliminary results indicate that participants improved confidence in: cooking (p=0.05), assembling and cooking a healthy meal without a recipe (p=0.05), experimenting with new ingredients (p=0.001), and knowing how to make use of food before it goes bad (p=0.03). In post class interviews participants identified that they enjoyed the social interaction and the hands-on participation in the classes, and that they used the recipes and ingredients at home. 

Conclusions:   Participatory, hands on cooking interventions based on Food Agency may be an effective way to engage low-income patients in community health clinics and to empower healthy behavior change. 

Purpose:

Inadequate health literacy (HL) and social isolation are risk factors for older adults. In the first phase of GeWinn, a community-based HL intervention aiming to counteract both risk factors, was developed and pilot tested. The intervention resulted in improved HL scores and was well-accepted by the participants. Moreover, the programs structure was shown to support self-reliant working groups of older people. After the revision and adaption of the program, in the second phase the current aim is to develop and implement strategies to scale up the intervention by reaching other regions of Bavaria, South Germany.

 

Methods:

A webinar was performed to inform regional multipliers of a health insurance about the intervention as well as instruct them to reach out to municipal stakeholders. A 4-step scaling up program was implemented with each participating community concerning information, co-operative planning, networking and kick-off meetings for the target group.

 

Results/findings:

In total, 40 multipliers participated in the webinar. Four of the 71 districts were acquired and participated with 12 municipalities after six months. The communities tended to need more time to implement the program. For example, it took six to eight months instead of four as originally scheduled to organize cooperative planning and networking. The communities needed frequent contacting to ensure general willingness and create a network of local stakeholders. 

 

Conclusions:

Close cooperation with the participating communities is shown to be helpful in the acquisition of local partners and the promotion of the program’s implementation. Networking meetings are well received and therefore good means to enhance the communities’ readiness. At the end of the intervention, there will be a meeting with stakeholders of the communities to discuss tailored methods for sustainable actions to establish and strengthen regional structures as well as improve HL in older adults. Therefore, the implementation of the intervention will not only support individuals but has the potential to promote whole regions in their health promotion.

Purpose: Nutrition professionals are often at the front line in the development, implementation, and scaling of preventive interventions to support healthy behaviors. Thus, it is important to assess whether these individuals have the tools necessary to facilitate effective interventions. The purpose of this study was to assess the knowledge and application of concepts from prevention and implementation science in nutrition professionals in the United States. 

Methods: Attendees of a session about prevention science at a large national nutrition conference in the United States were asked anonymously about their knowledge and application of prevention and implementation science. 

Results: Approximately 110 attendees answered polling questions during the conference session. Of the respondents, 65% of participants have implemented either evidence-based or evidence informed programs, yet 22% of participants do not evaluate programs, and 83% of participants had not heard of prevention science, implementation science, logic models, or seen these concepts in practice.

Conclusions: The effective implementation and evaluation of prevention programs is essential to support the development of healthy behaviors. To encourage the implementation and evaluation of effective programs, the following three areas are suggested for the nutrition field: additional training for nutrition professionals, the inclusion of technical assistance in the implementation of prevention programs, and encouraging interdisciplinary teams in program implementation and evaluation. Based on responses from attendees, additional training for nutrition professionals is necessary to support the development, dissemination, and scaling of evidence based programs to develop healthy behaviors and reduce the risk of chronic disease. Additionally, in the development of prevention programs, technical assistance may be helpful to provide training for professionals who are implementing programs. Lastly, interdisciplinary teams including prevention scientists and public health professionals could help to support effective nutrition interventions. 

 

Purpose: Low-income households often lack funds to purchase sufficient nutritious foods, which are necessary for health and wellbeing. The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week to purchase healthy foods in local farmers’ markets for 16 weeks during the summer. The purpose of this study was to describe participants’ experiences and perspectives of accessing nutritious foods, and facilitators and barriers to participating in the program; and to explore perceived program outcomes. This study is the first of its kind in Canada and fills gaps in the literature for longitudinal qualitative studies examining participants’ experiences of FMNCPs. Methods: Qualitative description was used to investigate participants’ experiences and perspectives of the FMNCP. We interviewed 28 adults from low-income households from three communities in BC who were enrolled in the program. Semi-structured interviews were conducted at two time points by two researchers; during the program, and 4 to 7 weeks after the program ended. Data generation and analysis was guided by Freedman et al.’s theoretical framework for nutritious food access in farmers’ markets. Two researchers jointly developed a coding scheme and coded the data using directed content analysis. Themes were developed by coding within and between time points. Results: Five main themes emerged from the analysis: 1) Coupon Program execution and delivery; 2) Availability of nutritious foods in farmers’ market; 3) Nutritional and social outcomes; 4) Enhanced nutritional knowledge 5) Suggestions for program improvement. All participants acknowledged that the program improved access to nutritious foods. Shopping at farmers’ markets increased accessibility to fresh produce, provided opportunities for education, and increased social interactions. Barriers such as transportation, limited variety in rural areas, as well as stigmatizing experiences were identified. Participants suggested extending the duration of the program, and allow for more types of foods to be purchased with the coupons. Conclusion: Participants viewed the program as an opportunity to access fresh and local foods, and identified several positive outcomes from the program. The results elucidate information required to scale-up similar programs to other provinces in Canada, and other parts of the world.

Purpose: Cardiovascular diseases are the leading cause of disability and deaths worldwide and secondary prevention is crucial to improve risk factors and reduce disease burden. Accessibility barriers contribute to underutilisation of traditional centre-based cardiac rehabilitation programs and alternative delivery models, including cardiac telerehabilitation, can be effective and cost-effective, but there is inadequate evidence about translating this research into routine clinical practice. This review of pragmatic and experimental studies synthesises current knowledge about implementing cardiac telerehabilitation, which is critical to support broader access to cardiac rehabilitation and improve individual, clinical, and health economic outcomes.

Methods: Four electronic databases were searched from 1990–09/11/2018 for studies evaluating implementation of cardiac telerehabilitation in routine clinical practice or implementation outcomes assessed in experimental trials among adults (>18 y) with coronary heart disease (myocardial infarction, angina, coronary revascularisation). This review follows PRISMA guidelines and is registered with PROSPERO (CRD42019124254).

Results: No studies evaluated cardiac telerehabilitation implementation in routine clinical practice. Eight studies evaluated aspects of implementation within experimental trials (n=1547). Acceptability (N=6), fidelity (N=5), appropriateness (N=4), implementation cost (N=3), and feasibility (N=1) were frequently evaluated from participant perspective. Interventions delivering personalised text-messages were considered useful, safe and appropriate; however, smartphone- or web-based app interventions that provided more comprehensive services, including individualised real-time monitoring and coaching were preferred. Most studies showed high intervention fidelity while few studies signalled potential of cardiac telerehabilitation to improve service access at a lower cost than traditional cardiac rehabilitation. Intervention delivered via mobile phone was found easy for everyday use among participants. Key outcomes, including adoption, penetration and sustainability (all N=0), and perspectives of CR practitioners and health service organisations, have received little attention.

Conclusions: Early experimental trials suggest cardiac telerehabilitation can successfully address the unmet needs of some individuals; however, there is much to learn about how interventions can be successfully, scalably, and sustainably translated into routine clinical practice to realise their potential impact on accessibility and participation rates, as well as person-centred, health, and economic outcomes.  

Purpose: Interprofessional collaboration and adaptation of e-health are necessary to implement innovative exercise and nutrition interventions in health practice. The aims of this qualitative study were 1) determine the relevant factors related to successful interprofessional collaboration, and 2) determine the relevant factors for implementation and susceptibility of our blended interventions in older adults, by allied health professionals in the Amsterdam metropolitan region.

Methods: This explorative qualitative study was the next step in implementation, subsequent to the VITAMIN RCT. In total 45 physiotherapy and 27 dietician practices were selected for recruitment. We combined fourteen semi-structured interviews with dieticians with two focus-groups of mixed exercise- and physiotherapists. After each focus-group and interview the two researchers evaluated and discussed the statements, factors and common believes in relation to the research questions. Transcripts were analyzed with MAXQDA software, and open, axial and selective coding was adapted by two independent researchers. A third researcher was available if consensus could not be reached.

Results: In current practice interprofessional collaboration is not common, mainly due to lacking knowledge about the other profession. Location is a facilitator, as well is previous experience. External factors as higher financial compensation to implement interprofessional work meetings were defined as possible facilitator to collaboration. The professionals defined a shared electronic patient database as necessity to interprofessional collaboration, especially due to the privacy regulations. Main encouraging factors related to blended interventions were timesaving consults, ability to reach immobile older adults, and cost saving healthcare. Main barrier was lacking e-health literacy of older adults.

Conclusions: This study shows that the exercise and nutrition professionals have a positive attitude towards future implementation of these types of blended and combined interventions for older adults. Furthermore, interprofessional collaboration is a point of attention in our regional allied healthcare system. Several external factors related to implementation, like financial compensation, make the adaptation of combined interventions with e-health for older adults challenging.

Keywords:    Ageing, Community, E-health, Lifestyle intervention, Public health

Purpose: To assess parental acceptability, appropriateness, feasibility and adoption of an m-health intervention to improve the nutritional quality of school lunchboxes.

Methods: A cluster randomised controlled trial was conducted in 32 primary schools throughout New South Wales, Australia. Primary schools were randomised to either a six month multi-component lunchbox intervention (SWAP IT) which included 10 weekly lunchbox messages sent directly to parents via a school mobile communication app (Skoolbag), provision of resources (water bottle, ice brick, parent booklet) and school nutrition guidelines, or to a control arm. Implementation outcomes were measured to assess the extent to which our intervention was implemented and inform future scale-up efforts. Acceptability, appropriateness, feasibility and adoption were assessed at follow up in all consenting parents from intervention schools, via a computer assisted telephone interview (CATI). Validated scales were used to measure acceptability (Acceptability of Intervention Measure), appropriateness (Intervention Appropriateness Measure) and feasibility (Feasibility of Intervention Measure). Adoption was measured via parental report of a change in lunchbox packing behaviour.

Results: Of parents who consented to participate in the CATI (n=769), 326 (42%) parents have completed the CATI (currently ongoing). The majority of parents reported downloading the Skoolbag app (81%), with 57% of parents opening four or more lunchbox messages. For acceptability, preliminary findings have shown that the majority of parents found the program appealing (91%), approved (96%), and liked SWAP IT (96%). SWAP IT was considered appropriate with parents agreeing that SWAP IT was fitting (97%), applicable (95%) and suitable (92%) and seemed like a good idea (97%). For feasibility, parents also agreed that SWAP IT was easy to use (97%), possible (97%) and implementable (92%). In regards to adoption, over 63% of parents reported that SWAP IT changed what they packed in the lunchbox. Finalised results from the CATI (completed by the end of 2019) and overall scores of validated measures will be presented.

Conclusion: Overall, SWAP IT was adopted by the majority of parents and was considered to be feasible, appropriate and acceptable.

Purpose: Understanding the use of evidence to inform park design is critical to reduce the research-practice-policy gap and maximise the public health impact of park infrastructure. The aim of this study was to explore stakeholder perceptions regarding factors that influence the use of research evidence to inform park planning and design, and potential strategies to enhance effective translation of research evidence into practice and policy.

Methods: One-on-one key-informant interviews were conducted between May-July 2018 with 23 stakeholders (65% male) in Australia. Stakeholders held a variety of positions in both government and non-government organisations within the park design, planning and management sector. Participants were asked to share experiences regarding: factors that influence park development and design; current policies in place in their organisation in relation to park development; ways to facilitate use of evidence to inform park design; and priorities for research evidence to support their work. The interviews were recorded and transcribed verbatim and content analysis was performed using NVivo 12 software.

Results: Research evidence is used by stakeholders and considered important; however, several barriers to using evidence were highlighted including: time and cost constraints; difficulties locating and accessing research; and limited research relevant to specific needs. Developing partnerships between researchers and park developers and providing more accessible evidence communicated in an informative way such as short summaries and reports, infographics, presentations, regularly disseminated park research updates and dedicated research databases emerged as key enablers. Two main research gaps were identified including research into park features that would encourage visitation and cost-benefit analyses studies.

Conclusions: This research is a first step to better understand potential strategies to promote more effective uptake and use of research evidence to inform future park planning and design. Researchers must generate policy-relevant research in a readily accessible, timely and user-friendly format. Findings from this research also highlight that multi-sectoral collaborations between relevant fields is essential to enhance park design, park visitation and ultimately public health. The strategies and lessons learnt could be applied to other fields of research and topic areas.

Purpose: Participant recruitment to community-based physical activity trials can be challenging. We are trialling different methods to recruit participants to the ComeBACK trial, a 3-arm pragmatic randomised controlled trial investigating the effectiveness of behavioural interventions on physical activity for adults with self-reported walking difficulty.

Methods: Recruitment to the ComeBACK trial is occurring using varied strategies

i) From the end of episode of care at an acute or rehabilitation hospital in New South Wales (NSW), South Australia (SA) and Victoria (VIC). Research staff facilitate screening at sites in VIC and SA. 

ii) In each of these states and Queensland recruitment also occurs from the general community using advertisements in social media and through consumer organisations. Patients recruited via this method are directed to a website where they are screened using the eligibility criteria. Research staff then contact the person to assess their interest and confirm their eligibility.

The costs associated with each of these recruitment methods is being collected.

Results/findings: Since the commencement of recruitment in February 2019, 520 people have been screened, 118 participants have been recruited and 113 randomised. 76% of participants recruited are female with an average age of 69 years.

In the first 5 months of recruitment, 1 person (3%) was recruited from the community and 29 (97%) from health services. Social media advertising via Facebook commenced in more recent months in metro regions of Melbourne, Sydney and Adelaide (per advertisement: average cost $235.00; average length 6 nights; average reach 15,172) and via a NSW government digital newsletter targeting older people. In the last 5 months 83 participants have been recruited, 59 (71%) from the community via advertisement and 24 (29%) from health services.

Conclusions: Several recruitment strategies have been successfully used in the ComeBACK trial. The use of advertising in both social media and with consumer organisations has yielded an increase in recruitment rates compared with recruitment from health services with or without the addition of research staff. Barriers to recruitment of participants directly from health services warrants further exploration to determine the suitability of this type of intervention within the Australian healthcare system.

Purpose:

This qualitative study investigated the experiences of NSW Local Health District (LHD) staff involved in implementation of a food environment policy – the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework (Framework) – developed by the NSW Ministry of Health. Evaluation of this ongoing, large-scale policy implementation to improve the food and drink offerings for staff and visitors in NSW health facilities adds significant evidence about how to successfully implement large-scale food environment policies in environments other than schools.

This presentation focuses on answering these research questions:

1.       To what extent have processes at the LHDs, and materials, tools and support from the Ministry, aided the implementation of the Framework?

2.       How and why did Framework implementation work or not work?

Methods:

Nine LHDs previously randomly selected for a related evaluation study were selected and two LHDs were added to improve representativeness (11 of 17 LHDs). Through a scoping and mapping exercise, key stakeholders involved in implementation were identified. Consenting interviewees from stakeholder groups in each LHD participated in either an individual or small group interview. Three large group interviews with Implementation Committees were also conducted. Two interviewers conducted all 75 interviews. Interviews were audio-recorded, transcribed, coded and thematically analysed in NVivo 11.

Findings:

The Framework premise to improve food environments was accepted by all stakeholders. Chief Executives of LHDs accepted responsibility for and drove the changes. They directed staff with relevant roles and skills to implement the Framework and these implementation leads, mostly health promotion staff, worked with dietitians and property managers to engage local retailers and work with them to implement the required changes. Initial retailer concerns were largely overcome with local and Ministry support and resources. The removal of sugar-sweetened drinks was a short-term win which encouraged ongoing implementation. Auditing and reporting drove retailer engagement with the Framework food and drink practices. 

Conclusions:

Large-scale implementation of a policy to improve food environments in hospitals required senior executive commitment, skilled implementers, resources, auditing and reporting, and willing retailers. 

 

Purpose: Australians are consuming almost double the recommended maximum salt intake. The Victorian Salt Reduction Partnership was established to coordinate efforts to reduce salt intake in the state of Victoria. As part of an intervention strategy, media and advocacy strategies were used to raise public awareness and stimulate industry and government action on salt reduction. This included periodically scheduled media releases of product category reports, which highlight the salt content of different processed foods within a category. This study aimed to perform an interim assessment of outcomes and identify if there are characteristics of the media strategy that led to better uptake and engagement.

Methods: Descriptive quantitative analysis of indicators of media coverage (media items, cumulative audience reach, advertising space rate) and food industry engagement (number of food manufacturers engaged, number and type of follow up actions) were performed for six product category reports (bread, cooking sauces, ready meals, dips and crackers, processed meats, Asian-style sauces). A qualitative analysis of the content and framing of the media release statements, which accompanied the product category reports, was also conducted in NVivo.

Results: A total of 759 media items (print and online news, radio and TV) were generated. On average, the cumulative audience reach was over 5.6 million Australians, and this ranged from less than one million to more than seven million. Approximately one-quarter of food manufacturers contacted were directly engaged by the VSRP, with between one and three manufacturers being engaged per report. The qualitative analysis of the media releases identified three main themes: general salt information (e.g. current salt intake, salt intake and health outcomes), outcomes of the product category report (e.g. range in salt levels, contribution to maximum daily salt intake) and calls to action (e.g. industry to reformulate, government to set salt targets). Differences in the themes and framing of product category reports were identified.

Conclusions: The media can be used as a tool to reach consumers with salt reduction messages and to engage food manufacturers in discussions about salt reduction. Further research is needed to determine what characteristics increase the effectiveness of media advocacy for nutrition interventions.

Purpose: The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) study aims to support physiotherapists working in South Western Sydney in Australia to deliver physical activity counselling within routine care. The purpose of this paper is to describe the implementation strategies to be used with physiotherapy teams within this study.

Methods: Pre-implementation planning for a hybrid type II implementation-effectiveness cluster randomised controlled trial. The Consolidated Framework for Implementation Research (CFIR) has been used as an overarching framework to guide implementation development. The Capabilities, Opportunities, Motivation- Behaviour (COM-B) behaviour change theoretical model was used to develop implementation strategies with consideration of evidence supporting behaviour change in healthcare and a local behavioural diagnosis. Extensive consultation with local stakeholders was undertaken to ensure strategies were context specific and have potential for scalability within the Australian healthcare setting if found to be effective and cost-effective.

Results: Two education and training workshops will be delivered to teams of physiotherapists 3-months apart with support and audit and feedback between the workshops to build clinicians’ Capabilities, Opportunities and Motivations to delivering physical activity counselling within routine care. Psychological capabilities will be addressed using the intervention functions of education, training and enablement and using behaviour change techniques (BCTs) such as ‘instruction on how to perform a behaviour’. Reflective and automatic motivation will be addressed using the intervention functions of persuasion, modelling, environmental restructuring and enablement and include BCTs such as ‘credible source’. Physical and social opportunity will be addressed using the intervention functions of modelling, enablement, environmental restructuring and training and include BCTs such as ‘prompts/cues’. Two key constructs from the CFIR have been important in implementation development; adaptability of the physical activity counselling intervention to suit different health conditions, different physiotherapy patterns of practice and inclusive of culturally diverse populations; and the implementation climate with consideration of workshop locations, length and timing.   

Conclusions: Implementation strategy development using theory, evidence and local stakeholder input increases the likelihood of successful behaviour change in physiotherapists and in turn physically inactive people receiving physiotherapy. This project is testing a potentially cost-efficient model of care to tackle the global burden of physical inactivity.

 

Purpose

 

The prescription of exercise in clinical care has been advocated worldwide through the ‘exercise is medicine’ (E=M) paradigm. The knowing-doing implementation gap of E=M, however, still exists at the level of clinicians. This means that despite clinicians know that prescribing active lifestyle as a treatment option will stimulate their patients to adopt a more physically active lifestyle, resulting in improved health, fitness and quality of life at the patient level, they do not provide tailored active lifestyle referral in routine clinical care. In this study, barriers and facilitators that clinicians experience regarding the implementation of E=M in routine clinical care are studied.

 

 

 

Methods

 

Semi-structured interviews were conducted with clinicians working in 4 departments of 2 university medical centers in the Netherlands. The development of the interview guide was guided by the framework for innovation within health care organizations of Fleuren et al (2014).

 

 

 

Results

 

Factors that were perceived as facilitators and barriers by clinicians to implement Exercises = Medicine in routine clinical care could be categorized in six main themes. These included: (1) factors related to the level of the clinicians, (2) factors related to the level of the department, (3) factors related to a broader context (hospital, society etc…), (4) factors associated with the patient, (5) practical factors, (6) factors related to referral options. Most determinants that were reported were related to the theme ‘factors related to the level of the clinicians’.

 

Conclusion

 

Within this study we identified key factors that currently hamper the implementation of E=M in Dutch routine care. The results will be used to guide implementation strategies towards more effective implementation of E=M into routine clinical care, and will feed into a blue print for the implementation of E=M in other hospitals.

 

Purpose. To stimulate healthy dietary habits among primary school-aged children (4-12 yrs), the City of Amsterdam integrated a dietary component as part of the Amsterdam Healthy Weight Programme (AHWP). Via a process evaluation we aimed to distil barriers and facilitating factors of the ‘JUMP-in’ healthy dietary school policy’s adoption, implementation and continuation, incorporating the perspectives of all stakeholders involved.

Methods. A mixed methods approach was used. Ten primary schools from socioeconomically disadvantaged neighbourhoods in Amsterdam where JUMP-in was implemented for one or two years, were included. Our data collection consisted of (1) interviews with involved health promotion professionals, school principals, school project coordinators and teachers, (2)  focus group discussions with parents and children, and (3) document analyses, e.g. from the structured implementation logs of the involved health promotion professionals. We explored perceptions of health care professionals, school principals, school project coordinators, teachers, parents and children to be able to compare different views on facilitating and hampering factors (triangulation). Descriptive statistics were obtained for quantitative questions and qualitative data was analysed via content analysis.

Results. The main facilitating factors for the implementation process of JUMP-in intervention on dietary habits were high parental support, the potential for tailoring the programme, a socio-political environment in favour of healthy eating, one school employee in charge of implementation, high teachers’ perceived  self-efficacy, knowledgeability and clarity regarding the school’s healthy dietary policies. On the other hand, main barriers were identified as: parents that do not support dietary policies, teachers who do not perceive implementing the programme as a priority in light of the regular curriculum, and parents who perceive the programme as insufficiently tailored to their cultural dietary habits.

Conclusion. In general we found a positive attitude towards and satisfaction with the JUMP-in programme. However, dissonance between programme elements (e.g. the potential to tailor the programme in some cases compromises clarity of programme guidelines) as well as between different stakeholders (e.g. guidelines were perceived clear among school principals or coordinators, whereas for some teachers guidelines were not clear) hamper successful long-term implementation of the programme.

Purpose:
TIPL is an initiative initiated in 2018 by the Danish Regions (an interest organization for the five regions in Denmark) with the aim of strengthening cooperation and cross-sectoral partnerships in public health promotion and prevention. TIPL is situated at Centre for Clinical Research and Prevention, Denmark.

Methods:
TIPL is a non-profit public initiative that facilitates different partners and organizations to meet and develop intersectoral partnership projects on prevention and health promotion. Project ideas are required to originate from challenges in public health and clinical practice and an evaluation and implementation design must be embedded for the project to be connected to TIPL.
TIPL offers a bank of resources, consisting of researchers, fundraisers and statisticians providing support with intervention design, data analysis, fundraising, partnership facilitation, mobilizing partners, and guidance in relation to evaluation, implementation and process. Thus, TIPL provides organizational and research support, but are not able to run nor fund projects.

Results/findings:
TIPL has received positive responses as an innovative setting for facilitating new projects. TIPL can offer research support and skills that are often difficult for the project owners to obtain. So far, the contribution from TIPL has been on mobilizing and involving partners in new projects, qualification and development of study- and evaluation design and fundraising. Mobilization of partners has been through three inspiration and networking meetings where a broad range of stakeholders have been gathered, ranging from interest organizations, municipalities, regions, GPs, NGOs and the private sector, resulting in the start-up of eight new projects. Foci of these projects are on cooperation across sectors, from hospitals to rehabilitation and smoking cessation programs in the municipalities and on involving NGOs in research projects.

Conclusions:
A common denominator for the projects is the facilitating role of TIPL in relation to gathering and mobilizing partners and in contributing to research design with a focus on evaluation, co-creation, and involving stakeholders in intervention design. The innovative potential for TIPL is in facilitating new types of partnerships, pragmatic approaches to evaluation and the development of new solutions, which would otherwise have been absent.

PURPOSE: Providing opportunities for elementary school-aged children to be physically active during the school day is important for obesity prevention and overall health. Classroom physical activity (CPA) has been shown to be effective for increasing student PA, but it is not widely practiced among teachers. This study examined teachers’ perspectives about CPA – including environmental, organizational, and personal factors - and their intention to provide CPA to their students.

METHODS: Teacher attitudes and beliefs about CPA, including beliefs about environmental supports or barriers and personal competence or skills, were assessed through a survey of all classroom teachers (n=165) at 10 public elementary schools. The survey included eleven scales, including 1) perceived educational benefits (3 items, alpha = .86); 2) perceived hassles (6 items, alpha = .77); 3) perceived competence (3 items, alpha = .94); 4) perceived autonomy (3 items, alpha = .83); 5) perceived autonomy support (6 items, alpha = .95); 6) principal support for CPA (1 item); 7) perceived norms (1 item); 8) organizational climate, which included two subscales, collegial behavior (6 items; alpha = .79) and restrictive behavior (4 items; alpha = .78); 9) openness to educational innovation (4 items, alpha = .74); 10) compatibility with instructional practices (4 items, alpha = .78); and 11) mindset (7 items, alpha = .72). Responses were made on 6 point Likert-type scales (strongly disagree to strongly agree). Hierarchical linear modeling was used to examine how the constructs predicted teachers’ intention to provide CPA to students, accounting for the nesting of teachers within schools.

RESULTS: Model results indicated that three of the eleven constructs significantly predicted teacher intention to provide CPA; perceived competence (B = .259, p <.001), autonomy (B = .143, p=.026) and hassles (B = -.129, p = .047).

CONCLUSION: Competence, or teachers’ belief that they could provide CPA to students, was the strongest predictor of their intent to provide CPA. However, feeling autonomous to implement CPA and perceiving fewer barriers to providing CPA also predicted intention. Addressing all of these factors through professional development could be effective for increasing teachers’ use of CPA.

Purpose: Organisational factors such as implementation climate, readiness and culture of the school may influence the decision for schools to adopt interventions, especially where coordinated action is required among teaching staff for implementation. Further, certain characteristics of interventions are theorised to predict the decision to adopt. We aimed to identify intervention characteristics that supported teachers’ and schools’ decision to adopt Transform-Us! in the first year following the project launch.

Methods: Transform-Us! is a school-based program to increase physical activity and reduce sedentary time freely available to all primary schools in Victoria, Australia (n=1,786). To calculate reach, adopting schools and teachers were recorded via the program website (teachers could register independently of their school). To understand conditions leading to adoption, school leaders and teachers completed a voluntary pre-training online survey upon registration focusing on intervention characteristics, organisational readiness and climate.

Results: 181 schools (Catholic 19.5%, Government 78.1%, Independent 2.4%) and 293 teachers adopted Transform-Us! in the first 12 months from inner regional (15.9%), major cities (73.2%), outer regional (8.5%), and remote areas (2.4%). Government school representation was 12% higher than the state average which coincided with underrepresentation in independent schools. Additionally, schools from inner regional areas were underrepresented by 16% compared to the state average. Of the adopting teachers, 43% did so independently of their school leadership. Teacher surveys (n=136) indicated teachers are already using active breaks (74.6%) and delivering active lessons (68.7%), with 93.9% confident in their ability to break up prolonged classroom sitting. School leaders reported (n=37) 85.5% of adopting schools had school level physical activity policies, 56.7% agreed physical activity is a top priority for their school and 75% of schools received funding for physical activity in the last year, and 77.8% reported Physical Education classes being taught by a specialist.

Conclusions: This study outlines the importance of teacher competence and confidence alongside school culture on reach and adoption rates across a state-wide intervention undergoing scale-up across Victorian schools. Understanding who and why schools, school leaders and teachers adopt programs helps tailor future dissemination activities. 

Purpose: This study examined gender-specific changes in self-esteem during adolescence and explored whether selected behavioral factors at age 11 years predict change in self-esteem between age 11 and 14 years among boys and girls in the UK. 

Methods: Participants were 9341 (4740 female) UK adolescents. Adolescents reported social media use at age 11 and self-esteem at age 11 and 14 years. Parents reported the physical activity and screen entertainment time of their children at age 11. Independent samples t-test assessed gender differences in self-esteem and change in self-esteem. Sex-specific repeated measures analysis of variance assessed changes in self-esteem. Change in self-esteem was regressed on each behavioral exposure for boys and girls; adjusting for significant behavioral exposures and then confounding factors (ethnicity, family income, body mass index). 

Results: Girls consistently reported lower self-esteem than boys (p<0.001) and experienced a greater decline in self-esteem during adolescence than boys (p<0.001). In final models, sport participation positively predicted change in self-esteem among boys and girls (p<0.05). Television viewing and social messaging exposure negatively predicted change in self-esteem among girls (p<0.01). 

Conclusions: Sport participation, television viewing and social messaging use are important independent targets for intervention for the optimal well-being of adolescents.

Purpose: The majority of reviews on physical activity (PA) and sedentary behaviour (SB) include English language studies only, which may exclude studies from low- and middle-income countries, including Indonesia. This study aimed to map PA and SB literature in Indonesian children and adolescents.

Methods: This study conforms to the “PRISMA Extension for Scoping Reviews (PRISMA-ScR)". A systematic search for accessing both published and grey literature was performed inception on the 10 August 2018. The following platforms and websites were accessed: (1) EBSCOhost Megafile ultimate; (2) Pubmed; (3) ProQuest dissertations and theses A&I; (4) Web of Science; (5) Google Scholar; (6) Google; (7) Neliti (Indonesian Science Repository); and (8) Electronic Repository Gadjah Mada University. Inclusion criteria for the literature: (1) targeted Indonesian children and adolescents, age 7 – 18 years old; (2) conducted on PA, physical inactivity, and/or SB; (3) written in Indonesian or English language, and (4) published as a journal article, conference proceeding, student thesis at Master or Doctoral level in full or abstract form, or report. Any research methods were eligible for inclusion. The evidence is presented in a descriptive narrative format.

Results: Out of 9,776 documents screened, 134 met the selection criteria. Most studies were journal articles (82.8%) and the majority of the full texts were in Indonesian language (Bahasa) (80.6%). The most popular design was cross-sectional (54.8%) and utilised self-report measurements (PA: 89%, SB: 96%). Rarely did studies employ qualitative, mixed methods, and longitudinal design. The most common topic studied was PA only (PA only: 76.1%, SB only: 10.4%). The majority of the studies examined the outcomes of PA and/or SB (39.3%) and the correlates of PA only (31.1%). 

Conclusions: Future studies need to focus more on interventions, validation, the prevalence of SB in large-scale samples, correlates of both SB only and PA plus SB, and determinants of SB. More studies need to be conducted to reveal in-depth personal views of PA and SB. More studies using device-based measurements, qualitative approaches, and mixed-methods are warranted.   

Keywords: physical activity, sedentary behaviour, review, children, adolescent, Indonesia

Purpose: The purpose of this study was to explore the impact of a seven-month physical activity intervention on health-related quality of life (HRQoL) and wellbeing of young people attending a Pupil Referral Unit (PRU).

Methods: HRQoL was measured using the KIDSCREEN-52 questionnaire. Semi-structured interviews were used to evaluate the staff (Group interview) and participants’ (individual interviews) experiences of, and attitudes to, the intervention using the ‘5C’s’: competence, confidence, connection, caring and character of positive youth development through sport (PYD) as the framework. Participants 14-16-years (n = 16) were recruited from one school-based PRU via purposive-convenience sampling. One-way repeated ANOVA’s, or non-parametric equivalents, were used to test for differences in HRQoL pre- post-intervention and 6-9 month follow up. Findings from the interviews were analysed using template analysis using the 5C’s as a priori themes.

Results/findings: There was a trend towards positive changes in all HRQoL dimensions from pre-intervention to the follow up point, but only two dimensions reached statistical significance (Feelings P = .038, d = 1.11; and Bullying P = .03, d = .95). There were minor reductions pre to post-intervention in the dimensions of: Emotion, About Yourself, Free Time, School and Learning, and Family and Home Life. Findings from the interviews indicated that both the young people and PRU staff could identify improvements in all 5C’s as well as the development of additional life skills. Connection received the most attention with pupils, and staff, placing greatest emphasis on their ability to develop relationships with others.

Conclusion: This research provides preliminary evidence to suggest that sport and physical activity can be used by staff in PRU’s to improve HRQoL and wellbeing for a vulnerable population facing poor health and educational outcomes. It can also increase confidence in young people and provide a means of improving relationships between young people and PRU staff.

Purpose: To describe the accelerometer measured patterns of sleep, sedentary behaviour and physical activity in adolescent females in New Zealand

Methods: The SuNDiAL Project is a cross sectional study aimed at describing the dietary intakes, nutritional status and lifestyle patterns of New Zealand adolescent females.  282 participants were recruited from 14 high schools throughout New Zealand in either March – April 2019 (n=145) or July – September 2019 (n=130).  Of those participants, 158 wore an ActiGraph Gt3x+ 24 h a day for seven days on an elasticated belt around the waist, with the accelerometer positioned over the right hip.  Participants completed a wear time diary over this time.  Sleep was identified using the Sadeh algorithm (constrained by bedtimes reported in the wear time diary). Sedentary behaviour, light intensity and moderate-to-vigorous physical activity was identified using Freedson cutpoints.

Results: 135 participants provided valid accelerometer data with an average wear time of 22.5 ± 1.84 h.  On average, this sample of adolescent girls (age 16.8 ± 0.9 years, 33% overweight or obese) slept for 7.11 ± 1.75 h per day, accumulated 3.58 ± 1.17 h per day of light intensity activity, 0.81 ± 0.54 h per day of moderate to vigorous physical activity and 11.47 ± 1.8 h per day of sedentary time.  Sedentary time was interrupted with more than a minute of activity 60 ± 20 times per day during waking hours.  On average, only one bout of sedentary time lasting greater than 30 min was accumulated each day, but the mean duration of this bout of sedentary time was 98.6 ± 123.6 min.  Thirty six participants (27%) met the New Zealand physical activity guidelines for this age group, and only 29 participants (21%) were sleeping more than 8 h per night.

Conclusions: Adolescent females in New Zealand spend a high proportion of their time sedentary, but accumulate a high number of breaks in sedentary time.  Few individuals are meeting the physical activity or sleep recommendations. Interventions aimed at re-proportioning the 24 h day to better meet 24 activity guidelines are clearly warranted.

Purpose: To date, there have been relatively little empirical investigations into adolescents’ food purchasing patterns in and around their school food environment. This cross-sectional study aimed to give insight in adolescents’ specific food purchasing patterns in their the school food environment. In addition, we explored the potential relationship with maternal monitoring and perceived relationship support.

Methods: A total of 726 adolescents (45.8% boys; M age = 13.78 ± .49; M zBMI = -.33 ± 1.02) and 713 mothers (M age = 45.05 ± 4.45; M BMI = 24.62 ± 4.17) participated in this study. Adolescents’ frequency of bringing and purchasing foods and beverages was assessed via a short Food Frequency Questionnaire (FFQ). Perceived maternal relationship support and maternal monitoring were measured via self-report questionnaires administered to either the adolescent or mother. Structural Equation Modelling (SEM) was conducted to explore the link between both variables and adolescents’ food purchasing behavior.

Results: The vast majority of the adolescents reported to buy foods or drinks less than one day per week in or around their school food environment. In contrast, they reported to bring foods and drinks mostly from home. The extent to which adolescents brought or purchased specific foods or drinks depended upon the degree of relationship support they reported to receive from their mother. No relationship was found between maternal monitoring and adolescents’ food purchasing behavior.

Conclusions: The home food environment plays an important role in what type of food or drinks are consumed within the school environment by younger adolescents (i.e. 12-14 years). This specific age group reports to make little use of the food environment in or around their school. This has implications for policy makers who aim to develop and implement measures to improve the school food environment in order to promote (younger) adolescents’ eating habits.

 

 

 

 

 

Purpose:

Dietary habits are established in childhood and may have lifelong influences on health outcomes. We aim to examine the prevalence of breakfast skipping and key food groups consumed by children at home and out-of-home, including school and other locations.

Methods:

Children aged 11-12 years were recruited from a primary school in Singapore and were asked to record their dietary intakes, eating location, and activities over a 4-day period using a self-administered time-use web-based diary.  Breakfast skipping was defined as not eating (except water) between waking and the commencement of morning school classes at 0800 for weekdays and 1100 for weekends.

Results

Among 114 children (55% males), the proportion who completed 4-day, 3-day and 1 to 2-day diaries were 61%, 9%, and 30% respectively.  Nearly half of the children reported consuming breakfast on all days while 42% skipped breakfast on some days and 11% never ate breakfast. Based on intakes averaged over 1 to 4 days, about half of the children reported not consuming any fruits or vegetables per day.  Even for children who reported consuming fruits and vegetables, the majority had less than 2 servings of fruits or 2 servings of vegetables per day. Fruits and vegetables were consumed by 40% and 70% of the children at home, respectively. A large proportion of the children reported not consuming any dairy products or wholegrains per day (72%, 65%). Most of those who consumed dairy products had less than 1 serving per day and mostly consumed at home. Three-quarter of the children reported consuming sugar-sweetened beverages (SSB) per day and consumed them at multiple locations. About one-third of SSB consumers had more than 1 serving per day.

Conclusions:

Less than half of the children consume breakfast regularly and intakes of fruit, vegetables, dairy, and wholegrains were generally inadequate, while daily consumption of SSB was common. A large proportion of the healthier food groups was consumed at home. These highlight the need to further review the food environment of children to increase their uptake of healthier foods.

Purpose:

Diet is a well-established risk factor for childhood obesity. During the transition to secondary school, dietary behaviours deteriorate with boys engaging more frequently in unhealthy dietary behaviours compared to girls. To date, limited literature has considered the factors that may be affecting this observed shift in boys’ and girls’ dietary behaviours at this age. The aim of this qualitative study was to explore how individual and environment factors (including household, social, and school factors) relate to the changes in boys’ and girls’ dietary behaviours as they transition into secondary school. 

Methods: 

Twenty-eight semi-structured interviews were conducted with a diverse sample of families from Surrey, BC, Canada. Interviews were conducted separately for one parent and child (11-13 years) from each family with interviewers probing for changes in youth’s environments that may be related to dietary behaviours. Codes were triangulated using three trained researchers. Thematic analysis was used to explore differences between boys and girls. 

Results:

The analysis suggests boys’ and girls’ exposure to parenting practices and expectations surrounding food consumption within the familial environment differed. Specifically, boys’ food consumption remained influenced by parental control whereas girls began to experience greater autonomy in food decisions including being more involved in food preparation. Boys further express pressure to consume larger quantities of food to increase body size whereas girls did not. Differences in the social environment also emerged; girls viewed fast food consumption as a key aspect of friendship, suggesting peer influence over this dietary behaviour, whereas boys consumed such foods based on hunger or convenience. Within the school environment, boys and girls experienced greater freedom during their school lunch hour but report using this time differently (boys-satiety or sports vs. girls-socialization). 

Conclusions: 

Boys and girls report differences in how parental, social and school environments influence their dietary behaviours as they transition to secondary school. Taking a gendered lens may help ensure that dietary interventions appeal to both boys and girls at this age. Addressing the retention of health promoting dietary behaviours can help protect against the development of childhood overweight and obesity. 

Purpose: Breastfeeding has beneficial effects on maternal and child health; however links between breastfeeding history and subsequent weight-related behaviors of mothers and their preschool-aged children are understudied. Thus,this study examined links among breastfeeding history and weight-related behaviors of mother:child dyads 2 to 5 years post breastfeeding.

Methods:Mothers (age=32.25±5.80SD years) of preschool children (age=3.47±1.09SD) completed an online survey assessing weight-related behaviors (dietary intake, child feeding strategies, sleep duration, eating behaviors, physical activity) of themselves and one of their randomly selected children aged 2-5 years. Mothers were divided into 2 groups based on breastfeeding history: 135 did not breastfeed and 415 had breastfed their child.

Results:T-tests revealed mothers who had breastfed had significantly (P<0.05) lower BMIs than never breastfeeders (27.23±7.53SD vs. 29.10 ±8.82SD). Sugar-sweetened beverage intake was significantly lower for mothers who had breastfed vs non-breastfeeders (0.83±0.86SD vs. 1.08±0.94SD servings/week). Breastfed children consumed significantly less 100% juice than comparators (4.17±2.70SD vs.5.31±2.53SD servings/week), although milk intake did not differ for mothers or children. Responses to 5-point Likert scales indicated mothers who had breastfed were significantly more likely to pressure children to eat healthy foods than other mothers (2.22±0.95SD and 2.01±0.99SD); no other child feeding behavior (i.e., restriction, control of food choice and timing,  rewarding healthy eating) differed. Mothers who had breastfed and their children had significantly longer sleep duration than counterparts (mothers=7.30±1.88SD and 6.84±1.71SD hours/night; children=10.60±2.14SD and 10.13±1.83SD hours/night, respectively). Mother and child eating behaviors (emotional eating, food neophobia), physical activity, and health status did not differ by breastfeeding history.

Conclusion:Breastfeeding history is associated with some, but not all, maternal and child weight-related behaviors 2-5 years post breastfeeding. Future studies should examine how length of breastfeeding affects mother:child dyad weight-related behaviors to identify temporal links and how they may support adherence to breastfeeding recommendations.

Objective: Physical activity is considered an effective method to improve sleep quality in adolescents and adults. However, there is mixed evidence among children. Our objectives were to investigate this association in children and to examine potential moderating variables.

Methods: Eight databases were systematically searched, and we included all study designs with a sample of healthy children ages 3-13 years-old. We identified 47 studies for meta-analysis. 

Results: Overall, we found little association between physical activity and sleep (r = .02, 95% confidence interval = -.03 to .07). There was a high amount of heterogeneity in the overall model (I² = 93%). However, none of the examined variables significantly moderated the overall effect, including age, gender, study design, risk of bias, study quality, measurement methodology, study direction, and publication year. Exploratory analyses showed some weak, but statistically significant associations for vigorous physical activity with sleep (r = .09, 95% CI = .01 to .17, I² = 66.3%), specifically sleep duration (r = .07, 95% CI = .00 to .14, I² = 41.1%)

Conclusion: High heterogeneity and the lack of experimental research suggests our findings should be interpreted with caution. The current evidence, however, shows little support for an association between physical activity and sleep in children.

 

 

 

Purpose: There is a link between exposure to food content through the food media environment and eating behaviors. Social media culinary videos constitute one of many food media platforms that expose audiences to food content. We conducted two studies to (i).  Analyze the nutritional content of social media culinary videos focusing on BuzzFeed’s Tasty and to (ii). Investigate the effects of exposure to BuzzFeed’s Tasty videos on adolescents’ hunger, intentions to eat and food choice behavior.

 

Methods: Quantitative cross-sectional content analyses were used to evaluate the nutritional content of 165 recipes from BuzzFeed’s Tasty using Nubel meal planning software.  The United States Department of Agriculture school lunch guidelines were used to evaluate the nutritional content of the recipes. For the experiment, a pre-test post-test experimental study was conducted on middle school children (N =126), mean age 13.88, SD =1.20. The participants were exposed to 4 minute 17 seconds of Tasty videos demonstrating either the preparation of sweet snacks (n =50) or fruits and vegetables (n =76). The measures were hunger, intentions to eat and cook the foods portrayed and food choice behaviour.

 

Results: The content analysis showed that a significant proportion contained high amounts of total fat 69% (χ²=13.96, p<.001), saturated fatty acids 74% (χ² = 19.09, p<.001). The guidelines recommend that the foods must be trans-fat free however 71% (χ²=15.17, p<.001) of the recipes contained trans fats. The experiments showed that, the effects of exposure to Tasty on intentions to eat and prepare vegetables and sweet snacks were statistically significant F(1,166) =8.11, p =005, η2 =.047 and F(1,166) =9.287, p =.003, η2 =.053, respectively. Exposure to sweet snacks also had an indirect effect on food choice behaviour mediated by intentions to eat sweet snacks.

 

In conclusion, Buzzfeed’s Tasty recipes fall short of the recommendations for healthy diets and have short term effects on intentions to eat.  Further research is warranted to determine the effects of long term, repetitive exposure.

 

 

 

 

 

 

Purpose

Cardiorespiratory fitness, the amount of daily moderate-to-vigorous physical activity (MVPA) and excessive adiposity, are recognized as important factors influencing overall health. This study aimed to assess if adolescents who were overweight at the age of 6 years old, present differences in cardiorespiratory fitness, daily time of MVPA and adiposity, when compared to adolescents who had normal weight at 6 years of age.

Methods

Retrospective study with 324 adolescents (181 girls, 143 boys) with a mean age of 13.9±1.63 years, conducted in five schools in the north and centre of Portugal. Anthropometric data at the age of 6 years were retrospectively collected from individual child health booklets records [Boletim de Saúde Infantil e Juvenil] provided by each participant, to calculate age and gender adjusted BMI percentiles according to World Health Organization references. Current weight, height and waist circumference were measured, and BMI and waist-to-height ratio were calculated. Body fat percentage was estimated by bio-impedance. Cardiorespiratory fitness was estimated using the 20-meter shuttle run test and physical activity was objectively measured by accelerometer.

Results/findings

Tracking of excessive adiposity from childhood to adolescence was confirmed for both genders, characterized by various measures of adiposity. In addition, and regardless gender, it was also found that the adolescents whom were overweight at the age of 6yr-old had significant lower levels of cardiorespiratory fitness in adolescence. However, no differences in the daily time of MVPA were found.

Conclusions

Early prevention of an overweight condition in childhood may be important in facilitating the acquisition of higher cardiorespiratory fitness values, and in the maintenance of a favourable adiposity status in adolescence.

Prupose:The research intends to design a scientific, reasonable and universally applicable physical activity (PA) intensity rating scale for Chinese preschoolers, so as to effectively help teachers in kindergartens and parents to understand the PA intensity for children, and master the skills to reasonably arrange PA curriculum.

 Methods:A group of 158 children and the other group of 27 children were selected from a kindergarten in Beijing. Children first wore the Polar Team 2 heart rate meter and the RT3 triaxial accelerometer, and then were tracked during indoor and outdoor activities. Researchers used the PA intensity rating scale to record students’ data prior to employing SPSS22.0 to analyze the data and verify the reliability, validity and rationality of the scale.

 Result/findings:From the conversion of text and graphs, the use of criterion validity test (average heart rate: r = 0.468, P < 0.01; Counts, r = 0. 472, P < 0. 01), and adding three physical indicators, i.e., breathing, sweating and complexion, to the second draft of the scale according to teachers' feedback, eventually, the intensity is divided into 6 levels. After testing, the correlation coefficient among raters using the second draft scale was 0.626 (P < 0. 05), which indicates the reliability of the scale. Additionally, the Spearman correlation coefficient between the evaluation results and heart rate was 0.593 (P < 0.01), and there were significant differences among groups of different heart rate level (P < 0.05). This implies the scale form has good criterion validity and discriminant validity. Therefore, the scale form was finalized, with three main intensity scales, namely, 1-2, 3-4, and 5-6, respectively corresponding to the lower, medium and higher PA intensity.

 Conclusions:The graph-based PA intensity scale form for Chinese preschoolers developed in this research is a rating scale for teachers with 6 options. It distinguishes the intensity of different PA played by children, help Chinese kindergarten teachers understand the PA intensity at any time, and enable them to arrange PA courses for children reasonably.

Purpose: Although diet is an essential component of a healthy lifestyle, diet quality of US children is suboptimal. Disparities exist; children from low-income, minority families are at greatest risk. Because parents influence home food choices, we investigated parent perspectives of factors that influence dietary choices.  Family-produced photographs added insight and context.   

Methods: Using a convergent mixed methods design (surveys, interviews, photographs), a purposive sample of parents/caregivers of 8-13 year-olds living in underserved communities in a large US city were recruited (n=18). Surveys were completed online; descriptive statistics were calculated. Mobile phones were used to take photographs of factors that make it easy/hard to eat healthfully; photographs were discussed during the interview. Interviews were scripted, digitally recorded, and professionally transcribed. Two coders used hybrid thematic analysis to separately code transcripts.  Coders met routinely to compare decisions and resolve differences. A codebook was maintained.

Results/Findings: All parents/caregivers were female and mostly 40-49 years old (61%), minority (56% Black/African-American, 44% Hispanic), and married/living with significant other (61%). Annual household income was $21,000-$44,000 (44%).  Emerging interview findings reveal that mothers have a strong influence on the home food environment, although child and spouse preferences exert an effect. Opinions vary as to the influence of culture. Availability, cost, convenience, and time are cited as positive and negative influences. Mothers use a variety of strategies to help their families eat healthy foods:  involving children in food shopping/preparation, buying food on sale, employing food substitutions, and making food-related activities fun.  Technology is used to locate recipes, find substitutions, or view demonstrations. Cooking is seen as an important life-skill, and mothers express interest in attending a cooking class with their children, although opinions vary as who the class leader should be (e.g., chef, nutritionist, knowledgeable/experienced community member). Although mothers want to help their families consume a healthy diet, photographs, supported by interviews, reveal beliefs, practices, and misconceptions that may limit effectiveness. 

Conclusions: Understanding family perspectives can provide insight into ways to enhance diet quality of children and families living in underserved communities.

Purpose:

Parental support, parental modelling and parental gender were the most documented parental factors associating with children’s physical activity (PA) level. However, whether physically active children would associate with higher PA level and less sedentary behaviour (SB) of their parents were not examined; thus this investigation was being the purpose of this study.    

 

Method:

This is a cross-sectional study using self-report questionnaires. Sixty families, parents with their children in average age of 5.23 years were recruited through convenience sampling. The Chinese version of IPAQ and PAQ-C were used to evaluate the PA levels, while the Chinese version of ASAQ-CH and ASBQ were used to measure the SBs of the parents and the children, respectively. The Pearson Correlation and regression analysis were applied to identify the associations of PA levels and SBs between children and their parents.  

 

Results:

The results showed no significant correlation between children and their parents on PA levels. However, the scatter plot showed a horizontal line distribution between children’s and parents’ PA. This represented parents’ PA level remains at the same level within the increasing PA of children. Yet, a separate regression analysis found that son-parent showed his total PA significantly predict parents’ total PA level (β=.356, p=.039), while daughter-parent showed her total PA only significantly predict parents’ moderate PA (β=-.42, p=.033). Moreover, domain-specific sedentary behaviour outcomes revealed that children’s SB for hobbies was positively correlated with parents’ SB for reading (r=.264, p=0.04), while children playing computer games was negatively correlated with parents’ SB for transportation(r=-.470, p<0.001).           

 

Conclusion:

Generally, active children would not associate with their parents’ PA. Instead, they might further increase parents’ SB. However, the study outcomes indicated a gender diversity on influencing parents’ behaviour. Therefore, further investigation through a qualitative study can be done to explore the reasons behind.

Purpose: Parental perceptions of different modes of transport correlate with adolescents’ mode choice for school trips. Whether parental attitudes towards active transport to school differ by mode and/or home-to-school distance is unknown. We compared parental perceptions of walking versus cycling to school in adolescents in Dunedin city, New Zealand and examined whether mode-specific motivations and barriers differ by home-to-school distance.

Methods: Parents (n=341; age: 47.5±5.2 years; 77.1% females) completed a survey about their adolescent’s (age: 13-18 years; 48.1% boys) transport to school habits and their own perceptions of walking/cycling to school. Participants were categorised into three groups according to home-to-school distance (calculated using Geographic Information Systems analysis): ‘walkable’ (≤2.25 km), ‘cyclable’ (>2.25 and ≤4.0 km) and ‘beyond cyclable’ (>4.0 km) distances. 

Results: Common modes of transport to school differed significantly across the ‘walkable’/’cyclable’/’beyond cyclable’ categories: car passenger: 25.7%/40.5%/60.6%; public/school bus: 5.5%/15.4%/28.4%; walking: 66.2%/28.2%/1.2%; cycling: 0.0%/7.7%/0.5% (all p<.001). Irrespective of the home-to-school distance, most parents regarded both walking and cycling to work and school as important. As home-to-school distance increased, parents more frequently reported active transport-related barriers and increased convenience of driving and trip-chaining. Compared to walking, parents perceived cycling to school to be less important (walking/cycling: 87.5%/62.5%), with less social support from parents (46.2%/17.1%), peers (20.6%/4.8%) and school (24.5%/12.4%) and more personal barriers (lack of adolescents’ interest: 51.5%/68.1%), environmental barriers (lack of footpaths/cycle paths: 35.0%/73.5%) and more safety concerns (35.0%/64.6%; all p<.001). As home-to-school distance increased, parents perceived less social support for walking to school whereas personal, environmental and safety-related barriers increased. Although less consistent, similar findings were observed for cycling to school. Parental perceptions of their adolescents' cycle skills did not differ across the three distance categories. Overall, 68.2% of parents expected to participate in walking/cycling to school decision-making for their adolescent.

Conclusions: Parents favoured walking compared to cycling to school. With increasing home-to-school distance, parental attitudes towards both walking and cycling were changing with less social support and more personal, environmental and safety-related barriers among those living further away. Future interventions should be mode-specific, take into account distance to school and focus on reducing parental concerns.

 

Purpose:

Global and international physical activity guidelines for children and youth provide recommendations to improve health outcomes and impact the prevalence of chronic disease in a world where physical activity is declining and sedentary behaviour is increasing in children and youth. This research aimed to systematically identify and compare national and international physical activity guidelines for children and youth. The guidelines were appraised as a means of promoting best practice in guideline development.

Methods:

The systematic review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO). Only national and international physical activity and/or sedentary behaviour guidelines were included in the review. Included guidelines targeted children and adolescents between the age of 5 and 18 years. A grey literature search was undertaken incorporating electronic databases, targeted websites, customized Google search engines and international expert consultation. The ‘Appraisal of Guidelines for Research and Evaluation II Instrument’ (AGREE II) was used to assess guideline quality.

Results:

Fifty countries were identified as having a national or international guideline for children and youth. There were twenty-five different national guidelines and three international guidelines (European Commission, Nordic countries, World Health Organisation (WHO)). There was variability in the guidelines in relation to targeted age group; guideline wording regarding type, amount, duration, intensity, frequency and total amount of physical activity; and date of release (2008 to 2019). Sedentary behaviour was included in 22 guidelines and three included sleep. There was marked variation in guideline quality. Total scores for all domains of the AGREE II assessment ranged from 25.8% to 95.3%, with similar variability in each of the six individual domains.

Conclusions:

International and national physical activity guidelines demonstrate considerable variability in relation to quality, development and recommendations, highlighting the need for rigorous and transparent guideline development methodologies to ensure appropriate guidance for population-based approaches. If countries do not have the resources to ensure this level of quality, the adoption or adolopment of the WHO guidelines or guidelines of similar quality is recommended.

Reference: PROSPERO 2017 CRD42017072558

Purpose: The purpose of the study was to analyze the cross-sectional associations between the adherence to the 24-hour movement guidelines and adiposity among children and youth.

Methods: An analysis was performed in 679 Czech children and youth (57% girls) aged 8–18 years. The amount of time spent in moderate-to-vigorous physical activity (MVPA) and SL duration were measured using wrist-worn ActiGraph accelerometer. Accelerometer data were processed using the GGIR open-source R package. Entertainment screen-time (ST) was investigated by two questions with nine response options. BMI z-score, fat mass percentage, and visceral adipose tissue (VAT) were used as adiposity indicators. Children were classified as meeting the overall 24-hour movement guidelines if they accumulated ≥60 min/day of MVPA, and engaged in less than 2 h/day of ST and uninterrupted SL of 9–11 hours for those younger than 14 years and 8–10 hours for those aged 14 years and over.

Results: In the total sample, 34.6% of children did not meet any component of the 24-hour movement guidelines, 42.3% met one, 18.7% met two, and 4.4% met all components. Children who met only the ST component had significantly lower odds of having excess VAT (odds ratio [OR]=0.44, 95% confidence interval [CI]: 0.21–0.92, p=0.028) in comparison with children who did not meet any component of the 24-hour movement guideline. A significant joint association of meeting the ST and SL guideline with VAT was confirmed (OR=0.10, 95% CI: 0.01–0.79, p=0.026). Children who met any two components of the 24-hour movement guidelines had 3.2 lower likelihood of having excess VAT (OR=0.31, 95% CI: 0.14–0.69, p=0.004). 

Conclusions: Meeting multiple components of the 24-hour movement guidelines was associated with a reduced risk of excess central adiposity. However, only a small proportion of children met all components of the 24-hour movement guidelines. A combined effect of physical activity, sedentary behavior and SL should be considered in designing effective intervention strategies to prevent childhood obesity.

Purpose:

Structured, autonomy supportive and controlling parenting practices have been associated with adolescent’s dietary behaviours. To date, little work has considered the interplay between parents’ and adolescents’ gender on dietary behaviours and parenting practices. Therefore, this study examined whether the associations between parenting practices and adolescents’ dietary behaviours are similar by adolescents’ gender and examined whether gender of parent moderated these relationships.

Methods:

This study conducted a secondary analysis of the Family Life Activity Health Sun and Eating (FLASHE) data. FLASHE recruited a nationally representative sample of US parents and adolescents to complete surveys about their health behaviours and environment. A total of 1633 adolescents (12-17 years; 50% girls) and 1619 (74% mothers) parents were analyzed. Linear regressions were used to assess the relationship between parenting practices and adolescents’ dietary behaviours (fruit and vegetable (F&V) or sugar-sweetened beverage (SSB) consumption). All models controlled for known confounders and were run independently for boys and girls. Parent gender was explored as a moderator in each sample of adolescents.

Results:

Parenting practices seem to have a greater association with boys’ dietary behaviours compared to girls. Boys consumption of F&V was found to have a significant positive association with use of structured (b=.24) and autonomy supportive (b=.20) parenting practices. Use of controlling parenting practices had a significant negative association with boys F&V consumption (b=-.12), but positive association with SSBs (b=.11). Girls F&V consumption only had a positive association with structured practices (b=.27).  Parent gender did not moderate these associations.

Conclusions:

The relationship between parenting practices and adolescents’ dietary behaviours differed by boys and girls. Controlling and autonomy supportive parenting practices was not implicated in girls but were in boys. These findings raise the possibility that gender may be an important factor in the associations between parenting practices and adolescent dietary behaviours. Further work exploring whether parents use different parenting practices based on gender of their child or whether boys and girls differ in the ways they respond to specific parenting practices is needed.

Purpose: To compare the acute effects of yoga to combined aerobic and resistance exercise on cognition and stress in healthy adolescents in a secondary school. We hypothesized both exercise groups would experience improvements relative to the control group, but effects would be significantly greater for yoga. This is one of the first studies to compare the effects of a single session of yoga to exercise in a non-clinical sample of adolescents in an ecologically valid setting.

Methods: Participants were 55 secondary school students (15.6 ±0.5 years), who were randomized at the class level to one of three conditions: a non-exercise attention-matched control (CON); combined aerobic and resistance exercise (ARE); or yoga (YOG). The YOG and ARE groups engaged in a 30-minute session of yoga and combined aerobic and resistance exercise, respectively. The CON group received a 40-minute lesson on nutrition. Measures of selective attention (d2 test of attention), stress (visual analogue scale), and arousal (felt arousal scale) were used pre and post intervention. Generalized linear mixed models were used to examine adjusted differences between groups.

Results: YOG outperformed ARE in selective attention processing speed (28.6 [95% CI = 2.34, 54.85]; p <0.05; d = 0.71). Also, there was a significant effect on stress favoring YOG over ARE (-22.2 [95% CI = -31.87, -12.44]; p <0.001; d = 1.52) and CON (-20.7 [95% CI = -30.28, -11.07]; p <0.001; d = 1.42). There was a significant group-by-time effect for arousal, favoring YOG over ARE (-1.3 [95% CI = -2.13, -0.44]; p = 0.002; d = 0.93) and CON (-1.1 [95% CI = -1.97, -0.29]; p = 0.007; d = 0.80).  

Conclusions: These findings suggest a single bout of yoga may improve cognition and stress to a greater extent than combined aerobic and resistance exercise. Yoga may be an efficacious exercise modality for improving selective attention and alleviating stress in the school environment.

Purpose:According to the Structured Days Hypothesis (SDH) children engage in more physical activity during school weekdays (WD) compared to days without school, such as weekend days (WED). However, most evidence for the SDH is from high-income countries. The aim of this study is to compare moderate-to-vigorous physical activity (MVPA) on WD vs. WED days and during school hours of adolecents from Brazil. Methods:Data were obtained from baseline of an RCT targeting increases in PA and improvements in cognition. All first year high-school students (n=1296) of full-time (7:30am–5pm) public schools (n=11) from one  educational district of Pernambuco state were invited to participate. Physical activity was obtained using Actigraph (GT3X+) onthe hip via a 7-day protocol. To be included in the day analysis (WD vs.WED) participants had to provide at least 10 hours of valid wear time. MVPA during school hours was also estimated. Separate ANOVA analyses by gender were performed to test differences in daily MVPA between WD and WED, and during school hours. Both models controlled for age and school. Results:A total of 828 adolecents (56.1% girls, mean=14.8±1.0yrs) provided 2,960 (WD=2,388), WED=572) valid days of data. Boys accumulated more daily MVPA during WED [52.8 min (95%CI: 48.0, 57.6)] compared to WD [50.0 min (95%CI: 47.6, 52.3), however this difference was not statistically significant. Girls accumulated more MVPA during WD [30.0 min (95%CI: 28.9, 31.1)] compared to WED [26.6 min (95%CI: 23.4, 29.9)]. During school hours boys accumulated more MVPA [26.4 min (95%CI: 25.0, 27.7)] compared to girls [16.0 min (95%CI: 15.3, 16.7)]. Estimates of MVPA varied significantly from school to school (range=16.3, 29.9 min).Conclusions:Findings for girls, but not for boys, were consistent with the SDH. Even though the schools have the same curriculum and routine, it appears that girls and boys accumulated differing amounts of MVPA within and between the schools. Future studies in low-to-middle-income countries should explore the segmented school day to better understand this setting.

Purpose: Globally, the trend of women's employment is rising and this increase draws attention to the complex relationship between maternal employment and children's wellbeing. The aim of the study is to review the relationships between maternal employment and the indicators of health behaviour of children and adolescents (6 to 18 years)—dietary intake, physical activity, and sedentary behaviour.

Methods: A systematic review, was conducted.  Searches were made of Scopus, PubMed, Science Direct, JSTOR, Google scholar and relevant websites. Peer-reviewed journal articles, conference papers, theses at masters/doctoral level in English were included; studies focused on obesity or overweight and people less than 6 or more than 18 years old were excluded.

Results: 14309 screened articles yielded 37 eligible papers, which showed associations between maternal employment and at least one domain of dietary pattern, physical activity and/or sedentary behavior.  Among these, 29 were from high-income countries, 6 from upper-middle-income and 2 from lower-income. Studies included were observational (cross-sectional and cohort) (51.35%), longitudinal (45.95%) and qualitative (2.7%). Data were collected using self-reported surveys, interview and objective devices, such as accelerometers. Nationally representative samples were used in 33.4% of studies. Dietary pattern was assessed in 29 samples, physical activity in 23 and sedentary behaviour in 21. The relationship of maternal employment with dietary pattern and physical activity were found inconsistent and influenced by many factors such as age of children, socioeconomic status, and family correlates. Screen time, the most commonly measured domain of sedentary behaviour (90.48%) in this review, was positively associated with maternal employment in 11 samples. Meta-analysis was not possible due to heterogeneity of analysis.

Conclusions:  The review suggested some evidence that dietary intake and physical activity of children and adolescents of employed mothers are different compared with unemployed mothers. Findings also suggest a greater prevalence of sedentary behaviour of children of working mothers. More studies need to find how to support employed mothers to promote the health of their children.

Keywords: Maternal employment, children, dietary pattern, physical activity, and sedentary behaviour.

Purpose: Although the proportion of individuals with a migrant background is growing worldwide, migrants are still severely underrepresented in health research. Social Stress Theory (SST) proposes that migrants are at higher risk of being exposed to psychosocial stressors compared to non-migrants, resulting in decreased well-being. However, studies comparing well-being in migrants and non-migrants have shown both, lower well-being (supporting SST) and higher well-being in migrants (Healthy Migrant Effect). Research on individual factors or mechanisms that are associated with well-being in migrant populations is dearly needed. We address this research gap by examining the role of physical exercise for well-being in migrants. We hypothesize that physical exercise buffers the negative effects of experienced stress on well-being and that the more vulnerable migrant populations benefit more from this stress-buffering effect.

Methods: Data from N = 18,714 adolescents from the CILS4EU study, a multinational, longitudinal panel that over-samples migrants, were analyzed with regression analyses to test the moderating effect of migration background on the relation between exercise and experienced stress (perceived discrimination) and well-being (life satisfaction).

Results/findings: In line with our hypothesis, migrants reported more discrimination and exercised less often than non-migrants. At the same time, migrants showed higher well-being. The regression analysis shows that discrimination was negatively (β = -.24, p < .001) and physical exercise positively associated with well-being (β = .12, p < .001). The interaction between discrimination and exercise was significant, such that exercise buffers the adverse effect of discrimination on well-being (β = .03, p < .05). Further, the positive effect of exercise on life satisfaction was stronger in migrants compared to non-migrants (β = .02, p < .05).

Conclusions: Well-being is not only a key determinant of integration but also of general health. Despite lower levels of exercise, migrants benefitted more from exercise for well-being compared to non-migrants. Because health behavior change interventions targeting the general population may not reach migrants, innovative, culturally sensitive interventions could lead to improved health behavior in migrants and, ultimately, resilience in the face of adversity and higher well-being.

Purpose: Childhood obesity has increased remarkably in low-middle income (LMIC) countries; however, validated measures of obesity-related behaviours and parenting practices are lacking. The current study evaluated the psychometric properties of an instrument designed to measure parenting practices and children’s physical activity (PA), screen time (ST), and sleep (SL) adapted to Brazilian families. 

 

Methods: Phase 1 involved translation of the instruments to Portuguese. The selected instruments included, the PA parenting practices questionnaire – PAPP (Vaughn, 2013), the bedtime routine questionnaire – BRQ (Henderson, 2010), the outdoor playtime recall (Burdette, 2004), and screen time and sleep items from the InFANT Study (Hesketh, 2013). Phase 2 involved cognitive interviews with 24 parents from urban and rural Caruaru, Brazil addressing the format, content and clarity of the items. Seventy-eight parent-child dyads then completed the adapted instrument as an interviewer-administered survey twice within 7 days. Child PA, sedentary time and SL were concurrently assessed using an ActiGraph GT3X+. Internal consistency and test-retest reliability was assessed using Cronbach’s alpha and Intraclass Correlation Coefficients (ICC). Concurrent validity was evaluated by calculating Spearman correlations between parent reported outcomes and objectively measured behaviours.

 

Results: Cronbach alphas for the PAPP and BRQ scales were acceptable, and ranged from 0.66 - 0.88. The scales “limiting outdoor play due to weather” (α = 0.39) and “maladaptive activities on sleep” (α = 0.16) were excluded due to low internal consistency. Test-retest reliability of the parenting practices were acceptable, and ranged from ICC = 0.82 - 0.99. Parent reported PA was positively correlated with objectively measured LMVPA (r=0.43, p < .05) and MVPA (r=0.39, p < .05). Parent reported SED time was positively correlated with objectively measured SED (r = 0.26, p < .05), and inversely correlated with LMVPA (r = -0.35, p < .05) and MVPA (r = -0.29, p < .05). Parent reported SL duration was positively correlated with objectively measured SL on weekdays (r = 0.29, p < .05), but not weekends.

 

Conclusions: Previously published instruments to measure children’s obesity-related behaviours and parenting practices, translated and adapted for use in Brazilian families, exhibited acceptable evidence of validity, internal consistency and test-retest reliability. 

Purpose: Childhood obesity is a global problem, with children from low-middle income (LMIC) countries being disproportionately affected. Understanding how parents influence children’s obesity-related behaviours would inform interventions to promote healthy lifestyle behaviours and prevent obesity. However, to date, no study has investigated the relationships between parenting practices and young children’s physical activity (PA) and screen time (ST) in families residing in rural Brazil. Therefore, the aim of this study was to examine the relationships between supportive and controlling parenting practices and movement behaviours in preschool-aged children residing in rural Brazil.  

 

Methods: Parent-child dyads from rural Caruaru, Brazil (n=78) completed a validated interviewer-administered survey measuring sociodemographic data, parenting practices and children’s movement behaviours, including PA and ST. Child PA and sedentary time were also objectively measured using an ActiGraph GT3X+ accelerometer. Spearman correlations were used to assess the relationships between parenting practices and children’s PA and ST.

 

Results: 53% of the children were male, with a mean age of 4.6±0.8, and 41% were mixed-race. Parents completing the interview were mostly female (92%), and employed full-time (54%). Rules around active play indoors (rho = - 0.31 to - 0.35), the use of PA to reward/control child behaviour (rho = 0.27 to 0.48), limiting or monitoring screen time (rho = 0.22 to 0.29), and limiting outdoor play due to weather (rho = -0.23 to -0.36) were controlling parenting practices significantly associated with PA (p< .05). Verbal encouragement for PA (rho = 0.27 to 0.33) and perceived importance and value of PA (rho = 0.34 to 0.35) emerged as significant supportive parenting practices associated with PA (p< .05). Greater exposure to TV (rho = 0.40), limiting or monitoring screen time (rho = - 0.56), and explicit modelling and enjoyment of screen time (rho = 0.49) were significant correlates of child ST (p< .05).

 

Conclusions: Supportive and controlling parenting practices shown to be salient in high-income countries emerged as significant correlates of children’s PA and ST behaviours in rural Brazilian families. The findings identify potential targets for family-based interventions to prevent childhood obesity and warrant further investigation in larger, more representative samples of rural Brazilian families. 

Purpose: Nutrition in early childhood is suboptimal internationally, contributing to high rates of overweight and obesity. Family meals are linked to improved child diet and health outcomes, making them a potentially valuable setting for nutrition promotion, but little is known about ways to engage parents on this topic (“sticky hooks”). The aim of this study is to assess parent interest in different types of family meals information, and whether this differs by education level.

Methods: An online survey of Australian parents with children aged 6 months to 6 years was conducted in 2014 (T1), with follow up in 2016 (T2). At T1 parents were asked to rate their interest in various types of information to support family meals (17 options), and how they would prefer to receive information about family meals (15 options). At T2 parents were asked what types of recipe resources they would use (6 items). Parents also reported their education level. Differences by education level (dichotomised to tertiary vs non-tertiary) were tested using Pearson’s Chi-Square test.

Results: Participants (n = 890 at T1, n = 387 at T2), mostly mothers (97%), reported high interest in recipes. Most indicated they were “very interested” in: healthy recipes (58%), easy recipes (57%), recipes to prepare with children (59%) and recipes the whole family will enjoy (60%), with no differences by education level. Recipes were more highly rated than other information such as benefits of family meals or ideas about planning or sourcing food. In regard to the method of receiving family meal promotion material, electronically on mobile or computer was rated highest (83% and 88% interested respectively), followed by newsletters (76-79%) and Apps (63%). Overall participants were just as interested in recipes or electronic cookbooks published by a university or health service as by well-known cooks, though those of lower education were less likely to be interested in evidence-based information from health professionals, researchers, or universities.

Conclusions: Knowing that recipes provided in various electronic formats are of interest to parents (a “sticky hook”), this could inform innovative approaches to engaging parents with interventions promoting healthy family mealtimes.

Purpose:

Out of School Hours Care (OSHC) services are important settings to promote healthy eating and physical activity among children. In 2018-2019 the NSW Ministry of Health Eat Smart Play Smart (ESPS) resource was disseminated to OSHC services across NSW, Australia to support the services with promoting positive healthy eating and physical activity behaviours. The aim of this study was to evaluate the access, use and effectiveness of existing resources in OSHC services. This is the first study in Australia of its kind and the findings may improve the reach of existing resources and inform the development of future interventions.

 Methods:

 All OSHC services in urban, regional and rural areas of NSW (approximately 1,744 services) were invited to complete a purposefully designed online survey. The survey included questions about access, use and effectiveness of resources, specifically the ESPS resources to promote healthy eating and physical activity behaviours. Data were analysed using descriptive statistics.

Results:

Survey responses were received from 80 OSHC services in NSW as of December 2019. Preliminary results indicate that 74% of respondents utilised the ESPS resource. Of the 26% who had not used the resource, 55% indicated it was because they never received a copy. Of the services who received the ESPS resource, 76% indicated the resource contributed to their service’s ability to meet the Australian National Quality Standards. Sections ranked most useful included afternoon tea recipes and menu planning. Educational materials (63%), support with encouraging child participation in healthy eating activities (35%) and professional learning (31%) were identified as areas in need of additional support to promote healthy eating behaviours. Similarly, educational materials (70%) and professional learning (66%) were identified as areas in need of additional support to promote physical activity behaviours. Suggested improvements included offering ESPS content in different formats (31%) and restructuring and simplifying the ESPS resource (28%).

Conclusion:

This evaluation provides valuable insights into existing resources and will inform future interventions for OSHC staff to improve knowledge and practices in the promotion of positive healthy eating and physical activity behaviours among attending children.

 

Purpose: Numerous studies have collected data on Australian children’s physical activity (PA). However, many of these studies are now underutilised and current participation rates are often determined by only a small proportion of the research which is undertaken. Difficulties also arise when attempting to make comparisons between different groups, geographical areas and time due to the methodological inconsistencies.  

 

 

Methods: An audit of Australian PA research was conducted on youth aged 0-18 years focusing on overall PA participation, active transport, sport, school-based PA, active play and sedentary behaviours. Online databases and grey literature were searched and a set of metadata was developed to assist with data extraction.  

 

 

Results: The systematic search yielded 22,283 records, of which 1002 articles were screened at full-text. Along with a grey literature search, over 200 datasets were identified. The coverage of these datasets spans 1951 till today, and consists of data from over 350,000 children. These datasets were financially supported mainly by government and non-government organisations, and mainly conducted through a University. Despite technological advances, the majority of research still utilised surveys and questionnaires to measure physical activity.

 

 

Conclusion: Data on PA participation in Australian children are extensive but suffer from inconsistencies. An understanding of what research has previously been conducted helps to shape future research. Utilising more consistent methodological approaches to collect data would allow for better harmonisation and a clearer picture of youth physical activity levels.

 

The 2012 National Health and Nutrition Survey declared a low prevalence of exclusive breastfeeding in Mexico as a public health problem. Only 14.1% of Mexican women breastfeed exclusively as recommended by the World Health Organization. The use of human milk substitutes or milk formula has become a common practice due to diverse factors such as the insertion of women into working life and the lack of breastfeeding promotion. Substitutes and milk formula influence the colonisation of the intestinal microbiota, which has been associated with obesity at late stages. Feeding practices of pregnant woman could have an impact on their nutritional status. However, in the Mexican population, the type of substitutes and milk formula has not been correlated with the intestinal microbiota. This study aims to associate microbiota whit infant formulas that prevail in Mexican childhood. Forty-nine women 18-35 years old, vaginal canal birth, whose infants were in a regular weigh for gestational age from Gynecology and Obstetrics Unit of the Occidental General Hospital (Guadalajara, Mexico) were included. Fecal samples were collected once a month for six months. Enumeration of lactic acid bacteria and enterobacteria group was done. Anthropometric parameters (weight and body length) and breastfeeding monitoring were analysed for six months. 93.9% were housewives with high school education. Low adherence to breastfeeding was observed. After 15 days there was a loss percentage of 53.1%, at first month 57.1%, second month 61.2%, third 59.2%, fourth 65.3%, fifth 71.4% and the sixth month 73.5%. In the first months, lactic acid enumeration was higher in infants with breastfeeding. Enterobactericeae enumeration was higher in infants with milk formula and mixed feeding. Lactobacillus paracasei spp. and Leuconostoc lactic were identified as the predominant bacteria in the newborn. In the last months, L. plantarum, L. pentosus, L. crispatus, and L. delbueckii were identified in all kind of feeding. Adherence to breastfeeding is low, despite hospital policies and information about the advantages of breastfeeding. Infants with breastfeeding have a lower enumeration of Enterobactericeae, which has been related to gastrointestinal and endocrinal disorders.

Purpose: This study aims to examine the association between the age of achieving six gross motor milestones and physical activity during childhood, and whether these associations are mediated by adiposity.

Methods: We gathered data from 217 children (6.9 ± 0.3 yrs) born weighing more than 1.5 kg, who participated in the baseline assessment of our four-year follow-up study. Adiposity was assessed as the percentage of fat (%fat) measured by dual-energy X-ray absorptiometry. Physical activity was measured using a triaxial accelerometer (Active style Pro HJA-350IT). Time (min/day) spent in moderate-to-vigorous physical activity (MVPA time) was used for analysis. The age at which children achieved the following motor milestones was obtained from the Maternal and Child Health Handbook records: holding head up (n = 121), sitting (n = 94), crawling (n = 146), standing supported (n = 144), walking supported (n = 116), and walking unsupported (n = 174). Potential confounders such as maternal age and pre-pregnancy body mass index, gestational age, and birth weight were also obtained from the Handbook records.

Results/findings: The mean ± SD MVPA time was 81.7 ± 22.5 min/day. The age of crawling or standing supported was negatively correlated with MVPA time (P < 0.05) and positively with %fat (P < 0.01), whereas MVPA time was negatively associated with %fat (P < 0.001), after controlling for gender and age. Multiple linear regression analysis revealed that a later age of crawling or standing supported was associated with decreased MVPA time (P < 0.05) and increased %fat (P < 0.001) even after adjusting for gender, age, accelerometer wear time, and the confounders. When %fat was introduced as a covariate in the model predicting MVPA time, the association between the age of crawling or standing supported and MVPA was completely attenuated, while %fat was significantly associated with MVPA time (P < 0.01).

Conclusions: Our results indicate that infants who crawled or stood at a later age spent less MVPA time during childhood; however, this association is mediated by adiposity. Strategies to prevent physical inactivity in these infants should focus on optimising their body composition.

Purpose: What was the family meal like thirty years ago? What can the past tell us about the present and future? How can behavioural nutrition benefit from archival data? These are the questions we sought to answer by analysing thirty-year-old interview data on the family meal for the first time. The purpose of this research was to investigate the family meal, its involved processes and expectations thirty years ago, allowing us to further our understanding of experiences of the family meal over the last three decades.

Methods: In 1992-1994, qualitative interviews regarding family eating behaviours were carried out with parents across South Australia. For the present study, transcripts from this sample were selected via purposeful sampling, which continued until theoretical saturation was achieved. Drawing on the methodology of grounded theory, data were analysed through the cyclical process of initial coding, focussed coding, memo writing and team meetings. This is the first time this data has been thoroughly analysed.

Findings: A total of 49 transcripts from 16 families were analysed. Analysis of the data shows that thirty years ago there were numerous considerations and processes involved in getting the family meal on the table. Parents spoke about needing to be flexible to achieve a family meal that fit their lifestyle, often requiring numerous strategies. Some parents upheld the traditions of their childhood, where others specifically changed their practices from those they remembered growing up. Some parents were adamant about sitting at the table and communicating, where others were more flexible in their renditions of the family meal, eating separate meals, at separate times, in separate places.

Conclusion: This data represents a time capsule of what the family meal was like thirty years ago. It is a baseline of data from which we can build, compare to the present and project into the future. It is a look into the past without relying on recollections and the memories of participants. With this information, we can gain a greater understanding of what was, which may help us with understanding what is, and what the future may hold for family meals.

Purpose: The family meal has been associated with health and wellbeing benefits for both adults and children. However, majority of the research is correlational, and thus unable to prove a causal relationship between family meals and positive outcomes. Our systematic review set out to determine the causal relationship between family meals and health and wellbeing and explore family members’ perceptions of the family meal. This is the first systematic review to investigate the impact the family meal has on the health and wellbeing of children and parents, and which collates parent and child perspectives on the family meal.

Methods: A systematic search across five databases was employed and aimed to capture family meal intervention and qualitative studies published between 2008-2019. To be included, interventions had to have an active intervention and control group, target the family meal and measure family meal and health outcomes post-intervention. Qualitative studies had to employ focus groups or interviews with parents or children, focussing on the family meal. Two reviewers were involved in screening of studies, appraising included articles and extracting data. Quantitative data was synthesised in narrative form, and qualitative data underwent meta-aggregation

Results: Thirty-two articles were deemed eligible for inclusion. Only one intervention included in this review exclusively targeted the family meal, the remaining studies included other target strategies as part of their intervention (e.g. physical activity, snacking, sleep routines). Only two of the eight interventions reported statistically significant differences between control and intervention groups for family meal frequency or quality. The qualitative studies identified multiple barriers to the family meal, including scheduling conflicts, exhaustion and lack of time, and reported family connection and communication as the main perceived benefits of the family meal

Conclusions: There is a gap between the benefits and barriers to the family meal identified through qualitative research, and current intervention strategies, with few interventions exclusively targeting the family meal. Interventions that are informed by qualitative literature and exclusively target the family meal are needed to further investigate the causal relationship between family meals and potential health and wellbeing outcomes for adults and children.

Objective:

This pilot study investigated the feasibility of FEAST, a community-based school program involving students, teachers, and volunteers (caregivers/community). It aimed to promote healthy eating, teach cooking skills, and develop food waste awareness, amongst children. 

Methods:

Children aged 10-12 years in Grades 5-6 from New South Wales (NSW) Australian primary-schools participated in the study. A pre-test/post-test design using mixed methods was used. FEAST is a curriculum-integrated program that provided training to teachers to deliver the program over 10-weeks. It was guided by social cognitive theory and used project-based approaches, which are student-centred and interactive involving theory and cooking activities. FEAST aligned with Australian Dietary Guidelines and has been recognized by the UN's Global Compact Network as a program capable of contributing to 7/17 SDGs. The primary outcomes were changes in self-reported fruit and vegetable (F&V) intakes (serves/day). Secondary outcomes included: (i) F&V variety, (ii) discretionary food intake, (iii) cooking skills, (iv) food waste perceptions and behaviours, (v) sustainability understanding and (vi) satisfaction with FEAST (by students and teachers).

Results:

Two schools involving six teachers, six classes, 158 students, and 14 volunteers participated in FEAST. Post-FEAST, 84% of students reported meeting recommended fruit intake (2 serves/day), which was a 6% increase from pre-FEAST data. Additionally, 26% of students reported consuming ≥4 serves of vegetables/day, which represented a 7% increase. Teachers reported high satisfaction with FEAST, observing children eating more F&Vs and less discretionary foods at school. Cooking activities were the most valuable component, helping students better understand how to prepare nutritious foods, reduce food waste and eat sustainably.

Conclusions:

The implementation of FEAST across NSW provides an invaluable opportunity to gain scholarly and translational research outcomes. Combining nutrition with wider aspects of food and sustainability may create alternative avenues for promoting nutrition education messages to children.

Given the challenges of promoting healthy and sustainable eating practices, FEAST is well-positioned to play a key student-engagement role by supporting the health-promotion within schools initiative, government-supported public health initiatives, SDGs and the national agenda to reduce food waste.

 

 

 

Purpose:                      Learning cooking skills (CS) at younger ages is associated with positive dietary outcomes and skill retention in later life. However, the next generation is no longer learning CS in the home, leaving a generation without these life skills. Furthermore, recent research has highlighted that children are not developing fine motor skills (FMS) at the normative rate, and therefore may not be physically able to perform CS proficiently. Thus, this research aimed to co-create with the research team, a chef and children, an age-appropriate cooking intervention based on motor skills and to evaluate the effectiveness of this interdisciplinary co-creative method of design.

 

Methods:                     A controlled short duration, high intensity cooking camp intervention underpinned by Social Learning Theory and Experiential Learning based on age appropriate motor skills was conducted. A range of different CS, based on current research, was covered by the intervention in a fun and engaging manner. The intervention content was co-created with Home Economists, a chef and human movement scientist and participants. The camp ran for one week – 3 hours/day for 5 days. Participants aged 10-11 years, with no exposure to Home Economic classes were recruited. Sixteen children took part in week one of the camp with pre and post measurements including perceived cooking competence and enjoyment. The control group (delayed intervention) did the same measurements in week one, receiving the intervention in week 2. The feasibility of the intervention was analysed using SPSS v25.

 

Results/findings:         Results indicate a significant improvement in the intervention group’s perceived cooking competence (P<0.001) compared to the control group.

 

Conclusions:               The novel interdisciplinary approach to the design of the intervention content ensured it was age appropriate by mapping cooking skills to motor skills. This is an effective method to designing successful cooking interventions and should be considered as a useful strategy in future studies.

Purpose: This paper discusses some innovative methods of vascular function assessment in children. Data will be presented from several studies carried out in different countries in children (from ages 6-16 years) in which non-invasive vascular function measurements were assessed together with the risk of cardio-metabolic syndrome.

Methodology: These methods are currently being used in several ongoing projects. These assessments are particularly innovative in that they can be carried out non-invasively. These include assessments of endothelial health via flow mediated dilatation (FMD), assessment of arterial stiffness using pulse Wave velocity (PWV) and microvascular assessments by studying changes in the retinal microvasculature. In addition to the vascular function assessments, hemodynamic variables such as heart rate and heart rate variability data will also be presented and discussed

Results: The talk will discuss the advantages and disadvantages of each of these measurements and identify the potential challenges that arise from the usage of these methods in the field.

Conclusions: Vascular function measurements are simple and non-invasive and can be easily carried out in children. Quality assurance as well as the need for careful training of the operators are, however, particularly important aspects that must be considered when planning such experiments. 

Keywords: Flow mediated dilation, Pulse wave velocity, retinal microvasculature, Children’s health.

Purpose: Food fussiness refers to the rejection of foods, which can lead to an inadequate consumption of a wide variety of foods. Parents can influence their child’s eating behaviours through the environment in which they rear their child. The majority of studies on children’s fussy eating have focused on mothers as the primary caregiver, however, recent findings suggest that fathers also have some child feeding responsibilities. With an increase in paternal feeding responsibilities, it is important to establish how this influences a child’s development of eating behaviours. Therefore, the aim of this research is to examine the associations between paternal factors and children’s fussy eating.

Methods: The study involved cross-sectional data from an Irish sample of fathers, who completed an online survey based on one of their children aged 5-12 years old (n=155). The Feeding Practices and Structure Questionnaire assessed paternal feeding practices. The Child Feeding Questionnaire assessed paternal perceived responsibility, while the Children’s Eating Behaviour Questionnaire assessed food fussiness. Associations were firstly assessed using t-tests and correlations followed by multiple linear regressions.

Results: Paternal concerns, perceptions of weight status and feeding responsibilities were not associated with child’s level of food fussiness. However, findings from the adjusted model illustrated that family meals was the only structure-related feeding practice inversely associated with food fussiness (β = -0.29 [CI 95%: -0.35 - -0.12]), such that fathers, who reported that their child more frequently consumed the same meal as the rest of the family, had a child with lower levels of food fussiness. Persuasive feeding was the only non-responsive feeding practice associated with food fussiness (β = 0.25 [CI 95%: 0.06 – 0.34), such that higher paternal reports of persuasive feeding was associated with higher levels of food fussiness.

Conclusion: Findings from this study illustrate the importance of including fathers in studies in relation to child feeding, as their feeding practices influence food fussiness in both a positive and negative manner. In addition, findings suggest that a whole-family approach, not just maternal, is necessary when developing interventions to address issues in relation to child’s dietary intake.

 

Purpose: Food selectivity (i.e., ‘picky’ or ‘fussy’ eating) may contribute to compromised nutrition and poor growth in childhood. Children with Autism Spectrum Disorder (ASD) tend to be at a higher risk of food selectivity; affecting up to 90% of children with the neurodevelopmental condition. ASD is increasing globally and currently affects one in every 60 children. Yet the clinical cut-off for ASD diagnosis under-represents children with subclinical ASD traits and girls, who are underdiagnosed. How ASD traits and food selectivity develop is poorly understood because the current evidence favours case-control study designs or only includes samples of children with diagnosed ASD. These studies fail to consider the full continuum of ASD traits in the population and assume food selectivity to be an expression of ASD, therefore providing unreliable evidence into the direction of effects. However, some evidence suggests that food selectivity during infancy and toddlerhood (e.g. late acceptance of solids during weaning and slow eating) may precede or exacerbate the expression of ASD traits. Large epidemiological studies with repeated measurements are needed to know ‘what came first’, food selectivity or ASD traits? This study aims to establish the direction of longitudinal pathways between ASD traits and food selectivity from infancy to early adolescence.

 

Methods: This study comprises of a secondary data analysis from Generation R, a birth cohort of N=7968 children born in Rotterdam. Food selectivity and ASD traits are measured in parallel at five time-points (1.5, 3, 5, 10 and 13 years old) using the parent-reported Child Behavior Checklist. Cross-lagged models will be used to examine the directionality of the food selectivity - ASD traits association across child development. 

 

 Results: Results are forthcoming.

 

Conclusions: Evidence derived from this study will guide behavioural interventions relating to the management and prevention of food selectivity and/or ASD traits. Such interventions are likely to contribute to the reduction of food selectivity, nutrient deficiencies and attendant health consequences, and potentially the expression of ASD traits. An enhanced understanding of the aetiological pathways can facilitate the development of a front-line screening tool for paediatric clinicians to identify feeding difficulties or ASD traits in the population.

 

 

Purpose:  Children and adolescents have influential voices among their peer groups; thus, obesity-focused youth advocacy programs has the potential to broadly address pediatric obesity, particularly among socially disadvantaged children. This convergent, mixed methods study sought to understand how students attending low- and middle-income schools perceive their skills as advocates and leaders, as well as how they communicate about health with their peers.

Methods: Surveys and brief semi-structured interviews were completed by elementary and middle school students in 21 low- and middle-income schools participating in an obesity prevention study. Surveys included a 17-item Youth Advocacy for Obesity Prevention scale (YAOP; Likert-type response set, range: 0-68, Cronbach’s alpha=0.82) assessing five constructs: self-efficacy for advocacy, perceived sociopolitical control, assertiveness, participatory competence, and health advocacy history. Multi-level modeling, accounting for school-level clustering, assessed associations between youth advocacy sum score and gender, school type, race, and BMI z-score. In interviews, students defined what “being healthy” means to them and described how they could convince their peers to be healthier. Interviews were inductively coded for emerging themes related to persuasive messaging.

Results/findings: Survey participants (n=289) were 67.8% female, 61.2% elementary, 52.7% African American, 16.1% Hispanic/Latino. Of these, a randomly selected half (n=131, 45.3%) completed interviews. Mean YAOP score was 41.3 (SD=0.67). Females reported higher scores than males (b=-0.19, SE=0.09, p=0.032), and elementary students had higher scores than middle school students (b=0.24, SE=0.09, p=0.015). No differences were identified by race or BMI z-score. Of the five constructs, students scored lowest on advocacy history and highest on participatory competence. Emerging themes for students’ persuasive messaging for peers included providing: general advice (e.g., eat healthy, be active), specific strategies (e.g., eat vegetables with every meal), and short-term (e.g., fitness, sports performance) and long-term (longevity, lack of illness) outcomes of being healthy. 

Conclusions:  Findings suggest that students in low- and middle-income schools perceive having skills for obesity-related health advocacy, and provide insight on students’ communication strategies related to health behavior. Future studies should seek to enhance these skills via training curricula, particularly for males and older students, and assess the potential impact of advocacy training on pediatric obesity outcomes.

Purpose: There is a lack of studies on parent-child physical activity and dietary intake that have included both parents. Therefore, the relative contribution of mothers’ and fathers’ physical activity and dietary intake related to that of their child remains unclear. The aim of this study was to assess the associations between mother-child and father-child moderate-to-vigorous physical activity (MVPA) and dietary intake, and to assess if the sex of the child and parents level of involvement in daily child care moderate these associations.

Methods: A cross-sectional analysis of data obtained from the Amsterdam Born Children and their Development study was conducted. The present study included 2167 mother-child pairs and 1954 father-child pairs for MVPA, and 2384 mother-child pairs and 2147 father-child pairs for dietary intake. MVPA was measured in METs/week for children and in minutes/week for parents. A total dietary intake score (DIS) was measured for participants average daily intake of fruits, vegetables, snacks and sugar-sweetened beverages (SSBs), using a self-report questionnaire. Linear regression analyses were used to assess the relationship between parent-child MVPA and DIS, separately for mothers and fathers, in four hierarchical models. In the second model of each analysis, correction was made for the other parent’ physical activity and/or dietary intake to examine the relative predictive value of each parent.

Results: A significant association between mother-child MVPA was found (β=0.013; 95%CI:0.006;0.021,p<.001). The association between father-child MVPA was only significant for fathers with a high level of child care involvement (β=0.014;95%CI:0.004;0.023, p<.01). A significant association was also found between mother-child DIS (β=0.254; 95%CI: 0.192;0.316), p<.001), and between father-child DIS, with a stronger association between father-son (β=0.234;95%CI:0.169;0.298,p<.001) compared to father-daughter (β=0.114;95%CI:0.047;0.181, p<.01).

Conclusions: Both parents contribute relatively to each other to the child’ MVPA and DIS with sex-specific effects. Therefore, this present study highlight the importance of including both parents in studies to child’ physical activity and dietary intake. Further investigation to parents involvement in daily child care is required.

Purpose: Very few studies have examined frequency of water consumption or factors related to water consumption in children despite findings that indicate that increased water consumption has been shown to be linked to decreased body weight and obesity prevention in children.  Understanding young people’s water consumption behaviors and how they relate to other nutrition and screen-time behaviors, knowledge, and attitudes.

Methods: This is a secondary data analysis of a study on coordinated school wellness (Arizona Department of Education Team Nutrition) with 9 low-income schools with students ages 9-13 (mean age=10.4±0.8; 50.5% female) in the state of Arizona in April and May of 2019. Students (n=507) completed the Kids’ Activity and Nutrition Questionnaire, which assesses dietary intake—including water intake, screen time behaviors, knowledge of dietary recommendations, and healthy food preferences. Mutually adjusted mixed model linear regressions were used to test the association between times of water intake and nutrition and screen-time behaviors, knowledge, and attitudes, adjusting for student sex and age and the clustering of children within schools.

Results: Students reported consuming water in the past day a mean of 5.2±2.6 times. Self-reported consumption of water was not related to sex or age (p>0.1). Water was positively associated with fruit (β=0.30; 95% CI=0.13,0.47), vegetable(β=0.21; 95% CI=0.03, 0.40), and diary intake(β=0.49; 95% CI=0.29, 0.70), but not sugar-sweetened beverage intake(β=0.03; 95% CI=-0.17, 0.23), TV-watching (β=-0.03; 95% CI=-0.16, 0.09)or other screen use (β=0.03; 95% CI=-0.07, 0.14). In terms of knowledge of recommendations for children around whole grains, fruits and vegetables, dairy, and physical activity, students’ water consumption was statistically significantly related to only recommendations for fruits and vegetables (p=0.006). Finally, in assessing students’ preferences for healthy dietary intake and physical activity, water consumption was related to higher preferences for vegetables (p<0.001) and for physical activity (p=0.025).

Conclusions: Water intake is associated with some but not all positive dietary behaviors, knowledge, and diet and physical activity preferences. More research is needed to examine water intake as a positive health behavior.

There are 6.5 million children in food insecure (FI) households in the United States (U.S.). Few studies have examined the differences in food shopping behaviors of low-income populations by food security status. Therefore, it is not well known whether the low-income food insecure families shop differently from those who are low-income but food secure (FS). Exploring the shopping patterns and behaviors of low-income and FI households may offer insight into the essentially unchanged prevalence of food insecure children. The purpose of this study was to investigate and describe the fruit and vegetable (F&V) shopping patterns and behavior of low-income families who are reportedly food insecure vs. those who are food secure. Cross-sectional data was collected using validated parent-reported surveys among parents of children enrolled across a convenience sample of schools serving predominantly low-income families (>75% children on free/reduced lunch program) in Houston, Dallas, Austin, New York City, Washington, D.C., and Southwest Florida in the fall semester of 2018 (n=88 schools, 4664 parents). Multilevel regression analysis was used to determine differences in F&V shopping behaviors by food security status. Responding parents were primarily mothers (93%), and Hispanic (85%). The majority (66%) of participants were food insecure. Over 80% of the participants reported shopping for F&V at the large grocery stores. Those who were FI were 12% less likely to shop for F&V at large chain grocery stores as compared to those who were FS (p=0.000). Food insecure households were significantly less likely to shop for F&V at warehouse club stores or discount superstores as compared to those who were FS (p=0.001). FI households were 18% more likely to shop at convenience stores as compared to those who were FS (p<0.01). Interestingly, >75% of participants reported never purchasing F&V from local convenience stores. Finally, those who were FI were 32% more likely to receive F&V from a food bank or pantry as compared to those who were FS (p<0.001). 

Purpose: This study examined the extent to which active school commuting and a range of 'bottom-end' health behaviours explain the increased risk of overweight/obesity among 11-year-old children living in the most deprived neighbourhoods in England. 

Methods: Subjects consisted of 7262 (3637 boys) 11-year-old English children. Children were classified as normal weight or overweight/obese. School commute mode (active/passive) and health behaviours were parent-reported. Health behaviour scores below the mean of the lower half of the distribution were classified as 'bottom-end' on this indicator. Neighbourhood deprivation was defined using the 2004 English Indices of Multiple Deprivation. Odds ratios (ORs) for being overweight/obese according to neighbourhood deprivation were estimated. A range of bottom-end health behaviours were explored to assess if they attenuated associations between neighbourhood deprivation and overweight/obesity.

Results: Children living in the most deprived neighbourhoods in England were most likely to be overweight/obese, commute to and from school actively and participate in all bottom-end health behaviours compared to children living in the least deprived neighbourhoods. Adjusting for significant bottom-end health behaviours reduced the OR for overweight/obese to 1.44 (95% CI 1.23 to 1.69) in the highest neighbourhood deprivation group compared to the lowest. 

Conclusion: Higher rates of overweight/obesity among children living in the most deprived neighbourhoods in England is not fully explained by participation in unhealthy behaviours. Active school commuting alone is unlikely to be enough to prevent and reduce inequalities in childhood overweight/obesity in England.

Purposes: Due to socioeconomic disparities in movement behaviors (MBs) among school-aged students, improving MBs in students from low- and middle- income families (LMIFs) in rural areas is important, which is an imperative part of promoting all children and adolescents active and healthy. This study examined the prevalence of meeting the 24-hour movement guidelines and its sociodemographic correlates among Chinese school-aged students from LMIFs in rural areas.

Methods: Using a multi-stage sampling, nationally representative school-aged students in rural areas in China were recruited in November 2017. The Health-Behavior School-aged Children questionnaire (HBSC) was used to collect participants’ information on moderate to vigorous physical activity (MVPA), screen time (ST), sleep duration (SLP). Meeting the 24-hour movement guidelines was defined as having more than 1 hour of MVPA, less than 2 hours of ST and more than 8 hours of SLP per day. The questionnaire also collected sociodemographic information, including sex, grade group (low, middle, high), race (Han, minority), family income (low, middle), parental education (low, high). Weight status (non-overweight and obesity, overweight and obesity, determined by WHO reference) was measured by portable device. Generalized linear model(s) was used to explore the predictors of MBs.

Results: Of all 35,372 participants, the prevalence of meeting the MVPA, ST, SLP and 24-hour movement guidelines was 9.5%, 63.1%, 43.8%, 3.7%, respectively. Only grade group was correlated with meeting the 24-hour movement guidelines (OR for low-grade group = 12.1, OR for middle-grade group = 3.3). The correlates of meeting the single MVPA, ST or SLP guideline were varied (e.g., MVPA: boys, younger students; ST: students with Han race and higher parental education level; SLP: boys, younger students, non-overweigh and obese participants). 

Conclusions: The prevalence of meeting the 24-hour movement guideline among Chinese school-aged students in rural areas was low. Different factors should be considered for effective interventions of MVPA, ST and SLP. High-grade students were interventional priority for better MBs. School-aged students who are socially disadvantaged should be an interventional priority. 

Purpose: Socioeconomically disadvantaged groups are less likely to be physically active. Walking is important to public health, therefore understanding correlates of walking will inform the development of targeted interventions. The aim of this systematic review was to examine the correlates of walking among socioeconomically disadvantaged adults.

Methods: PubMed and Scopus were searched up to May 2018 and titles/abstracts and full-texts were screened against eligibility criteria. Methodological quality was assessed. Correlates were synthesized when two or more comparisons were available. 32 studies were selected for synthesis. 19 examined overall walking, 15 examined leisure-time walking and 9 examined walking for transport (9 examined one or more types of walking).

Results: Employment status, home ownership, self-rated health, density or number of social ties, perceived neighborhood aesthetics, perceived walkability and perceived individual safety were positively associated with overall walking. Perceived neighborhood aesthetics, perceived walkability and perceived individual safety were positively associated with leisure-time walking. Objective walkability, perceived walkability and perceived individual safety were positively associated with walking for transport. Most studies were cross-sectional and used a validated measure of physical activity, few reported response rates of greater than 50%.

Conclusions: Strategies to improve self-rated health, social ties, neighborhood aesthetics, walkability and perceptions of individual safety should be the focus of interventions that aim to improve walking among socioeconomically disadvantaged groups. Recommends include that future studies: focus on leisure-time walking and walking for transport; place a greater focus on males; use longitudinal designs and examine variables relating to psychological, social, behavioral attributes and skills.

Purpose. High percentages of at-risk perceptual-motor development are reported among children growing up in disadvantaged communities. Therefore, the purpose is to investigate the usability of a Tailor-made Perceptual-Motor Development Program to overcome developmental delays in low SES communities.

Methods. The study was conducted in the rural Vaalharts region of the Northern Cape Province in South Africa. Preschool children between 3 and 5 years (n=43) were recruited from one primary school, and divided into an intervention (n=25) and control group (n=18). The teachers delivered a Tailor-made PMO program for 16 weeks, once a week, after receiving necessary training by means of a workshop from the researchers. A two group, pre-, post- and retention-test research design was followed and participant were measured with the MABC-2 test battery. A Mixed methods approach was followed to analyse the data including T-testing and repeated measures over time ANOVA with a post-hoc Bonferonni correction. Furthermore, monthly site-monitoring visits were conducted followed by discussions with the teachers regarding any challenges with a focus group reflection regarding the teacher’s experiences in conducting the program at the end. 

Results. Limited intervention effects (p>0.05) were found after the program delivery. Although teacher buy-in was found, many challenges were experienced, mainly due to knowledge and educational barriers of the teachers. Themes that emerged included feelings of an overload of information, complex lesson plans to implement and pedagogical barriers, both on an organizational and implementation level.

Conclusion. Findings from this study suggest that focussing on identifying and establishing only key behaviours of program delivery are important during training while it is also important to assess the competencies of teachers in these areas during training. In addition, frequent and ongoing support during the intervention period are essential to improve program delivery and to offer optimal developmental support.  These modifications can improve the delivery of tailor-made programs as a first step in empowering teachers to deliver such programs.

Keywords: Developing countries; early child development, gross motor; school readiness; low income settings, perceptual-motor development, intervention, teachers; training; South Africa

Purpose:Food insecurity is negatively associated with diet quality and health; however, links between food insecurity and maternal weight-related cognitions are understudied. Thus, this study explored relationships between food insecurity level and maternal body dissatisfaction, perceptions of their children’s BMI, and concerns about their children’s future weight status.

Methods:Mothers of children aged 2-5 years (maternal age=32.25±5.80SD years) completing an online survey were divided into groups using responses to Hager’s Food Insecurity screener (alpha=0.84): experiencing no (n=175), low (n=172), moderate (n=129), and high (n=74) food insecurity in the past 12 months.

Results:ANOVA and Tukey post hoc procedures revealed the no food insecurity group scored significantly (P<0.01) lower on the Eating Disorder Exam Questionnaire 4-point body dissatisfaction indicator item, indicating mothers experiencing no food insecurity were significantly more satisfied with their bodies than all other groups. A root cause of this dissatisfaction likely is linked to maternal BMI which also increased with food insecurity (high food insecurity mothers had significantly higher BMIs than other mothers; P=.01). Maternal selections of the silhouette representing their own children’s body size from 7 sex-specific child silhouettes of increasing BMI revealed a significant (P=.04), positive Spearman rank order correlation with food insecurity: as food insecurity rose, so did child silhouette BMI.  Similarly, Spearman rank order correlations of food insecurity level and scores on the 2-item, 5-point Likert Maternal Concern about Children’s Future Weight Status scale (alpha=0.91) (higher scores indicate greater concern child will be overweight) were significantly (P=.03), positive.

Conclusions:Findings support previously reported links between food insecurity and BMI and expands this to links between food insecurity and maternal weight-related cognitions of body dissatisfaction, maternal recognition of higher child BMIs, concern about their children’s future weight status. Future research should examine the interrelationships among maternal BMI, body dissatisfaction, and food insecurity continuum along with the impact of the psychological burden of mothers’ concern about their children’s current and future weight status and strategies for ameliorating this burden.

 

Purpose: Children and adolescents with a lower socioeconomic position (SEP) have poorer dietary behaviours compared to their counterparts with a higher SEP. A better understanding of the mechanisms behind such socioeconomic inequalities in dietary behaviours would provide useful information about modifiable factors to target in interventions that tackle the inequalities. Hence, this systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth.

Methods and results 

A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The majority of the studies had a moderate methodological quality. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. No consistent mediators at the organizational, community and policy level were found.

Conclusions 

Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating SEP inequalities in dietary behaviours. Rigorous studies exploring organizational, community and policy level mediators are warranted.

 

Purpose: To describe an opportunistic evaluation, of the impact of a scheme providing financial support for organised sports participation on child physical activity and organised sports participation.

Methods: A longitudinal survey of parents from primary schools (children aged 5-12 years) was conducted in the Hunter region of New South Wales, Australia. The study draws on a panel of parents established at the end of a randomized trial of a school-based healthy eating and physical activity intervention. Telephone surveys with participating parents were conducted at Baseline and approximately 10-12 months after the launch of the scheme that provided parents with a voucher enabling up to $100 discount on fees for organized sports membership. Parents were asked questions regarding registration and redemption of the voucher for their child, purpose for registering for a voucher and perceived acceptability of the scheme. Additionally, parents were asked whether their child participated in organized team and/or individual sports and the amount of time their child spent being physically active outside school hours.

Results/findings: Of the potential 975 parents who consented to be panel members, 511 completed the telephone surveys at both time points (52.4%). There was a high voucher redemption rate reported by parents within this sample (79.8%). The majority of parents perceived redemption of the voucher did not change their child’s physical activity levels. Children who redeemed a voucher were approximately three times as likely as those that did not redeem a voucher to participate in organized team sports (OR = 3.11; 1.41-6.87, p = 0.009). There was a no significant association in measures of self-reported physical activity levels outside of school hours and voucher redemption.

Conclusions: This study describes an opportunistic evaluation of a government voucher scheme to increase child physical activity levels in a large broadly population-based sample. Overall this post intervention sample appeared already highly motivated to participate in sport therefore high voucher usage rates made little difference to their participation in sport. The study highlights the challenges in undertaking naturistic evaluation of large-scale initiatives to improve population levels of physical activity.

 

Background: Sedentary behaviour (SB) is linked to adverse health outcomes, and socio-economically disadvantaged women are at high risk of both SB and poor health. This study aimed to 1) describe patterns of sitting, television (TV) viewing and computer use over time, and 2) determine the predictors of sitting, TV and computer use over time amongst women living in socioeconomically disadvantage neighbourhoods.

Methods: Data were collected three times over five years from women living in Victoria, Australia (2007-08= 4347, 2010-11=1912, 2012-13=1520). Women self-reported weekly sitting, TV and computer time, socio-demographic and health information. Sitting, TV and computer time assessed by reliable established measures. Multilevel-mixed modelling determined baseline sociodemographic and health predictors of change over time in sitting (linear regression), and in TV and computer use (negative binomial regression), adjusting for confounders.

Results: Mean sitting time decreased (40.9 to 40.1 hours/week), median TV time decreased (16.5 to 16.0 hours/week) and median computer time increased (9.5 to 14.0 hours/week) over five years. SB was highest amongst women who were younger, urban, highly educated, working full-time, never-married and with no children (sitting and computer), living with obesity and poor health (sitting and TV). Highest TV time was also evident in women with low education, lower income, not-working, smokers, those never-married and with no children. Annually, the average sitting time decreased by 30mins/week in women working full-time but increased by 6mins/week in not-working. Similarly, annual sitting decreased by 48mins/week in women with no children but increased by 12 and 48mins/week among those with two and three/more children, respectively. Average computer time increased annually by 5% among those with low education but decreased by 1% among those with high education. Women not-working and with children increased computer time by 7% and 5% per year respectively

Conclusion: Sitting and TV viewing time decreased while computer time increased over five years among women from socioeconomically disadvantaged neighbourhoods. Those with low education, not-working and with children appear at particular risk of increasing SB over time. Interventions aimed at preventing increases in SB could focus on women with these high-risk characteristics.

Purpose: Children residing in highly deprived neighbourhoods often experience poor health outcomes, including a greater likelihood of excess body size. While built environments that promote physical activity are considered important for children’s overall physical activity levels, less is known about how neighbourhood deprivation, physical activity and child body size are linked. The objective of this study is to determine possible associations between neighbourhood deprivation and the physical activity built environment with child body size, adjusting for the potential mediating influence of individual physical activity.

Methods: 1029 children (8-13 years), from eight diverse regions across Auckland, New Zealand participated in this child-centred, cross-sectional study. Using Geographic Information Systems, physical activity built environment features were objectively captured within individual, child-specific neighbourhood buffer boundaries. Associations between neighbourhood deprivation, the built environment and objectively measured body size (waist-to-height ratio; WtHR), through the pathway accelerometer-derived physical activity data, are being investigated using structural equation modelling in Mplus v.8.0.

Results: Preliminary results indicate neighbourhood deprivation and individual physical activity levels are associated with children’s WtHR (p<0.01). However, the physical activity built environment was not associated with physical activity (p=0.630), or WtHR (p=0.930). Boys and children of Pacific ethnicity had a greater WtHR than girls, as did children living in neighbourhoods of high deprivation (p’s<0.01). Further tests of mediation and model fit are currently being undertaken and will be reported.

Conclusions: Greater neighbourhood deprivation and lower overall physical activity levels are associated with excess body size in children. The role of the physical activity built environment in mediating this relationship is yet to be determined. Greater understanding of the pathways of association between neighbourhood deprivation, the physical activity built environments and child physical activity levels and body size is important in order to effectively target public health interventions to the level of the environment.

Background: Understanding socio-demographics disparities in diet quality can inform health policy and population-based interventions aimed at reducing nutritional and health inequities. Socio-demographic differences in diet quality have been described in adults, school-aged children, and adolescents, but few studies have explored these associations in preschoolers. Objective: To describe the diet quality of Canadian preschool-aged children and explore its associations with socio-demographic characteristics. Methods: Data from 100 children participating in the Guelph Family Healthy Study pilot, a family-based cohort-study, were used in this cross-sectional analysis. Children’s dietary intake was measured with three-day food records and diet quality was determined using the Healthy Eating Index (HEI-2015). Linear regression analysis was used to explore associations between diet quality and socio-demographic characteristics. Results: Children’s mean± SD HEI-2015 score was 68.9±9.31and 86% had HEI-2015 score in the “needs improvement” category (51-80 out of 100). Children’s overall HEI-2015 score was inversely associated with children’s age (ß= -0.19, 95%CI -0.37, -0.02); specific components of HEI-2015 score that decreased with children’s age included total fruit (ß= -0.19, 95%CI -0.37, -0.02), whole fruit (ß= -0.24, 95%CI -0.45, -0.03), refined grains (ß= -0.57, 95%CI -0.93, -0.21), and sodium (ß= -0.62, 95%CI -1.01, -0.24). Parental education was positively associated with children’s overall HEI score  (ß= 9.58, 95%CI 3.81, 15.35) and with scores for total fruit (ß= 1.00, 95%CI 0.39, 1.76), total vegetables (ß= 1.11, 95%CI 0.03, 2.18), total protein foods (ß= 1.06, 95%CI 0.28, 1.84), and seafood and plant protein (ß= 1.67, 95%CI 0.43, 2.89). Children who identified as Caucasian (ß= 4.29, 95%CI 2.46, 6.14), had Caucasian parent (ß= 3.01, 95%CI 0.78, 5.25), or had parent born in Canada (ß=2.32, 95%CI 0.53, 4.1) had higher scores for dairy component of HEI-2015. Conclusion: These results suggest that diet quality of Canadian preschoolers needs improvement and that there are disparities in diet quality across certain sociodemographics.  

Purpose: Populations in rural, geographically isolated areas, such as the Appalachian region of the United States, experience an aberrated food environment relative to those in other rural, urban and suburban areas. At the community level, the food environment shapes purchasing behaviors which has been linked to dietary intake. Interventions aiming to improve variety and quality of food items in persistently impoverished rural communities are lacking. This may contribute to poor dietary intake and higher rates of obesity relative to urban counterparts. Thus, this project seeks to understand how an exogenous shock (incentive) may influence purchasing habits among rural shoppers. 

Methods: Receipt data was compiled from individuals (n=111) living in one highly obese (>40%) Appalachian county, that shopped at two local grocery stores. Individuals redeemed their incentive ($25) as part of data collection funded through the Centers for Disease Control and Prevention High Obesity Program. Food items indicated on the receipt were categorized into the following: fruits and vegetables, meat and dairy protein, and candy/snack items. Additionally, the validated NEMS-GS food environment tool assessed the consumer food environment in one grocery store.  

Results/Findings: Individuals purchased the largest percentage of grocery items on meat and dairy protein, contributing 18.31% of receipt subtotals. Fruit and vegetable purchases followed with 13.10% of receipt subtotals, while candy/snack items contributed to 9.95% receipt subtotal. The NEMS-GS audit revealed a score of 18 for food item availability and a pricing score of –1, indicating a depleted food environment.    

Conclusions: Recipients commonly expanded their scope of food items to include protein-dense items, which otherwise may not have been purchased due to prohibitive costs. NEMS-GS further revealed the food access and environmental barriers residents face in rural Appalachian communities. These results support food environment enhancements within grocery stores to promote healthy food purchases among customers in rural areas. Intertwining targeted marketing and in-store promotions, may aid in the purchasing of items that could be viewed as seemingly unattainable to regularly purchase. Future interventions should sample receipt data and sales without an incentive to assess purchasing habits.    

Introduction: Physical inactivity is a major health concern as it is a determinant chronic disease and obesity. Cross-sectional studies show that residents of disadvantaged neighbourhoods and individuals from low socioeconomic groups are more likely to be insufficiently active. Little is known about the longitudinal patterns and influences of neighbourhood disadvantage on physical activity (PA) change in mid-aged adults.

Methods: Data comes from the HABITAT project, a multilevel longitudinal investigation of health and wellbeing in Brisbane, Australia. Data included 11,035 residents in 200 neighbourhoods in 2007, with follow-up data obtained in 2009, 2011, 2013 and 2016. Neighbourhood disadvantage was derived using a Census-based index and divided into quintiles. PA was self-reported (in the previous week), and an overall measure of energy expenditure was derived by multiplying the time (minutes/week) spent in walking, moderate activity and vigorous activity by an intensity value based on metabolic equivalent rates (Met.mins), and summing the products; 500Met.mins/week was defined as insufficient PA. Individual-level socioeconomic measures include education, occupation, and household income. Multilevel binomial logistic regression models were applied to investigate the impacts of neighbourhood disadvantage on having insufficient PA at five-time points.

Results: The probability of being classified as doing insufficient PA was highest among residents of the most socioeconomically disadvantaged neighbourhoods (OR: 1.74, 95%CI 1.45, 2.10), the least educated (OR: 1.84, 95%CI 1.57, 2.16), blue collar workers (OR: 1.34, 95%CI 1.13, 1.59), and members of lower income families (OR: 1.48, 95% CI 1.23, 1.79). Each of these same groups reportedly engaged in fewer Met.mins of total PA at each wave.

Conclusions: Key findings indicated that the likelihood of doing insufficient PA is greatest for low socioeconomic groups and residents of disadvantaged neighbourhoods. Policies and interventions aimed at creating supportive environments for physical activity, especially among the socioeconomically disadvantaged, should be a priority.  

Purpose: The aim of this study was to investigate deprivation differences in motor competence in school children.

Methods: National data were captured on 4,491 children (49.1% boys; aged 11.4±0.6 years) as part of the Dragon Challenge (DC) assessment implementation across 4 regions in Wales, between November 2014 and 2016. Motor competence was measured using the DC which involves nine tasks, completed in a continuous circuit within a timed trial. Tasks require the application of different combinations of fundamental, combined and complex motor skills. Participants were scored on their technical quality, performance outcomes, and time. A total DC score was calculated, with a larger score displaying higher motor competence. Participants’ home postcodes or lower/middle super output areas (if home postcodes were missing) were used to calculate Welsh Index of Multiple Deprivation (WIMD; 2014) scores and WIMD quintiles (1=most deprived). A two-way ANCOVA investigated the effect of sex and WIMD quintiles on motor competence, adjusting for age and ethnicity.

 Results: There was a significant interaction between WIMD quintiles and sex on DC Score, while controlling for age and ethnicity (F_(4,3627)=2.485, p=0.042). WIMD quintile was significant in girls (F_(4,3627)=5.402, p<0.001) and boys (F_(4,3627)=8.361, p<0.001). For girls, quintile 1 had a significantly lower adjusted mean DC score (31.00) than quintile 2 (1.83, CI 0.13 to 3.53; p=0.03), quintile 4 (2.57, CI 0.90 to 4.24; p<0.001), and quintile 5 (2.07, CI 0.26 to 3.87; p=0.01). For boys, adjusted mean DC score was significantly lower in quintile 1 (31.65) compare to quintile 3 (1.86, CI 0.24 to 3.48; p=0.01) and quintile 5 (3.46, CI 1.69 to 5.24; p<0.001); in quintile 2 (32.44) compared to quintile 5 (2.67, CI 0.85 to 4.50; p<0.001); and in quintile 4 (33.22) compared to quintile 5 (1.88, CI 0.05 to 3.71; p=0.04). No other significant differences in DC score between quintiles were found.

Conclusion: The present study was one of the first large-scale studies to investigate differences in motor competence by sex and levels of deprivation. Overall, results showed that national inequalities exist and focused services are warranted, particularly for those living in the most deprived neighbourhoods.

Background: Czech nutrition recommendations prioritize health aspects without considering affordability. Low socio-economic groups have the highest risk of nutrition-related noncommunicable diseases and cost has been identified as an obstacle to achieve a healthy diet, making the implementation of affordability into dietary guidelines necessary. The aim of this study was to develop a food basket (FB) for a low income Czech family of four that is nutritionally adequate, health-promoting and culturally acceptable at an affordable price.

Methods: Linear programming optimisation was used to ascertain that the FB covered the recommended nutrient intakes from the Czech Nutrition Society and from the World Health Organization (WHO). Cost of the FB was calculated on the basis of more than 3900 prices of 330 foods. Within a given cost constraint, all FBs were optimized for the highest possible similarity to the reported food group intake according to the most recent Czech National Food Consumption survey, which was used as a proxy for cultural acceptability.

Results: The optimised FB affordable at a daily food budget for a Czech family on minimum wage (CZK 177, ~ € 6.8) contained 76 foods and had an average relative deviation of 10% per food category from reported intake. The main deviations were: 72% less sweets and confectionery; 66% less salt; 52% less meat; 50% less milk products; 8% less potatoes; and 484% more milk; 69% more oils and fats; 20% more cereals; and 6% more vegetables.

Conclusions: The optimised FB can help to guide the development of food-based dietary guidelines for low income households in Czech Republic.

Objective: New strategies are needed to address modifiable NCD risk factors in low-to-middle-income countries, whilst not burdening the already-strained health care system. One possible solution is the role of the community health worker (CHW) in physical activity promotion at a primary health care level. Therefore, the aim of this research was to assess health status as well as current knowledge, attitudes and practices of CHWs regarding physical activity.

Methods: This observational study assessed the health profiles in 81 CHWs and physical activity knowledge through a self-administered survey in 159 CHWs.
Results: The CHWs (52% female; 37.9±smn;9.3 years) had a mean BMI of 29.7 (±smn;7.5kg/m2), with 74.1% being overweight or obese. Thirty two percent had hypertension and 9% were pre-hypertensive. The mean glucose levels were 5.7 (±smn;2.1mmol/l) and cholesterol was 4.8 (±smn;0.8mmol/l). Sixty-nine percent stated that they were familiar with the PA public health guidelines, and yet 19.7% believed that only vigorous PA is beneficial for health, whilst 45.9% did not know how to measure intensity. The majority (96.6%) believed that physical activity promotion is part of their job, however 22.4% felt they did not have sufficient knowledge to advice their community on PA, and only 15.9% reported having any formal training on PA.

Conclusion: There is a strong case for the task shifting of physical activity pre-participation screening, risk stratification and physical activity counselling to the role of the CHWs, however there are some initial issues that need to be addressed. Firstly, CHWs in South Africa appear to be as susceptible as their communities when it comes to prevalence of overweight and obesity as well as associated NCD risk factors, calling into question their ability to act as role models for health education. Furthermore, there appears to be some crucial gaps in PA knowledge and a lack of training which may hinder their physical activity counselling efficacy. Community health workers present a unique and important opportunity to safely improve physical activity levels in LMICs, however they need to be empowered through adequate training, as well as addressing their own behavioural change challenges.

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients and can be the ground for both communicable and NCDs. Nutrition is essential and Energy Expenditure (EE) assessment in an individual’s daily routine is the key to it as both undernutrition and over nutrition are detrimental. Currently, an individual is categorized as sedentary/ moderate/ heavy worker based on the Metabolic Equivalents (METs) of the activity and the duration it is performed. MET values are given for the activity as such but using this to classify an individual sedentary or moderate or a heavy worker is not appropriate especially when the duration of activity is less than 10 minutes. As there is no single effective tool available to calculate Total Energy Expenditure (TEE), a new concept was developed to calculate TEE using its 3 components Resting Energy Expenditure (REE), Activity Energy Expenditure (AEE) and Diet Induced Thermogenesis (DIT). (Copyright office, GOI Registration Number: L-84886/2019) Based on this concept, a simple android application has been developed, 24 hour Activity Recall Method abbreviated as “24 ARM”.

 

Key Words: Physical activity, Energy expenditure, METs, Resting energy expenditure, Activity energy expenditure, Diet-Induced Thermogenesis

Purpose: To examine mean differences in physical activity (PA) and physiological outcomes during exergaming and traditional exercise in healthy non-athlete adults and recently-retired elite athletes. 

Methods: In a causal-comparative study design, twenty healthy non-athlete adults and twenty recently-retired elite athletes were matched for sex, age, and BMI (18 females/group; X̅_age = 27.8 years, X̅_BMI = 22.7 kg/m²). Participants completed three separate 20-minute exercise sessions: (1) Just Dance; (2) Reflex Ridge; and (3) treadmill walking. We measured participants’ time in sedentary behavior (SB), light PA (LPA), and moderate-to-vigorous PA (MVPA) and energy expenditure (EE) using hip-worn ActiGraph GT3X+ accelerometers. We used the Omron HEM-705CP digital BP cuff to evaluate systolic and diastolic blood pressure (BP) change (BP_post – BP_pre). Finally, we employed Borg’s rating of perceived exertion (RPE) scale every four minutes during each exercise session to assess subjective PA intensity. A 2x3 ANOVA (2 cohorts [healthy adults vs. elite athletes]; 3 exercise sessions) examined mean differences for these outcomes.

Results: Significant main effects for cohort across all exercise sessions were observed for EE, systolic BP change, and RPE. In detail,  compared to recently-retired elite athletes, non-athlete adults had a significantly higher overall change in systolic BP (15.0 ± 9.7 mmHg; 10.5 ± 8.3 mmHg, respectively; p = 0.02, η² = 0.04) and had significantly higher EE overall (128.3 ± 45.9 kcalories; 107.2 ± 38.9 kcalories, respectively; p = 0.02, η² = 0.05). Moreover, despite no significant differences between cohorts insystolic BP and time at different PA intensities (p > 0.05), non-athlete adults reported significantly higher RPE compared to recently-retired elite athletes (11.2 ± 1.7; 9.4 ± 1.5, respectively: p < 0.001, η² = 0.3). 

Conclusions: Exergaming and traditional exercise elicited similar PA intensities in healthy non-athlete adults and recently-retired elite athletes while significantly increasing systolic BP change and EE in healthy adults. Therefore, health promotion programs in recently-retired elite athletes may require higher intensities to confer the same physiological health benefits seen in non-athlete adults, regardless of the PA modality. 

 

Purpose: The purpose of this study was to evaluate the effects of nutrition education on reducing sugar and sodium intakes in elementary school students and to establish healthy dietary behaviors for reducing sugar and sodium intakes in them.

Methods: Nutrition education was done for the fifth-grade students (531 total; 258 male and 273 female students) of five elementary schools located in the Incheon Metropolitan City, Korea. It was performed for five months from May to September in 2019. Contents of nutrition education consisted of the role of sugars and sodium, health problems due to their excessive intakes, and methods of reducing sugar and sodium intakes. Data were collected using self-administered questionnaires. Pretest was conducted to check the nutrition knowledge about sugars and sodium and dietary habits of eating sweet and salty foods one week before applying the nutrition education. After nutrition education, posttest was conducted to check for the degree of changes in nutrition knowledge and dietary attitudes. All data were analyzed SPSS program version 20.0.

Results: Average total score of nutrition knowledge significantly increased from 5.6 to 7.0 points (out of 10 points, p<0.001). There were significant increases in average scores of dietary attitudes related to salty eating habits from 32.5 to 38.2 points and sweet eating habits from 32.5 to 37.0 points (out of 50 points, p<0.001, respectively). Dietary behavior that showed the highest intent to act was for "I will check the sugar and sodium contents through nutrition labeling when purchasing processed foods." After nutrition education, students showed a significantly positive correlation between scores of nutrition knowledge and dietary attitudes about sugars and sodium, and the higher the level of nutrition knowledge, the higher was the willingness to dietary practice reducing sugar and sodium intakes (p<0.01).

Conclusions: These results showed a positive effect on changes in healthy dietary behaviors after nutrition education and indicated that the enhancement of nutrition knowledge was extended to the improvement of dietary habits. In addition, systematic and continuous nutrition education is needed for reducing sugars and sodium intakes in elementary school students in Korea.

Purpose: Food marketing to adolescents via traditional channels (e.g. television and print media) predominantly promotes energy dense nutrient poor foods and beverages. This has the effect of enhancing attitudes, preferences and increased intake of these foods in adolescents, with detrimental consequences for adolescent health. While the use of social media applications in adolescents has proliferated, little is known about the content of food marketing within these applications. This study aimed to explore the characteristics of food marketing content on Dutch and Australian adolescents’ (13-16 year olds; n=20) favourite social media accounts. Methods: Adolescent participants were invited to the University of Newcastle to meet with a researcher and to login to a maximum of three of their favourite social media account(s). They were asked to scroll through their social media feeds accompanied by a researcher who instructed them on how to identify and then extract food marketing content with screenshots (text, images) or recordings (videos, games) using a screen recorder application. The researcher ensured that no personal data was captured. Results: The study protocol and the results of a quantitative analysis of the extracted food advertisements are presented, providing insight into all food marketing content encountered on social media sites, including sponsored content, advergames (i.e. games promoting products) and social influencer advertising (e.g. video blogs promoting products). Ethical considerations and methodological strengths and limitations that are concerned with social media research are also discussed. Conclusions: The outcomes of this study contribute to a relatively unexplored research area, by providing valuable insights into the food and beverage marketing content on adolescents’ social media applications. This will help prioritise future research on the effects of social media food marketing targeted to adolescents.

Purpose: Traditional food marketing channels (e.g. television and print media) predominantly advertise energy dense nutrient poor foods and beverages. In adolescents, traditional food marketing has the effect of enhancing attitudes, preferences and increasing intake of marketed foods, with adverse effects on adolescent dietary behaviours. With adolescents being the most digitally-driven segment of the population, social media is increasingly used as a communication channel for food marketing targeting adolescents. Compared with traditional food marketing channels, social media offers food marketers opportunities for more implicit persuasion marketing techniques. However, no research to date has established a theoretical framework describing the psychological mechanisms that moderate and mediate the effect of social media food marketing (SMFM) cues on adolescents’ food-related attitudes and dietary behaviours. Methods: A draft theoretical framework was developed based on existing marketing frameworks, empirical research from literature and social cognitive theories. Subsequently, 10 Australian and European experts in the field of marketing, adolescent health, psychology, behavioural sciences and communication sciences provided their vision on the draft theoretical framework during 45-minute interviews, after which the framework was further adjusted and verified. Results: The developed SMFM theoretical framework describes the proposed psychological moderators and mediators involved in the effect of SMFM on adolescents’ food-related attitudes and dietary behaviours. It proposes that several cognitive, emotional and social mediators play a role in adolescents’ processing of SMFM cues. More specifically, the engaging and implicit nature of SMFM, combined with adolescents’ developing cognitive abilities mainly triggers heuristic or automatic pathways. This lowers adolescents’ active perception of marketing messages, while activating affect-based (i.e. emotional or social) processes, ultimately impacting their food-related attitudes and dietary behaviours. Several moderators, i.e. message or individual factors, are proposed to influence this relationship. Conclusions: This SMFM theoretical framework can be used as a tool that provides guidance for future research on the effects of social media food marketing in adolescents, with the ultimate purpose of helping adolescents identify and resist SMFM of energy dense nutrient poor foods. Empiric validation is warranted to confirm the processes described in the SMFM framework.

Purpose: With the improvement of world sports competition level, the importance of athletes' diet nutrition becomes more and more prominent. In order to better understand the nutritional status of young athletes and provide a favorable basis for the improvement of dietary nutrition of young athletes in competitive sports in the future, this paper conducts a dietary survey on Shanghai youth women volleyball players.

Methods: 16 players of Shanghai youth women's volleyball team were selected, aged 14.9±1.9 years, with a height of 178±4.8cm and a weight of 65.3±5.2kg. (1) Dietary survey method -- food weighing method was adopted. During the survey period, the consumption of all kinds of food and the amount of remaining food in each meal (including all food consumed except dinner, such as various fruits, drinks, snacks, etc.) were accurately weighed and recorded in detail. (2) Dietary review method: during the dietary survey period, ask and accurately record the weight of all snacks and fruits eaten by athletes after dinner, and try to keep the food packaging as a reference.

Results: Female athletes were found to have insufficient total calories, too little breakfast, too much dinner, and too much extra meals. The proportion of carbohydrate intake is too low, which is related to the fact that athletes do not know the role of sugar in sports training. It is necessary to strengthen the intake of sugar-rich food such as staple food of athletes, so as to avoid the effect of insufficient sugar storage on sports ability and training effect. Less VA and VB1; Calcium intake is low and zinc intake is low. 

Conclusions :(1) To strengthen athletes' understanding and learning of nutrition knowledge, let them know the importance of dietary nutrition, learn how to choose food according to their body's needs. (2) Strengthen the sports nutrition training for canteen staff . (3) The coach should not only be strict in training, but also give more guidance in dietary nutrition, so as to timely and reasonably urge the athletes to make scientific and reasonable choices of various foods during meals.

 

 

Purpose

 

Systematic and theory-based planning is an essential criterion for a successful intervention as well as for its sustainable continuity. Studies have shown that overweight prevention programs for children are of an unsystematic and non-evidence-based planning quality. The development of high-quality programs to prevent childhood obesity is very complex and needs effort in time and personnel. Thus, it is hardly possible to perform a systematic and target-group-specific project planning in professional life of health promoters. Aim of the project 'WEPI' is to develop an evidence-based and user-oriented planning tool to support and optimize the planning process of prevention programs for obesity in childhood and youth.

 

 

Methods

 

A Systematic Literature Review (SLR) was conducted in the databases PubMed, LIVIVO and Cochrane to identify existing tools for planning prevention and health promotion. Furthermore, expert interviews were carried out in schools and communities. The first functions of the WEPI planning tool were developed and optimized in focus groups with future user.

 

 

Results

 

The SLR revealed 628 hits of which 56 full texts were considered for further analysis. The four most comprehensive and evidence-based planning tools were chosen for a detailed comparison of the planning steps and context requirements. Components of planning were identified. Besides clarifying the experts meaning of planning and identifying difficulties in the planning process, the interviews also revealed the need for supporting a systematic planning process. Results were aggregated in the development of the WEPI planning tool. First functions were tested in focus groups and an optimized version of the WEPI planning tool can be presented. Subsequently the tool will be converted into a web-based application and tested in schools and communities.

 

 

Conclusions

 

The WEPI planning tool supports the development of evidence-based prevention planning and contributes to the standardisation and quality assurance of interventions as the planning process becomes transparent and comparable. The participative development of the tool and the subsequent transfer into a web-based application allows meeting the needs and the conditions of the user. The project is supported by the Federal Ministry of Health, Germany.

 

Purpose:To survey literature that defines/validates accelerometer-based physical activity measures (validation papers) and reports accelerometer-based physical activity levels among toddlers (assessment papers).

Methods:The search strategies were developed by the authors including a professional librarian. The key search terms included toddlers, accelerometers, and physical activity. The eligibility criteria were: English language articles published, , included samples of children aged 12 to 35 months, and used accelerometers to recognize physical activity. To be eligible as a validation paper, true physical activity behavior data had to be compared with concurrent accelerometer data. To be eligible as an assessment paper, physical activity measures during at least all waking hours had to be reported.

 Results:We identified seven original research papers as validation papers and 14 original research papers (with 11 independent samples) as assessment papers. Of the seven validation papers, five used ActiGraph accelerometers and six papers placed accelerometers on the hip. To recognize physical activity, five papers used an accelerometer count cut-point approach, and the remaining two used a machine learning approach. The suggested ActiGraph accelerometer cut-points varied across the papers. In the 11 assessment studies, six used ActiGraph, four used Actical, and one used Axitivity. Among them, seven placed accelerometers on the hip, two did so on the wrist, and the remaining two did so on the ankle. Various definitions for moderate- to vigorous-intensity physical activity (MVPA) were used across the assessment studies, reporting MVPA in a range of 4 to 58 minutes/day. The major limitations noted for toddler PA assessment included no consensus on accelerometer data processing rules (e.g.,  definitions of non-wear time, valid day, and activity intensity/type) and a lack of methodological means to differentiate toddlers’ unique passive movement, caregiver-carrying, from child-initiated movements.

 Conclusions:This scoping review summarizes the nature and extent of toddler physical activity research literature. Despite the critical need for accurate toddler physical activity assessment, there is no consensus on accelerometer data processing methods, making it difficult to advance the field. Future research should focus on methodologies for toddler physical activity assessment that account for toddlers’ unique behavioral patterns.

Background: Built environment correlates of adolescents’ active transport to school (ATS) have been extensively studied in urban areas whereas limited evidence exists for rural areas. School neighbourhood built environment (SN-BE) features may differ across urbanization settings and warrant further investigation. This study investigated correlations between school-level rates of ATS, objectively measured SN-BE features and adolescents’ perceptions of safety along the route to school among New Zealand adolescents living in different urbanization settings and within 4 km of their school (considered a reasonable cycling distance).  

Methods: Adolescents (n=1260; 43.6% male; 15.2±1.4 years) were recruited from 23 (out of 27) secondary schools located in large (n=11), medium (n=3) and small urban areas (n=4) and rural settlements (n=5) in the Otago region, New Zealand. Adolescents completed an online survey about their school travel and perceptions of safety. Responses were aggregated to present school-level averages. Home-to-school distance and SN-BE features (intersection density, residential density, mixed land use) were measured using GIS over 0.5 km and 1 km buffers.  Walkability index was calculated for each school.

Results: On average, 38.1% of adolescents used ATS (range: 27.8%-43.9%). School-level ATS rates were negatively correlated with SN-BE intersection density (0.5 km and 1 km buffers: r=-0.610; r =-0.589), residential density (r=-0.620; r=-0.604) and walkability index (r=-0.697; r=-0.642) (all p<0.01), whereas weak but significant positive correlation was found with mixed land use (r=0.095; r= 0.070; both p<0.05). School-level ATS rates were negatively correlated with adolescents’ concerns about safety of walking or cycling to school (walking: r=-0.763; cycling: r=-0.785), high traffic volume (r=-0.826) and presence of dangerous intersections (r=-0.751) along the school route. Adolescents’ perceptions of the presence/absence of footpaths and cycle paths along the school route were not significantly correlated with school-level ATS rates.

Conclusion: When assessed across different urbanization settings and among adolescents living within 4 km of their school, lower rates of school-level ATS were negatively related to SN-BE intersection density, residential density and walkability, and adolescents’ concerns about safety of walking/cycling to school, particularly in relation to traffic safety. Future ATS interventions should focus on SN-BE features and minimise adolescents’ traffic safety related concerns.    

 

Background: Safe route to school interventions aiming to encourage walking and/or cycling to school are promising strategies to increase adolescent rates of active transport to school.  Multiple factors influence whether adolescents walk and/or cycle to school. This article presents a comprehensive conceptual framework for modelling safe walking and cycling routes to secondary school. 

Methods: The framework has been developed based on the existing relevant frameworks  including: a) the ecological models which account for individual, social, environmental and policy factors as well as traffic and personal safety considerations; b) the Five E’s framework of transport planning which includes engineering, education, enforcement, encouragement, and evaluation components; and c) travel mode choice framework for school travel consisting of urban form, mediating and moderating factors.

Findings: The proposed framework takes into account the key components of the existing relevant frameworks and shows how they are interconnected with each other for modelling safe walking and cycling routes to secondary schools. The framework identifies that built environment features (land use mix, walking/cycling infrastructure, neighborhood aesthetics, and accessibility to local facilities) and traffic safety factors (traffic volume and speed, streetlights, safe road crossings, and quality of roadway surface) need to be considered when modelling safe walking and cycling routes to secondary schools.       

Conclusions: The framework suggests that modelling of safe school routes should focus on addressing the built environment features and traffic safety concerns. The framework needs to be tested using actual data in different geographical settings. Modelled routes should be evaluated prior to implementation using local data and ideally also incorporating feedback from stakeholders and future users. To be effective, modelling and creation of safe routes to secondary schools should be complemented by other interventions including education, enforcement, and encouragement to minimise perceived active transport-related traffic and personal safety concerns of adolescents and their parents. Future research should utilise multiple tools for assessing the school route built environment features including Geographic Information Systems and environmental scans.

Purpose: Sedentary behavior (SB) and cardiorespiratory fitness (CRF) are important issues in occupational health. The Worker’s Living Activity-time Questionnaire (WLAQ) was developed in a previous study to assess worker’s sitting times, and the WLAQ could be renewed for evaluating worker’s CRF if additional physical activity (PA) information were provided. The purpose of this study were to investigate criterion validity of an equation model using WLAQ for estimating maximal oxygen consumption (VO2max).

Methods: A total of 198 working adults completed anthropometric measurements, treadmill exercise test for VO2max, and the modified WLAQ (m-WLAQ) which provided additional questions about PA information with the original WLAQ. Multiple regression analyses were used to develop prediction equations for VO2max. The generated models were cross-validated by the PRESS method. Of all the participants, the data of 97 participants, who completed the m-WLAQ twice with a 1-week interval, were used to calculate intraclass correlation coefficients (ICC) for the m-WLAQ’s test-retest reliability analyses.

Results: Age (r = −0.29), sex (r = 0.48), body mass index (BMI) (r = −0.20), total sitting time (r = −0.15), and PA score, i.e., total points of PA information, (r = 0.47) were significantly correlated with VO2max. The models including age, sex, and BMI accounted for 43% of the variance in measured VO2max (SEE = 5.04 ml·kg−1·min−1). The percentages increased to 59% when the PA score was included into the models   (SEE = 4.29 ml·kg−1·min−1). Cross-validation analyses demonstrated good stability of the VO2max prediction models, while systematic under- and over-estimation of VO2max were observed in individuals with high and low fitness, respectively. The ICC of the PA score was 0.87 (0.82−0.91), indicating excellent reliability.

Conclusions: The PA score rather than sitting times derived from the m-WLAQ was correlated well with measured VO2max. The equation model using the PA score as well as age, sex, and BMI had a favorable validity in estimating VO2max. Thus, the m-WLAQ can be a useful questionnaire to assess workers’ SB and CRF concurrently, which makes it a reasonable resource for future epidemiological surveys in occupational health.

 

Purpose:

Better data is needed to more accurately determine children’s and adolescents’ physical activity participation. In the past, a considerable number of diverse questions have been used to measure participation levels, creating difficulties when trying to compare and combine data. Currently, Australia does not have a standardised set of survey questions. Using a consistent measurement approach would result in more comparable data and a clearer picture of how active children really are.

 

Methods:

A systematic search was conducted to identify all the datasets consisting of data on youth participation in physical activity and sedentary behaviour within Australia. The survey questions used to measure participation within these datasets were extracted and systematically classified into the various activity domains (overall physical activity, sport, active play, active transport, physical education, exercise, and screen and non-screen-time) using a specifically designed taxonomy. A Delphi panel ranked each question based on their alignment with national guidelines, their coverage and their validity and reliability.

 

Results:

Over 500 questions have previously been used to measure children’s and adolescents’ physical activity and sedentary behaviour within Australia over the past 70 years. To form a recommended set of questions a concentric approach was adopted, with one central recommended question for each activity domain, followed by a series of other possible questions. The ideal question selected is comparable with a large volume of historical data, have established reliability and validity, and allows us to assess compliance with guidelines.

 

Conclusion:

Greater clarity of physical activity measurement within Australia has long been desired. These recommendations will hopefully result in more consistent and comparable data being collected, and therefore more accurate measurement of how active our youth are.

 

 

 

The objective of this study was to systematically review the evidence of motor skill intervention programs on typically developing children’s fine motor development aged birth to six years.

Methods: Six electronic databases were searched with no date restrictions. Inclusion criteria were any school-, community- or home-based intervention targeting the development of fine motor skills of children aged birth to six years; randomized controlled trails (RCT) using quasi-experimental, experimental or single group pre-post designs with a minimum sample size of 15 participants per group; and statistical analyses of fine motor skill development at both pre- and post-intervention or addressing the intervention effects on fine motor skill development. Data were extracted on design, participants, intervention components, methodological quality and efficacy.

Results: Twenty-five of the total 31 studies reported positive intervention effects on fine motor skills. The meta-analyses included 19 studies and revealed moderate effect sizes of motor skill programs on fine motor, visual motor and manual dexterity outcomes. There were substantial differences between intervention settings, facilitators, length and content with most studies implemented in school settings and facilitated by teachers.

Conclusion: Fine motor skill development in the early years is an extensive upcoming field of interest for many international researchers. This review paper presents evidence on the positive effects of intervention programs that aim to enhance fine motor skills for young children. The findings are promising, but need to be interpreted with caution due to the high risk of bias in many of the studies.

Purpose: Obesity is a widespread health issue. Behavioral lifestyle interventions including dietary and physical activity modification have failed to achieve clinically significant weight loss. The review discusses the barriers to weight loss among obese adults. 

Methods: Potentially eligible original studies including adult participants with BMI > 25 kg/m² with controlled metabolic conditions, presenting without any secondary causes of obesity or psychological illness were identified through systematic search of databases (Cochrane Library, PubMed, Scopus, Wiley Online Library and WHO virtual health library) from January, 2009 to January, 2019. This was followed by critical appraisal and qualitative analysis of  chosen studies.

Results: A total of 4433 studies were identified in the initial search, of which 28 studies were finally analysed. Lack of patient’s readiness to change, low motivation and schedule incompatibility were identified as barriers to intervention initiation. Body image issues, musculoskeletal ailments, non compliance,lack of nutrition knowledge and cooking skills, emotional eating were challenges at the individual level. Obesogenic environments at home (lack of support, difficult family dynamics, cultural cooking style), work (job site, sedentary job, shift work, no recreational areas, unhealthy meal facilities) and neighbourhood (safety, walkable land use, pricing, concentration of fast food) were also found to hinder compliance. Biological adaptation due to consistent calorie restriction was responsible for weight plateau leading to dropouts from weight loss programmes.Sub-optimal behavioral skills like goal setting, stimulus control, self monitoring, problem solving and cognitive restructuring were associated with weight regain.

Conclusion:  The review highlights the need for addressing weight loss barriers among obese adults. A patient-centric and intensive counselling approach using cognitive behaviour therapy may be adopted for effectively modifying their diet and physical activity.

Purpose: Previous research has supported the validity and utility of the Youth Activity Profile (YAP) for providing accurate group-level estimates of physical activity (PA) and sedentary behavior (SB) in youth. The present study evaluated the cross-cultural validity of newly refined algorithms from the U.S. in a sample of youth from the Czech Republic.

Methods: Data sample consist of 570 youth from 7 schools in a mid-sized metropolitan area. The sample included 318 males (mean age = 14.2±2.81) and 252 females (mean age = 14.3±2.68). Participants wore an ActiGraph accelerometer on non-dominant wrist for a full week and then completed a customized version of the YAP at school to report PA levels in school (5 items), outside of school (5 items) and SB (5 items). The raw YAP data were converted into estimates of PA and SB using the prediction algorithms. The accelerometer data were processed using the R-based GGIR package to obtain estimates of MVPA minutes per day and averages were computed for weekdays and weekends. Standard measurement agreement methods were used to evaluate the agreement of corresponding estimates obtained from the YAP prediction algorithms. Agreement was examined separately for males and females and for distinct age groups using correlations and computed values of Mean Absolute Percent Error (MAPE). Equivalence testing was used to directly compare the equivalence for the different age and gender sub-groups.

Results: Correlations between the YAP and the accelerometer ranged from 0.14 to 0.50 for weekday and from 0.30 to 0.57 for weekend PA estimates. The MAPE values ranged from 3.7% to 34.9% for weekday and from 10.7% to 58.7% for weekend PA estimates. Error rates tended to be higher for the younger group than the older group on weekend PA estimates. Girls’ PA estimates shows less error rates than boys’ in both variables. Equivalence testing results revealed that estimates of PA were in the equivalence zone only for youngest group on week day.

Conclusions: Results provide preliminary evidence to support the cross-cultural validity of the YAP for estimating PA and SB in youth, but improvements in accuracy may be possible with country-specific calibration approaches.

Purpose: The purpose of this study was to initiate psychometric testing of the Our Outdoors Well-being Survey. The Our Outdoors Project engages citizens to characterize their public outdoor spaces with an overall goal of increasing physical activity and positive well-being through transparency, advocacy and participatory evaluation. The survey was designed to capture individuals’ momentary experiences of well-being in outdoor locations and to allow for scale-up to measure population-based changes in utilization of outdoor space using a citizen science mHealth app.

Methods: An initial item pool of 15 likert-type survey items was generated by reviewing existing well-being measures and item content, previous research on which specific aspect of health and well-being are thought to be influenced by the environment, and feedback from stakeholder groups. Self-report data were collected from three locations that varied in urbanicity; the total sample was n=137 adults. Participants completed the survey (paper or online) while using the space and reported on environmental attributes (e.g., noise). To evaluate the presence of a latent structure items were subjected to an exploratory factor analysis using Principal Axis Factoring and Varimax rotation. Once factors were identified, indices were created by averaging the items. To evaluate discriminate and convergent validity descriptive statistics were used to characterize the association between each of the indices and the participants’ perception of five outdoor space attributes: crime, noise, distance from traffic, beauty, and pleasant surroundings.

Results/Findings: The data were suitable for Factor Analysis (Bartlett's Test of Sphericity p < .001; KMO = .892). A two-factor solution was identified, with the first factor - positive wellbeing (α=.93) in outdoor space - accounting for 42.26% of the variance and the second factor- negative wellbeing (α=.88) in outdoor space - accounting for 22.21%. Bivariate correlations were observed in the expected directions. For example, positive well-being was positively associated with pleasant surroundings (r=.498, p<.001) negatively correlated with noise (r=-.220, p<.001).

Conclusions: The survey demonstrated promising psychometric qualities and warrants further evaluation. Short surveys such as these can offer quick and robust means of assessment of psychological well-being in outdoors spaces, a key factor in studies of physical activity and health.

Purpose: Food diary is often used to track eating habits and dietary behavior change. This study aimed to develop a food diary called My Eating Journal as a guidance tool for elementary students to eat diverse food groups and its recommended portion according to Balanced Nutrition Guidelines.

Methods: Subjects were 9-11 years old children from elementary schools in Bogor, Indonesia. The study used quasi experimental design and was divided into two stages. The first stage was to create a prototype (consist of food list and food frequency graph) and test for media acceptance level (content, attractiveness, easiness to use). The second stage was to validate the ability of My Eating Journal to improve eating habit. Subjects (n = 35) were asked to fill My Eating Journal every day for four weeks at school under teacher supervision. Data of knowledge, attitude, and practice related to Balanced Nutrition Guidelines were collected at baseline and post-intervention. At the end of week-4, consumption frequency for each food groups during intervention were assessed. Data were then analyzed using paired sample t-test.         

Results: The results showed that My Eating Journal are accepted by majority (85,7%) of subjects. Most of the subjects (87,6%) have no difficulty in converting their eating frequency of each food group from the food list into food graph.  There is no significance differences in knowledge and practice between baseline and post-intervention, but subjects’ attitude is significantly increased (p = 0,029). Almost half of the subjects (49,1%) are lacking on vegetable consumption (2,2 ± 1,3 times/day). There is no change on eating habit observed throughout the four weeks of filling in My Eating Journal.                

Conclusions: My Eating Journal can be easily used by elementary school students to assess their eating habits. The increase of attitude shows that there is a possibility of dietary behavior improvement if the parents provide vegetables and other healthy foods. 

Purpose: To assess the level of agreement between body size self-perception and actual body fatness determined by body mass index (BMI) and deuterium dilution methods in South African 6 to 8 years olds.

Methods: A cross-sectional study design was followed with a total of 202 children, boys (n=83; 41.1%) and girls (n=119: 58.9%) aged 6 to 8 years. To measure the level of agreement between subjective (silhouettes) and objective body size outcome measures, the children’s silhouette choices were compared to their measured BMI, and fatness determined by Deuterium Dilution method (DDM). The WHO BMI-for-age classification was used to classify children as underweight, normal, overweight and obese.

Results: Out of 202 children, 32.2%, 55.1%, 8.8% and 2.4% perceived their body size as underweight, normal, overweight and obese, respectively. Based on the BMI measured outcomes, 18.9%, 72.8%, 6.9% and 1.5% were classified as underweight/thinness, normal, overweight and obese, respectively. The outcomes of DDM on the other hand showed that, 8.9%, 65.3%, 16.3% and 9.4% were underweight, normal weight, overweight and obese, respectively. In summary 23.3% of children who were not underweight thought they were, whereas, 10.2%, 7.8% and 7% children who were normal, overweight and obese did not know they were. The applications of the Silhouettes’ and BMI resulted in either overestimation or underestimation in the three body weight categories. Overall, the kappa levels of agreements were small (<0.20), therefore the level of agreement for DDM with perception and BMI was poor. The agreements between body fatness measured by DDM and BMI, respectively, with perceptions were very low (Kendall tau; 0.16 and 0.23; p<0.001).

Conclusions: It can be concluded that when using silhouettes, children either overestimated being underweight or underestimated being normal weight, overweight and obese when compared to their actual measured weight status using DDM. There is also generally, poor to fair levels of agreement between body size perception outcomes, BMI and DDM outcomes in 6 to 8 years old South African school going children. As such, children and their parents should cautiously be made aware of the child’s actual weight status and referred for appropriate interventions. 

Purpose:

This study examined variations in physical activity (PA), body image dissatisfaction and chronic disease risks factors across socioeconomic households in major urban centers in Botswana, within a nutrition transition framework. We hypothesized that participants from middle-to-high income households will have lower PA, higher BMI, higher body image dissatisfaction and increased risk for chronic diseases compared to those from low income households. Declines in PA and the nutrition transition have important implications for obesity and incidence of chronic diseases in sub-Saharan Africa. Yet significant evidence gaps on these relationships persist. We considered a household survey as a novel approach to examining these relationships and narrowing of the evidence gaps.   

Methods:

Participants were 728 adults (Female, n = 66.2%), aged 18 to 90 years (M = 33.4; SD = 13.28), from low (62.6%), medium (15.7%) and high (21.7%) income households in three major urban areas in Botswana. A stratified cluster random sampling design was used, with neighborhood income as the stratifying unit. One adult from each household completed a socio-demographic questionnaire, the International Physical Activity Questionnaire, and a body image questionnaire. Weight and height were measured using a portable digital scale and a stadiometer. Various descriptive statistics, ANOVA and regression models were used to test for the hypothesized relationships.     

Results:

Participants from high income households had significantly higher BMI, higher incidence of diabetes and higher cholesterol than those from low and middle income households (p<.001). Time spent in moderate PA dropped with an increase in income (p<.001). Only 35.4% of the participants reported doing moderate to vigorous PA over the past seven days. Females had significantly lower PA, higher BMI, higher body image dissatisfaction and higher risks for chronic disease than males (p<.001). Being younger, female and having a higher BMI were significantly associated with higher body image dissatisfaction and higher risk for chronic disease (p<.001).  

Conclusions:

These findings confirm that declines in PA and a nutrition transition have important implications for health outcomes in Botswana and developing countries. The study highlights the potential of household surveys to increasing our understanding of these relationships and the need for community based interventions.  

 

Purpose:

Addressing food insecurity is critical in any efforts to reduce health disparities. The current widely held definitions of food security are holistic and nuanced, but measurement has not been. Measures such as the United States Department of Agriculture’s Household Food Security Survey Module (HFSSM) focus on food access and economic aspects of food insecurity, but do not fully consider the social, physical, health, and behavioral dimensions. The purpose of this study is to explore a diverse sample of food-insecure individuals in the US to understand their experiences and barriers related to food insecurity, as well as their perceptions of common experience-based measures of food insecurity (e.g., HFSSM). 

 

Methods:

Qualitative data collection will occur from January-March, 2020. We will interview a low-income racially/ethnically diverse sample of food insecure individuals (n=15-20) to explore their food insecurity experiences, conceptualizations of food insecurity, and perceptions of current tools and recommendations for improvement. The interviews will be completed in-person, will last approximately 60-minutes, be audio recorded with permission (or detailed notes will be taken), and verbatim transcription of audio will be completed. The qualitative approach will incorporate thematic analysis utilizing Creswell’s “lean coding” technique. 

 

Expected Findings and Conclusions:

In our previous qualitative work with food insecure populations, interviewees identified the utility of social capital in securing food (“Basically it’s like every end of the month is when we run out. And I call around and see if I can go to somebody’s house to eat...”), use of food pantries for emergency food supplies (and even chronic reliance), and prioritized certain food groups, such as meat (leading to limited dietary variety). These are examples of aspects of the food insecurity experience that are not currently captured in the HFSSM. The findings of this study, combined with other research activities being conducted as part of the larger project (e.g., literature scan, expert working group, and psychometric assessments) will help contribute to better understanding food insecurity measurement from the perspectives of those most affected in the US and results may be extrapolated and tested in other countries. 

 

 

Purpose: Obesity prevalence is greater in 6-11 year old girls than Non-Hispanic black (NHB) girls. Risk factors include unhealthy eating and home media use. This study examined the association of diet diversity and body weight change in NHB girls and media use patterns. Examining these associations is highly innovative given the controversial evidence of diet diversity on child growth with limited knowledge in NHB girls. Methods: 8-10 year old NHB girls enrolled in a 6-month 3-group randomized controlled trial (intervention (I), comparison (C), wait-list control (WLC)) were observed over 3 timepoints: baseline, post 1 (3 mo), post 2 (6 mo). Height, weight, and 2 dietary recalls (Nutrient Data System for Research) were collected at each timepoint (weekday/weekend). Body mass index was expressed as Z-scores (BMIZ) using CDC methods. Diet diversity was estimated from the recalls using serving counts of items within each food group (fruit, dairy (full fat (ff), not ff), vegetable, whole grain, protein/nuts, added sugars/candy) according to 2 methods: counts within food group, Simpson-Index (SI: proportion relative to number of foods within the group). Time child spent using media (TSM (hours/week)) (e.g., TV, videogames) was obtained via parent survey. Dietary and media variables were weighted by weekend/weekday. Mixed models tested the association of BMIZ with diet diversity measures, controlling for covariates (education, free/reduced lunch, day, randomization group and its interaction with age), with random intercept and slope. Models were tested with and without TSM and its interaction with diet. Results/findings: Child BMIZ at baseline was 0.73±1.29. In the I group, SI for dairy (not ff) was lowest at post 2 (0.24±0.26) compared to baseline (0.31±0.28) and post1 (0.30±0.27) (P= 0.04). In mixed models, TSM predicted higher BMIZ (beta=0.04 (Standard Error=0.01)) (P<0.03) irrespective of the diet measure. None of its interactions with diet measures were significant. Diet counts and SI were not associated with change in BMIZ. Conclusions: Dietary diversity in NHB girls was not associated with BMIZ. Findings are significant, suggesting that higher diet diversity does not equate with weight change among NHB girls, warranting preventive strategies that focus more on media use.

Background: The high prevalence of pediatric obesity in the U.S. is a healthcare burden; children with obesity are more likely to stay obese, leading to adverse health consequences. Obese children with waist circumferences over the 90^th percentile are at a higher risk for insulin resistance compared to obese children with waist circumferences under the 90^th percentile. Hispanic children are disproportionately burdened by overweight and obesity in the U.S. We must understand risk factors for obesity and high waist circumference among this population.

Methods: Participants were 209 primarily Mexican-American overweight and obese children and their guardians who completed baseline assessments for the Health4Kids pediatric obesity management study in San Antonio, TX. We also assessed past week time in moderate-to-vigorous physical activity (MVPA) via accelerometry. Research staff measured children’s and adult’s waist circumference with MyoTape to the nearest 0.1cm. Waist circumference was dichotomized to above and below the 90th percentile as a measure of excess visceral fat for the child. Waist circumference was dichotomized based on Hispanic-specific waist circumference cut-points to signify an increased risk for coronary heart disease for the adult. Logistic regression analyses were run to examine the relationship between excess visceral fat (child), moderate to vigorous activity (child), and waist circumference cut-points (adult).

Results: Children were 8.7 years old (95% CI [8.57, 9.03]) and female (51.7%). Children's MVPA was associated with waist circumferences (child) over the 90^th percentile (OR=.99, p= .01), therefore increased time spent in MVPA was associated with smaller waist circumference. Having a guardian above the cut-point for waist circumference was associated with having an excess of visceral fat (90^th percentile) (OR=2.16, p=.06).

Conclusion: Weight management programs should involve guardians to decrease the risk of excess visceral fat among both children and guardians. Even though a small association, moderate to vigorous physical activity, is still an integral part of obesity management, including reducing odds of excess visceral fat.

Culinary nutrition is an emerging strategy and evidence-based approach to increase healthy food consumption is through the utilization of experiential cooking skills that help expose participants to delicious tasting healthy foods, and offer solutions to cost, preparation, culture and specific health conditions. However, healthcare providers including Registered Dietitian Nutritionists (RDNs), those responsible for counseling patients in nutrition, do not typically receive formal training in experiential culinary nutrition. There is a critical gap in the education of healthcare professionals in practical and useful nutrition information that is tangible and useful for low-income minority populations including cooking skills, culturally relevant foods, language and messaging. We will present the methodology used to used to develop the framework of a comprehensive culinary nutrition training curriculum to improve knowledge and skills for RDNs, including a qualitative study to understand facilitators and barriers to healthy eating and overall food literacy through focus groups conducted with patients and RDNs at a large county healthcare system in Harris County, Texas, and pilot testing of the training curriculum. Three focus groups each with patients (n=40) and RDNs (n=17) were conducted in fall 2019. The data analysis conducted using NVivo identified themes and subthemes of the patient focus groups to understand dietary habits including culturally specific foods, typical eating patterns, frequency of cooking and barriers and facilitators to cooking. A Social Cognitive Theory framework was used to develop the RDN training curriculum consisting of 6, three-hour sessions of basic cooking skills (e.g., knife skills, vegetable roasting, culinary nutrition training, counseling strategies, and mock patient education). Our proposed framework includes a three step method for each session, 1) taste – provides participants the opportunity to consume delicious “healthy food” in order to change negative outcome expectations of “healthy food” tasting bad; 2) see – demonstration of recipes (cooking techniques) involves modeling and observational learning; and 3) do – gives participants the ability to increase behavioral capacity and self-efficacy through hands-on experiential preparation recipe(s) (cooking techniques). We will evaluate the training curriculum in fall 2019-spring 2020 and present the results of the evaluation.

Purposes: The course of fatigue and physical activity (PA) from discharge up to 5-7 years post stroke rehabilitation may be influenced by activity pacing behaviour (how people divide their energy and PA during the day). This study aims (1) to explore how people after stroke perceive their course of fatigue and PA post rehabilitation and (2) to explore participants’ experience of activity pacing behaviour, and its barriers and facilitators.

Methods: People after stroke (N=303) were followed from 3-6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after rehabilitation in the longitudinal cohort study Rehabilitation, Sports and Active lifestyle (ReSpAct1.0). Latent Class analyses were used to characterize diversity in the course of fatigue and PA (trajectories from T0-T3), based on questionnaire data. Based on these trajectories and participants’ characteristics (gender and age), a heterogeneous subsample of the ReSpAct1.0 study (N=20) will be invited, around 5-7 years post stroke rehabilitation, to fill in a short questionnaire and to participate in a semi-structured interview on how they experience their course of fatigue and PA, and on their activity pacing behaviour. The qualitative data will be combined with individual fatigue and PA trajectories and data on activity pacing behaviour into a longitudinal mixed-methods study. Audiotapes of the interviews will be transcribed verbatim. Both a thematic inductive and a deductive analysis (based on the Behaviour Change Wheel Taxonomy, centred on activity pacing behaviour) will be performed.

Results: Three fatigue trajectories were identified: (1) stable high (N=163), (2) stable low (N=41) and (3) recovery (N=2). Three PA trajectories were identified: (1) moderately active (N=196), (2) active (N=35) and (3) strongly improved PA (N=4). Further results will be presented during ISBNPA2020. 

Discussion: We found a large diversity in fatigue and PA trajectories post stroke rehabilitation (T0-T3). Further findings of this study will provide a deeper understanding of the diversity in fatigue in people after stroke and the role of activity pacing behaviour to obtain/maintain a physically active lifestyle.