Purpose: Increasing physical activity (PA) levels can reduce health risks associated with excess weight, underscoring the necessity of designing strategies easy for participants to adhere to. This study aims to explore changes in PA among physically inactive subjects with different weight status as a result of an intervention focusing on increasing PA through the use of outdoor spaces.

Methods: This is a multi-centre parallel-group randomised control trial, carried out in three European cities (Lahti, Limerick, Tallinn). The sample comprised 100 adults, aged between 25-65 years, enrolled in the HOPA study (ISRCTN64480977). During the intervention, participants were instructed to engage in outdoor PA (walking/running), at least three times/week, at least 30min/sessions, during eight weeks. Body mass index (BMI) was computed through the standardized formula, and participants were classified as either “normal-weight” (BMI<25kg/m²) or “overweight” (BMI≥25kg/m²) at baseline. Total weekly Light PA (LPA) and moderate-to-vigorous PA (MVPA), as well as weekly average sedentary time (SED) were measured at baseline and during week-8 of the intervention, over 9-consecutive days, using activPAL accelerometers. Changes in PA and SED, within- and between-groups, were estimated using the General Linear Model, with a significance level of 95%.

Results: At baseline, 62% of the sample was classified as overweight; from those, two participants changed their weight status at the end of the intervention. BMI groups differed at baseline only for SED (ρ=0.031), with the overweight group spending more time in SED (7.4h vs 6.7h). A significant time-effect was observed for LPA (ρ=0.007; η²=0.072) and MVPA (ρ<0.001; η²=0.129), but not for SED (ρ=0.170). A decrease in LPA (normal-weight group, from 568.2min to 514.6min; overweight group, from 502.3min to 484.3min), and an increase in MVPA (normal-weight group, from 240.8min to 289.7min; overweight group, from 212.8min to 252.4min) were noted for both groups. No significant group-time interaction effect was observed, indicating that changes were not related to the initial participants’ weight status.

Conclusions: Increases in MVPA were observed regardless of participants’ weight status. Findings highlight the role of outdoor spaces for enhancing PA, regardless of individuals’ weight status, with potential health benefits related to increases in PA.

Purpose: The relationship between the daily movements of obese adults, their blood pressure, and metabolic health has not yet been thoroughly studied. This research focuses on understanding how physical activity (PA), sedentary behavior (SB), and sleep (S) are associated with cardiovascular and metabolic health in obese adults in the U.S.
Methods: A total of 78 obese adults (BMI ≥ 30 kg/m²) who were otherwise healthy wore an ActiGraph GT9X monitor for an average of at least 20 hours a day for 2 weeks. We quantified the raw actigraphy data into light PA, moderate-to-vigorous PA (MVPA), SB and Sleep duration using GGIR. Body composition (percentage of body fat [PBF], percentage of visceral fat [PVF]) were assessed via DEXA. BMI (kg/m²) and metabolic outcomes (glucose, HDL, LDL, and triglycerides) were also measured. We used a compositional analysis (CODA) approach to understand how these factors are interrelated.
Results: Linear regression models utilizing CODA indicated significant associations between the outcomes and the relative time spent in the four movement behaviors, F(3,74) = 3.127, p = 0.03. The models accounted for a substantial proportion of the variance (R2 = 0.113). In brief, MVPA showed a strong relationship with lower systolic blood pressure (p=0.01), LDL, and PVF (p=0.01). Light PA was associated with higher PBF (t=1.97, p = 0.05). More sedentary behavior was associated with higher systolic and diastolic blood pressures (p < 0.01). Lastly, longer sleep duration was associated with lower systolic and diastolic blood pressures (p < 0.01), and lower PBF and PVF (p <0.01). No other significant relationships were identified.
Conclusions: In US adults with obesity, engaging in MVPA is especially beneficial for improving blood pressure and reducing LDL and visceral fat. Light PA also helps in reducing body fat. However, spending too much time sitting can have adverse effects on blood pressure. Moreover, getting enough sleep is good for maintaining healthy blood pressure and body composition. Future health programs for obese adults might focus on encouraging more MVPA, reducing sedentary behavior, and promoting proper sleep duration.

BACKGROUND/PURPOSE: Inactivity is a leading contributor to the primary chronic diseases that cause most premature deaths in the US (80%). In the U.S., over 80% of jobs are predominantly sedentary and most Americans (75.8%) do not meet physical activity (PA) guidelines. Meanwhile, other countries frequently integrate PA into the societal work culture. Japan has implemented an effective music-synchronized exercise routine (Radio Taiso [RT]), but this program has not been tested in the U.S. The purpose of this study is to explore the feasibility and effectiveness of implementing RT among U.S. employees. METHODS: Sedentary employees (n=31) were randomized into one of two PA break conditions (Walking or RT). Employees were asked to complete weekly educational PA lessons online and attempt to take three 10-minute PA breaks each workday. Surveys were administered pre-program and post-program measuring PA, workplace PA enjoyment (PACES), pain, and workplace wellbeing (HWQ). RESULTS/FINDINGS: Combined, both groups reported double PA energy expenditure from participation in the study (339.3 METS to 675.6 METS, p=0.011). The walking group reported significantly greater improvements in workplace productivity (p=0.025) while the RT group reported significantly greater improvements in focus (p=0.007) (HWQ) from pre to post. There were no significant changes in reported PA enjoyment, work-related pain, or work satisfaction in either group. Participants gave valuable qualitative feedback through a program evaluation survey to enhance future adaptation of RT programs for U.S. workplaces. Five RT participants reported less pain during/outside of work. Eight RT participants reported the RT regimen being their least favorite part of the study with five recommending more variety and three recommending RT be more adaptable for other fitness levels or time constraints. The walking group participants reported the weather as a facilitator to motivate walking breaks. Coworker support was more frequently reported as a facilitator for completing exercise among walking participants (n=4 vs. RT n=2). Both groups reported work commitments as the main barrier to their breaks (21 reports). One RT participant reported that coworkers would derogate them when they completed RT while at work. CONCLUSION: Results give researchers/worksite wellness coordinators insight into ways to improve future workplace PA programming.

Background
Detrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes (T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS).
Methods
Cross-sectional data from 2827 participants aged 40–75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships.
Results
The fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01–1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00–1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91–1.18) or NGM (OR = 1.05, 95%CI: 0.98–1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant.
Conclusion
Among middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.

Purpose: Gender norms can impact dietary habits in harmful ways (e.g., eating for body shape instead of health). These pressures may be elevated among adolescents (13–18 years), as they are forming their identities and often lean on social acceptance. Gender pressures have been shown to be greater for adolescent athletes who participate in club or high performance teams due to performance pressure over body shape and eating. However, these relationships fail to capture the experiences of athletes in high school sport spaces or those with more diverse gender identities. To fill this gap, this study explores how adolescents attending high school navigate their dietary habits in the context of their personal identities (i.e., gender and sport) and understanding of gender norms.
Methods: Thirty-three semi-structured interviews were conducted with adolescents (13-18 years; 55% athletes). Adolescents were recruited for an even split based on biological sex and self-identified their gender (i.e., boy, girl, non-binary, trans or other). Adolescents indicated how masculine or feminine they felt using a scale of one to 10 to provide deeper insights into how traditional norms were perceived to fit personal identities. Using a phenomenological approach, trends in adolescents’ reflections navigating their dietary habits were analyzed thematically based on gender and sport involvement.
Results: Six different themes emerged. The first two themes encompassed adolescents’ understanding of gender norms (i.e., behaviours, personality and appearance attributes) and experiences navigating them (i.e., tension and structure). Recognition of gender norms and dietary behaviours were overtly identified with being feminine but not masculine. The remaining themes outline adolescents’ experiences embodying or rejecting gender norms in eating as they attempted to appease socially acceptable standards over their body shapes (i.e., ideal body, quantity and quality matters, multi-factorial nature, and combating pressures). Eating for body shape occurred despite recognition of gender norms and was higher among athletes.
Conclusion: Our work suggests that dietary interventions targeting adolescents in schools should be tailored for gender and sport involvement. More inclusive designs could better support all adolescents in adopting health protective dietary habits and may be particularly important among athletes in school settings.

Purpose: COVID-19 negatively impacted mental well-being and health behaviours globally. Research suggests intersections between mental-wellbeing and health behaviours differs by sex, but this is under explored. To address this, we explored how changes in males’ and females’ mental well-being (i.e., anxiety, depression or worry) attributed to COVID-19 impacted unfavorable changes in health behaviours (i.e., decreased physical activity, healthy eating and increased alcohol intake).
Methods: Using self-reported, representative data from Canada, Columbia and Ireland the associations between mental well-being and health behaviours were explored by logistic regression. Participants were recruited through web-based panels. All models controlled for age and clinical diagnosis of anxiety or depression. Models were stratified by sex and country.
Results: Sex and country trends arose. Depression was associated (p<.05) with alcohol intake in all three countries among males and females (OR’s 1.4 to 1.7). It was also associated with physical activity in Canadian and Irish males (OR 1.2 and 1.5, respectively) and Canadian females (OR 1.1). Depression was further associated with males’ and females’ healthy eating in Canada and Ireland (OR’s 1.4 to 1.7). Anxiety was associated with all three health behaviours among Canadian males (OR’s 1.2). It was also associated with Canadian females’ healthy eating (OR 1.2) and alcohol intake (OR 1.3) as well as Irish females’ physical activity (OR 1.3). Worry was associated with Columbian males’ physical activity (OR 1.3) and females’ healthy eating (OR 1.4). Canadian females’ physical activity (OR 1.2) and alcohol intake (OR 1.2) were additionally associated with worry. Changes in mental well-being were associated most with changes in health behaviours among Canadians. Regardless of country, males expressed more changes on physical activity whereas females reported more changes on healthy eating. No sex-differences in alcohol intake arose across countries.
Conclusion: The relationships between mental well-being and health behaviours differed by sex and country. Males were vulnerable to physical activity changes whereas females were vulnerable to healthy eating. Country specific interventions that are tailored towards sex may better support all adults in maintaining proactive health behaviours during future pandemics. Greater research is needed to parse out how country context ultimately impacts these associations.

Purpose: This study focused on what attitudes and behaviors Nepali pregnant women had about taking iron supplements and how they were associated with their iron status.

Methods: A total of 3,534 women in their 2nd or 3rd trimester of pregnancy, from the Nepal Terai, participated in a trial on administering vitamin A supplements to night-blind pregnant women. At baseline, they were asked if they were taking iron pills during their pregnancy, if so, when, and how they took their pills, and if they felt better after taking iron supplements. Hemoglobin status was assessed using a Hemocue.

Results: A total of 1,439 women (40.7%) stated taking iron supplements. Of these women, 99.7% stated they took their iron pills after consuming a meal. However, only 2.4% of the women reported consuming food high in vitamin C with meals. Additionally, 33.6% reported drinking tea, of which 97.8% had their tea before a meal, and only 1 woman reported having tea with their meal. 79.2% stated that the iron pills made them feel better. 41.9% of women who stated the pills made them feel worse stopped taking iron pills, 10.2% who stated they were not sure how the pills made them feel stopped taking them, and none of the women who stated that they made them feel better stopped taking iron pills. Hemoglobin values were significantly greater (p < 0.001) in women who stated that the iron pills made them feel better (11.2 +/- 1.5 g/dl) compared with those who stated the iron pills made them feel worse (10.1 +/- 2.0 g/dl). In comparison, those who were unsure had a mean hemoglobin concentration between these two groups (11.0 +/- 1.5 g/dl).

Discussion: In conclusion, these results reinforce the concept that it is important to ask women how they feel when they take iron pills to find a better method for increasing iron status and to develop iron supplement protocols that decrease the side effects of iron supplementation.

Purpose: To synthesize the effectiveness of physical activity (PA) interventions for adults in Spanish-speaking Latin America.

Methods: This systematic review was registered in PROSPERO (CRD42021268804). A search was conducted in SPORTDiscus, MEDLINE, Web of Science, Google Scholar, Biblioteca Virtual de Salud, and Redalyc (up to August 2022). Studies included community-based PA interventions in Spanish-speaking Latin America measuring any PA outcome among adults (18+). Cross-sectional and in-patient studies were excluded. Study quality was assessed with the Effective Public Health Practice Project tool. Data were included from moderate to high-quality studies. Vote counting and binomial probability tests synthesized effectiveness outcomes by intervention strategy. Chi-square and Fisher’s exact tests were used to compare direction of effect based on prior testing and adaptation of intervention, use of theoretical framework, duration, subjective vs. objective measures, and study quality (weak vs. moderate/high).

Results: Of the 30 studies retained (n=16,617 participants), 12 (40%) of moderate and two (6.7%) of high quality were included in the main analysis of 33 PA outcomes. Improvements were seen in 2/3 of PA outcomes (66%, p=1) after individually-adapted behaviour change programs (n=789); 9/11 outcomes (82%, p=0.065) after group health education (n=835); 1/5 outcomes (20%, p=0.375) after health education plus additional strategies (n=280); and 6/6 outcomes (100%, p=0.031) after environmental and policy approaches (n=8409). PA improvements were seen in only 20% of outcomes from studies that mentioned the use of a theoretical framework compared to 78% of outcomes from studies that did not (p=0.005), and in only 20% of outcomes from studies that mentioned prior testing compared to 78% of outcomes from studies that did not (p=0.005). No differences were found in the direction of effect of outcomes in relation to adaptation, duration, self-report vs. objective measures, or study quality (weak vs. moderate/high).

Conclusions: Although our analyses did not take into account magnitude of effect, this systematic review highlights general patterns of intervention effectiveness that warrant further exploration, such as the finding that studies that did not report using a theoretical framework seemed to be more effective. Future research should explore whether widely used frameworks are applicable in a Latin American setting.

Purpose: As of 2022, 12.8% (17 million) of US households were food insecure, putting these households at an increased risk for numerous chronic diseases. Interventions aimed at improving financial planning skills have been found to positively influence delay discounting, defined as the tendency to place less value on rewards that are delayed in time, among vulnerable populations. In addition, lower-income individuals with good financial planning skills have been found to have lower levels of food insecurity. The aim of this research is to determine the feasibility and acceptability of a financial planning intervention to reduce food insecurity, delay discounting, and increase financial literacy among lower-income and food insecure households.

Methods: We conducted a pilot randomized controlled trial including financial planning lessons, one-on-one counseling, and weekly vignettes designed to prompt episodic future thinking. The control arm included nutrition education modeled after the Supplemental Nutrition Assistance Program Education Program. Eligible participants were lower-income, had at least one child in the home, and had marginal or low food security status. Our primary outcomes were food security and delay discounting. Focus groups assessed acceptability of the intervention and study activities.

Results/findings:
We recruited two cohorts of adults with a total of 13 participants in the intervention arm and 9 in the control arm. Preliminary analyses indicate a trend of reduced food insecurity in the intervention group (1.4-point change in raw food security score) over time while the control group remained the same. We also found a trend toward a difference in delay discounting with the intervention group having lower delay discounting (Control group mean score = 5.68; Intervention group mean score = .24). Focus groups revealed positive perceptions of the intervention and control arm sessions; however, study activities (e.g., daily prompts) were viewed as tedious.

Conclusions:
Our findings on feasibility, acceptability, and preliminary outcomes are encouraging. This pilot study was focused on the design phase and allows us to further refine the intervention and improve study protocols. Future work will involve further refinement of the intervention with input from community members and stakeholders and subsequent evaluation of the revised intervention through an efficacy study.