Modelling the impact of physical activity on public health: A review and critique

BackgroundWhile several reviews have assessed economic evaluations of physical activity in public health and, in most cases, found the interventions to be cost-effective, the validity of the conclusions reached depends on the appropriateness of the modelling methods used in the individual studies.ObjectiveTo provide an overview and critique of modelling approaches and key structural assumptions used in applied studies to estimate the impact of physical activity on population health.MethodsElectronic databases were systematically searched for relevant model-based economic evaluations. A thematic approach was used to assess the modelling studies. The critique determined the appropriateness of the modelling frameworks and plausibility of key structural assumptions.ResultsTwenty-five models were identified. Cohort models were most frequently used. High variability in the modelling of downstream diseases was found across studies analysing similar populations. Structural assumptions regarding the dynamics of change of physical activity were unrealistic in most cases. Heterogeneity was addressed in only a few studies, while health equity concerns were, at best, acknowledged by authors.ConclusionsThis literature is predominantly characterised by modelling approaches that may not adequately address the complexities associated with representing the physical activity behaviour- population health process. A consensus on how to model the impact of physical activity on public health and development of a reference model could help reduce these sources of uncertainty.     

An ecologically based examination of barriers to physical activity in students from grade seven through first-year university

PurposeThe first purpose was to identify barriers to physical activity that students in grade seven through first-year university experienced. A second purpose was to classify barriers using an ecological framework and to examine the pattern of barrier categories (i.e., intrapersonal, interpersonal, institutional, community, public policy, and physical environmental) and specific barrier types as grade increased. The use of an ecological model addressed limitations in prior research revolving around the identification of salient barriers in a manner that makes the design of effective interventions difficult.MethodsParticipants in grades 7–8 (n = 35), 9–10 (n = 67), 11–12 (n = 80), and the freshmen year of university (n = 109) listed barriers to physical activity on an open-ended measure.ResultsFindings revealed a trend for the average number of barriers reported per student to increase as grade in school increased. First-year university students reported significantly more barriers than all other grade groupings. The frequency of barriers reported within the ecological categories was dependent on the specific grade groupings. Further, within each ecological category, distinct barriers were reported across the different grade groupings.ConclusionsFindings highlight the utility of using an ecological model to categorize barriers, rather than simply classifying barriers as internal or external to an individual, as done in prior research. Understanding the pattern of ecologically based barrier categories and specific types of barriers will help to inform the content of future research and interventions designed to alleviate salient barriers to physical activity.     

Activity spaces in studies of the environment and physical activity: A review and synthesis of implications for causality

Activity spaces are increasingly used to understand how people interact with their environment and engage in activity but their use may raise challenges regarding causal inference. We conducted a systematic review of findings and the methodological, analytical and conceptual issues relevant to causal inference. Studies were included if they comprised a spatial summary of locations visited, assessed any part of the causal pathway between the environment, physical activity and health, and used quantitative or qualitative methods. We searched seven electronic databases in January 2018 and screened 11910 articles for eligibility. Forty-seven studies were included for review. Studies answered research questions about features of or environmental features within activity spaces using a range of spatial and temporal summary techniques. The conceptual challenge of using activity spaces to strengthen causal inference was rarely considered, although some studies discussed circularity, temporality, and plausibility. Future studies should use longitudinal and experimental designs and consider the potential and actual use of spaces for physical activity, and their relationship with total levels of activity.     

Rutas saludables,más allá del ejercicio físico: evaluación de una experiencia en población mayor de Gipuzkoa

IntroductionIn 2011 the Tipi-Tapa initiative was endorsed by the Public Health Department of Gipuzkoa to promote physical exercise through healthy walks in community-dwelling older adults, in collaboration with municipalities, citizens associations and primary care.ObjectiveTo evaluate, from the participants’ perspective, the Tipi-Tapa experience during 2012-2017 to identify the main successes and failures and share proposals of continuity and improvement.MethodMixed methods design with a qualitative core component and a supplementary questionnaire to all participants from 13 municipalities. The Chi-squared test was used to compare percentages. In the qualitative study, a purposive sampling was applied considering participants’ profiles through nine focus groups and 10 individual interviews. The interviews were audio recorded with previous consent. A thematic analysis was performed using conceptual maps and the MAXQDA software. Triangulation among researchers was done in a research-learning context.ResultsWe analysed 464 questionnaires; 64% from women and 36% from men. The participants’ mean age was 69.8 years; 75% were older than 65 years. The general satisfaction was 9.05/10 with significant differences in favour of women, older age groups and widows. In the qualitative study, 43 women and 37 men participated. Three main thematic areas were identified based on category coding and overlap: a) it is not just walking; b) organization, values and persons; and c) collaborative keystones and future challenges.ConclusionsThe health benefits perceived by participants go beyond physical exercise, with important implications for social interaction and cohesion. The complexity of the processes assessed entails methodological, organizational and collaborative requirements.     

The contribution of physical and social activity participation to social support and happiness among people with physical disabilities

BackgroundPrior studies have suggested that certain leisure activities provide health benefits to people with physical disabilities. Participation in social activities has been identified as a strong predictor of active coping strategies and social support from others. In addition, leisure-time physical activity (LTPA) has been found to be positively associated with health perceptions and quality of life.ObjectivesThe purpose of this study was to investigate the relationships between social activity and LTPA to social support and life satisfaction among people with physical disabilities.MethodsData were collected from Korean Association of Persons with Physical Disabilities. A total of 351 surveys were used.ResultsResults indicated that social activity, emotional and informational support, and tangible and affectionate support were significantly associated with happiness. However, there were no direct effects of LTPA and positive social interaction support on happiness. The study results showed significant direct effects of LTPA on emotional and informational support and positive social interaction.ConclusionThis study shows that it is important for people with physical disabilities not only to participate in LTPA, but also to be provided with opportunities for social activities. In particular, the importance of social activity to Korean people with physical disabilities as a means of receiving social support and increasing happiness was confirmed. The results suggest that practitioners need to create a variety of social activity opportunities, such as online social participation programs, community-based social programs, and social events for health.     

Physical activity promotion as a strategic corporate priority to improve worker health and business performance

BackgroundThe increasingly sedentary nature of work and its impact on health and productivity indicators demands the promotion of physical activity at the worksite.PurposeThis paper aims to present considerations for broad-scale application of corporate strategies designed to promote physical activity among employees and their families through employer-sponsored initiatives.ApproachThe benefits of physical activity are multifold, including health and wellbeing and productivity related outcomes. The workplace setting may be leveraged to promote physical activity levels through frequent and sustained exposures to effective interventions that reach employees and, indirectly, their families. Furthermore, employers represent a powerful stakeholder group that should leverage its influence on health policy initiatives designed to create supportive environments inside the workplace as well as the broader community. Specific principles, recommendations for action, and considerations for the prioritization of initiatives are provided based on essential elements for comprehensive programs and health policy initiatives and in the context of a social–ecological model and supportive research.ConclusionsPhysical activity promotion at the worksite should be an integrated initiative that measurably improves worker health and enhances business performance.     

Multidisciplinary design and analytic approaches to advance prospective research on the multilevel determinants of child health

PurposeCharacterizing the determinants of child health and development over time, and identifying the mechanisms by which these determinants operate, is a research priority. The growth of precision medicine has increased awareness and refinement of conceptual frameworks, data management systems, and analytic methods for multilevel data. This article reviews key methodological challenges in cohort studies designed to investigate multilevel influences on child health and strategies to address them.MethodsWe review and summarize methodological challenges that could undermine prospective studies of the multilevel determinants of child health and ways to address them, borrowing approaches from the social and behavioral sciences.ResultsNested data, variation in intervals of data collection and assessment, missing data, construct measurement across development and reporters, and unobserved population heterogeneity pose challenges in prospective multilevel cohort studies with children. We discuss innovations in missing data, innovations in person-oriented analyses, and innovations in multilevel modeling to address these challenges.ConclusionsStudy design and analytic approaches that facilitate the integration across multiple levels, and that account for changes in people and the multiple, dynamic, nested systems in which they participate over time, are crucial to fully realize the promise of precision medicine for children and adolescents.     

A systematic review of the evolution of GPS use in active living research: A state of the evidence for research,policy, and practice

This is the first systematic review to comprehensively capture Global Positioning Systems’ (GPS) utilization in active living research by investigating the influence of physical contexts and social environment on all intensities of physical activity and sedentary behavior among all age groups. An extensive search of peer-reviewed literature was conducted using six databases. Out of 2026 articles identified, 129 studies met the inclusion criteria. After describing the evolution of GPS use across four themes (study designs and methods, physical contexts and social environment, active transportation, and behaviors), evidence-based recommendations for active living research, policy, and practice were generated.     

Associations between the built environment and physical activity among adults with low socio-economic status in Canada: a systematic review

ObjectiveTo synthesize literature on the associations between the built environment and physical activity among adults with low socio-economic status (SES) in Canada.MethodsUsing a pre-specified study protocol (PROSPERO ID: CRD42019117894), we searched seven databases from inception to November 2018, for peer-reviewed quantitative studies that (1) included adults with low SES living in Canada and (2) estimated the association between self-reported or objectively measured built characteristics and self-reported or objectively measured physical activity. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Findings were synthesized using a narrative approach.SynthesisOf the 8338 citations identified by our search, seven studies met the inclusion criteria. Most studies included adults living in one province (Alberta, British Columbia, Ontario, or Quebec), with one study including a national sample. All studies were cross-sectional, and none controlled for residential self-selection. Sampling designs and data collection strategies were heterogeneous. Sample sizes ranged between 78 and 37,241 participants. Most studies measured SES using household income. Street connectivity, greenness, destination density, and walkability were positively associated with physical activity. Relative to the objectively measured built environment, associations between the self-reported built environment and physical activity were less consistent. Studies were of fair to good quality.ConclusionFindings suggest that the neighbourhood built environment is associated with physical activity among adults with low SES in Canada. More rigorous study designs are needed to determine whether or not the built environment and physical activity are causally related within this vulnerable population.     

Perceptions of the Environment for Eating and Exercise in a Rural Community

ObjectiveTo understand how members of a rural community perceive the effect of the built, natural, and social environments on their food choice and physical activity behaviors.MethodsA constructivist community environmental assessment was conducted including 17 individual qualitative interviews, 2 focus groups, and photo elicitation (n = 27) in a rural northeastern community where over 60% of the adult population is overweight or obese.ResultsParticipants described social, natural, and physical environmental factors that influenced their food choice and physical activity behaviors. Overweight and obesity were variably presented as an individual and/or a collective problem. Participants described conflicting goals for food choice and physical activity in the community, and an interrelationship between the social and physical environments.Conclusions and ImplicationsA community environmental assessment provides a view of the physical and social environments from the perspective of community residents that can serve as a foundation for locally tailored, community-based approaches to obesity prevention.     

Prevalence of physical activity in the European Union

Summary Objectives:This article is the second in a series of four that present data about physical activity in the 15 member states of the European Union collected by the Eurobarometer 58.2. The focus of this article is on days of vigorous and moderate physical activity, days of walking, and metabolic equivalence estimates (METs) for total physical activity from 15 member states of the European Union using the International Physical Activity Questionnaire (IPAQ).Methods:Data were collected in 2002 as part of the Eurobarometer by face-to-face interviews. A total of 16230 respondents age 15 years and older were interviewed. Sample sizes ranged about 1000 respondents in most nations. Physical activity was assessed with the last 7-days short version of the IPAQ.Results:: Median METs estimates in hours per week were the highest in the Netherlands (39.43 MET-hours/week), Germany (34.65 MET-hours/week in the eastern part, 33.90 MET-hours/week in the western part), and Luxembourg (31.55 MET-hours/week). The lowest METs estimates were reported in Northern Ireland (11.55 MET-hours/week), Sweden (18.65 MET-hours/week) and France (19.55 MET-hours/week).Conclusions:A comparison of the results with existing data on physical activity prevalence in the member states indicate some inconsistencies between studies which may be related to measurement problems, as well as to conceptual differences in the assessment of physical activity.     

How the natural environment in downtown neighborhood affects physical activity and sentiment: Using social media data and machine learning

BackgroundNatural environment might encourage physical exercise, hence enhancing human health and wellbeing. Social media offers an extensive repository of spatiotemporal data, containing details on the feelings and behaviors of individuals. However, investigations on physical activity and public sentiment in the natural environment of the downtown neighborhood are lacking in the existing literature.MethodsTo extract environmental and behavioral information from social media data and other multi-source data, natural language processing, semantic segmentation, instance segmentation, and fully convolutional neural networks are employed. The research examines how neighborhood blue-green spaces and other health-promoting facilities affect physical activity and public sentiment.ResultsThe results reveal that blue space visibility, activity facilities, street furniture, and safety all have a favorable influence on physical activity with a social gradient. Amenities, perceived street safety and beauty positively correlated to public sentiment. The findings from social media about the environment and physical activity are consistent with traditional surveys from the same time period with a 0.588 kappa value.ConclusionAccording to our findings, social media data might be utilized to learn more about how urban environments influence people's physical activity patterns. Also, the health-promoting effects of blue space require more investigation.     

Ambiente familiar,actividad física y sedentarismo en preadolescentes con obesidad infantil: estudio ANOBAS de casos-controles

ObjectiveThe aim of this study is to compare the levels of physical activity and sedentary behaviours in children with obesity and normal weight through accelerometer measures, and analyze the family environment related to physical activity.DesignCase-control study.LocationA health center and colleges of the Community of Madrid.ParticipantsA total of 50 obese children between 8 and 12 years of age (P > 97) and their mothers were matched by age, sex and socioeconomic status of their parents (1: 1) with 50 children with normopeso (GN; P < 85).Main measurementsPhysical activity levels were measured by accelerometer (ActiGraph GT3X), levels of physical activity of the primary caregiver were measured through physical activity questionnaire (IPAQ) and the environment in relation to the physical activity was measured by the Home Environment Scale (HES-S).ResultsThe group GO showed less vigorous physical activity than their peers in the GN group. Vigorous physical activity in the GO group was associated with modeling and parental policies regarding physical activity. A multiple regression analysis revealed that 21% of the variance of weight status of children was explained by sex, vigorous physical activity and maternal body mass index.ConclusionsThe levels of vigorous physical activity and the family environment differ between children with obesity and normal weight. Therefore, it is important to continue working on the awareness of illness and the promotion of healthy habits from Primary Care and the school and institutional context.     

苏州市社区建成环境与居民体力活动的关联分析

目的 了解苏州市居民体力活动水平,探索社区建成环境与居民体力活动的关联。方法 2017年采用多阶段整群随机抽样方法抽取苏州市25~64岁常住人群进行面对面调查,采用国际体力活动量表长卷（IPAQ-L）评估居民体力活动水平,采用居民环境步行量表简表（NEWS-A）评价社区建成环境主观感知。结果 苏州市居民过去1周总体力活动水平M=3 610.42 MET-min/w,以工作相关体力活动水平为主,交通、家务及休闲相关体力活动水平较低。控制社会人口学因素后,公共服务可及性与社区居民的总体力活动水平呈负相关（OR=0.522,95%CI：0.329~0.830）,场所设施多样性与工作相关体力活动水平呈负相关（OR=0.701,95%CI：0.492~0.999）,步行和自行车道设施与工作相关体力活动水平呈正相关（OR=1.603,95%CI：1.004~2.559）;交通安全与交通相关体力活动水平呈负相关（OR=0.642,95%CI：0.416~0.990）;住宅密度与休闲相关体力活动水平呈正相关（OR=1.001,95%CI：1.000~1.002）;此外,社区美观与舒适的主观感知程度越高,工作、交通、家务及总体力活动水平越高（OR=1.889,95%CI：1.176~3.033;OR=1.671,95%CI：1.120~2.495;OR=1.775,95%CI：1.143~2.756;OR=1.593,95%CI：1.079~2.350）。结论 完善步行道和自行车道设施、提高社区的美观和舒适程度对于增加居民体力活动有重要作用。     

Spousal support and self-determined physical activity in individuals with multiple sclerosis: A theory-informed qualitative exploration

BackgroundIndividuals with multiple sclerosis (MS) tend to exhibit high levels of sedentary behavior which contributes to increased disability and comorbidity. Understanding what factors underlie the motivation to be physically active in this group is therefore important.ObjectiveThis theory-informed qualitative study explored spousal support and behavior in fostering self-determined physical activity engagement of adults with MS.MethodsEight couples were interviewed using a semi-structured interview guide derived from Self-Determination Theory.ResultsAnalysis of transcribed audio recordings revealed that supportive and empathetic spousal communication, encouragement and expectations regarding physical activity, and bonding through co-participation increased feelings of relatedness. In addition, co-planning and problem-solving around physical activity and serving as a behavioral model facilitated perceptions of competency, while spouses who valued their partners’ independence and offered choice enhanced autonomous motivation for physical activity.ConclusionsInsight into the marital context that supports self-determined physical activity decisions of individuals with MS may better inform family-oriented health promotion approaches in this group.     

Physical activity for individuals living with a physical disability in Quebec: Issues and opportunities of access

BackgroundIndividuals living with a physical disability have reported difficulty in meeting their healthy living and leisure needs which could be a result of poor accessibility.ObjectiveThis qualitative study aimed to understand the relative accessibility of physical activity from the perspective of individuals living with a physical disability in Quebec, Canada.MethodsTwenty semi-structured interviews were conducted with current, past, non-members, and staff members of an adapted physical activity program. A qualitative approach with an inductive thematic analysis was used to interpret the data.ResultsWe identified five overarching themes focusing on participants’ experiences related to access: (i) physical activity opportunities; (ii) social interactions; (iii) relationships; (iv) infrastructure; (v) policies and public services. Participants highlighted that access to physical activity programming is shaped by a complex interaction of these overarching themes and their sub-themes.ConclusionsAccess to physical activity opportunities for individuals living with a physical disability cannot be understood in isolation from the broader public policies, infrastructure, social interactions, and relationships that shape their experiences. Policy makers and other health and recreational professionals must consider these broader factors when recommending or creating physical activity opportunities for individuals with physical disabilities.     

Longitudinal associations of neighborhood environment features with pediatric body mass index

IntroductionIt has been posited that policies to promote child health and prevent obesity should target neighborhood environments but evidence on the impact of neighborhoods on child weight is conflicting and longitudinal studies (which have benefits for causal inference) are scarce.MethodsWe used electronic health records (2007–2016) from an urban, pediatric integrated delivery system and linked children (N = 51,873, ages 6–19 years, 77% African American) to neighborhood-level data to investigate how changes in neighborhood environments relate to changes in body mass index (BMI). Measures of neighborhood environment were resources for healthy foods and physical activity (‘resources’), greenness, violent crime rate, perceived safety and social cohesion. Fixed effects models estimated associations between changes in neighborhood environment exposures and changes in BMI z-score and whether effects differed by sex, baseline age, neighborhood socioeconomic status and population density.ResultsApproximately 22% of the cohort was obese (BMI z-score ≥ 95th percentile). In adjusted models, increases in neighborhood greenness and perceived safety were associated with decreases in BMI z-score (mean change in BMI z-score for 1-SD increase for both: -0.012; 95% CI= (−0.018, −0.007)). Increases in neighborhood safety had a stronger effect in children ages 6–10 years than in older children. Increases in social cohesion were associated with increases in BMI z-score (mean change: 0.005 95% CI = (0.003, 0.008)) especially in boys. Increases in food and physical activity resources were not associated with changes in BMI.ConclusionsThis study suggests that increasing neighborhood greenness and safety are potential approaches to reduce children's BMI.     

Methodologies for assessing contextual exposure to the built environment in physical activity studies: A systematic review

Growing research has integrated Global Positioning Systems (GPS), Geographic Information Systems (GIS), and accelerometry in studying effects of built environment on physical activity outcomes. This systematic review aimed to summarize current geospatial methods of assessing contextual exposure to the built environment in these studies. Based on reviewing 79 eligible articles, methods were identified and grouped into three main categories based on similarities in their approaches as follows: domain-based (67% of studies), buffer-based (22%), and activity space-based (11%). Additionally, technical barriers and potential sources of uncertainties in each category were discussed and recommendations on methodological improvements were made.     

Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S.

ObjectivesThe purpose of this cross-sectional study was to examine associations between physical activity, screen-time, sleep duration, and their combinations based on 24-h movement guidelines with anxiety and depression among a nationally representative cohort aged 6–17 years in the US.MethodsThe 2016 National Survey of Children's Health (NSCH) data from a representative sample of children (n = 15,010) aged 6–11 years and adolescents (n = 20,708) aged 12–17 years were analyzed using logistic regression. This analysis examined parent-reported demographics, lifestyle-related behavioral variables, adverse childhood experiences, and history of anxiety and depression.ResultsPhysical activity participation was associated with anxiety and depression. Children with 0 days/week of physical activity were about twice more likely to have anxiety (Odds ratio (OR) = 2.19), and adolescents were over twice as likely to have anxiety (OR = 2.25) and depression (OR = 2.18), than peers with daily physical activity ≥ 60 min. There was no significant difference in the ORs of anxiety or depression between the children with daily physical activity and those with physical activity ≥60 min on 1–3 days/week or 4–6 days/week. Extracurricular activity participation and sleep duration were also significantly associated with anxiety and depression along with demographic variables such as race and weight status.ConclusionSome physical activity or organized extracurricular activity participation are associated with decreased odds of experiencing anxiety among children and adolescents, and depression among adolescents. Meeting all three 24-h movement guidelines was associated with lower ORs for anxiety for children and adolescents and depression among adolescents.