Is park visitation associated with leisure-time and transportation physical activity?

Objective
The aim of this study was to examine whether frequency of park visitation was associated with time spent in various domains of physical activity among adults living in a disadvantaged neighbourhood of Victoria, Australia.

Methods
In 2009, participants (n = 319) self-reported park visitation and physical activity including: walking and cycling for transport, leisure-time walking, leisure-time moderate- to vigorous-intensity physical activity, and total physical activity.

Results
The mean number of park visits per week was 3.3 (SD = 3.8). Park visitation was associated with greater odds of engaging in high (as compared to low) amounts of transportation physical activity, leisure-time walking, leisure-time moderate- to vigorous-intensity physical activity (MVPA) and total physical activity. Each additional park visit per week was associated with 23% greater odds of being in the high category for transportation physical activity, 26% greater odds of engaging in high amounts of leisure-time walking, 11% greater odds of engaging in MVPA, and 40% greater odds of high total physical activity.

Conclusions
Acknowledging the cross-sectional study design, the findings suggest that park visitation may be an important predictor and/or destination for transportation and leisure-time walking and physical activity. Findings highlight the potentially important role of parks for physical activity.

Combined associations of sitting time and physical activity with obesity in young adults

Background:
We investigated associations of total sedentary behavior (SB) and objectively-measured and self-reported physical activity (PA) with obesity.

Methods:
Data from 1662 adults (26–36 years) included daily steps, self-reported PA, sitting, and waist circumference. SB and PA were dichotomized at the median, then 2 variables created (SB/self-reported PA; SB/objectively-measured PA) each with 4 categories: low SB/high PA (reference group), high SB/high PA, low SB/low PA, high SB/low PA.

Results:
Overall, high SB/low PA was associated with 95 –168% increased obesity odds. Associations were stronger and more consistent for steps than self-reported PA for men (OR 2.68, 95% CI 1.36–5.32 and OR 1.95, 95% CI 1.01–3.79, respectively) and women (OR 2.66, 95% CI 1.58–4.49 and OR 2.00, 95% CI 1.21–3.31, respectively). Among men, obesity was higher when daily steps were low, irrespective of sitting (low SB/low steps OR 2.07, 95% CI 1.03– 4.17; high SB/low steps OR 2.68, 95% CI 1.36–5.32).

Conclusions:
High sitting and low activity increased obesity odds among adults. Irrespective of sitting, men with low step counts had increased odds of obesity. The findings highlight the importance of engaging in physical activity and limiting sitting.

Associations between young children's perceived and actual ball skill competence and physical activity

Objectives: The relationship between actual and perceived object control competence (ball skills) and the contribution to young children’s physical activity is not known.
Design: Cross sectional study.
Methods: The Test Gross Motor Development-2 assessed actual object control competence and a modified version of the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children assessed perceived object control competence. Moderate- to vigorous-intensity physical activity was measured via accelerometry. Three mixed regression models were performed: (i) object control competence as the predictor and the outcome as perceived object control, (ii) perceived object control competence as the predictor and the outcome moderate to vigorous physical activity and (iii) actual object control as the predictor and the outcome moderate to vigorous physical activity. Models adjusted for school clustering, monitor wear time, sex and age. Interactions between respective predictor variables and sex were performed if warranted. A total of 102 children (56% boys, 44% girls) aged 4–8 years (M 6.3, SD 0.92) completed assessments.
Results: Girls had lower perceived and actual object control competence and were less active than boys. Actual object control competence was positively associated with perceived object control competence (B = 0.11, t(96) = 2.25, p < 0.001, p = 0.027) and this relationship did not differ by sex (p = 0.449); however, neither actual (p = 0.092) nor perceived object control competence (p = 0.827) were associated with moderate to vigorous physical activity.
Discussion: Young children’s perceived ball skill abilities appear to relate to actual competence; however, these measures were not associated with physical activity. In older children, object control skill is associated with physical activity so targeting young children’s object control skills is an intervention priority.

Reliability and validity of the transport and physical activity questionnaire (TPAQ) for assessing physical activity behaviour

No current validated survey instrument allows a comprehensive assessment of both physical activity and travel behaviours for use in interdisciplinary research on walking and cycling. This study reports on the test-retest reliability and validity of physical activity measures in the transport and physical activity questionnaire (TPAQ).

Child physical activity levels and associations with modifiable characteristics in centre-based childcare

Objective: To describe children's physical activity levels during childcare and associations with modifiable characteristics. Methods: A cross-sectional study of 328 preschool children (43% girls; age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Results: Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Conclusions: Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity. Implications: Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.

How important is young children's actual and perceived movement skill competence to their physical activity?

OBJECTIVES: To determine the associations between young children's actual and perceived object control and locomotor skills and physical activity and whether associations differ by sex. DESIGN: Cross sectional study. METHODS: A total of 136 children consented. Children had actual skill (Test of Gross Motor Development-2), perceived skill (Pictorial Scale of Perceived Movement Skill Competence for Young Children), and moderate- to vigorous-intensity physical activity (MVPA) (accelerometers) assessed. Independent t-tests assessed sex differences. A regression (with MVPA as the outcome) was performed with all predictor variables (i.e. Actual Object Control, Actual Locomotor, Perceived Object Control, and Perceived Locomotor). Model 2 also adjusted for age, sex, accelerometer wear time and whether the child was from an English speaking background. Interaction terms between the respective actual or perceived skill factor and sex were added to assess sex differences. RESULTS: Analyses were conducted on 109 children (59 boys, 50 girls; mean age=6.5 years, SD=1.0). Boys had higher actual and perceived object control skill and were more active by an average of 19min per day. There were no sex differences in locomotor skills. There were no associations between skill factors and MVPA, except for girls, where locomotor skill was a significant predictor of MVPA (B=3.66, p=0.016). CONCLUSIONS: Actual rather than perceived skill competence was more important to MVPA in this sample. Locomotor skill competence may be more important than object control skill competence for girls as they may engage in types of physical activity that do not require object control mastery.

Does the presence and mix of destinations influence walking and physical activity?

Background: Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how specific destinations are related to activity. This study examined associations between types and mix of destinations and both walking frequency and physical activity. Method: The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Using geographic information systems, seven types of destinations were examined within three network buffers (400 meters (m), 800 m and 1200 m) of respondents' homes. Multilevel logistic regression was used to estimate effects of each destination type separately, as well as destination mix (variety) on: 1) likelihood of walking for at least 10 min ≥ 4/week; 2) likelihood of being sufficiently physically active. All models were adjusted for potential confounders. Results: All destination types were positively associated with walking frequency, and physical activity sufficiency at 1200 m. For the 800 m buffer: all destinations except transport stops and sports facilities were significantly associated with physical activity, while all except sports facilities were associated with walking frequency; at 400 m, café/takeaway food stores and transport stops were associated with walking frequency and physical activity sufficiency, and sports facilities were also associated with walking frequency. Strongest associations for both outcomes were observed for community resources and small food stores at both 800 m and 1200 m. For all buffer distances: greater mix was associated with greater walking frequency. Inclusion of walking in physical activity models led to attenuation of associations. Conclusions: The results of this analysis indicate that there is an association between destinations and both walking frequency and physical activity sufficiency, and that this relationship varies by destination type. It is also clear that greater mix of destinations positively predicts walking frequency and physical activity sufficiency.

Views of women and health professionals on mHealth lifestyle interventions in pregnancy: a qualitative investigation

BACKGROUND: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women's and health professionals' views of mHealth in antenatal care are limited.

OBJECTIVE: This study aimed to explore women's and health professionals' views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy.

METHODS: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed.

RESULTS: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women's advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care.

CONCLUSIONS: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care.

Associations between firefighters' physical activity across multiple shifts of wildfire suppression

The aim of this study was to examine the associations between firefighters' physical activity levels across consecutive shifts during a multi-day emergency wildfire and to determine whether sleep duration moderated these associations. Forty volunteer firefighters (31 males, 9 females) wore an activity monitor to concurrently measure physical activity and sleep duration. Sedentary time and time spent in light- (LPA), moderate- (MPA), and vigorous-intensity physical activity (VPA) during each shift were determined using monitor-specific cut points. During any given shift, every additional 60 min spent in LPA was associated with 7.2 min more LPA and 27.6 min MPA the following shift. There were no other significant positive or negative associations. No significant moderating effect of total sleep time was observed. Firefighters are able to maintain and/or increase their physical activity intensity between consecutive shifts. Further research is needed to understand firefighters pacing and energy conservation strategies during emergency wildfire deployments. Practitioner Summary To examine associations between firefighters' physical activity levels across consecutive shifts during a multi-day emergency wildfire and determine whether sleep duration moderated these associations. Firefighters are able to maintain and/or increase their physical activity intensity between consecutive shifts. No significant moderating effect of total sleep time was observed.

A systematic review of economic analyses of active transport interventions that include physical activity benefits

Physical inactivity is one of the leading causes for the growing prevalence of non-communicable diseases worldwide and there is a need for more evidence on the effectiveness and cost-effectiveness of interventions that aim to increase physical activity at the population level. This study aimed to update a systematic review published in 2008 by searching peer-reviewed and unpublished literature of economic evaluations of transport interventions that incorporate the health related effects of physical activity. Our analysis of methods for the inclusion of physical activity related health effects into transport appraisal over time demonstrates that methodological progress has been made. Thirty-six studies were included, reflecting an increasing recognition of the importance of incorporating these health effects into transport appraisal. However, significant methodological challenges in the incorporation of wider health benefits into transport appraisal still exist. The inclusion of physical activity related health effects is currently limited by paucity of evidence on morbidity effects and of more rigorous evidence on the effectiveness of interventions. Significant scope exists for better quality and more transparent reporting. A more consistent approach to the inclusion of benefits and disbenefits would reinforce the synergies between the health, environmental, transport and other sectors. From a transport sector perspective the inclusion of physical activity related health benefits positively impacts cost effectiveness, with the potential to contribute to a more efficient allocation of scarce resources based on a more comprehensive range of merits. From a public health perspective the inclusion of physical activity related health benefits may result in the funding of more interventions that promote active transport, with the potential to improve population levels of physical activity and to reduce prevalence of physical activity related diseases.

Promoting gross motor skills and physical activity in childcare: a translational randomized controlled trial

OBJECTIVES: Educator-led programs for physical activity and motor skill development show potential but few have been implemented and evaluated using a randomized controlled design. Furthermore, few educator-led programs have evaluated both gross motor skills and physical activity. Therefore, the aim of this study was to evaluate a gross motor skill and physical activity program for preschool children which was facilitated solely by childcare educators. DESIGN: A six-month 2-arm randomized controlled trial was implemented between April and September 2012 in four early childhood centers in Tasmania, Australia. METHODS: Educators participated in ongoing professional development sessions and children participated in structured physical activity lessons and unstructured physical activity sessions. RESULTS: In total, 150 children were recruited from four centers which were randomized to intervention or wait-list control group. Six early childhood educators from the intervention centers were trained to deliver the intervention. Gross motor skills were assessed using the Test of Gross Motor Development (2nd edition) and physical activity was measured objectively using GT3X+ Actigraph accelerometers. No statistically significant differences were identified. However, small to medium effect sizes, in favor of the intervention group, were evident for four of the five gross motor skills and the total gross motor skill score and small to medium effect sizes were reported for all physical activity outcomes. CONCLUSIONS: This study highlights the potential of educator-led physical activity interventions and supports the need for further translational trials within the early childhood sector.

A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial.

AIM: To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease (IHD).

METHODS AND RESULTS: In this single-blind, parallel, two-arm, randomized controlled trial adults (n = 171) with IHD were randomized to receive a mobile phone delivered intervention (HEART; n = 85) plus usual care, or usual care alone (n = 86). Adult participants aged 18 years or more, with a diagnosis of IHD, were clinically stable as outpatients, able to perform exercise, able to understand and write English, and had access to the Internet. The HEART (Heart Exercise And Remote Technologies) intervention involved a personalized, automated package of text messages and a secure website with video messages aimed at increasing exercise behaviour, delivered over 24 weeks. All participants were able to access usual community-based cardiac rehabilitation, which involves encouragement of physical activity and an offer to join a local cardiac support club. All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake (PVO2; primary outcome), self-reported physical activity, health-related quality of life, self-efficacy and motivation (secondary outcomes). Results showed no differences in PVO2 between the two groups (difference -0.21 ml kg(-1)min(-1), 95% CI: -1.1, 0.7; p = 0.65) at 24 weeks. However significant treatment effects were observed for selected secondary outcomes, including leisure time physical activity (difference 110.2 min/week, 95% CI: -0.8, 221.3; p = 0.05) and walking (difference 151.4 min/week, 95% CI: 27.6, 275.2; p = 0.02). There were also significant improvements in self-efficacy to be active (difference 6.2%, 95% CI: 0.2, 12.2; p = 0.04) and the general health domain of the SF36 (difference 2.1, 95% CI: 0.1, 4.1; p = 0.03) at 24 weeks. The HEART programme was considered likely to be cost-effective for leisure time activity and walking.

CONCLUSIONS: A mobile phone intervention was not effective at increasing exercise capacity over and above usual care. The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services.

Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations?

Background: There is growing recognition that the urban built environment influences physical activity at the population level, although the effects on disadvantaged groups are less well understood. Using the examples of open/green space and street connectivity, this paper explores whether enhancements to the built environment have potential for addressing physical activity-related health inequalities among Mori, Pacific and low income communities in New Zealand.

Method: A high-level review of the international literature relating open space and street connectivity to physical activity and/or related health outcomes at a population level was completed. Consideration was given to whether these features of the built environment have a disproportionate effect on disadvantaged populations.

Results: Findings from international studies suggest that open space and street connectivity have a beneficial effect on physical activity. Enhancing the built environment may be particularly advantageous for improving physical activity levels among disadvantaged populations.

Conclusion: It is likely that open space and street connectivity have a positive effect on physical activity behaviour; however due to the cross-sectional nature of existing research and the paucity of research among disadvantaged populations definitive conclusions about the effect in these populations cannot be made. Further research is required (e.g. natural experiments or quasi experimental research designs) to determine the effect of changing the environment on physical activity and obesity.

Use of active video games to increase physical activity in children: a (virtual) reality?

There has been increased research interest in the use of active video games (in which players physically interact with images onscreen) as a means to promote physical activity in children. The aim of this review was to assess active video games as a means of increasing energy expenditure and physical activity behavior in children. Studies were obtained from computerized searches of multiple electronic bibliographic databases. The last search was conducted in December 2008. Eleven studies focused on the quantification of the energy cost associated with playing active video games, and eight studies focused on the utility of active video games as an intervention to increase physical activity in children. Compared with traditional nonactive video games, active video games elicited greater energy expenditure, which was similar in intensity to mild to moderate intensity physical activity. The intervention studies indicate that active video games may have the potential to increase free-living physical activity and improve body composition in children; however, methodological limitations prevent definitive conclusions. Future research should focus on larger, methodologically sound intervention trials to provide definitive answers as to whether this technology is effective in promoting long-term physical activity in children.

Adolescents' ratings of features of parks that encourage park visitation and physical activity

BACKGROUND: The neighbourhood environment such as the availability of parks are a key, but under-researched, influence on adolescents' physical activity. In addition to overall physical activity levels, park-based physical activity and park visitation is low in this age group. Thus, it is critical to identify park features that may encourage or discourage adolescents from visiting parks. This study used a novel methodology to identify key physical characteristics of parks that are perceived to be important for park visitation and park-based physical activity among adolescents.

METHODS: Four secondary schools located in low, mid and high socio-economic status areas of Victoria, Australia were recruited. Using a purpose-built computer application, students in years 8-10 were presented with 44 original photographic images of park features. Participants rated each image (range 1-10) on how likely the feature would be to encourage them to visit a park and to engage in park-based physical activity, and placed symbols ('thumbs up'/'thumbs down') on aspects of the image that had a positive or negative influence on their ratings.

RESULTS: Participants (n = 99) had a mean age of 13.3 years (SD = 0.87) and 53% were female. Overall, the top three rated images prompting park visitation by adolescents were: a long steep slide, a flying fox and a table tennis table. These first two features were also reported as being likely to promote physical activity in the park. Differences in ratings were observed for boys and girls. The images that received the greatest number of "thumbs-up" symbols included large swings and slides, table tennis tables, no-smoking signs, flying foxes and BMX tracks. The images that received the greatest number of "thumbs-down" symbols included signage about rules, graffiti, toilets, concrete steps, and skate bowls.

CONCLUSION: Physically challenging play equipment is likely to encourage adolescents to visit and be active in parks. Rules, graffiti, toilets and skate bowls may discourage visitation. It is important for park designers, planners and policy makers to consider adolescents' views of what park design features are important so that parks are created that support and encourage visitation and optimise levels of physical activity when in the park.