“Can we walk?” Environmental supports for physical activity in India

India is currently facing a non-communicable disease epidemic. Physical activity (PA) is a preventative factor for non-communicable diseases. Understanding the role of the built environment (BE) to facilitate or constrain PA is essential for public health interventions to increase population PA. The objective of this study was to understand BEs associations with PA occurring in two major life domains or life areas—travel and leisure—in urban India. Between December 2014 and April 2015, in-person surveys were conducted with participants (N = 370; female = 47.2%) in Chennai, India. Perceived BE characteristics regarding residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking and bicycling, aesthetics, traffic safety, and safety from crime were measured using the adapted Neighborhood Environment Walkability Scale-India (NEWS-India). Self-reported PA was measured the International Physical Activity Questionnaire. High residential density was associated with greater odds of travel PA (aOR = 1.9, 95% CI = 1.2, 3.2). Land use mix-diversity was positively related to travel PA (aOR = 2.1, 95%CI = 1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score predicted a two-fold increase in odds of travel PA (aOR = 1.9, 95% CI = 1.1, 3.1) and a 40% decrease in odds of leisure PA (aOR = 0.6, 95% CI = 0.4, 1.0). However, the association of the aggregated score with leisure PA was not significant. Results suggest that relationships between BE and PA in low-and-middle income countries may be context-specific, and may differ markedly from higher income countries. Findings have public health implications for India suggesting that caution should be taken when translating evidence across countries.

Change4Life: evidence review on physical activity in children

This rapid evidence review aims to identify relevant literature on the physiological, psychological, social, and behavioural outcomes of physical activity participation among children aged 5 to 11 years, and provide an indication of the strength of the evidence for each outcome.

The Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time

From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18 years. Physical activity is an overarching term that consists of many structured and unstructured forms within school and out-of-school-time contexts, including organised sport, physical education, outdoor recreation, motor skill development programmes, recess, and active transportation such as biking and walking. This consensus statement presents the accord on the effects of physical activity on children's and youth's fitness, health, cognitive functioning, engagement, motivation, psychological well-being and social inclusion, as well as presenting educational and physical activity implementation strategies. The consensus was obtained through an iterative process that began with presentation of the state-of-the art in each domain followed by plenary and group discussions. Ultimately, Consensus Conference participants reached agreement on the 21-item consensus statement.

Understanding and validating accelerometry as a measure of physical activity in children with intellectual disabilities

Background Physical activity in children with intellectual disabilities is a neglected area of study, which is most apparent in relation to physical activity measurement research. Although objective measures, specifically accelerometers, are widely used in research involving children with intellectual disabilities, existing research is based on measurement methods and data interpretation techniques generalised from typically developing children. However, due to physiological and biomechanical differences between these populations, questions have been raised in the existing literature on the validity of generalising data interpretation techniques from typically developing children to children with intellectual disabilities. Therefore, there is a need to conduct population-specific measurement research for children with intellectual disabilities and develop valid methods to interpret accelerometer data, which will increase our understanding of physical activity in this population. Methods Study 1: A systematic review was initially conducted to increase the knowledge base on how accelerometers were used within existing physical activity research involving children with intellectual disabilities and to identify important areas for future research. A systematic search strategy was used to identify relevant articles which used accelerometry-based monitors to quantify activity levels in ambulatory children with intellectual disabilities. Based on best practice guidelines, a novel form was developed to extract data based on 17 research components of accelerometer use. Accelerometer use in relation to best practice guidelines was calculated using percentage scores on a study-by-study and component-by-component basis. Study 2: To investigate the effect of data interpretation methods on the estimation of physical activity intensity in children with intellectual disabilities, a secondary data analysis was conducted. Nine existing sets of child-specific ActiGraph intensity cut points were applied to accelerometer data collected from 10 children with intellectual disabilities during an activity session. Four one-way repeated measures ANOVAs were used to examine differences in estimated time spent in sedentary, moderate, vigorous, and moderate to vigorous intensity activity. Post-hoc pairwise comparisons with Bonferroni adjustments were additionally used to identify where significant differences occurred. Study 3: The feasibility on a laboratory-based calibration protocol developed for typically developing children was investigated in children with intellectual disabilities. Specifically, the feasibility of activities, measurements, and recruitment was investigated. Five children with intellectual disabilities and five typically developing children participated in 14 treadmill-based and free-living activities. In addition, resting energy expenditure was measured and a treadmill-based graded exercise test was used to assess cardiorespiratory fitness. Breath-by-breath respiratory gas exchange and accelerometry were continually measured during all activities. Feasibility was assessed using observations, activity completion rates, and respiratory data. Study 4: Thirty-six children with intellectual disabilities participated in a semi-structured school-based physical activity session to calibrate accelerometry for the estimation of physical activity intensity. Participants wore a hip-mounted ActiGraph wGT3X+ accelerometer, with direct observation (SOFIT) used as the criterion measure. Receiver operating characteristic curve analyses were conducted to determine the optimal accelerometer cut points for sedentary, moderate, and vigorous intensity physical activity. Study 5: To cross-validate the calibrated cut points and compare classification accuracy with existing cut points developed in typically developing children, a sub-sample of 14 children with intellectual disabilities who participated in the school-based sessions, as described in Study 4, were included in this study. To examine the validity, classification agreement was investigated between the criterion measure of SOFIT and each set of cut points using sensitivity, specificity, total agreement, and Cohen’s kappa scores. Results Study 1: Ten full text articles were included in this review. The percentage of review criteria met ranged from 12%−47%. Various methods of accelerometer use were reported, with most use decisions not based on population-specific research. A lack of measurement research, specifically the calibration/validation of accelerometers for children with intellectual disabilities, is limiting the ability of researchers to make appropriate and valid accelerometer use decisions. Study 2: The choice of cut points had significant and clinically meaningful effects on the estimation of physical activity intensity and sedentary behaviour. For the 71-minute session, estimations for time spent in each intensity between cut points ranged from: sedentary = 9.50 (± 4.97) to 31.90 (± 6.77) minutes; moderate = 8.10 (± 4.07) to 40.40 (± 5.74) minutes; vigorous = 0.00 (± .00) to 17.40 (± 6.54) minutes; and moderate to vigorous = 8.80 (± 4.64) to 46.50 (± 6.02) minutes. Study 3: All typically developing participants and one participant with intellectual disabilities completed the protocol. No participant met the maximal criteria for the graded exercise test or attained a steady state during the resting measurements. Limitations were identified with the usability of respiratory gas exchange equipment and the validity of measurements. The school-based recruitment strategy was not effective, with a participation rate of 6%. Therefore, a laboratory-based calibration protocol was not feasible for children with intellectual disabilities. Study 4: The optimal vertical axis cut points (cpm) were ≤ 507 (sedentary), 1008−2300 (moderate), and ≥ 2301 (vigorous). Sensitivity scores ranged from 81−88%, specificity 81−85%, and AUC .87−.94. The optimal vector magnitude cut points (cpm) were ≤ 1863 (sedentary), ≥ 2610 (moderate) and ≥ 4215 (vigorous). Sensitivity scores ranged from 80−86%, specificity 77−82%, and AUC .86−.92. Therefore, the vertical axis cut points provide a higher level of accuracy in comparison to the vector magnitude cut points. Study 5: Substantial to excellent classification agreement was found for the calibrated cut points. The calibrated sedentary cut point (ĸ =.66) provided comparable classification agreement with existing cut points (ĸ =.55−.67). However, the existing moderate and vigorous cut points demonstrated low sensitivity (0.33−33.33% and 1.33−53.00%, respectively) and disproportionately high specificity (75.44−.98.12% and 94.61−100.00%, respectively), indicating that cut points developed in typically developing children are too high to accurately classify physical activity intensity in children with intellectual disabilities. Conclusions The studies reported in this thesis are the first to calibrate and validate accelerometry for the estimation of physical activity intensity in children with intellectual disabilities. In comparison with typically developing children, children with intellectual disabilities require lower cut points for the classification of moderate and vigorous intensity activity. Therefore, generalising existing cut points to children with intellectual disabilities will underestimate physical activity and introduce systematic measurement error, which could be a contributing factor to the low levels of physical activity reported for children with intellectual disabilities in previous research.

Prevalence of physical activity in European adults — Compliance with the World Health Organization's physical activity guidelines

Background. Adults are recommended to engage in at least 150 min/week of moderate-to-vigorous physical activity (PA). Purpose. This study aimed to examine the level of compliance with PA recommendations among European adults. Methods. Using data from European Social Survey round 6, PA self-report data was collected from 52,936 European adults from 29 countries in 2012. Meeting PA guidelines was assessed usingWorld Health Organization criteria. Results. 61.47% (60.77% male, 62.05% female) of European adults reported to be engaged in moderate to vigorous PA at least 30 min on 5 or more days per week. The likelihood of achieving the PA recommended levels was higher among respondents older than 18–24. For those aged 45–64 years the likelihood increased 65% (OR = 1.65, 95% CI: 1.51–1.82, p b 0.001) and 112% (OR = 2.12, 95% CI: 1.94–2.32, p b 0.001) for males and females, respectively. Those who were high school graduates were more likely to report achieving the recommended PA levels than those with less than high school education (males: OR = 1.19, 95% CI: 1.12–1.27, p b 0.001; females: OR = 1.13, 95% CI: 1.06–1.20, p b 0.001). Conclusion. Although about 60% of European adults reported achieving the recommended levels of PA, there is much room for improvement among European adults, particularly among relatively inactive subgroups.

Physical activity in the nature benefits for family cohesion - action protocol

No século XXI, fatores socioeconómicos dão origem a uma diminuição da atividade física (AF) (TV, internet, etc.). Estima-se que 50% da população da União Europeia (EU) tem excesso de peso ou obesidade devido a uma dieta inadequada e sedentarismo, que fazem disparar a ocorrência de doenças crónicas (cardiovasculares, músculo esqueléticas, psicológicas, diabetes tipo 2, cancro, etc.) e uma consequente ameaça para a sustentabilidade dos sistemas de saúde e segurança social. A degradação da saúde nos países desenvolvidos, derivada dos estilos de vida atuais, apresenta também alterações no modelo de vivência familiar (famílias menos numerosas e monoparentais com crescimentos na ordem dos 36%). As famílias têm ainda que lidar com a escassez de tempo, a competitividade feroz no trabalho, o stress diário e os perigos em que os elementos mais jovens do agregado familiar incorrem (consumo substâncias ilícitas, distúrbios alimentares, depressão, suicídio e isolamento social) decorrentes do uso das novas tecnologias. “Atualmente, conforme as economias crescem as pessoas param de se movimentar. É urgente, apresentar uma estrutura para a ação, para que os stakeholders, revertam a situação de modo a combater os impactos desta epidemia de inatividade física, construindo ações preventivas e inovadoras, com impacto positivo no desenvolvimento humano”. Objetivo: Pretende-se através da oferta de actividade física e desportiva (AFD) planeada para famílias, promover além da saúde e estilos de vida saudáveis e resilientes, a coesão familiar. Dar resposta científica às preocupações da UE, intervindo como medida de implementação de políticas publicas consideradas prioritárias, de promoção da AF e estilos de vida saudáveis e resilientes, para assegurar um alto nível de proteção da saúde, com repercussão na diminuição dos custos com as doenças e suas consequências.

Evaluation of an intervention focusing on children to promote physical activity in the entire community: Feasibility, effectiveness and sustainability over time.

Regular physical activity (PA) during childhood is associated with physical, mental, emotional and social health benefits. The constant practice of PA is considered one of the best buys available in public health. The World Health Organization (WHO) recommends to perform at least 60 minutes per day of moderate to vigorous PA for children and adolescents in order to obtain health benefits. However, globally, this level of PA is hardly achieved. Children and adolescent who do not reach the recommended levels of PA are defined as physically inactive and nowadays physical inactivity constitutes a new type of pandemic. For this reason, the WHO launched a global action plan addressing physical activity with a goal of reducing physical inactivity in children and youth. The plan also included recommendation to improve individual and community health and contribute to the social, cultural and economic development of all nations. Worldwide, children and adolescents spend a significant amount of time in school and for this reason the school represents a fundamental educational setting that can play a pivotal role increasing students’ PA. Opportunities to be physically active should not be considered purely in relation to when children attend physical education classes but also making physical activity available during the school day, such as physically active lessons, and multicomponent PA interventions. Since school-based PA interventions are quite numerous, the present thesis focused on interventions delivered during school hours and that integrate small doses of PA as part of routine instruction. This type of intervention is called “Active Breaks.” Active Breaks consists of brief 5–15 minutes sessions of PA led by teachers who introduce short bursts of PA into the academic lesson. In light of this the present thesis aims to evaluate the feasibility, efficacy and sustainability of an Active Breaks intervention targeting children to promote PA.

Environmental factors associated with adults' participation in physical activity : A review

Background: Promoting physical activity is a public health priority, and changes in the environmental Contexts of adults' activity choices are believed to be crucial. However, of the factors associated with physical activity, environmental influences are among the least understood. Method: Using journal scans and computerized literature database searches, we identified 19 quantitative studies that assessed the relationships With physical activity behavior of perceived and objectively determined physical environment attributes. Findings were categorized into those examining five categories: accessibility of facilities, opportunities for activity, weather, safety, and aesthetic attributes. Results: Accessibility, opportunities, and aesthetic attributes had significant associations with physical activity, Weather and safety showed less-strong relationships. Where Studies pooled different categories to create composite variables, the associations were less likely to be statistically significant. Conclusions: Physical environment factors have consistent associations with physical activity behavior. Further development of ecologic and environmental models, together with behavior-specific and context-specific measurement strategies, should help in further understanding of these associations. Prospective Studies are required to identify possible causal relationships.

Psychological well-being and perception of disease severity in people with multiple sclerosis, who underwent a program of self-regulation to promote physical activity

Rehabilitation is very important for in the results of treatment in individuals with multiple sclerosis. Rehabilitation processes occur through gradual changes. These changes integrate intrinsic and extrinsic mechanisms of the individual, promoting adaptations to the needs and activities of daily living according to individual goals. Recommendations for exercise in multiple sclerosis: these recommendations apply only to patients with EDSS less than 7; moderate intensity aerobic exercise for a total of 20 to 30 minutes, twice or three times for week; the resistance training with low or moderate intensity is well tolerated by patients with MS; associated with these exercises were recommended flexibility exercises of moderate intensity, as well as strengthening exercises. The aim of this study is to examine the implications of the program of self-regulation in the perception of illness and mental health (psychological well-being domain) in multiple sclerosis patients.

Physical activity and mental health in ageing

This research brief examines the links between maintaining recommended levels of physical activity and positive effects on mental health and brain functioning as well as the public policy strategies in place to promote physical activity in the older population. It is based on three CARDI-funded projects:- Physical activity and core depressive symptoms in the older Irish adult population, led by Karen Morgan at the Royal College of Surgeons in Ireland.- Using aerobic exercise to promote brain plasticity, conducted by Richard Carson at Queen’s University, Belfast.- Leading dance for older people, led by Sylvia O’Sullivan at the University of Limerick.

Dyadic action control in overweight and obese couples: Effectiveness of a randomized controlled trial to promote physical activity.

BACKGROUND: Enhancing physical activity in overweight and obese individuals is an important means to promote health in this target population. The Health Action Process Approach (HAPA), which was the theoretical framework of this study, focuses on individual self-regulation variables for successful health behavior change. One key self-regulation variable of this model is action control with its three subfacets awareness of intentions, self-monitoring and regulatory effort. The social context of individuals, however, is usually neglected in common health behavior change theories. In order to integrate social influences into the HAPA, this randomized controlled trial investigated the effectiveness of a dyadic conceptualization of action control for promoting physical activity. METHODS/DESIGN: This protocol describes the design of a single-blind randomized controlled trial, which comprises four experimental groups: a dyadic action control group, an individual action control group and two control groups. Participants of this study are overweight or obese, heterosexual adult couples who intend to increase their physical activity. Blocking as means of a gender-balanced randomization is used to allocate couples to conditions and partners to either being the target person of the intervention or to the partner condition. The ecological momentary intervention takes place in the first 14 days after baseline assessment and is followed by another 14 days diary phase without intervention. Follow-ups are one month and six months later. Subsequent to the six-months follow-up another 14 days diary phase takes place.The main outcome measures are self-reported and accelerometer-assessed physical activity. Secondary outcome measures are Body Mass Index (BMI), aerobic fitness and habitual physical activity. DISCUSSION: This is the first study examining a dyadic action control intervention in comparison to an individual action control condition and two control groups applying a single-blind randomized control trial. Challenges with running couples studies as well as advantages and disadvantages of certain design-related decisions are discussed. This RCT was funded by the Swiss National Science Foundation (PP00P1_133632/1) and was registered on 27/04/2012 at http://www.isrctn.com/ISRCTN15705531.

Criterion-related validity of the short form of the international physical activity questionnaire in adults who are Deaf

Background: To implement appropriate programs for promoting physical activity (PA) in people who are Deaf, it is important to have valid instruments for assessing PA in this population. Objective: The main purpose of this study was to examine the criterion validity of the short form of the International Physical Activity Questionnaire (IPAQ-S) in Deaf adults. Method: This study included 44 adults (18e65 years) of both genders (63.6% were females) who met the inclusion criteria. Objective measures of PAwere collected using accelerometers, which were worn by each participant during one week. After using the accelerometer, the IPAQ-S was applied to assess participants’ physical activity during the last 7 days. Results: There was no significant correlation between the average time spent in moderate to vigorous physical activity (MVPA) as measured by the accelerometer (40.1 6 24.5 min/day) and by the IPAQ-S (41.3 6 57.5 min/day). The IPAQ-S significantly underestimated the time spent in sedentary behavior (7.6 6 2.7 h/day vs. 10.1 6 1.6 h/day). Sedentary behavior and MVPA as measured by the accelerometer and the IPAQ-S showed limited agreement. Conclusions: Our results show some limitations on the use of IPAQ-S for quantifying PA among adults who are Deaf. The IPAQ-S tends to overestimate the MVPA and to underestimate sedentary behavior in adults who are Deaf.

Correlation of habitual physical activity levels with flow mediated dilation of the brachial artery in 5-10 year old children

Endothelial dysfunction is an early key event of atherogenesis. Both fitness level and exercise intervention have been shown to positively influence endothelial function. In a cross-sectional study of 47 children, the relationship between habitual physical activity and flow-mediated dilation (FMD) of the brachial artery was explored. Habitual physical activity levels (PALs) were assessed using a validated stable isotope technique, and FMD of the brachial artery was measured via high-resolution ultrasound. The results showed that habitual physical activity significantly correlated with FMD (r=0.39, P=0.007), and remained the most influential variable on dilation in multivariate analysis. Although both fitness level and exercise intervention have previously been shown to positively influence FMD, this is the first time that a relationship with normal PALs has been investigated, especially, at such a young age. These data support the concept that physical activity exerts its protective effect on cardiovascular health via the endothelium and add further emphasis to the importance of physical activity in childhood.

Assessing flow in physical activity: The Flow State Scale-2 and Dispositional Flow Scale-2

The Flow State Scale-2 (FSS-2) and Dispositional Flow Scale-2 (DFS-2) are presented as two self-report instruments designed to assess flow experiences in physical activity. Item modifications were made to the original versions of these scales in order to improve the measurement of some of the flow dimensions. Confirmatory factor analyses of an item identification and a cross-validation sample demonstrated a good fit of the new scales. There was support for both a 9-first-order factor model and a higher order model with a global flow factor. The item identification sample yielded mean item loadings on the first-order factor of .78 for the FSS-2 and .77 for the DFS-2. Reliability estimates ranged from .80 to .90 for the FSS-2, and .81 to .90 for the DFS-2. In the cross-validation sample, mean item loadings on the first-order factor were .80 for the FSS-2, and .73 for the DFS-2. Reliability estimates ranged between .80 to .92 for the FSS-2 and .78 to .86 for the DFS-2. The scales are presented as ways of assessing flow experienced within a particular event (FSS-2) or the frequency of flow experiences in chosen physical activity in general (DFS-2).

Effects of interventions in health care settings on physical activity or cardiorespiratory fitness

Introduction: This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions. Methods: Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics. Results: Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effects on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates. Conclusion: Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.