Effects of a holistic health program on women's physical activity and mental and spiritual health

Intervention studies aimed at promoting increased physical activity have been trialled in many different settings including primary care, worksites and the community. Churches are also potential settings for physical activity promotion. However, little is known about the effectiveness of this setting for promoting physical activity, particularly in Australia. The purpose of this study was to evaluate the effectiveness of a mind, body and spiritually based health promotion program in increasing physical activity and promoting mental and spiritual health. Nineteen women completed the 8-week intervention, and 30 women in a non-health related 8-week program at the same church comprised a comparison group. Pre- and post-program surveys assessed outcome measures. Between-group differences over time were examined using one-way MANOVA's. Physical activity was higher in the intervention group than the comparison group. In contrast to the comparison group, both mental health (depression symptoms) and spiritual health improved significantly more among intervention participants. The data highlight the potential for a church-based setting and holistic approach to health promotion as a successful means of increasing physical activity and promoting mental and spiritual health among Australian women.

Physical activity and television viewing in relation to risk and undiagnosed abnormal glucose metabolism in adults

OBJECTIVE--The goal of this study was to assess the associations of physical activity time and television (TV) time with risk of "undiagnosed" abnormal glucose metabolism in Australian adults.

RESEARCH DESIGN AND METHODS--This population-based cross-sectional study using a stratified cluster design involving 42 randomly selected Census Collector Districts across Australia included 8,299 adults aged 25 years or older who were free from new type 2 diabetes and self-reported ischemic disease and did not take lipid lowering or antihypertensive drugs. Abnormal glucose metabolism (impaired fasting glycetnia [IFG], impaired glucose tolerance [IGT], or new type 2 diabetes) was based on an oral glucose tolerance test Self reported physical activity time and TV time (previous week) were assessed using interviewer administered questionnaires.

RESULTS--Alter adjustment for known confounders and TV time, the odds ratio (OR) of having abnormal glucose metabolism was 0.62 (95% CI 0.41-0.96) in men and 0.71 (0.501.00) in women for those engaged in physical activity [greater than or equal to] 2.5 h/week compared with those who were sedentary (0 h/week). The ORs of having abnormal glucose metabolism were 1.16 (0.791.70) in men and 1.49 (1.12-1.99) in women who watched TV > 14 h/week compared with those who watched [less than or equal to] 7.0 h/week. Higher TV viewing (> 14 h/week) was also associated with an increased risk of new type 2 diabetes in men and women and IGT in women compared with those watching < 14 h/week. Total physical activity of [greater than or equal to] 2.5 h/week was associated with a reduced risk of IFG, IGT, and new type 2 diabetes in both sexes: however, only the association with IGT in women was statistically significant.

CONCLUSIONS--These findings suggest a protective effect of physical activity and a deleterious effect of TV time on the risk of abnormal glucose metabolism in adults. Population strategies to reduce risk of abnormal glucose metabolism should focus on reducing sedentary behaviors such as TV time, as well as increasing physical activity.

Reaching out to promote physical activity in Australia: a statewide randomized controlled trial of a stage-targeted intervention

Purpose. This study examined the broader use of a print-media intervention, which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community, as a strategy suitable for a more diverse statewide population sample.
Methods. Participants were randomly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to Participate in a randomized controlled trial. Consenters were allocated to either intervention (n = 361) or control (n = 358) conditions. The intervention, a personalized letter plus stage-targeted booklets, was sent 1 week postbaseline. Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance (ANOVA) and mean squared statistics.
Results. The groups were similar at baseline (mean age 43 +/- 3 years; 64 % women). Process evaluation showed high intervention recall (76 % at 2 months) and high follow-up response rates (> 85 % at 8 months) were achieved. Nonsignificant increases in physical activity were observed (Fl,719 = 2.18, p = .14).
Discussion. A single mailing of stage-targeted print materials was not effective in promoting increases in physical activity among participants selected from the statewide population. Future research could examine how the effectiveness of print media might be enhanced, possibly by using supplementary media, community-based prompts, or other incentives.

Applying GIS in physical activity research: community walkability and walking behaviours.

Physical activity provides many health benefits, including reduced risk of cardiovascular disease, Type II diabetes and some cancers. Environmental exposure factors (e.g., the built environment) are now receiving ever-increasing attention. Large-scale interdisciplinary studies on the association between attributes of local community environments and residents’ physical activity are being conducted. We will focus on findings from Australia - the Physical Activity in Localities and Community Environments (PLACE) study. PLACE is examining factors that may influence the prevalence and the social and spatial distribution of walking for transport and walking for recreation. A stratified two-stage cluster sampling strategy was used to select 32 urban communities (154 census collection districts), classified as high and low ‘walkable’ using a GISbased walkability index (dwelling density, intersection density, net retail area and land use mix) and matched for socio-economic status. We report data on a sub-sample of 1,216 residents who provided information on the perceived attributes of their community environments (e.g., dwelling density, access to services, street connectivity) and weekly minutes of walking for transport and for recreation. Moderate to strong associations were found between GIS indicators of walkability and the corresponding self-report measures. The walkability index explained the same amount of neighborhood-level variance in walking for transport as did the complete set of self-report measures. No significant associations were found with walking for recreation. Relevant GIS-based indices of walkability, for purposes other than transport need to be   developed.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

Associations of children's perceived neighborhood environments with walking and physical activity

Purpose. To examine associations between children's perceptions of the neighborhood environment and walking and physical activity.
Design. Cross-sectional study of a school-based sample.
Setting. Elementary schools in Melbourne, Australia.
Subjects. 280 children aged 10 years (response rate 78%).
Measures. A self-report survey assessed children's perceptions of the neighborhood physical and social environments and their weekly walking frequency. Physical activity was also objectively measured using accelerometers.
Results. Multiple linear regression analyses showed a positive association between walking frequency and the number of accessible destinations in the neighborhood among boys; having a neighborhood that was easy to walk/cycle around and perceiving lots of graffiti were positively associated with walking frequency among girls. Perceiving lots of litter and rubbish was positively associated with boys' overall physical activity, but no environmental variables were associated with girls' overall physical activity.
Conclusion. Several different environmental factors were associated with walking and physical activity. Perceptions of the neighborhood environment were more strongly associated with girls' walking than with objectively-measured physical activity. Future studies should confirm these findings using objective measures and prospective study designs.

Promoting physical activity participation among children and adolescents

With global increases in the prevalence of overweight and obesity among children and adolescents, there has never been a more urgent need for effective physical activity programs. The aim of this narrative review is to summarize the evidence of the effectiveness of interventions that report physical activity outcomes in children aged 4–12 years and adolescents aged 13–19 years. A systematic search of electronic databases identified 76 interventions. Most interventions were delivered via the school setting (57 interventions), nine through the family setting, six via primary care, and four in community- or Internet-based settings. Children's physical activity interventions that were most effective in the school setting included some focus on physical education, activity breaks, and family strategies. Interventions delivered in the family setting were not highly effective, but many were pilot studies. The use of motivationally tailored strategies and program delivery in the primary care setting showed promise among adolescents. Many studies had methodological and reporting flaws (e.g., no baseline data, poor study design, physical activity measures of unknown reliability and validity, and poor reporting of sample size, response rates, attrition/retention, compliance, year of intervention, and duration of intervention). Publications reporting the results of evaluations of intervention studies should follow the Consolidated Standards of Reporting Trials guidelines or, for nonrandomized studies, should follow the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. Further evidence of the effectiveness of interventions promoting young people's physical activity in family and community settings is needed.

Reliability and validity of physical activity questionnaires for children: the children's leisure activities study survey (CLASS)

Examines the development of a reliable, valid and feasible method for assessing physical activity among children ages 5-6 and 10-12 years. Information on the subjects of the study; Assessment of test-retest reliability of a parental proxy questionnaire and a children's self-report questionnaire; Utilization of accelerometry to assess the criterion validity of the questionnaire.

Examining physical activity among 5- to 6- and 10- to 12-year-old children: The children's leisure activities study

The aim of this study was to describe the type, frequency, duration, and intensity of children's physical activity and to examine differences by sex, age, and socioeconomic status. Participants consisted of 5- to 6-year-old (n = 291) and 10- to 12-year-old (n = 919) children and their parents who were taking part in the Children's Leisure Activities Study (CLASS). Parents completed proxy questionnaires about their child's activities, and all children wore an accelerometer for 8 days. Accelerometry data showed that younger children accumulated approximately 4 hrs of moderate- to vigorous-intensity physical activity (MVPA) per day, and older children accumulated approximately 2 hrs per day. Fewer than three-quarters of 10- to 12-year-old boys and less than half of 10- to 12-year-old girls recorded 120 min of MVPA per day. Significant differences in the number of activities, as well as the type and frequency of activities performed, were observed by age and sex. The findings indicate that physical activities that appeal to older girls, such as lifestyle-type noncompetitive activities, should be considered in the development of physical activity promotion strategies.

Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults

Aims/hypothesis We analysed a sample of Australian adults to determine the strength of associations of TV viewing and participation in physical activity with the metabolic syndrome.

Methods This population-based cross-sectional study included 6,241 adults aged ge35 years who were free from diagnosed diabetes mellitus and self-reported ischaemic disease and were not taking lipid-lowering or antihypertensive drugs. The metabolic syndrome was defined according to the 1999 World Health Organization criteria. Participants self-reported TV viewing time and physical activity time for the previous week.

Results The adjusted odds ratio of having the metabolic syndrome was 2.07 (95% CI 1.49–2.88) in women and 1.48 (95% CI 0.95–2.31) in men who watched TV for >14 h per week compared with those who watched le7.0 h per week. Compared with those who were less active (<2.5 h per week), the odds ratio for the metabolic syndrome was 0.72 (95% CI 0.58–0.90) in men and 0.53 (95% CI 0.38–0.74) in women who were active (ge2.5 h per week). Longer TV viewing (>14 h per week) was associated with an increased risk of insulin resistance, obesity and dyslipidaemia in both men and women. A total physical activity time of ge2.5 h per week was associated with a reduced prevalence of both insulin resistance and dyslipidaemia in both sexes and reduced prevalence of both obesity and hypertension in women.

Conclusions/interpretation Increased TV viewing time was associated with an increased prevalence of the metabolic syndrome, while physical activity was associated with a reduced prevalence. Population strategies addressing the metabolic syndrome should focus on reducing sedentary behaviours such as TV viewing, as well as increasing physical activity.

Development of a reliable measure of walking within and outside the local neighbourhood: RESIDE's neighborhood physical activity questionnarire.

Background: The RESIDential Environment project (RESIDE) is a longitudinal study evaluating the impact of a new residential design code on walking. Objective: To develop a reliable measure of walking – undertaken within and outside the neighborhood – and overall physical activity. Methods: A test–retest reliability study was undertaken (n = 82, mean age 39 years). The instrument was based on the International Physical Activity Questionnaire (IPAQ-short version) and Active Australia Survey. It measured usual frequency and duration of (1) recreational- and transport-related walking within and outside the neighborhood and (2) other vigorous and moderate physical activities. Results: Reliability of recall of whether participants had walked within (k = 0.84) and outside (0.73) the neighborhood was acceptable. Similarly, recall of frequency and duration of transport and recreational-related walking within the neighborhood was excellent (ICC ≥ 0.82), as was recall of transport-related walking trips outside the neighborhood (ICC ≥ 0.84). Reliability for duration of recreational walking outside the neighborhood was fair to good (ICC = 0.55). The reliability of indices of total physical activity based on MET min/week (ICC = 0.82) and MET min/week dichotomized to ‘sufficient’ physical activity for health (kappa = 0.67) were both acceptable. Conclusions:  The Neighborhood Physical Activity Questionnaire (NPAQ) is sufficiently reliable for studies examining environmental correlates of walking within the neighborhood.

Injury prevention during physical activity in the Australian Defence Force

Introduction:
Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce.

Method:
Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims.

Results:
Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency.

Conclusion:
Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Levels of physical activity for colon cancer prevention compared with generic public health recommendations: population prevalence and sociodemographic correlates

Background: The proportion of Australian adults achieving physical activity levels believed to be sufficient for colon cancer prevention was estimated, and sociodemographic correlates (age, gender, educational attainment, occupation, marital status, and children in household) of meeting these levels of activity were analyzed.

Methods: Data from the 2000 National Physical Activity Survey were used to estimate the prevalence of participation in physical activity in relation to three criteria: generic public health recommendations, weekly amount of at least moderate-intensity physical activity currently believed to reduce risk of colon cancer, and weekly amount of vigorous-intensity physical activity believed to reduce risk of colon cancer.

Results: Overall, 46% of adults met the generic public health criterion, 26% met the colon cancer criterion based on participation in at least moderate-intensity physical activity, and 10% met the colon cancer criterion based on vigorous-intensity physical activity. Women were less likely than men to meet the colon cancer criteria. Younger and more educated persons were more likely to meet all three criteria. The most pronounced differences between gender, age, and educational attainment groups were found for meeting the amount of vigorous-intensity physical activity believed to reduce risk of colon cancer.

Conclusions: The population prevalence for meeting proposed physical activity criteria for colon cancer prevention is low and much lower than that related to the more generic public health recommendations. If further epidemiologic studies confirm that high volumes and intensities of activity are required, the public health challenges for colon cancer will be significant.

Exploring the feasibility and acceptability of using internet technology to promote physical activity within a defined community

ISSUE ADDRESSED: To explore the feasibility of using the Internet and e-mail to promote physical activity in a defined community.

METHODS: An online survey was conducted through a community-based Internet Service Provider (ISP). ISP clients were recruited via electronic newsletter and direct e-mail. Data were collected on preferred sources of assistance for physical activity advice and stage of motivational readiness for physical activity.

RESULTS: Valid surveys were completed by 797 (9% response rate). Participants were: 55% men; 56% aged >45 years; 57% worked full time; mean BMI was 28+/-8. Thirty-six per cent were in the early stages of motivational readiness for physical activity. More than 70% were somewhat to extremely interested in having access to a physical activity website.

CONCLUSION: Promoting physical activity via the Internet and e-mail is feasible and appealing to some people. Expanding the reach, appeal and use of this technology to deliver physical activity programs will be a challenge.

Understanding and influencing physical activity to improve health outcomes

Participation in physical activity is associated with significant benefits to health. We provide an overview of research relevant to understanding and influencing health-enhancing physical activity in adults. We describe a behavioural epidemiology framework that is designed to integrate the range of studies in the field; give brief examples of studies on the relationships between physical activity and health outcomes; and, we consider descriptive studies of adult populations on levels of participation. We describe research findings on the correlates of physical activity participation; describe ecological models of health behaviour that may be used in understanding and influencing physical activity; and, we review research findings on how environmental attributes can influence adults’ physical activity, particularly walking. There is considerable potential to use evidence-based approaches to increase the physical activity levels of whole populations, particularly through a focus on developing the attributes of community environments that can promote walking.