Omission of active commuting to school and the prevalence of children's health-related physical activity levels: the Russian Longitudinal Monitoring Study

Active School Commuting in School Children: A Narrative Review of Current Evidence and Future Research Implications

Active school commuting (ASC) has been proposed as a practical way to inculcate positive physical activity habits in children. This paper reviews the current evidence regarding ASC among children, highlights advances in research techniques and existing limitations in the field, and outlines future implications for research and promotion. A comprehensive literature search was conducted to identify English language studies on ASC among children aged 6-12 years, followed by a narrative review. ASC has witnessed a global decline, despite evidence of its contribution to physical activity levels. Context-dependent factors such as commuting distance and parental safety concerns are consistently identified as key determinants of ASC. Several promising interventions have been identified. Despite the limitations in intervention scope and quality, notable advancements in research techniques, such as multilevel regression and agent-based modelling, have been identified. Effective promotion of ASC to tackle childhood physical inactivity requires collaborative efforts among schools, parents, and the government, and should be tailored to address multilevel determinants within the local context. Future research should leverage recent advancements in research techniques to develop effective promotion strategies, while considering the context-dependent nature of ASC behaviours and addressing existing limitations, including the lack of standardised definitions and limited geographical and age coverage.

Safety aspects of riding with children: Descriptive analysis of adult riders' self-report

Active transport, including cycling, is promoted as an effective way of increasing children's physical activity and health. Parents can support children's riding by riding with them and it is important to address relevant safety issues. Little is known about parents' experience of safety-relevant aspects of riding with children. Participants in the Safer Cycling Study in New South Wales, Australia, who reported that they had ridden with children in the last 12 months were questioned about how they ride with children, and their experience of safety issues and crashes. Among the 187 respondents who had ridden with children on their bicycle, the most common form of carrier was a rear-mounted seat (48%) followed by a trailer (29%). Many respondents (79%) identified risks specific to riding carrying children, including those linked with specific carrier types and with use of footpaths. Most (92%) indicated that they change their behaviour when carrying a child on their bicycle; for example, riding more slowly, more carefully, and away from roads. Among crashes with a child on the bicycle, most were falls. Among the 345 participants who had ridden to accompany a child on a bicycle, approximately three quarters identified risks specific to accompanying children, such as managing the child's limited skill, awareness and predictability. Ninety-seven percent reported behavioural changes including positioning themselves as a barrier for their child and caution crossing roads. Findings suggest strategies to support parents in riding safely with children.

Associations of built environment and children's physical activity: a narrative review

PROBLEM

Childhood obesity has been an epidemic particularly in high-income countries. There is a considerable volume of data and studies depicting the rising number of obese children and adolescents in different countries. As suggested by the literature, physical inactivity is one the main drivers of childhood obesity. This paper addresses the associations of the built environment with physical activity of children in order to find to theoretically facilitate intervention and prevention measures. Literature: There is a large body of literature describing the overall determinants of children's physical activity. The built environment is one of the influential factors that have been partially examined. Among the physical environment indicators, distance to school has been repeatedly reported to be negatively associated with active travels to school; thus, it indirectly affects physical activity of children. Apart from distance to school, some other built environment indicators have also been less researched, such as population and construction densities, distance to the city center, land use mix, and type of urban fabric (urban, suburban, etc.).

OBJECTIVE

The purpose of this review was to shed light on some of the less-studied areas of the existing literature related to the relationship between the built environment and physical activity of children aged between 3 and 12 years.

METHOD

The English-language publications, majority of which were peer-reviewed journal papers published in recent years, were collected and descriptively analyzed. Two large categories were the backbone of this narrative review: (1) non-school outdoor activities of children that take place in the residential neighborhood and (2) commuting to school and the related interventions such as safe routes to school.

RESULTS

Seven areas were synthesized by this review of the literature. Differences in associations of the built environment and physical activity in (1) different types of urban forms and land uses such as urban, suburban, high-density, etc.; (2) different city sizes such as small towns, mid-sized cities, large cities and megacities; (3) different cultures, subcultures and ethnicities in the same city of country, e.g. the Asian minority of London or the Turkish minority of Germany; (4) between perceptions of parents and children and associations with children's physical activity, e.g. how they perceive safety and security of the neighborhood; (5) associations of the built environment with children's physical activity in less-studied contexts, e.g. many developing and under-developed countries or eastern European countries; (6) differences in built environment - physical activity associations in different regions of the world, e.g. continents; and finally (7) associations between mobility patterns of parents and their children's physical activity, for instance, the frequencies of taking public transport or walk as a commute mode.

CONCLUSION

Researchers are recommended to focus their less-researched subtopics mentioned under the Results section in accordance with local conditions observed in less-researched contexts so that measures and interventions are accordingly planned.

Active school transport and weekday physical activity in 9-11-year-old children from 12 countries

OBJECTIVES

Active school transport (AST) may increase the time that children spend in physical activity (PA). This study examined relationships between AST and weekday moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time (SED) and total activity during naturally organized time periods (daily, before school, during school and after school) in a sample of children from 12 countries.

METHODS

The sample included 6224 children aged 9-11 years. PA and sedentary time were objectively measured using Actigraph accelerometers. AST was self-reported by participants. Multilevel generalized linear and logistic regression statistical models were used to determine associations between PA, SED and AST across and within study sites.

RESULTS

After adjustment for age, highest parental educational attainment, BMI z-score and accelerometer wear time, children who engaged in AST accumulated significantly more weekday MVPA during all studied time periods and significantly less time in LPA before school compared with children who used motorized transport to school. AST was unrelated to time spent in sedentary behaviors. Across all study sites, AST was associated with 6.0 min (95% confidence interval (CI): 4.7-7.3; P<0.0001) more of weekday MVPA; however, there was some evidence that this differed across study sites (P for interaction=0.06). Significant positive associations were identified within 7 of 12 study sites, with differences ranging from 4.6 min (95% CI: 0.3-8.9; P=0.04, in Canada) to 10.2 min (95% CI: 5.9-14.4; P<0.0001, in Brazil) more of daily MVPA among children who engaged in AST compared with motorized transport.

CONCLUSIONS

The present study demonstrated that AST was associated with children spending more time engaged in MVPA throughout the day and less time in LPA before school. AST represents a good behavioral target to increase levels of PA in children.

Nutrition Transition and the Global Diabetes Epidemic

Low- and middle-income countries (LMICs) face a rapid change in the nutrition transition toward increases in noncommunicable diseases. Underlying this transition are shifts in the agricultural system and the subsequent growth of the modern retail and food service sectors across all regions and countries, a change in technology affecting physical activity and inactivity, mass media access, urbanization, and penetration of modern food systems into all societies. The resulting major shifts in diet are toward increased refined carbohydrates, added sweeteners, edible oils, and animal-source foods and reduced legumes, other vegetables, and fruits. Most countries are seeing increases in body mass index (BMI), overweight, and waist circumference (WC), and an increased WC-BMI ratio appears to be emerging in many regions. The implications of these rapidly changing diets and body compositions include the prevalence and severity of diabetes in LMICs.

Educación vial y movilidad en la Infancia

Resumen:La motorización creciente de los desplazamientos ha convertido al ambiente urbano en un lugar cada vez más hostil para los niños y niñas, quienes se encuentran entre los grupos humanos más vulnerables del tránsito. En esta etapa del desarrollo, la educación puede ser una herramienta clave para prevenir comportamientos de riesgo y promocionar hábitos de movilidad más saludables. El presente trabajo discute algunos aspectos relacionados con la educación vial en la infancia. Se destaca la importancia de considerar los patrones de movilidad típicos de cada edad, y de promover el uso de medios de transporte más saludables, equitativos y sustentables. Se señala además la necesidad de complementar las acciones educativas con intervenciones multi-sectoriales a diferente nivel.

Six-year trend in active commuting to school in Spanish adolescents. The AVENA and AFINOS Studies

BACKGROUND

Promoting daily routine activities, such as active commuting to school, may have important health implications for young people.

PURPOSE

The aim of the study was to examine the secular trend of active commuting to school in Spanish adolescents over a 6-year period (2001-2002 to 2006-2007). We also examined several factors that might explain this trend.

METHODS

Data comes from two separate cross-sectional studies, both representatives from the city of Madrid (Spain): AVENA and AFINOS studies. These took place in 2001-2002 and 2006-2007 and included 415 (198 girls) and 891 (448 girls) adolescents aged 13-17, respectively. Commuting to school was assessed using a standardized question about their habitual mode of transportation to school: walking, cycling, bus/subway, car, or motorcycle. Chi-square and binary logistic regression were used.

RESULTS

Percentage of active commuting girls decreased significantly from 61 % to 48 % (p = 0.002) from 2001-2002 to 2006-2007. Walking declined from 61 % to 46 % and the use of bus/subway increased from 25 % to 37 % in girls. Girls belonging to average/small families had lower odds of being active commuters than girls of large families (OR, 95 % CI: 0.69, 0.48 to 0.98). There were no significant differences in mode of commuting to school for boys (p = 0.269).

CONCLUSION

Spanish adolescent girls in 2007-2008 had lower levels of active commuting to school, mainly walking, than their counterparts 6 years before. Belonging to a large family was related with higher active commuting in girls.

Decreased external skeletal robustness in schoolchildren--a global trend? Ten year comparison of Russian and German data

Objectives

Obesity and a reduced physical activity are global developments. Physical activity affects the external skeletal robustness which decreased in German children. It was assumed that the negative trend of decreased external skeletal robustness can be found in other countries. Therefore anthropometric data of Russian and German children from the years 2000 and 2010 were compared.

Methods

Russian (2000/2010 n = 1023/268) and German (2000/2010 n = 2103/1750) children aged 6–10 years were investigated. Height, BMI and external skeletal robustness (Frame-Index) were examined and compared for the years and the countries. Statistical analysis was performed by Mann-Whitney-Test.

Results

Comparison 2010 and 2000: In Russian children BMI was significantly higher; boys were significantly taller and exhibited a decreased Frame-Index (p = .002) in 2010. German boys showed significantly higher BMI in 2010. In both sexes Frame-Index (p = .001) was reduced in 2010. Comparison Russian and German children in 2000: BMI, height and Frame-Index were different between Russian and German children. German children were significantly taller but exhibited a lower Frame-Index (p<.001). Even German girls showed a significantly higher BMI. Comparison Russian and German children in 2010: BMI and Frame-Index were different. Russian children displayed a higher Frame-Index (p<.001) compared with Germans.

Conclusions

In Russian children BMI has increased in recent years. Frame-Index is still higher in Russian children compared with Germans however in Russian boys Frame-Index is reduced. This trend and the physical activity should be observed in the future.

Using an agent-based model to simulate children's active travel to school

Background

Despite the multiple advantages of active travel to school, only a small percentage of US children and adolescents walk or bicycle to school. Intervention studies are in a relatively early stage and evidence of their effectiveness over long periods is limited. The purpose of this study was to illustrate the utility of agent-based models in exploring how various policies may influence children’s active travel to school.

Methods

An agent-based model was developed to simulate children’s school travel behavior within a hypothetical city. The model was used to explore the plausible implications of policies targeting two established barriers to active school travel: long distance to school and traffic safety. The percent of children who walk to school was compared for various scenarios.

Results

To maximize the percent of children who walk to school the school locations should be evenly distributed over space and children should be assigned to the closest school. In the case of interventions to improve traffic safety, targeting a smaller area around the school with greater intensity may be more effective than targeting a larger area with less intensity.

Conclusions

Despite the challenges they present, agent based models are a useful complement to other analytical strategies in studying the plausible impact of various policies on active travel to school.

Associations of children's independent mobility and active travel with physical activity, sedentary behaviour and weight status: a systematic review

Health benefits from children's independent mobility and active travel beyond school travel are largely unexplored.

OBJECTIVES

This review synthesized the evidence for associations of independent mobility and active travel to various destinations with physical activity, sedentary behaviour and weight status.

DESIGN

Systematic review.

METHODS

A systematic search in six databases (PubMed, Scopus, CINAHL, SportDiscus, PsychInfo, TRIS) for papers published between January 1990 and March 2012 was undertaken, focussing on children aged 3-18 years. Study inclusion and methodological quality were independently assessed by two reviewers.

RESULTS

52 studies were included. Most studies focussed solely on active travel to and/or from school, and showed significant positive associations with physical activity. The same relationship was detected for active travel to leisure-related places and independent mobility with physical activity. An inverse relationship between active travel to school and weight status was evident but findings were inconsistent. Few studies examined correlations between active travel to school and self-reported screen-time or objectively measured sedentary behaviour, and findings were unclear.

CONCLUSIONS

Studies on independent mobility suggested that children who have the freedom to play outdoors and travel actively without adult supervision accumulate more physical activity than those who do not. Further investigation of children's active travel to leisure-related destinations, measurement of diverse sedentary behaviour beyond simply screen-based activities, and consistent thresholds for objectively measured sedentary behaviour in children will clarify the inconsistent evidence base on associations of active travel with sedentary behaviour and weight status.

Cross-sectional and longitudinal associations between parenting style and adolescent girls' physical activity

BACKGROUND

Understanding the influences on physical activity is crucial, particularly among important target groups such as adolescent girls. This study describes cross-sectional and longitudinal associations between parenting style and girls' participation in organized sport, walking/cycling trips and objectively assessed moderate to vigorous physical activity (MVPA).

METHODS

Data were collected from adolescent girls (n=222) and their parents in 2004 and again in 2006. Parents self-reported their demographic characteristics and parenting style. Girls self-reported their organized sport participation and weekly walking/cycling trips, while MVPA was assessed using accelerometers. Linear regression and interaction analyses were performed. Interactions between socio-demographic factors and parenting style with organized sport, walking/cycling trips and MVPA are presented.

RESULTS

There were cross-sectional associations between authoritative (B=-0.45, p=0.042) and indulgent (B=-0.56, p=0.002) parenting and the number of walking/cycling trips, and authoritarian (B=0.27, p=0.033) parenting and frequency of organized sport. Significant interactions included those between: family status, authoritative parenting and daily (p=0.048) and week day (p=0.013) MVPA; education, indulgent parenting and MVPA on weekend days (p=0.006); and, employment, authoritarian parenting and duration and frequency of organized sport (p=0.004), highlighting the complexity of these relationships. Longitudinal analyses revealed significant decreases in organized sport and MVPA, significant increases in walking/cycling trips and no significant associations between parenting and physical activity.

CONCLUSION

Parenting styles appear to influence walking and cycling trips among adolescent girls, though not physical activity within other domains. Socio-demographic characteristics interact with the relationships between parenting and physical activity. While these findings can inform the development of family-based interventions to improve child and adolescent health, the direction of the observed associations and the number of associations approaching significance suggest the need to further explore this area.

The declining prevalence of overweight among Russian children: income, diet, and physical activity behavior changes

The aim of this study is to examine the relationships among income, diet, physical activity behaviors and overweight among Russian children during a period of economic upheaval. Subjects include 2151 schoolchildren aged 7-13 derived from cross-sectional waves of the Russia Longitudinal Monitoring Surveys in 1995 and in 2002. Diet was assessed by 24-h recall and physical activity (h/week) and household income by parental questionnaire. Hours spent in vigorous activities were low (1.0-1.5 h/week), and time spent in sedentary behaviors increased from 31 to 37 h/week between 1995 and 2002. In 1995 there was a direct relationship of income to energy and fat intake, and time spent in vigorous activity, and an inverse relationship of income to h/week spent in moderate activities (such as walking to school). The effect of having low income parents was less in 2002 than in 1995. Overweight prevalence did not differ significantly by income in either year, but there was a significant decline in overweight among high income children. Only hours spent in moderate physical activity was moderately protective against overweight. Income disparities do not explain trends in overweight among Russian children.

A cluster randomised school-based lifestyle intervention programme for the prevention of childhood obesity and related early cardiovascular disease (JuvenTUM 3)

Background

Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease. The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear, as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function. In this study a comprehensive school-based randomized intervention programme will be investigated in 10-14-year old children addressing the influence of lifestyle intervention on inactivity, cardiometabolic risk factors and early signs of vascular disease.

Methods/Design

15 secondary schools in Southern Germany are randomly assigned to intervention or control schools. Children in the fifth grade (10-11 years) will be observed over four years. The study combines a school-based with a home-based approach, aiming at children, teachers and parents. The main components are weekly lifestyle-lessons for children, taught by regular classroom teachers to increase physical activity in- and outside of school, to improve eating patterns at school and at home, to reduce media consumption and to amplify well-being. In 4-6 annual meetings, teachers receive information about health-related topics with worksheets for children and supporting equipment, accounting for school-specific needs and strategies. Parents' trainings are provided on a regular basis.

All examinations are performed at the beginning and at the end of every school year. Anthropometry includes measurements of BMI, waist and upper arm circumferences, skinfold thickness as well as peripheral blood pressure. Blood sampling includes lipid parameters, insulin, glucose, hsCRP, adiponectin, and IL-6 as well as testosteron and estrogen to determine maturation status. Vascular function is non-invasively assessed by measuring arterial stiffness in large arteries using a sphygmograph and by analysing arteriolar and venular diameters in the retinal microcirculation using a non-mydriatric vessel analyser. A questionnaire is filled out to determine daily physical activity, motivational factors, dietary habits, quality of life (KINDL-R) and socio-economic data. Physical fitness is assessed by a six-item test battery.

Discussion

Our study aims to provide a feasible long-term intervention strategy to re-establish childhood health and to prevent obesity-related cardiovascular dysfunction in children.

Trial Registration

NCT00988754

Built environment predictors of active travel to school among rural adolescents

BACKGROUND

Most studies of active travel to school (ATS) have been conducted in urban or suburban areas and focused on young children. Little is known about ATS among rural adolescents.

PURPOSE

To describe adolescent ATS in two predominantly rural states and determine if school neighborhood built environment characteristics (BECs) predict ATS after adjusting for school and individual characteristics.

METHODS

Sixteen BECs were assessed through census data and onsite observations of 45 school neighborhoods in 2007. ATS and individual characteristics were assessed through telephone surveys with 1552 adolescents and their parents between 2007 and 2008. Active travelers were defined as those who walked/cycled to/from school ≥1 day/week. Hierarchic linear modeling was used for analysis, conducted in 2009.

RESULTS

Slightly less than half (n=735) of the sample lived within 3 miles of school, of whom 388 (52.8%) were active travelers. ATS frequency varied by season, ranging from a mean of 1.7 (SD=2.0) days/week in the winter to 3.7 (SD=1.6) in the spring. Adolescents who attended schools in highly dense residential neighborhoods with sidewalks were most likely to be active travelers. ATS frequency was greater in school neighborhoods with high residential and intersection densities, on-street parking, food outlets, and taller and continuous buildings with small setbacks.

CONCLUSIONS

The BECs that support safe travel may be necessary to allow for ATS, whereas ATS frequency among adolescents may be influenced by a wider variety of design characteristics. Additional strategies to promote ATS and physical activity are needed in rural areas because of long commuting distances for many students.

Correlates of objectively assessed physical activity and sedentary time in children: a cross-sectional study (The European Youth Heart Study)

BACKGROUND

Identifying leisure time activities performed before and after school that influence time in physical activity (PA) and/or time spent sedentary can provide useful information when designing interventions aimed to promote an active lifestyle in young people. The purpose of this study was to examine associations between mode of transportation to school, outdoor play after school, participation in exercise in clubs, and TV viewing with objectively assessed PA and sedentary behaviour in children.

METHODS

A total of 1327 nine- and 15-year-old children from three European countries (Norway, Estonia, Portugal) participated as part of the European Youth Heart Study. PA was measured during two weekdays and two weekend days using the MTI accelerometer, and average percent of time in moderate-to-vigorous PA (MVPA) and time spent sedentary were derived. Potential correlates were assessed by self-report. Independent associations between self-reported correlates with percent time in MVPA and percent time sedentary were analysed by general linear models, adjusted by age, gender, country, measurement period, monitored days and parental socio-economic status.

RESULTS

In 9-year-olds, playing outdoors after school was associated with higher percent time in MVPA (P < 0.01), while participation in sport clubs was associated with higher percent time in MVPA (P < 0.01) in 15-year-olds. No associations with percent time sedentary were observed in either age group.

CONCLUSION

Frequency of outdoor play after school is a significant correlate for daily time in MVPA in 9-year-olds, while this correlate is attenuated in favour of participation in sport and exercise in clubs in 15-year-olds. Targeting walking to school or reduced TV viewing time in order to increase time in daily MVPA in children is unlikely to be sufficient. Correlates related to time spent sedentary need further examination.

Socio-economic factors and active commuting to school in urban Spanish adolescents: the AVENA study

BACKGROUND

This study aimed: (i) to describe the patterns of commuting to school in urban Spanish adolescents; and (ii) to examine the associations between active commuting to school (ACS) and socio-economic factors.

METHODS

From the AVENA Study, 2183 adolescents (1142 females) aged 13-18.5 years were gathered. Mode and time of transportation to school were self-reported by the adolescents. Parental education level (primary, secondary or university degree), parental professional level (managerial, skilled worker or unskilled worker/unemployed) and the type of school (public or private) were self-reported by the parents. The relationships between ACS and socio-economic factors were analysed by binary logistic regression.

RESULTS

Nearly <65% of the adolescents reported ACS and 83% of them spent <15 min travelling to school. In male adolescents, maternal primary education level showed an odds ratio (OR) of 1.55 (95% confidence interval, 1.12-2.15), with respect to mothers with a university degree. In female adolescents, mothers with a primary education level showed an OR of 0.68 (0.50-0.92), with respect to mothers with a university degree. Low maternal professional level showed an OR of 1.70 (1.29-2.24), with respect to high maternal professional levels. Students attending public schools showed an OR of 3.47 (2.46-4.90), with respect to students from private schools.

CONCLUSION

Most of the adolescents actively commuted to school, yet the time spent commuting was low. Socio-economic level seems to be inversely related to the ACS in adolescents. Type of school and maternal educational level were the main predictors of ACS.

Demographic, environmental, access, and attitude factors that influence walking to school by elementary school-aged children

BACKGROUND

Walking to school has been identified as an activity that contributes to children's daily exercise requirements. The purpose of this study was to better understand factors that influence walking to school by elementary school-aged children.

METHODS

A sample of 1,897 elementary school-aged children (84% response rate; 3rd-5th graders) throughout Michigan completed the Michigan Safe Routes to School Student Survey. The survey measures environmental, access, and attitudinal perceptions toward school routes and transportation methods.

RESULTS

Using logistic regression, the results indicate that the odds of walking to school increase the older children are (odds ratio (OR) = 1.80, 95% confidence interval (CI) = 1.20-2.70) and if students perceive that walking to school saves time (OR = 3.32, 95% CI = 1.44-7.66) or is safe (OR = 2.60, 95% CI = 1.06-6.39). The odds of a student walking to school decrease the farther a student lives from his or her school (OR = 0.11, 95% CI = 0.04-0.37), if his or her parents have a car (OR = 0.07, 95% CI = 0.02-0.22), and if the student has access to a school bus (OR = 0.07, 95% CI = 0.03-0.18). These factors are significant (p < .05) predictors of walking to school after controlling for other demographic, environmental, access, and attitude factors.

CONCLUSIONS

The study results support research indicating that environmental and access factors influence whether elementary school-aged children walk to school. In addition, when children perceive walking to school to be convenient (ie, saves time), their odds of walking to school increase. Future school- and community-based programs promoting walking to school should continue to focus on making walking to school not only safer, but also more convenient.

Active and passive commuting to school: influences on affect in primary school children

Active commuting among school children is being encouraged for physical and environmental reasons, but little is known about its influence on affect. The aim of this study was to test the hypothesis that children who walk further to school experience increased arousal and affective valence compared with children who walk a short distance. This was assessed with the children's feeling scale (CFS) and children's felt arousal scale (CFAS). Distance walked to school and affective change between home and school were assessed over a 2-week period in 99 children between 5 and 10 years of age. Home to school differences in CFS and CFAS scores were compared in children who walked a short (100-300 m); medium (301-500 m), and long distance (over 500 m). Although differences were not always statistically significant, there was evidence that the children who walked further reported a greater increase in their CFAS scores between home and school (average eta2 = .08, range: .01-.15) and, to a lesser extent, in their CFS scores (eta2 = .04, range: .002-.06). Further research is needed to explore whether there is an optimum walking distance and the contribution of other factors, especially social contacts during commuting, the environment, and the weather.

Walking and Bicycling to School: A Review

Walking and bicycling (active commuting) to school has been proposed as a strategy for increasing youth physical activity and decreasing the prevalence of overweight. Citations for this review were retrieved through PubMed, Transport, ERIC, and ISI database searches using relevant keywords (1975 to March 2007), government and organization Web sites, and bibliographic citations. This review presents (1) prevalence estimates for active commuting to school; (2) the correlates of active commuting to school, presented using a new conceptual framework; (3) the associations between active commuting to school and health (ie, physical activity, weight status, environmental); and (4) a summary of the findings and recommendations for further research. Considerable heterogeneity exists among the reviewed studies for sample size and demographics, the methods used to measure active commuting, and the definition used to identify a positive case (active commuter). In general, active commuting to school is much less prevalent in the United States compared with European countries. A wide range of correlates of active commuting to school have been studied (individual to policy level). Active commuters tend to be more active than nonactive commuters, although no difference in weight status was observed in most studies. More research is needed to corroborate these findings and build on the knowledge base so that effective walk-to-school interventions can be implemented independently or as part of other health promotion efforts, including physician counseling for physical activity.

Neighborhood road environments and physical activity among youth: the CLAN study

We examined associations between objective measures of the local road environment and physical activity (including active transport) among youth. There is little empirical evidence of the impact of the road environment on physical activity among children/adolescents in their neighborhoods. Most recent studies have examined perceptions rather than objective measures of the road environment. This was a cross-sectional study of children aged 8-9 years (n = 188) and adolescents aged 13-15 years (n = 346) who were participants in the 3-year follow-up of the Children Living in Active Neighborhoods (CLAN) longitudinal study in Melbourne, Australia. At baseline (2001), they were recruited from 19 state primary schools in areas of varying socioeconomic status across Melbourne. Habitual walking/cycling to local destinations was parent-reported for children and self-reported for adolescents, while moderate-to-vigorous physical activity (MVPA) outside school hours was recorded using accelerometers. Road environment features in each participant's neighborhood (area of radius 800 m around the home) were measured objectively using a geographical information system. Regression analyses found no associations between road environment variables and children's likelihood of making at least seven walking/cycling trips per week to neighborhood destinations. Adolescent girls residing in neighborhoods with two to three traffic/pedestrian lights were more likely to make seven or more walking/cycling trips per week as those whose neighborhoods had fewer traffic lights (OR: 2.7; 95% CI: 1.2-6.2). For adolescent boys, residing on a cul-de-sac, compared with a through road, was associated with increases in MVPA of 9 min after school, 5 min in the evenings, and 22 min on weekend days. Speed humps were positively associated with adolescent boys' MVPA during evenings. The road environment influences physical activity among youth in different ways, according to age group, sex and type of physical activity.

Walkability and safety around elementary schools economic and ethnic disparities

BACKGROUND

Children's physical inactivity and obesity are growing public health problems in the U.S., especially among low-income, minority populations. Walking to school may help address these problems.

METHODS

This cross-sectional study examined disparities in the environmental support for walking around 73 public elementary schools in Austin TX. GIS was used to measure the neighborhood-level walkability and safety. Field audits were conducted to assess the street-level walkability. Analyses of variance and regressions were performed to analyze economic and ethnic disparities.

RESULTS

For the top-quartile schools with higher poverty or Hispanic student percentages, the surroundings showed higher neighborhood-level walkability with shorter distances to school and more sidewalks compared with the bottom quartile. These areas, however, also had higher crash and crime rates and lower street-level walkability captured by visual quality, physical amenities, maintenance, and perceived safety. In predictions of environmental conditions using poverty and Hispanic student percentages, poverty was associated with many adverse conditions on the street level and with only two favorable situations, shorter distances to school and lower traffic volumes, on the neighborhood level. The Hispanic student percentage did not correlate with most street-level variables, but predicted both increased dangers from traffic and crime and higher neighborhood-level walkability with more sidewalks, greater density, and mixed land uses.

CONCLUSIONS

Economic and ethnic disparities exist in the environmental support for walking, suggesting the need for tailored interventions in promoting active living. Low-income, Hispanic children are more likely to live in unsafe areas with poor street environments but with some favorable neighborhood-level conditions.

Critical factors for active transportation to school among low-income and minority students. Evidence from the 2001 National Household Travel Survey

BACKGROUND

Walking to school may be an important source of daily physical activity in children's lives, and government agencies are supporting programs to encourage walking to school (e.g., Safe Routes to School and the CDC's KidsWalk programs). However, little research has looked at differences in behavior across racial/ethnic and income groups.

METHODS

This cross-sectional study used data from the 2001 National Household Travel Survey to document rates of walking and biking to school among low-income and minority youth in the U.S. (N=14,553). Binary models of the decision to use active transport to school were developed to simultaneously adjust for trip, individual, household, and neighborhood correlates. All analyses were conducted in 2007.

RESULTS

The data showed that low-income and minority groups, particularly blacks and Hispanics, use active travel modes to get to school at much higher rates than whites or higher-income students. However, racial variation in travel patterns is removed by controlling for household income, vehicle access, distance between home and school, and residential density.

CONCLUSIONS

Active transportation to school may be an important strategy to increase and maintain physical activity levels for low-income and minority youth. Current policy interventions such as Safe Routes to School have the opportunity to provide benefits for low-income and minority students who are the most likely to walk to school.

Patterns of physical activity and overweight among 7-13-year-old Russian children: a 7-year nationally representative monitoring study

This is a repeated cross-sectional study of overweight and physical activity (PA) and inactivity patterns of successive samples of 7-13-year-old Russian children who were surveyed six times between 1995 and 2002 as part of the Russian Longitudinal Monitoring Survey. This analysis focused on moderate/vigorous (MOD/VIG) PA (e.g., active commuting to school, during school MOD/VIG PA as part of physical education classes, and/or before/after school MOD/VIG PA) and inactivity patterns (e.g, television viewing habits) obtained through parent proxy-reports of 3,507 boys (M age = 10.1 years, SD = 2.0; body mass index = 17.5 kg/m2, SD = 3.0) and 3,273 girls (M age = 10.1 years, SD = 2.0; body mass index = 17.2 kg/m2, SD = 3.0). Time spent in MOD/VIG PA appears to be on the rise, while the proportion of those actively commuting to school is decreasing, especially among girls.

Active commuting to school: how far is too far?

BACKGROUND

Walking and cycling to school provide a convenient opportunity to incorporate physical activity into an adolescent's daily routine. School proximity to residential homes has been identified as an important determinant of active commuting among children. The purpose of this study is to identify if distance is a barrier to active commuting among adolescents, and if there is a criterion distance above which adolescents choose not to walk or cycle.

METHODS

Data was collected in 2003-05 from a cross-sectional cohort of 15-17 yr old adolescents in 61 post primary schools in Ireland. Participants self-reported distance, mode of transport to school and barriers to active commuting. Trained researchers took physical measurements of height and weight. The relation between mode of transport, gender and population density was examined. Distance was entered into a bivariate logistic regression model to predict mode choice, controlling for gender, population density socio-economic status and school clusters.

RESULTS

Of the 4013 adolescents who participated (48.1% female, mean age 16.02 +/- 0.661), one third walked or cycled to school. A higher proportion of males than females commuted actively (41.0 vs. 33.8%, chi2 (1) = 22.21, p < 0.001, r = -0.074). Adolescents living in more densely populated areas had greater odds of active commuting than those in the most sparsely populated areas (chi2 (df = 3) = 839.64, p < 0.001). In each density category, active commuters travelled shorter distances to school. After controlling for gender and population density, a 1-mile increase in distance decreased the odds of active commuting by 71% (chi2 (df = 1) = 2591.86, p < 0.001). The majority of walkers lived within 1.5 miles and cyclists within 2.5 miles. Over 90% of adolescents who perceived distance as a barrier to active commuting lived further than 2.5 miles from school.

CONCLUSION

Distance is an important perceived barrier to active commuting and a predictor of mode choice among adolescents. Distances within 2.5 miles are achievable for adolescent walkers and cyclists. Alternative strategies for increasing physical activity are required for individuals living outside of this criterion.

Validity and reliability of a school travel survey

BACKGROUND

Despite the growing interest in active (ie, nonmotorized) travel to and from school, few studies have explored the measurement properties to assess active travel. We evaluated the criterion validity and test-retest reliability of a questionnaire with a sample of young schoolchildren to assess travel to and from school, including mode, travel companion, and destination after school.

METHODS

To assess test-retest reliability, 54 children age 8 to 11 years completed a travel survey on 2 consecutive school days. To assess criterion validity, 28 children age 8 to 10 years and their parents completed a travel survey on 5 consecutive weekdays.

RESULTS

Test-retest reliability of all questions indicated substantial agreement. The questions on mode of transport, where you will go after school, and how you will get there also displayed substantial agreement between parental and child reports.

CONCLUSIONS

For this population, a questionnaire completed by school-age children to assess travel to and from school, including mode, travel companion, and destination after school, was reliably collected and indicated validity for most items when compared with parental reports.

Personal and environmental factors associated with active commuting to school in Switzerland

OBJECTIVE

To assess whether prevalence of active commuting and regular car trips to school varies across communities and language regions in Switzerland and to determine personal and environmental correlates.

METHODS

During the school year 2004/2005, 1345 parental questionnaires (response rate 65%) of children attending 1st, 4th and 8th grades were completed, 1031 could be linked to a GIS environmental database. A German-speaking, a French-speaking and a bilingual study area were included. Usual mode of transportation and frequency of regular car trips to school were assessed. Associations with personal and environmental factors were evaluated with multivariate regression models.

RESULTS

Seventy-eight percent of the children actively traveled to school. Twelve percent were regularly driven at least once a week by car. Major road crossings and distance were significantly related to usual mode of transportation, but not to regular car trips. Age, daycare attendance, parental safety concerns, number of cars in the household and belonging to French-speaking population were significantly associated with increased regular car trips.

CONCLUSION

Objective predictors are main deciding factors for active commuting to school as main mode of transport whereas personal and lifestyle factors are important factors associated with frequency of car use. Not only objective but also differing cultural attitudes should be considered when promoting non-motorized travel.

Activities contributing to energy expenditure among Guatemalan adults

BACKGROUND

Guatemala has experienced a substantial increase in overweight and obesity in recent years, yet physical activity patterns and consequent energy expenditure are largely unexplored in this population.

METHODS

To describe overall physical activity levels (PAL) and activities contributing to daily energy expenditure, we analyzed time spent in daily activities as reported by 985 women and 819 men, living in rural and urban areas of Guatemala in 2002-04.

RESULTS

Physical activity levels recommended to prevent obesity (PAL > or = 1.70) differed by residence/occupation among men (agricultural-rural: 77%; nonagricultural-rural: 36%; urban: 24%; P < 0.01), but not women (rural: 2%; urban: 3%; P = 0.5). Median energy expenditure was higher among agricultural-rural men (44 MET*h/d; MET = metabolic equivalent) compared to nonagricultural-rural (37 MET*h/d) and urban men (35 MET*h/d; P < 0.01); energy expenditure was slightly lower among rural compared to urban women (34 MET*h/d vs. 35 MET*h/d; P < 0.01). Occupation was the largest contributor to energy expenditure (19-24 MET*h/d); among women and nonagricultural-rural and urban men this was primarily of a light intensity. Energy expenditure in sedentary activities ranged from 2 MET*h/d among rural women to 6 MET*h/d among agricultural-rural men. Any sports/exercise time was reported by 35% and 5% of men and women, respectively. Nevertheless, the majority of participants believed they were significantly active to stay healthy.

CONCLUSION

Overall, energy expenditure was low in the population not dedicated to agricultural occupations; an increased focus on active leisure-time behaviors may be needed to counterbalance reductions in energy expenditure consequent to sedentarization of primary occupations.

National prevalence and correlates of walking and bicycling to school

BACKGROUND

Active travel to school provides youth with an opportunity to accumulate minutes of physical activity toward meeting recommended levels.

METHODS

The study included a nationally representative sample of U.S. children, aged 9 to 15 years, and one of their parents from 2004 (2256 pairs aged 11 to 15 and 5177 pairs aged 9 to 13). The objective was to estimate the prevalence of living within a mile of school, and of those who lived within a mile, the prevalence of active travel to school. Geographic, demographic, attitudinal, and behavioral correlates of active travel (defined as walking or bicycling to school one or more times during a usual week) were identified.

RESULTS

Nearly 35% of children live within a mile of school. Among those, 47.9% were classified as active travelers. Adjusted correlates were identified from each domain (three demographic, two geographic, two attitudinal, five behavioral), explaining approximately 10% of the variance in logistic regression models.

CONCLUSIONS

More than a third of youth aged 9 to 15 years live within a mile of school, but less than half of these students walk or bike to school even 1 day per week. The lowest proportions of active travelers among the independent correlates include students in the South, students living in rural areas, and students of parents with an advanced degree.

Associations between active commuting to school, fat mass and lifestyle factors in adolescents: the Kiel Obesity Prevention Study (KOPS)

OBJECTIVE

To examine possible associations between active commuting (walking or cycling) to school, parameters of adiposity and lifestyle factors in 14-year-old adolescents of the Kiel Obesity Prevention Study.

SUBJECTS

A total of 626 14-year-old adolescents.

METHODS

Measured body mass index (BMI), fat mass (FM), distance to school as well as self-reported modes and duration of commuting to school, time spent in structured and unstructured physical activities (PAs), media use, nutrition, alcohol consumption and smoking.

RESULTS

Parameters of adiposity did not differ between different commuting modes after stratifying by gender. Active commuters reported higher overall PA, which was caused by commuting activity and time spent in unstructured PA in girls and just by commuting activity in boys. In active commuters, 28.4% of overall PA was explained by commuting activity. Additionally, TV viewing was lower in active commuters. Compared to their inactively commuting counterparts, actively commuting boys were less likely to smoke. After controlling for potential confounders the interaction term 'active commuting by distance to school' and 'time spent in structured PA' were independent predictors of FM, whereas active commuting by itself showed no effect.

CONCLUSION

The present data suggest that active commuting to school per se does not affect FM or BMI until considering distance to school. Increasing walking or cycling distance results in decreasing FM. However, the everyday need to get to and from school may enhance adolescents' overall PA.

Occupation is more important than rural or urban residence in explaining the prevalence of metabolic and cardiovascular disease risk in Guatemalan adults

Diet and activity pattern changes consequent to urbanization are contributing to the global epidemic of cardiovascular disease; less research has focused on activity within rural populations. We studied 527 women and 360 men (25-42 y), all rural-born and currently residing in rural or urban areas of Guatemala. We further classified rural male occupations as agricultural or nonagricultural. Overweight status (BMI > or = 25 kg/m(2)) differed by residence/occupation among men (agricultural-rural, 27%; nonagricultural-rural, 44%; and urban, 55%; P< 0.01) and women (rural, 58%; and urban, 68%; P= 0.04). A moderate-to-vigorous lifestyle was reported by 76, 37, and 20% of men (agricultural-rural, nonagricultural-rural, and urban, respectively; P< 0.01); most women were sedentary, with no difference by residence. Prevalence of the metabolic syndrome was 17, 24, and 28% in agricultural-rural, nonagricultural-rural, and urban men, respectively (P= 0.2), and 44 and 45% in rural and urban women (P= 0.4). Dietary variables were largely unassociated with adiposity or cardio-metabolic risk factors; physical activity was inversely associated with the percentage of body fat in men. Percent body fat was inversely associated with HDL-cholesterol, and positively associated with triglycerides, blood pressure, and the metabolic syndrome in both men and women, and with LDL-cholesterol and fasting glucose in women. Differences in physical activity level, mainly attributable to occupation, appear more important than residence, per se, in influencing the risk for cardiovascular disease among men; differences among these sedentary women are likely related to other factors associated with an urban environment.

Active transportation to school over 2 years in relation to weight status and physical activity

OBJECTIVE

To prospectively examine potential benefits of active commuting to school on measures of weight status and physical activity in a sample of youth.

RESEARCH METHODS AND PROCEDURES

A cohort of students from seven elementary schools was measured four times--in the fall and spring of fourth grade (N = 1083) and fifth grade (N = 924). Participants were classified as active (walking, biking, or skateboarding to school almost every day for baseline analyses or at least 2 d/wk for analyses of consistent active commuting) or non-active commuters to school. Accelerometers were used to measure physical activity. Height, weight, and skinfolds were objectively assessed.

RESULTS

Boys who actively commuted to school had lower BMI (p < 0.01) and skinfolds (p < 0.05) than non-active commuters to school in the fourth grade. Active commuting to school over 2 years was not associated with BMI change or overweight status.

DISCUSSION

Walking and cycling to school may contribute to preventing excessive weight gain, or leaner children may walk or cycle to school.

Personal, family, social, and environmental correlates of active commuting to school

BACKGROUND

Active commuting to school may be an important opportunity for children to accumulate adequate physical activity for improved cardiovascular risk factors, enhanced bone health, and psychosocial well-being. The purpose of this study was to examine personal, family, social, and environmental correlates of active commuting to school among children.

METHODS

Cross-sectional study of 235 children aged 5 to 6 years and 677 children aged 10 to 12 years from 19 elementary schools in Melbourne, Australia. Self-administered questionnaires were completed by parents, and the older children. The shortest possible routes to school were examined using a geographic information system.

RESULTS

Among both age groups, negative correlates of active commuting to school included parental perception of few other children in the neighborhood and no lights or crossings for their child to use, and an objectively assessed busy road barrier en route to school. In younger children, an objectively assessed steep incline en route to school was negatively associated with walking or cycling to school. Good connectivity en route to school was negatively associated with walking or cycling to school among older children. Among both age groups, children were more likely to actively commute to school if their route was <800 meters. There were no associations with perceived energy levels or enjoyment of physical activity, weight status, or family factors.

CONCLUSIONS

For children, creating child-friendly communities and providing skills to safely negotiate the environment may be important. Environmental correlates of active transport in children and adults may differ and warrant further investigation.

Physical Activity and Active Commuting to Elementary School

PURPOSE

This study was conducted to determine if fifth-grade students who walked or bicycled to school on a regular basis were more physically active than those that did not.

METHODS

The sample consists of 219 fifth-grade students (10.3 +/- 0.6 yr, 44% male, 58% minority) from eight randomly selected urban and suburban elementary schools. Students wore an Acti-Graph physical activity monitor during the same week that they completed a daily survey to report their mode of transportation to and from school. Students were categorized on the number of reported active commuting trips, to and from school, per week (regular;>or=5 (N=11), irregular; 1-4 (N=25), nonactive; 0 (N=183)).

RESULTS

Compared with both other groups, regular active commuters accumulated 3% more minutes of moderate-to-vigorous physical activity (MVPA; P=0.04) during weekdays. This weekday difference was because of regular active commuters accumulating 8.5% more minutes of MVPA both before and after school (P <or= 0.01). No difference in physical activity was seen among groups during school or in the evening. Based on the mean number of minutes the students wore their monitors on weekdays (800 min.d), the 3% difference translates into approximately 24 additional minutes of MVPA per day for the regular active commuters.

CONCLUSION

Walking to school was associated with approximately 24 additional minutes of MVPA per day in fifth-grade students. Additional observational and experimental research in larger, more diverse samples is needed to further clarify the effects of active commuting to school on total daily physical activity and other health outcomes.

Active commuting to school among NSW primary school children: implications for public health

Regular active commuting by walking/cycling can help maintain an active lifestyle. The frequency, duration and correlates of school active commuting were examined for primary school children in NSW, Australia. Walking/cycling-only and in combination with bus/car were of short duration (median 7 or 4 min, respectively) and their frequency dropped within a short distance (>0.75 km) from school. Apart from distance, child's age, school affiliation and perceived safety, regular walking/cycling (10 trips, 22%) was associated with parents' travel mode to work and with father taking the child to school. Frequent walking/cycling (5 trips, 37%) was associated with child's level of independence and the perceived benefits of active commuting. Behaviour change in this setting requires multi-level strategies.

Physical activity levels of children who walk, cycle, or are driven to school

BACKGROUND

Active commuting to school by walking or bicycle is widely promoted to increase children's physical activity. However, there is little data to describe the impact that travel mode, and in particular cycling, may have on activity levels.

METHODS

Primary school children wore an accelerometer recording minute-by-minute physical activity, and completed questions describing travel habits. Total volume of physical activity and hourly physical activity patterns were estimated and groups of children compared by mode of travel to school. Data were collected as part of the European Youth Heart Study.

RESULTS

A total of 332 children (average age 9.7 years, standard deviation [SD] = 0.4 years) completed all measurements. Children who walked to school were significantly more physically active than those who traveled by car (accelerometer counts per minute [cpm]: 667.7, SD = 233.7 vs 557.3, SD = 191.4; p = 0.01). Those who cycled to school recorded higher accelerometer counts than those who traveled by car, but differences were not significant. Boys who walked or cycled to school were significantly more physically active than those traveling by car (walk: 732.2 cpm, SD = 253.1 vs 592.8 cpm, SD = 193.9; p=0.007; cycle: 712.6 cpm, SD = 249.1 vs 592.8 cpm, SD = 193.9; p = 0.013). In girls, walking but not cycling to school was significantly associated with higher daily physical activity levels (606.3 cpm, SD = 197.7, vs 523.4 cpm, SD = 185.0 cpm; p = 0.05).

CONCLUSIONS

In primary school-aged children, walking to school is associated with higher levels of overall physical activity compared with those who travel to school by motorized transport. Cycling is associated with higher overall physical activity only in boys.

Active commuting to and from school and BMI in elementary school children-preliminary data

BACKGROUND

United States National Health Objectives include increasing the proportion of trips made by walking to and from school for children who live within 1.6 km to 50%. The purpose of this objective is to increase the level of physical activity among children. However, the impact of walking, bicycling or skating (active commuting) to and from school on the prevalence of overweight is unknown.

METHODS

Body mass index (BMI) was measured for 320 children (age 10.2+/-0.7 years) in September. Over 5 months, an active commuting index (SI) and daily physical activity were estimated via questionnaire. In April, BMI and body fat were measured.

RESULTS

A significant positive association was found between April BMI and SI adjusting for September BMI (partial r=0.03, P<0.05). Positive associations were found between SI and physical activity before school (r=0.17, P<0.05) and daily moderate intensity physical activity (r=0.13, P<0.05). There were no significant association between SI and BF (P>0.05).

CONCLUSIONS

This preliminary data suggests that active commuting does not appear to provide sufficient amounts of physical activity to attenuate BMI; however, it may contribute to the attainment of physical activity recommendations. Future research is needed to objectively measure the impact of active commuting on the prevalence of overweight.

Epidemiology of leisure-time physical activity: a population-based study in southern Brazil

We aimed to measure the prevalence of physical inactivity (PI) during leisure time and to identify variables associated with it in a southern Brazilian adult population. A population-based cross-sectional study was carried out, covering a multiple-stage sample of 1,968 subjects aged 20-69 years. Weekly participation in leisure-time physical activity was addressed. For each activity, energy expenditure was calculated using data on duration, metabolic equivalent, and body weight. Energy expenditures of individual activities were summed to give a weekly total. PI was defined as fewer than 1,000 kilocalories per week. The prevalence of PI was 80.7% (95%CI: 78.9-82.4). After adjusted analyses, the following variables were positively associated with the outcome: female gender, age, living with a partner, and smoking. Schooling and economic status were inversely associated with PI. Chronically undernourished individuals were significantly more likely to be inactive. We found no differences according to skin color or alcohol consumption. In conclusion, the prevalence of PI in this adult population was higher than in populations from developed countries, but the associated variables were similar.

Contribution of School Programmes to Physical Activity Levels and Attitudes in Children and Adults

Although children and youth currently form the most active segments of the population in developed societies, there is a marked trend toward an increase in sedentary lifestyle among school-age children. The purpose of this review is to analyse the effects of school physical education (PE) programmes on: (i) the physical activity (PA) levels of participants as children and adults; and (ii) attitudes toward PE and PA in the same groups. Based on the literature analysed, it can be suggested that a sufficient quantity of a quality PE programme can contribute significantly to the overall amount of moderate-to-intense PA of the school-age child. Schools also have the potential to influence the habitual PA of children by encouraging increased participation in extracurricular sports activities, by favouring active commuting to school and by providing exercise equipment and supervision for youth in their neighbourhoods. Most young children have a very positive attitude towards PE. However, as they grow older, their perception of PE as a positive experience seems to become more ambiguous. From the few studies available, it seems likely that quality PE programmes help to maintain initial positive perceptions. Future research should address factors influencing the change of perceptions as a child matures. In addition to offering a quality PE programme, schools should ensure that the total weekly amount of PE is sufficient not only to maintain but also to enhance a child's physical fitness. More research is needed to determine the ability of school PE programmes to influence PA behaviour in adult life and to evaluate strategies that will make optimal use of the curricular time allocated to PE.

Physical inactivity: prevalence and associated variables in Brazilian adults

PURPOSE

To measure the prevalence of physical inactivity, and variables associated with it, in an adult southern Brazilian population.

METHODS

Population-based cross-sectional study covering a multiple-stage sample of 3182 subjects aged 20 yr or more. Physical activity was assessed through the short version of the International Physical Activity Questionnaire (IPAQ), using home interviews with last-week recall. The questionnaire covers leisure, occupation, transportation, and housework activities. Physical inactivity was defined as fewer than 150 min.wk(-1) spent in moderate or vigorous physical activities. The time spent in vigorous activities was multiplied by two.

RESULTS

The prevalence of physical inactivity was 41.1%. After multivariate analyses, inactivity was positively associated with age and socioeconomic status, and inversely associated with self-reported health status. Those with white skin color and women who live alone rather than with a partner were more likely to have physical inactivity. Body mass index showed a significant U-shaped relationship with inactivity among men.

CONCLUSION

The prevalence of physical inactivity in this Brazilian adult population is high, even though lower than reported in studies of leisure-time activity alone in other populations. Studies in developing countries may be seriously biased if activities during labor, transportation, and housework are not assessed.