Reliability and validity testing of a single-item physical activity measure

Get active now or later? The association between physical activity and risk and time preferences

Despite the well-established link between physical activity and positive health outcomes, much of the world's population remains inactive. Many people don't invest in health behaviours, such as physical activity, in the present, despite the long-term benefits of this. The aim of this study was to assess the relationship between physical activity levels and risk and time preferences in university students. A maximum likelihood model was used to jointly estimate risk and time preferences (elicited in an incentivised choice experiment), and to examine the relationship between these preferences and self-reported physical activity. Physically inactive people discounted the future significantly more than physically active people did. Physically active people made slightly more risky choices in our risk attitude task, although this directional relationship was not statistically significant. The link between time preferences and physical activity suggests that further research on behavioural strategies such as commitment devices, nudging or temptation bundling may be helpful in increasing physical activity for individuals who discount the future in favour of more immediate benefits.

Mechanisms underlying the associations between different types of nature exposure and sleep duration: An 18-country analysis

Whilst green space has been linked to healthier sleep outcomes, the roles of specific types of nature exposure, potential underlying mechanisms, and between-country variations in nature-sleep associations have received little attention. Drawing on cross-sectional survey data from an 18-country sample of adults (N = 16,077) the current study examined: 1) the relative associations between six different types of nature exposure (streetscape greenery, blue view from home, green space within 1 km, coast within 1 km, green space visits, blue space visits) and insufficient sleep (<6 h vs. 7-10 h per day); 2) whether these relationships were mediated by better mental wellbeing and/or physical activity; and 3) the consistency of these pathways among the different countries. After controlling for covariates, neighbourhood nature measures (green space, coast within 1 km) were not significantly associated with insufficient sleep; but nature visible from home (streetscape greenery, blue views) and recreational visits to green and blue spaces were each associated with less insufficient sleep. Significant nature-sleep associations were mediated, to varying degrees, by better mental wellbeing, but not self-reported physical activity. Country-level heterogeneity in the strength of nature-sleep associations was observed. Increasing nature visible from the home may represent a promising strategy for promoting healthier sleep duration at the population level, whilst nature-based interventions encouraging individuals to spend time in local green/blue spaces may be an appropriate target to assist individuals affected by insufficient sleep.

Adherence to physical activity recommendations and associations with self-efficacy among Norwegian adolescents: trends from 2017 to 2021

Background

The crucial role of physical activity (PA) in promoting well-being and overall health of adolescents is widely acknowledged. Previous global studies have consistently revealed low adherence to PA recommendations among adolescents, emphasizing potential links between PA engagement and self-efficacy in school-based populations. However, there is a need for further exploration of this relationship, in particularly gender differences and taking into account the potential influences of the COVID-19 pandemic. The objective of this study is to provide a comprehensive description of adherence to PA recommendations and its associations with self-efficacy in Norwegian school-based adolescents over the period from 2017 to 2021.

Methods

Cross-sectional data on physical activity (PA) levels and self-efficacy among 13-19-year-old Norwegian adolescents were collected from the Norwegian Ungdata Survey during the period 2017 to 2021. The survey, conducted in Norwegian lower- and upper-secondary schools, was administered electronically during school hours. All data collected is anonymous and has received approval from the Norwegian Agency for Shared Services in Education and Research (SIKT). Statistical analyses were performed using SPSS software.

Results

Girls consistently exhibited lower adherence to PA recommendations (17.6-19.8%) compared to boys (27.7-31.1%) each year from 2017 to 2021 (all p < 0.01). Similarly, girls reported lower self-efficacy (14.1 to 14.8 out of 20) than boys (15.5 to 15.9) during the same period (all p < 0.01). Regression analyses highlighted robust positive associations between PA and self-efficacy in those adhering to PA recommendations (i.e., physically active at least 5 times a week) and strong inverse associations for those reporting inactivity (never active) in both girls and boys from 2017 to 2021.

Conclusion

Adolescents in Norway report PA adherence ranging from 15 to 30%, with girls consistently exhibiting lower adherence to PA recommendations and reporting lower self-efficacy than boys. Notably, there are substantial associations between self-efficacy and both adherence to PA recommendations and inactivity over time. These findings underscore the significance of promoting adherence to PA recommendations during adolescence, especially among girls. Policymakers in Norway should focus on initiatives to increase PA levels among adolescents in both lower and upper secondary schools.

Move for Life an intervention for inactive adults aged 50 years and older: a cluster randomised feasibility trial

Background

Move for Life (MFL) is a theory-informed intervention that was developed to augment established physical activity (PA) programmes and enable inactive adults aged 50 years and older to be more active. This study examined the feasibility of MFL and sought to provide evidence of its potential for improving PA and associated health outcomes.

Methods

A 3-arm cluster randomised feasibility trial compared MFL intervention, usual provision (UP) and control (CON) groups at baseline (T0), post-intervention (T1, at 8, 10 or 12- weeks) and 6-month follow up (T2). We used purposive sampling strategies to recruit participants according to characteristics of interest. Feasibility outcomes assessed recruitment, fidelity, adherence, retention and data completion rates based on pre-set criteria. Primary outcomes were accelerometer-based moderate-to-vigorous intensity PA (MVPA) and self-reported compliance with physical activity guidelines (PAGL). Secondary outcomes included light intensity PA (LiPA), standing time, sedentary time, body composition (adiposity), physical function and psychological well-being. We used linear mixed models (continuous outcomes) or generalized estimated equations (categorical outcomes) to estimate group differences over time in the study outcomes.

Results

Progression criteria for feasibility outcomes were met, and 733 individuals were recruited. Considering a 6-month period (T0-T2), while self-reported compliance with PAGL increased in MFL relative to UP and CON and in UP relative to CON, standing time decreased in MFL relative to CON and sedentary time increased in the latter compared to UP. Waist circumference decreased in MFL relative to UP and CON. MFL outperformed UP in the Timed Up and Go Test while MFL and UP increased the distance covered in the Six-Minute Walk Test compared to CON. Psychological well-being increased in MFL relative to CON (all p < 0.05).

Conclusion

Findings show that MFL is feasible, while data are promising with regards to the potential of improving community PA programmes for adults aged 50 or more years.

Clinical trial registration

https://www.isrctn.com/Registration#ISRCTN11235176.

Exercise as medicine! Physical activity mitigated the impact of the COVID-19 pandemic on depressive symptoms in adults with depression

We investigated the longitudinal association between physical activity (PA) and symptoms of depression and anxiety in people with depression during the COVID-19 pandemic. We used data from baseline (June 2020) to wave 3 (June 2021) of the PAMPA Cohort, an ambispective cohort with adults in south Brazil. The Hospital Anxiety and Depression Scale assessed depressive and anxiety symptoms in all waves. Participants reported frequency (minutes), type (aerobic, strength, combined), and place (out of home, at home) of physical activity at baseline. Generalized linear models were used to investigate the interaction between time and PA, adjusting for possible confounding variables. Subjective memory decline was assessed using multivariate Cox proportional hazard regression models to obtain adjusted hazard ratio (HR) and respective 95% confidence interval (CI). Participants (n = 424) with self-reported clinically diagnosed depression were included. We observed a non-linear increase trajectory of depression during the first year of the COVID-19 pandemic. PA was associated with a slower trajectory of depressive (slope: -1.89; 95%CI: -3.34, -0.43 points) but not anxiety (slope: -1.33; 95%CI: -2.93, 0.25 points) symptoms during the COVID-19 pandemic. Participants who continued physically active from pre-pandemic in wave 1 showed a lower risk of subjective memory decline during follow-up than those who persisted inactive in the same period (HR: 0.52; 95%CI: 0.30, 0.89). PA attenuated the impact of the COVID-19 pandemic on depressive symptoms in adults living with depression in south Brazil. Regularity of physical activity was associated with fewer depression and anxiety symptoms and a lower risk of subjective memory decline.

Factors That Help and Hinder the Implementation of Community-Wide Behavior Change Programs

Novel community-wide approaches that gamify physical activity through challenges and competition have become increasingly popular in recent years. However, little is known about the factors that help or hinder their implementation. This qualitative study aimed to address this gap in the literature by systematically investigating the facilitators (organizational and experiential) and barriers to successful implementation of a community-wide intervention delivered in Gloucester, the United Kingdom. A two-phased process evaluation was conducted. Phase 1 involved the thematical analysis of open question feedback from n = 289 adults. Phase 2 included three focus groups conducted with n = 12 participants. This research showed that promoting the initiative through primary education settings was fundamental to enhancing awareness and participation. Social elements of the intervention were identified as a motivating factor for, and a consequential outcome of, participation. A lack of promotion to wider-reaching proportions of the community was perceived to be a significant barrier to implementation, potentially limiting inclusivity and participation in the activity. Game dynamics, timing, and fears regarding sustainability represented further difficulties to implementation.

Procrastination and physical activity: The moderated mediating effect of grit

Objective: To explore the relation between procrastination and physical activity in college students and test whether grit mediated, age and gender moderated the process. Participants: 610 college students (aged 20.07 ± 1.53; 45.2% males) in Shanghai. Methods: Procrastination, grit and physical activity were tested respectively by International Procrastination Scale, Grit-S scale and International Physical Activity Questionnaire. Results: Correlation analysis showed that procrastination, grit and physical activity were related in pairs. Procrastination was negatively correlated with physical activity. Grit mediated between procrastination and physical activity. Females showed stronger moderation effect from grit to physical activity than males, while the effect between procrastination and grit was more significant for the younger. Conclusion: The moderated mediating model provided a new strategy of improving personality traits which contributed to lack of physical activity. More psychologically relevant measures should be taken in reducing procrastination to improve physical activity via improving grit.

Gender-specific link between sleep quality and body composition components: a cross-sectional study on the elderly

Sleep duration has been associated with overweight/obesity. Since sleep quality and body composition alter during aging, we conducted this study to determine if sleep quality is linked to body composition components in elderly people. This is a cross-sectional study conducted on 305 Iranian community-dwelling elderly aged ≥ 65 years. Sleep quality and body composition components were evaluated using Pittsburgh sleep quality index and bioelectric impedance analysis, respectively. The association of sleep quality and body composition components was examined using linear regression analysis. The prevalence of poor sleep quality and overweight/obesity was 48.9% and 54.4% in men and 77.0% and 79.3% in women, respectively. Women had significantly higher scores in most PSQI items than men, indicating their worse sleep quality compared to men. Women also had significantly higher body mass index (BMI), body fat percentage, and visceral adipose tissue and lower skeletal muscle and fat-free mass percentages than men. In the adjusted regression model, men showed positive associations between the third tertile of poor sleep quality and BMI (B = 1.35; 95% CI 0.08-2.61) and waist circumference (B = 4.14; 95% CI 0.39-7.89), but they did not demonstrate an association between sleep quality and body composition components. In the adjusted regression model for women, there were positive associations for BMI (B = 1.21; 95% CI 0.34-2.07), waist circumference (B = 2.95; 95% CI 0.99-4.91), body fat percentage (B = 2.75; 95% CI 1.06-4.45), and visceral adipose tissue (B = 7.80; 95% CI 1.73-13.87); also there were negative associations for skeletal muscle (B =  - 1.40; 95% CI - 2.39 - - 0.41) and fat-free mass (B =  - 2.76; 95% CI - 4.46 - -1.07) percentages. Except for waist circumference, other variables differed between men and women (P < 0.001). Weight management, prevention of muscle wasting, and improvement of sleep quality should be considered in a consortium when designing healthcare strategies for the elderly.

Associations of the 'weekend warrior' physical activity pattern with all-cause, cardiovascular disease and cancer mortality: the Mexico City Prospective Study

OBJECTIVES

The objective was to investigate the benefits of the 'weekend warrior' physical activity pattern in Latin America, where many people take part in high levels of non-exercise physical activity.

METHODS

Participants in the Mexico City Prospective Study were surveyed from 1998 to 2004 and resurveyed from 2015 to 2019. Those who exercised up to once or twice per week were termed weekend warriors. Those who exercised more often were termed regularly active. Analyses were adjusted for potential confounders.

RESULTS

The main analysis included 26 006 deaths in 154 882 adults (67% female) aged 52±13 years followed for 18±4 years (mean±SD). Compared with those who reported no exercise, the HR (95% CI) was 0.88 (0.83 to 0.93) in the weekend warriors and 0.88 (0.84 to 0.91) in the regularly active. Similar results were observed for cardiovascular disease and cancer mortality, but associations were weaker. Stratified analyses showed that substantial reductions in all-cause mortality risk only occurred when the duration of exercise sessions was at least 30-60 min. The repeated-measures analysis included 843 deaths in 10 023 adults followed for 20±2 years. Compared with being inactive or becoming inactive, the HR was 0.86 (95% CI 0.65 to 1.12) when being a weekend warrior or becoming a weekend warrior and 0.85 (95% CI 0.70 to 1.03) when being regularly active or becoming regularly active.

CONCLUSIONS

This is the first prospective study to investigate the benefits of the weekend warrior physical activity pattern in Latin America. The results suggest that even busy adults could benefit from taking part in one or two sessions of exercise per week.

Level and correlates of physical activity among children and adolescents with juvenile idiopathic arthritis compared to controls: results from a German nationwide prospective observational cohort study

BACKGROUND

Physical active lifestyles are essential throughout growth and maturation and may offer potential preventive and therapeutic benefit in patients with juvenile idiopathic arthritis (JIA). Insufficient physical activity (PA), in contrast, can lead to aggravation of disease-related symptoms. This study aimed to i) examine PA levels in children and adolescents with JIA compared to general population controls and ii) investigate correlates of pronounced physical inactivity in order to identify risk groups for sedentary behaviour.

METHODS

Data from children and adolescents with JIA and population controls aged 3 to 17 years documented in the National Pediatric Rheumatologic Database (NPRD) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were used. Self-reported PA was collected from parents/guardians of children up to 11 years of age or adolescents 12 years of age and older. To compare PA-related data, age- and sex-specific pairwise analyses were conducted considering NPRD/KiGGS participants' data from 2017. Correlates of physical inactivity among patients were identified using a linear regression model.

RESULTS

Data of 6,297 matched-pairs (mean age 11.2 ± 4.2 years, female 67%, patients' disease duration 4.5 ± 3.7 years, persistent oligoarthritis 43%) were available for evaluation. Almost 36% of patients aged 3-17 years (vs. 20% of controls) achieved the WHO recommended amount of PA, while PA steadily decreased with age (18% of patients aged ≥ 12 years) and varied between JIA categories. Female adolescents and patients with enthesitis-related arthritis were least likely to achieve the minimum recommended level of PA. Physical inactivity was associated with female sex, higher age at disease onset, longer disease duration, more functional disability (C-HAQ) and higher disease activity (cJADAS-10).

CONCLUSIONS

Depending on JIA category, children and adolescents with JIA were similarly or even more likely to achieve the WHO recommended minimum level of PA compared to general population controls. However, since a large proportion of young JIA patients appear to be insufficiently physically active, engagement in targeted efforts to promote PA is urgently needed.

The "bubbles"-study: Validation of ultra-short scales for the assessment of depression, anxiety and stress symptoms

Depression, anxiety and stress symptoms cause substantial psychological and economic burdens around the globe. To mitigate the negative consequences, the negative symptoms should be identified at an early stage. Therefore, the implementation of very brief valid screening tools in mental health prevention programs and in therapeutic settings is advantageous. In two studies on representative German population samples, we developed and validated three ultra-short scales-the "bubbles"-that consist of only one item based on the Depression Anxiety Stress 21 subscales (DASS-21) for the assessment of depression, anxiety and stress symptoms. The results of Study 1 (N = 1,001) and Study 2 (N = 894) revealed that the bubbles are valid instruments that fit the DASS-21 subscales on the factor level. Moreover, the bubbles replicated the association pattern of the DASS-21 subscales with demographic variables, and with variables that belong to the negative and the positive dimension of mental health. Thus, due to their time- and cost-efficiency, the bubbles can be used as brief screening tools in research (e.g., large-scale studies, longitudinal studies, experience sampling paradigms) and in praxis. Their shortness can prevent fatigue, motivation decrease, and participants' drop-out.

Validity, reliability, and readability of single-item and short physical activity questionnaires for use in surveillance: A systematic review

BACKGROUND

Accurate and fast measurement of physical activity is important for surveillance. Even though many physical activity questionnaires (PAQ) are currently used in research, it is unclear which of them is the most reliable, valid, and easy to use. This systematic review aimed to identify existing brief PAQs, describe and compare their measurement properties, and assess their level of readability.

METHODS

We performed a systematic review based on the PRISMA statement. Literature searches were conducted in six scientific databases. Articles were included if they evaluated validity and/or reliability of brief (i.e., with a maximum of three questions) physical activity or exercise questionnaires intended for healthy adults. Due to the heterogeneity of studies, data were summarized narratively. The level of readability was calculated according to the Flesch-Kincaid formula.

RESULTS

In total, 35 articles published in English or Spanish were included, evaluating 32 distinct brief PAQs. The studies indicated moderate to good levels of reliability for the PAQs. However, the majority of results showed weak validity when validated against device-based measurements and demonstrated weak to moderate validity when validated against other PAQs. Most of the assessed PAQs met the criterion of being "short," allowing respondents to complete them in less than one minute either by themselves or with an interviewer. However, only 17 questionnaires had a readability level that indicates that the PAQ is easy to understand for the majority of the population.

CONCLUSIONS

This review identified a variety of brief PAQs, but most of them were evaluated in only a single study. Validity and reliability of short and long questionnaires are found to be at a comparable level, short PAQs can be recommended for use in surveillance systems. However, the methods used to assess measurement properties varied widely across studies, limiting the comparability between different PAQs and making it challenging to identify a single tool as the most suitable. None of the evaluated brief PAQs allowed for the measurement of whether a person fulfills current WHO physical activity guidelines. Future development or adaptation of PAQs should prioritize readability as an important factor to enhance their usability.

Associations Between Subjective Social Status and Health Behaviors Among College Students

OBJECTIVE

Examine the associations between subjective social status (SSS), diet, and health outcomes in college students.

METHODS

Cross-sectional study of 841 students enrolled at a large Midwestern university. Subjective social status within the US, as well as within the university, was measured using the MacArthur Scale of SSS. Outcomes included dietary intake (assessed using the Dietary Screening Questionnaire), body mass index, sleep, physical activity, alcohol use, and vaping behavior. Generalized linear models adjusting for students' sociodemographic characteristics were used to assess associations between SSS and outcomes of interest.

RESULTS

Higher SSS-US was associated with 4%, 3%, and 1% higher intake of fruits, whole grains, and fiber, respectively (P < 0.05). Higher SSS-US and SSS-university rankings were both significantly associated with lower body mass index and better sleep duration (P < 0.05). Higher SSS-university rankings were also associated with more days of physical activity and alcohol consumption (P < 0.05).

CONCLUSIONS AND IMPLICATIONS

In this exploratory study, higher SSS, apart from alcohol intake, was associated with more favorable health outcomes. More research is needed to consider additional psychological and biological mediators and dynamic aspects of SSS, examine potential interactions between SSS and racial and ethnic identities, and explore potential mechanisms underlying the observed associations.

Assessing Support for Policy Actions With Co-Benefits for Climate Change and Physical Activity in Canada

BACKGROUND

Calls to action addressing the interconnections between physical (in)activity and the climate crisis are increasing. The current study aimed to investigate public support for policy actions that potentially have co-benefits for physical activity promotion and climate change mitigation.

METHODS

In 2023, a survey through the Angus Reid Forum was completed by 2507 adults living in Canada. Binary logistic regressions were conducted. Separate models were created to reflect support or opposition to the 8 included policy items. Several covariates were included in the models including age, gender, political orientation, physical activity levels, income, urbanicity climate anxiety, and attitudes surrounding physical activity and climate change. The data were weighted to reflect the gender, age, and regional composition of the country.

RESULTS

Most individuals living in Canada strongly or moderately supported all actions (ranging from 71% to 85%). Meeting the physical activity guidelines, higher self-reported income, and scoring high on personal experience of climate change were associated with higher odds of supporting the policy actions related to climate actions.

CONCLUSIONS

Most adults living in Canada support policies that align with the recommended policy actions related to physical activity and climate change. National campaigns enhancing awareness and understanding of the bidirectional relationship between physical activity and climate change are warranted, and these should consider the consistent demographic differences (eg, gender, age, and political orientation) seen in public support for physical activity-related policies.

The relationship between workplace toxicity, stress, physical activity and emotional eating

This study examines the relationship between perceived workplace toxicity and stress of employees in the hospitality industry and emotional eating behaviors within the context of their physical activity levels. A cross-sectional design from amongst the quantitative research methods was used, in which data were collected via questionnaires from 846 participants who work in five-star hotels in Alanya, Turkey. The study concluded that workplace toxicity positively predicts stress and emotional eating, and the impact of workplace toxicity on emotional eating occurs via stress. Furthermore, physical activity plays a moderating role in the effect of workplace toxicity and stress on emotional eating. As employees' physical activity levels drop, the effect of both stress and workplace toxicity on emotional eating significantly increases. These results reveal that physical activity buffers the negative effects of workplace toxicity and stress on emotional eating.

The Temporal Relationship Between Moderate to Vigorous Physical Activity and Secondary Conditions During the First Year After Moderate to Severe Traumatic Brain Injury

OBJECTIVE

To determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist-worn accelerometer and secondary conditions in the first year after moderate to severe traumatic brain injury (TBI).

DESIGN

Prospective longitudinal cohort study.

SETTING

Four inpatient rehabilitation centers.

PARTICIPANTS

Individuals (N = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study.

INTERVENTIONS

Participants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6- and 12-months post injury.

MAIN OUTCOME MEASURES

Minutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone).

RESULTS

At baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point.

CONCLUSIONS

Given the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the effect of physical activity in individuals with moderate-severe TBI.

Investigating physical activity levels in adults who are blind and vision impaired

BACKGROUND

It is well established that meeting physical activity (PA) guidelines has a range of physical and mental health benefits. For people who are blind and vision impaired (BVI) there may be additional benefits in terms of social inclusion and the prevention of sight deterioration.

OBJECTIVE

This study aimed to quantify PA levels, barriers to and motivators for PA in adults who are BVI.

METHODS

PA levels, perceived barriers to, and motivators for PA were measured via questionnaire of 310 self-identifying BVI adults (n = 310 mean age = 29.77 ± 11.37, 55.8% male).

RESULTS

PA levels were low, with 21.7% meeting PA guidelines. Median PA levels were not statistically significantly different between different age groups. There was no significant difference between genders, though mean days of PA for males was 0.382 days lower than for females. There was a significant difference between PA levels between the "no vision" (B1) and "useful vision" (B3) groups (p = 0.027), and the "no vision" (B1) and the "low vision" (B2) groups (p = 0.003). Transport (54.8%) and lack of access to enjoyable activities (47.0%) were the most commonly cited barriers, while "to relax" (36.4%) and "to have fun" (35.6%) were most commonly cited as very important motivators.

CONCLUSIONS

This study provides a valuable insight into the low levels of PA that persist amongst adults with BVI. Future research should seek to gain a deeper understanding of the PA barriers, motivators and facilitators in this cohort.

A cross-sectional study of Australian teachers' health: are work-related factors associated with lifestyle behaviours?

Teacher's lifestyle behaviours are important because they lead to positive health outcomes for teachers themselves and because teachers model behaviour to their students. This cross-sectional study examined the lifestyle behaviours of a large sample of teachers in New South Wales (NSW), Australia and assessed the association between work-related factors and lifestyle behaviours. From February to October 2021, data were collected on the lifestyle behaviours, work-related factors and socio-demographics of primary and secondary school teachers in NSW, via an online survey. Associations between individual work-related factors and lifestyle behaviours were modelled using logistic regression and adjusted for sex, age, number of children and geographic location. Most of our survey sample (n = 1136) were women (75%) and 53% were reported as having overweight or obesity. Only 23% of teachers met the recommended physical activity guidelines, 39% met fruit intake guidelines, 9% met vegetable intake guidelines and 58% met healthy sleep guidelines. Most teachers (78%) met the recommendation of sugar-sweetened beverage consumption, 89% were not current smokers, but only 46% met the recommended alcohol consumption guidelines. Hours worked, teaching load, school sector and teacher role were associated with one or more lifestyle behaviours after adjusting for the demographic variables. This study highlights the need for additional support to improve the health-related behaviours of teachers in NSW. Policymakers should recognize the negative impact of high workloads on teachers' health-related behaviours, increasing their risk of chronic disease.

Use of a Single-Item Ecological Momentary Assessment to Measure Daily Exercise: Agreement with Accelerometer-Measured Exercise

Accelerometers have been used to objectively quantify physical activity, but they can pose a high burden. This study was conducted to determine the feasibility of using a single-item smartphone-based ecological momentary assessment (EMA) in lieu of accelerometers in long-term assessment of daily exercise. Data were collected from a randomized controlled trial of intermittently exercising, otherwise healthy adults (N = 79; 57% female, mean age: 31.9 ± 9.5 years) over 365 days. Smartphone-based EMA self-reports of exercise entailed daily end-of-day responses about physical activity; the participants also wore a Fitbit device to measure physical activity. The Kappa statistic was used to quantify the agreement between accelerometer-determined (24 min of moderate-to-vigorous physical activity [MVPA] within 30 min) and self-reported exercise. Possible demographic predictors of agreement were assessed. Participants provided an average of 164 ± 87 days of complete data. The average within-person Kappa was κ = 0.30 ± 0.22 (range: -0.15-0.73). Mean Kappa ranged from 0.16 to 0.30 when the accelerometer-based definition of an exercise bout varied in duration from 15 to 30 min of MVPA within any 30 min period. Among the correlates examined, sex was significantly associated with agreement; mean agreement was higher among women (κ = 0.37) than men (κ = 0.20). Agreement between EMA self-reported and accelerometer-measured exercise was fair, suggesting that long-term exercise monitoring through a single-item EMA may be acceptable.

The Impact of Different Intensities of Physical Activity on Serum Urate and Gout: A Mendelian Randomization Study

Physical activity is a potential protective factor against gout, but the role of exercise intensity in this context remains unclear. To overcome the limitations of observational studies in causal inference, this study employed a two-sample Mendelian randomization approach to explore the impact of different genetically proxied/predicted intensities of physical activity on serum urate concentration and the incidence of gout. Our data related to physical activity, serum urate, and gout were obtained from the UK Biobank, the Global Urate Genetics Consortium (GUGC), and the FinnGen dataset, respectively. Walking was included as representative of typical low-intensity physical activity in the analysis, and the other two types were moderate and vigorous physical activities. The estimation methods we used included the inverse-variance-weighted (IVW) method, MR-Egger regression, weighted-median method, simple-mode method, and weighted-mode method. Sensitivity analyses involved Rucker's framework, Cochran's Q test, funnel plots, MR-PRESSO outlier correction, and leave-one-out analysis. We found suggestive evidence from the inverse-variance-weighted method that moderate physical activity was a potential factor in reducing the incidence of gout (OR = 0.628, p = 0.034), and this association became more substantial in our subsequent sensitivity analysis (OR = 0.555, p = 0.006). However, we observed no distinctive effects of physical activity on serum urate concentration. In conclusion, our study supports some findings from observational studies and emphasizes the preventive role of moderate physical activity against gout. Given the limitations of the existing datasets, we call for future reexamination and expansion of our findings using new GWAS data.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Nursing Staff at an Academic Medical Center: A Cross-Sectional Analysis

BACKGROUND

Although several studies have recently described compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in nurses, few to date have examined these issues across nursing specialties. Such examination is needed to inform future nursing-subspecialty tailored interventions.

AIMS

To examine (1) differences in CS, BO, and STS across nursing specialties and (2) differences associated with demographic, work-related, and behavioral factors among nurses.

METHOD

A secondary analysis of survey responses from nurses (N = 350) at an academic medical center. Demographic, behavioral, work-related, and professional quality of life variables were analyzed using hierarchical regression analyses.

RESULTS

CS, BO, and STS scores significantly varied across specialties with emergency nurses experiencing significantly elevated rates of BO and STS, and lowest rates of CS; scores were also differentially associated with demographic, work-related, behavioral, and workplace violence variables.

CONCLUSIONS

Key differences in CS, BO, and STS by nursing specialty suggests the importance of tailoring BO and STS mitigative interventions. BO and STS risk factors should be assessed in nurses (e.g., behavioral health problems and poor sleep quality) and specialty-specific interventions (e.g., reducing workplace violence exposure in emergency settings) may be considered to improve CS while reducing BO and STS among nurses.

Re-assessing the social climate of physical (in)activity in Canada

Social-ecological models suggest that a strategy for increasing population physical activity participation is to reconstruct the "social climate" through changing social norms and beliefs about physical activity (PA). In this study, we assessed whether the PA social climate in Canada has changed over a five-year period after controlling for sociodemographic factors and PA levels. Replicating a survey administered in 2018, a sample of adults in Canada (n = 2,507) completed an online survey assessing social climate dimensions, including but not limited to descriptive and injunctive norms. Descriptive statistics were calculated, and binary logistic regressions were conducted to assess the associations of sociodemographic factors and year of the survey with social climate dimensions. Results suggest some social climate constructs are trending in a positive direction between 2018 and 2023. Physical inactivity was considered a serious public health concern by 49% of respondents, second to unhealthy diets (52%). Compared to those who participated in the 2018 survey, participants in 2023 were less likely to see others walking or wheeling in their neighbourhood (OR = 1.58, 95% CI: 1.41, 1.78), but more likely to see people exercising (OR = 0.82, 95% CI: 0.73, 0.92) and kids playing in their neighbourhood (OR = 0.75, 95% CI: 0.66, 0.85). No changes were reported between 2018 and 2023 in individuals' perceptions of whether physical inactivity is due to individual versus external factors (OR = 0.99, 95% CI: 0.87, 1.13). The findings of this work indicate a modest positive shift in some measured components of the social climate surrounding PA although attributing causes for these changes remain speculative.

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study

PURPOSE

Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors.

METHODS

A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations.

RESULTS

Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior.

CONCLUSIONS

Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA.

IMPLICATIONS FOR CANCER SURVIVORS

Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

Engagement in Physical Activity and Quality of Life Among Informal Caregivers of Older Adults

OBJECTIVES

This study examined (1) the association of caregiver engagement in physical activity (PA) with their quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between several caregiving stressors and their QoL, among informal caregivers of older adults.

METHODS

Multivariable regression was applied to data from 278 adult caregivers, aged 23-90 years, in Singapore.

RESULTS

Engagement in PA by caregivers was positively associated with psychological, social relationships, and environment domains of their QoL. Caregiver engagement in PA also mitigated the negative association between care-recipient mood impairment and QoL of caregivers in the physical health and social relationships domains.

DISCUSSION

QoL of caregivers may be improved or protected by their regular engagement in PA, especially when their care-recipients have mood impairment. Policymakers and practitioners should encourage caregivers to engage in PA and provide them with the necessary support to do so.

Effects of customer relationship management (CRM) strategies and socio-cognitive constructs on the physical activity of individuals with arthritis over time

BACKGROUND

Regular physical activity is important for arthritis self-management and could be promoted through tailoring community leisure and fitness centers' customer-relationship management (CRM) strategies.

OBJECTIVES

This study investigates the influence of two CRM strategies on individuals with arthritis reaching or maintaining two moderate-to-vigorous physical activity (MVPA) thresholds (≥150 and ≥45 minutes/week) from baseline-to-12 months and 12-to-24 months as well as mean changes in total minutes/week of MVPA. It also explores time-dependent variations in the influence of socio-cognitive variables on MVPA outcomes.

METHODS

Survey data from 374 participants with arthritis in a two-year randomized controlled trial (control versus two CRM strategies: IncentiveOnly and Incentive+Support) were used. Participants reported measures of physical activity participation, socio-cognitive decision-making, mental and physical wellbeing, friendship, community connectedness, sense of trust in others, and demographics.

FINDINGS/DISCUSSION

Receiving the Incentive+Support CRM strategy (versus control) increased participants' likelihood of reaching/maintaining both physical activity thresholds from 12-to-24 months (≥150 MVPA minutes/week, p < .001; ≥45 MVPA minutes/week, p < .032) but not from baseline-to-12 months. However, receiving the IncentiveOnly CRM strategy (versus control) did not predict reaching/maintaining these thresholds. Importantly, socio-cognitive decision-making variables' influence on reaching/maintaining these MVPA thresholds varied over time, suggesting CRM strategies may require further tailoring based on time-specific profiles. Perhaps because of new facility induced excitement, the mean change in total MVPA minutes/week for the control group significantly increased (26.8 minute/week, p = .014, 95% CI [5.5, 48.0]) from baseline-to-12 months, but subsequently declined by 11.4 minute/week from 12-to-24 months (p = .296, 95% CI [-32.7, 9.9]). Mean changes in total MVPA minutes/week were non-significant for those receiving IncentiveOnly content but significant for those receiving Incentive+Support content: baseline-to-12 months (38.2 minute/week increase, p = .023, 95% CI [4.9, 71.4]) and baseline-to-24-months (45.9 minute/week increase, p = .007, 95% CI [12.7, 79.1]).

Prospective Associations of Different Combinations of Aerobic and Muscle-Strengthening Activity With All-Cause, Cardiovascular, and Cancer Mortality

Importance

Studies examining the associations of different combinations of intensity-specific aerobic and muscle strengthening activity (MSA) with all-cause and cause-specific mortality are scarce; the few available estimates are disparate.

Objective

To examine the prospective associations of different combinations of moderate aerobic physical activity (MPA), vigorous aerobic physical activity (VPA), and MSA with all-cause, cardiovascular (CVD), and cancer mortality.

Design, Setting, and Participants

This nationwide prospective cohort study used data from the US National Health Interview Survey. A total of 500 705 eligible US adults were included in the study and followed up during a median of 10.0 years (5.6 million person-years) from 1997 to 2018. Data were analyzed from September 1 to September 30, 2022.

Exposures

Self-reported cumulative bouts (75 weekly minutes) of MPA and VPA with recommended MSA guidelines (yes or no) to obtain 48 mutually exclusive exposure categories.

Main Outcomes and Measures

All-cause, CVD, and cancer mortality. Participants were linked to the National Death Index through December 31, 2019.

Results

Overall, 500 705 participants (mean [SD] age, 46.4 [17.3] years; 210 803 [58%] female; 277 504 [77%] White) were included in the study. Compared with the reference group (doing no MPA or VPA and less than recommended MSA), the category associated with the lowest hazard ratio (HR) for all-cause mortality was more than 0 to 75 minutes of MPA combined with more than 150 minutes of VPA and 2 or more MSA sessions per week (HR, 0.50; 95% CI, 0.42-0.59). The optimal combinations for CVD and cancer mortality risk reduction were more than 150 to 225 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week (HR, 0.30; 95% CI, 0.15-0.57), and more than 300 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week (HR, 0.44; 95% CI, 0.23-0.82), respectively. Adjusted mortality rates represented an approximately 50% lower mortality rate for all-cause and cancer mortality and an approximately 3-fold lower mortality rate for CVD mortality.

Conclusions and Relevance

This cohort study demonstrated that balanced levels of MPA, VPA, and MSA combined may be associated with optimal reductions of mortality risk. Higher-than-recommended levels of MPA and VPA may further lower the risk of cancer and all-cause mortality, respectively.

Can digital health researchers make a difference during the pandemic? Results of the single-arm, chatbot-led Elena+: Care for COVID-19 interventional study

Background

The current paper details findings from Elena+: Care for COVID-19, an app developed to tackle the collateral damage of lockdowns and social distancing, by offering pandemic lifestyle coaching across seven health areas: anxiety, loneliness, mental resources, sleep, diet and nutrition, physical activity, and COVID-19 information.

Methods

The Elena+ app functions as a single-arm interventional study, with participants recruited predominantly via social media. We used paired samples T-tests and within subjects ANOVA to examine changes in health outcome assessments and user experience evaluations over time. To investigate the mediating role of behavioral activation (i.e., users setting behavioral intentions and reporting actual behaviors) we use mixed-effect regression models. Free-text entries were analyzed qualitatively.

Results

Results show strong demand for publicly available lifestyle coaching during the pandemic, with total downloads (N = 7'135) and 55.8% of downloaders opening the app (n = 3,928) with 9.8% completing at least one subtopic (n = 698). Greatest areas of health vulnerability as assessed with screening measures were physical activity with 62% (n = 1,000) and anxiety with 46.5% (n = 760). The app was effective in the treatment of mental health; with a significant decrease in depression between first (14 days), second (28 days), and third (42 days) assessments: F2,38 = 7.01, p = 0.003, with a large effect size (η2G = 0.14), and anxiety between first and second assessments: t54 = 3.7, p = <0.001 with a medium effect size (Cohen d = 0.499). Those that followed the coaching program increased in net promoter score between the first and second assessment: t36 = 2.08, p = 0.045 with a small to medium effect size (Cohen d = 0.342). Mediation analyses showed that while increasing number of subtopics completed increased behavioral activation (i.e., match between behavioral intentions and self-reported actual behaviors), behavioral activation did not mediate the relationship to improvements in health outcome assessments.

Conclusions

Findings show that: (i) there is public demand for chatbot led digital coaching, (ii) such tools can be effective in delivering treatment success, and (iii) they are highly valued by their long-term user base. As the current intervention was developed at rapid speed to meet the emergency pandemic context, the future looks bright for other public health focused chatbot-led digital health interventions.

Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries

The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults. Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics. Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities. The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention.

Sleep as a mediator of the relationship between social class and health in higher education students

A substantial body of research indicates that higher education students from lower social class backgrounds tend to have poorer health than those from higher social class backgrounds. To investigate sleep as a potential mediator of this relationship, online survey responses of students from five large Australian universities, one Irish university and one large Australian technical college were analysed in three studies (Study 1 N = 628; Study 2 N = 376; Study 3 N = 446). The results revealed that sleep quality, sleep duration, sleep disturbances, pre-sleep worries and sleep schedule variability mediated the relationship between social class and physical and mental health. Sleep remained a significant mediator when controlling for related variables and other mediators. Thus, the findings suggest that sleep partly explains social class differences in health. We discuss the importance of addressing sleep issues among students from lower social class backgrounds.

Hernia Active Living Trial (HALT): a feasibility study of a physical activity intervention for people with a bowel stoma who have a parastomal hernia/bulge

BACKGROUND

Parastomal bulging/hernia is a common complication associated with a stoma. Strengthening of the abdominal muscles via exercise may be a useful self-management strategy. The aim of this feasibility work was to address uncertainties around testing a Pilates-based exercise intervention for people with parastomal bulging.

METHODS

An exercise intervention was developed and tested in a single-arm trial (n = 17 recruited via social media) followed by a feasibility randomised controlled trial RCT (n = 19 recruited from hospitals). Adults with an ileostomy or colostomy with a bulge or diagnosed hernia around their stoma were eligible. The intervention involved a booklet, videos, and up to 12 online sessions with an exercise specialist. Feasibility outcomes included intervention acceptability, fidelity, adherence, and retention. Acceptability of self-report measures for quality of life, self-efficacy, and physical activity were assessed based on missing data within surveys pre- and post-intervention. Interviews (n = 12) explored participants' qualitative experiences of the intervention.

RESULTS

Nineteen of 28 participants referred to the intervention completed the programme (67%) and received an average of 8 sessions, lasting a mean of 48 min. Sixteen participants completed follow-up measures (44% retention), with low levels of missing data across the different measures, apart from body image and work/social function quality of life subscales (50% and 56% missing, respectively). Themes from qualitative interviews related to the benefits of being involved, including behavioural and physical changes in addition to improved mental health. Identified barriers included time constraints and health issues.

CONCLUSIONS

The exercise intervention was feasible to deliver, acceptable to participants, and potentially helpful. Qualitative data suggests physical and psycholosical benefits. Strategies to improve retention need to be included in a future study.

TRIAL REGISTRATION

ISRCTN, ISRCTN15207595 . Registered on 11 July 2019.

The impact of the first COVID-19 lockdown on weight management practices in UK adults: A self-regulation perspective

This study aimed to identify the impact of the first UK COVID-19 lockdown on individuals' weight management attempts (WMA). A self-regulation theoretical framework was used to identify predictors of continuing with a WMA, and weight change during the lockdown. An online retrospective cross-sectional study was conducted after the first UK COVID-19 lockdown. The sample consisted of 166 UK adults (M:31.08, SD:12.15) that were trying to manage their weight before the lockdown started. The survey assessed changes in WMA and practices, and measured perceived stress, flexible/rigid restraint, uncontrolled eating, craving control, and self-compassion. Results showed that 56% of participants reported disruption to their WMA during the lockdown. Participants with lower levels of perceived stress and higher flexible restraint were more likely to continue their WMA. Flexible restraint was a significant predictor of weight change. Interventions that promote flexibility in weight management may be beneficial for at-risk individuals under lockdown conditions.

Physical activity and long COVID: findings from the Prospective Study About Mental and Physical Health in Adults cohort

OBJECTIVES

The study investigated the longitudinal association between physical activity and the risk of long COVID in patients who recovered from COVID-19 infection.

STUDY DESIGN

We analyzed longitudinal data of the Prospective Study About Mental and Physical Health cohort, a prospective cohort study with adults living in Southern Brazil.

METHODS

Participants responded to an online, self-administered questionnaire in June 2020 (wave 1) and June 2022 (wave 4). Only participants who self-reported a positive test for COVID-19 were included. Physical activity was assessed before (wave 1, retrospectively) and during the pandemic (wave 1). Long COVID was assessed in wave 4 and defined as any post-COVID-19 symptoms that persisted for at least 3 months after infection.

RESULTS

A total of 237 participants (75.1% women; mean age [standard deviation]: 37.1 [12.3]) were included in this study. The prevalence of physical inactivity in baseline was 71.7%, whereas 76.4% were classified with long COVID in wave 4. In the multivariate analysis, physical activity during the pandemic was associated with a reduced likelihood of long COVID (prevalence ratio [PR]: 0.83; 95% confidence interval [CI]: 0.69-0.99) and a reduced duration of long COVID symptoms (odds ratio: 0.44; 95% CI: 0.26-0.75). Participants who remained physically active from before to during the pandemic were less likely to report long COVID (PR: 0.74; 95% CI: 0.58-0.95), fatigue (PR: 0.49; 95% CI: 0.32-0.76), neurological complications (PR: 0.47; 95% CI: 0.27-0.80), cough (PR: 0.40; 95% CI: 0.22-0.71), and loss of sense of smell or taste (PR: 0.43; 95% CI: 0.21-0.87) as symptom-specific long COVID.

CONCLUSION

Physical activity practice was associated with reduced risk of long COVID in adults.

Beyond the big city: using a systems approach to cultivate a cycling culture in small cities and towns in Ireland

Urban mobility and how people move in our towns and cities is garnering more attention, as solutions are sought to multiple challenges faced by residents; health and physical inactivity, climate change, air quality, urbanisation and accessibility. Traditional, siloed approaches limit impact and collaborative, systems approaches hold promise. However, systems approaches often remain theoretical and few practical applications of their added value have been demonstrated. This study illustrates how a systems approach can be used to underpin the development of a 9-step process to generate solutions for action on active mobility. The development of a systems map and a theory of change framework are key outputs of this 9-step process. The purpose of this paper is to describe how a systems map was developed in an Irish town utilising broad stakeholder engagement to map the variables that influence cycling in the town and to identify the leverage points for transformational interventions.

The relationships between passions, intentions, habit and exercise frequency

There were three purposes to this research. First, we sought to test the differential role of harmonious and obsessive passion in predicting intention and habit for exercise. The second goal of this research was to test the associations between intention, habit and exercise frequency. Last, the third goal was to assess the mediation role of intention and habit in the relationship between both forms of passion and exercise frequency. The sample consisted of 284 participants (140 males, 144 females) aged 18-60 years old (M age = 29.81, SD = 9.16). Regression paths of the structural model indicated significant associations: a) harmonious passion was significantly associated with intentions and habit; b) obsessive passion was significantly associated with habit; c) intentions and habit were significantly associated with exercise frequency. The mediation model variance explained was 17% (p < .001). The total effect via harmonious and obsessive passion was β = .57 (IC95% = .42, .73) and the total indirect effect was β = .11 (IC95% = .02, .24). Having harmonious passion for a fitness activity appears to have the potential to increase regular physical activity among exercisers. Individuals who recognize the significance of physical exercise and participate in activities they enjoy the most can affirm the positive effects on their health from being active.

Regional Differences in Self-Reported Health, Physical Activity and Physical Fitness of Urban Senior Citizens in Austria

The aim of this study is to compare data on the health status, self-reported exercise and non-exercise physical activity as well as fitness parameters, such as grip strength, of people in retirement in two cities that are both considered urban centres according to the statistical office of the European Union (EUROSTAT), but differ by geographic location. Self-reported physical activity questionnaires and objective assessments of physical fitness indicators collected by sports scientists were used and examined for differences. A total of 210 people (66.3 years ± 2.3) in Salzburg (n = 90) and Vienna (n = 120) was analysed. While no differences were found in self-reported health, there were differences in self-reported exposure to self-reported exercise and non-exercise physical activity, with the Viennese population being more inactive than their more western comparison group. In addition, the objective indicators for muscle strength, balance and flexibility of the lower extremities differed significantly in favour of the more western Austrian population. We recommend assessing the situation of older people in Austria regarding their physical activity and fitness on a regional basis, even if they live in cities of the same category. Future projects should therefore aim to consider specific regional needs during development and incorporate both subjective and objective indicators when monitoring the success of such programs.

Incidence of memory complaints during the COVID-19 pandemic in Southern Brazil: findings from PAMPA cohort

Population-level studies investigating the incidence of memory complaints during the COVID-19 pandemic are scarce.

Objective

This study aimed to examine the incidence of memory complaints over 15 months during the COVID-19 pandemic in adults from Southern Brazil.

Methods

Data from the PAMPA (Prospective Study about Mental and Physical Health in Adults) cohort, a longitudinal study with adults residing in Southern Brazil, were analyzed. An online-based, self-administered questionnaire was used to assess self-rated memory. Participants rated their memories as excellent, very good, good, fair, or poor. Incident memory complaints were defined as worse memory perception from baseline to follow-up. Cox proportional hazard models were used to identify factors associated with the increased risk of memory complaints.

Results

During follow-up, a cumulative incidence of 57.6% for memory complaints was observed. Female sex (hazard ratio [HR] 1.49; 95% confidence intervals [CI] 1.16-1.94), lack of access to prescribed medicine (HR: 1.54; 95%CI 1.06-2.23), and worsened anxiety symptoms (HR: 1.81; 95%CI 1.49-2.21) were associated with an increased risk of memory complaints. Regular practice of physical activity was associated with a reduced risk of memory complaints (HR: 0.65; 95%CI 0.57-0.74).

Conclusion

Since the COVID-19 pandemic, 6 in 10 adults in Southern Brazil have developed memory complaints. Factors including sex and lack of medications increased the risk of incident memory complaints. Physical activity reduced the risk of incident memory complaints during the COVID-19 pandemic.

Formative assessment: Is Australia ready for a physical activity surveillance system?

OBJECTIVES

This study investigated the feasibility of establishing a comprehensive and standardised physical activity surveillance system (PASS) in Australia to guide policy and programs to address this public health priority.

METHODS

We gathered information about existing data and reporting obligations in relation to physical activity, by conducting cross-sectoral workshops for each state and territory. This information was synthesised by sector/domain using the socioecological model. We developed a set of potential PASS indicators for feedback from the policymakers in the National Physical Activity Network.

RESULTS

Jurisdictions identified existing physical activity-relevant surveillance measures across socioecological levels and sectors. The most common were individual behavioural measures; less common were interpersonal, settings, environmental, and policy measures. Feedback was gathered from policymakers about model indicators that could be considered in future discussions.

CONCLUSIONS

Our findings reveal areas where data availability is most widespread as well as areas of deficiency. Although this process identified relevant cross-sectoral indicators, further feasibility assessment will require national-level discussions, cross-agency planning, and leadership by Federal and State governments to progress PASS discussions further.

IMPLICATIONS FOR PUBLIC HEALTH

The existing physical activity surveillance system in Australia is fragmented and lacks nationwide standardisation. Most physical activity surveillance focuses on individual behaviours, and limited monitoring occurs of broader elements of the "physical activity system." Improvements will contribute to more informed and accountable decision-making and enable more effective monitoring of progress at multiple levels towards achieving state and national physical activity goals. Policymakers need to embrace this agenda and further the discussions on the scope, shape, and structure of a physical activity surveillance system.

Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study

INTRODUCTION

Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV.

METHODS AND ANALYSIS

We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques.

ETHICS AND DISSEMINATION

Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05006391.

Lifestyle and work-related correlates of psychosocial health among Australian teachers: a cross-sectional study

Aim

This study examined the psychosocial (psychological distress, job-specific wellbeing, burnout) health of a large sample of teachers in New South Wales (NSW), Australia, specifically the association between psychosocial health, work-related factors, and lifestyle behaviours.

Subject & methods

An online survey collected lifestyle behaviours, work-related factors, and socio-demographics from primary and secondary school teachers in NSW from February to October 2021. Associations between work-related factors, lifestyle behaviours, and psychosocial health were modelled using logistic regression in R and adjusted for gender, age, and geographic location.

Results

In our sample (n = 1136), 75% were women and 28% of the sample worked in rural or remote areas. Women reported higher levels of psychological distress (51%), compared with men (42%), and over 30% of teachers reported high levels of burnout. Teachers who engaged in three or more positive health-related behaviours had lower odds of psychological distress and burnout as well as higher odds of job-specific wellbeing. Multiple work-related factors such as hours worked, teaching load, teaching experience, teacher type, and teacher role were associated with one or more aspects of psychosocial health after adjusting for socio-demographic variables.

Conclusion

More is needed to support the psychosocial health of teachers in NSW. Future lifestyle programs for this population should include psychosocial outcomes to further explore the relationship between teachers' health-related behaviour and their psychosocial health.

Supplementary information

The online version contains supplementary material available at 10.1007/s10389-023-01874-9.

Motivational Correlates, Satisfaction with Life, and Physical Activity in Older Adults: A Structural Equation Analysis

Background: Motivation is a crucial factor in predicting health-related outcomes, and understanding the determinants of motivation can provide valuable insights into how to improve health behaviors and outcomes in older adults. In this study, we aimed to investigate the associations between intrinsic and extrinsic exercise motivation, basic psychological needs, satisfaction with life, and physical activity among the elderly population. Methods: The sample consisted of 268 older adults (59 male, 209 female) aged 65-90 years old (Mage = 68.11, SD = 6.95). All participants reported that they were exercising, on average, 1.65 days (SD = 0.51) per week. Factor analysis was conducted using a two-step approach. First, a confirmatory factor analysis and then a structural equation model considering all variables under analysis was performed. Results: the structural model displayed acceptable fit to the data: χ2/df = 3.093; CFI = 0.913; TLI = 0.908; SRMR = 0.071; RMSEA 0.079 [0.066, 0.092]. Significant direct effects were found as theoretically proposed, namely: (a) intrinsic motivation were positively and significantly associated with basic psychological need satisfaction (p < 0.001); (b) extrinsic motivation were negatively but not significantly associated with basic psychological needs (p < 0.001); and (c) basic psychological need satisfaction were positively and significantly associated with satisfaction with life (p < 0.001) and physical activity (p < 0.001). Conclusions: Intrinsic motivation and basic psychological needs play a crucial role in shaping exercise behavior and overall well-being. By understanding these motivation and needs, exercise and health professionals can work towards fulfilling them and achieving a greater sense of satisfaction in the life of the elderly and promote exercise adherence.

Developing a Single-Item General Self-Efficacy Scale: An Initial Study

General self-efficacy represents the global sense of personal capability across various situations and tasks. The aim of the present study was to develop and validate a single-item general self-efficacy scale which balances practical demands and psychometric concerns. The psychometric properties of the proposed Single-Item General Self-Efficacy Scale (GSE-SI) were examined among 231 Singaporean adults. Results based on three statistical methods demonstrated good reliability (.594 .607 and .726, respectively, M = .642), as compared with the reliability scores from other single-item scales. It also showed satisfactory criterion-related validity evidence (i.e., correlation with a multiple-item general self-efficacy scale, r = .795). Validity evidence based on relationships with other constructs was supported by the correlations between the scores of general self-efficacy and the scores of six relevant constructs (i.e., positive correlations with life satisfaction and positive emotions, negative correlations with negative emotions, task and perceived stress, and illness symptoms). More importantly, the GSE-SI and multiple-item scale scores showed consistent correlation patterns with their relevant constructs. Both GSE-SI and multiple-item scale scores significantly discriminated between the three clusters in a similar pattern. The present results show that the GSE-SI is a reliable and valid measure of general self-efficacy and can be recommended in future research to complement the constraints of multiple-item scales.

An examination of the reciprocal associations between physical activity and anxiety, depressive symptoms, and sleep quality during the first 9 weeks of the COVID-19 pandemic in Belgium

During the initial outbreak of the global COVID-19 pandemic, many countries imposed a total lockdown (containment at home). Although it was still allowed in Belgium to be physically active or exercise with people from your household in the vicinity of your home, engaging in sports or physical activity in a group or club context was no longer permitted. To examine whether a lack of physical activity was potentially threatening to the mental well-being of citizens and vice versa, the present study examined concurrent and reciprocal relationships between physical activity and anxiety, depressive symptoms, and sleep quality during the COVID-19 lockdown in a 9-week longitudinal design. In a sample of 983 Belgian adults (75.1% female; M _age = 43.78, range = 18-82 years), we explored these relationships at both the between- and within-person levels through random intercept cross-lagged panel models. The findings indicate that more physical activity was associated with lower symptoms of anxiety and depression and better sleep quality, a finding observed both at the between-person (across weeks; β_anxiety = -0.25, β_depression = -0.30, β_{sleep quality} = 0.24, p < .001) and within-person level (within weeks; β_anxiety = -0.10, β_depression = -0.14, β_{sleep quality} = 0.11, p < .05). Moreover, at the within-person level, an increase in feelings of anxiety and depression at one moment predicted lower levels of physical activity one week later (β_anxiety = -0.04, β_depression = -0.06, p < .05). Since poor mental health poses a threat to the maintenance of physical activity, the current findings suggest that it is critical to invest in the mental health of individuals during distressing times.

Can rehabilitation adherence among stroke patients be measured using a single item?

AIMS AND OBJECTIVES

To assess the concurrent validity between logbooks and a single-item rehabilitation adherence measurement for patients with stroke. Agreement between caregivers and patients and between caregivers and physical therapists regarding a single-item measurement was investigated, and its predictive validity was explored.

BACKGROUND

Adherence to therapy is a primary determinant of treatment success. There are no standard instruments for measuring rehabilitation adherence available for stroke patients.

DESIGN

Prospective longitudinal study.

METHODS

Seventy-five patients with stroke were recruited, measured four times and followed for 6 months. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to ensure comprehensive reporting. Adherence was documented in logbooks, and single-item measurements were compared. Predictive validity was explored by assessing associations between adherence levels, self-care ability and health-related quality of life. The Spearman's correlation coefficients, weighted kappa, and generalised estimating equations statistics were used to explore the concurrent validity, measurement agreement, and predictive validity, respectively.

RESULTS

Logbook records had a fair correlation (r_s  = .23, p = .04) with the single-item rehabilitation adherence measurements. There was moderate agreement (kappa = 0.42, p < .001) between caregiver and patient assessments and fair agreement (kappa = 0.29, p = .017) between caregiver and physical therapist assessments of patients' rehabilitation adherence levels. Perfect rehabilitation adherence, based on the logbook and single-item measurements, predicted better scores for self-care ability and quality of life than imperfect rehabilitation adherence during 6 months after inclusion.

CONCLUSIONS

There was fair concurrent validity between logbooks and single-item rehabilitation adherence measurements and moderate and fair adherence measure agreement between caregivers and patients and caregivers and physical therapists, respectively. Logbooks and single-item rehabilitation adherence measurements had adequate predictive validity.

RELEVANCE TO CLINICAL PRACTICE

Single-item rehabilitation adherence measurement is a workable and straightforward method to assess stroke patients' rehabilitation adherence in busy clinical care settings. Caregivers can represent stroke patients regarding their reported rehabilitation adherence.

PATIENT OR PUBLIC CONTRIBUTION

Patients were diagnosed with stroke in the study hospital. Rehabilitation physicians transferred patients to a research nurse who then screened them for the inclusion criteria and invited them and their family caregivers to participate in this study if they met the requirements. We also recruited seven physical therapists responsible for the physical therapy of the study participants. After participants signed informed consent, the research nurse encouraged participants to respond to research questions face to face, including rehabilitation adherence data, daily physical function, and quality of life. Each participant was measured four times at baseline and at 1, 3, and 6 months after inclusion in this study. Physical therapists had to score their patients' rehabilitation adherence levels before discharge.

TRIAL REGISTRATION DETAILS

Not applicable.

Assessment of lifestyle "vital signs" in healthcare settings

Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has led to an increasing call to assess adverse lifestyle factors in healthcare settings. This approach could be aided by designating health-related lifestyle factors as "vital signs" that can be recorded during patient visits. Just such an approach has been used for assessing patients' smoking habits since the 1990s. In this review, we assess the rationale for addressing six other health-related lifestyle factors, beyond smoking, in patient care settings: physical activity (PA), sedentary behavior (SB), participation in muscle strengthening exercises, mobility limitations, diet, and sleep quality. For each domain, we evaluate the evidence that supports currently proposed ultra-short screening tools. Our analysis indicates strong medical evidence to support the use of one to two-item screening questions for assessing patients' PA, SB, muscle strengthening activities, and presence of "pre-clinical" mobility limitations. We also present a theoretical basis for measuring patients' diet quality through use of an ultrashort dietary screen, based on evaluation of healthy food intake (fruits/vegetables) and unhealthy food intake (high consumption of highly processed meats and/or consumption of sugary foods and beverages) and a proposed evaluation of sleep quality using a single-item screener. The result is a 10-item lifestyle questionnaire that is based on patient self-report. As such, this questionnaire has the potential to be employed as a practical tool for assessing health behaviors in clinical care settings without impairing the normal workflow of healthcare providers.

Impact of the first year of the "This girl can" physical activity and sport mass media campaign in Australia

INTRODUCTION

Addressing gender inequalities in physical activity is an important public health goal. A major campaign, 'This Girl Can' (TGC) was conducted by Sport England from 2015, and TGC was licenced in 2018 by VicHealth in Australia for development and use in a 3-year mass media campaign. The campaign was adapted through formative testing to Australian conditions and implemented within the state of Victoria. The purpose of this evaluation was to assess the initial population impact of the first wave of the TGC-Victoria.

METHODS

We assessed campaign impact using serial population surveys, with the target population being women living in Victoria who were not meeting the current physical activity guidelines. Two surveys were carried out before the campaign (October 2017 and March 2018), and the post-campaign survey immediately following the first wave of TGC-Victoria mass media (May 2018). Analyses were primarily on the cohort sample of 818 low-active women followed across all three surveys. We measured campaign effects using campaign awareness and recall, and self-report measures of physical activity behaviour and perceptions of being judged. Changes in perceptions of being judged and in reported physical activity were assessed in relation to campaign awareness over time.

RESULTS

Overall, TGC-Victoria campaign recall increased from 11.2% pre-campaign to 31.9% post-campaign, with campaign awareness more likely among younger and more educated women. There was a slight increase of 0.19 days in weekly physical activity following the campaign. Feeling that being judged was a barrier to physical activity declined at follow up, as did the single item perceptions of feeling judged (P < 0.01). Feeling embarrassed decreased, and self-determination increased, but exercise relevance, theory of planned behaviour and self-efficacy scores did not change.

CONCLUSIONS

The initial wave of the TGC-Victoria mass media campaign showed reasonably high levels of community awareness and encouraging decreases in women feeling judged whilst being active, but these did not yet translate into overall physical activity gains. Further waves of the TGC-V campaign are in progress to reinforce these changes and further influence the perception of being judged among low-active Victorian women.

A pragmatic strength and conditioning intervention for firefighters: Feasibility of the Tactical Athlete Resilience Program (TARP)

ISSUE ADDRESSED

Firefighting is physically and mentally taxing and recruits are expected to have optimal health and fitness. However, physical fitness tends to decline following initial training, placing firefighters at an increased risk for stress and injury. Efforts are needed to engage and support firefighters in maintaining adequate health and fitness to withstand the rigorous demands of their occupation. This study examined the feasibility of TARP, a pragmatic strength and conditioning intervention for metropolitan-based firefighters, delivered in collaboration with a professional National Rugby League club.

METHODS

A mixed-methods approach was utilised to examine program implementation, recruitment and sample characteristics, intervention satisfaction and acceptability, and participants' response to the intervention. Evaluation measures included field notes taken during steering committee meetings, participant flow data, baseline and follow-up outcome measures, self-report questionnaires, and telephone interviews with a sample of participants.

RESULTS

Participants (N = 113) were predominantly men (82%) with a mean age of 43 ± 9.3 years and BMI of 26.6 ± 2.9 kg/m² . Program satisfaction was high (95% very satisfied or somewhat satisfied) among program completers (42% retention). Key strengths of the program included delivery through the professional sports club, quality of facilities and equipment, and scheduling flexibility. Future programs should consider incorporating education or training to support behaviour change maintenance and strategies to retain participants at follow-up.

CONCLUSIONS

Results provide valuable insights into the design and delivery of interventions for firefighters and demonstrate the importance of strong partnerships between community stakeholders.

Understanding shedders: Which socio-demographic, health and wellbeing characteristics best inform appropriate health promotion action in men's sheds and a 'Shed for Life'?

ISSUE ADDRESSED

Men's sheds ('Sheds') have been identified as inherently health promoting and as potential settings to engage 'hard-to-reach' men in more structured health promotion initiatives. However, little is known about the socio-demographic or health and wellbeing characteristics of Shed members ('Shedders') on which such initiatives might be based. This study captures a baseline cross-sectional analysis of Shedders (n = 384) who participated in 'Sheds for Life', a health promotion initiative tailored to Sheds.

METHODS

Objective health measures (body composition, blood pressure, blood lipids) captured via health screening as well as socio-demographic and health and wellbeing measures (physical activity, subjective wellbeing, mental health, social capital, cooking and diet) via questionnaires were assessed. Descriptive statistics were generated and differences between groups were determined via parametric and non-parametric testing. Bivariate analysis was used to determine associations and regression analysis then estimated various predictors on mental wellbeing, life satisfaction and loneliness.

RESULTS

Participants were mostly over 65 years (77.3%), retired (88.6%) with limited educational attainment (77%). The majority were in the 'at-risk' categories for objective health measures, with most being referred to their GP following health screening (79.6%). Older Shedders were also more likely to meet physical activity guidelines. Mental wellbeing was positively correlated with life satisfaction and increased social capital and these were also positively correlated with physical activity (P < .05).

CONCLUSIONS

Findings highlight the potential of Sheds in reaching a 'hard-to-reach' and 'at-risk' cohort of men. Despite a high prevalence of 'at-risk' objective health measures, participants report their health in positive terms. Future health promotion initiatives should capitalise on the inherent health-promoting properties of Sheds. SO WHAT?: Findings raise important implications for prioritising and designing health promotion initiatives in Shed settings.

How is Physical Activity Measured in Spinal Muscular Atrophy and Duchenne Muscular Dystrophy?

BACKGROUND

Physical activity (PA) provides many substantial benefits to help reduce risk for cardiometabolic disease, improve cognitive function, and improve quality of life. Individuals with neuromuscular disorders (NMDs), such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD) are characterized by muscular weakness and fatigue, which limits the capacity to reach the recommended guidelines of PA. Measuring PA in these populations can provide insight to participation in daily activities, track disease progression, and monitor efficacy of drug treatments.

OBJECTIVE

The objective of this study was to identify how PA is measured in SMA and DMD using instrumented and self-report methods, and how these methods are employed in ambulatory and non-ambulatory groups.

METHODS

A scoping review was performed to identify studies that reported PA in these neuromuscular disorders. Inclusion was determined after a multi-stage review process by several reviewers, followed by an in-depth analysis of metrics reported by each tool that was used.

RESULTS

A total of nineteen studies were identified and included in this review. Sixteen studies included instrumented measures and four studies utilized self-reported measures, with eleven studies also reporting PA information from a non-ambulatory group. A variety of metrics have been reported using both classes of measurement tools.

CONCLUSION

Although a wide variety of research exists that details both instrumented and self-reported measurement tools, feasibility, cost, and study aims are important factors to consider in addition to testing methodology when selecting which type of tool to use. We recommend using a combination of instrumented and self-report measures to provide context to the PA measured in these populations. Improvements in both instrumented and self-report methodologies will add valuable knowledge about the disease burden and efficacy of treatment and disease management methods in SMA and DMD.

Development and Validation of Single Items for Fatigue and Recovery in Dancers

PURPOSE

To examine the construct validity and reliability of 2 single items for fatigue and recovery in dancers. The construct validity was assessed using reference instruments: the fatigue items of the Brunel Mood Scale (BRUMS) and the Short Recovery and Stress Scale (SRSS). A secondary aim was to explore the respondent interpretation of these 2 items using a concept identification approach.

METHODS

Two hundred forty-three (N = 243) dancers completed single-item fatigue and recovery (unipolar and bipolar), BRUMS, and SRSS once for construct validity. For reliability, 49 dancers completed the questionnaires twice, 1 week apart. Using a concept identification approach, 49 dancers were also asked comprehension and interpretation of fatigue and recovery.

RESULTS

The fatigue item correlated with SRSS stress items (rs = .37-.51) and BRUMs fatigue items (rs = .63-.66). The recovery item was only partially confirmed in terms of construct validity, when using the SRSS recovery items as reference (rs = .39-.43). Reliability was confirmed for the single items of fatigue (κ = .77-.78) and recovery (κ = .71-.78). Main responses for the concept of fatigue were tiredness (34.7%), muscle soreness (17.3%), and energy (13.0%). Main responses for the concept of recovery were muscle soreness (43.0%), tiredness (27.9%), and fatigue (24.0%).

CONCLUSION

We provide preliminary confirmation of the validity and reliability of the single item fatigue in dancers. The recovery item was only partially confirmed in terms of construct validity, when using the SRSS recovery items as reference, but did display acceptable reliability and agreement. Further research is warranted further exploring other measurement properties.