Global, regional, and national trends and patterns in physical activity research since 1950: a systematic review

A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world

BACKGROUND

The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide.

METHODS

To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country.

RESULTS

We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA.

CONCLUSION

Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.

Accelerometer-Measured Physical Activity, Fitness and Indicators of Cardiometabolic Risk among Rural Adolescents: A Cross-Sectional Study at 15-Year Follow-up of the MINIMat Cohort

BACKGROUND

Little is known about the relationship of physical activity (PA) and fitness with cardiometabolic risk among rural adolescents in low- and middle-income countries. Thus, we examined the associations of PA and fitness with selected cardiometabolic indicators along with potential gender-based differences in a birth cohort of rural adolescents from southeast Bangladesh.

METHODS

We utilized data from the 15-year follow-up of Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort (n = 2253). Wrist-worn ActiGraph wGT3x-BT accelerometers were used to estimate sedentary time (ST) and PA. Fitness was assessed using: handgrip strength, standing long jump, and Chester Step Test. Anthropometric parameters, systolic blood pressure (SBP), and fasting lipid, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Linear regression and isotemporal substitution models were fitted.

RESULTS

The adolescents spent 64 min/day (inter-quartile range: 50-81) in moderate-to-vigorous physical activity (MVPA). A 10-minute-per-day higher vigorous PA (VPA) was associated with: 4.9% (95% confidence interval (CI): 2.9-6.8%) lower waist circumference (WC), 3.2 mmHg (95% CI: 1.5-4.8) lower SBP, 10.4% (95% CI: 2.9-17.3%) lower TG, and 24.4% (95% CI: 11.3-34.9%) lower HOMA-IR. MVPA showed similar associations of notably smaller magnitude. Except for WC, the associations were more pronounced among the boys. Substituting ST with VPA of equal duration was associated with lower WC, SBP, triglyceride and HOMA-IR. Grip strength was favorably associated with all indicators, displaying considerably large effect sizes.

CONCLUSION

Our findings indicated beneficial roles of PA- particularly VPA- and muscular fitness in shaping cardiometabolic profile in mid-adolescence. VPA and grip strength may represent potential targets for preventive strategies tailored to adolescents in resource-limited settings.

An Overview of Physical Activity Research Evolution in Africa: The Global Observatory for Physical Activity-GoPA!

OBJECTIVE

To describe the evolution of physical activity (PA) research in Africa, examine income and gender inequalities, and discuss future possibilities.

METHODS

A secondary analyses of the Global Observatory for Physical Activity data on PA research in Africa (1950-2019).

RESULTS

We identified 514 PA articles from 47 African countries in the past 70 years. Majority (83.1%) of the articles were published between 2012 and 2019. Fifteen countries had no publications. Six countries (South Africa [n = 156], Nigeria [n = 85], Ethiopia [n = 44], Ghana [n = 41], Kenya [n = 39], and Cameroon [n = 20]) accounted for about 75% of the publications. Most articles were observational (92.4%), single-country studies (78.4%), with male first (58.4%) and last authors (68%), and were classified as surveillance studies (45.1%). Few studies addressed interventions (5.8%) and policy (3.5%) or used device-based PA measurement (14.0%). The number of articles per country was positively related to human population level (r = .552, P = .000) and gross domestic product % spent on research and development (r = .301, P = .040). The publication rate per 100,000 people was positively related with the human development index (r = .349, P = .016) and negatively with the gender inequality index (r = -.360, P = .019).

CONCLUSIONS

Our results provide an overview and status of PA research in Africa, highlighting country differences and gender inequalities in authorship. The findings may be used to benchmark the evolution of research in the region and to inform areas for improvement. There is an urgent need for more PA interventions and policy studies in Africa.

Gender Differences in Physical Activity and Health-Related Authorships Between 1950 and 2019

BACKGROUND

The objective of this study was to investigate gender differences in authorship in physical activity and health research.

METHODS

A bibliometric study including 23,399 articles from 105 countries was conducted to estimate the participation of female researchers in physical activity publications from 1950 to 2019. The frequency of female researchers was analyzed and classified by first and last authors and the overall percentage of female authors by region and country.

RESULTS

The proportion of female first authors increased from <10% in the 50s and 80s to 55% in the last decade. On the other hand, the proportion of last authors increased from 8.7% to 41.1% in the same period. Most publications with female researchers were from the United States, Canada, Australia, Brazil, the Netherlands, Spain, England, Germany, Sweden, and China. Nine of these countries had over 50% of the articles published by female first authors. However, in all 10 countries, <50% of the articles were published by female last authors.

CONCLUSIONS

The proportion of female researchers increased over time. However, regional differences exist and should be addressed in gender equity policies. There is a gap in the participation of female researchers as last authors. By actively addressing the gender gap in research, the global society can harness the full potential of all talented individuals, regardless of gender, leading to more inclusive and impactful scientific advancements.

Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity

BACKGROUND

A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice.

METHODS

Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice.

RESULTS

When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms.

CONCLUSIONS

To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts.

Lifestyle and patterns of physical activity in Hadza foragers

OBJECTIVES

Physically active lifestyles are associated with several health benefits. Physical activity (PA) levels are low in post-industrial populations, but generally high throughout life in subsistence populations. The Hadza are a subsistence-oriented foraging population in Tanzania known for being physically active, but it is unknown how recent increases in market integration may have altered their PA patterns. In this study, we examine PA patterns for Hadza women and men who engage in different amounts of traditional foraging.

MATERIALS AND METHODS

One hundred and seventy seven Hadza participants (51% female, 19-87 years) wore an Axivity accelerometer (dominant wrist) for ~6 days during dry season months. We evaluated the effects of age, sex, and lifestyle measures on four PA measures that capture different aspects of the PA profile.

RESULTS

Participants engaged in high levels of both moderate-intensity PA and inactivity. Although PA levels were negatively associated with age, older participants were still highly active. We found no differences in PA between participants living in more traditional "bush" camps and those living in more settled "village" camps. Mobility was positively associated with step counts for female participants, and schooling was positively associated with inactive time for male participants.

CONCLUSIONS

The similarity in PA patterns between Hadza participants in different camp types suggests that high PA levels characterize subsistence lifestyles generally. The sex-based difference in the effects of mobility and schooling on PA could be a reflection of the Hadza's gender-based division of labor, or indicate that changes to subsistence-oriented lifestyles impact women and men in different ways.

Could the Hybridization of the SE/TGfU Pedagogical Models Be an Alternative for Learning Sports and Promoting Health? School Context Study

The present study aims to analyze the influence of the Sport Education (SE)/Teaching for understanding (TGfU) hybrid unit on enjoyment, perceived competence, intention to be physically active, skill execution, decision making, performance and game involvement. A short-term (12-lesson) pre-test/post-test quasi-experimental design was conducted in two groups: control (technical approach: 70 students; age = 14.43 ± 0.693; n = 32 female) and experimental (hybrid unit SE-TGfU: 67 students; age = 13.91 ± 0.900; n = 30 female). The coding instrument was based on the Game performance Assessment Instrument. The Enjoyment and Perceived Competence Scale and the Measure of Intentionality to be Physically Active questionnaire were also used. The results of pairwise comparisons between the groups showed higher post-test scores for most dependent variables for boys and girls using the hybrid SE/TGfU unit. Lower post-test scores were found in pairwise comparisons for several dependent variables in both boys and girls. The present study showed that the application of hybrid models SE/TGfU could increase and help facilitate students' game involvement and game performance, enjoyment, perceived competence and intention to be physically active, in both boys and girls. In future studies, it would be necessary to analyze psychological variables in the educational context for a deeper assessment.

Physical Activity Interventions for Adults Aged 60+ Years in Low- and Middle-Income Countries: A Scoping Review

BACKGROUND

Most reviews investigating physical activity interventions for older people consider evidence primarily from high-income countries. This review examined physical activity interventions for older people from low- and middle-income countries.

METHODS

We searched 9 electronic databases to identify randomized controlled trials or quasi-randomized trials studies investigating physical activity interventions for people aged 60+ in low- and middle-income countries. Following study selection, one reviewer extracted relevant data. A second reviewer double-checked the data extraction of a randomly selected sample of interventions (20%). Data were summarized using descriptive statistics.

RESULTS

We included 234 studies from 19 countries, investigating 259 distinct physical activity interventions. Studies were mostly conducted in upper middle-income countries (89%), often assessing physical activity interventions through randomized controlled trials (82%). Most studies investigated a mixed population in terms of sex (68%), with a mean age between 65 and 70 years (36%), not selected on the basis of having a specific health condition (55%). The intervention most commonly investigated was structured exercise (63%) and "no intervention" was the most frequent comparator (47%). The outcomes measured more often were intrinsic capacity (59%) and functional ability (51%), whereas physical activity, falls, and social outcomes were rare. Only 2 studies targeted underserved populations.

CONCLUSION

Although we identified a substantial number of randomized controlled trials, most evidence for physical activity interventions for older people in low- and middle-income countries is limited to upper middle-income countries. Gaps identified included interventions targeting populations with underserved backgrounds, using sport as an intervention, and assessing the impact of physical activity interventions on physical activity, falls, and social outcomes.

Time Trends of Cardiovascular Disease in the General Population and Inflammatory Arthritis

Cardiovascular diseases (CVDs) are the leading causes of death in the world, but declining trends for cardiovascular (CV) mortality and morbidity have been observed during the last decades. Reports on secular trends regarding the excess CV mortality and morbidity in rheumatoid arthritis show diverging results. Data support that also patients with inflammatory arthritis have benefited from improved treatment and prevention for CVD, which can be observed, for example, in decreased case fatality after CV event. However, several recent studies indicate a remaining excess CV risk in patients with inflammatory arthritis.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys

BACKGROUND

Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries.

METHODS

We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years.

RESULTS

The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved.

CONCLUSION

Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Historical development of accelerometry measures and methods for physical activity and sedentary behavior research worldwide: A scoping review of observational studies of adults

This scoping review identified observational studies of adults that utilized accelerometry to assess physical activity and sedentary behavior. Key elements on accelerometry data collection were abstracted to describe current practices and completeness of reporting. We searched three databases (PubMed, Web of Science, and SPORTDiscus) on June 1, 2021 for articles published up to that date. We included studies of non-institutionalized adults with an analytic sample size of at least 500. The search returned 5686 unique records. After reviewing 1027 full-text publications, we identified and abstracted accelerometry characteristics on 155 unique observational studies (154 cross-sectional/cohort studies and 1 case control study). The countries with the highest number of studies included the United States, the United Kingdom, and Japan. Fewer studies were identified from the continent of Africa. Five of these studies were distributed donor studies, where participants connected their devices to an application and voluntarily shared data with researchers. Data collection occurred between 1999 to 2019. Most studies used one accelerometer (94.2%), but 8 studies (5.2%) used 2 accelerometers and 1 study (0.6%) used 4 accelerometers. Accelerometers were more commonly worn on the hip (48.4%) as compared to the wrist (22.3%), thigh (5.4%), other locations (14.9%), or not reported (9.0%). Overall, 12.7% of the accelerometers collected raw accelerations and 44.6% were worn for 24 hours/day throughout the collection period. The review identified 155 observational studies of adults that collected accelerometry, utilizing a wide range of accelerometer data processing methods. Researchers inconsistently reported key aspects of the process from collection to analysis, which needs addressing to support accurate comparisons across studies.

Prenatal and postnatal correlates of moderate-to-vigorous physical activity in midlife: evidence from the 1970 British Cohort Study

Background

It is hypothesised that lifelong physical activity behaviours are established in early life, however there is minimal, and contradictory, evidence examining prenatal and postnatal factors in relation to adulthood physical activity. We investigated associations between prospectively ascertained prenatal/postnatal factors and device-measured moderate-to-vigorous physical activity (MVPA) in midlife.

Methods

Analyses included 5011 participants from the 1970 British Cohort Study, a birth cohort study of individuals born within the same week. At birth, the following factors were ascertained: socioeconomic position (SEP), maternal age, number of previous pregnancies, maternal smoking, maternal diabetes, gestational age, birth weight, breastfeeding status and infant health concerns. MVPA was captured at age 46 with a thigh-worn accelerometer device following a 24-hour protocol over 7 days.

Results

In sex-adjusted models, lower SEP (−6.7 min/day (95% CI: −9.0 to –4.4) in those with a partly or unskilled paternal occupation), younger maternal age (0.4 min/day (0.2 to 0.5) per additional year of maternal age), maternal smoking during pregnancy (−2.5 min/day (−4.0 to –1.0)) and post-term gestational age (−7.4 min/day (−11.5 to –3.4); boys only) were associated with lower MVPA at age 46. In the mutually adjusted model, associations did not change but there was some evidence that birth weight may also be associated with MVPA levels.

Conclusions

SEP, maternal age, maternal smoking, post-term birth in boys and birth weight were associated with MVPA in midlife, indicating that midlife physical activity behaviours may be partially established at birth. Early interventions in disadvantaged environments may have a positive impact on physical activity throughout the life course.

Bibliometric Analysis of Literature on Physical Activity and COVID-19

The coronavirus disease 2019 (COVID-19) pandemic induced a sudden surge in COVID-19 related publications. This bibliometric analysis aimed to analyze literature on physical activity and COVID-19 published in the PubMed database. The search terms ((physical activity [MeSH Terms] OR physical inactivity [MeSH Terms]) AND COVID-19 [MeSH Terms]) were applied to obtain publications from the inception of PubMed to February 2022. The analyses included the year of publication, type of publication, and origin of publication by country, region, and country income. The research areas were analyzed for research articles and systematic reviews. Of 1268 articles, 143 articles were excluded, and 1125 articles were analyzed. A total of 709 articles (63.02%) were published in 2021. A majority of publications were research articles (n = 678, 60.27%). The USA (n = 176, 15.64%), countries in the European Region (n = 496, 44.09%), and high-income countries (n = 861, 76.53%) were dominant publishing countries. Of 699 research articles and systematic reviews, surveillance and trends of physical activity were the main research area, followed by health outcomes, and correlates and determinants of physical activity. There is a wide gap in publication productivity in the field of physical activity and health during the pandemic among different countries' economic statuses.

Surveillance of physical activity and sedentary behaviour in czech children and adolescents: a scoping review of the literature from the past two decades

BACKGROUND

This study aimed to map the available evidence related to physical activity (PA) and sedentary behaviour (SB) in Czech children and adolescents and suggest future directions and improvements to strengthen the surveillance of PA and SB in the Czech Republic.

METHODS

The search of articles published between January 2000 and December 2020 included the Medline and Medvik databases and a manual search in eight Czech journals related to the topic. This review followed the "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews".

RESULTS

Out of 350 identified articles, 79 articles met the criteria for selection and referred to 27 studies. The majority of the articles were cross-sectional (89%), approximately two-thirds of the articles (61%) examined only PA, and half of the articles (51%) employed device-based assessments. Approximately 47% of the articles reported the prevalence of physical inactivity on the basis of inconsistently defined recommendations. Approximately 14%, 23%, and 10% of the articles focused on active transportation, organized PA (including physical education or leisure-time PA), and parent-child PA, respectively.

CONCLUSIONS

Future studies need to focus on longitudinal design and interventions, randomly selected samples, a mix of device-based and self-reported methods, and the recognition of health-related 24-hour time use patterns. This review advocates the government-supported development of a national surveillance system that will help to reduce insufficient PA and excessive SB.

Does exercise prevent major non-communicable diseases and premature mortality? A critical review based on results from randomized controlled trials

Observational studies show that physical activity is strongly associated with a reduced risk of premature mortality and major non-communicable diseases. We reviewed to which extent these associations have been confirmed in randomized controlled trials (RCTs) for the outcomes of mortality, cardiovascular disease (CVD), type 2 diabetes (T2D), and fracture. The results show that exercise does not reduce all-cause mortality and incident CVD in older adults or in people with chronic conditions, based on RCTs comprising ∼50,000 participants. The results also indicate a lack of effect on cardiovascular mortality in people with chronic conditions, based on RCTs comprising ∼11,000 participants. Furthermore, there is inconsistent evidence regarding the effect of exercise on fractures in older adults, based on RCTs comprising ∼40,000 participants. Finally, based on RCTs comprising ∼17,000 participants, exercise reduces T2D incidence in people with prediabetes when combined with dietary modification, although evidence for the individual effect of exercise is lacking. Identified shortcomings of the current evidence include risks of publication bias, lack of high-quality studies in certain high-risk populations, and inconstant evidence with respect to some outcomes. Thus, additional large trials would be of value, especially with fracture as the primary outcome. In conclusion, according to current RCT evidence, exercise can prevent T2D assuming it is combined with dietary intervention. However, the current evidence shows that exercise does not prevent premature mortality or CVD, with inconsistent evidence for fractures.

Gender differences in physical activity and sedentary behavior: Results from over 200,000 Latin-American children and adolescents

More physical activity and less sedentary behavior is beneficial for children and adolescents. Worldwide, gender differences are >8% favorable for men and the Latin-American region presents an even higher level of insufficient physical activity among women, with a lack of information in young population. Thus, the aim of the current study was to describe the gender differences in physical activity and recreational sedentary behavior in children and adolescents from Latin-American countries. The targeted age range was 5 to 17 years and included 219,803 participants (106,698 boys and 113,105 girls) from 33 out of 47 Latin-American countries identified. Physical activity guidelines from the World Health Organization (≥60 minutes of moderate-to-vigorous physical activity seven days of the week) and <3 hours recreational sedentary behavior daily were the references. In general, boys showed a higher prevalence of meeting physical activity guidelines in comparison with girls. A higher proportion of girls met the <3 hours recreational sedentary behavior cut-point in only ten countries. Thirty percent of the identified countries had no available data. The majority had data from the Global School-based Student Health Survey with data principally on adolescents and only 11/33 countries reported data in the last 5-year period. In conclusion, gender differences in the compliance with physical activity guidelines and the <3 hours recreational sedentary behavior cut-point are evident among children and adolescents from Latin-American countries, with boys being more active than girls.

Capacity for childhood obesity research in Latin American and US Latino populations: State of the field, challenges, opportunities, and future directions

Childhood obesity is a major problem in Latin America and among US Latinos. Effective public health policies require contextually relevant evidence to guide them, which demands sustained research capacity. The objectives of this study are to determine research productivity in Latin America and in the United States focused on Latino populations and examine domains of research capacity (research infrastructure, training programs, mentoring, funding, and networks). We conducted a scoping review of indexed childhood obesity-related articles published June 2015-December 2019. We collected data on perceptions of capacity for childhood obesity research among Latin American investigators through an online survey. We identified 612 childhood obesity-related articles (505 from Latin America, 124 from the United States, and 17 US-Latin America collaborations). Brazil, Mexico, Chile, Colombia, and the United States are the top publishing countries. There are similar numbers of obesity, nutrition, and physical activity articles, but physical activity research capacity lagged in other domains (research training, funding, and networking opportunities). Complementary research areas, including sedentary behavior, systems science, and policy studies, are uncommon in Latin America but more prevalent in the United States, whereas sleep research is nascent across settings. Realizing the promise of an effective cross-border collaborative childhood obesity prevention agenda will require committed investment in all domains of research capacity and across all relevant topics.