Effectiveness of the Children's Fitness Tax Credit: A scoping review

OBJECTIVES

A scoping review was conducted to synthesize the literature examining impact of the Children's Fitness Tax Credit (CFTC) on the physical activity (PA) of Canadian children. Specifically, we posed two research questions seeking evidence for: (1) equitable take-up (e.g., claiming, use) of the CFTC by Canadian families; and (2) effectiveness of the CFTC in promoting or facilitating PA or sport participation among Canadian children and adolescents.

METHODS

A search was conducted in May 2023 of five databases (e.g., Medline, Scopus) and hand searching using terms such as children, adolescents, physical activity, sport, tax credit or taxation. Documents were included if they were data-based studies, available in English or French, and related to the research questions. They were then coded for characteristics of the document, sample, data, behaviour, and findings.

SYNTHESIS

Of 318 possible documents, 7 documents revealing 26 findings were included after a full-article scan. Most of the documents were published and had a national scope. The most frequent source of data was from parental reports (62%), with the most common types of behaviour being tax claim take-up rates (31%) or PA (27%). For the two research questions, the available evidence suggests no support for equitable take-up of the CFTC or the amount claimed, and most of the findings indicated no (64%) or limited effectiveness of the tax credit (29%).

CONCLUSION

The CFTC had limited to no impact in promoting PA among Canadian children, particularly for those experiencing low income.

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.

An open label feasibility study of a nutrition and exercise app-based solution in cirrhosis

Background

Nutrition and exercise are the mainstay of therapy for the prevention and treatment of frailty in cirrhosis. This pilot study assessed feasibility of the online delivery of an app-based semi-supervised nutrition and exercise intervention in this population.

Methods

The 11-week pilot recruited adults with cirrhosis who owned internet-connected devices. Patients were encouraged to participate in exercise sessions 3× per week including a combination of online group exercise (weekly) and home-based follow-along exercise (biweekly). They also participated in group nutrition classes (five sessions) and one-to-one exercise and nutrition check-ins delivered through the app. Primary outcome measures pertained to program feasibility: recruitment, retention, adherence, and satisfaction. Exploratory measures included physical performance (liver frailty index [LFI], 6-minute walk test [6MWT]), health behaviour domains, and quality of life.

Results

Twenty three patients completed baseline measures. Of these, 18 (72%) completed end of study measures (mean MELD-Na, 9.2; female, 44.4%). Over 70% of participants fulfilled 75% or more of the feasibility criteria. Satisfaction with the program was high (mean, 89%). Exercise program modifications were required for 17 patients to accommodate health events or abilities. Exploratory evaluation showed improvement in the LFI and the 6MWT by -0.58-units (95% CI: -0.91 to -0.25) and 46.0 m (95% CI: 22.7-69.3) respectively without changes in quality of life or health behaviour domains.

Conclusions

Outcomes demonstrate feasibility of the app-based delivery of programming with promising exploratory impact on efficacy for physical performance. Findings can guide the design of a large-scale app-based randomized controlled trials in cirrhosis.

Physical activity, screen time and dietary behaviours in New Zealand adolescents prior to and following the onset of the COVID-19 pandemic

BACKGROUND

Insufficient physical activity, high screen time, and unhealthy dietary patterns among adolescents may have worsened during the pandemic, but data are lacking. This study compared physical activity, screen time and fruit and vegetable intake in adolescents from Dunedin, New Zealand, 5-6 years before (Study 1) and during (Study 2) the COVID-19 pandemic.

METHODS

Adolescents completed an online survey as part of the Built Environment and Active Transport to School (BEATS) studies in 2014/2015 (Study 1; n = 1,266; age: 15.3 ± 1.4 years; 54.6% female) and 2021/2022 (Study 2; n = 819; age: 15.2 ± 1.4 years; 47.4% female). The proportion of adolescents meeting guidelines for physical activity (≥ 60 min/day of moderate-to-vigorous physical activity), outside school screen time (≤ 2 h/day) and fruit and vegetable intake (> 1 serving/day for both fruit and vegetables) was calculated. Data were analysed using multivariable linear and logistic regression modelling.

RESULTS

Few adolescents met recommended health behaviour guidelines. Compared to Study 1, significantly greater proportions of adolescents at Study 2 met guidelines for physical activity (16.7% vs. 23.1%; p < 0.001) and outside school screen time (13.3% vs. 18.3%; p < 0.001) while fruit and vegetable intake was not different (29.6% vs. 27.0%; p = 0.322). Compared to Study 1, average outside school screen time at Study 2 was lower on both weekdays (5.0 ± 2.9 vs. 4.6 ± 2.9; p < 0.001) and weekend days (6.9 ± 3.5 vs. 6.1 ± 3.6 h/day; p < 0.001). Reported frequency of consuming sweets was higher and soft drinks lower at Study 2 versus Study 1.

CONCLUSIONS

Despite observed higher levels of physical activity and lower levels of outside school screen time during the pandemic compared to the pre-pandemic levels, few adolescents met health behaviour guidelines at both time points. Therefore, comprehensive health promotion that aims to improve physical activity levels, screen time and dietary patterns for adolescents is still necessary to prevent chronic health conditions adulthood.

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.

Exploring the Promise of Telemedicine Exercise Interventions in Children and Adolescents With Congenital Heart Disease

Youth with congenital heart disease (CHD) have reduced exercise capacity via various physical and psychosocial mechanisms. In addition to limited physiologic exercise capacity, these patients experience lower levels of physical activity, physical activity self-efficacy, health-related quality of life, and endothelial function. The study of exercise interventions and cardiac rehabilitation programs in pediatric CHD populations remains limited, particularly home-based interventions that incorporate real-time physiologic monitoring. Home-based interventions provide improved access and convenience to patients. This is principally important for patients from geographically disperse regions who receive their care at centralized subspecialty centres, as is the case for Canadian pediatric cardiac care. These programs, however, have traditionally not permitted the supervision of safety, technique, and adherence that are afforded by hospital/facility-based programs. As such, telemedicine is an important evolving area that combines the benefits of traditional home and facility-based cardiac rehabilitation. An additional key area lacking study surrounds the types of exercise interventions in youth with CHD. To date, interventions have often centred around moderate-intensity continuous exercise. High-intensity interval training might offer superior cardiorespiratory advantages but remains understudied in the CHD population. In this review, we highlight the existing evidence basis for exercise interventions in youth with CHD, explore the promise of incorporating telemedicine home-based solutions, and highlight key knowledge gaps. To address identified knowledge gaps, we are undertaking a 12-week randomized crossover trial of a home-based telemedicine high-intensity interval training intervention in youth with repaired moderate-severe CHD using a video game-linked cycle ergometer (known as the MedBIKE; https://spaces.facsci.ualberta.ca/ahci/projects/medical-projects/remote-rehab-bike-projects).

An online mind-body program improves mental health and quality of life in primary biliary cholangitis: A randomized controlled trial

BACKGROUND AND AIMS

People with primary biliary cholangitis (PBC) experience high rates of mental distress and fatigue despite standard of care therapy. We aimed to assess the impact of an online mind-body intervention on these symptoms.

METHODS

This 12-week RCT used sequential mixed-methods evaluation. Alongside standard of care, participants with primary biliary cholangitis were randomized to receive weekly countdown emails, or the intervention consisting of (i) a weekly 20-30 minute-mind-body follow-along video, (ii) weekly 5-10-minute psychology-based "managing chronic disease skills videos," and (iii) 10-minute telephone check-ins. The primary outcome was a change in the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes evaluated changes in fatigue, perceived stress, resilience, and health-related quality of life. ANCOVA determined between-group differences.

RESULTS

Of the 87 randomized patients (control group: n = 44, intervention group: n = 43), the between-group HADS total score improved by 20.0% (95% CI 4.7, 35.2, p = 0.011). Significant improvements were seen in depression (25.8%), perceived stress (15.2%), and 2 primary biliary cholangitis-40 domains [emotional symptoms (16.3%) and social symptoms (11.8%)] with a mean satisfaction of 82/100. This corresponded with end-of-study qualitative findings. Although no improvements were observed in fatigue in the main analysis, a significant benefit was observed in the subgroup of intervention participants (20/36;56%) who completed the mind-body video routine at least 3 times per week.

CONCLUSION

This intervention improved measures of mental wellness and quality of life with high satisfaction and reasonable adherence. Future studies could explore strategies to optimize adherence and target fatigue.

Predicting family physician physical activity electronic medical record inputs

OBJECTIVE

To compare characteristics of patients with and without physical activity noted in primary care electronic medical records.

METHODS

We used pan-Canadian family physician electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPSSSN) to compare patient and provider characteristics on one visit per patient selected at random. Since patients were nested by providers, univariate statistics were explored then a multilevel model was constructed.

RESULTS

The dataset included 769,185 patients, of whom 14,828 (1.9%) had physical activity information documented. Male patients, aged 25-34.9, no comorbidities prior to the random visit date, moderate or elevated blood pressure risk categories prior to the random visit date, the least materially deprived quintile, and with median body mass index in the normal category prior to the random visit date had the most physical activity mentions. Of the 879 family physicians in the sample, just over half (56.1%) documented physical activity at least once across their patients. More female physicians and physicians who practised in academic sites documented physical activity. In a two-level logistic model to predict physical activity documented in the randomly selected visit: older than mean patient age, having fewer comorbidities, younger than mean family physician age, academic teaching sites, and electronic medical record systems were statistically significant covariates.

CONCLUSIONS

This work adds to existing literature by describing the frequency and the patient and family physician characteristics of physical activity documentation in the Canadian primary care context. Overall, patient physical activity was rarely documented in electronic medical records.

The feasibility and acceptability of an online mind-body wellness program for patients with primary biliary cholangitis

Background

Persons with primary biliary cholangitis (PBC) experience significantly higher rates of mental distress and impaired health related quality of life (HrQoL) than the general population. Given limited evidence, but a high need, our primary aim was to assess feasibility and acceptability of a 12-week, online, mind-body wellness program in people with PBC.

Methods

This was a single-group, sequential mixed-methods, pre-post feasibility, and acceptability study. Core program components included follow-along movement, meditation and breathwork videos, and cognitive behavioural therapy informed activities. This was supplemented by weekly phone check-ins. Feasibility was assessed by recruitment, adherence, and retention. The pre-post exploratory efficacy assessment included surveys for fatigue, perceived stress, anxiety, depression, HrQoL, and resilience. A qualitative descriptive approach with semi-structured interviews evaluated study experiences.

Results

Thirty-two participants were recruited within 30 days and 29 (91%) were retained to end-of-study. Of these, 25 (86%) adhered to carrying out the mind-body practice at least 2-3 days per week. Feedback supported acceptability (satisfaction score 90%). Significant improvements were observed in fatigue (13%, p = 0.004), anxiety (30%, p = 0.005), depression (28%, p = 0.004), and five PBC-40 domains (itch, fatigue, cognitive, emotional, general symptoms). Qualitative interviews revealed improved stress management, better coping, and a more positive mindset. Fatigue and self-sabotaging thoughts were cited as barriers to participation.

Conclusions

These findings suggest that a 12-week online mind-body intervention is feasible and acceptable in patients with PBC. After iterative refinement, a randomized controlled trial will be designed using this feedback.

Evaluating a Telemedicine Video Game-Linked High-Intensity Interval Training Exercise Programme in Paediatric Heart Transplant Recipients

Paediatric heart transplant recipients (HTRs) have reduced exercise capacity, physical activity (PA), health-related quality of life (HRQoL), and self-efficacy towards PA. Exercise interventions have demonstrated improvements in exercise capacity and functional status in adult HTRs, with a specific emerging interest in the role of high-intensity interval training (HIIT). Studies of exercise interventions in paediatric HTRs have been limited and nonrandomized to date. HIIT has not yet been evaluated in paediatric HTRs. We thus seek to evaluate the safety and feasibility of a randomized crossover trial of a 12-week, home-based, video game-linked HIIT intervention using a cycle ergometer with telemedicine and remote physiological monitoring capabilities (MedBIKE) in paediatric HTRs. The secondary objective is to evaluate the impact of the intervention on (1) exercise capacity, (2) PA, (3) HRQoL and self-efficacy towards PA, and (4) sustained changes in secondary outcomes at 6 and 12 months after intervention. After a baseline assessment of the secondary outcomes, participants will be randomized to receive the MedBIKE intervention (12 weeks, 36 sessions) or usual care. After the intervention and a repeated assessment, all participants will cross over. Follow-up assessments will be administered at 6 and 12 months after the MedBIKE intervention. We anticipate that the MedBIKE intervention will be feasible and safely yield sustained improvements in exercise capacity, PA, HRQoL, and self-efficacy towards PA in paediatric HTRs. This study will serve as the foundation for a larger, multicentre randomized crossover trial and will help inform exercise rehabilitation programmes for paediatric HTRs.

The 2022 ParticipACTION Report Card on Physical Activity for Children and Youth: Focus on the COVID-19 pandemic impact and equity-deserving groups

Introduction

The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive national assessment of physical activity and related behaviors, characteristics, and opportunities for children and youth. The 2022 Report Card assigned grades based on data gathered during the COVID-19 pandemic to reflect this extraordinary time-period in Canada. Further, while not graded, efforts were made to summarize key findings for early years children and those identifying as: having a disability, Indigenous, 2SLGBTQ+, newcomers to Canada, racialized, or girls. The purpose of this paper is to summarize the 2022 ParticipACTION Report Card on Physical Activity for Children and Youth.

Methods

The best available physical activity data captured during the whole COVID-19 pandemic was synthesized across 14 different indicators in four categories. The 2022 Report Card Research Committee assigned letter grades (i.e., A-F) based on expert consensus of the evidence.

Synthesis

Grades were assigned for: Daily Behaviors (Overall Physical Activity: D; Active Play: D-; Active Transportation: C-; Organized Sport: C+; Physical Education: Incomplete [INC]; Sedentary Behaviors: F; Sleep: B; 24-Hour Movement Behaviors: F), Individual Characteristics (Physical Literacy: INC; Physical Fitness: INC), Spaces and Places (Household: C, School: B-, Community and Environment: B), and Strategies and Investments (Government: B-). Compared to the 2020 Report Card, the COVID-19 specific grades increased for Active Play and Active Transportation; and decreased for Overall Physical Activity, Sedentary Behaviors, Organized Sport, and Community and Environment. There were many data gaps for equity-deserving groups.

Conclusion

During the COVID-19 pandemic, the grade for Overall Physical Activity decreased from a D+ (2020) to a D, coinciding with decreases in grades reflecting fewer opportunities for sport and community/facility-based activities as well as higher levels of sedentary behaviors. Fortunately, improvements in Active Transportation and Active Play during COVID-19 prevented a worse shift in children's health behaviors. Efforts are needed to improve physical activity for children and youth during and post-pandemic, with a greater emphasis on equity-deserving groups.

An Umbrella Review of the Best and Most Up-to-Date Evidence on the Built Environment and Physical Activity in Older Adults ≥60 Years

Objectives: To present the best and most up-to-date evidence on associations between built environment (BE) attributes and overall and specific domains of physical activity (PA) (i.e., leisure, transport, walking, and cycling) in older adults (≥60 years).

Methods: An umbrella review was undertaken to compile evidence from systematic reviews using the Joanna Briggs Institute methodology. A comprehensive search (updated 16 August 2022), inclusion/exclusion of articles via title/abstract and full-text reviews, data extraction, and critical appraisal were completed. Only reviews with a good critical appraisal score were included.

Results: Across three included systematic reviews, each BE attribute category was positively associated with ≥1 PA outcome. A larger number of significant associations with BE attributes were reported for transport walking (13/26), total walking (10/25), and total PA (9/26), compared to leisure walking (4/34) and transport cycling (3/12). Fewer associations have been examined for leisure cycling (1/2).

Conclusion: Although the causality of findings cannot be concluded due to most primary studies being cross-sectional, these best and most up-to-date findings can guide necessary future longitudinal and experimental studies for the (re)design of age-friendly communities.

Parents as Agents of Change in Managing Pediatric Obesity: A Randomized Controlled Trial Comparing Cognitive Behavioral Therapy versus Psychoeducation Interventions

Background: Obesity interventions for parents of children with obesity can improve children's weight and health. This randomized controlled trial (RCT) evaluated whether a parent-based intervention based on cognitive behavioral therapy (CBT) principles was superior to a parent-based intervention based on a psychoeducation program (PEP) in improving children's obesity. Methods: This study was a pragmatic, two-armed, parallel, superiority RCT. Conducted at a Canadian outpatient pediatric obesity management clinic (September 2010-January 2014), this trial included families with children 8-12 years with an age- and sex-specific BMI ≥85th percentile. The 16-week manualized interventions were similar in content and delivered to parents exclusively, with different theoretical underpinnings. The primary outcome was children's BMI z-score at postintervention (4 months). Secondary outcomes included anthropometric, lifestyle, psychosocial, and cardiometabolic variables. Data were collected at preintervention (0 months), postintervention (4 months), 10, and 16 months. Intention-to-treat analysis using linear mixed models was used to assess outcomes. Results: Among 52 randomly assigned children, the mean age (standard deviation) was 9.8 (1.7) years and BMI z-score was 2.2 (0.3). Mean differences in BMI z-score were not significantly different between the CBT (n = 27) and PEP (n = 25) groups from 0 to 4-, 10-, and 16-month follow-up. At 4 months, the mean difference in BMI z-score from preintervention between the CBT (-0.05, 95% CI = -0.09 to 0.00) and PEP (-0.04, 95% CI = -0.09 to 0.01) groups was -0.01 (95% CI = -0.08 to 0.06, p = 0.80). Similar results were found across all secondary outcomes. Conclusions: Our CBT-based intervention for parents of children with obesity was not superior in reducing BMI z-score vs. our PEP-based intervention.

Food Intake and Food Selection Following Physical Relocation: A Scoping Review

Objectives: To synthesize the current available evidence on the changes in food intake and food selection after physical relocation in non-refugee populations. Methods: The inclusion criteria were studies with a measurement of food selection and/or food intake in non-refugee populations where physical relocation had occurred with self-reported or objective assessment of the neighbourhood physical environment before and after relocation. Databases searched included MEDLINE, EMBASE, CINAHL and SCOPUS from 1946 to August 2022. Results: A total of four articles met the inclusion criteria. Overall, these studies gave longitudinal (n = 2) and cross-sectional (n = 2) evidence to suggest that moving to an urban neighbourhood with more convenience stores, cafés and restaurants around the home was associated with an increase in unhealthy food intake in adult populations. Additional factors such as income, vehicle access, cost, availability and perceptions of the local food environment played a role in shaping food selection and food intake. Conclusion: Four internal migration studies were found. The limited evidence base calls for more research. Future studies should include children and apply appropriate research designs to account for neighbourhood self-selection and concurrent life events. International migration studies should include assessment of neighbourhood physical environments pre- and post-relocation.

Associations Between Parent's Perceived Neighborhood Environment and Objectively Measured Walkability With Their Children's Physical Activity

BACKGROUND

Neighborhoods are one setting to promote children's physical activity. This study examined associations between neighborhood features and children's physical activity and whether season or socioeconomic status modified these associations.

METHODS

Parents (n = 641) of children aged 6-10 years completed the Neighborhood Environment Walkability Scale-Abbreviated. Walkability was objectively measured at 400, 800, and 1200 m around the centroid of participants' postal codes. Children's physical activity was measured via StepsCount pedometers and parental report. Regression analyses were performed with interaction terms for season and socioeconomic status. Multiple imputation was used primarily to triangulate the results for children with missing steps data (n = 192).

RESULTS

Higher perceived residential density and traffic hazards were significantly associated with lower squareroot transformed parental-reported physical activity and steps per day, respectively. Higher perceived aesthetics was associated with higher squareroot transformed parental-reported physical activity. Socioeconomic status modified 2 associations though they were not significant upon stratification. During winter months, better perceived infrastructure and safety for walking was associated with higher squareroot transformed parental-reported physical activity. No other significant associations emerged.

CONCLUSION

Residential density, traffic hazards, and aesthetics are important for children's physical activity. Few associations were modified by socioeconomic status or season. The need for objective and subjective measures of the neighborhood environment and children's physical activity is apparent.

Measurement of obesity in primary care practice: chronic conditions matter

Primary care providers can deliver tailored advice and support to patients who are overweight or have obesity. The 2020 Canadian Adult Obesity Practice Guideline for primary care providers recommended that patients’ waist circumference (WC) be measured if their height and weight place them in the overweight or Class I obesity category. The guideline does not recommend how often providers should measure WC nor describe how often this is measured in current practice. We reviewed electronic medical records (EMRs) of 707,819 Canadian adult patients aged 40 and older. Among them, 48.7% had 1 or more body mass index (BMI) recorded; 11.5% had at least 1 waist measurement recorded. Of those with a BMI classified as overweight or having Class I obesity, 23.7% had at least 1 WC measurement recorded, which differed by chronic disease. WC was documented in more patients who had diabetes mellitus (36.8%) than hypertension (26.1%), or osteoarthritis (24.3%). This difference may be reflective of more specific advice in diabetes guidelines. To our knowledge, this is the first study to describe documentation of WC measurement for patients who are overweight or have Class I obesity in Canadian primary care EMRs across obesity-related conditions.

Investigation of movement-related behaviors and energy compensation in people living with liver disease: A scoping review

The importance of integrated movement behaviours (MB, i.e., physical activity [PA], sedentary behaviour, and sleep) and their interdependence for health has been recently discussed in the literature. The proposition that the amount of time spent in any one of these behaviours may impact the amount of time spent in another is supported by the ActivityStat hypothesis. The aim of this review is to (1) to assess whether individuals with liver disease display MB and/or energy (i.e., total energy expenditure [EE], basal EE, resting EE, and activity EE) compensation throughout the day and/or days; and (2) to examine whether a prescribed PA intervention triggers compensatory responses. Documents were included if they focused on people living with liver disease; analysed MB and/or EE components; were data-based; and were published in English. Fifteen documents were included in the final synthesis. The one finding that addressed research question 1 showed no compensatory response. As for research question 2, most of the findings suggest no compensation effects in response to a PA intervention. There is insufficient evidence to support the ActivityStat hypothesis in people living with liver disease. Further research should be conducted to test this hypothesis using standardized methodological procedures.

Relationships Between Physical Activity, Boredom Proneness, and Subjective Well-Being Among U.K. Adults During the COVID-19 Pandemic

This investigation sought to examine physical activity (PA) as a potential determinant of chronic boredom and associated well-being within the context of COVID-related restrictions. A representative sample of U.K. adults (N = 1,521) completed a survey on June 1, 2020. Bivariate analyses demonstrated that individuals who met guidelines and maintained or increased PA scored higher on life satisfaction, worthwhileness, and happiness and lower on anxiety (i.e., indicators of well-being) and boredom proneness (d = 0.13-0.43). Boredom proneness was correlated with all indicators of well-being (r = .38-.54). A series of regression models revealed that PA predicted lower boredom proneness and better life satisfaction, worthwhileness, and happiness. Boredom proneness accounted for the covariance between PA and well-being. Prospective research is needed to confirm causality of the observed relationships.

Content of physical activity documentation in Canadian family physicians' electronic medical records

The purpose of this study was to examine the content of physical activity inputs in Canadian family physician electronic medical records. Of 1 225 948 patients aged 18-64 years, a sample of 1535 patients' charts were reviewed. A minority (n = 148; 9.6%) of patients had at least 1 mention of physical activity at any time. Insufficient information existed to determine physical activity domain (21.6%), purpose (50.0%), or meeting of guidelines (98.1%). Novelty: This study examines the physical activity content of what Canadian family physicians document in their electronic medical records.

A208 ASSESSING FEASIBILITY AND ACCEPTABILITY OF AN ONLINE MIND-BODY WELLNESS PROGRAM FOR PRIMARY BILIARY CHOLANGITIS

Background

Persons with primary biliary cholangitis (PBC) experience significantly higher rates of fatigue, stress, anxiety, depression, and impaired health related quality of life (HRQOL) as compared to the general population. While online wellness programming has been shown to be effective in decreasing fatigue and improving mental wellness in a variety of chronic disease populations, limited data is available for PBC.

Aims

This pilot study aimed to assess the hypothesis that a 12-week, online, mind-body wellness program would be feasible (assessed through adherence and retention) and acceptable in people with PBC. We also aimed to explore indicators of impact on measures of wellbeing.

Methods

Persons with PBC were recruited across Alberta and British Columbia in January 2021. The program included a 20–30 minute video containing low intensity mindful movement, meditation, and breathwork (goal 2–3 times/week) as well as a weekly behaviour change tip, PBC tip from a physician, and PBC nutrition tip. The online programming was accompanied by brief (10-minute) once weekly phone check-ins from a member of the study team, and optional once monthly zoom group sessions hosted by the Canadian PBC Society. Satisfaction and adherence were assessed at the end of the study using a survey. The pre-post exploratory efficacy assessment included: fatigue (Modified Fatigue Impact Scale), perceived stress (Perceived Stress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and HRQOL (PBC-40). Using a qualitative descriptive approach, we conducted semi-structured interviews at the end of the study to explore experiences with the intervention, and gather feedback for improvement.

Results

Participants (N = 32) completed baseline surveys and 29 (91%) were retained to end-of-study. Twenty-five (86%) adhered to the program goal of carrying out the mind-body practice at least 2–3 days per week. Comparing baseline to end-of-study, significant reductions were observed in fatigue (13%, p=0.004), anxiety (30%, p=0.005), and depression (28%, p=0.022), and significant improvements were observed in the PBC-40 itch (22%, 0.043), fatigue (13%, 0.005), cognitive (17%, 0.006), and emotional (18%, 0.001) domains. Eleven individuals participated in qualitative interviews, reporting an increase in energy, a more positive outlook, and increased knowledge of PBC. Feedback supported acceptability (satisfaction score of 90%), with fatigue cited as the primary barrier to increased program participation.

Conclusions

These findings suggest that a 12-week online mind-body intervention is feasible and acceptable to persons with PBC and has promising impact on efficacy. Recognizing the limitations of a single-arm study with a small sample size, a future RCT will be designed using this feedback.

Funding Agencies

MITACS Accelerate, Canadian PBC Society

Development of a 24-Hour Movement Behavior Questionnaire for Youth: Process and Reliability Testing

OBJECTIVE

To develop and evaluate the reliability of a 24-hour movement behavior questionnaire for physical activity, sedentary behavior, and sleep for youth in South Korea.

DESIGN

Mixed-methods study using literature review, expert panels, pilot tests, and test-retest reliability.

SETTING

Seoul and Gyeongg-do, South Korea.

PARTICIPANTS

A convenience sample of middle and high school students for a pilot test (n = 120) and reliability testing (n = 147).

MAIN OUTCOME MEASURES

The reliability of a 24-hour movement behavior questionnaire.

ANALYSIS

Cohen's kappa, Spearman, and intraclass correlation coefficients for test-retest reliability testing.

RESULTS

The questionnaire consisted of 19 questions in 5 categories: general information, sleep and nap, active transportation-related activity, school life, and free-time activities. The 24-hour movement behavior questionnaire achieved moderate reliability for all sleep, physical activity, and sedentary (r = 0.79, 0.61, 0.56). The amount of sleep, physical activity, and sedentary behavior indicated moderate-to-good rest-retest reliability, with intraclass correlation coefficients ranging from 0.54 to 0.79 (P < 0.01).

CONCLUSIONS AND IMPLICATIONS

The 24-hour movement behavior questionnaire was reliable for measuring sleep, physical activity, and sedentary behavior in Korean adolescents aged 13-17 years. The development of this questionnaire could facilitate more accurate and useful measurements of adolescent's activities and lifestyles in South Korea.

Ambient air pollution and movement behaviours: A scoping review

This scoping review summarizes the literature about how ambient (outdoor) air pollution impacts movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), or beliefs about movement behaviours. Of 6552 potential documents, 58 documents and 218 findings were included in the final synthesis. Most studies were from the United States and China, involved cross-sectional designs, and included mixed age groups. Overall, unfavourable changes/associations (i.e., decreased/lower physical activity, increased/higher sedentary-related behaviour, and decreased/lower sleep duration and quality) or no change/association in movement behaviours in relation to ambient air pollution were identified. Our findings suggest that more attention should be given to understanding the impact of ambient air pollution on movement behaviours in general and in diverse countries and vulnerable populations such as children or older adults.

Development of a Theoretically Informed Web-Based Mind-Body Wellness Intervention for Patients With Primary Biliary Cholangitis: Formative Study

Background

Mind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development.

Objective

This study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC.

Methods

The steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development.

Results

Barriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator.

Conclusions

The Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components.

Trial Registration

ClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527

Protocol for an evaluation of the Designing Communities to Support Healthy Living in Aging Residents Study

BACKGROUND

In collaboration with building developers, the Housing for Health team is contributing to the design of community-based congregate living facilities to support healthy living in older adults. There may also be opportunities to improve the surrounding neighbourhoods by collaborating with the municipalities where the developments are located. We will evaluate whether one or more of these comprehensive interventions lead to changes in the perceived, microscale, and macroscale neighbourhood-built environment (BE) and amenities, and impacts on the physical activity (PA), healthy eating, and social connections of residents. In parallel, we will gather qualitative data to provide a more in-depth understanding of how the BE may facilitate or hinder resident's healthy living outcomes.

METHODS

This project employs a quasi-experimental pre-post design with at least one or more intervention and control sites. The quantitative BE evaluation will include pre- and post-intervention assessments of neighbourhood macroscale (e.g., layout of communities) and microscale (e.g., street details and characteristics) changes using Geographical Information Systems (GIS) and Microscale Audit Pedestrian Streetscapes (MAPS) audits, respectively. The quantitative resident evaluation will include self-report (i.e., surveys) and objective assessments (i.e., accelerometers, Global Positioning System [GPS]) of residents at baseline (3-6-months pre-move-in) and follow-up (3-6-months and 9-12-months post-move-in if possible). The qualitative resident-environment component will involve in-depth semi-structured interviews post-intervention with building residents, family members, and stakeholders involved in the design/development and/or operation of the intervention site(s). Participant observations will be completed in the building and neighbourhood environments of the intervention site(s).

DISCUSSION

Findings will provide evidence on whether and how comprehensive changes to the BE and amenities of at least one congregate living facility and the surrounding neighbourhood can impact PA, healthy eating, and social connections of older adults. Successful intervention elements will be scaled up in future work. We will disseminate findings to a broad audience including the scientific community via peer-reviewed publications, conference presentations, and discussion panels; and the private, public, and not-for-profit sectors via reports, public presentations, and/or communications via our partners and their networks.

TRIAL REGISTRATION

Protocol ID: 1819-HQ-000051. ClinicalTrials.gov ID: NCT05031273. Registered 29 June 2021 with ClinicalTrials.gov.

Stationary Behavior and the Step-Defined Sedentary Lifestyle Index in Older Adults After Total Knee Arthroplasty

OBJECTIVES

To measure stationary behavior in a cohort of older adults after total knee arthroplasty (TKA) and determine the clinical utility of the step-defined sedentary lifestyle index (SLI) as a measure of stationary behavior after TKA.

DESIGN

Cross-sectional measurement study.

SETTING

Participants were recruited from a community intake clinic for hip and knee surgeries.

PARTICIPANTS

Sixty-five older adults 3 months after TKA (N=65).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Stationary behaviors, including stationary time, stationary bouts, breaks from stationary time, and the proportion of participants meeting the SLI, were measured in older adults 3 months post TKA using accelerometry. A 2-way analysis of variance test (α=0.05) was conducted to determine the effects of SLI (<5000 or ≥5000 daily steps) and possible interactions with sex on stationary behavior.

RESULTS

Participants spent 80% (13.17±2.3h) of their waking time in stationary time and had an average of 6.06 bouts of stationary time >30 minutes per day. Forty (61.5%) of the participants fell below the SLI of 5000 steps/d. SLI had significant effects on both waking stationary time (P<.001) and number of breaks in stationary time (P<.001), with participants taking <5000 daily steps having longer stationary times and fewer breaks in stationary time. Sex had a significant effect on the number of breaks in stationary time (P=.04), with men (n=23, 35%) reporting more breaks than women (n=42, 65%) (mean difference 13.36; 95% confidence interval, -2.67 to 18.69). No interactions were found between SLI and sex.

CONCLUSIONS

Both women and men had high levels of stationary behavior 3 months post TKA. The SLI discriminated waking stationary time and breaks in stationary time and may have clinical utility in measurement of stationary behavior.

Location-Based Sedentary Time and Physical Activity in People Living With Coronary Artery Disease

PURPOSE

Sedentary time (ST) and lack of physical activity increase the risk of adverse outcomes for those living with coronary artery disease (CAD). Little is known about how much ST, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) that CAD participants not attending cardiac rehabilitation engage in, the locations where they engage in these behaviors, and how far from home the locations are.

METHODS

Participants completed a survey and wore an accelerometer and global positioning system receiver for 7 d at baseline and 6 mo later.

RESULTS

Accelerometer analyses (n = 318) showed that participants averaged 468.4 ± 102.7 of ST, 316.1 ± 86.5 of LPA, and 32.9 ± 28.9 of MVPA min/d at baseline. ST and LPA remained stable at 6 mo, whereas MVPA significantly declined. The global positioning system (GPS) analyses (n = 315) showed that most of participant ST, LPA, and MVPA time was spent at home followed by other residential, retail/hospitality, and work locations at baseline and 6 mo. When not at home, the average distance to a given location ranged from approximately 9 to 18 km.

CONCLUSIONS

Participants with CAD spent the majority of their time being sedentary. Home was the location used the most to engage in ST, LPA, and MVPA. When not home, ST, LPA, and MVPA were distributed across a variety of locations. The average distance from home to a given location suggests that proximity to home may not be a barrier from an intervention perspective.

Assessing Patient Proficiency with Internet-Connected Technology and Their Preferences for E-Health in Cirrhosis

There is a rapidly evolving need for e-health to support chronic disease self-management and connect patients with their healthcare teams. Patients with cirrhosis have a high symptom burden, significant comorbidities, and a range of psychological and cognitive issues. Patients with cirrhosis were assessed for their readiness and interest in e-health. Adults attending one of two outpatient cirrhosis clinics in Alberta were recruited. Eligible participants were not required to own or have experience with digital technologies or the Internet. Medical history, socioeconomic status, and attitudes regarding e-health, the Computer Proficiency Questionnaire, and the Mobile Device Proficiency Questionnaire were used to describe participants' knowledge and skills. Of the 117 recruited patients, 68.4% owned a computer and 84.6% owned a mobile device. Patients had mean proficiency scores of 72.8% (SD 25.9%) and 69.3% (SD 26.4%) for these devices, respectively. In multiple regression analyses, significant predictors of device proficiency were age, education, and household income. Most patients (78.7%) were confident they could participate in videoconferencing after training and most (61.5%) were interested in an online personalized health management program. This diverse group of patients with cirrhosis had technology ownership, proficiency, and online behaviours similar to the general population. Moreover, the patients were very receptive to e-health if training was provided. This promising data is timely given the unique demands of COVID-19 and its influence on self-management and healthcare delivery to a vulnerable population.

Comparison of physical activity patterns across large, medium and small urban areas and rural settings in the Otago Region, New Zealand

AIM

This study compared accelerometer-measured physical activity (PA) patterns in adolescents living in diverse urban and rural areas of Otago, New Zealand.

METHOD

Participants (n=377; age: 14.9±1.4 years; 66.8% female; 23 schools) completed an online school travel survey, anthropometry and seven-day PA accelerometer assessment. Participants resided in large (n=237), medium (n=45) and small (n=44) urban areas or rural settings (n=51).

RESULTS

Overall, participants participated in 54.4±21.0 minutes of moderate-to-vigorous physical activity (MVPA) daily and 35.0% met PA guidelines (school day vs weekend day: 40.8% vs 26.0%; p<0.001) with no difference across geographical settings. A greater proportion of males (43.2% vs 31.9%; p=0.016), school sport participants (70.1% vs 54.0%; p=0.005) and active-transport-to-school users (40.2% vs 26.1%) met PA guidelines compared to their counterparts. Compared to rural adolescents, those from large urban areas accumulated more MVPA during the school commute time (before school: 8.3±6.7 vs 5.3±3.8 minutes, p<0.001; after school: 10.1±6.0 vs 7.7±4.3 min, p=0.003), but overall spent more time sedentary (584.9±84.7 vs 527.8±88.2 minutes/day; p<0.001).

CONCLUSION

PA in Otago adolescents is low, with significant differences by gender, sport participation, mode of travel to school and geographical setting. Increased PA should be encouraged in both urban and rural adolescents.

Machine learning sleep duration classification in Preschoolers using waist-worn ActiGraphs

OBJECTIVE

To create a sleep duration classification technique for waist-worn ActiGraph accelerometers in preschool-aged children.

METHODS

Children wore ActiGraph wGT3X-BT accelerometers on their right hip for 7 days (24 h/day). Ground truth nap, sleep, and wake were estimated through visual inspection of accelerometer data, guided by sleep log-sheets and previously published visual inspection heuristics. Raw accelerometer data (30Hz) were used to generate 144 features aggregated to 1-min epochs. Machine learning classification (ie, Random Forest and Hidden Markov Modeling [HMM]) predicted nap, sleep, and wake. A simplified prediction formula was also created using features (n = 10) with the highest mean decrease in Gini index during training of Random Forests, and temporally smoothed with rolling median calculations.

RESULTS

Children (n = 89, mean age = 4.5 years, 67% boys) contributed >600,000 min of accelerometer data. Overall classification accuracy of the Random Forest and HMM classifier was 96.2% (95%CI: 96.1, 96.2%), with a Kappa score of 0.93. Additionally, overall classification accuracy for the temporally smoothed simplified formula was 93.7% (95%CI: 93.6, 93.7%) with Kappa = 0.87. Nap prediction accuracy was 99.8% for the final machine learning model, and 86.1% for the simplified formula. For participant-level daily summaries, generally small but statistically significant differences were found between machine learning and ground truth behaviour predictions, whereas non-significant differences were found between the simplified formulas and ground truth predictions.

CONCLUSIONS

Predictions for both machine learning and the simplified formula had almost perfect agreement with visual inspection ground truth measurements. Future research is needed to confirm these findings using polysomnography ground truth sleep measurements.

Determinants of physical activity among adults in the United Kingdom during the COVID-19 pandemic: The DUK-COVID study

Objectives This study examined the impact of the COVID-19 lockdown on the physical activity (PA) of UK adults and potential motivational determinants of such behaviour. Design and methods A survey was conducted with 1,521 UK adults recruited through Prolific.co in early June 2020. Along with demographic information, questions assessed current PA, changes in PA modalities (i.e., overall, around the home, for transport, in the workplace, in the local neighbourhood, at recreation/sport facilities) related to the lockdown, and beliefs about capabilities, opportunities, and motivations according to the COM-B model. A series of logistic regressions were constructed to examine associations between shifts in the PA modalities and the COM-B components. Results The majority of respondents (57%) had either maintained or increased their levels of PA during the COVID-19 lockdown. However, the proportion meeting PA guidelines (31%) was low and engagement in sedentary-related behaviour for both work and leisure increased substantially during the lockdown. The components of the COM-B model were associated with shifts in PA. In particular, physical opportunity (odds ratios ranging from 1.14 to 1.20) and reflective motivation (odds ratios ranging from 1.11 to 1.25) appeared to be the most consistent predictors of behaviour. Conclusions If UK adults believed they had the physical opportunity and were motivated, they were more likely to have maintained or increased their PA during the COVID-19 lockdown. However, the majority of adults are not meeting the UK guidelines on PA and the prevalence of PA is substantially lower than national surveys prior to the pandemic. Statement of contribution What is already known on this subject? The COVID-19 pandemic has significantly disrupted the daily routines of citizens globally. Engagement in physical activity appears to have declined as a result of the requirement to self-isolate and stay in place. The COM-B model of behaviour change is a useful framework for identifying the correlates and determinants of behaviour. What does this study add? Though most UK adults maintained or increased their engagement in physical activity during the COVID-19 pandemic, the majority did not meet recommended guidelines. Reflective processes and physical opportunity were the primary predictors of change in physical activity.

Associations between objectively-measured and self-reported neighbourhood walkability on adherence and steps during an internet-delivered pedometer intervention

BACKGROUND

Accumulating evidence suggests that the built environment is associated with physical activity. The extent to which the built environment may support adherence to physical activity interventions is unclear. The aim of this study was to investigate whether the neighbourhood built environment constrains or facilitates adherence and steps taken during a 12-week internet-delivered pedometer-based physical activity intervention (UWALK).

METHOD

The study was undertaken in Calgary (Canada) between May 2016 and August 2017. Inactive adults (n = 573) completed a telephone survey measuring sociodemographic characteristics and perceived neighbourhood walkability. Following the survey, participants were mailed a pedometer and instructions for joining UWALK. Participants were asked to report their daily pedometer steps into the online program on a weekly basis for 12 weeks (84 days). Walk Score® estimated objective neighbourhood walkability and the Neighbourhood Environment Walkability Scale-Abbreviated (NEWS-A) measured participants self-reported neighbourhood walkability. Regression models estimated covariate-adjusted associations of objective and self-reported walkability with: 1) adherence to the UWALK intervention (count of days with steps reported and count of days with 10000 steps reported), and; 2) average daily pedometer steps.

RESULTS

On average, participants undertook 8565 (SD = 3030) steps per day, reported steps on 67 (SD = 22.3) of the 84 days, and achieved ≥10000 steps on 22 (SD = 20.5) of the 84 days. Adjusting for covariates, a one-unit increase in self-reported walkability was associated on average with 45.76 (95CI 14.91, 76.61) more daily pedometer steps. Walk Score® was not significantly associated with steps. Neither objective nor self-reported walkability were significantly associated with the UWALK adherence outcomes.

CONCLUSION

The neighbourhood built environment may support pedometer-measured physical activity but may not influence adherence to pedometer interventions. Perceived walkability may be more important than objectively-measured walkability in supporting physical activity during pedometer interventions.

Movement behaviours and physical, cognitive, and social-emotional development in preschool-aged children: Cross-sectional associations using compositional analyses

BACKGROUND

Movement behaviours (e.g., sleep, sedentary behaviour, and physical activity) in isolation have demonstrated benefits to preschool-aged children's development. However, little is known on the integrated nature of movement behaviours and their relationship to healthy development in this age range. Thus, the objective of this study was to examine the relationships between accelerometer-derived movement behaviours and indicators of physical, cognitive, and social-emotional development using compositional analyses in a sample of preschool-aged children.

METHODS

Children (n = 95) were recruited in Edmonton, Canada. Movement behaviours were measured with ActiGraph wGT3X-BT accelerometers worn 24 hours/day. Physical (i.e., body mass index [BMI] z-scores, percent of adult height, and motor skills), cognitive (i.e., working memory, response inhibition, and vocabulary), and social-emotional (i.e., sociability, externalizing, internalizing, prosocial behaviour, and cognitive, emotional, and behavioural self-regulation) development were assessed. Objective height and weight were measured for BMI z-scores and percent of adult height, while the Test of Gross Motor Development-2 was used to assess motor skills. The Early Years Toolbox was used to assess all cognitive and social-emotional development indicators. Compositional linear regression models and compositional substitution models were conducted in R.

RESULTS

Children accumulated 11.1 hours of sleep, 6.1 hours of stationary time, 5.1 hours of light-intensity physical activity (LPA), and 1.8 hours of moderate- to vigorous-intensity physical activity (MVPA) per day. Movement behaviour compositions were significantly associated with physical (i.e., locomotor skills, object motor skills, and total motor skills) and cognitive (i.e., working memory and vocabulary) development (R2 range: 0.11-0.18). In relation to other movement behaviours in the composition, MVPA was positively associated with most physical development outcomes; while stationary time had mixed findings for cognitive development outcomes (i.e., mainly positive associations in linear regressions but non-significant in substitution models). Most associations for LPA and sleep were non-significant.

CONCLUSIONS

The overall composition of movement behaviors appeared important for development. Findings confirmed the importance of MVPA for physical development. Mixed findings between stationary time and cognitive development could indicate this sample engaged in both beneficial (e.g., reading) and detrimental (e.g., screen time) stationary time. However, further research is needed to determine the mechanisms for these relationships.

Policy-influencer perspectives on the development, adoption, and implementation of provincial school-based daily physical activity policies across Canada: A national case study

Objectives

School-based daily physical activity (DPA) policies represent a promising intervention for increasing physical activity levels among children. Between 2005 and 2010, five Canadian provinces adopted and implemented DPA policies. This national case study explored facilitators and challenges to developing, adopting and implementing DPA policies from the perspective of key stakeholders (‘policy-influencers’) in these five provinces.

Methods

Development, adoption and implementation of DPA policies at the provincial level was the phenomenon of interest, with each province constituting a distinct case. Semi-structured interviews were conducted with 15 purposively selected policy-influencers across the five case provinces. Cases were first analyzed separately, and then concurrently in a cross-case comparison. Qualitative content analysis was used to code interviews and develop themes.

Results

Four themes related to the development, adoption, and implementation of DPA policies emerged: existing resources and capacity for policy change; top-down policy development/adoption and bottom-up implementation; political will and windows of opportunity; and, ideology and policy change. Each of these themes encompassed facilitators and challenges related to policy processes surrounding development, adoption and implementation of DPA policies.

Conclusion

These findings can inform development of future health-related polices in schools. Stakeholders can, for instance, remain attuned to the opening of political windows and capitalize on them as an opportunity to advocate for policy change or create communities of practice to enhance coordination among policy stakeholders. Future studies that explore why other jurisdictions have failed to adopt DPA policies might yield novel insights regarding leverage points to support widespread diffusion of DPA policies.

•

Between 2005 and 2010, five Canadian provinces adopted and implemented DPA policies.

•

A national case study explored facilitators and challenges to adopting and implementing provincial DPA policies.

•

Four key themes related to policy change: capacity, adoption and implementation, political will, and ideology.

•

Recommendations can inform development and implementation of school-based physical activity and health promotion policy.

Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey

Background

Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth.

Methods

A national sample of Canadian parents (n = 1472) of children (5–11 years) or youth (12–17 years) (54% girls) completed an online survey that assessed immediate changes in child movement and play behaviours during the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors that may influence movement behaviours were assessed. Correlations between behaviours and demographic and parental factors were determined. For open-ended questions, word frequency distributions were reported.

Results

Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels, less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental encouragement and support, parental engagement in PA, and family dog ownership were positively associated with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents reported adopting new hobbies or accessing new resources.

Conclusions

This study provides evidence of immediate collateral consequences of the COVID-19 outbreak, demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery period, and to inform strategies to mitigate potential harm during future pandemics.

Within-class grouping: evidence versus conjecture

Lou, Abrami, Spence, Poulsen, Chambers, and d'Apollonia (1996) reported the findings from a quantitative review showing generally positive but variable effects of within-class grouping on pupil achievement and other outcomes. Replying in the National Institute Economic Review (July 1998), Prais argued for whole-class teaching claiming that we mis-summarised our findings. In this abbreviated rejoinder, we argue that our findings are: useful; not so variable as to be meaningless; provide evidence of beneficial effects for pupils of all relative abilities; are thorough and detailed; and provide a rather complete picture of the available evidence. In contrast, we believe that Prais (1998) has relied too heavily on conjecture and selective citation to offer a view of within-class grouping which is a serious mis-summarisation of the findings.

Built environment changes and active transport to school among adolescents: BEATS Natural Experiment Study protocol

INTRODUCTION

Natural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014-2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019-2022) will examine the effects of BE changes on adolescents' active transport to school in Dunedin, New Zealand.

METHODS AND ANALYSIS

The BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning.

ETHICS AND DISSEMINATION

The BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders.

TRIAL REGISTRATION NUMBER

ACTRN12619001335189.

The extent to which family physicians record their patients' exercise in medical records: a scoping review

OBJECTIVE

Exercise is an effective modality for the prevention and treatment of chronic conditions and family physicians are the healthcare providers tasked to manage patients' chronic disease status. However, little is known about the exercise documentation in family-physician records. Therefore, a scoping review was conducted to describe family-physician-recorded exercise-related advice to patients in electronic medical records.

DESIGN

Scoping review.

SETTING

Primary care clinics.

SEARCH STRATEGY

PubMed, Medline, SPORTDiscus, Google, Dissertations & Theses Global, OCLC PapersFirst (via First Search) and included references were searched between 1 January 1990 and 10 June 2018. Extracted information included year, geographic origin, data input structure, input frequency and content of exercise inputs in family physicians' electronic medical records. The primary outcomes are the structure, purpose and frequency of inputs.

RESULTS

Of a possible 1758 documents, 83 remained after a title and abstract scan and 22 after a full-text review. These documents included 32 findings of physical activity/exercise medical record documentation: counselling/advising patients (50.0%), status (12.5%), embedded questionnaires (12.5%), status as a risk factor (12.5%), health promotion documentation (6.3%), inactivity status (3.1%) and grading (3.1%). The frequency of exercise inputs in primary care records vary from as low as 0.4% of patients with documentation of physical activity health promotion inputs to as high as 87.8% of patients with exercise or physical activity status recorded. The majority of included documents (63.6%) were focused on patients with identified chronic conditions.

CONCLUSION

The findings suggest that the structure and purpose of exercise documentation is often unclear or unspecified. Studies that present exercise information from family-physician medical records tend to focus on patients with specific chronic conditions and present little detail about the field from which information was extracted. The review found that the proportion of patients with physical activity or exercise information is often less than half.

One small step for man, one giant leap for men's health: a meta-analysis of behaviour change interventions to increase men's physical activity

OBJECTIVE

To determine the effects of behaviour change interventions on men's physical activity (postintervention), sustained change in physical activity behaviour (≥12 months postintervention) and to identify variations in effects due to potential moderating variables (eg, theoretical underpinning, gender-tailored, contact frequency).

DESIGN

Systematic review with meta-analysis. Pooled effect size (Cohen's d) was calculated assuming a random-effects model. Homogeneity and subsequent exploratory moderator analyses were assessed using Q, T² and I².

DATA SOURCES

Medline, EMBASE, CINAHL, SportDiscus and Web of Science to April 2019.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

Randomised control trials of behaviour change interventions in men (≥18 years) where physical activity was an outcome and data were from men-only studies or disaggregated by sex.

RESULTS

Twenty-six articles described 24 eligible studies. The overall mean intervention effect on men's physical activity was 0.35 (SE=0.05; 95% CI 0.26 to 0.45; p<0.001). This effect size is consistent with an increase of approximately 97 min of total physical activity per week or 980 steps per day. Intervention moderators associated with greater increases in physical activity included objective physical activity outcome measures, a gender-tailored design, use of a theoretical framework, shorter length programmes (≤12 weeks), using four or more types of behaviour change techniques and frequent contact with participants (≥1 contact per week). 12 studies included additional follow-up assessments (≥12 months postintervention) and the overall mean effect was 0.32 (SE=0.09; 95% CI 0.15 to 0.48; p<0.001) for that sustained increase in physical activity.

SUMMARY

Behaviour change interventions targeting men's physical activity can be effective. Moderator analyses are preliminary and suggest research directions.

Parental support of the Canadian 24-hour movement guidelines for children and youth: prevalence and correlates

Background

To explore the prevalence of parental support for meeting the Canadian 24-Hour Movement Guidelines for Children and Youth, identify key interactive support profiles among the four movement behaviors, and investigate subsequent sociodemographic and social cognitive correlates of these profiles.

Methods

A sample of Canadian parents (N = 1208) with children aged 5 to 17 years completed measures of the theory of planned behavior (TPB), and support of the four child movement behaviors via questionnaire. Differences in the proportion of parents supporting these four health behaviors were explored and demographic and social cognitive (attitude and perceived control) correlates of combinations of parental support for the four health behaviors were evaluated.

Results

Child and youth sleep behavior had the highest parental support (73%) and moderate to vigorous physical activity support had the lowest prevalence (23%). Interactive profiles of the four movement behaviors yielded six primary clusters and comprised wide variation from parents who supported none of these behaviors (19%), to parents who supported all four behaviors (14%). These profiles could be distinguished by the age of the child (younger children had higher support) and the gender of the parent (mothers provided more support), as well as constructs of the TPB, but TPB cognitions were more specific predictors of each health behavior rather than general predictors of aggregate health behavior clusters.

Conclusions

Teenagers and fathers may represent key targets for parental support intervention of the 24-Hour Movement Guidelines. Intervention content may need to comprise the underlying foundations of attitude and perceived behavioral control to change parental support while considering the unique features of each health behavior to maximize related intervention effectiveness.

The relationship between transport-to-school habits and physical activity in a sample of New Zealand adolescents

OBJECTIVES

Adolescents using active transport (AT) to school have higher levels of physical activity (PA) compared with motorized transport (MT) users. This study compared school day and weekend day PA in adolescents using AT, MT, or combined AT and MT (AT + MT) to travel to school.

METHODS

Adolescents (n = 314; age: 14.7 ± 1.4 years; 32.8% boys) from Dunedin (New Zealand) wore an accelerometer for 7 days and completed a self-reported survey regarding mode of transport to school (73 AT, 56 AT + MT, and 185 MT). Data were analyzed using t tests, analysis of variance, and χ ² tests.

RESULTS

Although the proportion of adolescents meeting PA guidelines significantly differed among transport groups (AT, 47.9%; AT + MT, 46.4%; MT, 33.5%; p = 0.048; overall, 39.2%), the observed differences were due mainly to girls. Compared with MT, AT and AT + MT engaged in more moderate-to-vigorous PA (MVPA) per day (AT: 61.2 ± 23.2 min; AT + MT: 59.6 ± 21.7 min; MT: 52.5 ± 19.6 min; p = 0.004; p < 0.001, adjusted for gender), per school day and before school. Immediately after school (15:00-16:00), AT engaged in significantly more MVPA compared with AT + MT and MT. No differences in MVPA between the groups were observed in the late afternoon/early evening period during school days or on weekend days.

CONCLUSION

Compared with MT users, adolescent girls using AT or AT + MT accumulated more MVPA during school commute time. AT + MT to school is also a plausible way to increase adolescent girls' PA when AT only is not feasible.

Automatic associations of breast cancer and heart disease with fruit and vegetables and physical activity

Objectives:

This exploratory research examined if breast cancer or heart disease is automatically associated with physical activity compared to fruit and vegetable stimuli; if reading messages about reducing risk of breast cancer or heart disease through physical activity and fruit and vegetable consumption would affect automatic associations; and if automatic associations were related to intentions to be physically active or consume fruit and vegetables.

Methods:

Participants were 80 women who completed pretest measures of automatic associations, then read a breast cancer, heart disease, or control message, followed by posttest measures.

Results:

There was a significant association of breast cancer–related words with fruit and vegetables compared to physical activity. Heart disease was also more strongly associated with fruit and vegetables than physical activity at pretest but not at posttest. There were no other significant findings.

Conclusion:

This research highlights that fruit and vegetables rather than physical activity are more strongly associated with perceptions of breast cancer and heart disease. Automatic associations are an attitudinal construct, and the strength of association between fruit and vegetables, rather than physical activity, indicates how messages may be processed.

Levels and correlates of 24-hour movement behaviors among South Koreans: Results from the Korea National Health and Nutrition Examination Surveys, 2014 and 2015

PURPOSE

This study aimed to examine the levels and correlates of 24-h movement behaviors (i.e., physical activity, sedentary time, and sleep), and different patterns of these behaviors in a nationally representative sample of South Koreans aged 12 years and older. This study also aimed to examine the sociodemographic correlates of 24-h movement behaviors stratified by age groups.

METHODS

Self-reported, repeated cross-sectional data from 10,708 participants in the 2014 and 2015 Korea National Health and Nutrition Examination surveys were used. Key variables included moderate-to-vigorous intensity physical activity, muscular strengthening exercises, walking, active transportation, sedentary time, and sleep. Sociodemographic variables included age, sex, household income, area of residence, and education level. Descriptive statistics by sex and age as well as general linear models by age group were performed.

RESULTS

The proportions of individuals meeting the moderate-to-vigorous intensity physical activity, muscular strengthening exercises, and sleep guidelines were, respectively, 21.6%, 22.1%, and 32.5% in male youth; 6.9%, 4.5%, and 22.8% in female youth; 55.5%, 30.8%, and 54.0% in male adults; 48.8%, 14.4%, and 57.6% in female adults; 44.0%, 30.6%, and 45.5% in male older adults; and 29.5%, 8.9%, and 37.3% in female older adults. The proportions of individuals showing the most ideal combinations of 24-h movement behaviors were only 3.2% in youth, 0.4% in adults, and 0 in older adults. Universally, older age, female sex, or living in metro Seoul were associated with unfavorable patterns of 24-h movement behaviors across different age groups. However, the associations of income and education with movement behaviors were mixed across age groups.

CONCLUSION

Overall, the proportion of South Koreans with a healthy 24-h movement behavior pattern is low. The sociodemographic correlates of different types of 24-h movement behaviors should be considered when designing targeted interventions for the promotion of healthy active living for South Koreans.

Political Orientation and Public Attributions for the Causes and Solutions of Physical Inactivity in Canada: Implications for Policy Support

Objectives: To examine how public attributions for the causes and solutions of physical inactivity and individuals' self-identified political orientation are associated with support for different policy actions in addressing physical inactivity. Methods: A secondary data analysis was conducted with a sample of 2,044 Canadian adults. Two sets of 2 X 3 analyses of variance and post-hoc analyses were conducted to assess (1) the mean differences by the causes of the issue of physical inactivity (individual, or both internal and external/external) and political orientation (liberal, centrist, and conservative), and (2) responsibility for solutions (private matter, or both private and public health matter, and /public health matter) and political orientation on support for least, moderate, and most intrusive policy actions. Results: No interaction effects existed between causal attribution and political orientation on policy support, but a main effect of causal attributions for physical inactivity and political orientation was significant. Those who held internal attributions for the cause of physical inactivity showed less support for policies compared to those who held external causal attributions or both internal and external causal attributions. Conservative individuals reported the least support for all policy actions in comparison to liberal or centrist orientations. There were interaction effects between responsibility for solutions and political orientation on policy support. Conservative individuals who perceived the responsibility for solving physical inactivity as a private matter had less support for all three policy actions. Conclusions: Public acceptance of policy actions addressing physical inactivity varies by the attributions the public have regarding causes and responsibility for solving the problem, and by political orientation. Advocacy and messaging for policy implementation in the physical activity arena needs to be communicated in ways that encourage reflective and informed deliberation that is representative of the Canadian population.

Make Room for Play: An Evaluation of a Campaign Promoting Active Play

In the context of rising screen time, only a third of Canadian children are achieving adequate amounts of active play, an important source of physical activity. ParticipACTION, a national not-for-profit organization, created the "Make Room for Play" campaign targeting parents with television advertisements depicting how screen time takes away from active play. The advertisements featured children engaging in active play (e.g., jump rope) while a black screen progressively sequesters the room for them to play. This study's purpose was to evaluate the campaign using the hierarchy of effects model, a framework for conceptualizing the impact of mass media campaigns. It was hypothesized that recall would relate to intermediate (e.g., cognitions, self-efficacy) and distal (e.g., parental support) factors. Twenty-six percent of the general population and caregiver samples surveyed (N = 1576) recalled (unaided) the advertisement and 45.9% recalled when prompted. Parental support was significantly higher in those recalling the campaign, p = .009. Twenty-four percent of parents reporting unaided recall (versus 14.0% of those not) tried to engage in active play with their children and 21.2% (versus 12.0%) tried to create opportunities for children to engage in play. Strengths and limitations of mass media approaches targeting active play and screen time are discussed.

Physical activity and sedentary behavior across three time-points and associations with social skills in early childhood

Background

The growth and development that occurs in early childhood has long-term implications, therefore understanding the relevant determinants is needed to inform early prevention and intervention. The objectives of the study were to examine: 1) the longitudinal associations of physical activity and sedentary behavior with social skills and 2) how physical activity and sedentary behavior track over three time-points.

Methods

Participants were from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. A total of 251 eligible toddlers and their parents participated at baseline in 2014/15 (time 1; 1.6 ± 0.2 years) and a sub-sample participated at 1-year (time 2; n = 79; 2.7 ± 0.3 years) and 2-year (time 3; n = 77; 3.7 ± 0.4 years) follow-ups. Sedentary time (≤25 counts/15 s), light-intensity physical activity (LPA; 26–419 counts/15 s), and moderate- to vigorous-intensity physical activity (MVPA; ≥420/15 s) were objectively measured with wGT3X-BT ActiGraph accelerometers, and standardized for wear time. Parents reported their children’s screen time (television/video, video/computer games) at all three time-points. Parents also reported on children’s social skills using the Adaptive Social Behavior Inventory (ASBI) at time-points 2 and 3, and comply (e.g., cooperates; 10 items), express (e.g., joins play; 13 items), and disrupt (e.g., teases; 7 items) subscales were created by summing items. Generalized estimating equations (GEE) were conducted to address objective one. Tracking coefficients (low: β1 < 0.30; moderate: β1 = 0.30–0.59; moderate-high: β1 = 0.60-0.90; high: β1 > 0.9) were conducted using GEE to address objective two.

Results

Across the study, screen time was negatively associated with express (b = − 0.068, 95%CI: -0.114, − 0.023) and comply (b = − 0.056; 95%CI: -0.094, − 0.018) scores and positively associated with disrupt scores (b = 0.004; 95% CI: 0.001, 0.006). Findings were similar for television/videos but less consistent for video/computer games. No associations were observed for physical activity. Screen time significantly tracked at moderate-high levels (β₁ = 0.63; 95% CI: 0.45, 0.81), while all other behaviors tracked at moderate levels (β₁ = 0.35–0.49; p < 0.01) over the three time-points.

Conclusions

Screen time was unfavorably associated with social skills across early childhood. Furthermore, all behaviors tracked at moderate to moderate-high levels from toddler to preschool ages. Therefore, promoting healthy physical activity and sedentary behavior patterns early in life, especially for screen time, may be important.

Assessing the social climate of physical (in)activity in Canada

BACKGROUND

Ecological models suggest that a strategy for increasing physical activity participation within a population is to reconstruct the "social climate". This can be accomplished through 1) changing norms and beliefs, 2) providing direct support for modifying environments, and 3) implementing policies to encourage physical activity. Nevertheless, surveillance efforts have paid limited attention to empirical assessment of social climate. This study responds to this gap by assessing the social climate of physical activity in Canada.

METHODS

A representative sample of Canadian adults (n = 2519, male/female = 50.3%/49.7%, Mage = 49.1 ± 16.3 years) completed an online survey asking them to assess social climate dimensions including social norms of physical (in)activity, perceptions of who causes physical inactivity and who is responsible for solving physical inactivity, and support for physical activity-related policy. Descriptive statistics (frequencies) were calculated. Multinomial logistic regressions were constructed to identify whether demographic variables and physical activity participation associated with social climate dimensions.

RESULTS

Physical inactivity was considered a serious public health concern by 55% of the respondents; similar to unhealthy diets (58%) and tobacco use (57%). Thirty-nine percent of the respondents reported that they often see other people exercising. Twenty-eight percent of the sample believed that society disapproves of physical inactivity. The majority of respondents (63%) viewed the cause of physical inactivity as both an individual responsibility and other factors beyond an individuals' control. Sixty-seven percent of respondents reported physical inactivity as being both a private matter and a public health matter. Strong support existed for environmental-, individual-, and economic-level policies but much less for legislative approaches. The social climate indicators were associated with respondents' level of physical activity participation and demographic variables in expected directions.

CONCLUSION

This study is the first known attempt to assess social climate at a national level, addressing an important gap in knowledge related to advocating for, and implementing population-level physical activity interventions. Future tracking will be needed to identify any temporal (in)stability of these constructs over time and to explore the relationship between physical activity participation and indicators of the national social climate of physical activity.

The short-term effects of a mass reach physical activity campaign: an evaluation using hierarchy of effects model and intention profiles

Background

Mass reach physical activity campaigns are designed to deliver physical-activity related messages to a large population across different media including print, television, radio, and websites. Few evaluations have examined the short-term effects of a mass reach campaign on participants who were engaged with the campaign. The current research examined the short-term effects of the ParticipACTION 150 Play List, a mass reach physical activity campaign, on participants who registered with the campaign website.

Methods

Participants (N = 7801) completed a registration questionnaire measuring demographic information, awareness and recall of physical activity and sport advertising, and self-reported number of activities tried or planned to try from the 150 Play List. A follow-up survey was completed by 1298 participants from the original sample. Additional questions assessed experience with the 150 Play List and attitudes towards campaign advertisements.

Results

Approximately 14.5% of participants cited the ParticipACTION 150 Play List and 23.6% mentioned a ‘getting active’ message when recalling advertisements. Those who named the 150 Play List or getting active reported more activities tried and more activities planned than those who did not. They were also more likely to say they had tried a new activity and planned ongoing participation. It was also found that participants with a disability were more likely to have tried a new activity compared to those not in a minority group. Other correlates of trying new activities at follow-up were younger age, more positive reported experience with the 150 Play List, and more favourable attitudes towards campaign advertisements. Those who did not intend continued participation, or who were unsure at baseline and then decided against continued participation at follow-up, reported they were less sedentary or encouraging others to be active.

Conclusions

This research addresses the gap in evidence regarding the efficacy of mass reach physical activity campaigns by informing whether a year-long campaign like the 150 Play List can be effective in influencing the behavior of those engaged with the campaign. The results reinforce the idea that ‘top of mind’ awareness should be measured. Investigating intention profiles can help inform campaign impacts and continuation intentions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6218-7) contains supplementary material, which is available to authorized users.