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Milton K, Hanson CL, Pearsons A, Chou R, Stamatakis E. A narrative review of global and national physical activity and sedentary behaviour guidelines development processes - The GUidelines Standards (GUS) project. Prev Med 2024; 183:107959. [PMID: 38636671 DOI: 10.1016/j.ypmed.2024.107959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Clinical and public health guidelines serve to direct clinical practice and policy, based on the best available evidence. The World Health Organization (WHO) and national health bodies of many countries have released physical activity and sedentary behaviour guidelines. Despite significant overlap in the body of evidence reviewed, the guidelines differ across jurisdictions. This study aimed to review the processes used to develop global and national physical activity and sedentary behaviour guidelines and examine the extent to which they conform with a recommended methodological standard for the development of guidelines. METHODS We extracted data on nine sets of guidelines from seven jurisdictions (WHO, Australia, Canada, Japan, the Netherlands, United Kingdom, and United States). We rated each set of guidelines as high, medium, or low quality on criteria related to the rigour of the development process. RESULTS We observed variation in the quality of guidelines development processes across jurisdictions and across different criteria. Guidelines received the strongest overall ratings for criteria on clearly describing the evidence selected and stating an explicit link between the recommendations and the supporting evidence. Guidelines received the weakest overall ratings for criteria related to clearly describing the methods used to formulate the recommendations and reporting external review by experts prior to publication. Evaluated against the selected criteria, the strongest processes were undertaken by the WHO and Canada. CONCLUSIONS Reaching agreement on acceptable guideline development processes, as well as the inclusion and appraisal procedures of different types of evidence, would help to strengthen and align future guidelines.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia, UK.
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Alice Pearsons
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Roger Chou
- Departments of Medicine, and Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, USA
| | - Emmanuel Stamatakis
- Mackenzie Wearables Research Hub, Charles Perkins Centre, University of Sydney, Australia; School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia
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Milton K, Morris JL, McLaughlin M, Cameron A, Dewhurst S, Gardner S, Gomersall S, Blackshaw J. Infographic. All health professionals should talk about physical activity with patients. Br J Sports Med 2024:bjsports-2023-107823. [PMID: 38503468 DOI: 10.1136/bjsports-2023-107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | | | - Matthew McLaughlin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
| | | | | | | | - Sjaan Gomersall
- Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Jamie Blackshaw
- United Kingdom Department of Health and Social Care, London, UK
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Prince SA, Lang JJ, de Groh M, Badland H, Barnett A, Littlejohns LB, Brandon NC, Butler GP, Casu G, Cerin E, Colley RC, de Lannoy L, Demchenko I, Ellingwood HN, Evenson KR, Faulkner G, Fridman L, Friedenreich CM, Fuller DL, Fuselli P, Giangregorio LM, Gupta N, Hino AA, Hume C, Isernhagen B, Jalaludin B, Lakerveld J, Larouche R, Lemon SC, Loucaides CA, Maddock JE, McCormack GR, Mehta A, Milton K, Mota J, Ngo VD, Owen N, Oyeyemi AL, Palmeira AL, Rainham DG, Rhodes RE, Ridgers ND, Roosendaal I, Rosenberg DE, Schipperijn J, Slater SJ, Storey KE, Tremblay MS, Tully MA, Vanderloo LM, Veitch J, Vietinghoff C, Whiting S, Winters M, Yang L, Geneau R. Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users. Int J Behav Nutr Phys Act 2023; 20:144. [PMID: 38062460 PMCID: PMC10704660 DOI: 10.1186/s12966-023-01533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.
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Affiliation(s)
- Stephanie A Prince
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, K1A 0K9, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Justin J Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, K1A 0K9, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Adelaide, South Australia
| | - Margaret de Groh
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, K1A 0K9, Canada
| | - Hannah Badland
- Social and Global Studies Centre, RMIT University, Melbourne, Australia
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Lori Baugh Littlejohns
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Population and Public Health, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Gregory P Butler
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, K1A 0K9, Canada
| | - Géna Casu
- Association pour la santé publique du Québec (ASPQ), Montréal, Québec, Canada
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Rachel C Colley
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | | | - Iryna Demchenko
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liraz Fridman
- Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel L Fuller
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Adriano A Hino
- Health Sciences Graduate Program, School of Medicine and Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Clare Hume
- School of Public Health, University of Adelaide, Adelaide, Australia
| | | | - Bin Jalaludin
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Stephenie C Lemon
- Prevention Research Center, UMass Chan Medical School, Worcester, Massachusetts, USA
| | | | - Jay E Maddock
- School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- School of Planning, Architecture, and Landscape, University of Calgary, Calgary, Alberta, Canada
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Aman Mehta
- Maroondah City Council, Victoria, Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jorge Mota
- Research Center in Physical Activity, health and Leisure (CIAFEL)-Faculty of Sports-University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Victor D Ngo
- Canadian Institute of Planners, Ottawa, Ontario, Canada
| | - Neville Owen
- Swinburne University of Technology, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Adewale L Oyeyemi
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | | | - Daniel G Rainham
- Healthy Populations Institute, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Nicola D Ridgers
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Adelaide, South Australia
| | | | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sandra J Slater
- Bachelor of Science in Public Health Program, School of Pharmacy, Concordia University Wisconsin, Mequon, Wisconsin, USA
| | - Kate E Storey
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Mark S Tremblay
- Outdoor Play Canada, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Mark A Tully
- School of Medicine, Ulster University, Londonberry, United Kingdom
| | - Leigh M Vanderloo
- ParticipACTION, Toronto, Ontario, Canada
- School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | | | - Stephen Whiting
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Linchuan Yang
- Department of Urban and Rural Planning, School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Robert Geneau
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, K1A 0K9, Canada
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Carr S, Atkin AJ, Jones AP, Milton K. The cross-sectional associations of chronic conditions and disability with self-reported physical activity among adults in England. Prev Med 2023; 177:107754. [PMID: 37951545 DOI: 10.1016/j.ypmed.2023.107754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Using cross-sectional data from the 2018 Health Survey for England, this study describes the types of impairment reported by people with chronic conditions and the association of chronic conditions and impairments with physical activity(PA). METHODS Participants self-reported the presence of seven chronic health conditions (diabetes; stroke/ischemic heart disease; hypertension; chronic obstructive pulmonary disease (COPD); asthma; arthritis/rheumatism/fibrositis; back problems), 11 types of impairment (vision, hearing, mobility, dexterity; learning; memory; mental health; stamina; social or behavioural; other; none); and their PA using the International Physical Activity Questionnaire. Multivariable Poisson regression was used to estimate the association of a)impairment type, b)number of impairments, and c)impairment type and chronic condition (mutually adjusted) with PA. RESULTS In total, 2243 adults (55% female, 44% age > 55 yrs) reported having a chronic condition. PA volume (MET minutes per week: median (IQR)) was highest in participants with asthma (2093 (693-4479)), and lowest in those with COPD (454 (0-2079)). There was a negative association between number of impairments and levels of PA. After adjustment for age, sex, ethnicity and education, and mutually adjusting for all other conditions and impairments, diabetes (Incident rate ratio (95% confidence interval): 0.83 (0.73-0.94)), COPD (0.76 (0.59-0.99)), a mobility impairment (0.63 (0.56-0.72)), a dexterity impairment (0.86 (0.75-0.98)), or a memory impairment (0.84 (0.72-0.99)) was negatively associated with PA. CONCLUSION Future PA research requires consideration of the number and types of impairments that individuals experience, as well as assessing chronic conditions. This will improve understanding of the barriers to PA participation and inform interventions.
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Affiliation(s)
- Shelby Carr
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Andrew J Atkin
- School of Health Sciences, University of East Anglia, Norwich, UK; Norwich Epidemiology Centre, University of East Anglia, Norwich, UK.
| | - Andy P Jones
- C3 Collaborating for Health, SBC House, Restmor Way, Wallington, SM6 7AH.
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK.
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Alsop T, Lehman E, Brauer S, Forbes R, Hanson CL, Healy G, Milton K, Reid H, Rosbergen I, Gomersall S. What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement. Br J Sports Med 2023; 57:1419-1427. [PMID: 37793699 DOI: 10.1136/bjsports-2023-106870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
The WHO has called for action to integrate physical activity promotion into healthcare settings, yet there is a lack of consensus on the competencies required by health professionals to deliver effective movement behaviour change support. The objective of this study was to establish key competencies relevant for all health professionals to support individuals to change their movement behaviours. Consensus was obtained using a three-phase Delphi process. Participants with expertise in physical activity and sedentary behaviour were asked to report what knowledge, skills and attributes they believed health professionals should possess in relation to movement behaviour change. Proposed competencies were developed and rated for importance. Participants were asked to indicate agreement for inclusion, with consensus defined as group level agreement of at least 80%. Participants from 11 countries, working in academic (55%), clinical (30%) or combined academic/clinical (13%) roles reached consensus on 11 competencies across 3 rounds (n=40, n=36 and n=34, respectively). Some competencies considered specific to certain disciplines did not qualify for inclusion. Participants agreed that health professionals should recognise, take ownership of, and practise interprofessional collaboration in supporting movement behaviour change; support positive culture around these behaviours; communicate using person-centred approaches that consider determinants, barriers and facilitators of movement behaviours; explain the health impacts of these behaviours; and recognise how their own behaviour influences movement behaviour change support. This consensus defines 11 competencies for health professionals, which may serve as a catalyst for building a culture of advocacy for movement behaviour change across health disciplines.
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Affiliation(s)
- Tahlia Alsop
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Emily Lehman
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Sandra Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Genevieve Healy
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research and Innovation, The University of Queensland, St Lucia, Queensland, Australia
| | - Karen Milton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Ingrid Rosbergen
- Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Sjaan Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research and Innovation, The University of Queensland, St Lucia, Queensland, Australia
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Gill JM, Chico TJ, Doherty A, Dunn J, Ekelund U, Katzmarzyk PT, Milton K, Murphy MH, Stamatakis E. Potential impact of wearables on physical activity guidelines and interventions: opportunities and challenges. Br J Sports Med 2023; 57:1223-1225. [PMID: 37549997 DOI: 10.1136/bjsports-2023-106822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Jason Mr Gill
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Timothy J Chico
- Infection, Immunity, and Cardiovasccular Disease, University of Sheffield, Sheffield, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic Diseases and Ageing, The Norwegian Institute for Public Health, Oslo, Norway
| | | | - Karen Milton
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Marie H Murphy
- Institute for Sport Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Emmanuel Stamatakis
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Stamatakis E, Ahmadi M, Murphy MH, Chico TJ, Milton K, Del Pozo Cruz B, Katzmarzyk PT, Lee IM, Gill J. Journey of a thousand miles: from 'Manpo-Kei' to the first steps-based physical activity recommendations. Br J Sports Med 2023; 57:1227-1228. [PMID: 37549996 DOI: 10.1136/bjsports-2023-106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Emmanuel Stamatakis
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Ahmadi
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marie H Murphy
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, Scotland, UK
| | - Timothy James Chico
- Infection, Immunity, and Cardiovasccular Disease, University of Sheffield, Sheffield, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Borja Del Pozo Cruz
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- Faculty of Education, University of Cádiz, Cádiz, Spain
| | | | - I-Min Lee
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jason Gill
- British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Chen S, Hong J, Milton K, Klepac B, Ma J, Pedisic Z. Analysis of national physical activity and sedentary behaviour policies in China. BMC Public Health 2023; 23:1024. [PMID: 37254122 PMCID: PMC10230767 DOI: 10.1186/s12889-023-15865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
PURPOSE The aims of this study were to advance knowledge on physical activity (PA) and sedentary behaviour (SB) policies in China and to highlight related gaps and opportunities in the Chinese policy landscape. METHODS Literature and web-based searches were performed to identify national PA and SB policies in China. We assessed which of the 17 elements of the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT, version 2) are included in each of the policy documents and whether and how they address the 'cornerstones' of PA and SB policy: PA and SB guidelines, targets, surveillance and monitoring, and public education programmes. RESULTS We found 60 national PA and SB policies, of which 54 focused on PA only and 6 focused on both PA and SB. There was a rapid increase in the number of policies issued between 2002 and 2021. In totality, the policies include all 17 key elements for a successful national policy approach to PA promotion according to the HEPA PAT. The policies reflect engagement from a range of sectors and encompass PA targets, recommendations for PA and SB, mandates and recommendations for school-related PA, plans for public education on PA, and plans for surveillance and monitoring of PA and SB. CONCLUSION Our findings demonstrate that there has been increasing focus on PA and SB policies in China, which reflects efforts by policymakers to address the health burden of insufficient PA and excessive SB. More emphasis may be placed on SB in Chinese policy, particularly in terms of setting specific targets for population SB. Policymakers and other relevant public health stakeholders in China could also consider developing or adopting the 24-hour movement guidelines, in accordance with recent trends in several other countries. Collaboration and involvement of different sectors in the development and implementation of Chinese PA and SB policies should continue to be facilitated as part of a whole-of-system approach to health promotion.
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Affiliation(s)
- Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne, 3011, Australia.
| | - Jintao Hong
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Karen Milton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Bojana Klepac
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, 3000, Australia
| | - Jiani Ma
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, CV1 5FB, UK
- School of Health and Social Development, Deakin University, Geelong, 3220, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, 3220, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, 3011, Australia
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Carr S, Atkin AJ, Jones AP, Pulsford R, Milton K. A Scoping Review of Disability Assessment in Prospective and Cross-Sectional Studies That Included Device-Based Measurement of Physical Activity. J Phys Act Health 2023:1-7. [PMID: 37146983 DOI: 10.1123/jpah.2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Evidence on the prevalence, determinants, and health outcomes of physical activity in disabled people is limited. It is possible that the limited availability of high-quality scientific evidence is due to the extent and nature of disability assessment in physical activity research. This scoping review explores how disability has been measured in epidemiological studies that included accelerometer-based measurement of physical activity. METHODS Data sources: MEDLINE (Ovid), Embase, PsychINFO, Health Management Information Consortium, Web of Science, SPORTDiscus, and CINAHL. ELIGIBILITY CRITERIA Prospective and cross-sectional studies that included an accelerometer measurement of physical activity. Survey instruments used in these studies were obtained, and questions relating to the International Classification of Functioning, Disability and Health domains of (1) health conditions, (2) body functions and structures, and (3) activities and participation, were extracted for analysis. RESULTS Eighty-four studies met the inclusion criteria, from which complete information on the 3 domains was obtained for 68. Seventy-five percent of studies (n = 51) captured whether a person had at least one health condition, 63% (n = 43) had questions related to body functions and structures, and 75% (n = 51) included questions related to activities and participation. CONCLUSION While most studies asked something about one of the 3 domains, there was substantial diversity in the focus and style of questions. This diversity indicates a lack of consensus on how these concepts should be assessed, with implications for the comparability of evidence across studies and subsequent understanding of the relationships between disability, physical activity, and health.
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Affiliation(s)
- Shelby Carr
- Norwich Medical School, University of East Anglia, Norwich,United Kingdom
| | - Andrew J Atkin
- School of Health Sciences, University of East Anglia, Norwich,United Kingdom
- Norwich Epidemiology Centre, University of East Anglia, Norwich,United Kingdom
| | - Andy P Jones
- Public Health, Norfolk County Council, Norwich,United Kingdom
| | - Richard Pulsford
- Sport and Health Sciences, University of Exeter, Exeter,United Kingdom
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich,United Kingdom
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Harvey DL, Milton K, Jones AP, Atkin AJ. A Review of Sedentary Behavior Assessment in National Surveillance Systems. J Phys Act Health 2023; 20:348-357. [PMID: 36863356 DOI: 10.1123/jpah.2022-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/13/2022] [Accepted: 01/05/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Temporal changes in sedentary behavior patterns reflect the evolving nature of our built and social environments, particularly the expanding availability of electronic media. It is important to understand what types of sedentary behavior are assessed in national surveillance to determine whether, and to what extent, they reflect contemporary patterns. The aims of this review were to describe the characteristics of questionnaires used for national surveillance of sedentary behavior and to identify the types of sedentary behaviors being measured. METHOD We reviewed questionnaires from national surveillance systems listed on the Global Observatory for Physical Activity (GoPA!) country cards to locate items on sedentary behavior. Questionnaire characteristics were categorized using the Taxonomy of Self-reported Sedentary Behavior Tools (TASST). The purpose and type of sedentary behaviors captured were classified using the Sedentary Behavior International Taxonomy (SIT). RESULTS Overall, 346 surveillance systems were screened for eligibility, of which 93 were included in this review. Most questionnaires used a single-item direct measure of sitting time (n = 78, 84%). Work and domestic were the most frequently captured purposes of sedentary behavior, while television viewing and computer use were the most frequently captured types of behaviors. CONCLUSION National surveillance systems should be periodically reviewed in response to evidence on contemporary behavior patterns in the population and the release of updated public health guidelines.
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Affiliation(s)
- Danielle L Harvey
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich,United Kingdom
| | - Karen Milton
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich,United Kingdom
| | - Andy P Jones
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich,United Kingdom
| | - Andrew J Atkin
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich,United Kingdom
- Norwich Epidemiology Centre, University of East Anglia, Norwich, Norfolk,United Kingdom
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11
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Milton K, Gomersall SR, Schipperijn J. Let's get moving: The Global Status Report on Physical Activity 2022 calls for urgent action. J Sport Health Sci 2023; 12:5-6. [PMID: 36528290 PMCID: PMC9923423 DOI: 10.1016/j.jshs.2022.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Sjaan R Gomersall
- School of Human Movement and Nutrition Sciences and School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense 5230, Denmark
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12
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Fernandez M, Young A, Milton K, Pinhiero M, de Luca K, Ferreira P, Hebert J. Physical activity promotion in chiropractic: a systematic review of clinician-based surveys. Chiropr Man Therap 2022; 30:55. [PMID: 36514061 PMCID: PMC9749165 DOI: 10.1186/s12998-022-00467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. METHODS Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the 'Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices' tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors' views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. RESULTS From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). CONCLUSION A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors' own PA participation.
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Affiliation(s)
- Matthew Fernandez
- School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Anika Young
- grid.1004.50000 0001 2158 5405Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Karen Milton
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marina Pinhiero
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie de Luca
- grid.1023.00000 0001 2193 0854School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Paulo Ferreira
- grid.1013.30000 0004 1936 834XSydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Jeffrey Hebert
- grid.266820.80000 0004 0402 6152Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Hunter RF, Cleland CL, Busby J, Nightingale G, Kee F, Williams AJ, Kelly P, Kelly MP, Milton K, Kokka K, Jepson R. Investigating the impact of a 20 miles per hour speed limit intervention on road traffic collisions, casualties, speed and volume in Belfast, UK: 3 year follow-up outcomes of a natural experiment. J Epidemiol Community Health 2022; 77:jech-2022-219729. [PMID: 36379715 PMCID: PMC9763225 DOI: 10.1136/jech-2022-219729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation. METHODS An observational, repeated cross-sectional design was implemented, using routinely collected data for road traffic collisions, casualties, speed and volume. We evaluated difference-in-differences in collisions and casualties (intervention vs control) across three different time series and traffic speed and volume pre-implementation, at 1 and 3 years post-implementation. RESULTS Small reductions in road traffic collisions were observed at year 1 (3%; p=0.82) and year 3 post-implementation (15%; p=0.31) at the intervention site. Difference-in-differences analyses showed no statistically significant differences between the intervention and control sites over time for road traffic collisions. There were 16% (p=0.18) and 22% (p=0.06) reductions in casualty rates at years 1 and 3 post-implementation, respectively, at the intervention site. Results showed little change in mean traffic speed at year 1 (0.2 mph, 95% CI -0.3 to 2.4, p=0.14) and year 3 post-implementation (0.8, 95% CI -1.5 to 2.5, p=0.17). For traffic volume, a decrease in 57 vehicles per week was observed at year 1 (95% CI -162 to -14, p<0.00) and 71 vehicles at year 3 (95% CI -213 to 1, p=0.05) post-implementation. CONCLUSION A 20 mph speed limit intervention implemented at city centre scale had little impact on long-term outcomes including road traffic collisions, casualties and speed, except for a reduction in traffic volume. Policymakers considering implementing 20 mph speed limit interventions should consider the fidelity, context and scale of implementation.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire L Cleland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Paul Kelly
- Physical Activity for Health Research Centre (PHARC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, England, UK
| | - Kelly Kokka
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, UK
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14
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Sims J, Milton K, Foster C, Scarborough P. A profile of children's physical activity data from the 2012 and 2015 health survey for England. BMC Public Health 2022; 22:1785. [PMID: 36127714 PMCID: PMC9490976 DOI: 10.1186/s12889-022-14150-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Low childhood physical activity levels constitute an important modifiable risk for adult non-communicable disease incidence and subsequent socio-economic burden, but few publications have explored age and sex related patterns within the UK population. The aims were to profile child physical activity data from the Health Survey for England from 2012 (1,732 respondents) and 2015 (5,346 respondents). Methods Reported physical activity episodes were converted to metabolic equivalents with reference to child-specific compendiums. Physical activity levels were aggregated for each domain, and again to produce total physical activity estimates. Contributions from each domain to total physical activity were explored, stratifying for age, sex, socio-economic deprivation, ethnicity, and weight status. Further analyses were run stratifying for physical activity levels. Few differences were detected between the survey iterations. Results Boys reported higher absolute levels of physical activity at all ages and across all domains. For boys and girls, informal activity reduces with age. For boys this reduction is largely mitigated by increased formal sport, but this is not the case for girls. Absolute levels of school activity and active travel remained consistent regardless of total physical activity, thereby comprising an increasingly important proportion of total physical activity for less active children. Conclusions We recommend a specific focus on establishing and maintaining girl’s participation in formal sport thorough their teenage years, and a recognition and consolidation of the important role played by active travel and school-based physical activity for the least active children.
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Affiliation(s)
- Jamie Sims
- Department of Population Health, University of Oxford, Nuffield, Old Road Campus, OX3 7LF, Oxford, UK. .,Department of Sport, Health Sciences and Social Work, Oxford Brooks University, Headington Campus, OX3 0BP, Oxford, UK.
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Charlie Foster
- School for Policy Studies, Social Science Complex, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Peter Scarborough
- Department of Population Health, University of Oxford, Nuffield, Old Road Campus, OX3 7LF, Oxford, UK
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15
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Jepson R, Baker G, Cleland C, Cope A, Craig N, Foster C, Hunter R, Kee F, Kelly MP, Kelly P, Milton K, Nightingale G, Turner K, Williams AJ, Woodcock J. Developing and implementing 20-mph speed limits in Edinburgh and Belfast: mixed-methods study. Public Health Res 2022. [DOI: 10.3310/xazi9445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Transport initiatives such as 20-mph (≈30-km/h) speed limits are anticipated to result in fewer road casualties and improve perceptions of safety, leading to increases in active travel. Lower speeds may also lead to more pleasant environments in which to live, work and play.
Objectives
The main objective was to evaluate and understand the processes and effects of developing and implementing 20-mph speed limits in Edinburgh and Belfast. The focus was on health-related outcomes (casualties and active travel) that may lead to public health improvements. An additional objective was to investigate the political and policy factors (conditions) that led to the decision to introduce the new speed limits.
Design
This was a mixed-methods study that comprised an outcome, process, policy and economic evaluation of two natural experiments.
Setting
The study was set in Edinburgh, Scotland, and Belfast, Northern Ireland, from 2000 to 2018.
Participants
The whole population of each city were participants, as well as stakeholders involved in implementation and decision-making processes.
Intervention
The intervention was the implementation of 20-mph legislation, signage, enforcement, and education and awareness-raising in Edinburgh (citywide) and Belfast (city centre).
Main outcome measures
The main outcomes measured were speed; number, type and severity of road collisions; perceptions; and liveability.
Data sources
The following data sources were used – routinely and locally collected quantitative data for speed, volume of traffic, casualties and collisions, and costs; documents and print media; surveys; interviews and focus groups; and Google Street View (Google Inc., Mountain View, CA, USA).
Results
Collisions and casualties – the overall percentage reduction in casualty rates was 39% (the overall percentage reduction in collision rates was 40%) in Edinburgh. The percentage reduction for each level of severity was 23% for fatal casualties, 33% for serious casualties and 37% for minor casualties. In Belfast there was a 2% reduction in casualties, reflecting differences in the size, reach and implementation of the two schemes. Perceptions – in Edinburgh there was an increase in two factors (support for 20 mph and rule-following after implementation) supported by the qualitative data. Liveability – for both cities, there was a small statistical increase in liveability. Speed – mean and median speeds reduced by 1.34 mph and 0.47 mph, respectively, at 12 months in Edinburgh, with no statistically significant changes in Belfast. History, political context, local policy goals, local priorities and leadership influenced decision-making and implementation in the two cities.
Limitations
There was no analysis of active travel outcomes because the available data were not suitable.
Conclusions
The pre-implementation period is important. It helps frame public and political attitudes. The scale of implementation and additional activities in the two cities had a bearing on the impacts. The citywide approach adopted by Edinburgh was effective in reducing speeds and positively affected a range of public health outcomes. The city-centre approach in Belfast (where speeds were already low) was less effective. However, the main outcome of these schemes was a reduction in road casualties at all levels of severity.
Future work
Future work should develop a statistical approach to public health interventions that incorporates variables from multiple outcomes. In this study, each outcome was analysed independently of each other. Furthermore, population measures of active travel that can be administered simply, inexpensively and at scale should be developed.
Study registration
This study is registered as ISRCTN10200526.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Claire Cleland
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | | | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Ruth Hunter
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Kieran Turner
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - James Woodcock
- Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
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16
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Sharp C, Mackintosh K, Willmot R, Hughes R, McNarry M, Milton K. P01-14 National policy response to the Sustainable Development Goals: a physical activity case study of Wales. Eur J Public Health 2022. [PMCID: PMC9436026 DOI: 10.1093/eurpub/ckac095.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
Population level changes in physical activity (PA) may benefit from policy intervention. In response to the UN Sustainable Development Goals, Wales introduced legislation (the Well-being of Future Generations (Wales) Act 2015) to holistically improve health and well-being, including the translation of national policy into practice. This audit provides a case study approach that could be replicated by researchers in other countries to appraise the role of PA actions in national and sub-national policies.
Description
An audit of policies published by national and sub-national public bodies between 2015 and 2020 was conducted. The list of identified policies was reviewed by an external panel to act as a ?critical friend? to verify its inclusiveness. Content of the policies were extracted and synthesised to determine: (i) how many policies included a PA action; (ii) what the drivers of those policies were; (iii) the content of the PA actions; and (iv) how the PA actions aligned with the Well-being of Future Generations (Wales) Act 2015.
Results
A final list of 73 policies was obtained. Only 16 national-level documents had a PA action, which had been published by 4/13 public bodies (who are bound by the Act). Of the 19 sub-national well-being policies, 15 included PA actions. Most policies were considered reactive and varied in terms of the clarity and specificity of the actions, the assignment roles/responsibilities, and the setting of targets; all overarching principles which can be used to strengthen national and sub-national policy in the future. The most common theme of action across the national-level documents was the broad action of PA promotion, which was identified in nine of the 16 documents. The actions within the national-level documents were reflected in the sub-national well-being plans.
Lessons
This research used a novel approach to assess alignment of policies related to PA and the Sustainable Development Goals (SDGs) in Wales. It provides an overview of the current status of policy related to PA in Wales, which can be used in manifestos and frameworks to shape the subsequent actions of public bodies.
Main messages
This case study provides a valuable example of how to utilise PA to address broader health and wellbeing agendas, and specifically the SDGs. It also demonstrates an approach to achieving stronger connections between national and sub-national policy to support the translation of policies into practice.
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Affiliation(s)
- Catherine Sharp
- Welsh Institute of Physical Activity, Health and Sport, Swansea University , Swansea, United Kingdom
| | - Kelly Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University , Swansea, United Kingdom
| | - Rhi Willmot
- Welsh Institute of Physical Activity, Health and Sport, Swansea University , Swansea, United Kingdom
| | - Rachel Hughes
- Dotiau Ltd, Dotiau Ltd , Monmouthshire, United Kingdom
- Faculty of Social and Life Sciences, Wrexham Glyndwr University , Wrexham, United Kingdom
| | - Melitta McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University , Swansea, United Kingdom
| | - Karen Milton
- Norwich Medical School, University of East Anglia , Norwich, United Kingdom
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17
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Milton K, Chalkley A. O3-4 Progress on addressing the cornerstones of physical activity policy for children and youth in England. Eur J Public Health 2022. [PMCID: PMC9421868 DOI: 10.1093/eurpub/ckac094.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background There has been an increasing focus on the importance of national policy to address population levels of physical inactivity. It has been suggested that the four ?cornerstones' of policy comprise: 1) national guidelines on physical activity levels; 2) setting population goals and targets; 3) surveillance or health monitoring systems; and 4) public education. The aim of the current paper was to analyse the policy actions which have addressed each of these elements for children and youth in England and to identify areas of progress and remaining challenges. Methods A literature search was undertaken to identify past and present documents relevant to physical activity policy for children and youth in England. Each document was analysed to identify content relevant to the four ?cornerstones' of policy. Results Physical activity guidelines for children and youth have been in place since 1998 and reviewed periodically to ensure they reflect the latest scientific evidence. The setting of physical activity targets has focused on the provision of opportunities for physical activity, particularly through physical education (PE) in schools, rather than in relation to the proportion of children meeting recommended physical activity levels. There has been much surveillance of children's physical activity but this has been undertaken infrequently over time, by a wide range of organisations, and with varying inclusion of different domains of activity such as school PE, leisure time activity and active travel. There has only been one campaign in England targeted at children and their intermediaries (Change4Life), which was an obesity campaign focussing on dietary behaviour in combination with physical activity. Most recently an infographic supporting the physical activity guidelines for children and young people was developed, but details of its dissemination and usage are unknown. Conclusions There have been many developments in physical activity policy in England targeted at children and youth. The area of greatest progress is national physical activity guidelines. Establishing prevalence targets, streamlining surveillance systems, and investing in public education would strengthen national policy efforts to reduce physical inactivity.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia , Norwich, United Kingdom
| | - Anna Chalkley
- Loughborough University , Loughborough, United Kingdom
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18
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Chalkley A, Coppinger T, Murtagh E, Harrington D, Johansen D, Seghers J, Skovgaard T, Milton K. O7-6 Global Matrix 3.0 Physical Activity Report Card for Children and Youth: A comparison across Europe. Eur J Public Health 2022. [PMCID: PMC9421735 DOI: 10.1093/eurpub/ckac094.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The Global Matrix of report card grades on physical activity serves as a public health awareness tool by summarising the status of child and youth physical activity prevalence and action. Since schools and the wider community and environment are critical influences on the physical activity levels of children and youth, this research sought to examine the factors considered when assigning these grades across included European countries. Specifically, we sought to: (1) provide a detailed examination of the evidence informing these indicators across participating European Global Matrix 3.0 countries; (2) explore the comparability of the grades for these two indicators across Europe; (3) detail any limitations or issues with the methods used to assign grades; and (4) provide suggestions on how future grading of the indicators could be improved. Methods Key documents relating to the European countries involved in the 2018 Global Matrix 3.0 were collated. This inlcuded the long and short forms of the report card for each country as well as the scientific paper. A template was developed and used to capture information on: the grade assigned for each indicator; details of the data used to assign the grade, the source of the data; indication of the quality of the data and any reported challenges or issues in assigning the grade for both the ‘School' and ‘Community and Environment' indicators. Results Seventeen of the 20 European Report Card countries (85%) had a grade for schools, and 15 countries (75%) had a grade for community and environment. All countries considered between one and five factors when assigning the grade for these indicators. There were wide disparities in the number and sources of evidence used to assign the grades for both indicators, limiting the comparability of the evidence between different countries. Conclusions To enable comparability, the authors recommend moving towards an agreed standardised set of metrics for grading each indicator. Furthermore, it would be useful to develop and share common tools, methods and instruments in order to collect data in a uniform way across countries. Such action will ultimately make the Global Matrix a more robust tool for future use.
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Affiliation(s)
- Anna Chalkley
- School of Sport, Exercise and Health Sciences, Loughborough University , Loughborough, United Kingdom
| | - Tara Coppinger
- Sport, Leisure & Childhood Studies Department, Cork Institute of Technology , Cork, Ireland
| | - Elaine Murtagh
- Mary Immaculate College, University of Limerick , Limerick, Ireland
| | - Deirdre Harrington
- Diabetes Research Centre, University of Leicester , Leicester, United Kingdom
| | - Danielle Johansen
- Research and Innovation Centre for Human Movement and Learning, UCL University College & University of Southern Denmark , Odense, Denmark
| | - Jan Seghers
- Physical Activity, Sports & Health Research Group, KU Leuven , Brussels, Belgium
| | - Thomas Skovgaard
- Research and Innovation Centre for Human Movement and Learning, UCL University College & University of Southern Denmark , Odense, Denmark
| | - Karen Milton
- Norwich Medical School, University of East Anglia , Norwich, United Kingdom
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19
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Milton K, Poole K, Cross A, Gasson S, Gokal K, Lyons K, Pulsford R, Jones A. 'People don't get cancer, families do': Co-development of a social physical activity intervention for people recently affected by a cancer diagnosis. Eur J Cancer Care (Engl) 2022; 31:e13573. [PMID: 35285105 PMCID: PMC9285961 DOI: 10.1111/ecc.13573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/20/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This research took a co-design approach to develop a social intervention to support people affected by a cancer diagnosis to be physically active. METHODS We conducted semi-structured interviews with five key stakeholder groups: (1) adults with a recent breast or prostate cancer diagnosis; (2) family and friends of cancer patients; (3) healthcare professionals; (4) physical activity providers; and (5) cancer charity representatives. Inductive content analysis was used to identify themes in the data. We then worked with a subset of participants to co-develop the intervention. RESULTS Participants welcomed the idea of a social approach to a physical activity intervention. Input was received on the timing and format of delivery, how to communicate about physical activity to cancer patients and their family and friends and the types of physical activity that would be appropriate. Our findings suggest that interventions need to be flexible in terms of timing and delivery and offer a wide range of physical activity options. These findings directly informed the co-development of 'All Together Active'. CONCLUSION All Together Active is designed to support cancer patients and their family and friends to be active throughout treatment and beyond, benefiting their physical and mental health.
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Affiliation(s)
- Karen Milton
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Karen Poole
- School of Health SciencesUniversity of SurreySurreyUK
| | | | - Sophie Gasson
- School of Health SciencesUniversity of SurreySurreyUK
| | - Kajal Gokal
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Karen Lyons
- Connell School of NursingBoston CollegeNewtonMassachusettsUSA
| | - Richard Pulsford
- Sport and Health SciencesUniversity of Exeter, St Luke's CampusExeterUK
| | - Andy Jones
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
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20
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Atkin AJ, Carr S, Friedenreich C, Biddle SJ, Milton K. Behavioural epidemiology of physical activity in people living with chronic conditions. Br J Sports Med 2022; 56:896-897. [PMID: 35288373 DOI: 10.1136/bjsports-2021-105171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Andrew J Atkin
- School of Health Sciences, University of East Anglia, Norwich, UK .,Norwich Epidemiology Centre, University of East Anglia, Norwich, UK
| | - Shelby Carr
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Christine Friedenreich
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
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21
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Harvey DL, Milton K, Jones AP, Atkin AJ. International trends in screen-based behaviours from 2012 to 2019. Prev Med 2022; 154:106909. [PMID: 34871663 DOI: 10.1016/j.ypmed.2021.106909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Many adults accumulate considerable time in screen-based behaviours, some of which have been associated with negative physical and psychological health outcomes. The aims of this study were to characterise contemporary patterns of screen-based behaviours and describe their temporal trends by global region, age, sex and education. Data covering the period 2012-2019 were obtained in aggregated form from GWI (previously known as Global Web Index), a global market research company. Temporal trends in the duration of adults' (16-64 years) self-reported personal computer, laptop and tablet use, mobile phone use, broadcast television viewing, online television viewing and games console use were described using data from over 2 million participants from 46 countries. For each activity, participants selected from response options ranging from less than 30 min to more than 10 h. Internationally, daily screen time increased from approximately 9 h in 2012 to 11 h in 2019, with notable increases in mobile phone use (approx. 2 h), online television viewing (approx. 37 min) and games console use (approx. 26 min). Differences were seen in the duration of time spent engaging in screen-based behaviours across regions and between socio-demographic groups, with Latin America, the Middle East and Africa and younger age groups seeing greater increases in overall screen time. The findings have important implications for health behaviour surveillance and for research exploring the links between screen-based behaviours and health.
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Affiliation(s)
- Danielle L Harvey
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom.
| | - Karen Milton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom
| | - Andy P Jones
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom
| | - Andrew J Atkin
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom; Norwich Epidemiology Centre, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom
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22
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Nightingale GF, Williams AJ, Hunter RF, Woodcock J, Turner K, Cleland CL, Baker G, Kelly M, Cope A, Kee F, Milton K, Foster C, Jepson R, Kelly P. Evaluating the citywide Edinburgh 20mph speed limit intervention effects on traffic speed and volume: A pre-post observational evaluation. PLoS One 2021; 16:e0261383. [PMID: 34972123 PMCID: PMC8719778 DOI: 10.1371/journal.pone.0261383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Traffic speed is important to public health as it is a major contributory factor to collision risk and casualty severity. 20mph (32km/h) speed limit interventions are an increasingly common approach to address this transport and health challenge, but a more developed evidence base is needed to understand their effects. This study describes the changes in traffic speed and traffic volume in the City of Edinburgh, pre- and 12 months post-implementation of phased city-wide 20mph speed limits from 2016-2018. METHODS The City of Edinburgh Council collected speed and volume data across one full week (24 hours a day) pre- and post-20mph speed limits for 66 streets. The pre- and post-speed limit intervention data were compared using measures of central tendency, dispersion, and basic t-tests. The changes were assessed at different aggregations and evaluated for statistical significance (alpha = 0.05). A mixed effects model was used to model speed reduction, in the presence of key variables such as baseline traffic speed and time of day. RESULTS City-wide, a statistically significant reduction in mean speed of 1.34mph (95% CI 0.95 to 1.72) was observed at 12 months post-implementation, representing a 5.7% reduction. Reductions in speed were observed throughout the day and across the week, and larger reductions in speed were observed on roads with higher initial speeds. Mean 7-day volume of traffic was found to be lower by 86 vehicles (95% CI: -112 to 286) representing a reduction of 2.4% across the city of Edinburgh (p = 0.39) but with the direction of effect uncertain. CONCLUSIONS The implementation of the city-wide 20mph speed limit intervention was associated with meaningful reductions in traffic speeds but not volume. The reduction observed in road traffic speed may act as a mechanism to lessen the frequency and severity of collisions and casualties, increase road safety, and improve liveability.
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Affiliation(s)
- Glenna F. Nightingale
- The Scottish Collaboration for Public Health Research (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew James Williams
- Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Ruth F. Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - James Woodcock
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kieran Turner
- The Scottish Collaboration for Public Health Research (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Claire L. Cleland
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael Kelly
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Andy Cope
- Sustrans, Cathedral Square, College Green, Bristol, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - Ruth Jepson
- The Scottish Collaboration for Public Health Research (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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23
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Williamson C, Baker G, Tomasone JR, Bauman A, Mutrie N, Niven A, Richards J, Oyeyemi A, Baxter B, Rigby B, Cullen B, Paddy B, Smith B, Foster C, Drummy C, Vandelanotte C, Oliver E, Dewi FST, McEwen F, Bain F, Faulkner G, McEwen H, Mills H, Brazier J, Nobles J, Hall J, Maclaren K, Milton K, Olscamp K, Campos LV, Bursle L, Murphy M, Cavill N, Johnston NJ, McCrorie P, Wibowo RA, Bassett-Gunter R, Jones R, Ruane S, Shilton T, Kelly P. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): International consensus statement and user guide. Int J Behav Nutr Phys Act 2021; 18:164. [PMID: 34923991 PMCID: PMC8684545 DOI: 10.1186/s12966-021-01230-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Effective physical activity messaging plays an important role in the pathway towards changing physical activity behaviour at a population level. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC) are outputs from a recent modified Delphi study. This sought consensus from an international expert panel on how to aid the creation and evaluation of physical activity messages. In this paper, we (1) present an overview of the various concepts within the PAMF and PAMC, (2) discuss in detail how the PAMF and PAMC can be used to create physical activity messages, plan evaluation of messages, and aid understanding and categorisation of existing messages, and (3) highlight areas for future development and research. If adopted, we propose that the PAMF and PAMC could improve physical activity messaging practice by encouraging evidence-based and target population-focused messages with clearly stated aims and consideration of potential working pathways. They could also enhance the physical activity messaging research base by harmonising key messaging terminologies, improving quality of reporting, and aiding collation and synthesis of the evidence.
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Affiliation(s)
- Chloë Williamson
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK.
| | - Graham Baker
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queens University, Kingston, Canada
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Nanette Mutrie
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Ailsa Niven
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Justin Richards
- Faculty of Health, Victoria University Wellington, Wellington, New Zealand.,Sport New Zealand Ihi Aotearoa, Wellington, New Zealand
| | - Adewale Oyeyemi
- Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria
| | - Beelin Baxter
- Department of Health and Social Care, UK Government, London, UK
| | - Benjamin Rigby
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | - Brett Smith
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Clare Drummy
- Southern Health & Social Care Trust, Portadown, UK
| | | | - Emily Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Fatwa Sari Tetra Dewi
- Department of Health Behavior, Environment and Social Medicine; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fran McEwen
- Sport New Zealand Ihi Aotearoa, Wellington, New Zealand
| | | | - Guy Faulkner
- University of British Columbia, Vancouver, Canada
| | - Hamish McEwen
- Sport New Zealand Ihi Aotearoa, Wellington, New Zealand
| | - Hayley Mills
- Canterbury Christ Church University, Canterbury, UK
| | - Jack Brazier
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - James Nobles
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Jennifer Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kate Olscamp
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, USA
| | | | | | | | - Nick Cavill
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Nora J Johnston
- Centre for Active Living, University of Alberta, Edmonton, Canada
| | - Paul McCrorie
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rakhmat Ari Wibowo
- Department of Health Behavior, Environment and Social Medicine; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | | | | | - Trevor Shilton
- National Heart Foundation of Australia, Curtin University, Perth, Australia
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
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24
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Semwal T, Milton K, Jepson R, Kelly MP. Correction to: Tweeting about twenty: an analysis of interest, public sentiments and opinion about 20mph speed restrictions in two UK cities. BMC Public Health 2021; 21:2168. [PMID: 34836540 PMCID: PMC8626972 DOI: 10.1186/s12889-021-12259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tushar Semwal
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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25
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Semwal T, Milton K, Jepson R, Kelly MP. Tweeting about twenty: an analysis of interest, public sentiments and opinion about 20mph speed restrictions in two UK cities. BMC Public Health 2021; 21:2016. [PMID: 34740345 PMCID: PMC8570070 DOI: 10.1186/s12889-021-12084-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background Twenty miles per hour (20mph) speed limits (equivalent to roughly 30kmh) have become part of public health policies to reduce urban road collisions and casualties, especially in Western countries. Public opinion plays a crucial role in opposition to and acceptance of policies that are advocated for improving public health. Twenty miles per hour speed limit policies were implemented in Edinburgh and Belfast from 2016 to 2018. In this paper, we extract public opinion and sentiments expressed about the new 20mph speed limits in those cities using publicly available Twitter data. Methods We analysed public sentiments from Twitter data and classified the public comments in plain English into the categories ‘positive’, ‘neutral’, and ‘negative’. We also explored the frequency and sources of the tweets. Results The total volume of tweets was higher for Edinburgh than for Belfast, but the volume of tweets followed a similar pattern, peaking around 2016, which is when the schemes were implemented. Overall, the tone of the tweets was positive or neutral towards the implementation of the speed limit policies. This finding was surprising as there is a perception among policymakers that there would have been public backlash against these sorts of policy changes. The commonly used hashtags focused largely on road safety and other potential benefits, for example to air pollution. Conclusions Overall, public attitudes towards the policies were positive, thus policymakers should be less anxious about potential public backlash when considering the scale-up of 20mph speed restrictions.
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Affiliation(s)
- Tushar Semwal
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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26
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Al Siyabi H, Mabry RM, Al Siyabi A, Milton K. A Critique of National Physical Activity Policy in Oman Using 3 Established Policy Frameworks. J Phys Act Health 2021; 18:1473-1478. [PMID: 34686615 DOI: 10.1123/jpah.2021-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This paper aimed to assess the development process, content, and early implementation of Oman's national physical activity plan of action to identify strengths and areas for improvement. METHODS Data were extracted from 4 documents: national noncommunicable diseases policy, physical activity plan of action, and 2 World Health Organization Mission Reports. Three policy frameworks and approaches (physical activity content analysis grid, health-enhancing physical activity policy audit tool, and policy cube approach for diet-related noncommunicable diseases) were used. RESULTS The findings demonstrated that policymakers engaged a broad range of sectors in developing a national plan. It aligned with many of the elements from the 3 policy frameworks (ie, multisectoral approach, political commitment/leadership, identification of national goals and targets, time frame for implementation). The main gaps included the lack of a specified sustainable funding mechanism, systems for monitoring progress, and an emphasis on general interventions, with limited focus on specific target groups. CONCLUSION A range of sectors were engaged in the development of Oman's national physical activity plan of action, with strong political commitment and using global guidance and local evidence. Establishing a strong accountability framework, including a clear financing mechanism, is critical for Oman to meet its target for a 10% relative reduction in physical inactivity by 2025.
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27
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Milton K, Kelly MP, Baker G, Cleland C, Cope A, Craig N, Foster C, Hunter R, Kee F, Kelly P, Nightingale G, Turner K, Williams AJ, Woodcock J, Jepson R. Use of natural experimental studies to evaluate 20mph speed limits in two major UK cities. J Transp Health 2021; 22:101141. [PMID: 34603959 PMCID: PMC8463832 DOI: 10.1016/j.jth.2021.101141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Reductions in traffic speed can potentially offer multiple health and public health benefits. In 2016, implementation of 20mph (30kph) speed limit interventions began in Edinburgh (city-wide) and Belfast (city centre). The aims of this paper are to describe 1) the broad theoretical approach and design of two natural experimental studies to evaluate the 20mph speed limits in Edinburgh and Belfast and 2) how these studies allowed us to test and explore theoretical mechanisms of 20mph speed limit interventions. METHODS The evaluation consisted of several work packages, each with different research foci, including the political decision-making processes that led to the schemes, their implementation processes, outcomes (including traffic speed, perceptions of safety, and casualties) and cost effectiveness. We used a combination of routinely and locally collected quantitative data and primary quantitative and qualitative data. RESULTS The evaluation identified many contextual factors influencing the likelihood of 20mph speed limits reaching the political agenda. There were substantial differences between the two sites in several aspects related to implementation. Reductions in speed resulted in significant reductions in collisions and casualties, particularly in Edinburgh, which had higher average speed at baseline. The monetary value of collisions and casualties prevented are likely to exceed the costs of the intervention and thus the overall balance of costs and benefits is likely to be favourable. CONCLUSIONS Innovative study designs, including natural experiments, are important for assessing the impact of 'real world' public health interventions. Using multiple methods, this project enabled a deeper understanding of not only the effects of the intervention but the factors that explain how and why the intervention and the effects did or did not occur. Importantly it has shown that 20mph speed limits can lead to reductions in speed, collisions and casualties, and are therefore an effective public health intervention.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia, UK
| | - Michael P. Kelly
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Graham Baker
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, UK
| | - Claire Cleland
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, UK
| | | | | | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, UK
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, UK
| | - Kieran Turner
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, UK
| | - Andrew J. Williams
- Division of Population and Behavioural Science, School of Medicine, University of St Andrews, UK
| | - James Woodcock
- Centre for Diet and Activity Research, University of Cambridge, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, UK
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28
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Bauman AE, Kamada M, Reis RS, Troiano RP, Ding D, Milton K, Murphy N, Hallal PC. An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity. Lancet 2021; 398:456-464. [PMID: 34302766 DOI: 10.1016/s0140-6736(21)01165-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
Pre-Olympic Games predictions commonly include an increase in population-based physical activity in the host city, as often stated in the bid, but the post-Olympic Games effects on physical activity have not been summarised. In this Series paper, we aim to do the following: examine mentions of a physical activity legacy in pre-Olympic bid documentation; analyse existing physical activity surveillance data collected before, during, and after the Olympic Games in hosting areas around the world; and evaluate Google Trends data surrounding the London 2012 Olympic Games as a case study of community interest in the topic of exercise during the time of the Olympic Games. Before 2007, little mention of physical activity was made in pre-Olympic Games documentation, but, after that, most documents had targets for population physical activity or sports participation. The synthesis of available surveillance data indicates that there was no change in the prevalence of physical activity or sports participation, except for the 2008 Summer Olympics in Beijing and the 1998 Winter Olympics in Nagano; although, the increase in participation in Nagano might not be attributable to the Olympic Games since there was no change in participation in winter sports. The Google Trends data showed an acute spike in searches with the term "Olympic" immediately associated with the London Olympic Games period and showed a sustained peri-Olympic increase in searches with the term "exercise". By themselves, the Olympic Games have not improved population-wide physical activity but might be an important missed public health opportunity. Such a legacy will require strategic planning and partnerships across the International Olympic Committee and the Olympic, sport, and public health agencies and a thorough evaluation framework implemented throughout the pre-Olympic Games and post-Olympic Games period in the host country.
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Affiliation(s)
- Adrian E Bauman
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Masamitsu Kamada
- School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Rodrigo S Reis
- Prevention Research Center, Brown School, Washington University in Saint Louis, St Louis, MO, USA; Urban Management, Pontifical Catholic University of Parana, Curitiba, Brazil
| | - Richard P Troiano
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ding Ding
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Niamh Murphy
- Sport and Exercise Science, Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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29
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Chalkley A, Milton K. A critical review of national physical activity policies relating to children and young people in England. J Sport Health Sci 2021; 10:255-262. [PMID: 33010524 PMCID: PMC8167315 DOI: 10.1016/j.jshs.2020.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/11/2020] [Accepted: 08/31/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND There has been an increasing focus on the importance of national policy to address population levels of physical inactivity. It has been suggested that the 4 cornerstones of policy comprise (1) national guidelines on physical activity (PA), (2) setting population goals and targets, (3) surveillance or health-monitoring systems, and (4) public education. The current study aimed to review the policy actions that have addressed each of these elements for children and youth in England and to identify areas of progress and remaining challenges. METHODS A literature search was undertaken to identify past and present documents relevant to PA policy for children and youth in England. Each document was analyzed to identify content relevant to the 4 cornerstones of policy. RESULTS Physical activity guidelines (Cornerstone 1) for children and youth have been in place since 1998 and reviewed periodically. Physical activity targets (Cornerstone 2) have focussed on the provision of opportunities for PA, mainly through physical education in schools rather than in relation to the proportion of children meeting recommended PA levels. There has been much surveillance (Cornerstone 3) of children's PA, but this has been undertaken infrequently over time and with varying inclusions of differing domains of activity. There has been only 1 campaign (Cornerstone 4) that targeted children and their intermediaries, Change4Life, which was an obesity campaign focussing on dietary behavior in combination with PA. Most recently, a government infographic supporting the PA guidelines for children and young people was developed, but details of its dissemination and usage are unknown. CONCLUSION There have been many developments in national PA policy in England targeted to children and young people. The area of most significant progress is national PA guidelines. Establishing prevalence targets, streamlining surveillance systems, and investing in public education with supportive policies, environments, and opportunities would strengthen national policy efforts to increase PA and reduce sedentary behavior.
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Affiliation(s)
- Anna Chalkley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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30
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Milton K, Bauman AE, Faulkner G, Hastings G, Bellew W, Williamson C, Kelly P. Maximising the impact of global and national physical activity guidelines: the critical role of communication strategies. Br J Sports Med 2021; 54:1463-1467. [PMID: 33239351 PMCID: PMC7719904 DOI: 10.1136/bjsports-2020-102324] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/23/2022]
Abstract
Objectives Physical activity guidelines are evidence-based statements on recommended physical activity levels for good health. Guidelines, in isolation, are unlikely to increase population levels of physical activity; appropriate and effective communication is fundamental to maximising their impact. The aim of this paper is to provide a planning framework for physical activity guideline communication, including an overview of key audiences, aims and approaches. Methods All authors considered and agreed on the three broad issues to address by consensus. We identified key sources of evidence through scoping of the literature and our knowledge of the research area. Results Whether guidelines are global or national, communication of the physical activity guidelines should be informed by: (1) a situational analysis that considers the context in which the communication will take place and (2) a stakeholder analysis to determine the key target audiences for the communication and their values, needs and preferences. Audiences include policy-makers within and outside the health sector, other key stakeholders, the general public, specific population subgroups, health professionals and non-health professionals with a role in physical activity promotion. The aims and approach to communication will differ depending on the target audience. Conclusion Communication to raise awareness and knowledge of the physical activity guidelines must be supported by policies, environments and opportunities for physical activity. Besides the intrinsic value of the physical activity guidelines, it is essential that substantial effort is put in to diligently planning, funding and implementing their communication from the outset.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adrian E Bauman
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Guy Faulkner
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - William Bellew
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Chloë Williamson
- Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK
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31
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Fynn JF, Hardeman W, Milton K, Jones A. Exploring influences on evaluation practice: a case study of a national physical activity programme. Int J Behav Nutr Phys Act 2021; 18:31. [PMID: 33593380 PMCID: PMC7885395 DOI: 10.1186/s12966-021-01098-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to improve physical activity behaviour are a core part of public health policy and practice. It is essential that we evaluate these interventions and use the evidence to inform decisions to improve population health. Evaluation of 'real-world' interventions provide an opportunity to generate practice-relevant evidence, however these interventions are difficult to evaluate. Various guidelines have been developed to facilitate evaluation, but evidence about their effectiveness in practice is limited. To explore influences on evaluation practice in an applied context, we conducted a case study of Sport England's 'Get Healthy Get Active' (GHGA) programme. This was a national programme that funded 33 projects that were delivered and evaluated across England. The programme was chosen as it was designed to generate evidence on the role of sport in increasing physical activity and improving health. The study aimed to explore and appraise whether strategies intended to facilitate project evaluation, including funder requirements to use a standardised evaluation framework and specific data collection methods, were effective in generating evidence that enabled the programme to meet its aims. METHODS We applied a collective case study design involving 35 semi-structured interviews, and documentary analysis of multiple sources of evidence from 23 physical activity projects funded by GHGA. We applied thematic and framework analysis. We developed a logic model and mapped actual outcomes against intended outcomes. A narrative synthesis is provided. We discuss implications for the effective commissioning and evaluation of public health interventions. RESULTS We identified five main themes of influences on evaluation practices that can act as barriers and facilitators to good practice: programme and project design; evaluation design; partnerships; resources; and organisational structures and systems. These influences are context-specific and operate through a complex set of interactions. CONCLUSION Developing a better understanding of how influences on evaluation practice can act as facilitators or barriers is vital to help close current gaps in the evidence-based practice cycle. Critically, organisational structures and systems are needed to facilitate collaborative decision making; integration of projects and evaluation across partners organisations; transfer of knowldege and insights between stakeholders; and more rapid feedback and dissemination.
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Affiliation(s)
- Judith F Fynn
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andy Jones
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK
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32
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Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020. [PMID: 33239350 DOI: 10.1136/bjsports-2020-102955.pmid:33239350;pmcid:pmc7719906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. METHODS The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. RESULTS The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. CONCLUSION These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018-2030 and to strengthen surveillance systems that track progress towards national and global targets.
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Affiliation(s)
- Fiona C Bull
- Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland .,School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Katja Borodulin
- Age Institute, Helsinki, Finland.,Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Belgium
| | - Catherine Carty
- Institute of Technology Tralee, Tralee, Co Kerry, Ireland.,UNESCO Chair of Transforming the Lives of People with Disabilities, their Families and Communities, Through Physical Education, Sport, Recreation and Fitness
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sebastien Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Roger Chou
- Departments of Medicine, and Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Paddy C Dempsey
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK.,Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Loretta DiPietro
- Department of Exercise and Nutrition Science, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Science, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Muthoni Gichu
- Department of Non-Commuicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Science, School for Policy Studies, University of Bristol, Bristol, UK
| | - Peter T Katzmarzyk
- Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Estelle Lambert
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael Leitzmann
- Department ofEpidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Karen Milton
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, UK
| | - Francisco B Ortega
- PROFITH (PROmoting FITness and Health through physical activity) research group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Spain
| | - Chathuranga Ranasinghe
- Sports and Exercise Medicine Unit and Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Emmanuel Stamatakis
- Charles Perkins Centre, University of Sydney, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard P Troiano
- Epidemiology and Genomics Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Vrije Universiteit, Amsterdam, The Netherlands.,Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Wari
- National Department of Health, Port Moresby, Papua New Guinea
| | - Juana F Willumsen
- Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland
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33
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Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54:1451-1462. [PMID: 33239350 PMCID: PMC7719906 DOI: 10.1136/bjsports-2020-102955] [Citation(s) in RCA: 3334] [Impact Index Per Article: 833.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. METHODS The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. RESULTS The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. CONCLUSION These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018-2030 and to strengthen surveillance systems that track progress towards national and global targets.
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Affiliation(s)
- Fiona C Bull
- Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Katja Borodulin
- Age Institute, Helsinki, Finland
- Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Belgium
| | - Catherine Carty
- Institute of Technology Tralee, Tralee, Co Kerry, Ireland
- UNESCO Chair of Transforming the Lives of People with Disabilities, their Families and Communities, Through Physical Education, Sport, Recreation and Fitness
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sebastien Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Roger Chou
- Departments of Medicine, and Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Paddy C Dempsey
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Loretta DiPietro
- Department of Exercise and Nutrition Science, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Science, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Muthoni Gichu
- Department of Non-Commuicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Science, School for Policy Studies, University of Bristol, Bristol, UK
| | - Peter T Katzmarzyk
- Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Estelle Lambert
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael Leitzmann
- Department ofEpidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Karen Milton
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, UK
| | - Francisco B Ortega
- PROFITH (PROmoting FITness and Health through physical activity) research group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Spain
| | - Chathuranga Ranasinghe
- Sports and Exercise Medicine Unit and Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Emmanuel Stamatakis
- Charles Perkins Centre, University of Sydney, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard P Troiano
- Epidemiology and Genomics Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Vrije Universiteit, Amsterdam, The Netherlands
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Wari
- National Department of Health, Port Moresby, Papua New Guinea
| | - Juana F Willumsen
- Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland
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34
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DiPietro L, Al-Ansari SS, Biddle SJH, Borodulin K, Bull FC, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Willumsen JF. Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group. Int J Behav Nutr Phys Act 2020; 17:143. [PMID: 33239105 PMCID: PMC7690200 DOI: 10.1186/s12966-020-01042-2] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. METHODS The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. RESULTS Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. CONCLUSIONS Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.
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Affiliation(s)
- Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
| | | | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Australia
| | - Katja Borodulin
- Age Institute, Helsinki, Finland
- Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Fiona C Bull
- Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, USA
| | - Greet Cardon
- Department of Movement and Sports Sciences, University of Ghent, Ghent, Belgium
| | - Catherine Carty
- UNESCO Chair, Institute of Technology Tralee, Tralee, Ireland
| | - Jean-Philippe Chaput
- Department of Pediatrics, University of Ottawa, Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Group, Ontario, Canada
| | - Sebastien Chastin
- School of Health and Life Sciences, Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Roger Chou
- Departments of Medicine, and Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Paddy C Dempsey
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Ulf Ekelund
- Department of Chronic Disease and Ageing, Norwegian Institute of Public Health, Department of Sport Medicine, Norwegian School of Sport Science, Oslo, Norway
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Muthoni Gichu
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Russell Jago
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Peter T Katzmarzyk
- Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Estelle Lambert
- Research Centre for Health through Physical Acivity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Karen Milton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Francisco B Ortega
- PROFITH (PROmoting FITness and Health through physical activity) research group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Spain 26. Sports and Exercise Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chathuranga Ranasinghe
- Charles Perkins Centre, University of Sydney, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Emmanuel Stamatakis
- Institute for Musculoskeletal Health, The University of Sydney, and Sydney Local Health District, Sydney, Australia
| | - Anne Tiedemann
- Epidemiology and Genomics Research Program, National Cancer Institute, Bethesda, USA
| | - Richard P Troiano
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Juana F Willumsen
- Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland
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35
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Klepac Pogrmilovic B, Ramirez Varela A, Pratt M, Milton K, Bauman A, Biddle SJH, Pedisic Z. National physical activity and sedentary behaviour policies in 76 countries: availability, comprehensiveness, implementation, and effectiveness. Int J Behav Nutr Phys Act 2020; 17:116. [PMID: 32948193 PMCID: PMC7501705 DOI: 10.1186/s12966-020-01022-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background Evidence on current, national physical activity (PA) and sedentary behaviour (SB) policies is limited. We, therefore, analysed availability, comprehensiveness, implementation, and effectiveness of PA and SB policies internationally. Methods In this cross-sectional study, Global Observatory for Physical Activity (GoPA!) Country Contacts from 173 countries were asked to provide data on their national PA and SB policies by completing GoPA! Policy Inventory. Data were collected for 76 countries (response rate = 44%). Results Formal written policies for PA and SB were found in 92% (95% confidence interval [CI]: 86, 98) and 62% (95% CI: 50, 75) of countries, respectively. Sixty-two percent (95% CI: 51, 73) of countries have national PA guidelines, while 40% (95% CI: 29, 52) have SB guidelines. Fifty-two (95% CI: 40, 64) and 11% (95% CI: 3, 19) of countries have quantifiable national targets for PA and SB, respectively. The most represented ministries/departments involved in the promotion of more PA and/or less SB were in the sport (reported by 99% countries; 95% CI: 96, 100), health (97%; 95% CI: 94, 100), education (94%; 95% CI: 88, 100), and recreation and leisure (85%; 95% CI: 71, 99) sectors. The median score (0–10) for the comprehensiveness of PA and SB policies was 4 (95% CI: 4, 5) and 2 (95% CI: 2, 3), respectively. For PA and SB policy implementation it was 6 (95% CI: 5, 6). For the effectiveness of PA and SB policies it was 4 (95% CI: 3, 5) and 3 (95% CI: 2, 4), respectively. PA and SB policies were generally best developed in high-income countries and countries of European and Western-Pacific regions. Conclusions Most of the included countries have PA policies, but their comprehensiveness, implementation, and effectiveness are generally low-to-moderate. SB policies are less available, comprehensive, implemented, and effective than PA policies. PA and SB policies are better developed in high-income countries, compared with low- and lower-middle-income countries, and in countries of European and Western-Pacific regions, compared with other world regions. More investment is needed in development and implementation of comprehensive and effective PA and SB policies, particularly in low- and lower-middle-income countries.
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Affiliation(s)
- Bojana Klepac Pogrmilovic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia.,Mitchell Institute, Victoria University, 300 Queen Street, Melbourne, VIC, 3000, Australia
| | | | - Michael Pratt
- University of California San Diego Institute for Public Health, 9500 Gilman Drive, San Diego, USA
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD, 4300, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia.
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36
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Fynn JF, Hardeman W, Milton K, Murphy J, Jones A. A systematic review of the use and reporting of evaluation frameworks within evaluations of physical activity interventions. Int J Behav Nutr Phys Act 2020; 17:107. [PMID: 32831111 PMCID: PMC7444034 DOI: 10.1186/s12966-020-01013-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Evaluation of physical activity interventions is vital to inform, and justify, evidence-based policy and practice to support population-wide changes in physical activity. Several evaluation frameworks and guidance documents have been developed to facilitate the evaluation and reporting of evaluation studies in public health. However, there is a lack of evidence about whether frameworks are being used to guide evaluation. There continues to be claims of poor and inconsistent reporting in evaluation studies. The aim of this review was to assess the use of evaluation frameworks and the quality of reporting of how they were applied within evaluation studies of physical activity interventions. OBJECTIVES 1. To identify whether evaluation frameworks are reported to have been used within evaluation studies of physical activity interventions, and which frameworks have been used. 2. To appraise the quality of reporting with regards to how evaluation frameworks have been used. METHOD We developed a checklist of indicators to enable a critical appraisal of the use and reporting of different evaluation frameworks in evaluation studies. We conducted a systematic search and review of evaluation studies published between 2015 and the date of the search to appraise the use and reporting of evaluation frameworks. A narrative synthesis is provided. RESULTS The review identified 292 evaluation studies of physical activity interventions, only 69 (23%) of these mentioned using an evaluation framework, and only 16 different frameworks were referred to. There was variation in the quality of reporting of framework use. 51 (74%) studies were identified as being explicitly based on the stated framework, however only 26 (38%) provided detailed descriptions consistently across all the checklist indicators. Details of adaptations and limitations in how frameworks were applied were less frequently reported. The review also highlighted variability in the reporting of intervention components. More consistent and precise reporting of framework and intervention components is needed. CONCLUSION Evaluation frameworks can facilitate a more systematic evaluation report and we argue their limited use suggests missed opportunities to apply frameworks to guide evaluation and reporting in evaluation studies. Variability in the quality of reporting of framework use limits the comparability and transferability of evidence. Where a framework has been used, the checklist of indicators can be employed to facilitate the reporting of an evaluation study and to review the quality of an evaluation report.
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Affiliation(s)
- Judith F Fynn
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joseph Murphy
- Physical Activity for Health Research Cluster, Physical Education and Sport Sciences Department, University of Limerick, Limerick, Ireland
| | - Andy Jones
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK
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Murtagh EM, Murphy MH, Milton K, Roberts NW, O'Gorman CS, Foster C. Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age. Cochrane Database Syst Rev 2020; 7:CD012554. [PMID: 32678471 PMCID: PMC7389819 DOI: 10.1002/14651858.cd012554.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality. OBJECTIVES Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time. MAIN RESULTS We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies. AUTHORS' CONCLUSIONS Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.
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Affiliation(s)
- Elaine M Murtagh
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Marie H Murphy
- Sport & Exercise Sciences Research Institute, University of Ulster, Newtownabbey, UK
- Doctoral College, University of Ulster, Newtownabbey, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nia W Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Clodagh Sm O'Gorman
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Charles Foster
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Fynn JF, Hardeman W, Milton K, Jones AP. A scoping review of evaluation frameworks and their applicability to real-world physical activity and dietary change programme evaluation. BMC Public Health 2020; 20:1000. [PMID: 32586301 PMCID: PMC7318477 DOI: 10.1186/s12889-020-09062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Physical activity and dietary change programmes play a central role in addressing public health priorities. Programme evaluation contributes to the evidence-base about these programmes; and helps justify and inform policy, programme and funding decisions. A range of evaluation frameworks have been published, but there is uncertainty about their usability and applicability to different programmes and evaluation objectives, and the extent to which they are appropriate for practitioner-led or researcher-led evaluation. This review appraises the frameworks that may be applicable to evaluation of physical activity and/or dietary change programmes, and develops a typology of the frameworks to help guide decision making by practitioners, commissioners and evaluators. METHODS A scoping review approach was used. This included a systematic search and consultation with evaluation experts to identify evaluation frameworks and to develop a set of evaluation components to appraise them. Data related to each framework's general characteristics and components were extracted. This was used to construct a typology of the frameworks based on their intended programme type, evaluation objective and format. Each framework was then mapped against the evaluation components to generate an overview of the guidance included within each framework. RESULTS The review identified 71 frameworks. These were described variously in terms of purpose, content, or applicability to different programme contexts. The mapping of frameworks highlighted areas of overlap and strengths and limitations in the available guidance. Gaps within the frameworks which may warrant further development included guidance on participatory approaches, non-health and unanticipated outcomes, wider contextual and implementation factors, and sustainability. CONCLUSIONS Our typology and mapping signpost to frameworks where guidance on specific components can be found, where there is overlap, and where there are gaps in the guidance. Practitioners and evaluators can use these to identify, agree upon and apply appropriate frameworks. Researchers can use them to identify evaluation components where there is already guidance available and where further development may be useful. This should help focus research efforts where it is most needed and promote the uptake and use of evaluation frameworks in practice to improve the quality of evaluation and reporting.
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Affiliation(s)
- Judith F Fynn
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andy P Jones
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK
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Engelen L, Drayton BA, Young S, Daley M, Milton K, Bauman A, Chau JY. Impact and process evaluation of a co-designed 'Move More, Sit Less' intervention in a public sector workplace. Work 2020; 64:587-599. [PMID: 31658091 DOI: 10.3233/wor-193020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High levels of sitting are associated with increased risk of adverse health outcomes, including chronic disease. Extensive sitting at work is common, hence organisations should provide options to employees to reduce prolonged sitting. OBJECTIVE To assess the efficacy and acceptability of a co-designed intervention to increase standing and reduce sitting in a public-sector office. METHODS Forty-six adults participated in the quasi-experimental study (30 intervention; 16 control). The intervention involved providing sit-stand desks, prompts, workshops, and information emails to assist behavior change. Participants wore a thigh-mounted Actigraph GT3X+ for five working days and responded to an online questionnaire at baseline (BL), 6 (T1) and 13 weeks (T2) post intervention. RESULTS Inclinometer-measured proportion of time standing increased in the intervention group from 14% (baseline) to 28% (T1) and 27% (T2) (67 minutes more standing over an 8-hour workday). Intervention participants reduced sitting time from 79% (BL) to 63% (T1 and T2), (80 minutes less sitting over an 8-hour workday). The control group showed no changes. The program was highly recommended (94%), and perceived to support behavior change (81%). CONCLUSIONS This Move More, Sit Less intervention appears to be efficacious and acceptable. Future interventions should be co-designed to ensure culturally appropriate components and higher acceptability.
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Affiliation(s)
- Lina Engelen
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Brad A Drayton
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Sarah Young
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,National Heart Foundation, East Sydney, NSW, Australia
| | | | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Josephine Y Chau
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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Abstract
Physical inactivity is a key risk factor for a wide range of non-communicable diseases, yet a large proportion of the population fail to meet recommended physical activity levels. Healthcare has been identified as a key setting in which to intervene to encourage physical activity behaviour change. However, those working in the healthcare sector must be provided with training opportunities to increase knowledge, competence and motivation. We reviewed the structure and content of the current health-related courses at the University of East Anglia to identify opportunities to deliver more content on physical activity. We identified five areas for action: the development of new learning outcomes; the creation and delivery of taught sessions on physical activity; providing resources to faculty members to support the integration of the topic across all relevant modules and courses; the development of electronic resources for students; and modifications to the Problem-Based Learning (PBL) scenarios. Taking a multi-faceted and integrated approach was important to avoid physical activity being viewed as a 'bolt-on' topic. It also helped to maximise exposure to the topic while minimising disruption to the course structure and timetable. The actions taken have proved feasible and have been well received by students and staff.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia , Norwich, UK
| | - Jonathan Larner
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia , Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia , Norwich, UK
| | - Andy Jones
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia , Norwich, UK
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Klepac Pogrmilovic B, O'Sullivan G, Milton K, Biddle SJH, Pedisic Z. A systematic review of instruments for the analysis of national-level physical activity and sedentary behaviour policies. Health Res Policy Syst 2019; 17:86. [PMID: 31722717 PMCID: PMC6854623 DOI: 10.1186/s12961-019-0492-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022] Open
Abstract
Background This systematic review aimed to identify and critically assess available instruments for the analysis of national-level physical activity (PA) and sedentary behaviour (SB) policies and provide recommendations for their future use. Methods We conducted a systematic search of academic and grey literature through six bibliographic databases, Google and the websites of three international organisations for PA promotion to identify instruments that are used or that may be used for national-level PA/SB policy analysis. In order to describe and categorise the identified instruments, we used the Comprehensive Analysis of Policy on Physical Activity framework. This framework specifies the elements of a comprehensive analysis of PA/SB policies through the following categories: purpose, level, policy sector, type of policy, stages of policy cycle and scope of analysis. Results Out of 22,071 screened items, 26 publications describing 16 instruments met the selection criteria. All the instruments can be used for analysing PA policy, whilst only two include questions about SB policy. None of the instruments allow for the analysis of all the relevant components of national PA/SB policy. Some important elements of PA policy analysis, such as the tourism and research sectors, the agenda-setting and endorsement/legitimisation stages, and the effects of policy, are addressed by only a few instruments. Moreover, none of the instruments address unwritten formal statements, informal policies, and the termination and succession stages of the policy cycle. Conclusion Designing new instruments or adapting existing ones is needed to allow for a more thorough analysis of national PA and SB policies. Given that policy analysis covering all important components of PA/SB policy may be extremely time-consuming, a way forward might be to develop a set of complementary instruments, with each tool collecting detailed information about a specific component.
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Affiliation(s)
- Bojana Klepac Pogrmilovic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia
| | - Grant O'Sullivan
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Stuart J H Biddle
- Centre for Health, Informatics, and Economic Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia.
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Minns Lowe CJ, Kelly P, Milton K, Foster C, Barker K. "WALK30X5": a feasibility study of a physiotherapy walking programme for people with mild to moderate musculoskeletal conditions. Physiotherapy 2019; 107:275-285. [PMID: 32026829 DOI: 10.1016/j.physio.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To explore the feasibility of delivering and evaluating a web-based walking intervention for people with long term musculoskeletal conditions (LTMCs), to determine its acceptability and the feasibility of conducting a definitive trial. DESIGN Prospective randomised feasibility study, with blind outcome assessment at baseline, 3 and 6 months. SETTING Hospital based physiotherapy service. PARTICIPANTS Forty one adults referred for assessment and advice for any mild/moderate LTMCs. doing <120minutes of moderate intensity activity per week. INTERVENTIONS Participants randomised to: 1. Usual care: one usual physiotherapy advice and assessment session, including setting a physical activity goal and one follow up session (8 weeks). 2. "Walk30×5": session one, usual care plus intervention of walking programme. Participants were shown the website and podcasts and practiced how to use them. One follow up session (8 weeks). OUTCOME MEASURES Primary: timed six minute walk test (T6MWT). Secondary: step count, self-reported pain, fatigue, mood, self-efficacy, happiness, objective blood pressure, peak expiratory flow rate, and self-report and accelerometer measured physical activity. RESULTS Recruitment target achieved. No adverse events occurred. Adherence was high and the intervention acceptable. Loss to follow up n=3 (7%) at 3 months, n=8 (20%) at 6 months. T6MWT and step count proved suitable outcomes, unlike accelerometry. Estimated sample size for a definitive trial is 216. CONCLUSIONS "Walk30×5" is ready for evaluation in a future, appropriately powered (n=216), phase III trial. If effective, the intervention will provide a cheap, highly accessible intervention to enable people with mild/moderate LTMCs to achieve UK physical activity guidelines. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN78581097.
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Affiliation(s)
- Catherine J Minns Lowe
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Headington, Oxford OX3 7HE, UK.
| | - Paul Kelly
- Institute for Sport, Physical Education and Health Sciences (ISPEHS), Moray House School of Education, University of Edinburgh, EH8 8AQ, UK.
| | - Karen Milton
- The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, UK.
| | - Charlie Foster
- The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, UK.
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Headington, Oxford OX3 7HE, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
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Klepac Pogrmilovic B, O'Sullivan G, Milton K, Biddle SJH, Bauman A, Bellew W, Cavill N, Kahlmeier S, Kelly MP, Mutrie N, Pratt M, Rutter H, Ramirez Varela A, Woods C, Pedisic Z. The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Int J Behav Nutr Phys Act 2019; 16:60. [PMID: 31375132 PMCID: PMC6679550 DOI: 10.1186/s12966-019-0822-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Policy analysis is considered essential for achieving successful reforms in health promotion and public health. The only framework for physical activity (PA) policy analysis was developed at a time when the field of PA policy research was in its early stages. PA policy research has since grown, and our understanding of what elements need to be included in a comprehensive analysis of PA policy is now more refined. This study developed a new conceptual framework for PA policy analysis - the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. METHODS The development of the CAPPA framework was based on: (i) an extensive review of literature; (ii) an open discussion between the authors; (iii) three rounds of a Delphi process; and (iv) two-rounds of consultations with PA policy stakeholders. RESULTS The CAPPA framework specifies 38 elements of a comprehensive analysis of PA policies in the following six categories, which comprise the building blocks of the framework: (i) purpose of analysis (including auditing and assessment of policies); (ii) policy level (including: international; national; subnational; local; and institutional policies); (iii) policy sector (including: health; sport; recreation and leisure; education; transport; environment; urban/rural planning and design; tourism; work and employment; public finance; and research sectors); (iv) type of policy (including: formal written policies; unwritten formal statements; written standards and guidelines; formal procedures; and informal policies); (v) stage of policy cycle (including: agenda setting; formulation; endorsement/legitimisation; implementation; evaluation; maintenance; termination; and succession); and (vi) scope of analysis (including availability; context; processes; actors; political will; content; and effects). Based on the CAPPA framework, we also proposed broad and inclusive definitions of PA policy and PA policy analysis. CONCLUSION The CAPPA framework may be used to guide future studies related to PA policy and to provide a context for the analysis of its specific components. The framework could be used in the same way for sedentary behaviour policy research. Future research should examine the extent to which PA policy analysis has covered each of the elements specified in the CAPPA framework and analyse the elements for which evidence is lacking. Future studies should also determine whether the existing tools allow for auditing and assessment of all the CAPPA elements and develop new tools if needed to allow for a more comprehensive PA policy analysis.
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Affiliation(s)
- Bojana Klepac Pogrmilovic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia
| | - Grant O'Sullivan
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Stuart J H Biddle
- Institute for Resilient Regions, University of Southern Queensland, 37 Sinnathamby, Boulevard, Springfield Central, QLD, 4300, Australia
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Camperdown, Sydney, NSW, Australia
| | - William Bellew
- Sydney School of Public Health, University of Sydney, Camperdown, Sydney, NSW, Australia
| | | | - Sonja Kahlmeier
- Department of Health, Swiss Distance University of Applied Science FFHS, Regensdorf/Zurich, Switzerland
| | - Michael P Kelly
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Nanette Mutrie
- Moray House School of Education, Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, Scotland, UK
| | - Michael Pratt
- University of California San Diego Institute for Public Health, 9500 Gilman Drive, San Diego, USA
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Faculty of Medicine, University de los Andes, Bogota, Colombia
| | - Catherine Woods
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Luimneach, Ireland
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC, 3001, Australia.
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Strain T, Milton K, Dall P, Standage M, Mutrie N. How are we measuring physical activity and sedentary behaviour in the four home nations of the UK? A narrative review of current surveillance measures and future directions. Br J Sports Med 2019; 54:1269-1276. [PMID: 31118181 PMCID: PMC7116237 DOI: 10.1136/bjsports-2018-100355] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 12/12/2022]
Abstract
Background/objectives To explore and describe the comparability between the surveys of the UK home nations (England, Northern Ireland, Scotland, Wales) that monitor compliance with the Chief Medical Officers’ physical activity (PA) recommendations. We also suggest ways to improve the UK national PA and sedentary behaviour (SB) surveillance systems. Methods We identified national surveys that monitor PA and SB through searching UK-wide and devolved administration websites, the Global Observatory for Physical Activity Country Cards and the Active Healthy Kids Report Cards. Subsequently, we extracted information from survey documentation on the survey commissioners and contractors, method of administration, current questionnaire details relevant to the PA recommendations, questionnaire changes over the previous decade and the most recent prevalence figures. Results For adults and older adults, five surveys assess the moderate-to-vigorous PA (MVPA) recommendation, three assess muscle strengthening and three assess SB. For older adults only, three assess balance and co-ordination. For children, seven assess MVPA, none assess muscle strengthening and five assess SB. Only one survey reports on the under 5 PA recommendation. There is no part of the recommendations for which comparable estimates can be calculated across all four home nations. The greatest variation is among the SB questions and reporting. No survey has regularly used device-based measures. Conclusion UK surveillance of the PA recommendations is complex, undertaken separately in the home nations, using multiple surveys that cover adults and children separately. We recommend that the costs and benefits of harmonising the existing questionnaires are considered, along with the potential introduction of device-based measures.
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Affiliation(s)
- Tessa Strain
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Philippa Dall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Martyn Standage
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, Moray House School of Education, University of Edinburgh, Edinburgh, UK
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Klepac Pogrmilovic B, O’Sullivan G, Milton K, Biddle SJH, Bauman A, Bull F, Kahlmeier S, Pratt M, Pedisic Z. A global systematic scoping review of studies analysing indicators, development, and content of national-level physical activity and sedentary behaviour policies. Int J Behav Nutr Phys Act 2018; 15:123. [PMID: 30486826 PMCID: PMC6263060 DOI: 10.1186/s12966-018-0742-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/25/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND National policy approaches to physical activity (PA) promotion and sedentary behaviour (SB) reduction are needed to address rising rates of non-communicable diseases. Understanding the policy process and impact through robust research and evaluation is crucial for facilitating successful reforms in national health policy. This scoping review, therefore, aimed to map the evidence on indicators, development, and content of national PA and/or SB policies globally. METHODS A systematic search of academic and grey literature was conducted through six bibliographic databases, Google, and websites of three large organisations for PA promotion. RESULTS Out of 24,872 screened documents, 203 publications from 163 studies were selected. The selected studies investigated PA/SB policies in 168 countries worldwide, and we provided summary results for each of the countries. Overall, 69, 29, and 2% of the analyses of national PA/SB policies were conducted for high-, middle-, and low-income countries, respectively. Twenty-two percent of the studies mentioned SB policies as part of their analysis, with only one study focusing solely on assessing SB policies. Operational definitions of policy were found in only 13% of publications. Only 15% of the studies used a conceptual or theoretical framework. A large variety of methods were used for data collection and analysis of PA/SB policy. CONCLUSIONS We found that PA policy research is much more developed than it was considered several years ago. Research around SB policies is still in its infancy, but it seems to have experienced some positive progress in the last few years. Three key issues were identified that should be addressed in further research: [i] there is a lack of PA/SB policy research in low- and middle-income countries, which is an important limitation of the current body of evidence; [ii] the definition of policy varied significantly across studies, and most studies did not rely on any theoretical framework, which may impede cross-study comparisons; and [iii] studies have used a variety of methods to analyse policy, which may also cause problems with comparability. Future PA/SB policy research should aim towards a clearer conceptualisation of policy, greater reliance on existing theoretical frameworks, and the use and further development of standardised methods for PA/SB policy analysis.
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Affiliation(s)
- Bojana Klepac Pogrmilovic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC 3001 Australia
| | - Grant O’Sullivan
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC 3001 Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ UK
| | - Stuart J. H. Biddle
- Institute for Resilient Regions, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD 4300 Australia
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Camperdown, Sydney, NSW Australia
| | - Fiona Bull
- Surveillance and Population Based Prevention, Prevention of Noncommunicable Disease, World Health Organization, Geneva 27, Switzerland
- Faculty of Human Science, The University of Western Australia, Perth, Australia
| | - Sonja Kahlmeier
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Michael Pratt
- San Diego School of Medicine, University of California, 9500 Gilman Drive, San Diego, USA
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC 3001 Australia
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Milton K, Chau J, McGill B, Bauman A. A review of UK media coverage of physical activity associated with the publication of special issues in a high-impact medical journal. Public Health 2018; 163:87-94. [PMID: 30107297 DOI: 10.1016/j.puhe.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/08/2018] [Accepted: 07/01/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The media is a substantial vehicle for conveying public health messages to the public. This study examined the extent to which the publication of special issues in a high-impact medical journal in 2012 and 2016 generated media interest in physical activity and health in the UK and explored the main issues that were reported. STUDY DESIGN This is a systematic narrative review of print media. METHODS Relevant print news articles were identified by searching Factiva and Google News. The timeframe of each search was 2 weeks, using the publication date of each special issue as the anchor point. Overall, 20 articles were included in the analysis for 2012 and 37 articles for 2016. RESULTS The news media coverage was encouraging for the profile of physical activity and health. In 2012 and 2016, common themes included the benefits of physical activity and the risks of being inactive, comparisons between mortality rates from physical inactivity and smoking and the recommended volume of physical activity to benefit health. CONCLUSIONS The profile given to an issue through prestigious scientific publication is one of the levers for community attention and policy change. Efforts are needed to further use the media for improving policy, practice and public awareness, which are antecedents to population health change.
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Affiliation(s)
- K Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
| | - J Chau
- Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, 2050, New South Wales, Australia
| | - B McGill
- Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, 2050, New South Wales, Australia
| | - A Bauman
- Sydney School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, 2050, New South Wales, Australia
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Milton K, Varela AR, Strain T, Cavill N, Foster C, Mutrie N. A review of global surveillance on the muscle strengthening and balance elements of physical activity recommendations. J Frailty Sarcopenia Falls 2018; 3:114-124. [PMID: 32300699 PMCID: PMC7155319 DOI: 10.22540/jfsf-03-114] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 11/03/2022] Open
Abstract
Introduction: Despite the importance of muscle strengthening and balance activities for health, these elements of the physical activity recommendations are often omitted from communication campaigns and national surveillance systems. This paper reviews national physical activity surveillance systems to determine which tools assess muscle strengthening and balance activities. Methods: We reviewed each tool that was used to inform the Global Observatory for Physical Activity (GoPA) country card prevalence estimates. Results: Of the 139 countries with GoPA country cards, 21 countries reported having no physical activity prevalence data. The prevalence estimates for 74 countries came from the World Health Organization 2014 Global Status Report on Non-Communicable Diseases. For the remaining 44 countries, a range of national and international surveys were used. A limited number of tools sought to assess muscle strengthening activities, and even fewer assessed balance and coordination activities. Discussion: Several issues arise from this review, including the need to: verify the strength of the evidence to inform whether muscle strength and balance should be given equal prominence to the aerobic recommendation; establish which activities count towards different aspects of the guidelines; and confirm whether the muscle strengthening and balance components of the guidelines are ‘in addition’ to the aerobic component.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Institute for Sport, Physical Education, and Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education, and Health Sciences, University of Edinburgh, Edinburgh, UK
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Foster C, Kelly P, Reid HAB, Roberts N, Murtagh EM, Humphreys DK, Panter J, Milton K. What works to promote walking at the population level? A systematic review. Br J Sports Med 2018; 52:807-812. [PMID: 29858468 PMCID: PMC6258897 DOI: 10.1136/bjsports-2017-098953] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations. DESIGN A systematic review. DATA SOURCES 10 electronic databases searched from January 1990 to March 2017. ELIGIBILITY CRITERIA Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a 'no intervention', or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles. RESULTS 12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).
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Affiliation(s)
- Charlie Foster
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, Institute of Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Hamish A B Reid
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Nia Roberts
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elaine M Murtagh
- Department of Arts Education and Physical Education, Mary Immaculate College, Limerick, Ireland
| | - David K Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jenna Panter
- MRC Epidemiology Unit and CEDAR, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
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Ramirez Varela A, Salvo D, Pratt M, Milton K, Siefken K, Bauman A, Kohl HW, Lee IM, Heath G, Foster C, Powell K, Hallal PC. Worldwide use of the first set of physical activity Country Cards: The Global Observatory for Physical Activity - GoPA! Int J Behav Nutr Phys Act 2018; 15:29. [PMID: 29587783 PMCID: PMC5869782 DOI: 10.1186/s12966-018-0663-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022] Open
Abstract
Background The work of The Global Observatory for Physical Activity-GoPA! is the first global effort to compile standardized country-level surveillance, policy and research data for physical activity in order to better understand how countries and regions address promoting physical activity. GoPA! developed standardized country-specific physical activity profiles (“Country Cards”) to summarize country-level data through 2013. The aim of this study was to assess use of the Country Cards, identify the factors associated with their use, and develop recommendations for supporting country-level physical activity promotion. Methods Cross sectional internet-based survey conducted between August–October 2016. Target study participants were national physical activity leaders and advocates in academia, government and practice from the GoPA! countries, and members of the International Society of Physical Activity and Health. A Country Card use composite score was created based on the diversity and frequency of use. Statistical analyses on the associations between the composite score and respondent characteristics, country characteristics, barriers and opinions were conducted (including descriptive analyses and a logistic regression with robust standard errors). Results One hundred forty three participants from 68 countries completed the survey. Use of the Country Cards was associated with being part of the GoPA! network, knowing about the Country Cards, and on the stage of country capacity for physical activity promotion. Country Card knowledge varied by country income group, region and the country specific context. More diverse and frequent use of the cards (highest tertile of the composite score for use) was associated with: 1. Being a country contact vs general participant (OR 18.32–95% CI 5.63–59.55, p = 0.002), and 2. Collaborating with a government representative working in NCDs on a monthly or more frequent contact vs less frequent contact (OR 3.39–95% CI 1.00–11.54, P < 0.05). Conclusions For the Country Cards to have a broader impact, GoPA! will need to widen its reach beyond the academic sector. With further refinement of the cards, and training in their implementation, they could be an important tool for advancing country capacity for contextually-relevant strategies, actions and timelines for PA promotion. Electronic supplementary material The online version of this article (10.1186/s12966-018-0663-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Deborah Salvo
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, Austin, USA.,Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - Michael Pratt
- San Diego School of Medicine, University of California, San Diego, USA
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katja Siefken
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Harold W Kohl
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, Austin, USA.,The University of Texas at Austin, Austin, USA
| | - I-Min Lee
- Harvard Medical School, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, USA
| | - Gregory Heath
- College of Medicine Chattanooga, University of Tennessee, Chattanooga, USA
| | | | | | - Pedro C Hallal
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Lowe CM, Milton K, Kelly P, Foster C, Barker K. “Walk30X5”: the development and feasibility evaluation of a physiotherapy walking programme for people with mild to moderate musculoskeletal conditions. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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