Physical activity interventions among youth living in rural and remote areas: A systematic review

OBJECTIVES

Physical activity (PA) interventions have potential to improve health and social outcomes among youth. The aim of this study was to collate the evidence on the effectiveness of PA and sports-based interventions among youth living in rural and remote areas.

METHODS

We searched five databases and grey literature (HealthInfoNet). Search terms included PA, rural status, adolescents, and outcome measures. Studies were included if published in English, recruited 10- to 18-year olds, and were based in rural or remote communities (Modified Monash Model [MMM] area classification range of MMM 3-7). Quasi-experimental and pre-experimental and post-experimental PA interventions were included. Two authors evaluated the articles independently following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and relevant data were extracted. International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020199001).

RESULTS

Of the 11802 studies identified, 6 were included in the review. Most studies were excluded for not meeting MMM 3-7 criteria. Four of the included studies had sports-related interventions, and 2 had walking-based interventions. Outcomes included self-efficacy, mental health, and academic performance. One study reported a positive effect of PA on self-efficacy (β = 0.26, p=0.018, odds ratio = 1.43 [95% confidence interval: 1.07-1.92]).

CONCLUSION

Few community-based PA interventions have been evaluated in rural areas. There is a need for future evaluations in rural areas and include PA as an outcome measure.

IMPLICATIONS FOR PUBLIC HEALTH

The findings highlight the need for measurement of PA outcomes in PA interventions in rural and remote areas. The findings also highlight the need for research to utilise a standardised measure of rurality.

Efficacy of a school-based education intervention on the consumption of fruits, vegetables and carbonated soft drinks among adolescents

OBJECTIVES

To evaluate the efficacy of a school-based education intervention on the consumption of fruit, vegetables and carbonated soft drinks among adolescents.

DESIGN

Cluster-randomised controlled trial.

SETTING

Eight secondary schools from Dhaka, Bangladesh, participated in this trial and were randomly allocated to intervention (n 160) and control groups (n 160).

PARTICIPANTS

A total of 320 students from 8th to 9th grades participated and completed the self-reported questionnaires at baseline, and at 8 and 12 weeks. The intervention included weekly classroom-based nutrition education sessions for students and healthy eating materials for students and parents. Repeated measures ANCOVA was used to assess the effects of the intervention.

RESULTS

Daily fresh fruit intake was more frequent in the intervention (26 %) compared to the control group (3 %) at 12 weeks (p = 0·006). Participants from the intervention group also reported a significantly (P < 0·001) higher (49 %) proportion of fresh vegetable intake compared to the control group (2 %) at 12 weeks. Frequency of daily carbonated soft drinks intake decreased (25 %) in the intervention group at 12 weeks compared to baseline, while it remained unchanged in the control group; the interaction effect was observed significant (P = 0·002).

CONCLUSION

Our school-based education intervention increased the daily frequency of fresh vegetables and fruit intake and decreased carbonated soft drink consumption among adolescents in the intervention group. There is a need for scaling up the intervention to engage students and empower them to develop healthy dietary habits.

The Feasibility of a Text-Messaging Intervention Promoting Physical Activity in Shift Workers: A Process Evaluation

Workplace health promotion programs (WHPPs) can improve shift workers' physical activity. The purpose of this paper is to present the process evaluation of a text messaging health promotion intervention for mining shift workers during a 24-day shift cycle. Data collected from intervention participants with a logbook (n = 25) throughout the intervention, exit interviews (n = 7) and online surveys (n = 17) examined the WHPP using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) framework. The program reached 66% of workers across three departments, with 15% of participants dropping out. The program showed the potential to be adopted if the recruitment strategies are improved to reach more employees, especially when involving work managers for recruitment. A few changes were made to the program, and participant adherence was high. Facilitators to adopt and implement the health promotion program included the use of text messaging to improve physical activity, feedback on behaviour, and providing incentives. Work-related fatigue was reported as a barrier to implementing the program. Participants reported that they would recommend the program to other workers and use the Mi fitness band to continue monitoring and improving their health behaviour. This study showed that shift workers were optimistic about health promotion. Allowing for long-term evaluation and involving the company management to determine scale-up should be considered for future programs.

If You Build It Will They Come? Park Upgrades, Park Use and Park-Based Physical Activity in Urban Cape Town, South Africa-The SUN Study

The development and upgrade of recreational public spaces are key government strategies to increase opportunities for physical activity (PA) and enhance social interaction and community cohesion. This study aimed to evaluate differences in park use and park-based PA in recently upgraded/developed parks (intervention, n = 4) against established parks (control, n = 4) and in regional parks in high- and low-income settings (n = 2). Additionally, associations between target area features, park use and PA were identified. Direct observation of park use and attributes was conducted using the System for Observing Play and Recreation in Communities (SOPARC) over four months. Despite more park users in intervention parks (2519 vs. 1432), control park visitors were 48% more likely to be engaged in PA (p < 0.001). Similarly, while high-income park users attracted more visitors (2135 vs. 1111), they were 79% less likely to be engaged in any PA compared with low-income park visitors. The likelihood of both use of and PA by gender and age differed by features. Active recreation features in intervention parks attracted more users than the same features in control parks. In this study, upgraded or newly developed parks attracted more visitors but not necessarily overall greater levels of physical activity.

The prevalence of chronic diseases in international immigrants: a systematic review and meta-analysis

Aims:

The purpose of this study is systematically to review and synthesise available prevalence data of major chronic diseases in international immigrants.

Methods:

Four electronic databases were searched to retrieve peer-reviewed original articles published in English between January 2000 and December 2020. Cross-sectional, cohort, or longitudinal studies that reported the prevalence of cardiovascular disease, any type of cancer, chronic obstructive pulmonary disease, and type 2 diabetes among immigrant adults were included. We calculated pooled prevalence using random-effects meta-analyses.

Results:

Of 13,363 articles retrieved, 24 met the eligibility criteria. The pooled prevalence of diabetes was 9.0% (95% confidence interval (CI) 7.6–10.4) with a higher prevalence in North American countries 11.1% (95% CI 8.0–14.1) than in the other destination countries: 6.6% (95% CI 5.1–8.1) including Italy, Sweden, The Netherlands, Australia, and Israel. The pooled prevalence of cardiovascular diseases and respiratory diseases was 7.7% (95% CI 5.7–9.6) and 6.5% (95% CI 2.3–10.7), respectively. Only two articles reported the prevalence of cancers (2.7% and 3.8%). We found high heterogeneity among all studies regardless of the disease.

Conclusions:

The prevalence of diabetes was higher than other chronic diseases in international immigrants. There is a strong need to enhance health information systems to understand the magnitude of chronic diseases among different immigrant subgroups.

Physical activity and sedentary behaviour in shift and non-shift workers: A systematic review and meta-analysis

Research examining the prevalence, physical activity (PA) and sedentary behaviour (SB) in shift workers show mixed results. This systematic review and meta-analysis aimed to compare PA and SB in shift workers with non-shift workers following the PRISMA guidelines. Ebscohost megafile ultimate (CINHAL, E-journals, Academic search ultimate, health source consumer edition, SPORT Discus), PubMed, Scopus, Web of Science, and Science Direct databases were searched up to April 2021. Cross-sectional and baseline data from longitudinal studies reporting PA and SB in full time workers were eligible. Data on participants characteristics and time spent in PA and SB and/or prevalence of workers meeting PA guidelines were extracted and pooled with random effects model. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) 10-item checklist was adapted and used. A total of 49 studies met inclusion criteria and 21 studies included for meta-analysis. The prevalence of meeting physical activity guidelines (OR 0.84, 95% CI: 0.68, 1.03) and standardized mean difference (SMD) of time spent in moderate-to-vigorous physical activity (SMD -0.1, 95% CI: -0.4, 0.20) were similar in shift and non-shift workers. Time spent in sedentary behaviour was lower in shift workers than non-shift workers (SMD -0.2, 95% CI: 0.50, -0.001). While the differences in PA are not so evident between shift and non-shift workers, the prevalence of sufficient PA was low in both groups. These preliminary findings provide support for inclusion of physical activity and sedentary behaviour in health promotion interventions targeted at shift workers.

School physical activity policies and associations with physical activity practices and behaviours: A systematic review of the literature

The development and implementation of school policies is considered a key strategy for the promotion of physical activity (PA) in children and adolescents. This study aimed to systematically review and synthesise existing literature focusing on the associations between formal written school-based PA policies and (a) school PA practices and (b) PA behaviours of school-aged children and adolescents. Fifty-one papers reporting on 52 studies met the eligibility criteria. All but two studies were from high income countries, most used cross-sectional designs and demonstrated fair methodological quality, and just over a third examined language aspects of policies. Findings predominantly indicated a lack of or inconclusive associations between the various characteristics examined and PA outcomes. Inconclusive associations were identified between both PA practice and behaviour outcomes and state level policies, policies focusing on PE and school-day PA, and in studies examining language aspects of policies. Inconclusive associations with both types of outcomes were more likely to be identified compared to a lack of associations in studies using self-report measures and in studies not providing information about the quality of exposure and outcome measures used. Overall, findings highlight the need for further research that acknowledges the complex relationship between school policies and PA outcomes and employs robust methodological approaches to enhance our understanding of this area.

Effectiveness of a school-based intervention on physical activity and screen time among adolescents

OBJECTIVES

To evaluate the effectiveness of a multi-component school-based intervention on physical activity (PA) and screen time (ST) among urban adolescents in Bangladesh.

DESIGN

Cluster-randomised controlled trial.

METHODS

Eight high schools were randomly assigned to either intervention group (IG) or control group (CG). Participants (n = 160 per group, 40 school) were in grades 8-9. A 12-week multi-component intervention was developed based on the WHO's Health-Promoting Schools framework. The IG received weekly supervised circuit exercise (30 min/week), health education session (10 min/week) with health educational materials, and lunchtime sports activities (20 min/week). The main outcome measures included self-reported PA, ST, knowledge on PA and SB, which were assessed at baseline, 8 and 12 weeks. Repeated measures ANCOVA was used to evaluate the intervention effects.

RESULTS

Total PA (MET-min/week) was increased from baseline to 8 and 12 weeks in the IG (3%-5%) but decreased in the CG (5%-3%) and significantly improved in the IG compared to the CG (p < 0.001) over time. Average ST (min/day) reduced from baseline to 8 and 12 weeks in the IG (28%-35%), while remained unchanged in the CG (6%-5%). The IG had a significantly lower average ST than the CG at 12 weeks. The average knowledge scores on PA and SB were significantly higher in the IG than the CG at 12 weeks (p < 0.001).

CONCLUSIONS

Our intervention has demonstrated some promising effects on increasing PA, reducing ST, and improving PA and SB knowledge. This study underscores the need for a scaled-up evaluation in other locations including rural settings.

Efficacy of interactive video gaming in older adults with memory complaints: A cluster-randomized exercise intervention

Purpose

The effects of aging on physical and mental health may be ameliorated by regular participation in physical activity (PA). There is also evidence for the benefits of various training modalities on cognition and functional ability in older adults. The aim of this study was to compare effects of a 12-week active video gaming intervention (X Box Kinect Sports) to conventional multimodal supervised exercise on fitness, functional ability and cognitive performance in older adults with memory complaints.

Methods

Participants (n = 45, 72±5 yrs.) were recruited from 6 retirement homes and cluster-randomized into the Interactive Video Gaming (IVG) group (N = 23) or Conventional Multimodal (CM) group (N = 22), meeting 2 x 1 hour sessions, weekly for 12 weeks. Pre-post measures included: 6 min walk, timed up and go, dynamic balance, functional reach, Mini-Mental State Examination, N-back Task and the Modified Stroop task.

Results

The IVG group demonstrated significant improvement in the total number correct responses on the Stroop task (P = 0.028) and for average reaction time of correct colour-words (P = 0.024), compared to the CM group. Functional ability improved significantly in the IVG group, including the 6-min walk (P = 0.017), dynamic balance (P = 0.03), timed up and go (P<0.001) and functional reach (P<0.0010).

Conclusion

An active interactive video gaming intervention was more effective than conventional multimodal exercise in improving executive and global cognitive performance and functional capacity in older adults with subjective memory complaints.

Trial registration

Pan African Clinical Trial Registry—PACTR202008547335106.

Community-Based Approaches to Reducing Health Inequities and Fostering Environmental Justice through Global Youth-Engaged Citizen Science

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world's youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Changes in risk factors for non-communicable diseases associated with the 'Healthy choices at work' programme, South Africa

BACKGROUND

Globally 71% of deaths are attributed to non-communicable diseases (NCD). The workplace is an opportune setting for health promotion programs and interventions that aim to prevent NCDs. However, much of the current evidence is from high-income countries.

OBJECTIVE

The aim of this study was to evaluate changes in NCD risk factors, associated with the Healthy Choices at Work programme (HCWP), at a commercial power plant in South Africa.

METHODS

This was a before-and-after study in a randomly selected sample of 156 employees at baseline and 137 employees at 2-years. The HCWP focused on food services, physical activity, health and wellness services and managerial support. Participants completed questionnaires on tobacco smoking, harmful alcohol use, fruit and vegetable intake, physical activity, psychosocial stress and history of NCDs. Clinical measures included blood pressure, total cholesterol, random blood glucose, body mass index, waist circumference and waist-to-hip ratio. The 10-year cardiovascular risk was calculated using a validated algorithm. Sample size calculations evaluated the power of the sample to detect meaningful changes in risk factors.

RESULTS

Paired data was obtained for 137 employees, the mean age was 42.7 years (SD 9.7) and 64% were male. The prevalence of sufficient fruit and vegetable intake increased from 27% to 64% (p < 0.001), those meeting physical activity guidelines increased from 44% to 65% (p < 0.001). Harmful alcohol use decreased from 21% to 5% (p = 0.001). There were clinical and statistically significant improvements in systolic and diastolic blood pressure (mean difference -10.2 mmHg (95%CI: -7.3 to -13.2); and -3.9 mmHg (95%CI: -1.8 to -5.8); p < 0.001) and total cholesterol (mean difference -0.45 mmol/l (-0.3 to -0.6)). There were no significant improvements in BMI. Psychosocial stress from relationships with colleagues, personal finances, and personal health improved significantly. The cardiovascular risk score decreased by 4.5% (> 0.05).

CONCLUSION

The HCWP was associated with clinically significant reductions in behavioural, metabolic and psychosocial risk factors for NCDs.

Transforming the workplace environment to prevent non-communicable chronic diseases: participatory action research in a South African power plant

Background: The workplace is an important setting for the prevention of non-communicable diseases (NCDs). Policies for transformation of the workplace environment for occupational health and safety in South Africa have focused more on what to do and less on how to do it. There are no guidelines and little evidence on workplace-based interventions for NCDs.

Objective: The aim of this study was to learn how to transform the workplace environment in order to prevent and control cardio-metabolic risk factors for NCDs amongst the workforce at a commercial power plant in Cape Town, South Africa.

Methods: The study design utilized participatory action research in the format of a cooperative inquiry group (CIG). The researcher and participants engaged in a cyclical process of planning, action, observation and reflection over a two-year period. The group used outcome mapping to define the vision, mission, boundary partners, outcomes and strategies required. At the end of the inquiry the CIG reached a consensus on their key learning.

Results: Substantial change was observed in the boundary partners: catering services (78% of progress markers achieved), sport and physical activities (75%), health and wellness services (66%) and managerial support (65%). Highlights from a 10-point consensus on key learning included the need for: authentic leadership; diverse composition and functioning of the CIG; value of outcome mapping; importance of managerial engagement in personal and organizational change; and making healthy lifestyle an easy choice.

Conclusion: Transformation included a multifaceted approach and an engagement with the organization as a living system. Future studies will evaluate changes in the risk profile of the workforce, as well as the costs and consequences for the organization.

"In Initiative Overload": Australian Perspectives on Promoting Physical Activity in the Workplace from Diverse Industries

Introduction: With two thirds of adults in paid employment and one third physically inactive, workplaces are an important setting for promoting more physical activity. We explored the attitudes and practices of employees and managers from different industries towards sitting and moving at work, to inform the development of acceptable solutions for encouraging businesses to adopt activity-promoting workplaces. Method: We conducted focus groups with employees and structured interviews with upper/middle managers from 12 organisations in a range of industries (e.g., education, healthcare, manufacturing, construction, insurance, mining). Topics focused on past and current workplace health and wellness initiatives, workplace culture and environment related to physical activity, responsibility for employee physical activity patterns at work, and enablers of/barriers to activity promoting workplaces. Results: Physical activity was not an explicit priority in existing occupational health and wellness initiatives. Instead, there was a strong focus on education about preventing and managing injuries, such as manual handling among non-office workers and desk-based ergonomics for office workers. Physical activity was viewed as a strategy for maintaining work ability and preventing injury, particularly in blue-collar staff, rather than for chronic disease prevention. Managers noted structural/organisational barriers/enablers to promoting physical activity at work (e.g., regulations, costs, competing concerns), while employees tended to focus on individual constraints such as time and geographic location. The issues of "initiative overload" and making physical activity a part of "business as usual" emerged as strong themes from employees and managers. Conclusions: While there is stakeholder enthusiasm for creating activity-promoting workplaces, multi-level support is needed to make physical activity an integral part of day-to-day business. The synergism between occupational health and safety priorities could be leveraged to facilitate the creation of activity-promoting workplaces.

Changing Diet and Physical Activity in Nurses: A Pilot Study and Process Evaluation Highlighting Challenges in Workplace Health Promotion

OBJECTIVE

To use the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate and understand key implementation and context factors of a diet and physical activity (PA) workplace intervention for nurses.

METHODS

A 3-month pilot intervention was developed to promote diet and PA behavior through self-monitoring, goal setting, and social support using pedometers, a smartphone app, and a dedicated Facebook group. Measures included diet quality, daily PA, adoption, and implementation (including qualitative data). Maintenance was assessed at 6-month follow-up.

RESULTS

Forty-seven nurses participated in the study. At 3 months, fruit and vegetable intake significantly increased (P = .04) whereas PA significantly decreased (P = .01). The intervention was partially adopted as planned, with low reach and efficacy. Participants reported that changing 2 behaviors at the same time was difficult, with the majority feeling it was easier to change diet than to become more physically active.

CONCLUSIONS AND IMPLICATIONS

The ability to change diet and PA behaviors at the same time was challenging in nurses. Future studies examining whether similar occupational groups with high stress, fatigue, and lack of time face the same challenges would contribute to understanding these results.

Australian fitness professionals' level of interest in engaging with high health-risk population subgroups: findings from a national survey

OBJECTIVES

Fitness industry professionals (personal trainers, group instructors) may have a role in health promotion, particularly when working with subgroups with known health risks (e.g. older adults, obese). The aim of this study is to examine fitness professionals' level of interest in engaging with high-risk populations.

STUDY DESIGN

Cross-sectional evaluation of a national survey.

METHODS

In 2014, 9100 Australian registered exercise professionals were invited to complete an online survey. Respondents reported their level of interest in engaging with nine health-risk population subgroups. A multivariable logistic regression analysis assessed the odds of being classified as having a 'low level' of interest in training high health-risk subgroups, adjusting for demographic and fitness industry-related factors.

RESULTS

Of 1185 respondents (aged 17-72 years), 31.1% reported having a 'high level' of interest in training high health-risk subgroups. The highest level of interest was among 'obese clients' and 'adults (18-64 years) with chronic health conditions'. In the adjusted analysis, males (odds ratio [OR], 1.55, 95% confidence interval [CI]: 1.06-2.25) and those in urban settings (OR, 2.26, 95% CI: 1.54-3.37) were more likely to have a 'low level' of interest.

CONCLUSIONS

Fitness professionals have a modest level of interest in training high health-risk subgroups. In addition to the development of strategies to increase interest, research should examine whether fitness professionals are able to safely prescribe exercise to high health-risk subgroups.

Physical activity and sedentary behaviour in a flexible office-based workplace: Employee perceptions and priorities for change

ISSUE ADDRESSED

Many Australian employees now regularly work from home in some capacity. This new way of working has not been widely studied in relation to the potential implications for employees' health-related behaviour or workplace health promotion. The aim of this study was to explore office-based employees' perceptions of the impact of flexible work on physical activity and sedentary behaviour; and preferences for associated interventions.

METHODS

Three focus groups were conducted with office-based employees (n = 28) 6 months after the introduction of a flexible work policy. A semi-structured interview format with open-ended questions was used with summary statements to check understanding. Sessions were audiotaped, and dominant themes were identified. Findings on intervention preferences were interpreted using a social cognitive framework. An overview of results was provided to a group of managers (n = 9) for comment.

RESULTS

Employees reported that physical activity was not impacted, but sedentary behaviour had increased, with flexible work. Intervention preferences focussed on occupational sedentary behaviour, self-regulation, prompts and social connections, and not the physical work environment. Managers agreed with employees' preferences and also wanted interventions to be sustainable.

CONCLUSION

Self-directed interventions with social components and targeting occupational sedentary behaviour were more acceptable than physical activity interventions in this flexible workplace. SO WHAT?: Health promotion for workplaces with flexible work practices may benefit from prioritising strategies that promote self-regulation and social connections rather than being linked to the physical worksite.

Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship

Objectives The aim of this review was to assess the risk of cardiovascular disease (CVD) events associated with shift work and determine if there is a dose-response relationship in this association. Method Electronic databases (PubMed, Scopus, and Web of Science) were searched for cohort or case-control control study designs in any population, reporting exposure to shift work as the main contributing factor to estimate CVD risk. For each study, adjusted relative risk (RR) ratios and 95% confidence intervals (CI) were extracted, and used to calculate the pooled RR using random-effect models. Meta-regression analysis was conducted to explore potential heterogeneity sources. Potential non-linear dose-response relationships were examined using fractional polynomial models. Results We included 21 studies with a total of 173 010 unique participants. The majority of the studies were ranked low-to-moderate risk of bias. The risk of any CVD event was 17% higher among shift workers than day workers. The risk of coronary heart disease (CHD) morbidity was 26% higher (1.26, 95% CI 1.10-1.43, I ²= 48.0%). Sub-group analysis showed an almost 20% higher risk of CVD and CHD mortality among shift workers than those who did not work shifts (1.22, 95% CI 1.09-1.37, I ²= 0% and 1.18, 95% CI 1.06-1.32 I ²=0%; respectively). After the first five years of shift work, there was a 7.1% increase in risk of CVD events for every additional five years of exposure (95% CI 1.05-1.10). Heterogeneity of the pooled effect size (ES) estimates was high (I ²=67%), and meta-regression analysis showed that sample size explained 7.7% of this. Conclusions The association between shift work and CVD risk is non-linear and seems to appear only after the first five years of exposure. As shift work remains crucial for meeting production and service demands across many industries, policies and initiatives are needed to reduce shift workers' CVD risk.

The economic burden of physical inactivity: a systematic review and critical appraisal

OBJECTIVE

To summarise the literature on the economic burden of physical inactivity in populations, with emphases on appraising the methodologies and providing recommendations for future studies.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42016047705).

DATA SOURCES

Electronic databases for peer-reviewed and grey literature were systematically searched, followed by reference searching and consultation with experts.

ELIGIBILITY CRITERIA

Studies that examined the economic consequences of physical inactivity in a population/population-based sample, with clearly stated methodologies and at least an abstract/summary written in English.

RESULTS

Of the 40 eligible studies, 27 focused on direct healthcare costs only, 13 also estimated indirect costs and one study additionally estimated household costs. For direct costs, 23 studies used a population attributable fraction (PAF) approach with estimated healthcare costs attributable to physical inactivity ranging from 0.3% to 4.6% of national healthcare expenditure; 17 studies used an econometric approach, which tended to yield higher estimates than those using a PAF approach. For indirect costs, 10 studies used a human capital approach, two used a friction cost approach and one used a value of a statistical life approach. Overall, estimates varied substantially, even within the same country, depending on analytical approaches, time frame and other methodological considerations.

CONCLUSION

Estimating the economic burden of physical inactivity is an area of increasing importance that requires further development. There is a marked lack of consistency in methodological approaches and transparency of reporting. Future studies could benefit from cross-disciplinary collaborations involving economists and physical activity experts, taking a societal perspective and following best practices in conducting and reporting analysis, including accounting for potential confounding, reverse causality and comorbidity, applying discounting and sensitivity analysis, and reporting assumptions, limitations and justifications for approaches taken. We have adapted the Consolidated Health Economic Evaluation Reporting Standards checklist as a guide for future estimates of the economic burden of physical inactivity and other risk factors.

Promoting Diet and Physical Activity in Nurses

OBJECTIVE

To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses.

DATA SOURCE

English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non-peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses.

DATA EXTRACTION

Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer.

DATA SYNTHESIS

Extracted data were synthesized in a tabular format and narrative summary.

RESULTS

Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA.

CONCLUSIONS

Outcomes of interventions to change nurses' PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.

Participation in fitness-related activities of an incentive-based health promotion program and hospital costs: a retrospective longitudinal study

PURPOSE

A retrospective, longitudinal study examined changes in participation in fitness-related activities and hospital claims over 5 years amongst members of an incentivized health promotion program offered by a private health insurer.

DESIGN

A 3-year retrospective observational analysis measuring gym visits and participation in documented fitness-related activities, probability of hospital admission, and associated costs of admission.

SETTING

A South African private health plan, Discovery Health and the Vitality health promotion program.

PARTICIPANTS

304,054 adult members of the Discovery medical plan, 192,467 of whom registered for the health promotion program and 111,587 members who were not on the program.

INTERVENTION

Members were incentivised for fitness-related activities on the basis of the frequency of gym visits.

MEASURES

Changes in electronically documented gym visits and registered participation in fitness-related activities over 3 years and measures of association between changes in participation (years 1-3) and subsequent probability and costs of hospital admission (years 4-5). Hospital admissions and associated costs are based on claims extracted from the health insurer database.

ANALYSIS

The probability of a claim modeled by using linear logistic regression and costs of claims examined by using general linear models. Propensity scores were estimated and included age, gender, registration for chronic disease benefits, plan type, and the presence of a claim during the transition period, and these were used as covariates in the final model.

RESULTS

There was a significant decrease in the prevalence of inactive members (76% to 68%) over 5 years. Members who remained highly active (years 1-3) had a lower probability (p < .05) of hospital admission in years 4 to 5 (20.7%) compared with those who remained inactive (22.2%). The odds of admission were 13% lower for two additional gym visits per week (odds ratio, .87; 95% confidence interval [CI], .801-.949).

CONCLUSION

We observed an increase in fitness-related activities over time amongst members of this incentive-based health promotion program, which was associated with a lower probability of hospital admission and lower hospital costs in the subsequent 2 years.

Evaluation of a school-based physical activity intervention in Alexandra Township

Objectives. Non-communicable diseases and limited participation in school physical education have become increasing concerns in South Africa. In response to these concerns, a schoolbased physical activity intervention, Healthnutz, was implemented in three primary schools in Alexandra Township, Johannesburg. Evaluation of Healthnutz included assessing its feasibility and acceptability, and short-term changes in learners’ physical fitness, knowledge and attitudes. Methods. To assess feasibility and acceptability, a situational analysis and focus groups with teachers and programme monitors were conducted. Pre-post fitness testing (3-month interval) was conducted with learners, and a questionnaire assessed changes in learners’ knowledge, attitudes, self-efficacy, and perceived barriers to physical activity, in control and intervention schools. Results. At implementation, teachers identified the need for more physical activity in the school environment and were positive about Healthnutz. Follow-up focus group discussions suggested that it was positively impacting teachers, learners and the school in general. Scores for sit and reach (p<0.001), sit ups (p<0.02) and shuttle run (p<0.0001) improved significantly in intervention but not control schools. A significant decrease was observed in learners’ perceived external barriers to physical activity (p<0.0001) along with a positive change in learners’ self-efficacy for physical activity (p<0.05). Conclusions. Healthnutz raised awareness of the importance of physical activity in intervention schools. Findings indicate that even limited exposure to a physical activity intervention can lead to a significant improvement in aspects of learners’ fitness, knowledge, attitudes and perceptions regarding physical activity. Furthermore, training and support of teachers needs to be nonjudgemental and empowering.

Fitness-related activities and medical claims related to hospital admissions - South Africa, 2006

INTRODUCTION

We report on the effect of an incentive-based wellness program on medical claims and hospital admissions among members of a major health insurer. The focus of this investigation was specifically on fitness-related activities in this insured population.

METHODS

Adult members of South Africa's largest private health insurer (n = 948,974) were grouped, a priori, on the basis of documented participation in fitness-related activities, including gym visits, into inactive (80%, equivalent to < or =3 gym visits/y), low active (7.0%, 4-23 gym visits/y), moderate active (5.2%, 24-48 gym visits/y), and high active (7.4%, >48 gym visits/y) groups. We compared medical claims data related to hospital admissions between groups after adjustment for age, sex, medical plan, and chronic illness benefits.

RESULTS

Hospitalization costs per member were lower in each activity group compared with the inactive group. This same pattern was demonstrated for admissions rates. There was good agreement between level of participation in fitness-related activities and in other wellness program offerings; 90% of people only nominally engaged in the wellness program also were low active or inactive, whereas 84% of those in the high active group also had the highest overall participation in the wellness program.

CONCLUSION

Participation in fitness-related activities within an incentive-based health insurance wellness program was associated with lower health care costs. However, involvement in fitness-related activities was generally low, and further research is required to identify and address barriers to participation in such programs.