International Journal of Behavioral Nutrition and Physical Activity

BackgroundStudies examining the associations of intensity-specific leisure time physical activity duration with all-cause, cardiovascular disease (CVD), and cancer mortality are scarce and no quantitative or dose-response meta-analysis has been published. ObjectiveWe examined the associations of moderate, vigorous, and moderate to vigorous leisure time physical activity duration with all-cause, CVD, and cancer mortality, using aggregate and individual participant data. MethodsWe performed a systematic review and meta-analysis of both published and unpublished cohort studies that included data on intensity-specific leisure time physical activity. Hazard ratios (HR) were calculated by comparing high versus low levels of physical activity. We also harmonized and pooled individual participant data from unpublished large cohorts to assess dose-response associations with the same three mortality outcomes, as retrieved from National Death Registries. ResultsA total of 3.36 million participants across 25 cohorts and 17 countries, corresponding to 247,463 all-cause, 70,204 CVD, and 76,294 cancer deaths were included in our aggregate meta-analysis. Compared to low physical activity, the association of high moderate intensity leisure time physical activity with mortality ranged from an HR of 0.84 (95% CI= 0.79, 0.89) for all-cause mortality to 0.90 (0.86, 0.95) for cancer mortality; and vigorous intensity from 0.86 (0.79, 0.93) for all-cause mortality to 0.88 (0.83, 0.91) for cancer mortality. Our pooled individual participant data analysis included 967,184 participants with an average follow-up time of 12.2 (SD= 4.7) years and 60,206 all-cause, 11,525 CVD, and 23,740 cancer deaths. The dose-response analysis showed a general L-shaped association across each outcome. For all-cause mortality, compared to the reference group with no leisure time activity, the minimal and optimal doses of vigorous intensity were 60 mins/week (0.86 [0.84, 0.89]) and 200 mins/week (0.69 [0.67, 0.71]), respectively. For moderate intensity, the corresponding doses were 100 mins/week (0.88 [0.86, 0.90]) and 340 mins/week (0.77 [0.75, 0.79]). ConclusionsOur meta-analysis shows distinct differential associations of moderate and vigorous physical activity with all-cause, cardiovascular, and cancer mortality risk. Improvements in leisure time physical activity approximately equivalent to 60 mins/week of vigorous or 100 mins/week of moderate activity, may be linked with measurable health benefits. Our findings, synthesized uniquely through aggregated and pooled individual participant meta-analyses offer novel evidence to guide decisions on contents of leisure time physical activity focused interventions and preventive guidelines.

ObjectiveTo examine whether teacher education levels and child-teacher ratios are associated with childrens physical activity, psychosocial functioning, and BMI in a large, population-based sample of preschoolers in Stockholm, Sweden. Study designIn a cross-sectional study of 124 public preschools, we analyzed data from two measurement occasions (2020 and 2021) for 3,302 children with accelerometer data, 2,666 with Strengths and Difficulties Questionnaire (SDQ) scores, and 3,518 with measured BMI. Teacher education and child-teacher ratios were obtained from the Swedish National Agency for Education. Mixed-effects regression models accounted for clustering and adjusted for demographic and neighborhood characteristics. ResultsAcross preschools, an average of 31.8% of full-time teachers had a teaching degree, and the mean child-teacher ratio was 5.1 (SD 0.7). No strong associations were observed between teacher education levels or child-teacher ratios and childrens moderate-to-vigorous physical activity (MVPA), inactivity, SDQ, or BMI. Compared with the median, attending preschools with teacher education levels above the 75th percentile was associated with -0.22 minutes (95% CI: -0.84 to 0.40) of daily MVPA, and the 25th percentile with -0.04 minutes (95% CI: -0.77 to 0.69). Similarly, increasing the child-teacher ratio from 5.0 to 5.5 children per teacher corresponded to -0.45 minutes (95% CI: -1.17 to 0.28) of daily MVPA, with negligible differences in SDQ and BMI z-scores. ConclusionsIn this large, representative sample of Stockholm preschoolers, teacher education levels and child-teacher ratios were not associated with childrens physical activity, psychosocial functioning, or BMI, suggesting that factors beyond staffing characteristics may play a more central role in shaping childrens health in preschool settings.

ImportanceEating from out-of-home food outlets (OHFO) is common and linked to poor dietary quality, weight gain, and obesity. In response, England implemented mandatory calorie labelling regulations in April 2022 to encourage reformulation and reduce calorie consumption. Few studies have examined the impact of a national calorie labelling policy on OHFO menus. ObjectiveExamine pre-post changes in energy content of menu items from large OHFO in England after mandatory calorie labelling. Design, Setting, and ParticipantsObservational study using data from MenuTracker, a longitudinal database of online menus. Data were collected in September 2021 (pre-policy) and September 2022 (post-policy) from large OHFO in England. 15,057 pre-policy and 15,988 post-policy menu items were included from 78 large OHFO chains present in both periods. InterventionImplementation of mandatory calorie labelling on menus of large OHFOs in England. Main Outcomes and MeasuresMean energy content (kcal) of menu items, examined overall and by food group and chain type. Changes in energy content for removed, continuous, and new items to assess reformulation. ResultsOverall, a reduction of 9 kcal (95% CI: -16 to -1) in mean energy content was observed post-policy. Significant reductions per item in beverages (-36 kcal), burgers (-103 kcal), and mains (-30 kcal). By chain type, significant reductions per item in pubs, bars, and inns (-52 kcal), restaurants (-23 kcal), and entertainment venues (-49 kcal). Changes driven by removal of higher kcal items (458 kcal, 95% CI: 394 to 523) and addition of lower kcal items (434 kcal, 95% CI: 370 to 499). No significant change in energy content for continuously available items, indicating limited evidence of reformulation. Conclusions and RelevanceThe 2022 mandatory calorie labelling policy in England led to a small reduction in mean energy content of menu items, driven by removal of higher calorie items and addition of lower calorie items. Elsewhere, we did not find evidence of changes in kcal purchased or consumed, suggesting these menu changes did not focus on the most commonly consumed items. Further research is needed to evaluate longer-term menu changes and additional strategies to enhance policy impact on consumer behavior and public health.

IMPORTANCEMovement behaviours (e.g. sedentary behaviour (SB), moderate and vigorous physical activity (MVPA), light intensity physical activity (LIPA) and sleep) are linked to cognition, yet the relative importance of each component is unclear, and not yet explored with compositional methodologies. OBJECTIVETo examine how time spent in one behaviour (e.g. SB, MVPA, LIPA, sleep) relative to all others is associated with overall cognition, including executive function and memory. DESIGN, SETTING, AND PARTICIPANTSThe 1970 British Cohort Study (BCS70) is an ongoing prospective birth cohort study of adults born in England, Scotland and Wales in a single week. At age 46, participants wore an accelerometer device and completed cognitive screening. Linear regression was used to examine cross-sectional associations between movement behaviours and cognitive scores, using a compositional approach. Isotemporal substitution was performed to model the effect of reallocating time between components of daily movement on cognition. EXPOSURESA thigh-mounted activPAL accelerometer device was worn without removal for one week. Daily time in SB, MVPA, LIPA and sleep were derived using a validated processing algorithm. MAIN OUTCOMES AND MEASURESStandardised scores of executive function (letter cancellation and verbal fluency), memory (immediate and delayed wordlist recall) and a composite score were derived from computer administered cognitive tasks. RESULTSThe sample comprised 4,481 participants (52% female). Time in MVPA relative to SB, LIPA and sleep was positively associated with cognition after adjustments for education and occupational physical activity, but additional adjustment for health status attenuated associations. SB relative to all other movements was robustly positively associated with cognition. Modelling time reallocation between components revealed a higher cognition percentile after MVPA theoretically replaced just 9 minutes of SB (+1.31; 95% CI: 0.09, 2.50), 7 minutes of LIPA (+1.27; 0.07, 2.46) or 7 minutes of sleep (+1.20; 0.01, 2.39). CONCLUSIONS AND RELEVANCERelative to time spent in other behaviours, more time spent in MVPA and SB was associated with higher cognitive scores. Displacement of MVPA time, given its smaller relative amount, appear most deleterious. Efforts should be made to preserve MVPA time, or reinforce it with time taken from other behaviours.

ImportancePhysical activity guidelines are predominantly based on questionnaire-based studies measuring only longer planned physical activity bouts (>10-15 continuous minutes). To date, short intermittent bouts of physical activity that may be beneficial for health ("micropatterns"), have counted very little towards physical activity guidelines (currently 150-300 minutes of moderate or 75-150 minutes of vigorous intensity activity per week). ObjectiveWe examined all-cause and cardiovascular disease (CVD) mortality associations of wearable device-captured activity accumulated through intermittent moderate to vigorous (IMVPA; [≤]3 min) and vigorous (IVPA; [≤]1 min) intensity bouts, by guideline adherence for a) active adults (eg. doing at least 150 mins/wk of moderate or 75 mins/wk of vigorous intensity physical activity), and b) inactive adults (not meeting the above amounts). DesignProspective cohort study SettingUK Biobank Participants62,899 adults (mean age 61 years, 55.7% female) with wrist-worn accelerometer data, followed up for an average of 8.0 (SD= 0.9) years ExposuresIntermittent moderate-vigorous (IMVPA; [≤]3 min) and vigorous (IVPA; [≤]1 min) intensity bouts; stratified by participants meeting and not meeting physical activity guidelines. Main outcomes and measuresAll-cause and CVD mortality obtained through linkage with the National Health Service (NHS) Digital of England and Wales or the NHS Central Register and National Records of Scotland. Cox restricted cubic spline regression were used to assess the dose-response associations. ResultsThere were 1,583 all-cause and 442 CVD deaths among 62,899 adults (mean age 61 years, 55.7% female). Micropatterns accrued IMVPA and IVPA showed linear beneficial dose response associations in both the inactive and active groups. We observed a 1.4 to 2.0-fold lower mortality risk among inactive compared to active adults. For all-cause mortality, a median 4.0 minutes/day of IVPA was associated with a hazard ratio (HR) of 0.40 [0.32, 0.52] in inactive adults and 0.74 [0.58, 0.95] in active adults, compared to not doing any IVPA. For CVD mortality, a median of 13.0 minutes/day of IMVPA was associated with an HR of 0.32 [0.22, 0.51] in inactive adults and 0.53 [0.37, 0.78] in active adults. Analogous patterns of dose-response were present when adherence to guidelines was assessed using questionnaire-based data that only considered continuous activity bouts lasting at least 10 minutes. Conclusions and relevanceAmong participants not meeting guidelines, intermittent moderate-vigorous physical activity showed stronger beneficial dose-response association with all-cause and CVD mortality, compared to active adults, highlighting potential health benefits from brief activity bursts for less active adults. Considering such activity patterns are hardly represented in the evidence used to develop current guidelines, our findings support the transition of future guidelines towards wearables-informed evidence.

BackgroundQuantifying the contribution of the out-of-home food and drink (OOHF) sector on the English national diet could inform effective nutrition policy development. However, rigorous data and analysis for estimating the relative contribution of the OOHF sector to total diet is lacking. ObjectivesTo quantify the nutritional contribution per day and per eating occasion of the OOHF sector on adults diets in England in terms of energy, total fat, saturated fat, sugar and salt, overall and across key demographics. DesignData collected from n=1232 participants (51% female) in a multi-stage online survey including demographics and mean 4.5 (SE 0.03) 24-hr dietary recalls over a 2-3 week period. Four waves of data collection (September 2023 -May 2024) captured seasonal differences. Hierarchical multilevel models explored differences in energy between 1) eating occasions or 2) days, containing OOHF versus not. Total nutritional differences by OOHF across demographics were described. ResultsMedian out-of-home (OOH) eating occasion energy intakes were 440kcal (vs 294kcal for non-OOH occasions). After adjustment, energy intakes during OOH eating occasions were 196kcal [95%CI: 171, 221] (p<0.001) larger than non-OOH occasions. OOH days contained 103kcal [29, 177] (p=0.006) more than non-OOH days, but evidence of association was not robust to multiple testing. OOHF contributed a median of 11.0% (IQR: 0, 23.4) energy to total weekly energy intake. Participants exceeded recommended daily nutritional intakes more often on OOH days versus non-OOH days (>70g fat (female): 43% vs 29%, >90g fat (male): 29% vs 16%; >20g saturated fat (female): 62% vs 53%, >30g saturated fat (male): 36% vs 28%; >90g total sugars: 33% vs 26%; >6g salt: 32% vs 18%). ConclusionsThe OOHF sector makes a substantial contribution to the national English diet, with food prepared OOH linked to higher energy and poorer nutritional intakes. Population-wide nutrition policies targeting the sector are needed.

IntroductionWhole system approaches to public health challenges such as low physical activity levels have the potential to create sustained behaviour change at a population level and tackle health inequalities. However, there is currently little evidence of the nature or effectiveness of adopting whole system approaches. This study evaluated whether a whole system physical activity intervention (JU:MP), was effective at improving physical activity in five- to eleven-year-olds. MethodsA before and after controlled study with two-arms (JU:MP intervention and control), was conducted in Bradford, UK with data collected at baseline and 24-months follow-up. Habitual physical activity was measured via accelerometry. The primary outcome was difference in moderate-to-vigorous intensity physical activity (MVPA) between groups at 24-months. Secondary outcomes included: sedentary time (ST), counts per minute (CPM), BMI z-score, waist circumference, social, emotional and behavioural health, and quality-of-life. An exploratory analysis compared intervention effects between sub-groups. Results1,453 children were recruited. 330 children with valid wear-time at baseline and 24- months (JU:MP group n=175, control group n =155) were included in the final analysis of physical activity outcomes. The JU:MP group improved levels of MVPA (+4.99 minutes/day, (CI = 1.01, 8.96), standardised mean difference (SMD) = 0.29), ST ( -8.69 minutes/day, CI = -16.76, -0.61), SMD = -0.20) and CPM (+32.72, CI = 5.93, 59.53, SMD = 0.28) compared to controls. There were minor differences between groups in all secondary outcomes, favouring the JU:MP group. Exploratory sub-group analysis revealed that MVPA improved for boys (+7.34 minutes/days, CI = 0.70, 13.99, SMD = 0.36) and South Asian heritage children (+7.20 minutes/day, CI = 1.67, 12.72, SMD = 0.52) in the JU:MP group compared to the control group. Conclusion: whole system approaches hold considerable promise for addressing childrens levels of physical activity at scale, whilst also tackling inequalities. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSThe physical activity levels of children are influenced by complex political, environmental and social systems. The World Health Organisation and the International Society of Physical Activity and Health both advocate for whole system change to support population level improvements in physical activity. What the study addsThis study provides evidence that improving population levels of physical activity in children can be achieved by taking a whole system approach. How this study might affect research practice or policyThis study can give confidence to policy makers and practitioners who are considering or continuing to take a whole system approach to improve physical activity for populations at greatest need.

BackgroundSedentary behaviour has been the focus of considerable clinical, policy and research interest due to its detrimental effects on health and wellbeing. This systematic review aims to (1) develop a more precise description of different categories of interventions that aim to reduce sedentary time in adults by identifying specific components that form an intervention; (2) explore the effect of different categories of interventions in reducing time spent sedentary in adults. MethodsTen electronic databases, websites of relevant organisations (e.g. the Sedentary Behaviour Research Network), and relevant reviews were searched. Inclusion criteria: Randomised controlled trials (RCTs), including cluster and randomised cross-over trials, in the adult population (clinical and non-clinical). Any study including a measure of sedentary behaviour was included even if reducing sedentary behaviour was not the primary aim. Exclusion criteria: Interventions delivered in schools, colleges, or workplaces; studies investigating the immediate effects of breaking up sitting time as part of a supervised (usually laboratory-based) intervention. Two review authors conducted data extraction and quality assessment (GRADE approach). ResultsSearches identified 39,223 records, of which 85 studies met the inclusion criteria and were included in the review. Interventions shown to significantly reduce time spent sedentary were those which incorporated the provision of information, education, or support (advice/recommendations), in conjunction with either counselling (mean difference: -52.24 minutes/day; 95% CI: -85.37 to -19.10) or a form of structured/prescribed physical activity (standardised mean difference: -0.15; 95% CI: -0.23 to -0.07). However, this positive effect was not maintained at follow-up. No interventions were shown to break up prolonged sitting. ConclusionsThis review presents a novel way of categorising interventions according to the types of components they comprised. There is evidence that interventions might be effective in reducing time spent sedentary immediately post-intervention. There were limited studies measuring sustained behaviour change.

BackgroundA recent meta-analysis suggested that using physical activity calorie equivalent (PACE) labels results in people selecting and consuming less energy. Only one included study was conducted in a naturalistic setting, in four convenience stores. The current study aimed to estimate the effect of PACE labels on energy purchased in worksite cafeterias. Methods and findingsA stepped-wedge randomised controlled trial to test the effect of PACE labels (which include kcal content and minutes of walking required to expend the energy content of the labelled food) on energy purchased. The setting was ten worksite cafeterias in England, which were randomised to the order in which they introduced PACE labels on selected food and drinks following a baseline period. The study ran for 12 weeks with over 250,000 transactions recorded on electronic tills. The primary outcome was total energy (kcal) purchased from intervention items per day. The secondary outcomes were: energy purchased from non-intervention items per day, total energy purchased per day, and revenue. Regression models showed no evidence of an overall effect on energy purchased from intervention items, -1.3% (95% CI -3.5% to 0.9%) during the intervention. Of the 10 cafeterias, there were null results in five, significant reductions in four, and a significant increase in one. There was also no evidence for an effect on energy purchased from non-intervention items, -0.0% (95% CI -1.8% to 1.8%), and no clear evidence for total items -1.6% (95% CI -3.3% to 0.0%). Revenue increased during the intervention, 1.1% (95% CI 0.4% to 1.9%). Study limitations include using energy purchased and not energy consumed, and access only to transaction-level sales, rather than individual-level data. ConclusionOverall, the evidence was consistent with PACE labels not changing energy purchased in worksite cafeterias. There was considerable variation in effects between cafeterias, suggesting potentially important unmeasured moderators. Trial registrationThe study was prospectively registered on ISRCTN (date: 30.03.21; ISRCTN31315776).

BackgroundUniversal Free School Meals (UFSM) were introduced by the Welsh Government in 2022 to provide every primary school child (aged 4-11) with a free meal at lunch time by 2024, aiming to improve nutrition and reduce inequality. While evidence suggests UFSM can support dietary quality and social inclusion; uptake remains inconsistent, and concerns have been raised regarding meal quality and portion sizes. Aims/ObjectivesThis study explored the perceptions of children and parents regarding the rollout of UFSM in Wales, focusing on perceived health, wellbeing and social impacts whilst also identifying factors influencing non-uptake. MethodsA mixed-methods study was conducted, combining qualitative focus groups with 56 children in year 6 (aged 10-11) across eight primary schools in Wales. A cross-sectional survey was also completed by 410 parents from 110 Welsh primary schools. Qualitative data from focus groups and open-ended survey questions were analysed thematically using Braun and Clarkes framework, whilst closed-ended survey items were analysed descriptively to complement and contextualise qualitative findings. ResultsThree themes emerged from the childrens data. (1) The Food Experience, (2) The Social Value of Lunchtime, and (3) Fuel for Learning and Feeling Good. Children valued the social and emotional aspects of mealtimes but reported mixed experiences with food quality, variety, and portion sizes. Parents similarly expressed concerns about meal nutritional quality but also highlighted the policys benefits in reducing financial strain, stress, and daily time pressures. ConclusionsUFSM is widely supported for promoting inclusion and access to food. Nevertheless, improving meal quality, portion sizes, and menu diversity is essential to sustain participation and maximise the policys long-term health and equity benefits.

BackgroundSchools are a valuable setting for the implementation of effective interventions to improve healthy eating, physical activity, sedentary behaviour and prevent overweight and obesity in children recommended by global guidelines. Robust evidence from systematic reviews, considered the gold standard source of evidence to inform public health policy and practice decisions, suggests school-based interventions produce modest improvement however effects across trials are heterogenous. To date no systematic reviews have sought to comprehensively consolidate the global evidence to identify the effectiveness of specific healthy eating and physical activity components of school-based interventions as aligned to current guidelines. ObjectiveTo 1) develop an inventory of global guideline-aligned recommendations of school-based healthy eating, physical activity, sedentary behaviour intervention componentry targeting children 5 to 12 years, and 2) explore their effectiveness via consolidation, and secondary data analysis, of existing systematic review evidence. MethodsA mixed methods study was conducted, which incorporated: 1) an umbrella review of the global systematic review evidence to develop an inventory of individual school-based healthy eating, physical activity, and sedentary behaviour intervention components; and 2) consolidation of existing systematic review evidence and secondary data analysis of primary studies to explore the effectiveness of individual intervention components. ResultsOf 8745 records, 228 full texts were screened against eligibility criteria which identified 12 eligible systematic reviews of which eight isolated the effects of individual intervention components. Forty-nine individual healthy eating (n=26), physical activity or sedentary behaviour (n=22), or other obesity prevention (n=1) intervention components were included in the inventory. Beneficial components were identified in each of the seven recommended opportunities for multicomponent school-based interventions: healthy eating in the classroom (e.g. curriculum, food growing experiences, fruit and vegetable breaks), healthy food available at school (e.g. strategies to encourage selection of healthier foods, free cooled water, free fruit and vegetables), healthy food brought to school (e.g. information on healthy food to bring to school), healthy eating outside of school/involving families (e.g. interactive family programs), physical activity in the classroom (e.g. short activity breaks, curriculum, increased intensity/quality of physical education (PE) classes), physical activity outside of the classroom/during break times (e.g. teacher/student led organised physical activity at break times), physical activity outside of school/involving families (e.g. interactive family programs, information to parents on benefits of physical activity). ConclusionsThe study findings demonstrate the breadth of components that have been trialed as part of multi-component school-based interventions globally and identified a range of components that are likely beneficial in addressing obesity-related behaviours and could be prioritised in future school-based interventions.

IntroductionPhysical activity (PA) promotion among school-aged youth is a global health priority. Recommendations for such promotion include implementing whole-of-school approaches that maximize resources across the school environment. This study examined schools participation in an annual, government-led, and emirate-wide initiative in Dubai, called the Dubai Fitness Challenge, in which the goal is to accrue 30 minutes of PA every day for 30 days (as such, the initiative is colloquially referred to as "Dubai 30x30"). MethodsA mixed-methods design was employed for this study. Three schools were recruited using convenience sampling. Participants were 18 physical education teachers, 20 classroom teachers, 2 principals and 45 students. Data sources included surveys, focus groups, and interviews. Data were analyzed using descriptive statistics, multinomial logistic regression, and open and axial coding to develop themes. ResultsSchool staff reported that most Dubai 30x30 activities were provided in physical education, at break times during school, and before and after school. Students reported that they mainly participated in Dubai 30x30 activities during physical education and occasionally participated in activities after school and on weekends. During school, students were more likely to reach higher PA intensity levels when they were in contexts other than the regular classroom setting. Among school staff, physical education teachers were most involved and classroom teachers were least involved in promoting Dubai 30x30. Parent engagement was high. Staff perceived that Dubai 30x30 brought the community together, but physical education teachers also indicated there was a lack of implementation guidance and they felt burdened. Participants believed Dubai 30x30 increased PA participation and helped to promote their schools. DiscussionThis study provides an initial glimpse into schools participation in Dubai 30x30 and suggests that a whole-of-school PA lens is useful in gleaning information that could help to increase and optimize PA opportunities for students.

Abstract Background: Previous physical activity simulation studies only account for the effects of cardiovascular diseases, diabetes, dementia, and some cancers, which neglects many of its costs and benefits. We estimate the health and economic impacts of increased physical activity in Australia, including those on mental health, increased injury rate, and conditions mediated by other risk factors, commencing 2021, over 20 years. Methods: We used a Proportional Multistate Lifetable Model specified with disease rate and risk factor forecasts, and causal associations, derived from the Global Burden of Disease study and other sources. Findings: If all Australians shifted to the maximum physical activity level of 4200+ MET-min/week, there would be: 653,000 (230,000 - 1,210,000) or 0.16% more HALYs lived; 9,720 (7,400 to 12,700) or 1.33% fewer deaths before age 75; increased working age income of AUD$16.8 billion ($12.8 - $22.2 billion); and decreased health expenditure of $748 million (-$4.46 billion - $6.98 billion) or 0.02%. Net health gains diminish for each additional 600 MET-min/week increase in physical activity, and above 4,200 MET-min/week the health costs from injuries outweigh the reduction in health costs from avoided disease. Because of injuries, increasing physical activity in the lowest activity group to meet the physical activity guidelines reduces health expenditure more ($1.86 billion; 896 million - 3.13 billion) than shifting to maximum activity levels. Interpretation: Increasing physical activity levels in Australia would improve population health (even allowing for injuries due to participation), reduce health spending, and increase income. Funding: Australian Sports Commission. TB is funded by NHMRC Investigator Grant (2023) #2026992

BackgroundPublic physical activity programs are time-limited and often lacking sufficient support for citizens to maintain physical activity engagement. In this project, municipal stakeholders; civil society organizations; citizens with type 2 diabetes (T2D), cardiovascular diseases (CVD), and/or obesity; and researchers were involved in the co-creation and implementation of interventions to support citizens in continuing physical activity engagement following a municipal rehabilitation program. The primary aim of this study was to investigate the effect of these interventions on physical activity engagement in civil society sports organizations. Secondary aims were to investigate acceptability and effect of these interventions on physical and mental health, and organizational development and collaboration. MethodsThis was a convergent mixed methods study using a quantitative prospective intervention study with a historic control group, and a qualitative descriptive study. These were analyzed separately and then integrated. Quantitative data from citizens were collected before; and 0, 3 and 6 months after ending their rehabilitation program. Outcomes included physical activity engagement in civil society organizations; and changes in objectively measured physical activity, physical and mental health. Qualitative data were collected among citizens, civil society, and municipal representatives. Themes included physical activity engagement, acceptability, and organizational development and collaboration. ResultsAmong the 33 included citizens (58% women, median (25th; 75th percentile) age of 67.6 (63.9; 74.1) years), six lived with T2D; nine with CVD; and 18 were obese. Of the 21 citizens who were not engaged in physical activities in civil society organizations before entering the rehabilitation program, 67% started and remained active at 6-month follow-up--significantly more than in the historic control group. Light physical activity increased by a mean (95% confidence interval) of 15.4 (2.3; 28.5) min/day from 0 to 6 months after the rehabilitation program; all other outcomes remained unchanged. This was assisted by experienced high acceptability of the linking interventions and strengthened collaboration between the municipal health center and civil society organizations. ConclusionsThe co-created interventions led to increased physical activity engagement in civil society organizations. This supports co-creation as a method to link municipal rehabilitation programs with physical activities in civil society organizations. Trial registrationClinicalTrials.gov: NCT05493345, 2022-08-05

BackgroundVigorous (VILPA) and moderate-to-vigorous (MV-ILPA) intermittent lifestyle physical activity refer to brief bouts of physical activity (<1 and <3 minutes, respectively) embedded in daily routines. Evidence suggests that 4-6 daily bursts of VILPA/MV-ILPA can significantly reduce the risk of cardiovascular disease and some cancers. These "micropatterns" of activity may offer a time-efficient and accessible alternative to structured exercise, particularly for women from socioeconomically diverse backgrounds who face intersecting barriers to traditional forms of physical activity. This study aimed to explore womens perspectives and experiences of VILPA/MV-ILPA and co-design a micropatterns intervention to promote these behaviours among socioeconomically diverse women. MethodsThe study involved a series of three co-design workshops with women in Glasgow (N=19) and Sydney (N=31). Workshops incorporated participatory activities, education, training, discussion, and reflection to explore the concept of micropatterns, related facilitators and barriers and co-design the intervention. This study was guided by the Behaviour Change Wheel and MRC and 6SQuID intervention development frameworks. Data were audio-recorded, transcribed, and analysed using thematic framework analysis. ResultsParticipants identified a range of barriers (e.g. concerns about ability and safety, low mood, sociocultural norms) and facilitators (e.g. adaptability, dual-purpose activities, minimal time commitment) to engaging in micropatterns. Following reflection on the barriers and facilitators, six modifiable factors were identified to be addressed in the intervention, these included: lack of knowledge and awareness, concerns about ability and safety, low mood and poor mental health, sociocultural norms and environmental constraints. Participants identified thirteen intervention components that utilized seven intervention functions (education, persuasion, training, environmental restructuring, modelling, incentivisation, and enablement) to promote VILPA/MV-ILPA activities. Participants emphasised the importance of educational content, social support, and inclusive delivery formats (e.g. short videos, visual materials). Terminology such as "Mindful Movement" and "Boosting Everyday Movement" were preferred over technical acronyms and jargon. ConclusionsThe final intervention involved a six-week programme of education, training, goal setting and VILPA/MV-ILPA tracking. Due to the popularity of social components and mixed perceptions of the accessibility of digital technology, the intervention was designed with three different delivery mechanisms:1) a smartphone application, 2) a smartphone application and a wearable device (e.g. Fitbit) and 3) workshops, a smartphone application and a wearable device. With further testing, this co-designed intervention could offer a feasible approach to promoting physical activity micropatterns among women from diverse socioeconomic backgrounds.

Backgroundparkrun, an international movement which organises free weekly 5km running events, has been widely praised for encouraging inactive individuals to participate in physical activity. Recently, parkrun received funding to establish 200 new events across England, specifically targeted at deprived communities. This study aims to investigate the relationships between geographic access, deprivation, and participation in parkrun, and to inform the planned expansion by proposing future event locations. MethodsWe conducted an ecological spatial analysis, using data on 455 parkrun events, 2,842 public green spaces, and 32,844 English census areas. Poisson regression was applied to investigate the relationships between the distances to events, deprivation, and parkrun participation rates. Model estimates were incorporated into a location-allocation analysis, to identify locations for future events that maximise deprivation-weighted parkrun participation. ResultsThe distance to the nearest event (in km) and the Index of Multiple Deprivation (score) were both independently negatively associated with local parkrun participation rates. Rate ratios were 0.921 (95%CI = 0.921-0.922) and 0.959 (0.959-0.959), respectively. The recommended 200 new event locations were estimated to increase weekly runs by 6.9% (from 82,824 to 88,506). Of the additional runs, 4.1% (n=231) were expected to come from the 10% most deprived communities. ConclusionParticipation in parkrun is wide spread across England. We provide recommendations for new parkrun event location, in order to increase participation from deprived communities. However, the creation of new events alone is unlikely to be an effective strategy. Further research is needed to study how barriers to participation can be reduced. Online Map, data, and source codeAn interactive online map is available here, and the annotated R source code and all data that were used to generate the results of this study are provided on a repository.

Background/AimsPhysical inactivity, sedentary behaviour (SB) and inadequate sleep are key behavioural risk factors of cardiometabolic diseases; each is mainly considered in isolation. The study aim was to investigate associations of five movement behaviour compositions with adiposity and cardiometabolic biomarkers. MethodsCross-sectional data from 15,246 participants from the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) were analysed. Time spent in sleep, SB, standing, light-intensity physical activity (LIPA) and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included BMI, waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides and HbA1c. Compositional linear regression examined associations between compositions and each outcome, including modelling reallocation of time between behaviours. ResultsThe average daily composition of the sample(age:53.7{+/-}9.7years; 54.7%female) was 7.7hrs sleeping,10.4hrs sedentary,3.1hrs standing,1.5hrs LIPA and 1.3hrs MVPA. A greater proportion of MVPA time and smaller proportion of SB time was associated with better outcomes. Reallocating time from SB,standing,LIPA or sleep into MVPA had the largest theoretical improvement across all outcomes. For example, replacing 30min of SB, sleep, standing or LIPA with MVPA was associated with -0.63 (95%CI -0.48,-0.79), -0.43 (-0.25,-0.59), -0.40 (-0.25,-0.56) and -0.15 (0.05,-0.34)kg/m2 lower BMI, respectively. A larger proportion of standing time was beneficial for outcomes; sleep had a detrimental association when replacing LIPA or MVPA and positive association when replacing SB. The minimal displacement into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day. ConclusionsCompositional data analyses revealed a distinct hierarchy of behaviours. MVPA demonstrated the strongest, most time-efficient protective associations with cardiometabolic outcomes. Theoretical benefits from reallocating SB into sleep, standing or LIPA required substantial changes in daily activity.

The individual and societal factors influencing long-term recreational exercise participation during the transition from adolescence to young adulthood are not well explored. We modelled latent longitudinal recreational exercise trajectories spanning 8 years from age 16 to 24, and examined demographic, socioeconomic, behavioural, academic, and psychological predictors at age 15 of trajectory-group membership. We also explored whether trajectories were associated with health, mental health, and educational achievement at age 25. Finite mixture modelling was conducted with population-based longitudinal cohort study data collected from 2006-2017 by the Longitudinal Survey of Australian Youth (LSAY). The study sample comprised 9,353 students (49% female) from 356 Australian schools. Self-reported recreational exercise frequency data were collected in 2007, 2008, 2009, 2011, and 2014. Longitudinal latent trajectories of reported recreational exercise participation were estimated using group-based trajectory modelling for two scenarios: daily/guideline-adherent exercise versus non-daily exercise (model 1) and exercise at least once weekly versus exercise less than once weekly (model 2). Four distinct classes of long-term recreational exercise participation were identified for each model. Model 1: guideline-adherent exercisers (17.9% of the sample), never guideline exercisers (27.5%), guideline drop-outs (15.2%) and towards guideline (39.4%). Model 2: regular weekly (69.5% of the sample), decreasing (17.4%), increasing (4.8%), and infrequent (8.3%). In both models, predictors at age 15 for lower long-term exercise participation included female gender, lower self-efficacy, sport participation and parental socioeconomic status, and higher screen-time and academic literacy. At age 25, people in the guideline-adherent exerciser trajectory (model 1) reported better general health, whereas people in the regular weekly trajectory (model 2) had better general health and reduced rates of psychological distress, were happier with life and were more optimistic for the future relative to participants from other trajectory groups. Interventions and health-promotion activities to support sustained engagement in recreational exercise should particularly address the needs of females, people with low self-efficacy, reluctant exercisers, higher academic achievers, and youth experiencing socioeconomic disadvantage.

BackgroundMost physical activity interventions adopt a one-size-fits-all approach, often developed and tested in higher socioeconomic groups, with little consideration of barriers experienced by women from lower socioeconomic backgrounds. Micropatterns, defined as brief bursts of moderate-to-vigorous incidental physical activity lasting under three minutes, represent a form of everyday movement that requires minimal time, equipment, or planning, making them a promising target for intervention. This randomized controlled study evaluated the feasibility, acceptability and potential effectiveness of a co-designed wearable-based micropatterns intervention aimed at increasing moderate-to-vigorous physical activity (MVPA) among socioeconomically diverse women. MethodsA multi-centre, single-blinded, 6-week randomised controlled feasibility study was conducted among women from Sydney, Australia and Glasgow, UK aged [&ge;]30 years who self-reported no leisure time physical activity and could comfortably participate in activities of daily living. To ensure socioeconomic diversity, we used quota-based recruitment with area-level and individual-level indicators of socioeconomic status. Participants were randomised to one of three intervention arms; 1) Smartphone application only (APP); 2) smartphone application combined with a wearable device (Fitbit Inspire 3; W-APP); and 3) smartphone application and wearable device, supplemented by a social community component that included two in-person workshops and online forums (W-APP-C). Feasibility was assessed as completion rates of the study and follow-up surveys were conducted to assess the acceptability of the intervention. Wrist-worn accelerometry was collected at pre- and post-intervention to assess the potential effectiveness of the intervention. ResultsForty-three participants (mean age (SD); 54.8 (10.7) years) were recruited across both sites (APP n = 13; W-APP n = 17; W-APP-C n = 13). When taking into consideration individual-level indicators of socioeconomic status including income, number of dependents, and educational attainment, there was diverse representation across low (20.9%), medium (48.8%), and high (30.2%) socioeconomic groups. Completion of the 6-week intervention was high across both intervention sites and all three trial arms (86%). Qualitative feedback from both trial sites indicated high satisfaction, the majority of the participants thought the intervention was enjoyable (97.9%), user-friendly (69.9%), the wearable technology increased motivation to do activity (87.5%), and the community workshops were beneficial (75%). Across all participants, there was an average daily increase of 9.8 (27.8) min/day MVPA following the intervention. The greatest increase in MVPA was observed in the W-APP-C group (15.5 (23.1) min/day), followed by the APP group (11.4 (25.5) min/day), and the W-APP group 2.6 (32.1) min/day. ConclusionsThis multi-centre randomised controlled feasibility trial highlights the feasibility and acceptability of a wearable-based micropattern intervention in women from socioeconomically and culturally diverse backgrounds.

IntroductionPhysical activity (PA) is an important part of a healthy lifestyle for children and youth, but many adolescents do not fulfil the recommendations. The FIT FIRST concept can be a part of recommended PA, since it offers multiple sporting activities modified for the school setting, emphasizing high intensity, student engagement, enjoyment of movement, and inclusivity. The aim of the paper is to present the protocol for a study that will investigate the effects of FIT FIRST Teen over a full school year on cardiorespiratory fitness, body composition, muscle strength and quality of life as well as the fidelity, intervention dose, acceptability, appropriateness and feasibility of the intervention via an effectiveness-hybrid design (type 1). Methods and analysisA cluster-randomized controlled trial is conducted between August 2024 and August 2025 with 12 schools, >20 classes in an intervention group and 12 schools, >20 classes as controls. The effectiveness of the FIT FIRST Teen intervention will be evaluated through pre- and post-intervention testing over the course of one school year, using multi-level regression analysis to evaluate the intervention effects. Performance in Yo-Yo intermittent recovery level 1 test for children (YYIR1C) is the primary outcome. Secondary outcomes are blood pressure and resting heart rate, muscle strength, muscle mass, fat percentage, quality of life (including physical and psychological well-being, peer and social support, autonomy and parent relations, and school environment), body image, functionality appreciation, motivation for physical activity, sports club participation and self-perception. To examine the potential for an impactful nationwide upscaling of the FIT FIRST Teen program, a comprehensive evaluation of the implementation will be conducted on all intervention schools. A mixed method approach will be adopted, with data collected via logbooks, observations, and interviews. Ethics and dissemination.The Regional Committees on Health Research Ethics for Southern Denmark (Videnskabsetisk Komite, Region Syd) has evaluated the FIT FIRST TEEN protocol and given it an ethics waiver (S-20210099). The study is registered at clinicaltrials.gov (NCT06615791) and the results will be disseminated through scientific papers and public engagement activities. Danish laws for collection and use of personal data will be followed, and parents will be asked for written content before publication.