PURPOSE

Socioeconomic inequalities in health and health behavior are increasingly viewed as emerging from complex systems characterized by interrelated mechanisms at multiple levels, feedback loops, and nonlinearities. A systematic review of research that examined this topic from a systems perspective is needed to understand the (shared) drivers of socioeconomic inequalities in health and health behavior and to identify knowledge gaps.

METHODS

SCOPUS, Web of Science, and PubMed databases were searched in August 2021 for peer-reviewed studies in English in high-income OECD countries containing a conceptual systems model or a simulation model of socioeconomic inequalities in health or health behavior in adulthood. Two independent reviewers screened abstracts and full texts. For each included publication, data on type of model, extent of application of a complex systems approach, model evidence base, and direction and polarity of model relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework and relationships were summarized in a conceptual systems map.

RESULTS

A total of 34 publications were included; 15 contained a conceptual systems model and 19 contained a simulation model. General health outcomes (e.g., health status, well-being) were more commonly modeled than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors, and sleep was only included in one model. Intermediary determinants (e.g., material circumstances, psychosocial factors) were included in all but one model, whereas structural determinants (e.g., ethnicity, policies, societal values) were included in 62% of models. The summary conceptual systems map visualizes important feedback loops and shared drivers, like social cohesion and housing, of multiple outcomes. Key concepts of a complex systems approach (i.e., feedback loops, nonlinearities) were explicitly applied by about half of the included studies.

CONCLUSIONS

Empirical research applying a complex systems approach to understanding socioeconomic inequalities in health and health behavior is in its infancy. This review analyzes the existing literature on the topic, including the main shared drivers and feedback loops, for researchers to build upon and to guide researchers and policymakers aiming to apply a complex systems approach to understand socioeconomic inequalities in health.

Purpose:

A voluntary National Healthy Food and Drink Policy was released in 2016 to improve the healthiness of food and drinks for staff and visitors in New Zealand healthcare facilities and other public sector organizations. However, tools to support policy implementation were not developed, representing a significant gap. This study aimed to design, develop and evaluate a new tool to support food providers in implementing the National Policy.

Methods:

The Double Diamond Model was used to co-design and co-develop a new web-based tool. Authors’ previous research findings: (i) systematic review of barriers and enablers to workplace healthy food policy implementation, (ii) review of current supportive tools and resources, and (iii) interviews with food providers and public health professionals in New Zealand healthcare facilities, were used by a user experience (UX) designer in the Discover and Define phases. The MoSCoW framework was used to prioritize the functions and features of the prototype. During the Develop phase, project stakeholders and advisers provided feedback on the low-fidelity prototype used in the subsequent stages. UX testing of the high-fidelity prototype through interactive interviews with the end users (food providers) will be completed in the Deliver phase early in 2023. UX testing data will be used to organize and prioritize identified issues to improve the tool’s usability.

Results/findings:

A new digital tool, Healthy Kai (Food) Finder, a searchable packaged food and drink product database, was identified as the most necessary tool to support Policy implementation. Essential functions were basic and advanced searches for policy-compliant products, sorting list options, and compiling a list of selected products. Future features included reporting products missing from the database and the ability for users to self-assess products and recipes against the Policy’s criteria.

Conclusion

Comprehensive research informing the development of the Healthy Kai Finder, and UX testing with food providers, will enhance the acceptance and usability of the new digital tool. Incorporation of more functions to support implementation of healthy food policies, with the possibility of including foods/drinks compliant with school food policies in the tool’s database, would increase Healthy Kai Finder’s usefulness.

Purpose: There is a dearth of robust natural experimental studies examining the effects of urban green space interventions on physical activity and wellbeing. The aim of this study was to examine the impact of a new sustainable “sponge park” in a deprived and high flood-risk area in Manchester (UK) on park use, physical activity and other wellbeing-promoting behaviours. The 1.4-hectare park was co-designed with the local community and includes rain and sunken gardens, a permeable piazza, play equipment and biodiverse planting.

Methods: Two comparison sites were matched to two intervention sites using eight correlates of physical activity at neighbourhood (e.g., population density) and site levels (e.g., pedestrian infrastructure). All sites were in the 10% most deprived areas in the UK. The primary outcome (observed walking) and secondary outcomes (vigorous physical activity, socialising, taking notice) were assessed using the MOHAWk behaviour observation tool. Observations involved baseline data collection (2018) before the intervention was implemented in 2020, and follow-ups at 3-months (2020) and 15-months (2021) post-intervention. Negative binomial regression models were used to estimate the effects of the intervention compared to the comparison group, controlling for key covariates. Intercept surveys were also used to assess self-reported outdoor space usage in the intervention and control sites at baseline and 12-months post-intervention.

Results: Compared to the comparison sites, the total number of people observed walking at the intervention park increased at 3-months (incidence rate ratio (IRR) 2.18, 95% CI 1.07–4.43) and 15-months post-intervention (IRR 3.44, 95% CI 2.11–5.62). There were also similar observed increases at the intervention sites compared to the comparison sites in vigorous physical activity, socialising and taking notice. Self-reported increases in outdoor space usage from baseline to follow-up were twice as large in the intervention sites compared to the comparison sites.

Conclusions: Creating sustainable parks is a promising intervention to encourage walking and support wellbeing activities, especially within deprived areas. Interventions that involve community collaboration may be particularly effective. More robust natural experimental studies like this are now needed to inform policy and decision-makers on the effectiveness of a wider range of urban green space interventions in different contexts.

Purpose

The purpose of this study was to determine the environmental impact of current Norwegian diets, measured by global warming potential (GWP, kg CO₂-eq), acidification (ACID, kg SO₂-eq), freshwater- (EUTF, kg P-eq) and marine eutrophication (EUTM, kg N-eq), water use (WU, m³), and land use (LU/LUC, m²a). Further, the analysis aimed to compare the environmental impact of the current diet with two scenarios based on the Norwegian Food-Based Dietary Guidelines (FBDGs) and the EAT-Lancet Planetary Health Diet.

Methods

Information on current consumption was derived from the Norwegian national dietary survey Norkost 3 (2x24-hour recall; n= 1,787; ages 18-71 years). The two modelled diets were designed to follow the respective guidelines while mimicking the current diet in terms of food choices. Environmental impact values were estimated using a newly developed database including cradle-to-fork life cycle assessment values for foods on the Norwegian market.

Results

The food groups contributing most to environmental impact of current Norwegian diets were meat and meat products (GWP, EUTF, ACID, LU/LUC), dairy and dairy products (WU), and cereal grains and cereal grain products (EUTM). Women on average had lower total dietary environmental impact per day than men (25-45% lower across all impact categories), largely due to disparities in energy intake.

Transitioning to a diet following the Norwegian FBDGs resulted in reductions in GWP, EUTF, ACID, WU, LU/LUC, ranging from 4-26%, while an increase was observed for EUTM.  Further, a transition to a diet falling within EAT-Lancet Planetary Health Diet ranges resulted in 17-67% reductions in all impact category totals.

Conclusions

To our knowledge, this is the first study to estimate the environmental impact of self-reported Norwegian diets using nationally representative environmental impact data. Results indicate that overall environmental burden of Norwegian diets is in line with that seen in other Scandinavian countries and Western Europe, and that an adjustment to diets following the national FBDGs could lead to reductions across multiple impact categories. Further, a more dramatic shift to a diet following EAT-Lancet guidelines could offer additional environmental benefits.

Purpose. Childhood obesity usually presents a socioeconomic gradient with higher prevalence in children and adolescents from lower socioeconomic status families, especially in high-income countries. However, less is known about the effect of the accumulation of several social vulnerabilities over time on adolescent’s weight status. The main purpose of this study was to explore cross-sectional and prospective associations between the accumulation of social vulnerabilities and weight status in adolescents in Spain. 

Methods. This study includes data from a large cohort of adolescents enrolled in the SI! Program for Secondary Schools trial in Spain, evaluated at baseline [n=1282 (48.0% girls; 12.5(0.5) years)], at 2-year [n=1174 (48.0% girls; 13.9(0.4) years)] and at 4-year [n=1067 (47.7% girls; 15.8 (0.4) years)] follow-ups. Four socioeconomic vulnerabilities were taken into account to construct a socioeconomic vulnerability score, namely low household income, low parental education, a migrant background (at least oneparent/caregiver born outside Spain), and parental unemployment (at least one parent unemployed or living on social assistance). Obesity was defined according to age- and sex-adjusted z-scores using validated cut-off points for body mass index (BMI) at each assessment. Associations between vulnerabilities and BMI/obesity were analysed using generalized linear and Poisson distribution-adjusted models. 

Results. At baseline, 9.7% of participants presented obesity. Compared to adolescents without any, participants exposed to “one” or “2 or more” socioeconomic vulnerabilities at baseline presented higher obesity prevalence ratio (PR: 1.93 (95% CI:1.65-2.24) and PR: 3.01 (95% CI: 2.79-3.24), respectively). This obesity gradient was observed throughout the study and accentuated over time, especially when considering adolescents with “2 or more” vulnerabilities [2-year follow-up PR: 3.91 (95% CI:2.15-7.10); 4-year follow-up PR: 4.25 (95% CI: 4.25-4.26)]. Additionally, weight gain over time was significantly higher in participants accumulating “2 or more” vulnerabilities compared to adolescents without any [between-group difference in z-BMI between baseline and 4-year follow-up: 0.11 (95% CI: 0.03-0.18)]. Conclusions. A significant gradient in obesity linked to the exposure to social disadvantages in adolescents was found, being stronger as the number of vulnerabilities increased and as the adolescent aged. Therefore, tailored preventive policy actions are required in adolescents, particularly targeting the most vulnerable groups.

Purpose: Research has established associations between lifestyle risk behaviours (physical inactivity, poor diet) and poor mental health among adolescents. Digital interventions which target multiple lifestyle risk behaviours are efficient, scalable and may improve mental health outcomes (e.g. quality of life [QoL], depression). However, limited evidence exists to determine effectiveness. We aimed to assess the effectiveness of digital health interventions targeting lifestyle risk behaviours on mental health or wellbeing outcomes in adolescents.

Methods: Systematic review with meta-analysis of 10 electronic databases from 01 January 2005 to 17 August 2022 including:(i) cluster/randomized controlled trials (cRCT/RCT) of digital health interventions; (ii) participants 10-24 years old, without significant acute or chronic disease(s); (iii) intervention targeting ≥1 lifestyle risk behaviour (physical activity, diet, sedentary behaviour, sleep, alcohol or smoking); (iv) study outcome of mental health or wellbeing. Review is registered with PROSPERO (CRD42021247738) and conducted and reported in accordance with PRISMA statement guidelines. Primary outcome was objective or self-reported change in any mental health or wellbeing outcome. Outcomes were grouped, summarized qualitatively, and combined using a random effects meta-analysis.

Results: 17 studies were identified (13 RCTs, 4 cRCTs) including 9070 participants, mean age 15.3±1.2 years, 55.8% female (16-100%). A variety of digital health interventions were used including text messaging (n=5), mobile applications (n=3), websites (n=4), email (n=1), or a combination of these (n=4). Mental health or wellbeing outcomes identified included QoL (n=4), self-efficacy (n=5), depression (n=6), anxiety (n=4), negative affect (n=2) and self-esteem (n=1). One study measured mental health or wellbeing as a primary outcome. Interventions had small but non-significant positive effects on physical (standardized mean difference 0.30, [95% CI -0.05-0.66]; p=0.10) and psychosocial QoL (0.38, [-0.08-0.83]; p=0.10), depression (-0.02, [-0.09-0.05]; p=0.60), anxiety (-0.13, [-0.45-0.19]; p=0.42) and negative affect (-0.61, [-1.59-0.37]; p=0.22) at post intervention follow-up compared to usual care controls.

Conclusions: Despite known associations between lifestyle risk behaviours and mental health among adolescents, reporting of effects on mental health is limited. Small changes demonstrate potential for digital health interventions to improve these outcomes among adolescents, yet studies with a greater focus on mental health or wellbeing are needed.

Purpose

Physical activity, sedentary behavior and sleep have fundamental impacts on health and well-being. Their sociodemographic and environmental correlates are well understood. Far less is known about how these behaviors fluctuate across the year. The aim was to explore how device-measured movement patterns change across the week, seasons, and around temporal events (Christmas-New year, daylight saving time [DST] transitions).

Methods

This cohort study included 368 parents from Adelaide, Australia (mean age = 40.2 years [SD = 5.9]) who wore Fitbit activity trackers 24 hours a day for 12 months. Minute-by-minute data on sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) was collected using purpose-design “FitnessLink” data capture software. Temporal patterns of each behavior were analysed descriptively. Associations with specific temporal cycles (day of the week, season) and events (Christmas-New year, DST transitions) were explored using multi-level mixed-effects linear regression.

Results

Movement patterns varied significantly (p<0.05) by day of the week and season, and at annual events. Participants slept more on weekends relative to weekdays (+32 min/day), during autumn and winter relative to summer (+4 and +11 min/day), and over Christmas-New Year relative to the week before the holiday (+24 min/day), and slept less in the week after DST ended (April) relative to the week prior (-7 min/day). Participants had longer sedentary time on weekdays, during winter, after Christmas-New Year and after DST ended (+45, +7, +12 and +8 min/day respectively). They also had more LPA in autumn, winter, and during and after Christmas-New Year (-6, -15, -17 and -31 min/day respectively). Finally, participants had less MVPA on weekends and during winter (-5 min/day and -2 min/day respectively). Across the year, 14-day moving averages varied by 30 min/day for sleep (6% of mean sleep duration), 35 min/day for sedentary behavior (6%), 43 min/day for LPA (14%) and 7 min/day for MVPA (21%).

Conclusions

Movement behavior fluctuations associated with temporal events are overlaid on a weekly and seasonal rhythm. Understanding these fluctuations may inform the design and timely implementation of health promotion campaigns and interventions.

Purpose:

Lifestyle and body weight recommendations have been issued to improve health outcomes in postmenopausal breast cancer (PMBC) survivors. However, the majority of PMBC survivors does not meet these recommendations. Although health care professionals (HCPs) could play a key role in the promotion of favorable lifestyle behaviors among PMBC survivors, this is not structurally embedded in clinical care. Optimal approaches to promote sustained adherence to lifestyle and body weight recommendations in PMBC survivors are lacking. This Delphi-study aimed to identify and understand expert-opinion on potential barriers and facilitators for promoting adherence to these lifestyle and bodyweight recommendations in PMBC survivors. 

Methods:

The expert panel consisted of oncology HCPs (N=57), patient advocates (N=5) and PMBC survivors (N=38). They completed 3 questionnaires. Questionnaire 1 aimed to generate ideas. Questionnaire 2 aimed to validate and prioritize the barriers and facilitators obtained from the first questionnaire. Questionnaire 3 aimed to rank barriers and facilitators. The Behavior Change Wheel was used as theoretical framework for analysis. Thematic analysis was applied to identify key overarching themes based on the top-ranked facilitators and barriers. Potential Behavioral Change Techniques (BCTs) and intervention strategies were identified using the Behavior Change Technique Taxonomy version 1 and the Behavior Change Wheel.

Results:

11 core categories of key barriers/facilitators for the promotion of adherence to recommendations for lifestyle and body weight among PMBC survivors were identified. For each core category, relevant BCTs and practical potential intervention strategies were selected based on suggestions from the expert panel. These included: increasing knowledge about the link between lifestyle and cancer; enabling self-monitoring of lifestyle behaviors followed by evaluation; offering group lifestyle counselling for PMBC survivors, enhancing social support for favorable lifestyle behaviors; and stimulating multidisciplinary collaboration among HCPs.

Conclusions:

Findings provide valuable insight for the development of interventions promoting healthy lifestyle behavior among PMBC survivors and on how to stimulate HCPs to provide lifestyle support to their patients. 

Introduction:

Physical inactivity and obesity are widely prevalent in Heavy Goods Vehicle (HGV) drivers. We analysed whether obesity classification influenced the effectiveness of a bespoke structured lifestyle intervention (SHIFT study) for HGV drivers.

Methods:

The SHIFT programme was evaluated within a cluster randomised controlled trial, across 25 transport depots in the UK.  After baseline assessments, participants within intervention sites received a 6-month multi-component health behaviour change intervention. Intervention responses (verses control) were stratified by obesity status (BMI <30 kg/m², n = 131; BMI ≥30 kg/m², n = 113) and compared using generalised estimating equations.

Results:

At 6-months, favourable differences were found in daily steps (adjusted mean difference 1827 steps/day, p<0.001) and sedentary time (adjusted mean difference -57 mins/day, p<0.001), in drivers with obesity undertaking the intervention, relative to controls with obesity. Similarly, in drivers with obesity, the intervention reduced body weight (adjusted mean difference -2.37 kg, p=0.002) and led to other favourable anthropometric outcomes, verses controls with obesity. Intervention effects were absent for drivers without obesity, and for all drivers at 16-18 months.

Conclusion:

Obesity classification influenced HGV drivers’ behavioural responses to a multi-component health-behaviour change intervention. Therefore, the most at-risk commercial drivers appear receptive to a health promotion programme.

Background: Everyday in Australia, almost 2 million primary school aged children pack a school lunchbox, containing on average, three serves of discretionary foods. Despite the size of the problem, limited interventions targeting the nutritional quality of school lunchboxes exist. We aim to outline the optimisation process to design and scale-up a school nutrition intervention that is effective at improving the nutritional quality of school lunchboxes that can be implemented with high fidelity, low cost and achieve high reach.

Methods: A series of sequential studies were undertaken which aimed to optimise the effectiveness, cost effectiveness, reach and adoption of a school nutrition intervention. An mHealth intervention was developed targeting parents lunchbox packing behaviours. The process to optimise the mHealth intervention included: 1) Formative research to identify parental barriers to packing healthier lunchboxes; 2) a pilot cluster RCT to assess the feasibility, acceptability, effectiveness and cost effectiveness of the mHealth intervention (n= 12 schools, 3022 students); 3) an optimisation study  designed to increase parental engagement with the intervention (n=511 parents); 4) a hybrid implementation-effectiveness trial  conducted across a broad range of schools to determine effectiveness of the intervention on discretionary lunchbox energy , cost effectiveness and potential for scale-up (n= 32 schools); 5). Comparative effectiveness research to identify core intervention components and 6) dissemination strategies were piloted to inform scale-up to increase program adoption.

Results: The mHealth intervention aimed to address four key parental barriers to packing healthier lunchboxes including child preference, convenience, time, and cost. The pilot RCT was effective at increasing lunchbox energy from healthier foods aligned to dietary guidelines (79.2kJ, p=0.04), was acceptable to 95% of parents at a cost of $31/student. Using optimised parental messages, the implementation-effective trial was effective at decreasing discretionary foods packed in school lunchboxes (--117.26kJ, p=<0.01), at a cost of $6.02, which was further reduced to $0.07/student following comparative effectiveness research.  

Conclusions: The use of sequential studies resulted in the development of an effective, cost effective and highly scalable school nutrition intervention. Dissemination strategies have been identified to inform a national scale-up.

Purpose: In the field of public health, optimisation processes (cyclical and data-driven) are increasingly recognised for their potential to improve interventions and maximise health impacts; however, the experimental methods vary greatly. Here, we describe a novel optimisation approach, via sequential randomised and controlled trials (RCTs), that we successfully used to improve a school-based physical activity policy implementation intervention known as Physically Active Children in Education (PACE).

Methods: In response to an identified need to enhance the suitability of PACE for delivery at scale, we embarked on an optimisation project to improve PACE using a series of three RCTs conducted in primary schools in NSW, Australia. Within each trial we collected data on effectiveness, costs and implementation indicators (e.g., acceptability, fidelity, qualitative feedback) to inform incremental improvements. Effectiveness data was used to ensure that PACE remained an effective model for policy implementation. Other data were used to weigh the relative impact and cost of discrete PACE components to determine, in consult with stakeholders, where potential adaptations could be made.  

Results: Trial 1: A 2017 pilot study in 12 schools showed the efficacy of PACE: school's policy implementation improved leading to increased physical activity of students. Minor changes were made to delivery of components and addition of three components to address outstanding barriers. Trial 2: A 2018 implementation-effectiveness trial in 61 schools showed that PACE was effective and cost-effective. Three components that were costly and challenging for scale-up due to in-person delivery were adapted to distance delivery (Adapted PACE). Trial 3: A 2019 noninferiority trial in 48 schools showed that Adapted PACE minimised the relative cost of delivery without losing its meaningful effect on policy implementation. The remaining in-person components were adapted for the option of online delivery.-

Conclusion: The optimisation of PACE is the first of its kind to employ sequential RCTs to improve an implementation strategy. Through this process we identified a scalable PACE model that is as effective as possible within the resource constraints of end-users (delivery providers and schools). This approach was well-suited to our research setting and may set precedence for optimisation research undertaken in similar contexts.

Background

People experiencing psychosis often suffer from poor physical health, the result of complex interactions between medication adverse effects and maladaptive health behaviours (e.g., physical inactivity, unhealthy eating, smoking, substance abuse). Modifiable health behaviours (e.g., regular physical activity, abstinence from smoking, alcohol, and other substances) can significantly mitigate health risks, but it is critical that intervention or support for such behaviours occurs early - at the onset of first episode psychosis (FEP) - before unhealthy habits and associated health conditions take hold. Further, any intervention or system of support must draw from the lived experiences of people living with psychosis and the barriers they face in remaining ‘healthy’ within the context of healthcare services.

Methods

Our research used a process of iterative experience-based co-design to create a system of support for the health of young people experiencing FEP and to create a set of principles to guide healthcare within early intervention services. Participants included FEP service users, members of their family, and mental health service providers. The co-design process incorporated indigenous Māori knowledge and creative outputs by which young people could communicate their lived experiences of psychosis and state what they wanted to see in an ideal system of support. Data collection involved a series of workshops, focus groups, online surveys, and interviews, which resulted in written responses, audio recordings, and creative outputs (e.g., art). The research team are using phenomenographic and thematic analyses to understand the data and to achieve the research objectives.

Results and implications

Data are still being analysed, and so we will present an outline of the co-design process and the preliminary outcomes. Co-design processes that account for the lived experience of people living with serious mental illness should guide mental health care. This research will hopefully provide a template for such co-design, in addition to tangible outcomes that support the health and well-being of those experiencing FEP.

Background & objective: Monitoring food intake and physical activity (PA) using tracking applications may support behavior change. However, few longitudinal studies identify the characteristics of people who track their behavior, findings that could be useful in the design and targeting of tracking-related interventions. Our objective was to identify predictors of past-year food and PA tracking among young adults.

Methods: Data were available for 676 young adults participating in the ongoing longitudinal Nicotine Dependence in Teens Study. Potential predictors were measured in 2017-20, and past-year food and PA tracking were measured in 2021-22 at age 34. Each potential predictor was studied in a separate multivariable logistic regression model controlling for age, sex, and educational attainment.

Results: One-third (37%) of participants reported past-year PA tracking and 14% reported past-year food tracking (10% reported both). Attended university, higher household income, being employed, meeting MVPA guidelines, compensatory behaviors after overeating, self-report overweight, trying to lose weight, higher identified behavior regulation, reporting a variety of exercise behaviors, pressure to lose weight, and eating disorder diagnosis predicted past-year PA tracking. Female sex, compensatory behaviors after overeating, self-report overweight, trying to lose weight, body-related embarrassment, higher introjected regulation, reporting a wide variety of exercise behaviors, and pressure to lose weight predicted past-year food tracking.

Conclusion: Food and PA tracking is relatively common among young adults. However, the association between tracking and maladaptive behaviors (such as compensatory behaviors after overeating) and the link between tracking and eating disorders, warrant further investigation.

Purpose: Researchers partnered with staff and parents of a federally funded preschool program for low-income families to develop and implement a family-centered obesity prevention intervention, known as Communities for Healthy Living, in a northeastern city in the United States. This study estimated associations between parents’ perceived exposure (vs. not) to specific intervention subcomponents and changes in both parental empowerment and weight-related parenting practices over an academic year.

Methods: Preschool programs (n=16) were randomly assigned one of three start times for transition from control to intervention, following a stepped wedge design. During intervention periods, three intervention subcomponents were delivered: a media campaign (e.g., brochures on weight-related parenting), enhanced nutrition support (e.g., healthy growth letter mailed home, staff provided training regarding healthy weight discussions with parents), and an opt-in 10-week wellness program for parents (PConnect). All parents with children enrolled during intervention periods were invited to complete a survey in fall and spring of the 2017 and 2018 school years assessing empowerment (items=15; e.g., critical awareness, resource recognition, relationship building), weight-related parenting practices (items=9; e.g., diet, activity, sleep), and perceived exposure to intervention subcomponents. Approximately one-in-four eligible parents completed fall and spring surveys (n=363). We used mixed effects linear regression models to estimate adjusted mean change in empowerment and weight-related parenting, by perceived exposure (vs. not) to intervention subcomponents, including brochures (n=268 vs. 95), healthy growth letter (n=251 vs. 79), discussion with staff (n=192 vs. 171), and PConnect graduation (attended ≥ 70% of sessions vs. not, n=48 vs. 301).

Findings: Controlling for key confounders, change in weight-related parenting did not significantly differ by recall of any intervention subcomponent. However, parents who recalled exposure to the healthy growth letter (vs. not) and those who graduated from PConnect (vs. not) reported significantly greater mean estimated increases in parental empowerment (b=0.11 [95% CI=0.02,0.20]; b=0.20 [95% CI=0.07,0.33]; respectively).

Conclusions: These results suggest unique intervention subcomponents may pose differential impacts on participant outcomes, and underscore important implications regarding intervention design: tailored materials (e.g., growth letter) and sustained interpersonal interaction (e.g., graduating from PConnect) may be associated with meaningful changes in parental empowerment. 

Purpose: Inequality in accessing physical activity (PA) amenities has been shown as a consistent predictor of low levels of PA among the underprivileged population. Community-wide initiative interventions, therefore, are expected to narrow the gaps of inequalities in access and create more opportunities for PA. This study aims to evaluate community-wide program/policies, in terms of their availability, implementation and public participation.

Methods: Policy availability was assessed by using Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework in terms of the stage of policy cycle, policy sector, type of policy and policy level - whether each investment covered international, national, subnational, regional or institutional/local. The weighted score is expressed in percentage. Data for evaluating policy implementation and public participation was driven from Thailand’s Surveillance on Physical Activity 2021 comprising 7,665 national representative samples from 77 provinces. Policy implementation and public participation was assessed from the public perception and participation in the community-wide initiative programs/policies. Descriptive analysis was employed to evaluate the availability, implementation and participation rate, whereas binary logistic regression was applied to examine sociodemographic factors associated to participation rate. 

Results: The availability of community-wide initiative policies scored 43.5%, suggesting there have been inadequate amounts of policies/programs available either at the national or community level. Only 11.6% of the investments were accessible to the public, and only 8.7% of the community participated in the programs. Females (OR 0.759, p-value 0.000) and children/ adolescents (OR 0.576, p-value 0.000) were less likely to access and participate in the programs compared to males and adults. Those with secondary and post-secondary education are more likely to participate in community-wide initiative programs than their counterparts with lower educational attainment. Regional differences also determine participation rate to community-wide investments.

Conclusion: Low accessibility and public participation in community-wide initiative investments indicated that the existing policies have not been able to serve the whole community members. To improve access and participation rate of community-wide initiative programs, future investments should consider to address more the underprivileged in order to provide a more-equitable access to all community members.

Purpose: Engaging in active transport will enable individuals to increase their habitual levels of physical activity. However, 90% of trips in Toowoomba, a town in regional Southeast Queensland Australia, is made with private vehicles despite the average distance being less than 5 km. The aim of this study was to engage citizen scientists (CS) to identify factors that help or hinder their active transport choices.

Methods: We used the Our Voice citizen science methodology developed at Stanford University. After recruiting CS, they completed a ‘discovery walk’ in their neighbourhood taking photos of things that help or hinder active transport choices. They rated each photo and provided a narrative explaining their reason for taking the photo. Once all CS in the group has completed the walk, they met for a group discussion. The CS worked together to analyse the data (photo’s) arranging them into themes and highlighting priority actions. Two CS from each group were selected to advocate for the actions to decision makers.

Results: Three groups of CS were recruited; children aged 10-12 years (n=10), adults (n=10) and adults >65 years (n=10), representing a life course approach. An average of 160 photos, which were geo-coded, was taken per CS group. The children highlighted the need for safer crossings especially from their school to the park. They requested a zebra crossing closer to the school’s bus stop. Similar to the children, safety of crossings was a major theme identified by the adults. The adults highlighted that road signs at crossings prioritizes vehicles, not pedestrians, and requested that this be reversed. The CS noted that the poor condition of the pavements made it harder for people with prams or wheelchairs to navigate. Improved maintenance of the paths was requested as they were uneven and could lead to tripping. Four CS delivered a presentation to a local council committee and the Deputy Mayor. The CS recommendations have informed the council’s walking program with some of the changes being implemented.

Conclusion: Engaging the community as CS using the Our Voice methodology highlighted components of the bult environment that should addressed to encourage active transport.

Purpose

Both Participatory Action Research (PAR) and systems dynamics are increasingly used to tackle the complex problem of childhood obesity. In the ‘¡Chic@s en Acción!’ study, youth-centered PAR is combined with Intervention Mapping and systems thinking tools to develop, implement and evaluate actions aimed at promoting healthy energy balance-related behaviors (EBRBs) together with 9-12-year-old children from a disadvantaged neighborhood in Zaragoza, Spain. In this participatory needs assessment, we aimed to gain insight in children’s perspectives on factors that drive their EBRBs.

Methods

During the school year (2021-2022), in so called ‘action teams’, children conducted peer-research to assess the needs of same-aged children in their neighborhood, in terms of EBRBs and aspects in their environment contributing to their EBRBs. Data was collected through 18 participatory group meetings with three groups of 9–12-year-old children (n = 6-8 per group) from two schools. The action teams collected data from their peers through questionnaires, that were completed by 75 children. Based on this data, the action teams created three causal loop diagrams (one focused on physical activity and sedentary behavior, one on dietary behavior, and one on sleep), depicting the most important drivers of children’s EBRBs and its interconnectedness.

Results

The most important factors driving children’s EBRBs perceived by children were: being alone at home, using screens before sleep and unhealthy family behaviors (focused on food choices and family rules) are barriers for children’s healthy behaviors. The factor being alone at home showed to be a link between all three CLDs. Children identified the following needs: creating healthy celebrations, providing ideas for healthy recipes, more possibilities for playing outside, availability of parks close by for playing outside, being active within the family context, and increasing individual motivation to being physically active.

Conclusions

Our participatory health needs assessment resulted in a comprehensive overview of child-perceived important drivers of children’s EBRBs and their needs. Insights in children’s perspectives on the mechanism through which their EBRBs are shaped are essential for developing better tailored, and thereby potentially more effective, interventions.

Background: Food parenting practices are associated with child weight. Such associations may reflect effects of parents’ practices on children’s intake and weight. However, longitudinal, qualitative, and behavioral genetic evidence suggests these associations could in some cases reflect parents responding to children’s genetic risk for obesity – an instance of gene-environment (GE) correlation. We aimed to test for GE correlation across multiple domains of food parenting, and to explore the role of parent-reported child appetite in GE relationships.

Materials and methods: Data on relevant variables were available for N=187 parent-child dyads (7.54±2.67 years; 44.4% girls) participating in RESONANCE, an ongoing pediatric cohort study. Children’s polygenic risk scores (PRS) for obesity were derived based on adult GWAS data. Parents reported on their feeding practices (Comprehensive Feeding Practices Questionnaire) and their child’s eating behavior (Child Eating Behavior Questionnaire). PROCESS was used to examine interaction effects of child eating behaviors on associations between child obesity PRS and parental feeding practices, adjusting for child age. 

Results: Of the 12 parental feeding practices, 2 were associated with child obesity PRS, namely restriction for weight control (β= .182, p=.011) and teaching about nutrition (β= -.217, p=.003). Moderation analyses demonstrated that when children had high genetic obesity risk and showed high (vs. low/moderate) food responsiveness, or low (vs. moderate/high) satiety responsiveness, parents were more likely to restrict food intake to control weight. 

Conclusions: Our results suggest that parents may mold their feeding practices in response to a child’s propensity toward higher or lower body weight, and adoption of food restriction to control weight may depend on parental perceptions of child appetite. Research using prospective data on child weight and appetite and food parenting from infancy is needed to further investigate how gene-environment relationships evolve through development.

Purpose: Office-workers spend up to two-thirds of their daytime sitting. The Covid-19 pandemic resulted in a shift from office-based working to home-office working, or a hybrid of both. Recent evidence suggests that home-office working further increases sedentarism compared to the office environment, which may have further deleterious effects on the health of employees unless addressed. To successfully implement interventions that reduce sedentarism while working remotely, it is important to understand, from an employer’s perspective, the barriers and facilitators to reducing sedentarism. The Click2move project aims to support active and healthy jobs in Europe by developing a co-created intervention to reduce sedentarism in home-office workers.

Methods: Participants were recruited through an expression of interest form circulated via the European Network for Workplace Health Promotion, through personal communication with companies and social media. Semi-structured interviews were conducted, with all interviews recorded, transcribed and subsequently coded using MAXQDA and thematic analysis, guided by the COM-B model and the Behaviour Change Wheel, was performed.

Results: A total of 20 employers, 8 from Spain, 9 from Ireland and 3 from The Netherlands, aged between 18-65, participated in the interviews. Meeting schedules and workload, such as back-to-back meetings or achieving deadlines, were identified as barriers to reducing sedentarism. Adapting the culture to reduce sedentarism through participating in physical activity (PA) during work hours (e.g., normalising taking brief walks between meetings by managers) was identified as a key target to reduce sedentarism in a home-office context. The use of technology as a delivery method, the use of PA competitions amongst employees and offering numerous/personalised approaches for any future intervention were seen as feasible approaches, with all interviewees showing a willingness to promote digital strategies to support this.

Conclusion: Future interventions aimed at reducing sedentarism in a home-office context should consider a variety of behaviour change techniques that consider the aforementioned barriers and facilitators. There is a need for managers to lead by example, through normalising increased participation in PA amongst staff, while delivering the intervention in a digital form appears to be a feasible approach that would be supported by managers.

Background

Few people meet the weekly recommended guidelines for participation in physical activity, which is unlikely to change without the development and implementation of innovative interventions. One such intervention is Snacktivity™. Snacktivity™ is a novel and complementary approach that could motivate people to be physically active. It focuses on promoting short (2–5 min) and frequent bouts, or ‘snacks’ of physical activity throughout the whole day. The use of mobile health technologies has been suggested as a mechanism to implement innovative health behaviour change interventions, such as Snacktivity™, at scale. This study reports the systematic, theory-driven processes and user testing applied to develop a smartphone-based physical activity application called SnackApp, that aims to support the public with their participation in Snacktivity™.

Methods and Results

Intervention mapping was used to develop the SnackApp via a six-step process. These steps included a needs assessment and the identification of the determinants of physical activity and behaviour change techniques. SnackApp was based on control theory and the habit formation model. The SnackApp was linked with a wearable device (Fitbit Versa Lite) to facilitate automated capture of Snacktivity™. To promote participation in Snacktivity™ the SnackApp includes the provision for goal setting, activity planning and social support. The SnackApp was user-tested for 28-days in 15 inactive adults. App engagement (as measured by mobile app analytics) was analysed to determine SnackApp usage to aid further app development.

Over the 28-day study period participants engaged with the SnackApp on average 77 times, for an average total SnackApp time use of 12.6 mins/p/w, with most of this time spent on the SnackApp dashboard (14 bouts lasting 7.5 minutes p/w). On average, engagement with SnackApp was higher among males than females when considering overall use. App rating score (User Mobile Application Rating Scale) was 3.5/5 suggesting the SnackApp was rated as moderate to good on this scale.

Conclusion

User testing of the SnackApp suggests that physically inactive adults are keen to engage with novel interventions such as Snacktivity™ to promote their participation in physical activity. The SnackApp was considered useful to support engagement with Snacktivity™.

Purpose: The purpose is to determine the feasibility, acceptability, and preliminary efficacy of the Breast cancer and Resistance Exercise Program (B-REP) Trial among a diverse sample of breast cancer survivors. Methods: The pilot study used a 2-arm randomized controlled trial design with N=47 breast cancer survivors (Mage=55.1, SD=11.9; 42.6% self-identified as non-White; 58.1% Stage I diagnosis, M=35.4, SD=18.2 months since diagnosis). Intervention participants (n=28) received 12, once-weekly synchronous 1:1 supervised exercise sessions delivered over Zoom. Minimal care participants (n=19) received a printed exercise instruction booklet. All participants received resistance bands and an individualized exercise program based on their baseline strength assessment. Measures included attendance tracked by research staff throughout the study, 10 repetition maximum strength and self-reported physical activity minutes measured at baseline and post-intervention, and follow-up online semi-structured interviews at post-intervention. Descriptive statistics and repeated measures ANOVAs were used to analyze quantitative data. Deductive thematic analysis was used to analyze interviews. Results: B-REP demonstrated high rates for feasibility outcomes of enrollment (78.6%) and post-intervention assessment completion (92.9%). The acceptability outcomes were high for session attendance (97.9%) and satisfaction (Mscore=4.87 out of 5, SD=.18). The 2 x 2 condition by time repeated measures ANOVAs showed that upper body strength significantly increased (F(1,38)=7.298 p=.01) for the intervention group (Mbaseline=23.9, SD=8.4 and Mpost=28.9, SD=8.9) versus minimal control (Mbaseline=24.5, SD=7.3 and Mpost=25.5, SD=8.7). Lower body strength also significantly increased (F(1,38)=6.209, p=.02) for the intervention group (Mbaseline=28.6, SD=12.7 and Mpost=27.7, SD=14.9) versus minimal control (Mbaseline=37.7, SD=16.2 and Mpost=30.0, SD=16.2). B-REP did not influence self-reported physical activity (p=.24). From the interviews, participants enjoyed the focus on resistance exercise and the interventionist’s gentle approach. Suggestion for improvement include using different exercise equipment and adding a social support component. Discussion: Online-delivered resistance exercise is feasible, acceptable, and shows promising efficacy for improving strength among a diverse sample of breast cancer survivors. Limitations include a small sample recruited from one cancer center. Strengths include using a rigorous study design and objectively measured outcomes. Future research is needed to determine efficacy on muscular strength and cancer-related outcomes such as health-related quality of life and to incorporate participants’ feedback.

Purpose

Little research has examined the composition of waking behaviours assessed using postural devices and associations with health. The aim of this cross-sectional study was to examine the associations of posture-based device-measured waking movement behaviour compositions (i.e., sitting, standing [LPA], and stepping) with adiposity markers (i.e., waist circumference [WC] and body mass index [BMI]) among children and adolescents.

Methods

Pooled data from eight Australian (Melbourne, Victoria; 2007-2014) studies involving 1,199 children and youth (age range 1.8-20.0 years; age_m 9.8±4.0; 51.5% girls). activPAL (i.e., posture monitor) measured waking movement behaviours (i.e., sitting, standing, and stepping time), anthropometric (WC and BMI) and demographic data (age, sex)) were assessed. Waking 3-part compositions of sitting, standing and stepping were formed using compositional data analysis. Linear regression models, stratified by age bands (<5 years, 5-12 years, >12 years), tested associations of waking composition with standardized zBMI and zWC (adjusted for study and total wear time).

Results

No significant associations of overall composition with adiposity outcomes were found for children <5 years old (n=114). For children 5-12 years (n=702), the overall waking composition was associated with zWC but not zBMI. Specifically, a higher proportion of sitting time was associated with lower zWC (β= -0.230, SE=0.092), a higher proportion of standing time was associated with higher zWC (β= -0.159, SE=0.061), and no association was found for stepping proportion. For adolescents (n=304), the overall waking composition was associated with both adiposity outcomes. Specifically, a higher proportion of sitting time was associated with higher zBMI (β= -0.441, SE=0.198), a higher proportion of standing time was associated with lower zBMI (β= -6.020, SE=0.217) and lower zWC (β= -0.809, SE=0.218), and a higher proportion of stepping time was associated with a higher zWC (β= 0.467, SE=0.162).

Conclusions

 Adiposity markers appear more consistently associated with movement behaviour compositions in adolescents than in younger children, although for waist circumference, some associations were in the opposite expected direction. No associations were detected for children under 5 years. Longitudinal analysis is needed to further understand these relationships.

Purpose: Early Childhood Education and Care (ECEC) services are important for supporting young children to establish positive physical activity (PA) and sedentary behaviours (SB), yet many children do not achieve movement guidelines. Play Active is an evidence-informed PA policy intervention combined with resources and training to enable ECEC services to successfully implement their policy. SB findings from the Play Active pragmatic cluster randomised trial will be presented.

Methods: In 2021-22 a pragmatic trial to test the effectiveness and implementation of the Play Active intervention was conducted with 81 ECEC services (646 educators) in Perth, Western Australia. Educator practices associated with children’s PA and SB (sitting and screen time, confining equipment use e.g., highchairs) were assessed using established items (EPAO, NAPSACC, PLAYCE) in an online survey. Services randomised to the intervention (n=40) selected 3-5 policy strategies to employ during the 3-month trial implementation period. 38% selected at least one SB-focused policy strategy. Process evaluation outcomes included awareness, fidelity, reach, and acceptability of the intervention and implementation strategies. Analysis included descriptive statistics and generalised linear mixed effects models.

Results/findings: Intervention group educators reported high awareness of the Play Active policy recommendations (90%). Play Active acceptability was high for both educators (83%) and directors (78%). Fidelity and reach were high for most implementation strategies (75%-100%). There was a significant increase in the uptake of policy practices, however there were no changes in educator practices related to child sedentary time or use of confining equipment. Approximately 80% of children were expected to sit for <20 minutes at a time and 65% had zero minutes of screen time/day.   

Conclusions: The Play Active intervention resulted in increased uptake of policy practices. However, there was no change in educator practices related to child sedentary time, which may be explained by the policy focus on PA, the relatively short 3-to-5-month policy implementation period and extensive staff turnover and shortages exacerbated by the impact of COVID-19 on the ECEC sector. Importantly, Play Active had high awareness, acceptability, fidelity and reach. Future research should investigate the effectiveness of Play Active over longer implementation periods and its potential for scale up.

Purpose: To summarise the evidence of the impact of physical activity on dynamic balance and falls among middle-aged people.

Methods: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs). Data Sources included Medline, EMBASE, CINAHL, and LILACS from inception to July 2021. Studies were selected for inclusion if they were RCTs investigating the effect of physical activity on dynamic balance and falls in people aged 40-64 years compared to non-active control.  We calculated pooled effect sizes using random-effects models. Standardised mean differences (SMD) and mean difference (MD) were calculated. The GRADE system was used to assess the certainty of the evidence. A meta-regression was conducted to examine the effect of participants’ characteristics on the pooled effect size.

Results/findings: 16 trials with a total participant of 947 were included. Participation in physical activity improved dynamic balance (n=16 trials; SMD 1.10 95% CI 0.66 to 1.54; low certainty evidence), timed up and go test (n=8; MD=1.07 seconds, 95% CI 0.39s to 1.75s; low certainty evidence) and functional reach (n=5; MD=5.80cm, 95% CI 2.52cm to 9.08cm; very low certainty evidence), among middle-aged people. We found a significant difference in the impact of interventions that involved 3D exercises (i.e., yoga and Tai Chi) versus non-3D (p for comparison=0.006). We did not detect a significant difference in the effect of physical activity on dynamic balance in the trials involving multicomponent exercises compared to single exercises (p for comparison=0.74). Additionally, the size of the intervention effect on dynamic balance was not influenced by the methodological quality or length of the intervention. No included studies investigated falls as an outcome.

Conclusions: Participation in physical activity appears to offer significant promise for improving balance in middle-aged people, although the certainty of the evidence is low. Greater effects were seen from interventions involving more coordination, such as yoga and Tai Chi. Our results support the promotion and support of physical activity programs to improve balance during middle age to prepare for healthy ageing and potentially prevent falls. Further studies are needed to investigate the impact of physical activity on falls in this population.

Purpose:

It is difficult to increase physical activity (which necessitates compensatory changes in other daily activities), as people quickly return to their old habits once interventions finish. Embedding behavior change in daily routines may be the key to ongoing success. This study aimed to explore how routinization was associated with prospective variation in daily 24-h activity behaviors over a full year, and to examine cross-sectional associations with these behaviors.

Methods:

At baseline, participants in the ARIA study (n=340, mean age=40y (SD 6), 56% female) completed an 8-item routinization questionnaire. For the 13 months following, they wore Fitbit activity trackers from which daily times spent in moderate-to-vigorous physical activity, light physical activity, sedentary behavior and sleep were derived. Total variation in these behaviors was calculated for each participant using the sum of the values in their 13-month day-to-day compositional variation matrix. Mixed models to account for clustering within families were used to regress the routinization score (independent) against total activity variation (dependent), and to regress routinization (independent) against the baseline (averaged over first month) 24-hour activity composition (independent). All models were adjusted for age, sex, education and study cohort.

Results:

Higher routinization was associated with lower day-to-day total activity variation over the 13 months (std beta –0.22, p<0.001). Routinization was associated with the baseline activity composition (ChiSq 8.7, p=0.03). A +1 SD difference in routinization was associated with 15 min/d less sedentary behavior, which was compensated by +9 min/d light physical activity, +4 min/d sleep and +2 min/d moderate-to-vigorous physical activity. 

Conclusion:

Subjective measurement of routinization broadly aligns with device measured daily activity variation. Stronger routinization appears to be beneficially related to daily 24-hour activity behaviors. Understanding how to strengthen routinization may contribute to the success of activity behavior interventions.

Purpose: Utilising fathers to support their daughters and enhance their cricket skills may be an innovative approach to addressing traditional socio-cultural views of cricket relating to gender, by improving girls’ enjoyment of cricket, participation, and long-term retention in in the sport. Therefore, the aim of this study was to assess the feasibility of the novel 'Daughters and Dads Cricket' program.

Methods: In a single arm, pre-post study, fathers (n=34, 43.1±4.4 years) and daughters (n=34, 9.4±1.5 years) from Newcastle, Australia were recruited. The 9-week program was delivered by trained facilitators and included weekly educational and practical sessions, plus home-based tasks. A-priori feasibility benchmarks targeted recruitment (20 dyads), fidelity (≥80%), attendance (≥70%), compliance with home-program (≥70%), program satisfaction (mean score ≥4 out of 5) and retention (≥85%). Preliminary efficacy outcomes were assessed, including cricket skill proficiency, daughters’ enjoyment in cricket, intention to keep playing cricket and long-term retention in cricket.

Results: Feasibility benchmarks were exceeded for recruitment (n=34 dyads), fidelity (98% education, 100% for practical), attendance (88%), satisfaction (fathers: 4.6/5, daughters: 4.8/5) and retention (97%). The home-program compliance fell short of the compliance goal (64%). Preliminary efficacy was confirmed with medium-to-large effect size changes in 11 of the 13 daughters’ cricket skill proficiency outcomes. Promising findings were also identified for daughters’ enjoyment of cricket (daughters self-report at 9-weeks: d=0.3, fathers’ proxy at 9-weeks: d=0.5 and at 12-month: d=0.1), intention to continue playing cricket (90% of fathers and 97% of daughters agreed/strongly agreed to keep playing informal cricket at end of the program) and long-term retention in cricket (at 12-months fathers were playing cricket with their daughters an average of 1.3 (0.6) days per week, while 67% of daughters (n=20) were playing informal cricket).

Conclusion: A cricket-focused program targeting daughters and dads was feasible and led to medium-to-large improvements in cricket skill proficiency among the daughters. At the end of the program, daughters were engaged with cricket, as shown by high levels of enjoyment, intention to continue playing and their long-term retention in cricket at 12-months. Examining the future efficacy in a larger trial is warranted.

Purpose: Around the globe, young children fall short of daily physical activity recommendations.  Early childhood education and care environments (i.e. childcare) have the potential to shape physical activity habits early in life.  Gardening may contribute to children’s physical activity however childcare center gardening is seldom studied.  We examine the impact of a gardening intervention on children’s time in moderate or vigorous (MVPA) and sedentary (SED) activity while at the childcare center.

Methods: In this randomized controlled trial (RCT) 15 childcare centers in low-income areas of Wake County, North Carolina, were randomly assigned to: (1) intervention (year 1), (2) waitlist control (year 1-control; year 2 - intervention), or (3) control year 2.  The sample includes 325 children aged 3–5 years, with n=293 having physical activity data for at least one time point.  The garden intervention comprised six raised garden beds planted with vegetables and fruits, and a booklet of 12 gardening activities. Physical activity was measured at each data collection period for 3 days using Actigraph GT3x accelerometers, secured at the waist.  Analyses employ repeated measures linear mixed models (SAS v9.4 proc mixed) accounting for clustering of children within center. Model covariates included number of days with no outside time (0-2), number of days with rain (0-2), cohort (year 1 or 2), and accelerometer wear minutes.

Results/ findings: At baseline, children (3.9 ± 0.53 years; 51% girls; 58.6 ±28.9 BMI%) accumulated 34.8±12.6 minutes of MVPA and 273±37 minutes of sedentary time each day. Accelerometer wear days were similar across groups (2.5 days). A significant intervention effect was found for both MVPA (p <0.0001)  and SED minutes (p = 0.0004). With children attending the intervention centers getting 5.8 minutes more MVPA and 15.2 minutes less sedentary time each day.

Conclusions: This study employs compelling research design and measures to address an important gap in the empirical literature.  Results suggest that FV gardening within childcare centers may be an effective strategy to encourage physical activity early in life.

Purpose: Considerable distress and worries related to diagnosis, prognosis, and treatment in newly diagnosed breast cancer patients can cause poor quality of life (QoL) and potentially even poor treatment and cancer outcomes. Therefore, understanding the correlates of QoL may help breast cancer patients improve QoL and prepare for treatments and recovery. The primary purpose of the present study was to examine the associations between comprehensive health-related fitness (HRF) measures and physical and mental QoL in newly diagnosed breast cancer patients from the Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study.

Methods: The current study is a cross-sectional design that was conducted in Edmonton and Calgary, Canada. A total of 1,458 newly diagnosed breast cancer patients who completed HRF and QoL assessments within 90 days of diagnosis were included in the study. HRF assessments consist of VO_2peak treadmill test, predicted one repetition maximum and muscular endurance tests using chest press and leg press, handgrip strength, curl-up, sit-and-reach test, and body composition by dual x-ray absorptiometry. QoL included physical component summary (PCS) and mental component summary (MCS) that were assessed by the SF-36. We analyzed the associations between quartiles of HRF and binary PCS and MCS (bottom 20%) using univariate and multivariate logistic regression adjusted for demographic, medical, and behavioral covariates.

Results: In univariate models, all health-related fitness variables except for total lean mass were significantly associated with PCS while only lean/fat ratio was associated with MCS. In multivariate models, relative VO_2peak, relative upper body strength, and lean mass percentage were significantly associated with PCS. More specifically, the least fit groups were 2-3 times (relative VO_2peak: OR=2.08, 95% CI=1.21-3.57; relative upper body strength: OR=3.19, 95% CI= 1.98-5.14; lean mass percentage: OR=2.31, 95% CI=1.37-3.89) more likely to report poor/fair PCS compared to the most fit groups. There were no meaningful associations for MCS.

Conclusions: All three major components of HRF (cardiorespiratory fitness, muscular fitness, and body composition) were independently associated with better physical QoL, but not mental QoL, in newly diagnosed breast cancer patients. An exercise intervention to improve comprehensive HRF may help newly diagnosed breast cancer patients maximize their physical QoL.

Purpose: Evaluate gender differences in physical activity (PA) across age groups based on five Brazilian cohorts. The main research question is how does the gender gap change with age? The innovative aspect relies on exploring gender inequalities in PA throughout several age groups.

Methods: Data comes from four Pelotas birth cohort studies, following all live births in urban area for each respective year (1982, 1993, 2004, and 2015), and the ‘Como vai?’ Pelotas cohort study (60+y). Wrist-worn accelerometry (Actigraph or GENEActive) data was obtained from 1, 2, 4, 6, 11, 15, 18, 23, 30, and 60+ year-old participants. Raw PA data were processed with GGIR package (v2.2) using five-second epoch. Overall PA (OPA) was defined as the average of ENMO per day (mg). MVPA was defined as the average daily minutes spent >100mg, only calculated from age 6y onwards. Cohort-specific mean and 95%CI for OPA and MVPA were calculated by sex (male/female). To estimate pooled effects, random effects meta-analysis for relative (ratio: male/female) and absolute (difference: male-female) gender inequalities were calculated using Stata 17.

Results/findings: The analytical sample per cohort ranged from N=965 to N=3462. Pooled absolute difference was 5 mg for OPA (95%CI 3.1-7), and 19.3 minutes for MVPA (95%CI 12.7-25.9), in favour of males. For OPA the widest gap was found at age 11y (9.8 mg; 95%CI 8.7-11), while for MVPA the largest difference was found at age 18y (32.9 minutes; 95%CI 30.1-35.7). Older adults (60+y) showed no significant absolute gender gap for OPA. Pooled OPA relative ratio results showed males did 0.13 times more OPA than females (1.13; 95%CI 1.09-1.16), with highest ratio for 18-year-olds (1.24; 95%CI 1.23-1.25). Regarding MVPA, the pooled ratio was 1.70 (95%CI 1.57-1.84), with highest relative inequalities among older adults (2.00; 95%CI 1.92-2.08).

Conclusions: The PA gender gap begins early in life and remains marked in all age groups, being late adolescence the period with largest absolute gap and older adults the group with highest relative inequalities. PA promotion actions targeting women and efforts to tackle sociocultural barriers to PA are essential and must start early in life.

Purpose: More than 2 million early care and education (ECE) providers, mostly women, provide care to over 10 million preschool-age and elementary school age children in the US. Our prior studies demonstrate that over 30% of ECE providers are food insecure with concurrent poor diet quality. We present the conceptual framework, design and study measures of Nurturing Healthy Teachers, a quasi-experimental cluster, non-randomized controlled study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among ECE teachers.

Methods: A convenience sample of 30 elementary schools with pre-kindergarten classrooms meeting the eligibility criteria are currently being recruited in Houston, Texas. Eligible schools (n=30) are assigned 1:1 into the intervention or comparison group. All teachers/providers in the 15 intervention schools will be eligible to receive NHT intervention, while those in the 15 comparison schools will receive CHF online modules-only in the 2022-2023 and 2023-2024 school years. The primary outcome of is food insecurity. Secondary outcomes include diet quality, mental health, and metabolic health. Metabolic markers and skin carotenoid levels will be assessed using in person assessments (finger-stick blood measure for HbA1c, weight measurement, blood pressure measurement, and Veggie Meter), while all other measures will be obtained via questionnaire. Process evaluation data using mixed methods will measure dosage, reach, fidelity and acceptability.

Results/findings: Grounded in the Social Cognitive Theory constructs, NHT combines strategies from two evidence-based programs that are currently being implemented at scale: Create Healthy Futures and Brighter Bites. Developed by Penn State Extension Better Kid Care, CHF is a web-based nutrition education plus peer support strategies to improve nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy dietary habits. Brighter Bites provides a weekly distribution of ~20 pounds of donated fresh fruits and vegetables, plus healthy recipe tastings, and nutrition education. We will present the study design, intervention logic model and results of our baseline data collection.

Conclusions: Given the scalability of Brighter Bites and CHF, if found to be effective, a platform for rapid dissemination of NHT among ECE providers already exists.  

Purpose: Research examining relationships between diet quality (DQ) and healthcare use over time is needed to inform healthcare policy. This study investigated the relationship between 1) baseline DQ and 2) change in DQ over time, cumulative Medicare claims and charges over 21-years in a cohort of mid-aged Australian women.

Methods: Secondary analysis of the Australian Longitudinal Study on Women’s Health (ALSWH) cohort (1946-51). Dietary data from food frequency questionnaires at Survey 3 (2001, then aged 50-55years) and Survey 7 (2013) were used to construct DQ change trajectories using the Australian Recommended Food Score (ARFS), with higher ARFS scores indicating higher DQ. Cumulative Medicare Benefits Schedule data over the previous 21-years (2001-2021) were reported by baseline ARFS quintile (n=8,228) and category of DQ change (n=6,553). Linear regression models investigating study aims were adjusted for area of residence, socioeconomic status, lifestyle factors, and private health insurance status.

Results/findings: Women with higher vegetable ARFS sub-scale scores at baseline were associated with fewer 21-year cumulative Medicare claims (β=-4.9, 95%CI -7.4,-2.5) and charges (β=-$AU315.40, 95%CI -$AU506.60, -$AU124.20). For all women, baseline higher dairy sub-scale scores were associated with higher Medicare claims (β=16.3, 95%CI 10.3, 22.4) and charges (β=$AU1,165.20, 95%CI $AU695.10, $AU1,635.30). No association identified between baseline total ARFS or fruit, grains and meat sub-scales with 21-year healthcare claims or charges. Compared to women whose DQ score remained stable, those with worsened DQ over time (change ≤-4 points) made more claims and higher charges; median [Q1, Q3] 413 [277, 588] claims $AU27,073 [$AU16,723, $AU42,134], compared to 387 [259, 559] claims and $AU25,686 [$AU15,201, $AU40,309]. Change in total ARFS and ARFS subscales were identified as predictors of 21-year cumulative healthcare claims. For each 10-point increase in ARFS over time, 12 fewer healthcare claims were made (95% CI 3 – 22). Each 10-point increase in vegetable and dairy ARFS sub-scale scores were also associated with significantly fewer claims.

Conclusions: Greater baseline vegetable variety was associated with fewer 21-year healthcare claims and charges. Women whose DQ worsened over time had higher 21-year healthcare claims and charges compared with those whose DQ remained stable.

BACKGROUND: Classroom teachers and early childhood educators (ECEs) play an important role in promoting physical activity and fundamental movement skills in children. However, teachers face several barriers to promoting physical activity and fundamental movement skills, including inadequate training and professional development. Capacity building interventions, such as training and professional development workshops, provision of resources, or communities of practise, may improve teachers' and ECEs' perceived capabilities, knowledge, and attitudes related to physical activity and fundamental movement skills.

PURPOSE: This systematic review and meta-analysis aimed to determine the efficacy of capacity building interventions on teachers’ and ECEs’ perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills.

METHODS: An exhaustive literature search of six electronic databases was conducted and machine-learning assisted systematic review was used to identify relevant studies. Controlled trials and single-group pre-post studies were included if they measured the effect of a capacity building intervention on in-service or pre-service classroom teachers’ or ECEs’ physical activity or fundamental skills related perceived capabilities, knowledge, or attitudes. The effects of interventions were synthesised using random effects meta-analysis.

RESULTS: A total of 22 studies reporting on 25 unique samples were included in the meta-analyses. A total of 19 studies reported on perceived capabilities, eight studies reported on knowledge, and eight studies reported on attitudes. Interventions most commonly included training/professional development, resources and toolkits, communities of practice, mentorships, and ongoing support. Results showed that capacity building interventions significantly improved teachers’ and ECEs’ perceived capabilities (g = 0.614, 95% CI = 0.442, 0.786), knowledge (g = 0.792 95% CI = 0.459, 1.125), and attitudes (g = 0.376 95% CI = 0.181, 0.571).

CONCLUSION: Findings from this review provide strong support that capacity building interventions are efficacious at improving teachers’ and ECEs’ perceived capabilities, knowledge, and attitudes related to promoting physical activity and teaching fundamental movement skills. Pre-service teachers and ECEs should be provided training in physical activity and fundamental movement skills as part of their degrees, and continual professional development and capacity building should be offered to in-service teachers and ECEs to promote physical activity and fundamental movement skills in children.

Purpose: Preliminary evidence suggests that web-based physical activity interventions with tailored advice and Fitbit integration are effective and may be well suited to older adults. Therefore, this study aimed to examine the engagement, acceptability, usability, and satisfaction with ‘Active for Life,’ a web-based physical activity intervention providing computer-tailored physical activity advice to older adults.

Methods: Inactive older adults (n=243) were randomly assigned into 3 groups: 1) tailoring+Fitbit, 2) tailoring-only, or 3) a wait-list control. The tailoring+Fitbit group and the tailoring-only group received 6 modules of computer-tailored physical activity advice over 12 weeks. The advice was informed by objective Fitbit data in the tailoring+Fitbit group and self-reported physical activity in the tailoring-only group. This study examined the engagement, acceptability, usability, and satisfaction of Active for Life in intervention participants (tailoring+Fitbit n=78, tailoring only n=96). Wait-list participants were not included. Engagement (Module completion, time on site) were objectively recorded through the intervention website. Acceptability (7-point Likert scale), usability (System Usability Scale), and satisfaction (open-ended questions) were assessed using an online survey at post intervention. ANOVA and Chi square analyses were conducted to compare outcomes between intervention groups and content analysis was used to analyse program satisfaction. 

Results: At post-intervention (week 12), study attrition was 28% (22/78) in the Fitbit+tailoring group and 39% (37/96) in the tailoring-only group. Engagement and acceptability were good in both groups, however there were no group differences (module completions: tailoring+Fitbit: 4.72±2.04, Tailoring-only: 4.23±2.25 out of 6 modules, p=.14, time on site: tailoring+Fitbit: 103.46±70.63, Tailoring-only: 96.90±76.37 minutes in total, p=.56, and acceptability of the advice: tailoring+Fitbit: 5.62±0.89, Tailoring-only: 5.75±0.75 out of 7, p=.41). Intervention usability was modest but significantly higher in the tailoring+Fitbit group (tailoring+Fitbit: 64.55±13.59, Tailoring-only: 57.04±2.58 out of 100, p=.003). Participants reported that Active for Life helped motivate them, held them accountable, improved their awareness of how active they were and helped them to become more active. Conversely, many participants felt as though they would prefer personal contact, more detailed tailoring and more survey response options. 

Conclusions: This study supports web-based physical activity interventions with computer-tailored advice and Fitbit integration as engaging and acceptable in older adults. 

PURPOSE: University students undertake prolonged periods of habitual sedentary behaviour which can adversely affect future health. This issue was exacerbated further by the onset of restrictions to freedom of movement due to the COVID-19 pandemic in March 2020. However, in July 2021 the UK government reopened all sectors of the economy and limits on social contact were largely abolished, leading to a contextual shift towards pre-pandemic societal norms. Despite this, little is known about how sedentary behaviour in university students has been influenced since the removal of covid-related restrictions. The aim of this study is therefore to explore correlates of sedentary behaviour across four academic years from October 2019 (pre-pandemic) to October 2022 (15-months following the removal of covid-related restrictions) in UK university students.

METHODS: This study used an online self-report survey to obtain sociodemographic information and to quantify levels of mental wellbeing (MWB), perceived stress (PS), moderate to vigorous physical activity (MVPA), body mass index (BMI), and sedentary behaviour (SB) in four cohorts of university students from prior to the pandemic (October 2019) to 15-months following the removal of COVID-related restrictions (October 2022) in UK university students (n=7,100). A pooled cross-sectional analysis was used to explore the relationships between sedentary behaviour and other lifestyle factors over time.

RESULTS: The regression model was statistically significant (R² = .27, F(1, 7) = 382.21, P<.001). MWB and MVPA were positively related to SB (P<.001 & P=0.01) whereas PS and BMI were negatively related to SB (P<.001). Compared to 2019, SB was higher in 2020 and 2022 (P<.001) but was not different in 2021 (P=0.03).

CONCLUSION: These findings demonstrate that behavioural and psychological correlates of sedentary behaviour remain constant across four years despite substantial changes in sedentary behaviour due to the COVID-19 pandemic. Importantly, the implementation of COVID related restrictions led to an increase in sedentary behaviour beyond pre-pandemic levels that still remains despite a contextual shift towards pre-pandemic society. As such, universities and policy makers should make a concerted effort to explore methods of reducing sedentary behaviour to develop an environment in which students’ health can thrive. 

Purpose: Our previous observational studies showed that a self-reported diet of < 50% carbohydrates and > 23% unsaturated fats is associated with positive outcomes in head and neck cancer (HNC) patients. The purpose of this single-blinded randomized controlled trial (RCT) is to test the preliminary effects of implementing a carbohydrate-restricted, high-fat (CRHF) diet in HNC patients undergoing definitive radiotherapy (RT).

Methods: From January 2020 to August 2021, thirteen newly-diagnosed HNC patients that planned to receive RT at Augusta Victoria Hospital in Palestine, were enrolled and randomized to one of two arms—a CRHF arm (N=6) who received ~30% carbohydrates, ~45% fats, and ~25% proteins or a standard diet (SD) arm (N=7). Three meals per day were provided to all participants for 2-weeks before RT and 6-7 weeks during RT, with adequate calories estimated for weight maintenance. The per-protocol analysis included (N=4) participants in the CRHF arm and (N=5) participants in the SD arm. Outcomes were nutritional status (assessed by patient-generated subjective global assessment (PG-SGA)), body composition (assessed by fat-mass (FM) and lean body mass (LBM), nutrition impact symptoms (NIS), and tumor progression, and were assessed at baseline, 2-weeks (before RT), and 1.5-2 months post-RT.

Results: Both arms showed improvements in PG-SGA score at 2-weeks. Post RT, a non-significant, but greater percent weight loss was observed in the CRHF arm compared to the SD arm. Conversely, the CHRF arm maintained more LBM and lost more FM than the SD arm. The most common NIS were taste deterioration and pain for the CRHF arm, and dry mouth, early satiety, fatigue, pain, and loss of appetite for the SD arm. There was one recurrence in the CRHF arm and one mortality in the SD arm.

Conclusion: This pilot RCT shows that dietary intervention may improve the PG-SGA score before RT. There were fewer NIS observed in the CRHF arm. The CRHF had greater FM loss but better LBM maintenance than the SD arm. These preliminary results can be used to develop a larger sample size, with more statistical power to test the efficacy of implementing a CRHF diet on HNC outcomes.

Purpose: To explore associations of neighborhood characteristics (greenness and walkability), physical activity, and social participation at two time periods. Methods: This is a population-based prospective cohort study of cross-sectional baseline data from the Canadian Longitudinal Study on Aging (CLSA), with a follow-up period at 3 years. The CLSA is a nationally representative, stratified random sample of Canadian men and women, aged 45-85 years at baseline (2011-2015, n=51388). Data on different aspects of social participation (e.g., positive social interaction, and desire to participate in more activity) at follow-up were used as outcomes. The CLSA baseline database was linked with the Canadian Active Living Environments, a measure of walkability, and Normalized Difference Vegetation Index, a measure of greenness. Physical activity was measured using the Physical Activity Scale for Elderly. Walkability, greenness, and total physical activity from baseline were used as exposure variables. Results: The primary associations of interest and assessment of interactions will be analyzed using linear and ordinal logistic regression modeling with the models being adjusted for age, sex, education, and household income. The analytic sample consists of 50.0% females (n=16,735, age 72.9±5.6 years). At follow-up, 33.4% (n=5,637) participants reported desiring more social interactions and 34.7% (n=5,811) participants scored the maximum possible value (100) on the Medical Outcomes Study measure of positive social interactions. We will examine the relationships between older Canadians’ neighbourhood environment, total physical activity, and social participation to gain a better understanding of how these factors influence one another and provide insight into the design of age-friendly environments.  Conclusion: The goal of this study is to inform future work on how external factors such as the natural and built environments can facilitate or hinder social participation among older adults.

Purpose: To determine whether a sedentary time reduction intervention conducted with older adults residing in an assisted living setting would lead to changes in social engagement. Methods: A pre-post intervention, mixed-methods design was used. Data were collected at the beginning and end of a 12-week intervention aimed at increasing standing breaks and reducing sedentary time in three assisted living facilities across Canada (Alberta, Ontario, New Brunswick). Environmental cues such as posters, table cards, and floor stickers were implemented to encourage standing breaks. Participants (n=43, 80.6% female) were given the Keele Assessment of Participation Questionnaire (KAP) before and after the 12-week intervention to assess their social participation across 7 domains. Participants were also invited to focus group discussions after the conclusion of the intervention to gather more insight into the effects of the intervention. Focus groups were transcribed verbatim, and thematic analysis was performed. Results: Analysis of the KAP indicated no statistical changes in participation across any domain from pre-intervention to post-intervention. Several key themes emerged from thematic content analysis of focus group discussions, including sense of belonging, enjoyment, and staff interaction. Across all three provinces, participants endorsed the importance of social interaction and participation, but were clear that their personal choice to participate was of utmost importance. In one facility, residents initially stated that intervention did not increase their social participation, but later acknowledged the sense of belonging they gained from participating in the program. Some residents also suggested that despite the presence of the environmental cues, there are some institutional barriers within the residence which preclude social participation. Conclusion: In conclusion, a sedentary time reduction intervention may not significantly affect social engagement across all older adults. The lack of significance may be due to the highly social nature of congregate living in assisted living facilities where older adults eat their meals together in a dinning room, and are able to participate in several recreation activities planned by staff. Enjoyment related to the sedentary time reduction intervention indicates that social engagement may be critical for reducing sitting time among older residents in assisted living.

Purpose: Food insecurity exists among college students, but the reasons why students lack access to food can vary greatly. Many students at residential liberal arts colleges rely on campus dining options for meals. More research investigating how food insecurity manifests at these institutions is needed to design effective campus-wide interventions that students are willing to utilize. The goal of this research was to determine if there were relationships between campus dining participation and collaboration, cooking habits, dietary habits, perceived stress, and food security status.

Methods: Participants (n = 532) were undergraduate students at two residential liberal-arts institutions in rural environments. Participants completed an online survey at the beginning and end of the semester. The surveys contained questions about demographics, cooking habits, campus dining participation, meal plans, the perceived stress scale (PSS), and food security status (six-item US Household Food Security Survey Module). Chi-square analyses were used to determine relationships between food security status and other variables.

Results: 41% (n = 322) of participants experienced food insecurity within the previous 30 days of survey completion. Perceived stress and number of meals cooked in a residence per week was significantly higher in food insecure participants (p <0.001, p =0.05, respectively). Enrollment in the \"continuous\" meal plan, which provided unlimited access to campus cafeterias, was associated with higher food security than participants on meal plans with a set number of meals per semester or having no meal plan (p < 0.001). Students willing to donate a meal punch or campus dining dollars to another student were more likely to be food secure (p < 0.001). Daily servings of fruit and vegetable intake did not vary by food security status.

Conclusions: Perceived stress, cooking more frequently, and enrollment in smaller meal plans or no meal plan was associated with food insecurity. All three of these factors may be interrelated -- for example, students on smaller meal pleans may need to cook more frequently. Better understanding of the association between food insecurity and barriers to accessing campus dining environments or cooking while in college is crucial for creating sustainable interventions.

Purpose: Lowering sugar-sweetened beverage (SSB) intake is a public health goal that remains elusive. Roughly three-quarters of children and adults in the United States (US) drink SSBs on a given day. Interventions designed to increase water access, such as installing drinking water fountains or providing water filters, have shown promise in lowering SSB intakes. Therefore, policies that improve access to safe drinking water may support SSB reduction. Nonetheless, comparisons of the frequency of state policies that increase water access have not been compared to policies that restrict SSBs. 

Methods: We used a publicly available dataset from the US Centers for Disease Control and Prevention (CDC) on obesity legislation in the US between 2001 and 2017 to investigate the frequency and status of bills designed to improve water access compared with bills designed to restrict SSB access. 

Results: Across the 17-year study period, 38 states and the District of Columbia enacted a total of 98 bills to increase access to drinking water and/or limit access to SSBs. Forty-nine bills restricted SSBs, 38 expanded water access, and 11 addressed both efforts within a single bill. Twelve states did not pass any bills to improve access to drinking water or to decrease access to SSBs. Of 207 dead bills that were either not voted on favorably or not selected for reading over the study period, nearly three quarters (n=150) were solely dedicated to SSB restriction. The ratio of enacted-to-dead bills was roughly one to one for increasing water access (37:38), compared with one to three for restricting SD access (49:150). Furthermore, the only two bills that were vetoed were designed to restrict access to SDs.

Conclusion: Although efforts to legislate SSB restriction were more common than those to expand water access, water access bills were met with less opposition. Policy efforts to increase drinking water access offer considerable promise in conjunction with ongoing policy efforts to restrict SSB intake.

Purpose: Changes in sleep and physical activity and worsened depressive symptoms were observed in older adult populations during early stages of the COVID-19 pandemic. Quantifying these changes as the pandemic progressed and understanding behavioral predictors of increases in depressive symptoms following major stressor events like the pandemic onset could inform future intervention and public health responses. 

Methods: We used data from older adults in the Adult Changes in Thought study collected at pre-pandemic study visits (2016-February 2020) and a one-time survey approximately 1 year into the pandemic period (April-July 2021) to characterize activity and sleep behaviors (daily total sitting; TV and computer time; days/week briskly walking; sleep disturbance) and depressive symptoms (N=896). We subtracted pre-pandemic Center for Epidemiological Studies-Depression (CES-D) 10-item scale scores from pandemic scores to calculate CES-D change. We used paired t-tests to compare levels of pre- and during-pandemic behaviors and used multivariable linear regression to explore potential pre-pandemic predictors of CES-D change score, adjusted for demographics, time between measurements, body mass index, retirement status, difficulty with activities of daily living and pre-pandemic CES-D, social support, and fatigue scores. 

Results: Mean age pre-pandemic was 77.2 (SD=6.6), with 3.0 years between measurements on average. Participants (89% White, 58% female, 83% retired, mean 17 years education) reported significantly more TV (3.0 vs. 2.6 hours) and computer (2.3 vs. 1.9 hours) time, fewer days briskly walking (0.7 vs. 1.6 days/week), more sleep disturbance (53.4 vs. 46.7 PROMIS t-score), and higher depressive symptoms (5.2 vs. 3.7 CES-D; 20.8% vs. 9.7% CES-D score >=10) in pandemic vs. pre-pandemic comparisons (p<0.0001). Higher pre-pandemic sleep disturbance and computer time were associated with larger increases in CES-D (B=0.07 [0.03,0.11] and B=0.20 [0.01,0.38], respectively) and higher fatigue was associated with larger decreases in CES-D (B=-0.08 [-0.10,-0.06]). No associations with pre-pandemic total sitting, TV, or brisk walking time were observed. 

Conclusions: Findings suggest prior better sleep quality and less sedentary computer time may be associations with less worsening in depressive symptoms from stressor events, like pandemics, but that physical activity and TV time may not. Future research on these relationships with objective measures is warranted. 

Purpose. Physical activity (PA) is crucial for good health, however, meeting the Canadian PA guidelines (>150 minutes of weekly moderate-to-vigorous PA) remains a challenge. Wrist-worn wearable activity trackers (WATs) have quickly grown in popularity and these devices are often marketed as a potential tool to improve PA. However, it is unclear whether owning a WAT increases adherence to PA guidelines and if differences in exercise motivation and WAT use are associated with MVPA. The objectives of this study were to 1) identify the proportion of individuals meeting PA guidelines among WAT users compared to non-users, and 2) examine whether exercise motivation, WAT use and demographic characteristics predict MVPA.

Methods. Canadian adults aged 18+ years were recruited (February – November 2022) to participate in this cross-sectional study. Participants completed an online questionnaire that measured exercise motivation (BREQ-3), WAT use (i.e., current user vs non-user) and demographic information (i.e., age, sex, employment status). Chi-squared test was used to determine differences in the proportion of WAT users and non-users meeting PA guidelines. Multiple linear regression was used to examine associations of exercise motivation, participant demographic characteristics and WAT status on MVPA.

Results & Findings. 551 participants were included in the study (WAT users, n = 388; Non-users, n = 163; 66% Female). A higher proportion of WAT-users met MVPA guidelines (79.4%) compared to non-users (62.6%;χ² = 17.02, p <.001).  Our regression showed that both intrinsic motivation (β = 61.2  ± 23.6, p < .01) and integrated regulation (β = 92.8 ± 21.8, p <.001) were significantly associated with greater minutes of weekly MVPA after controlling for age, sex, and employment status. Using a WAT was associated with a 34-minute increase in weekly MVPA, however the association was not significant (p = .21).

Conclusions. Results from this study contribute to our understanding of associations between WATs with PA. While a greater proportion of WAT users adhere to guidelines, integrated regulation and intrinsic motivation for exercise remain the strongest predictors of MVPA regardless of WAT status. More research should employ longitudinal designs to further understand the impact of WATs on motivation for exercise over time.  

Purpose: A low-quality diet increases the risk of cardiovascular diseases and, consequently, the risk of on-duty cardiac events among firefighters. Qualitative studies have provided a picture of the barriers to healthy eating at the fire station. However, to our knowledge, factors that may influence firefighters’ food choices while on duty have never been quantitatively investigated. Therefore, the purpose of this study was to identify factors that may influence firefighters’ food choices at the fire station.

Methods: An online questionnaire (Qualtrics, Provo, UT, USA) was sent to full-time and part-time firefighters in Québec. The survey consisted of two main sections: the assessment of diet (ratio of servings of good and poor foods for cardiovascular health) and the examination of social (Social Support for Healthy Eating Questionnaire), environmental (Perceived Food Environment Questionnaire in a French-Canadian population), occupational and individual (Regulation of Eating Behavior Scale) factors that may influence firefighters' diet at work. Correlational analyses via Kendall’s tau-b coefficient were used to test the relationships between these variables.

Results/findings: Ninety-three (93) firefighters (91 males and 2 females, age: 37.6 ± 11.5 years, years of experience as firefighter: 14.0 ± 9.8 years) responded to the questionnaire. Co-workers’ social support for healthy eating showed a positive correlation with food quality (t = 0.171, p = 0.01). Conversely, the number of co-workers at the fire station was negatively correlated with food quality (t = -0.149, p = 0.04) and positively correlated with frequency of fast food meals (t = 0.153, p = 0.04). Frequency of the latter is also positively associated with the perceived fast food availability around the fire station (t = 0.171, p = 0.03). Nutritional literacy varies inversely with fast food frequency (t = -0.162, p = 0.05). Finally, frequency of meals cut by emergency calls was positively associated with diet quality (t = 0.224, p = 0.01).

Conclusions: Social support, number of teammates, perceived food environment and nutritional literacy seem to influence the quality of food at the fire station. This exploratory study will support further intervention studies aimed at improving firefighters' food choices.

Purpose: Physical literacy is a complex construct that encompasses “the motivation, confidence, physical competence, and knowledge and understanding to value and engage in physical activity for life.” Early childhood educators (ECEs) play a critical role in shaping young children’s relationship with movement and physical activity that influence their physical literacy journey. There is a paucity of measurement tools that assess the motivation, knowledge, and confidence aspects of physical literacy. The purpose of this study was to develop and assess the face and content validity of an online survey tool to assess physical literacy constructs for ECEs in both a professional teaching context and their own personal context. Methods: An environmental scan of the literature guided the physical literacy knowledge, attitudes and behaviours (PL-KABQ) item creation. Face validity and content validity were evaluated by two physical literacy experts and one early childhood educator expert.  Content validity was quantified by the content validity index. Readability was measured with the Flesch-Kincaid Reading Level with a grade 8 reading level target. Feasibility was assessed by completion time measured in minutes. A cross-sectional design was used to test internal consistency of the PL-KABQ items by calculating Cronbach's alpha. Results: A 25-item survey (7 knowledge items) was created to collectively represent a holistic metric of knowledge, attitudes, and behaviours related to physical literacy. The readability score was initially grade 15, but after five revisions the final readability score was grade 8.8. Cronbach’s alpha was determined to be 0.87 indicative a strong unifying and underlying construct. The median survey completion time was 8 minutes. Discussion: A novel physical literacy assessment tool for knowledge, attitude, and behaviour domains was developed for a special population of early childhood educators. The current study is the first step in the process to validate this tool. The results indicate a strong Cronbach’s alpha level, which paves the way to continue the development with intra-rater reliability. Future research will begin to use this tool as a baseline measure for PL knowledge, attitudes and behaviours of ECEs so that we can measure the impact of continuing competence education for working practitioners.

Abstract

Purpose

Childcare interventions targeting physical activity and sedentary behaviour often employ in-person training to supplement early childhood educators’ (ECEs) knowledge and self-efficacy to provide physically active programming to children in care. However, this approach is resource-intensive, and limits reach to ECEs. The purpose of the Training pre-service EArly CHildhood educators in physical activity (TEACH) pilot study was to examine the implementation (e.g., fidelity, feasibility, acceptability) of an e-Learning course targeting physical activity and sedentary behaviours among a sample of pre-service (i.e., post-secondary students) and in-service (i.e., practicing) ECEs in Canada.

Methods

A pre-/post-pilot study design was used, and implementation outcomes were assessed cross-sectionally at post-intervention. Pre-service ECEs were purposefully recruited from Canadian colleges (n = 3) and in-service ECEs were recruited via social media. Following the e-Learning course, a process evaluation survey (n = 32 pre-service and 121 in-service ECEs) and interviews (n = 3 pre-service and 8 in-service ECEs) were conducted to explore ECEs’ perspectives on the e-Learning course. Intervention fidelity was assessed using e-Learning course metrics pulled from the web platform. Descriptive statistics were calculated for quantitative data, while thematic analysis was conducted for qualitative data.

Results

Moderate-to-high fidelity to the TEACH study e-Learning course was displayed by pre-service (68%) and in-service (63%) ECEs. The course was reported to be highly acceptable, compatible, effective, feasible, and appropriate in complexity; however, some ECEs noted technical difficulties with the e-Learning platform and a longer than anticipated course duration as challenges. ECEs reported especially enjoying content on outdoor play (87.5% and 91.7%) and risky play (84.4% and 88.4%) among pre- and in-service ECEs, respectively.

Conclusions

The TEACH e-Learning course was feasible to implement and well received among both pre-service and in-service ECEs. Findings demonstrate the value of e-Learning for professional development interventions for ECEs. Modifications to the TEACH e-Learning course, based on participants’ feedback, will be used to make improvements to improve scalability of this training.

Purpose

Food insecurity (FI) is a public health issue of concern and a sociodemographic factor that drives health inequities and affected approximately 13.5% of U.S. households in 2020. Using penalized logistic regression as a novel methodology, we previously characterized the major prevalent dietary patterns in the U.S. food-insecure cancer survivor population [1]. The goal of the present analysis was to evaluate how those characterized patterns related to mortality, a critical prognostic outcome in cancer survivors.

Methods

This analysis employed data from the National Health and Nutrition Examination Survey (NHANES, 1999-2018) and public-use linked mortality files from the National Center for Health Statistics (NCHS). We used penalized logistic regression (logit), with binary outcomes for FI and FI risk factors, and principal components analysis (PCA) to extract dietary patterns as previously described [1]. We computed index scores and fit covariate-adjusted Cox-Proportional Hazards models to evaluate the relationship between adherence to these diet indices and the risks of all-cause and cancer-specific mortality within 2,495 eligible cancer survivors. 

Results/findings

We extracted four patterns using penalized logit and named them according to the outcome variable used in each model (FI, Age, SNAP, Household Size). Two patterns were extracted with PCA and were named the Modified Western and Prudent patterns due to their interpretations. In the survival analysis, we found significant positive associations between adherence to the FI pattern (HR: 1.23, 95% CI: 1.05-1.44), the SNAP pattern (HR: 2.20, 95% CI: 1.45-3.36), and the risk of all-cause mortality. There was an inverse association between the Modified Western pattern (HR: 0.54, 95% CI: 0.35-0.83) and all-cause mortality.

Conclusions

Major dietary patterns prevalent in the food-insecure cancer survivor population deleteriously impacted survival in the U.S. cancer survivor population. Given the extant health disparities food insecure cancer survivors face, these results highlight a potential area for targeted interventions and policies to mitigate those disparities.

References

1.         Maino Vieytes, C.A.; Zhu, R.; Gany, F.; Burton-Obanla, A.; Arthur, A.E. Empirical Dietary Patterns Associated with Food Insecurity in U.S. Cancer Survivors: NHANES 1999–2018. Int. J. Environ. Res. Public. Health 2022, 19, 14062, doi:10.3390/ijerph192114062.

Purpose: The purpose of this analysis was to evaluate the relationship between physical activity levels of older adults and geriatric relevant health outcomes, and to determine whether neighbourhood characteristics alter this association. Methods: Data from the Canadian Longitudinal Study on Aging (CLSA) were used to assess geriatric relevant outcomes of physical impairment, medication use, severity of daily pain, and depressive symptoms. Data from the Canadian Active Living Environments (Can-ALE) and the Normalized Difference Vegetative Index (NDVI) were used to determine neighbourhood walkability and greenness, respectively. The analytic sample included adults who were 65 years or older at baseline (n=16,735, age=73±5.6, 50% female). Results: Adjusted odds ratios and 95% confidence intervals for the base relationships were calculated using proportional odds logistic regression (physical impairment, pain, medication use), and linear regression (depressive symptoms). Moderation effects of environmental factors were assessed using greenness and walkability. The base relationships showed protective associations between each additional hour per week of total physical activity and physical impairment (OR=0.95, p<.001), daily pain severity (OR=0.98, p< .001), medication use (OR=0.98, p< .001), and depressive symptoms (OR=0.95, p<.001). Additive effects were seen when greenness was added to physical impairment (p=.04), daily pain severity (p<.01), and depressive symptoms (p=.01) but no moderation was seen with walkability. Sex differences were observed in that greenness moderation was found in severity of daily pain in males but not in females. Conclusions: Neighbourhood greenness shows a moderation effect on the protective associations between physical activity and geriatric relevant health outcomes in a sample of over 15,000 Canadian seniors. Future research investigating geriatric relevant health outcomes and physical activity should consider neighbourhood greenness as a potential moderator.

Purpose:

Muscular fitness (MF) activity provides a range of health benefits, including improvements in metabolic function, bone health, and mental health. MF activity seldom features within Physical Education (PE) curricula due to perceived barriers among some PE teachers. These barriers typically centre around confidence, time and a perceived lack of facilities. The aims of this study were to (1) assess if an online continued professional development (CPD) course can increase PE teacher knowledge of MF activity (2) assess the feasibility of an online CPD course to enhance PE teacher knowledge and competence of MF activity, and (3) assess the acceptability of the content and design of an online CPD course.

Methods: 

A user-centred approach to the development of an online CPD platform was undertaken with five secondary school PE teachers across three meetings to inform CPD content and design. Once the CPD course was developed, UK secondary school PE teachers were invited to enrol, and 119 teachers expressed an interest in taking part. A pre-course quantitative quiz was included to assess knowledge and understanding of the concepts covered. The quizzes were completed by 44 enrolled teachers and a wait-list control group (n=21).  Upon CPD completion, teachers provided feedback which was analysed qualitatively. 

Results: 

Pre-and-post CPD knowledge quiz data were available from 65 participants (55.4% male). The median knowledge quiz change score was significantly higher in the CPD group than in the wait-list control group (U=37,z=−5.96,p<0.01). Qualitative data analysis provided three primary themes reflecting factors associated with the acceptability and feasibility of the course: (1) practical application, (2) support and resources, and (3) knowledge and confidence. A further 19 secondary themes provided further context and were conceptualised using pen profiles. 

Conclusions: 

Improvements in PE teachers’ MF activity knowledge and practice were observed following completion of a user-centred CPD programme. The online platform was beneficial to overcoming the limitations of face-to-face CPD, such as time and financial constraints. Further, the CPD content was beneficial and appropriate to their teachers’ practice. Future work is required to establish links between teachers’ learning following CPD, the translation into PE practice and student MF outcomes.

Purpose: Socioeconomically disadvantaged (SED) adults are found to be less active during leisure time in comparison with higher socioeconomic groups. Recreational walking (RW) is an important type of leisure time physical activity which is considered budget-free and without specific skills or equipment. Local environmental factors affecting RW behavior are particularly important for SED adults who are more dependent on their direct environment. Limited papers studied the role of the perceived local environment in peri-urban areas on RW, especially among SED adults. The following research questions will be answered: (1) Which perceived environmental factors play a role in RW among SED adults? (2) Which actions can be identified by SED adults to promote RW?

Methods: Purposeful convenience sampling was used to recruit 38 SED adults (25-65 y/o) in two peri-urban municipalities in Belgium. Walk-along interviews (n=38) have been performed in the participants’ neighborhood to identify local environmental factors affecting RW. 20 participants joined a focus group (n=4) afterwards to categorize the identified environmental factors in the different environmental types (physical, sociocultural, political and economic) of the ANGELO framework, and to identify local actions to promote RW. The interviews and focus groups were transcribed ad verbatim. MaxQDA was used for thematic content analysis.  

Results: The participants added the information environment (dissemination, retrieving and understanding of information) to the ANGELO framework, as they felt it was lacking. Furthermore, the availability of well-maintained walking surfaces, toilets, street lighting and seating options (physical environment), but also social support, dog-ownership, stigmatization, social isolation (sociocultural environment) and affordability (direct and indirect links – economic environment) are identified important environmental factors in RW among SED adults. The identified political and economic factors are intertwined with the other environmental factors. Improving communication and knowledge transfer, stimulation of physical, sociocultural, and economic accessibility, and promotion of physical and social safety are identified most important action points for the local government to facilitate RW. 

Conclusion: Different environmental types interact and are embedded in each other. A broad comprehension of the various dimensions of the local environment are necessary to understand the mechanisms affecting RW among SED adults.

Purpose

Physical activity (PA) access is an issue especially during winter and for people with lower socioeconomic status. In Switzerland, open gym programs with opportunities for PA activities (movement landscapes) are offered for preschoolers and their parents for free or for nominal price during winter time. The aim of the study was to evaluate whether children are physically active during these open gym programs and which types of movement they perform.

Methods

Preschoolers (2-5 years old) from 8 sites of two Swiss activity programs (MiniMove & Ä Halle wo’s fägt) were randomly selected to participate as part of a larger program evaluation. All children were observed using the System for Observing Play and Leisure Activity in Youth (SOPLAY). Additionally, 5-8 children per gym were observed with the System for Observing Children's Activity and Relationships during Play (SOCARP) over 12 minutes per child. Simultaneously to SOCARP, the children wore an ActiGraph accelerometer on their right hip.

Results

According to SOPLAY, 56% (SD=0.2) of children (N=1633) attending the open gym program engaged in moderate to vigorous (MV)PA. According to SOCARP (N=45), children engaged in MVPA 61% of the observed 12 (SD=0.16) minutes. Accelerometry data (N=45) confirmed that 56% (SD=0.16) of the recorded time was spent in MVPA. Movement types observed were: climbing (21%), on a swing (14%), climbing and jumping on the gymnastic box (12%), and on the slide (12%). The intensity of PA in those areas varied from 62% MVPA (slide), 60% MVPA (climbing), 55% MVPA (gymnastic box), to 31% MVPA (swing).

Conclusions

The overall intensity of PA in the Swiss Winter open gym programs is relatively high (>50% MVPA) as indicated both by observation and accelerometry. A large variety of movement types are promoted including endurance and strength activities; however, intensity does vary within the different activities. The lowest intensity is observed at the swing, which may be due to children sitting, being pushed from their parents. This notwithstanding, open gym programs can contribute to a higher level of MVPA and help potentially underserved populations to meet the PA recommendations of WHO (2020).

Purpose:  Individuals experiencing food insecurity are at an elevated risk for several adverse physical and mental health outcomes. Contributors to food insecurity are multi-factorial and include individual and community-level factors, including access to nutritious foods. This study aimed to explore differences in the accessibility, quality, and selection of fresh produce and low-fat foods in a person’s neighborhood by food security status.

Methods: A cross-sectional survey was administered to English-speaking adults living in the state of Virginia from February to July 2022. The survey included demographic information and previously validated measures of household food security status (USDA Economic Research Service) and healthful food access (NEMS). Food security status was categorized as high (HFS), marginal (MFS), low (LFS), or very low (VLFS). Results were analyzed using descriptive statistics and chi-squared tests were used to explore differences in access by food security status. Cohen’s w effect sizes were also calculated. The threshold for significance was set a priori at 0.05 and a Bonferroni correction was applied (p<0.007).

Results: Of the 2,018 respondents, 25.2% experienced HFS, 14.9% MFS, 20.0% LFS, and 39.9% VLFS. There were medium effects of food security status on produce accessibility, quality, and selection (w=0.32, 0.30, 0.33, respectively; p<0.001). Nearly half (49.0%) of HFS respondents strongly agreed that produce was easy to access in their neighborhood compared to 17.7% of people experiencing VLFS. More VLFS respondents strongly disagreed that produce was easy to access (13.0%), high quality (8.8%), and abundant (11.5%) in their neighborhood compared to HFS respondents (5.1%, 3.5%, and 4.7%, respectively). There were medium effects of food security status on low-fat food accessibility and quality (w=0.31, 0.32 respectively; p<0.001). Respondents experiencing VLFS disagreed or strongly disagreed that low-fat foods were accessible and high quality (27.7% and 25.6% respectively). There was a small effect of food security status on low-fat food selection (w=0.29; p,0.001).

Conclusions: Respondents experiencing food insecurity reported lower perceived access to produce and low-fat foods in their neighborhoods than respondents experiencing food security.  Strategies to improve neighborhood access to healthful foods for people experiencing food insecurity are needed to help mitigate existing disparities in health outcomes.   

Purpose: The 2014 Brazilian Food Guide (BFG)’s messages are mostly qualitative and based on food practices and behaviors, such as meal planning, cooking, and eating modes. This study investigates if the adherence to these food practices is aligned with a healthier diet according to the BFG’s recommendations for food intake based on the level of food processing. Methods: A cross-sectional analysis was conducted using a quota-based subsample of adults from the NutriNet-Brasil Cohort. The participants completed the Food Practices Brasil Scale (FPBr), a validated 24-items scale which accesses four dimensions of healthy food practices encompassed by the BFG: planning, domestic organization, eating modes, and food choices. Each item has four possible frequency-based answers; the sum of them generates a score ranging from 0 to 72. Web-based 24h-recalls (up to three per person) were used for calculating the usual percentage of energy intake (%energy) of ten food groups, divided into three categories: ‘eating more’ (plant-based fresh/minimally processed foods, fruits, vegetables, whole grains, legumes, and nuts); ‘limit’ (processed foods, red meat, and table sugar); and ‘avoiding’ (ultra-processed foods). The association between quartiles of the FPBr-score and food groups’ %energy was analysed through crude and adjusted linear regression models; the results were expressed in terms of geometric means. Results: The participants (n=2052) were 39.8 (sd=13.5) years old on average. Most of them were women (52.6%), had completed up to high school (69.1%), and self-declared as white (56.7%). Adjusted means for the %energy of plant-based fresh/minimally processed foods were 27.4% (95%CI 26.7-28.2) and 37.9% (95%CI 36.9-38.6) among those classified in the first and fourth quartiles of the FPBr-score, respectively. Conversely, these percentages were 16.4% (95%CI 15.8-17.0) against 14.8% (95%CI 14.1-15.4) for processed foods and 26.3% (95%CI 25.6-27.0) against 17.1% (95%CI 16.3-17.8) for ultra-processed foods. Except for red meat, all the other food groups were also associated with the FPBr-score in the expected direction. Conclusions: In general, healthier food practices were aligned with a healthier diet. These results support the use of messages based on practices and behaviors in Food-Based Dietary Guidelines and reinforce the importance of policies that enable people to adopt them.

Background: Many research study datasets have been collected to answer questions about the relationship between accelerometer-measured physical activity and cardiometabolic health. This scoping review aimed to map the available datasets across the world which have collected accelerometer-measured physical activity and markers of cardiometabolic health. This data was then used to develop of a publicly available resource, named the Global Physical Activity Dataset catalogue (GPAD) to house the identified datasets, to facilitate future research studies on questions related to physical activity and cardiometabolic health.

Methods: Databases, trial registries and grey literature (inception until 09/2022) were systematically searched to identify studies that have collected data on physical activity and cardiometabolic health outcomes. Inclusion criteria were; datasets must have included accelerometer-measured physical activity in adults aged ≥18 years, a sample size >400 participants (unless recruited participants in a lower middle-income country where a sample size threshold was  100), utilised an observational, longitudinal or trial based study design and collected at least one cardiometabolic health marker (unless only body mass was measured). Two reviewers independently screened the search results to identify eligible studies and the characteristics of each dataset were extracted.

Results: A total of 16,720 study reports were identified and after screening, 319 were eligible, with 124 unique datasets in these study reports meeting the review inclusion criteria. Datasets were found in 49 countries, with the most developed in Europe (n=54) and the least in Africa and Oceania (n=4 and n=3 respectively). The most common accelerometer was the waist-worn ActiGraph. Body mass was the most frequently measured cardiometabolic health marker in datasets (121/124 datasets), followed by blood pressure (83/124 datasets).  The number of participants in the included datasets ranged from 120 to 103,712. Once the review processes had been completed the GPAD catalogue was developed(https://lboro-climb.shinyapps.io/gpad/).

Conclusion: This review identified datasets from around the world that have collected potentially harmonisable accelerometer-measured physical activity and cardiometabolic health markers. The GPAD catalogue is an online open-source resource which will enable easier identification of potentially harmonisable datasets, to answer important health research questions

Purpose: Many colorectal cancer survivors (CRC) experience long-term side effects of treatment, with cancer-related fatigue (CRF) listed as the most reported and severe problem. Observational studies among CRC survivors suggest an association between a healthy lifestyle and decreased risk of CRF; intervention studies are sparse. Importantly, there are no interventions that recruited only CRC survivors experiencing fatigue. We designed the SoFiT-study to assess the effect of a personalized 6-month lifestyle intervention compared with usual care on CRF.

Methods: The SoFiT-study is an ongoing parallel randomized controlled trial aiming to recruit 184 participants. Eligible are persons who experience CRF and who completed treatment for stage I-III CRC between six months and five years ago. Participants randomized to the intervention group receive personalized coaching from a lifestyle coach for 6 months to increase adherence to the lifestyle recommendations of the World Cancer Research Fund regarding adopting healthy dietary behaviours, maintaining a healthy weight, and increasing physical activity. The intervention is personalized to the current level of adherence to WCRF recommendations of the participant, and to the preference of the participant; additionally, it is personalized by applying behavioural change techniques tailored to the specific behavioural determinants of the participant. Participants randomized to the usual care group receive two lifestyle coaching sessions after completion of the 6 months measurements. The primary endpoint is the difference in change in CRF between intervention and usual care group from baseline to 6 months assessed by the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale. Secondary, differential changes in skeletal muscle echo-intensity, gut microbiota composition, health-related quality of life, physical performance, and sleep quality and duration are assessed. Primary outcome data are expected the last quarter of 2023.

Results/findings: Recruitment is ongoing, n=92 participants were recruited so far (Dec 2022). Baseline data on the level of CRF, on adherence to the WCRF lifestyle recommendations and on behavioral determinants will be presented, together with further details on the design of the intervention.

Conclusions: The SoFiT trial will show whether adopting a healthier lifestyle can reduce CRF. Adopting healthy lifestyle behaviours may also contribute to better health-related quality of life. 

Purpose:

Smartphones and wearable devices with activity-tracking functions offer great opportunities to support health behavior change. They can deliver evidence-based behavior change techniques and provide just-in-time adaptive interventions for physical activity. However, there is a dearth of epidemiological research on consumer usage patterns in the real world and the determinants of long-term engagement. We aim to investigate the distribution, patterns, and determinants of engagement with activity trackers in Germany.

Methods:

A web-based survey assessing the experience of and attitudes toward activity trackers was developed for a sub-study embedded in the German National Cohort (NAKO), called \"Smartphone- & Wearable-based Activity Trackers–Determinants of Engagement\" (SWEAT-DE). The questionnaire addresses ownership, types of devices, usage patterns of activity trackers, and determinants of usage based on the Capability, Opportunity, Motivation, Behavior (COM-B) model. Face validity and content validity of the questionnaire were assessed qualitatively by an expert group. The test-retest reliability is planned with a one-week interval in between among university students. The correlation coefficient of continuous variables and Cohen's kappa for categorical variables will be calculated between the test and retest. Each study center will sequentially distribute the questionnaire via email to at least 2000 participants per study center.

Results:

The project is ongoing in the data collection process of test-retest, and the official questionnaire distribution to NAKO participants is planned for the beginning of 2023. This study will present: 1) the prevalence of owning and using consumer activity trackers and their distribution in the German National Cohort study; 2) the degree of engagement and usage patterns and their population characteristics; 3) the individual-level behavioral constructs of activity tracker users vs. non-users and long-term engaged users vs. discontinued users.

Conclusions:

The study results will provide insights into the user characteristics, usage patterns, and determinants of uptake and engagement with activity trackers. Moreover, they have significant implications for understanding how to increase long-term engagement with activity trackers using modifiable factors like capability, opportunity, and motivation. These findings will be of interest to developers and researchers in designing digital behavior change interventions for physical activity using a smartphone- or wearable-based activity tracker.

Purpose: Affective determinants of exercise behavior are receiving increasing attention in research on health promotion and prevention. To date, however, little is known about changes in affective exercise determinants during multi-week training programs in insufficiently active individuals. This applies in particular to the currently discussed advantages and disadvantages of moderate-intensity continuous training (MICT) compared with high-intensity interval training (HIIT) with regard to the affective experience of these two training types, which is important for exercise adherence. Therefore, referring to the Affect and Health Behavior Framework (AHBF), this within-subject study investigated changes in affective exercise determinants as a function of training type and sequence consisting of MICT and HIIT.

Methods: Forty insufficiently active healthy adults (M_age = 27 ± 6 years; 72% women) underwent two 6-week training periods in a randomized sequence (MICT–HIIT vs. HIIT–MICT) within 15 weeks. Pre-post questionnaires and in-situ measurements, during and after a standardized vigorous-intensity continuous exercise session (VICE), were used to assess affective attitude, intrinsic motivation, in-task affective valence, and post-exercise enjoyment. These four affect-related constructs were collected before, between, and after the two training periods. For each of the four affect-related constructs, we separately fitted a mixed model for repeated measures including the fixed effects training type (MICT vs. HIIT), training period (period 1 vs. 2), and sequence (MICT–HIIT vs. HIIT–MICT) according to a 2x2 cross-over design. We set the significance level of α = .0125 to adjust for multiple testing using the Bonferroni correction.

Results: Mixed models revealed a significant effect for training sequence (p = .011) – but not for training type (p = .045) – on changes in in-task affective valence in favor of the MICT–HIIT sequence. Moreover, no significant training type or sequence effects were found for the constructs of reflective processing examined following the AFBH framework: exercise enjoyment, affective attitude, and intrinsic motivation.

Conclusions: Based on our results, individual-based training recommendations should consider the effects of variety and training sequence to develop tailored interventions that lead to more positive affective experiences – in particular during exercise – and thus to the maintenance of exercise behavior in previously inactive individuals.

Purpose: To explore factors that predict interest in participating in nutrition interventions for individuals with low incomes in the United States (US).

Study Design, Setting, and Participants: A cross-sectional online survey using Qualtrics panels was conducted in March and April of 2020 with adults 18 years and older who lived in Virginia, US, and were eligible for the US federal nutrition assistance program, Supplemental Nutrition Assistance Program (SNAP). SNAP provides monetary benefits to eligible individuals to supplement their food budget with the goal of eliminating food insecurity.

Methods: Survey questions included the following: socio-demographic information, including SNAP participation; food resource management skills and physical activity levels adapted from the Expanded Food and Nutrition Education Program (EFNEP) validated questionnaire for adults; number of days of poor mental health from the Centers for Disease Control and Prevention Health-Related Quality of Life questionnaire; and interest in nutrition interventions (designed by the survey development team). Frequencies and means were computed for each measure. Pearson chi-square analyses were utilized to predict different socio-demographic factors (age, gender, education, income, race, ethnicity, and SNAP participation) and food resource management skills and interest in nutrition interventions. All analyses were conducted using IBM SPSS Statistics for Windows (Released 2021, Version 28.0. Armonk, NY: IBM Corp.).

Results: A total of 1,309 (93.0%) participants completed all of the questions of interest for this specific study. Age, race, and participation in SNAP within the past 12 months were the only demographic variables found to be significantly associated with interest in nutrition interventions (p<.05). A higher proportion of respondents who expressed interest in nutrition interventions indicated overall higher mean frequencies of planning meals before shopping, shopping with a grocery list, and poor mental health days (p<.05).

Conclusions: The findings help characterize individuals with interest in nutrition interventions designed for audiences with low-incomes and can be used to help inform and tailor recruitment strategies, as well as potential intervention content.

PURPOSE: Retirement is a common life transition associated with changes in physical activity engagement. The impact of retirement on physical activity appears to vary across socioeconomic positions which may serve to increase socioeconomic disparities in physical activity, and consequently health, in older age. However, further longitudinal studies focused specifically on retirement transition period are needed. The purpose of the current study was to examine changes in self-reported physical activity engagement across retirement transition among retirees from different occupational backgrounds.

METHODS: Public sector workers (n=3541) from the Finnish Retirement and Aging cohort study were followed annually approximately 6 months before and after retirement transition. Occupational background was categorized based on the International Standard Classification of Occupations: High (classes 1-2), Middle (classes 3-4), Low (classes 5-9). The amount and intensity of weekly leisure-time or commuting related physical activity was assessed annually with a four-item questionnaire and expressed as METh/week. Binary variables were created for physical inactivity (<14METh/week) and participation in vigorous physical activity (yes/no). Differences in changes across retirement transition by occupational backgrounds were estimated using linear and logistic regressions with generalized estimating equations while adjusting for gender, age and self-reported health.

RESULTS: Physical activity increased during retirement transition, although the increases were smallest among participants with low occupational background (High: 2.87 METh/week, 95% CI 1.78–3.97; Middle: 2.67, 1.58­–3,77; Low: 1.12, 0.04­–2.19; time*occupation, p=0.049). The participants with high (OR 0.72, 95% CI 0.62–0.82) and middle (OR 0.81, 0.70–0.93) occupational background were less likely to be physically inactive after retirement transition when compared to before retirement, while no changes were observed among participants with low occupational background (OR 0.94, 0.82–1.07; time*occupation p=0.022). In addition, participants with low occupational background were less likely to participate in vigorous physical activity after retirement transition (OR 0.85, 0.75–0.96), whereas no changes were observed among participants with high (OR 1.05, 0.93–1.18) or middle occupational background (OR 1.04, 0.92–1.19, time*occupation p=0.026).

CONCLUSIONS: Retirement transition increases disparities in physical activity engagement across occupational backgrounds with the least favorable changes observed among participants with low occupational background.

Background. Children are insufficiently active, with vast inequalities which disadvantage girls and those from lower socio-economic backgrounds. It is acknowledged that researchers should move towards bottom-up approaches, understanding the perspectives and knowledge of individuals at the centre of research. Children’s voices are often excluded from issues which directly impact them, with perceptions that they lack the capability for meaningful discussions. However, children are likely to provide valuable insights and their perspectives should contribute to intervention development. Purpose. To understand primary school pupils’ views and experiences of physical activity and wearable technologies within schools. Method. Semi-structured focus groups (N= 9) were conducted with 41 Year 5 and 6 pupils (19 girls, 22 boys) from across 6 primary schools based in the South-West of England. Information sheets and consent forms were sent home to pupils’ parents/carers, and those who received consent participated in focus groups. Focus groups were recorded, transcribed, and the data was analysed using a reflective thematic approach. Findings. Pupils highlighted that academic learning was often a barrier to physical activity, as well as acknowledging the influence of the playground space and equipment. Social factors, particularly friendships and the influence of teachers, was recognised as contributing to their engagement, or lack of, in certain activities. Conversations took place regarding physical activity gender differences and included girls stating they had experienced exclusion, particularly in football, as well as gender stereotyping which was a barrier to their engagement. Individuals’ competence and confidence, which included feelings of embarrassment, could prevent children from engaging, particularly the least active. Finally, autonomy was important for children, who valued choice and variety. When discussing wearable technologies children reported that they liked monitoring their steps. However, they highlighted that less sporty children were not as likely to own a device. Pupils acknowledged that technologies could often lead to competition, which may be less enjoyable for less active children. Conclusion. Pupils contributed valuable knowledge and experiences. The findings from this study can contribute to a more detailed understanding of pupils’ perspectives on physical activity and wearable technologies in primary schools, which can be used to inform intervention design.

Purpose

Students rate their mental health status (mean 3.15 on a five points Likertscale) worse than their physical (mean 2.56) and general health status (mean 2.38).

Regarding to the student’s behavior, they spend an average of 5.5 h/week, spread over 4 days a week, in natural environments. Nature is important to students for relaxation (mean 1.38 on a four points Likertscale), quality of life (mean 1.36) and as setting for physical activity (mean 1.65).

First analyses of variance suggest that nature users (from 2 to 7 days/week) benefit significantly compared to non-nature users (never up to 1 day /week).

Further statistical analyses to examine associations regarding to student’s health (behavior) will follow.

First results show that the mental health of students is a serious issue. Nature can be a resource for coping with demands in the university setting. A special consideration on personal and environmental determinants which affect student’s nature contact is necessary.

Purpose: Childhood obesity is a major health equity problem. Despite substantial efforts, rates of childhood obesity remain concerning, and inequalities are widening. Childhood obesity is more prevalent in underserved populations, necessitating targeted interventions. We aimed to analyse the landscape of current early childhood obesity prevention trials and to understand whether and how priority populations have been targeted and reached.

Methods: We completed systematic searches of five databases (e.g. Medline, EMBASE) and trial registries for all planned, ongoing and completed randomised controlled trials evaluating behavioural early childhood obesity prevention interventions. Eligible trialists were invited to join the TOPCHILD Collaboration and share their individual participant data and unpublished intervention materials. We analysed trial location, target populations, intervention reach and key intervention elements.

Results: 48 trials with >50,000 children have joined TOPCHILD. Interventions varied in content (i.e. adressing nutrition, physical activity and/or sleep), delivery features and effectiveness. We identified trials across all continents in 15 countries; the majority (n=44) were from high-income countries, albeit 5 trials were from middle-income countries (Belarus, Brazil, Guatemala, China). Most trials targeted universal populations (n=34), and results were frequently not stratified by priority population. Thirteen trials targeted specific priority populations, including lower socio-economic background populations (n=7) and specific cultural backgrounds (n=6). Trials reported challenges in reaching priority populations. For instance, some recruited in geographical low socio-economic areas but mainly reached the higher-socioeconomic position populations within these areas. Trials that were embedded in pre-existing services to target participants within a priority population group reported higher reach. One trial found that lower health literacy was associated with lower intervention effectiveness, highlighting the importance of health literacy considerations when designing interventions.

Discussion: We mapped whether early obesity prevention interventions targeted and reached priority populations. We found low numbers of interventions specifically targeting priority populations or conducted in low- and middle-income countries. Based on our findings, we derived key recommendations for future interventions and policy to address the major health equity burden of childhood obesity, including more targeted interventions, stratifying reporting by priority population, appropriate health literacy considerations and selecting targeted behaviour change techniques (e.g. social support).

Purpose:

The aim of this study was to assess the prevalence of implementation of obesity prevention policies, practices, and programmes in Early Childhood Education and Care (ECEC) services in New South Wales (NSW), Australia.

Methods:

A cross-sectional study was conducted using a randomly selected sample of 1,026 centre-based ECECs in NSW. A 50-item survey measured the implementation of 7 evidence-based healthy eating (HE) and 8 evidence-based physical activity (PA) policies and practices. Service demographic characteristics were also assessed. Participating services were randomly allocated to receive items related to either HE (267 services) or PA (234 services). Surveys were conducted between October 2021 and June 2022, taking 30 minutes to complete. Descriptive statistics were used to report prevalence of implementation.

Results/findings:

Of 1026 ECEC services, a total of 501 (50% consent rate) completed the survey and were included in the analysis. Of the participating services, 81.4% were long daycares and 18.3% were preschools, 76.8% were in major cities and 61% were located in a low socio-economic area.

In services that prepare food, 91.89% of menu planners/cooks use nutrition guidelines to plan their menus. For all services, 29.59% reported that more than half of their educators participated in professional development or training which promotes HE for children. Outside mealtimes, almost half (48.32%) of services reported undertaking planned HE education lessons at least weekly.

On average, 3-6-year-olds are provided with 331.79 minutes (SD=173.70) of child-initiated free-play per day, and 109.57 minutes (SD=92.12) of structured, educator-led PA per day. Most (82.76%) services reported providing daily activities to intentionally teach and develop fundamental movement skills for children. Only 19.83% of services reported that more than half of their educators participated in training promoting PA for children, and only 13.79% offered PA education (workshops or meetings) to all parents/families.

Conclusions:

Findings of this study indicate the prevalence of implementation of evidence-based HE and PA policies and practices to be variable across NSW, Australia. Several evidence-practice gap were identified, particularly HE and PA training for educators and the provision of PA education for all families per sector recommendations. Efforts to support implementation of these practices is required.

Purpose

This study will provide a detailed description and explore potential predictors of exercise adherence (percentage of performed exercise volume/prescribed exercise volume) to a combined resistance and endurance training intervention during chemotherapy treatment for patients with breast cancer (BRCA). 

Methods

The Phys-Can is a multicentre 6-month exercise trial conducted in Sweden (in Linköping, Lund and Uppsala). Participants were randomized to one of four conditions: high (HI) or low-moderate (LMI) intensity exercise groups, with or without behaviour change support. Randomized women receiving neo- or adjuvant chemotherapy in 21-day cycles for six cycles without treatment delays and with avalible resistance (n=143) and endurance (n=148) data will be included in the planned analyses. Adherence for endurance and resistance training will be analyzed in multilevel regression analyses due to the hierarchical nature of the data (i.e., observations at each time point were nested within participants). Predictors to be included in the analyses: chemotherapy treatment dose, randomized exercise intensity (HI vs LMI), baseline aerobic fitness, baseline physical activity, baseline BMI, and baseline co-morbidity. 

Results

A preliminary descriptive analysis of participants without chemotherapy treatment delays shows the mean (SD) exercise volume for resistance (n=143) training across the entire chemotherapy treatment period was 68 % (18) for HI and 65 % (11) for LMI. The mean (SD) exercise volume for endurance training (n=148) was 54 % (16) for HI and 62% (11) for LMI. The mean volume per week varied throughout the cycles (i.e., lower levels in the weeks after the chemotherapy cycle) and decreased for each cycle. The total mean (SD) for the first and last cycle of resistance training 94% (9) and 55% (5) respectively, and for endurance training 72% (2) and 47% (15) respectively. 

Conclusions

Preliminary descriptive analysis shows variation of exercise adherence throughout the chemotherapy treatment trajectory, but also a trend of lower levels at the end of the chemotherapy treatment period compared to the beginning of treatment. These patterns will be described further by plotting adherence for each chemotherapy week and predictors for adherence will be explored. This knowledge will contribute to optimising exercise programming for patients receiving chemotherapy against BRCA.

Abstract

Purpose: The diagnosis and treatment of breast cancer is associated with substantial stress and uncertainty that may threaten quality of life (QoL) in newly diagnosed breast cancer patients. Examining the correlates of QoL in newly diagnosed breast cancer patients may identify important intervention targets to improve QoL and better prepare patients for treatment. The present study aimed to examine the associations between a comprehensive set of high-quality health-related fitness (HRF) measures and the general health component of QoL in a large sample of newly diagnosed breast cancer patients.

Methods: Newly diagnosed breast cancer patients were recruited between 2012-2019 in Edmonton and Calgary, Canada as part of the Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study. All participants (N=1,458) had early-stage disease and completed baseline HRF and QoL assessments within 90 days of diagnosis. HRF assessments included measures of cardiorespiratory fitness (VO_2peak treadmill test), muscular fitness (upper and lower body strength and endurance tests), and body composition (dual x-ray absorptiometry). The general health component of the SF-36 was used to assess QoL among participants. Binary logistic regression was used to examine the associations between HRF and general health (dichotomized into poor/fair versus good/very good/excellent). Univariate and multivariate models were adjusted for key demographic, medical and behavioural covariates.

Results: Significant adjusted univariate associations were observed between general health and relative VO_2peak (p=0.013), absolute VO_2peak (p=0.021), relative upper body endurance (p=0.05), relative handgrip strength (p<0.001), body mass index (p=0.029), lean mass percentage (p=0.011), body fat percentage (p=0.05) and lean/fat ratio (p=0.009). However, in multivariate models, only relative handgrip strength emerged as significant. In particular, the least fit group was 3.7 times more likely to report poor/fair general health compared to the most fit group (OR=3.67, 95% CI=1.85-7.28).

Conclusion: Muscular strength, measured by relative handgrip strength, was the only component of HRF to emerge as independently associated with general health in newly diagnosed breast cancer survivors. Future studies aiming to mitigate the effects of a cancer diagnosis on QoL in breast cancer patients may benefit from the inclusion of an exercise intervention targeting muscular strength.

Purpose:

Social media can influence individuals toward both healthy and unhealthy eating behaviours and has become a popular source of food and nutrition information. Nutrition is one of the most discussed health topics on Instagram, however, little is known about the content of nutrition-related posts by popular accounts. Therefore, the aim of this study was to examine the content of nutrition-related posts by popular Australian Instagram accounts using a machine learning approach.

Methods:

Australian Instagram accounts that primarily posted about nutrition, with over 100,000 followers were identified. All posts from a 12-month period, excluding stories, were extracted and screened to identify posts containing information about nutrition. Text-based captions of included posts were uploaded to Leximancer, a content analysis software that uses machine learning to identify key concepts and themes in textual data. Instagram posts from each theme were read by the authors to develop an agreed upon interpretation and select illustrative quotes.

Results/findings:

A total of 10,964 Instagram posts from 61 Instagram accounts were included in the final sample. The mean engagement (number of likes plus number of comments) for included posts was 1,854 and mean number of followers was 279,505. Five overarching themes were identified. In decreasing order of magnitude, the themes were: 1) recipes; 2) eating practices; 3) body goals; 4) food literacy and 5) cooking and eating at home. Information about the benefits of healthy eating and how to prepare healthy meals occurred frequently throughout the Instagram posts. Additionally, the marketing of supplements and online programs for meal plans and weight loss occurred throughout posts under each theme.

Conclusions:

The popularity of social media content about recipes and healthy eating indicate that social media may be a useful setting for wide-reaching nutrition promotion campaigns. Nutrition-related content about “body goals” and weight loss may contribute to restrained and disordered eating. There is a large amount of marketing claims about supplements and online nutrition programs present on Instagram. Future research should examine the accuracy of nutrition information on Instagram, and how consumers use social media to inform their eating behaviours.

Purpose: This study describes the process evaluation of (i) the ecofit workouts delivered via the smartphone app, (ii) the characteristics, use and perceptions of outdoor gyms, and (iii) factors influencing selection of outdoor gym locations, included in the ecofit effectiveness trial. The trial aimed to determine the effects of an innovative multicomponent physical activity intervention promoting resistance and aerobic-based physical activity using mHealth, outdoor gyms, and social support.

Methods: We evaluated the ‘ecofit’ intervention using a two-arm cluster randomised controlled trial from September 2019 to March 2022 in two regional municipalities of New South Wales, Australia. We recruited a sample of 245 participants (72% female, mean age 53.4 years [SD=13.9]) who were randomised to the ecofit intervention (n=122) or waitlist control (n=123) group. The intervention group received access to a smartphone app, which included standardised workouts tailored to 12 outdoor gym locations. Process evaluation data were collected using surveys (n=69), user data through the ecofit app and qualitative interviews at the 3-month time-point. Data were analysed using descriptive statistics and presented as means (standard deviations [SD]) or counts (percentages) as appropriate. Qualitative data were analysed using Nvivo 11 software.

Results/findings: The outdoor gyms (N=12) in this study varied in the number of pieces of installed equipment (min=3, max=19). Most locations (75%) included ‘trail-based’ equipment. Of the total number of logged workouts (n=1,447), 53% were park-based (i.e., 47% were ‘Home Challenges’). Participants logged workouts in an average of 3 (SD = 2.3) different outdoor gym locations.

Proximity to outdoor gym facilities (mean=5.5, SD=1.1; 1=‘not at all’, 6=’completely’) appeared to be the most important factor influencing the choice of facility to work-out. Almost all (90%) participants self-reported that the scenery was pleasant and 74% indicated that the quality of the outdoor gym equipment was good, at the location they used the most. Regarding the qualitative interviews, participants generally expressed positive views about the outdoor gyms and preferred those with more varied equipment.

Conclusion: This study demonstrated that locations with a variety of equipment and proximity of outdoor gym facilities were important factors to promote outdoor gym use.

Purpose: Canada, Australia, the World Health Organization and other countries have released 24-hour movement guidelines for the early years which integrate physical activity, sedentary behaviour, and sleep, focusing more holistically on supporting children to achieve a healthy 24-hour day. The guideline development process, however, highlighted the dearth of quality evidence, particularly from large-scale studies. The Sleep and Activity Database for the Early Years (SADEY) project will assemble a large, pooled database of 24-hour movement behaviours, their determinants and health indicators in young children (birth to 5.99 years), to advance knowledge in these areas. This presentation will describe the SADEY methods and preliminary sample.  

Methods: Researchers are being identified who have and are willing to share medium- to large-scale datasets (>100 children) of device-measured (waist-worn ActiGraph accelerometers) physical activity and sedentary behaviour, and parent-reported or device-measured sleep. Led by the co-ordinating centre at the University of Wollongong and supported by the International Children’s Accelerometry Database (ICAD), SADEY is pooling these studies using R and Microsoft SQL Server to create a harmonised database of young children’s 24-hour movement behaviours, health and developmental indicators, and determinants. Data contributors and external researchers can apply to access and analyse data via a virtual (off-premises) computer system.

Results: To date, 11 researchers from 7 countries have expressed interest in collaborating by contributing data from 12 studies. Ethics clearance and data sharing agreements have been secured for many of these studies and the SADEY 1.0 database will be assembled by early 2023. Data collection and harmonisation processes and descriptive findings will be presented.

Conclusion: SADEY will be used to address questions of global importance to public health policy and practice, for example - How much does the mix of movement behaviours across the 24-hour day impact healthy development?, What is the optimal mix of these behaviours?, and; What factors can be targeted to support young children in achieving the optimal mix of 24-hour movement behaviours? Additionally, SADEY seeks to develop and disseminate protocols, and develop capacity, on how to objectively assess movement behaviours, and seeks partnerships with stakeholders that promote knowledge translation on movement behaviours.

Purpose:

The aims of this study were to identify the percentage of time youth spend in moderate-to-vigorous physical activity (MVPA) and inactivity during organised sport or dance, and to identify the associated contextual factors that impact on time spent in these behaviours.

Methods:

A systematic review and meta-analysis were conducted. Included studies sampled youth aged ≤ 18 years currently participating in organised youth sport or dance. Studies had a quantitative study design and baseline measure of time spent in MVPA or inactivity during a youth sport or dance session. Five electronic databases were searched: Scopus, SPORTDiscus, PubMed, Web of Science, and PsycINFO, with forward searching in Google Scholar to identify eligible articles that had cited the included studies. Meta-analysis was conducted to estimate the pooled mean percent time spent in MVPA/inactivity using random-effects models. Analyses were conducted using Stata Version 17.

Results/findings:

From an initial pool of 7,518 nonduplicate records, 31 articles from 30 studies met the inclusion criteria. Most studies were conducted in the US (n = 16) and used accelerometry (n = 27) as the primary physical activity measure. Only 7 studies targeted youth dance. Meta-analysis revealed that the mean (95% CI) time spent in MVPA during organised sport was 38.2% (33.8, 42.5) and mean time spent inactive was 29.7% (22.7, 36.7). Most studies explored contextual factors during practices only. There were several contextual factors that appeared to influence MVPA, including task contexts (e.g., warm-up, gameplay, free play), demand contexts (i.e., contexts that foster participation and inclusion), and coach contexts (e.g., coaches’ MVPA during practice). Some task contexts (e.g., instruction, fitness) and demand contexts (i.e., contexts that foster exclusion like elimination games) also appeared to influence inactivity.

Conclusions:

The findings indicate that in organised youth sport and dance there is potential to increase time in MVPA, particularly during practices.  Sport and dance are likely one of the widest reaching out-of-school settings for physical activity. In many countries, most youth participate in at least one sport annually, so optimising the setting for MVPA could have substantial public health impact.

Background: Diverse samples in research trials are important to the generalizability of findings and providing access to cutting-edge treatments. Thus, we evaluated whether there were indications of a digital divide in the recruitment, randomization, engagement, retention, and/or efficacy in a post-smoking cessation weight management trial.

Methods: The study initially recruited participants near Memphis, Tennessee, USA and later transitioned to remote assessment and national recruitment, due to the COVID-19 pandemic. All 305 randomized participants (32.1% men, 43.3% identified as Black, 10.5% non-urban, 58.0% with income <$50,000) received 7-20 telephone-based interventions sessions over 2-8 months (depending on randomization assignment) and cellular scales for self-weighing.

Results: Recruitment: Radio advertisements were the best method for recruiting participants who identified as Black, and electronic recruitment strategies (e.g., Google, Facebook advertisements) were most effective for non-urban participants. Randomization: Individuals identifying as Black (OR = 0.53, 95% CI: 0.33-0.84) had decreased odds of proceeding from recruitment to randomization, and individuals residing in non-urban areas (OR = 8.76, 95% CI. 1.15-66.77, p = 0.036) had increased odds of being randomized. Engagement: Participants identifying as White self-weighed more frequently than participants identifying with other racial groups (M(SD)=3.0(1.9) days/week vs. 2.3(1.8), p=0.002), with no differences observed by rurality or income. Similarly, individuals identifying as White had higher session attendance (47%) compared to those who identified with other racial groups (39% of sessions, p=0.01), with no differences by rurality or income. Retention: While 12-month retention was overall high (89%), individuals who identified as Black (16.7% vs. 6.3% for White participants, p = 0.005) and participants with lower incomes (i.e., <$50,000) (15.7% vs. 2.4% of participants with higher incomes, p = 0.0002) had significantly higher attrition. Efficacy: All three weight management interventions were successful at reducing or eliminating post-cessation weight gain, and 46.9% of participants were successful at quitting smoking, with no race, rurality, or income-based differences (ps > 0.05).

Conclusion: Findings indicate that this behavioral intervention trial with minimal technology requirements was successful at recruiting and treating a diverse sample of participants. Future research should test additional strategies for reducing disparities in the recruitment-to-randomization pipeline, retention, and engagement.

Purpose: Cardiovascular disease (CVD) and cancer (CAN) are the leading causes of death in many countries worldwide. Although physical activity provides many health benefits, patients with CAN or CVD experience many barriers to physical activity. Understanding the physical activity levels in patients with CAN and CVD is important to improve their physical activity levels. The primary purpose of this study was to examine independent and combined associations of a CAN and/or CVD diagnosis with physical activity in Korean adults.

Methods: The current study is a cross-sectional design. A total of 32,655 adults, who completed the self-reported assessments of CAN and CVD diagnosis, and physical activity from the Korea National Health and Nutrition Examination Survey between 2015 and 2019, were included. Participants were asked to report their diagnosis of different types of CAN and CVD, and were divided into four groups depending on CAN and CVD diagnosis. Physical activities were measured using the Korean version of the Global Physical Activity Questionnaire. Chi-square analyses and analysis of variance were used to identify the differences in demographic, medical, and physical activity variables among the four diagnosis groups. Analysis of covariance and multinomial logistic regression were used to compare physical activity levels among the four diagnosis groups after adjusting for covariates. Factorial ANCOVA was used to examine the associations of time since diagnosis and time between diagnosis of CAN and/or CVD with physical activities.

Results: In adjusted model, participants diagnosed with CAN only participated in more leisure time physical activity compared to those diagnosed with neither disease (p=0.045) and CVD only (p=0.024), more walking compared to those diagnosed with neither disease (p=0.002), CVD only (p<0.001), and both (p=0.015) diseases, and more strength exercise than those diagnosed with neither (p=0.009) and both diseases (p=0.001).  

Conclusions: Although Physical activity levels in Korean adults are insufficient regardless of CAN and/or CVD diagnosis, people diagnosed with CAN only participated in more physical activity than those diagnosed with neither, both diseases, and CVD only. Different strategies may be required for each diagnosis group to improve their physical activity levels. 

An emerging barrier to student physical activity at school, particularly among girls are traditional uniforms that may be impractical for participating in physical activity (e.g. dresses, skirts and black leather shoes). Modifying the school uniform to be sports uniform everyday may be a simple intervention to improve student’s physical activity (PA). The aim of this study was to assess the impact of an activity enabling uniform on primary schools students’ cardiovascular fitness and PA across the school day.

A cluster randomised controlled trial was undertaken in 13 primary schools in New South Wales, Australia with students in grade 4,5 or 6.  Schools were randomised to either an activity friendly uniform intervention, whereby students wore their sports uniform every day of the school week, or to a usual practice control. Physical fitness was measured using the shuttle run test and PA was measured in steps and counts per minute using wrist worn accelerometers for 5 school days. Linear mixed models will be used to compare student fitness and PA (across the segmented school day) between the intervention and control groups at follow-up, controlling for baseline. All analyses will follow intention to treat principles, with missing data addressed using multiple imputation. To reduce bias and ensure adequate power no preliminary data will be analysed prior to final data collection, which is due for completion in December 2022.

Results of the study will report overall difference in physical fitness levels and step count between intervention and control schools at follow-up. 13 schools have completed baseline data, there were 684 consenting students of which 602 had valid shuttle run data and 620 had valid accelerometer data.

Given the many challenges faced when implementing, at scale, school PA interventions this study is aiming to support a school uniform policy change as a simple means of improving student PA; one that does not require significant resource to build the capacity of schools and their staff to support implementation. It also has the ability to support other school PA programs by having students ready to engage in PA at any time of the week, especially for girls.

Purpose: Monitoring of physical fitness (PF) in children and youth is important because PF is a summative indicator of health. There exist different ways of monitoring the PF levels in younger populations. The digital measurement of PF within a video meeting seems to be cost-effective and has the potential for wide-reach. However, there is almost no evidence how reliable this kind of measurement is. Therefore, the aim of this study was to assess the reliability of a new digital instrument.

Methods: We developed the digimot test on the basis of four tasks of the MoMo test profile (Worth, et al. 2015). The original test profile is validated, discussed with experts and frequently used within a population-based monotoring in Germany (MoMo study). Within the new digimot test, PF was assessed by means of these four tasks: ‘Jumping-sideways’, ‘Sit-ups’, ‘Push-ups’, ‘Stand and reach’. The validation sample (n=47, aged 8-12 yrs, n♂=28, n♀=19) participated in two different test settings: ‘digital’ in a Zoom meeting at their homes and ‘in presence’ in test rooms. Both measurements - ‘digital’ and ‘in presence’ - were reseacher-assessed by exactly the same trained researcher. Statistical significance was set at p<0.05. Descriptive and inferential statistical analyses (t and sign tests, Spearman and Pearson correlations) were performed using SPSS. The reliabilities were estimated on the basis of  mean comparisons in combination with the degrees of correlations.

Findings: The results revealed a satisfactory reliability of ‘Jumping-sideways’ (no difference, r=0.66, p<0.001), a very good reliability of ‘Sit-ups’ (no difference, r=0.70, p<0.001), a not satisfactory reliability of ‘Push-ups’ (no difference, r=0.41, p=0.005) and a very good reliability of ‘Stand and reach’ (no difference, r=0.88, p<0.001).

Conclusions: The study provides support that the digimot test is a reliable alternative to ‘in presence’ tests. Three of four tasks turned out to be sufficiently reliable. To enhance the reliability of ‘Push-ups’, motivational aspects should be proved. Additional research is needed which aims to the integration of a task for the endurance performance.

Purpose: Children are spending an increasing amount of time alone with screens, which seems to affect both their physical and mental health. Furthermore, the field lacks feasible and effective interventions conducted in a natural setting. The Screen Free Time with Friends Feasibility Trial will be conducted to test the feasibility, including acceptability and compliance, to an intervention aiming to reduce screen media use and promote time physically with friends during leisure time in 10-11-year-old children.

Methods: A non-randomized single group feasibility trial will be conducted from February to October 2023 including approximately 200 children (aged 10-11 years) and 200 parents (at least one per child) from three different schools recruited from three different municipalities in Denmark (ClinicalTrials.gov ID: NCT05480085).The Screen Free Time with Friends intervention is a multicomponent intervention targeting families, afterschool clubs and local communities and has been developed based on a thorough development process following the Medical Research Council UK framework for developing and evaluating complex interventions. The implementation approach will allow the intervention to vary across different local communities yet maintaining the integrity of the core components of the intervention.

Feasibility and acceptability of the intervention will be assessed during the intervention using process evaluation inspired by the RE-AIM framework including focus groups interviews with parents, afterschool club personnel and local stakeholders. Participation, recruitment, retention rate and compliance to the outcome measurements (objectively measured physical activity, screen time, screen media addiction, wellbeing, social relations, leisure time activities, sociodemographic background) will be investigated and presented.

Conclusion: The trial will investigate the feasibility including acceptability and compliance with regards to the intervention and the planned outcome measurements. This feasibility study will ensure the final essential refinements before the intervention program will be implemented in a large randomized controlled trial investigating the effect of the intervention. 

Purpose

College is a time when many young adults learn independence and self-management. College students often report eating processed foods which may be due to a lack of cooking knowledge (CK), nutrition knowledge (NK), and cooking self-efficacy (CSE), leading to poor overall diet quality (DQ). This study aimed to assess if greater CK, NK, and CSE, predicted DQ in college students.

Methods

A cross-sectional convenience sample of undergraduates completed an online survey assessing health behaviors. DQ was measured using the Short Healthy Eating Index (sHEI), assessing adherence to the 2015-2020 Dietary Guidelines for Americans. Scores range from 0-100, with higher scores indicating healthier DQ. CK, NK, and CSE were measured using the Food Preparation Knowledge and Confidence Survey, scores range from 1-5, with higher scores indicating better knowledge and self-efficacy. A Pearson correlation examined the directionality of relationships among variables.  A linear regression determined whether CK, NK, and CSE predict DQ. 

Results

Students (N=851) were on average 19.7 (±1.6) years old, primarily White (90.7%), female (63.8%), and underclassmen (58.6%). 38.3% of students perceived their NK as poor or fair and 26.9% perceived their CK as poor or fair. The mean CSE score was 3.9. The mean sHEI score was 47.9.  CSE (r=.263, p<.001), NK (r=.345, p<.001), and CK (r=.261, p<.001) were positively correlated with DQ. The overall regression model was significant, R² = 0.14, F(3, 757) = 39.3, p<0.001.  CSE (β=1.89, p=.009) and NK significantly predicted DQ (β=2.61, p<.001). CK did not predict DQ. 

Conclusions

CSE and NK positively predicted DQ, highlighting the need to implement college-aimed initiatives incorporating nutrition and cooking education to improve overall DQ in college students. Providing students with comprehensive nutrition and cooking education can support positive behavior change, improve overall DQ, and reduce risk for developing chronic disease in adulthood. 

Purpose: The built environment affects physical activity in adults; less is known about whether the neighborhood environment, as reported by parents, is associated with childhood physical activity.

Methods: We conducted a cross-sectional analysis using questionnaire data from the LEGACY Girls Study, a North American cohort of 1,068 girls, primarily aged 6-13 years at enrollment (2011-2013). Guardians (97% mothers) were asked by questionnaire if they 1=“strongly disagreed” to 4=“strongly agreed” that their neighborhood had: shops within walking distance, transit stops within walking distance, sidewalks on most streets, four-way intersections, high traffic, high crime, many recreational facilities, many physically active residents, and many interesting things to look at while walking (data available for 964 girls). Girls, aged ≥10 years, were asked these same questions (n=560). We used log-binomial regression models adjusted for age, race/ethnicity, study center, and maternal education to estimate relative risks (RRs) and 95% confidence intervals (CIs) for each neighborhood characteristic in association with being physically inactive (no report of free play, riding a bike, etc.) while at home in the past week. We used the weighted kappa statistic to evaluate mother-daughter inter-rater agreement .

Results: Forty-two percent of girls were physically inactive while at home in the past week. Girls in high crime and high traffic neighborhoods, as reported by guardians, had 26% (RR=1.26, 95% CI=1.07-1.48) and 37% (RR=1.37, 95% 1.13-1.65), respectively, higher risk of being physical inactive compared with girls in low crime/traffic neighborhoods. Girls, aged ≥10 years, who reported living in a neighborhood without many physically active residents had a 53% (RR=1.53, 95% CI=1.01-2.32) higher risk of being physically inactive compared with girls in neighborhoods with many physically active residents. Mother-daughter agreement on neighborhood characteristics was fair to moderate, with weighted kappa statistics ranging from 0.19 (many physically active residents) to 0.60 (sidewalks on most streets).

Conclusions: These findings support the need for policies and programs focused on the built environment for physical activity promotion in youth, especially given that we have previously found an association between childhood physical inactivity and early puberty in girls, a risk factor for breast cancer and other health outcomes. 

Purpose: Exergaming’s potential to promote young children’s cognition and health remains largely unknown. We conducted a randomized crossover trial to evaluate the preliminary effects of a home-based educational exergaming program (LeapTV™) versus usual practice on preschool children’s executive function, sedentary behavior, and physical activity (PA).

Methods: A total of 34 preschool children (17 girls, Mage = 4.72±0.73 years; BMI-z = 0.39±1.08) were recruited. Participants were randomized to either exergaming condition (30 minutes/day, 5 days/week) or usual practice condition for 12 weeks, followed by a 1-week washout period (week 13) and a second 12-week crossover phase. Executive function was assessed by the Dimensional Change Card Sort (DCCS) test; sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA) were assessed via ActiGraph GT3X+ accelerometers. All participants underwent identical assessments at baseline, week 13, and week 26.

Results: Compared with usual practice, exergaming intervention increased children’s executive function by 1.9 DCCS unit (95% confidence interval [95% CI], -0.34 to 4.04; d = 0.22); decreased sedentary time by 22.1 minutes (95% CI, -25.22 to 18.98; d = 0.29); decreased light PA by 9.56 minutes (95% CI, -7.09 to -12.02; d = 0.22); and increased MVPA by 4.05 minutes (95% CI, 2.35 to 5.74; d = 0.20), respectively.

Conclusion: This study demonstrates the implementation of a home-based educational exergaming intervention would promote meaningful improvements in preschool children’s executive function and PA behaviors. Despite the promising findings, such intervention merits larger trials to maximize and confirm the potentials of LeapTV™.

Purpose: Youth with ID have low fitness and physical activity levels and poor diet quality.  Physical literacy (PL) and food literacy (FL) are hypothesized to underlie the healthy physical activity and eating habits. PL comprises motivation, confidence, and physical competence for physical activity engagement.  FL entails the capacity to learn about food and nutrition and make healthy choices. We developed and piloted a PL/FL program for youth with ID ages 12-16 yrs. Originally designed for in-person programming, the pandemic required significant redesign for remote delivery.

Methods: Six youth (4 male, 2 female) participated in remote sessions weekly (2 separate groups of 3 youth each) over 12 weeks. An ID-trained fitness instructor led 30-minute sports skills sessions focused on ball and locomotor skills using equipment sent to the home  (balls, low hurdles, paddles). A registered dietitian and 2 nutrition students led 30-minute nutrition education sessions on food group identification, making healthy choices, snack preparation, and taste testing. Families received tablets to access Zoom^TM, food preparation equipment, food lists, and pre-paid credit cards for food purchases. 

Results:  Attendance was 88%; all participants completed the program. Protocol fidelity was 91%.  Youth satisfaction data revealed that 5/6  liked the sport sessions   “a lot”; 1 liked them “a little bit”.  Two liked the nutrition sessions “a lot”, 3 liked them “a little”, and 1 did not like them.  Five youth felt the sessions were “just right”; 1 indicated they were “too hard”.  Parent satisfaction data indicated that 5/6 were satisfied overall. Four parents indicated their teen enjoyed the sport sessions; 5 indicated their teen enjoyed the nutrition sessions. Three felt the program increased their teen’s interest in physical activity/sports; 5 indicated the program motivated their teen to eat healthy foods. However, only 2 parents felt they had adequate space for the sport sessions. 

Conclusions: This small pilot suggests that a PL/FL program for youth with ID is feasible and acceptable. Effective interventions that promote positive health behaviors in youth with ID are needed.  PL/FL interventions for the ID population warrant further research, including evaluating in-person, remote, and hybrid formats.

Purpose: The ecological momentary assessment (EMA) has been used to identify the impact of social and environmental contexts on movement behaviors in various populations. However, few EMA studies focused on the interface of multiple contexts in promoting physical activity (e.g., outdoor and not alone as a joint context). This study combined two EMA studies collected among college students in US and Taiwan (TW) to fill this research gap.

Methods: The two EMA studies were designed to understand the psychosocial and environmental determinants of daily movement behaviors in college students. Participants in each country responded to 6 EMA surveys for 7 (US) or 14 (TW) days during waking time using an app. For each survey, they reported if they were sitting, standing, or moving, staying outdoors or indoors, and alone or with someone else.

Results: A total of 6,072 EMA surveys from 279 participants (US=118; TW=161) were included in the analysis. Findings suggested that, compared to staying indoors and alone,  participants were more likely to report movements with higher energy expenditure if they were outdoors and not alone (t= 24.75, p<.001), indoor and not alone (t= 4.31,  p<.01), or outdoor and not alone (t= 28.74, p<.001). They were more likely to report moving than sitting if they were staying outdoors, regardless of being alone or not (ts= 21.86 and 27.04, p<.001). These results were consistent between the US and Taiwanese college students. However, US students were more likely to report movement behaviors with higher energy expenditure and moving than sitting at any EMA survey (ps<.001). The models adjusted for participants’ sex, age, and BMI.

Conclusions: This cross-country EMA study identified identical phenomena that outdoor context and the presence of other people are jointly associated with more movements at a given time. The outdoor context tends to be relatively more important than being alone or not in promoting physical activity. The current study dichotomizes both the outdoor and social contexts into four simple but independent momentary contexts. Future EMA studies are encouraged to apply various items to capture and study the diversity of our social and environmental contexts for promoting active lifestyles.  

Purpose: Rural and urban active living environments are characterized by different opportunities for physical activity. Distinct rural-urban environments may interact with sociodemographic correlates, resulting in different physical activity behavioural patterns between rural and urban residents. This study aimed to 1) compare domain-specific physical activity patterns based on rural-urban location, and 2) explore interactions between sociodemographic correlates, domain-specific physical activity behaviour, and rural-urban location.

Methods: We used self-reported nationally representative cross-sectional data from the 2017 annual cycle of the Canadian Community Health Survey. Physical activity domains measured included active transportation, recreation, and occupational/household. Adjusting for relevant sociodemographic factors, we did two analyses: 1) binary logic regression to determine the odds of reporting any activity in each domain, 2) ordinary least squares regression using the sub-samples reporting >0 minutes per week of activity to compare how much activity was reported in each domain. 

Results: Rural residents were less likely to report any active transportation (OR=0.59, 95% CI [0.51, 0.67], p<.0001). Rural females reported an average of 7 fewer minutes of active transportation per week than urban females. For recreational physical activity, rural males had lower odds (OR=0.75, 95% CI [0.67, 0.83], p<.0001) and rural females had higher odds (OR=1.19, 95% CI [1.08, 1.30], p=.0002) of reporting any participation compared to urban residents. Rural females reported an average of 10 fewer minutes per week of recreational physical activity compared to urban females. Rural males (OR=1.90, 95% CI [1.74, 2.07], p<.0001) and females (OR=1.33, 95% CI [1.21, 1.46], p<.0001) had higher odds of reporting any occupational/household physical activity.

Conclusions: In Canada, urban residents tend to participate in more active transportation and recreational activity, while rural residents participate in more occupational/household physical activity. Location-based differences in physical activity are best understood by examining multiple domains and must include appropriate sociodemographic interactions, such as income and sex/gender.

Purpose

This review sought to evaluate health interventions aimed at adolescents that used theories of identity in the design of their behaviour change strategies. It aimed to investigate which theories have been used and how, as well as which intervention strategies have been most successful and why.

Methods

Six databases (PsycINFO, MEDLINE, Web of Science, EMBASE, CINAHL, and ERIC) were searched and results were screened by title, abstract and full text using defined inclusion and exclusion criteria. Data extraction and quality assessment were conducted by two reviewers for all studies and results were summarised in a narrative synthesis.

Results/Findings

A total of 26 studies from 20 papers were included in the review. Most interventions were based on self-affirmation theory (n = 15) and used a simple self-affirmation manipulation to strengthen aspects of a participant’s identity that were highly valued by them before presenting them with health risk or health promotion materials. Other identity theories/concepts used included role identity, implicit drinking identity and deviance regulation theory. Studies addressed a range of different health behaviours including diet, physical activity, alcohol use and smoking. Most studies (n = 16) were unsuccessful in achieving statistically significant changes to health behaviours.

Conclusions

Using psychological theories that are pertinent to adolescent development, such as identity theories, as a basis for intervention design is a step in the right direction. However, the low success rates found by this review highlight the importance of taking adolescent values into consideration. Health is not a priority for adolescents, so interventions need to find other ways to support adolescents to make changes that fit into their lives and matter to them. For example, several studies included in this review aimed to reduce alcohol consumption in undergraduate students. Alcohol consumption is an accepted social norm within this group and is tied to important social events and relationships. The ‘student drinker’ identity is also highly prevalent. Therefore, reducing alcohol consumption is not something that is valued by most students. If interventions can strengthen healthy identities that are highly valued by adolescents they may have more success in supporting them to make healthier choices.

Purpose: More studies should adopt a combine approach to modifiable lifestyle behaviors because of their potential synergistic effects on health. This study will 1) determine differences in children’s time allocation, considering sex and period of the week, and 2) identify family determinants associated with children’s time use.

Methods: In 2016/2017, we pooled cross-sectional questionnaire data from 3-10-year-old Portuguese children (n=8472). Using a standardized questionnaire, parents reported children’s time use in different behaviors - sleep, study, screen media, indoor and outdoor play, and commute to and from school - as well as children’s participation in sports, and family socioeconomic characteristics (e.g., siblings, type of family, and degree or urbanization). Correlations between time use indicators were performed and pairwise correlations were calculated. Multiple linear regressions were performed. First, using screen time as dependent variable (independent variables: indoor play, outdoor play, school commute, study time, sleep duration; child characteristics were used as control variables). Second, using children’s time use indicators as dependent variables (independent variables: family characteristics).

Results: Time-use correlation between activities was similar between boys and girls. Overall, boys accumulated more screen-time and spent more time in outdoor activities, but less in indoor plays in comparison with girls. Moreover, the time spent in different activities was correlated, particularly during the weekdays. However, the interaction between screen-time and outdoor play, indoor play, study-time and school commuting time was weak. Relevant effect on the time spent using screen media devices came from the sleep duration (more sleep=less screen). Also, children who practiced an organized sport, spent less time on screen, especially on weekends. Lastly, the time devoted for each task or activity was determined by a set of family sociodemographic factors such as urbanization and parental employment.

Conclusions: Identifying time spent in multiple activities that differ by sex (and associated determinants) is critical for the development of activity promotion strategies, and may help to inform evidence-based policies designed to increase physical activity and decrease sedentary behavior in young children.

Purpose: To assess the sleep strategies and lifestyle behaviors that nurses working irregular night shifts use to improve their sleep quality, and to compare the strategies of good and poor sleepers to determine whether the differences between the two groups could provide insights into possible good strategies.

Methods: A qualitative interview study was performed. Thirty-four nurses working irregular night shifts participated; 17 were classified as good sleepers and 17 as poor sleepers based on the Sleep-Wake Experience List. Data were collected through semi-structured, face-to-face interviews, using a guide of open questions regarding strategies/lifestyle behaviors around the night-shift set and for switching to a normal sleep rhythm after the night-shift set. The interviews were recorded, transcribed, translated, and analyzed by two researchers using thematic analysis and NVivo v. 12.

Results: Both groups described similar and different strategies that help them work and sleep well during and after night shifts. However, good sleepers mentioned a greater number of strategies and seemed to have thought about them more than poor sleepers. The most common strategies were having a clear structure, being organized—especially regarding sleeping time—maintaining a daily routine, and adjusting the sleep environment.

Conclusion: First, this is the first study that uses semi-structured interviews to explore sleep strategies among nurses working irregular night shifts who are good and poor sleepers. Second, the study findings indicate that good sleepers have a clear, consistent plan for the night shift period. Third, having a clear structure, being organized, maintaining a daily routine, and adjusting the sleep environment are often part of such a plan. To promote good quality sleep among nurses working irregular night shifts, they could be stimulated to develop such plans, therein considering their individual characteristics. Future interventions and research should help identify and encourage nurses to experiment with strategies/behaviors to find out what works best for them.

Purpose: The purpose of this study was to investigate the sleep quality of nurses working irregular shifts (including night shifts) and to determine whether sleep quality is associated with the need for recovery.

Methods: A descriptive cross-sectional study design was used. The study was conducted with 405 nurses working irregular shifts at Maastricht University Medical Center in Maastricht, the Netherlands, from September 2019 to January 2020. Data were collected using an online questionnaire that included sociodemographic characteristics, health, lifestyle behaviors, the Sleep-Wake Experience List, sleep problems, sleep duration, and the Need for Recovery scale. Data analysis was performed using descriptive statistics, chi-square tests, t-tests, AN(C)OVA’s and multiple linear regressions.

Results: In general, nurses working irregular shift experienced bad sleep quality. Nurses who worked irregular shifts, including night shifts, had even poorer sleep quality than those who did not work night shifts. Nurses who worked irregular shifts, including night shifts, demonstrated more difficulties in daily functioning than nurses who did not work night shifts. Sleep quality was significantly associated with the need for recovery and remained so after controlling for confounding variables (β =.554, p = .001).

Conclusion: First, the study findings show that nurses who work irregular shifts suffer from low sleep quality. Second, the study results show that nurses working night shifts had poorer sleep quality than those who work shifts but no night shifts. Third, this study is the first to find evidence that sleep quality is significantly associated with the need for recovery of nurses working irregular shifts. Given that a high need for recovery has been demonstrated to be a strong predictor of ill health, the findings suggest that enhancing sleep quality in nurses working irregular shifts may lead to a lower need for recovery, which may in turn lead to better health and less risk for burnout and sickness absence. Therefore, it is important to assess in future research whether sleep quality in nurses working irregular shifts can be improved by either optimizing irregular shifts schedules or by using certain sleep hygiene strategies.

Purpose: High sodium intake remains a pressing public health concern in Singapore with over 90% of the adult population exceeding the WHO daily limit, despite governmental efforts.  As over 75% of adults usually eat out daily and given the high level of sodium in popular outside foods, the food service sector is a key focus for policy interventions. We therefore explored the food supply chain stakeholders’ experience and perspectives towards existing and potential sodium reduction interventions.

Methods: We conducted 22 semi-structured interviews among food service vendors, suppliers and manufacturers. Participants were recruited by purposive sampling and thematic analyses using both deductive and inductive approaches were used.

Results:  Commercial considerations were a dominant motivating factor. Existing and potential interventions were seen as requiring considerable effort with varying degrees of risk, and without comparable benefits. Systemic issues such as limited healthier food supplies challenged the implementation of interventions while strong institutional leadership was viewed as an important facilitator. Technical barriers including lack of nutrition knowledge increased the perceived effort for programme implementation.  Perceived fairness was key to policy acceptability and compliance. However, constructs of fairness varied. Mandatory regulations were seen as a way of facilitating fairness and driving systemic change. Policies leveraging on negative emotional appeals such as warning labels were thought to be more effective in influencing supply chain and consumers’ behaviour. Yet, if the policy posed reputational or earnings risks, it was perceived as being restrictive and prompted participants to consider measures of evasion. Vendors viewed themselves as having to negotiate between policy requirements and customers’ expectations. The suitability of the policy was viewed to be context dependant, with certain settings being more appropriate for healthier food policy measures.

Conclusion: A comprehensive suite of policy measures are needed to shift the current status-quo where the benefits of selling healthier foods are vastly outweighed by the perceived efforts and risks involved. Key efforts to support this shift include creating a dominant supply of alternative healthier options, generating consumer demand for healthier foods, and reducing technical barriers for policy implementation.

Purpose:

Many physical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the intervention period. One possible cause of this lack of sustainability is that insufficient attention was paid to environmental factors that facilitate physical activity. A focus on interventions at both the environmental and individual levels might facilitate change in the long-term. This community-based study seeks to test a new multi-level (both environmental and individual levels), multi-component intervention to increase moderate intensity physical activity among people with low-incomes living in U.S. public housing developments, over a 2-year period.

Methods: 

The design of this study is a prospective, cluster randomized controlled trial, with housing developments (n=12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual intervention (E+I, 3 developments), against an assessment only control group (3 developments). The E only intervention consists of community health workers leading walking groups, an advocacy program for residents, and provision of walking maps/signage. The I only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is moderate intensity physical activity measured by accelerometry among an evaluation cohort (n=50 individuals at each of 12 developments) at 2-year follow up. Mediation (e.g., neighborhood walkability, social support, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to examine future implementation of multi-level physical activity interventions among public housing residents.

Results/findings: 

This ongoing trial is currently recruiting the baseline evaluation cohort; 154 individuals have been enrolled to date. Final results are anticipated in 2025.

Conclusions:

Findings will inform whether a community-based multi-level approach will lead to sustained physical activity promotion over two years. If effective, this trial has the potential for implementation through other federal and state housing authorities. 

Purpose: Health technologies provide opportunities to deliver lifestyle interventions targeting the metabolic syndrome (MetS). The purpose of this study was to test the feasibility of a health technology-assisted lifestyle intervention with imposed and self-selected components in adults with complex chronic conditions designed to decrease MetS risk.

Methods: U-DECIDE was a single-centre, 26-week, randomised controlled trial. The setting was specialist kidney and liver disease outpatient clinics in an Australian tertiary hospital. Patients had at least one feature of the MetS and had been referred for dietetic consultation. All participants received an individualised dietary assessment from a dietitian, an activity monitor (Fitbit® Inspire HR) and usual multidisciplinary care. Intervention participants received all follow-up contacts virtually. Additionally, they had access to a suite of health technology options from which to choose including frequency of text-messages (1-3 per week), online and mobile app-based nutrition and exercise information and group-based telehealth with diet (monthly) and exercise (weekly) specialists. The primary outcome was feasibility of delivery, determined by a priori criteria for safety (number of study-related serious adverse events (SRSAEs)), recruitment (≥50% of eligible patients), retention (≥70% participants completing end-of-program assessments), exposure (≥75% of intervention group have greater access to health professional contact than controls) and telehealth adherence (≥80% attendance at scheduled sessions). Secondary outcomes included difference in MetS severity score (MetSSS) at 26 weeks.

Results/findings: Of 67 randomised participants (intervention n=33, control n=34), 37 (55%) were men, median (IQR) age was 51 (41-58) years. Amongst intervention participants, 76% chose 2-3 text messages per week, 76% and 79% chose telehealth exercise and diet sessions respectively. The intervention group had no SRSAEs, and exceeded targets for recruitment (52%), retention (81%) and exposure (94%). Telehealth adherence was below target at 46% attendance.  There were no differences between groups for changes in MetSSS (N=26; intervention 0.4±1.1AU; control -0.4±2.1AU; MD (I-C), 95%CI: 0.78, -0.52-2.07; p=0.23).

Conclusion: Health technology-assisted lifestyle interventions for adults with complex chronic conditions are feasible in tertiary healthcare. Targeted solutions to support telehealth attendance are needed. Given the requirement for physical assessment, the utility of MetSSS as an outcome measure for telehealth interventions requires further consideration.

Background: Physical activity (PA) has many health benefits for young people. However, young adult women generally face a sharp decline in PA from transition into young adulthood, possibly due to negative societal and cultural norms influences. Therefore, this review aims to identify the self-perceived barriers and facilitators of young adult women's PA by reviewing qualitative studies and providing some contextual implications for future research.

Methods:  Medline, Pubmed, Scopus, SPORTDiscus, and Web of Science were searched to identify qualitative studies published between January 2000 and February 2022 that examined the barriers and facilitators of young adult women’s PA between ages 18 and 40. Research quality was appraised using the Critical Appraisal Skills Programme tool. Data were extracted and thematically analyzed based on the social-ecological model (SEM) tenets.

Results:  Barriers and facilitators from 23 studies were correspondingly distributed at five levels of SEM. The most frequently cited facilitators at the intrapersonal level were health and body-related goals, and barriers included lacking time and low self-awareness. Interpersonally, social relatedness and support were facilitators, while family commitment and social embarrassment were strong barriers. At the organizational level, organizations (family, workplace, neighbor, etc.) that provide sufficient facilities and a PA-friendly environment were facilitators and vice versa. PA venues (gym, etc.) provide women-centered programs with tailored and inclusive programs were strong facilitators. At the community level, gender stereotypes and norms such as body image concerns and mainstream beauty, femininity and PA choice, mother identity and family obligations, and women’s religious identity were outstanding barriers. Facilitators were providing a more inclusive environment and greater social acceptance.  At the environmental level, the distinct barriers for women were possible risks like sexual harassment and violence.

Conclusion: This systematic qualitative review showed that young adult women's self-report barriers and facilitators to PA are often gendered and beyond the personal level. Research in the future should emphasize the social-cultural influences rather than merely targeting individual education and behavior changes. Future studies may benefit from applying multilevel strategies employing the SEM model. Moreover, qualitative research is also needed to fully understand the implementation context and compensate for the gaps in quantitative analysis. 

Purpose: Children as the subject of many investigations into their food practices, should have their voices amplified and included to produce more appropriately and contextually tailored food and nutrition strategies that better cater to their needs and thus are more likely to garner intended nutritional outcomes. However, the extent and nature of children’s participation in research investigating factors affecting their food practices is unknown. Therefore, a scoping review was conducted to identify the extent of primary-school age children’s (aged 6-11 years) participation in qualitative research investigating food practice determinants across high income countries, and the methods used to perform this research. Methods: Six electronic databases were searched (Cochrane Library, CINAHL, Embase, ERIC, Medline and PsychInfo) for articles published up until February 2022. Hart’s Ladder of Children’s Participation was used to assess children’s level of participation. Findings: The search identified 107 peer-reviewed studies (121 papers). Ten percent (10%, n=11) were classified as non-participatory, 60% (n=64) as participatory, where 30% (n =32) were unable to be assessed due to a lack of information. Of the 64 participatory studies, 69% (n=44) achieved a more passive form of participation at all research stages (Level 4 on Hart’s Ladder, assigned but informed). Thirty-one percent (31%, n=20) reached Levels 5 and/or 6 (consulted and informed; and adult initiated, shared decisions with children) within later research stages (i.e., data collection, analysis and dissemination). No studies were found to have any research stage at the most active child-led degrees of participation, Levels 7 and 8. Conclusion: The findings of this review highlight the need for more opportunities to be presented to children to actively participate in food-related research, as well as an exploration of the methods and structures to support this. This review also hopes to inform how future food and nutrition research may more actively incorporate children’s perspectives.

Purpose: People with lived refugee experiences have fled their homes and that experience is forced, generally sudden and stressful, and often coupled with dislocation from family and friends. Food security is essential for families from refugee backgrounds and is vital to understand the motivations behind food selection behaviours. Food is intimately intertwined with self-identity, connects people to loved ones and therefore plays a vital role following forced displacement. 

Aims: To understand the facilitators and barriers of accessing cultural foods during the settlement journey for refugee-background families, from the perspectives of workers who support the settlement journey

Methods: Participatory action research methodology was used and governed by a steering committee of academic researchers and community members. Focus group participants were adult settlement and other workers who regularly interacted with people from refugee backgrounds, spoke English, and preferably self-identified with a refugee background.  Participants were recruited through community organisations in Brisbane, Australia, and focus groups were held at organisational workplaces or online.  The focus group guide was co-designed, focus groups were co-facilitated (where possible), and data analysis was conducted collaboratively by the steering committee. 

Outcomes: Eight focus groups (n=32) were conducted between June and October 2021.  Food security (specifically cultural foods access), culture and mental health were interrelated.  This was fundamental to all discussions, and when cultural food access, culture or mental health were maintained or adversely impacted, all three factors were likewise affected. The behaviours around purchasing cultural foods were motivated by the desire to express and validate culture, which in turn improved mental health. It was also found that individual and community support systems sustained access to cultural foods, while social, environmental, institutional and political structures impacted access to cultural foods, sometimes detrimentally.

Conclusions: This study highlights the need for behavioural interventions that foster social capital for refugee-backgrounds families, and consider food security, culture and mental health collectively.  Additionally, there is need for increased awareness of the settlement journey, and policy makers should incorporate cultural inclusivity into policies, by working with communities and providing opportunities for people to express their culture, improve access to cultural foods, and maintain mental health. 

Purpose: To describe the design of the mobile Lifestyle Intervention for Food and Exercise (mLIFE) app, the technical challenges that were encountered and addressed, and the 3-month participant feedback on intervention components. mLIFE is a 12-month randomized, remotely delivered, behavioral weight loss, physical activity (PA), and nutrition intervention.

Methods: The mLIFE app components included self-monitoring of diet (using a nutrient and food database), PA (syncing to FitBit Charge2), and weight (connecting Aria scale), as well as intervention delivery (via podcasts and tips of the day) and activities to facilitate social support. Participants earned points within the app by providing social support to fellow participants. A log of technical challenges with designing and implementing the app was maintained. At 3 months, participants were asked to rate each intervention component on a scale of 1 (completely unsatisfied) to 7 (completely satisfied). Themes for open ended comments were categorized. 

Results/Findings:  Technical challenges (n=4) were identified and addressed over the design and implementation of the mLIFE app. These included 1) finding a comprehensive, searchable nutrient database that could be easily integrated into mLIFE, 2) change of FitBit Aria scale from wifi to Bluetooth, which limited automatic syncing, 3) time zone and daylight savings time challenges, and 4) adding interactive discussion features. There were 106 participants in cohort 1 (mean age 49.3±11.8 y, 93% female, mean BMI 33.6±5.5 kg/m²) and 83 (78%) completed the 3-month feedback survey. Participants rated the overall study as 5.8±1.4 out of 7. Mean feedback ratings for each of the components from highest to lowest were 6.0±1.2 for tips of the day, 6.0±1.4 for weight monitoring, 5.9±1.5 for PA monitoring, 4.9±1.6 for podcasts, 4.5±1.6 for social interactions, and 4.4±1.9 for diet tracking. Of the 32 written comments on the overall intervention, the major themes identified were related to difficulties with the diet tracking feature (50% of comments), limited discussion interactions (13%), and lack of personalization (13%).

Conclusions:  The findings of this descriptive analysis can help to inform future mobile health interventions to avoid or resolve these identified technical challenges.

Purpose

People diagnosed with lung cancer typically have a higher symptom burden than other prevalent cancers. Additionally, people diagnosed with lung cancer are older adults (65y+) with comorbidities. Physical activity has shown to be beneficial for those with lung cancer for physical and psychological health, though few in this group meet physical activity guidelines. Digital technology can provide tailored and relatively low-cost interventions. Older adults are often wrongly assumed to lack digital skills, interest and not engage with digital technology regularly. Would involving intended users in designing these digital interventions result in better engagement?

Methods

A Patient Advisory Group (PAG) was formed using online dissemination of a recruitment flyer and the Involve Hull network. All members of the PAG had received or cared for someone diagnosed with lung cancer. In a series of workshops, the PAG helped to adapt a website for those diagnosed with cancer iteratively. After the first two workshops, Think-Aloud interviews were conducted with participants without prior knowledge of ExerciseGuideUK (n=7). Anonymised results were presented to the PAG to discuss potential revisions. All PAG workshops and interviews were conducted via Zoom.

Results/Findings

Twenty-five of the 41 comments raised in the Think-Aloud interviews were taken to the PAG. Sixteen comments were not presented to the PAG, 13 simple functionality revisions, and three were not feasible. The doctoral researcher (JC) presented suggested revisions to the PAG. The PAG unanimously disagreed with 56% of the initial suggestions, including the phrasing of physical activity information and language regarding behaviour change techniques.

Conclusion

It was challenging to hear, after initial revisions, the platform did not meet the needs of those with lung cancer from their perspective. Though often difficult to hear such feedback, it is vital for intervention and personal academic development. Including a sustained PAG over several months with intended users of digital interventions will lead to more relevant, accessible, and usable interventions. Through engaging with those who have cared for or living with a lung cancer diagnosis, JC gained insight into the needs of the study population and what to consider during the development of a digitally-based physical activity intervention.

Purpose: Physical activity (PA) affects blood glucose levels, which can be measured by continuous glucose monitors (CGMs). Feedback based on data from wearable devices like Fitbit and CGMs provide health information to users in real-time and are used for remotely delivered interventions to promote healthy behaviors like PA. Providing feedback via text messages using data collected from sensors provide opportunities for increasingly personalized motivational messages tailored to promote healthy behaviors at an individual level.  The objectives of this study were to qualitatively examine participant perceptions of lessons learned and behaviors changed throughout a remotely delivered mHealth PA intervention utilizing wearable sensors.

Methods: Twelve insufficiently active overweight/obese cancer survivors (aged 35-75) were recruited from a local tumor registry and participated in a pilot PA intervention study (November 2019 - September 2020). In the study, participants wore a Fitbit wristband and a CGM sensor for four weeks. They received personalized feedback messages 3-4 times a week, based on their real-time Fitbit and CGM data, via text messages during the intervention. At the end of the four-week intervention period, participants answered questions in individual interviews (semi-structured interview guide) on their CGM and Fitbit experience and usage, followed by their thoughts on what they’d learned throughout the study procedures.

Results: Participants reported learning about their health habits throughout the study, further indicating that they perceived take-a-ways from their participation that they could continue to carry over into their daily lives post-intervention. These lessons encompassed topics from PA patterns, glucose patterns, and diet, plus combinations of these topics. Because of the CGM, participants were more aware of the biological consequences of their behavior, leading to health behavior rumination and motivating them to change those behaviors – in contrast with mere Fitbit tracking or food diary tracking.

Conclusions: This research shows how personalized text messages using biological feedback provided motivation to improve participant’s diet and PA, expanding previous research describing barriers to PA engagement. It demonstrates how increasing access to personal biological information can positively relate with motivation to engage in PA. Health messaging should focus on avoiding health-related problems and instead focus on health improvement.

Purpose: Food insecurity has been a public health concern throughout the COVID-19 pandemic, with a range of responses to support household food security through governmental action and the emergency food system (food banks, food pantries, and other organizations that distribute food at no cost). Emergency food providers have navigated many changes since the pandemic began. We aimed to capture the experiences of stakeholders in the emergency food system and describe current needs in Minnesota (USA).

Methods: We conducted semi-structured interviews with key stakeholders in Minnesota’s emergency food system between September and October 2022, including nine state- and regional-level stakeholders and four food pantry managers. State- and regional-level stakeholders worked in government, at food banks, in Cooperative Extension (the community outreach division of the university system), or at non-profit organizations supporting or working with the emergency food system. Each of the food pantry managers we interviewed served rural communities and worked in their positions during the COVID-19 pandemic. We analyzed data using rapid qualitative analysis methods to identify recurring experiences and perceptions across interviews.

Results: Key strengths we identified included the presence of established networks of emergency food providers in Minnesota, the ability to share best practices with other providers and adapt to quickly changing contexts, support provided through governmental and non-profit organizations, and on-going provider commitments to ensure receiving emergency food is a dignified experience with choice. Enhancing labor capacity was a key need identified by all state- and regional level and two food pantry managers. All participants described how increased economic and food support early in the pandemic allowed them to adapt, but now support has decreased while, concurrently, inflation and other factors, but particularly high food prices, have limited supply and driven need.

Conclusion: The emergency food system successfully adapted to the dynamic situation and safely provided food in their communities during the pandemic. Despite this, emergency food providers require support in the form of quality food, funding, and labor support to enhance their ability to respond to increasing demand. Policymakers and industry should pursue strategies to support the emergency food system’s capacity to meet expanded need.

Purpose

Intuitive eating (IE) is a non-dieting approach to health, emphasizing internal cue recognition. This cross-sectional study evaluated the relationship between IE and dining out frequency (DOF) in undergraduates, providing insight regarding the role of the college food environment in IE behaviors.  

Methods

A convenience sample of Northeastern undergraduates were recruited via email to participate in an online health survey assessing IE and weekly DOF. IE was measured using Tylka’s IE scale-2, with higher scores indicating greater frequency of IE. Inclusion criteria included undergraduates between 18-25 years old with complete data sets. A MANOVA indicated differences in IE among participants with different DOF. Pearson’s r identified associations between DOF, IE, and IE subscales. 

Results/findings

Undergraduates (N=845) were primarily White (90.7%) and female (66.4%). The average IE score was 3.2 (± 0.5) out of 5. Most dined out 1-2 times per week (61.9%, n=524), followed by participants who never dined out (18.5%, n=155), those who dined out 3-4 times per week (16.4%, n=139), and 5-7 times per week (3.2%, n=27). There was a significant difference in IE based on DOF, F(12, 2217.4)=7.96, p<.001; Wilk’s Λ = 0.940, partial η2=.028. Tukey's HSD test for multiple group comparisons revealed IE was significantly different between those who never dined out (M=3.4 ± 0.04)  and those who dined out 1-2 times per week (M=3.2 ± 0.02), (p<0.05), 95% CI= [0.02, 0.26]. There were significant negative associations between DOF and IE scores (r(844)= -0.2, p<0.001), and several IE subscales including eating for physical rather than emotional reasons (r(844)=-0.2,p<0.001), reliance on hunger and satiety cues (r(844)=-0.1, p<0.001), and body-food choice congruence (r(844)=-0.2, p<0.001). 

Conclusions

DOF indicated significantly different IE behaviors within undergraduates, suggesting the college food environment is a possible determinant in IE. This research warrants exploration of facilitating wellness interventions within the college food environment to improve health behaviors.

Purpose: Children’s health habits tend to worsen as they approach adolescence. Parental health can play an important role in their children’s health behaviors. The main purpose of this study was to explore the association between children’s health behaviors and parental health throughout middle childhood and preadolescence.

Methods: The SI! Program for Elementary schools included 1770 children from 48 schools in Madrid, Spain. Children were assessed at baseline (6.3 years, 47.4% girls), first follow-up (FU) (8.9 years, 47.5% girls) and second FU (12.0 years, 47.0% girls). Families completed a series of validated questionnaires on their children’s adherence to the Mediterranean diet, physical activity, screen time, and sleep behaviors. Additionally, families self-reported their Blood pressure, Exercise, (body) Weight, diet (Alimentation), and Tobacco use, which were used to calculate the validated Fuster-BEWAT health score (FBS). Children meeting the recommendations for each health behavior were compared overtime and according to parental FBS.

Results: The percentage of children with high adherence to the Mediterranean diet and meeting the recommendations for screen time and sleep behavior decreased over time. Conversely, the number of children meeting the recommendations for physical activity increased. The odds of meeting the recommendations for screen time and sleep behavior significantly decreased from baseline to the second FU (0.09 [95%CI: 0.07; 0.11]; 0.07 [95%CI: 0.05; 0.11], respectively). The odds of meeting the recommendations were significantly higher at baseline in children from families with ideal FBS score in adherence to the Mediterranean diet (2.93 [95%CI: 2.02; 4.25]), physical activity (2.02 [95%CI: 1.40; 2.92]), and screen time (1.52 [95%CI: 1.06; 2.20]) than those with intermediate or poor FBS. This trend was maintained over time for all health behaviors, although no statistically significant differences were found at subsequent assessments.

Conclusions: Healthy habits decline during middle childhood, particularly diet, screen time, and sleep behaviors. Children from families with ideal FBS were consistently associated with meeting recommendations more frequently than those from families with intermediate or poor FBS. Parental health behaviors directly influence children’s health, and therefore health promotion programs on children should also aim to improve families’ health habits.

Purpose: Active transportation provides an array of health and societal benefits, including social capital. Previous research examining active transportation and behaviors of community participation has exclusively sampled high-income Western countries. However, little is known about how active transportation relates to community participation in low- and middle-income countries with diverse cultural, political, and physical climates. The current cross-cultural study investigates the relationship between active transportation and community participation to assess if and how this relationship varies across contexts.

Methods: This investigation uses a cross-sectional research design with the World Health Association Study on Global Ageing and Adult Health (SAGE) Wave 1 data (2007-2010). SAGE examines health, health behaviors, and aging in adults aged 50 and older (N = 47,103) in China, Russia, Ghana, South Africa, India, and Mexico. Active transportation is a continuous variable (0-7 days per week of walking or biking for transportation). Community participation is a 4-item scale that assesses meeting with local community leaders, working with neighbors to make community improvements, and attending meetings to address community issues. Each country is modeled independently using linear regression to assess the relationships between active transportation and community participation, controlling for an array of important covariates, including education, gender, and self-rated health.

Results: Findings show that active transportation has a positive relationship to community participation in Mexico (b = .03; p = .028), Russia (b = .04; p = .002), South Africa (b = .05; p = .044), and Ghana (b = .04; p = .000). Active transportation was not related to community participation in China. In India, active transportation has a very small negative relationship to community participation (b = -.01; p = .048).

Conclusions: Active transportation has societal benefits beyond individual health, including a positive association with community participation in Mexico, Russia, Ghana, and South Africa in adults aged 50 and older. Infrastructure supportive of active transportation is critical not only for individual health outcomes in older adults, but also to support the involvement of older adults in community affairs. More work is needed to understand cultural dynamics that may change the relationship between active transportation and community participation.

Purpose: Childcare centres are opportune settings for cultivating food provision practices that align with both human and planetary health, as they are widely accessed for substantial time periods. This is the first study to describe environmentally sustainable and healthy food provision practices including food budgets and explore staff perceptions on these domains in Victorian (Australian) childcare. 

Methods: An explanatory sequential design was utilised with quantitative data collection (surveys and audits), followed by qualitative (semi-structured interviews). Surveys captured food cost/child/day and environmentally sustainable food practices based on the World Health Organisation's Sustainable Healthy Diets Guiding Principles. Frequency of practices were assessed via likert scale and scored from 1 (never) to 4 (always). Mann-Whitney U tests analysed differences by centre type, location, and socioeconomic position.  Food served/wasted for one day was measured using calibrated scales and entered into a web-based menu assessment tool.  Semi-structured interviews explored staff perceptions on the findings. Themes were coded to the Theoretical Domains Framework. 

Results:  Survey results (n=129) showed lowest average scores were for “reduced packaged foods” (2.7/4). Only 23% purchased food locally from farmers/markets. This was lower in regional centres (8%) (p=0.04). Average food cost/child/day was AUD3.80, with 27% spending ≤AUD2.50/child/day and no differences by centre type, location, or socioeconomic position. Less than half (47%) of staff had previous nutrition training. One menu in the audits (n=12) was compliant with nutrition guidelines with the remainder serving insufficient quantities of some food groups, yet 9-64% of food served was wasted.   Interview themes (n=12) were “knowledge”- uncertainty about environmentally sustainable food and the need for resources, “skills” – support needed for planning, shopping, and budgeting, and “belief about consequences” – local food is expensive and will not fit budgets.

Conclusions: There appears to be a lack of sustainable food knowledge and skills, insufficient training, and restrictive food budgets. The intersection of healthy, environmentally sustainable, and budget-friendly food provision remains under-researched and likely difficult to achieve. This sector requires strong government policy action, research, and practice guidelines that supports food provision that is environmentally sustainable, healthy, and affordable, to contribute positively to human and planetary health at scale. 

Purpose: Active commuting to/from school (ACS) rate in Spanish youth is around 60%, but cycling trips are very scarce (<1%), and to date it is unknown what is the physical activity energy expenditure (PAEE) derived from different modes of commuting to/from school. Therefore, the ENERGYCO study aims to address this gap through two phases: the phase one will focus on the validation and testing of a protocol to measure Physical Activity Energy Expenditure (PAEE) derived from different modes of commuting to/from school (i.e., walking, cycling, and driving). While the phase two will consist of quantifying the PAEE derived from an eight-week cycling to/from school intervention using the validated protocol and its effect on different health outcomes.

Methods: Participants will be Spanish adolescents (phase 1: ~50 adolescents aged 12 to 16 years from one city; phase 2: ~300 adolescents aged 13 to 14 years from 3 cities). In phase one, different instruments will be used to measure the PAEE of commuting to/from school: 1) Global Positioning System + accelerometer, 2) Senseware PRO3 Armband, and 3) COSMED K5. In phase two, a cycling program will be implemented as familiarization and after that, participants will cycle to/from school for a total of 8 weeks. During phase two, participants will self-report their sociodemographic characteristics, mode of commuting to/from school and other destinations, and psychosocial and health status. In addition, PAEE, body composition, physical fitness, and blood pleasure will be evaluated.

Results: After quantifying the PAEE derived from different modes of commuting to/from school, the real PAEE of these activities will be known. Furthermore, we consider that an intervention based on completing eight weeks of cycling to/from school will impact different health parameters in the adolescents.

Conclusions: The ENERGYCO study will contribute substantially to society, providing knowledge about the contribution of a daily behaviour. Moreover, a positive impact in the health and quality of life of adolescents is expected through the increase of their PAEE. Future research on youth health may consider these findings to quantify the PAEE of commuting to/from school that occurs daily and in every scholar.

Purpose:  Studies show that physical activity (PA) and adequate sleep protect cognitive health as people age.  Few studies have examined activity patterns across the 24-hour activity cycle (24HAC) which includes PA, sedentary time (ST), and sleep, in older adults, despite interdependencies among these behaviors.  We used data from the Adult Changes in Thought activity monitor (ACT-AM) study to explore cross-sectional associations between the 24HAC and cognition in older adults.

Methods:  Participants (N=1034) in the ACT-AM study were dementia-free adults over age 65 who wore activPAL accelerometers for 7-days between April 2016 and July 2018.  We extracted daily activPAL sitting, standing, stepping, and in-bed (representing sleep) time to represent 24HAC behaviors. We used Latent Profile Analysis (LPA) to define 24HAC profiles and assigned each participant to the profile with highest posterior probability using Latent GOLD 6.0 software.  Cognitive Abilities Screening Instrument item response theory (CASI-IRT) scores measured global cognition.  The association between cognition and 24HAC profile was estimated using a linear regression model adjusted for age, sex, race/ethnicity, BMI, education, depressive symptoms, and self-rated health, and corrected for profile assignment uncertainty. P-values were obtained using a Wald-type test.

Results:  Participants were mean age 77 +/- 7 years, 55.8% female, 90.2% White, 1.4% Hispanic, with mean CASI-IRT 0.61 +/- 0.69.  Participants’ average sit, stand, step, and sleep hours/day were: 10 (2), 4 (1.6), 1.4 (0.7), and 8.5 (1.1). We identified 4 classes: 1) “most active/least sedentary” (12.8%); 2) “moderately active low sleepers” (24.9%); 3) “average activity/sleep” (43.8%); and 4) “least active” (18.6%).  Compared to class 3, profiles 1 and 2 had more women, were younger, had lower BMI, and better physical function, sleep quality, and CASI-IRT scores. Compared to the “average activity” group, the “least active” class had lower CASI-IRT scores (β= -0.24, p= 0.017) in unadjusted associations that were non-significant in adjusted models (β= -0.027, p= 0.80).

Conclusions:  LPA is a helpful approach for describing 24HAC behaviors in older adults.  We did not see cross-sectional associations between 24HAC classes and cognition in this relatively healthy sample.  Future studies can use LPA to link 24HAC profiles to changes in cognition over time.

Purpose

In Australia, family day care (FDC) is a form of childcare where education and care are provided for up to four children below school age and an additional three school-aged children, in a home environment. Research shows that the food and physical activity environments in FDC can be improved to better support healthy behaviours. As online platforms can be a practical method to assist in quality improvement, it is feasible to consider the development of an online support tool in this sector. The aim was to develop an online support tool to improve nutrition and physical activity practices in FDC.

Methods

Formative work included review of FDC food and movement policies (n=23), an observational study (n=33) and online survey (n=186) of the healthy eating and active living (HEAL) environments and practices within FDC, and online focus groups (n=10) to obtain feedback on the tool from stakeholders. Regular meetings with stakeholders ensured co-development of the tool with the sector. A pilot study will be conducted to test the feasibility and acceptability of the tool, followed by a randomised controlled trial (RCT) to explore efficacy of the tool. An online survey will be used to collect data. For the RCT, the survey will collect data at baseline and at six months after commencement of the intervention to measure improvements in the ways that HEAL policies and practices are reflected in quality improvement planning.

Results

Key priority areas for improving HEAL practices in FDC identified in the formative work were role modelling healthy eating behaviours, decreasing screen time, and increasing time for physical activity. For the RCT, the efficacy of the intervention will be tested using an intention to treat approach and linear mixed models. Outcome variables at six months post-intervention will be validated against a checklist, which will be used to rate the quality of the FDC service provider’s quality improvement plan.

Conclusion

The tool is predicted to serve as a platform for reporting against the National Quality Standard, to identify gaps between policy and practice, and to facilitate HEAL practice improvements.

Purpose: Young women spend an average of 50 minutes daily on social media. Therefore, social media platforms may be promising intervention tools to address pertinent aspects of women’s health including body image and health literacy. We aimed to co-design a lifestyle intervention on social media targeting eating, physical activity, and social well-being behaviours that is evidence-based, acceptable and engaging for young women aged 18-24 years.

Methodology: The study used a participatory design framework and previously published iterative mixed methods approach between August-October 2022. A participatory needs assessment was conducted with young women, dietitians, and digital marketers. Data were collected in two phases. Phase 1 involved expert discussions (n=12), with experts being consulted on intervention objectives. Phase 2 involved codesign workshops, where 19 young women (n=6-9 in each workshop) and two researchers met weekly over three weeks. We used a structural approach for designing and planning interventions, known as Intervention Mapping.

Findings: Matrices for the intervention objectives were constructed using expert panel discussions, and feedback was sought from young women in participatory workshops. In collaboration with young women, the intervention is being designed and produced using an iterative process. Preliminary analysis shows that most participants prefer Instagram for daily stories and static posts and TikTok for video content. Regarding health, all participants agreed that self-care and mental health is equally as important as physical health. The participatory groups and professional experts will design the implementation plan. The protocol of the process and effect evaluation will be executed by academic researchers with input from young women.

Conclusion: The study involves end-users throughout the process while at the same time developing interventions based on existing evidence. This study may guide other researchers or health professionals seeking to engage young women in the co-design of women’s health promotion or intervention content on social media. The effectiveness of the social media lifestyle program will be tested in a pilot randomized controlled trial.

Low student mental wellbeing (SMW) is increasingly reported amongst adolescents worldwide. Changing physical activity behaviour (PAB), i.e., increasing moderate-to-vigorous physical activity (MVPA) and decreasing sedentary behaviour (SB) can potentially improve SMW. Vocational education and training (VET) students are a vulnerable group that are prone to insufficient physical activity (PA) and SMW problems. Therefore, this study aims to evaluate the effect of a PA-based lifestyle intervention on PAB and SMW of VET-students.

In a quasi-experimental study 126 VET-students were non-randomly allocated to a 20-week PA-based lifestyle intervention or an education-as-usual control group. Measurements were conducted before and after the intervention. PAB(i.e., SB and MVPA) was measured using the international physical activity questionnaire. SMW, operationalized as lack of depressive symptoms and presence of self-esteem, were measured with the Centre for Epidemiologic Studies Depression scale and the Rosenberg self-esteem scale, respectively. Repeated measures ANOVAs were used to evaluate the intervention effects on PAB and SMW.

Repeated measures ANOVA revealed a significant time*group effect (F(1, 89) =  8.40, p = .01) for SB but not for MVPA. SB decreased in the intervention group and increased in the control group. For MVPA a significant negative main effect of time was found (F(1, 89) = 5.74, p = .02), thus in both groups MVPA decreased significantly over time. No time*group effects were found for depressive symptoms or self-esteem.

In summary, the PA-based lifestyle intervention significantly decreased the amount of SB, but had no effect on MVPA. Unfortunately, the intervention did not influence any of the SMW concepts. A possible reason could be that the PA-based lifestyle intervention in this study focused on more than only increasing PA. Thus, it is possible that the intervention was not intensive enough to change MVPA levels in the intervention group, resulting in not finding significant effects on SMW. Future research should investigate whether more intensive PA-based lifestyle interventions are more effective in increasing MVPA and subsequently SMW. Future research could also take additional lifestyle factors (e.g. sleep and nutrition) into account, since several lifestyle factors can have an effect on SMW.

Purpose: This scoping review explores the implementation models and frameworks used to develop, explore, and/or evaluate community-based physical activity programs for children. The foundational components of the implementation models and frameworks and practical application in real-world settings are also described. The findings provide context into the strategies used previously by researchers and program developers to support the implementation of physical activity programs at a community level.

Methods: The methodological framework developed by Arksey and O’Malley (2005) and the updated recommendations from Levac, Colquhoun and O’Brien (2010) were used to search, identify, and summarize applicable studies. This review also met the requirements in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Reviews Checklist (PRISMA-ScR). A detailed search of six databases and three academic journals was conducted. The search string included a variety of terms related to physical activity, children, implementation science, and community-based programs. To be eligible for inclusion, the articles had to be peer-reviewed and had to use an implementation model or framework to guide the development, exploration, and/or evaluation of a community-based physical activity intervention for children ages 5 to 12 years. Information about the article, the program, and the implementation model/framework were extracted and summarized. 

Results: The search retrieved 42,202 articles, of which 27 met the inclusion criteria. Of the identified models and frameworks, eleven guided program development, one explored the barriers and facilitators for program implementation, and two evaluated implementation and physical activity outcomes. Tailoring, situational analysis, and element identification were common components among the identified models and frameworks. 

Conclusions: As program implementation can affect the success of physical activity initiatives, researchers and program developers should consider using implementation models and frameworks to guide their community-based programs. The included articles were all published in the last ten years, demonstrating the use of implementation models and frameworks in community-based physical activity initiatives is still in its infancy and requires further exploration. Further research examining the application of new and existing implementation models and frameworks in developing, exploring and evaluating community-level programs is warranted.

Purpose: The impact of community-based programmes to prevent and manage non-communicable diseases may be limited unless they can be scaled up and sustained. Social network analysis – the measurement of the structural relationships between individuals or organisations – may serve as an important tool to better understand the potential role of social networks in scaling up and sustaining complex community-based physical activity and nutrition programmes. 

Methods: This was a mixed-methods study using a complex, South African healthy lifestyles initiative as a case study (Western Cape on Wellness, WoW!). This programme is made up of a core team, over 60 partner organisations, and over 700 community champions. The first phase was a network survey. Sixty-seven network partners were asked about their relationships along five themes: centralisation, quality of relationships, cliques, leaders, and shared goals. Network relationships and visualisations were determined using UCINET and NetDraw software. Semi-structured interviews were then conducted with fourteen purposively sampled network stakeholders, representing the WoW! team, partners, and champions. Interview transcripts were analysed with the help of NVivo using Framework Approach. 

Findings: Results revealed a centralised network around the WoW! team, other possible network leaders, overall unclear role differentiation, and low rural representation. Despite testing the survey process, there was still a fairly low response rate (39%) which brings into question the practicality of collecting social network survey data from these complex settings. Interviewees supported the survey findings and provided contextual understanding of the network, such as how centralisation affected them. However, participants indicated that while some aspects of the research are useful, such as the visual outputs, most of the analyses did not provide enough information for them to take action in the network. Participants suggested the use of a “live mapping” tool that can provide the visual benefits of social network analysis while taking into account the data collection capabilities and information needed to measure, monitor, and act in complex community networks. 

Conclusions: This research contributes to the development of practical network analysis tools in improving the scale-up and sustainability of complex community programmes, particularly in low-income settings where it may be needed most.

Purpose: The primary aim of this project is to determine preference-based, culturally-appropriate fruits/vegetables (F/V) meeting the Dietary Approaches to Stop Hypertension (DASH) diet recommendations for immigrant, Hispanic/Latinx individuals with hypertension and obesity via a phased, iterative process. 

Methods: Phase 1, the initial conceptualization of a culturally-appropriate, medically-tailored “DASH box” utilized a 21-question survey of validated tools to understand patient demographics, social determinants of health, and F/V preference. The survey was administered to 49 patients or providers at a community health clinic, originating from varying Latin American countries. Phase 1 informed the development of 3 F/V boxes consisting of  culturally appropriate, high-preference F/V in varying modalities (fresh, frozen, canned) and 3 F/V boxes with culturally-appropriate, high carotenoid F/V in varying modalities utilized in the next phase of the study. Phase 2, or the formative intervention, includes 7 individual interviews to gather qualitative feedback on the DASH box contents and perceptions of health. 

 Results/findings: For the 38 women (78%) and 11 men (22%) who completed surveys, highest preferences for fruits were mango (58.3%), watermelon (52.1%), and banana (47.9%), and vegetable preferences included tomato (41.7%), cucumber (43.8%), and lettuce (37.5%).  In the patient sample, 41.7% reported food insecurity, and 46.9% indicated they were unable to afford healthful foods for balanced meals. Emerging themes from the formative interviews show participants prefer fresh F/V to frozen, with little preference for canned foods. The F/V boxes continuing all fresh items were unanimously preferred over other boxes with some frozen or canned foods. Additionally, all participants expressed that “the foods in the box were appropriate for their culture”, and interviewee 3 said, “all of the [boxes] have something good, I think that the best option is the most natural”. Financial and transportation barriers were identified as challenges to obtaining F/V in the diet. 

Conclusions: Little research displays the work highlighting community opinions to encompass cultural food preferences. Our study provides formative contributions to research regarding culturally-appropriate fruit and vegetable preferences in a Hispanic/Latinx community.

Purpose:

To synthesise the barriers and facilitators to the dissemination of research related to the prevention of non-communicable diseases (NCD) to end-users of public health research.

Methods:

A mixed methods systematic review, was conducted following the JBI convergent integrated approach. A search of 3 electronic databases was undertaken to identify studies published between Jan 2000 -May 2021 together with grey literature searches. We included quantitative, qualitative and mixed methods studies investigating factors influencing the dissemination of NCD research. Quantitative evidence was extracted, then converted into ‘qualitized’ data and categorised into themes based on the Framework for Knowledge Translation (FKT) which include: the user group, the issue, the research, the researcher-user relationship and dissemination strategies.

Preliminary results/findings:

The initial database search yielded 27,192 articles. After removal of duplicates, we screened 20,343 titles and abstracts, and retrieved 643 articles. Following full-text review, we included 11 qualitative, 1 quantitative and 4 mixed-methods studies, conducted in 9 different countries and on physical activity (n=6), nutrition (n=1), healthy body weight (n=1), and obesity prevention (n=1). Factors affecting dissemination were categorised across all 5 themes of the FKT. Barriers related to ‘the user group’ were inadequate timing and perceived low value of disseminated guidelines, and facilitators being end-users’ interest and support in health and inclusion of stakeholders in dissemination process. Regarding ‘the issue’, perceived difficulties in linking research to policy hindered dissemination and an organisation (audience) prioritises that health facilitated dissemination. For ‘the research’, a reported barrier was lack of compatibility of content of guidelines and organisation goals (audience) and a facilitator was guidelines being evidence-based. Barriers regarding ‘the researcher-user relationship’ were the researcher and practitioners’ different priorities and a facilitator was the mutual benefits for members of partnership. Regarding ‘dissemination strategies’, barriers were unclear target audiences and lack of communication skills, with facilitators being endorsement by recognised organisations or professionals and disseminating research findings through existing channels.

Conclusion:

This review identified the key barriers and facilitators that can be targeted to improve the dissemination of research related to NCD and their risk factors including nutrition, physical activity and obesity prevention.  

Purpose: To identify types of vigorous intermittent physical activity that are feasible to implement as ‘exercise snacks’ in workplace interventions.

Methods: We conducted a scoping review to examine the peer reviewed literature on interventions involving brief bouts of vigorous intermittent physical activity. We searched five databases for articles reporting on experimental and quasi-experimental studies that involved brief bouts of vigorous-intensity physical activity (e.g., high intensity interval training, HIIT) with physical and/or mental health outcomes in adults published up to March 2022. We extracted and synthesised data on characteristics of the intervention (types of activities, duration, frequency), participants, settings and outcomes. 

Results: We identified 82 relevant articles (54% RCT, 24% cross-over, 12% randomised pre-post). Half the studies were conducted in a laboratory or clinical setting, 11% were school-based, 7% in mixed settings, 25% did not report the setting, and none were in workplaces. Studies involved participants who self-identified as sedentary/inactive (40%), were overweight/obese (29%), or had chronic conditions (30%). The most common type of activity performed in brief vigorous bouts was cycling, followed by running or sprinting, and walking. Nearly one fifth of studies involved interventions with mixed vigorous activities such as running plus football, game-based activities, and circuit training (e.g., squats, push ups, jumping jacks). Only 2 studies gave participants free choice of the activities they would like to do at high intensity in intermittent intervals. Intervention duration, composition and frequency varied from one session on a cycle ergometer (4X4-min exercise + 4X3-min rest) to 20-minute circuit training with drills and games twice per week for three months, to 16-minute HIIT sessions of self-selected activities twice per week for five years. Most studies measured outcomes related to cardiometabolic health, while few examined effects on mental health. 

Conclusion: Translating evidence of the benefits of vigorous intermittent physical activity into workplaces requires more attention. Most studies in this scoping review were based in laboratory or clinical settings. The feasibility and acceptability of engaging in vigorous intermittent bursts of cycling and sprinting and other activities in workplace settings require further investigation with end-users in formative research before testing in larger trials.

Purpose: Fidelity assessment is essential to dissemination and implementation science. Fidelity can be measured through direct, independent observer, assessment which is rigorous and expensive and/or indirect, implementer, assessment. Understanding the utility of indirect assessment is important to determine its potential to provide valid fidelity information in large trials or where implementation of interventions covers a broad geographic area. This study compared direct and indirect measures of fidelity from a 12-week family healthy weight program, Building Healthy Families (BHF), across 7  rural US communities.

Methods: Trained observers completed weekly direct assessments in each community while community implementation teams (CITs) provided weekly indirect assessments immediately following the completion of each session. Direct assessment measured key components on a 3-point scale (0=did not cover, 1=inconsistently covered, 2=completely covered), indirect assessment used a 10-point scale (1= did not achieve objective to 10= completely achieved objective). Correlations between direct and indirect assessments for each fidelity component (i.e., nutrition and physical activity (PA) content, self-regulation support, and family engagement) were completed within and across communities. Descriptive statistics were also completed.

Results/findings: Direct and indirect fidelity assessments were significantly correlated for PA content (r=0.92), nutrition content (r=0.37), and family engagement (r=0.41), but not for self-regulation (r=0.05). The rank order of the fidelity assessments differed between direct (highest to lowest=nutrition, PA, self-regulation, family engagement) and indirect (highest to lowest=family engagement, PA, nutrition, and self-regulation). While not powered to examine significant differences in direct-indirect assessment correlations by community, there were variations in these relationships across communities.

Conclusions: Correlations between direct and indirect fidelity assessments may indicate that (1) the measures assessed different aspects of fidelity, (2) an existence of social desirability in indirect assessment, or (3) different perceptions between trained independent observers and implementers trained to deliver BHF rather than to assess fidelity--or some combination of these factors. Determining the relationship between direct/indirect assessments to participant outcomes will provide additional information on the utility of each method and determine which factors are most relevant to the development and implementation of fidelity assessments that are efficient and allow for rapid monitoring and feedback.  

Better Late Than Never?! Five Compelling Reasons for Putting Physical Activity in Low- and Middle-Income Countries High Up on the Public Health Research Agenda

Purpose
The aim of this manuscript is to acknowledge the uncertainty of evidence in the field of domain-specific physical activity in low- and middle-income countries. The unique disposition of people from low- and middle income countries and their relationship with physical activity (social and cultural norms, priority setting) is discussed and social, cultural, environmental and structural factors that shape physical activity behaviour from low- and middle income country contexts are explored.

Methods
39 established researchers presented their expertise in the field of physical in low- and middle income countries in a discussion. Key messages have been drawn from the expert knowledge to present future avenues for physical activity policy, intervention and multisectoral collaboration.

Findings
Since 2020, the world has been navigating an epidemiologic transition with both infectious diseases (COVID-19) and noncommunicable diseases intertwined in complex and diverse ways. People in low- and middle-income countries not only have the highest risk of developing chronic diseases, they also develop the diseases at a younger age, they suffer longer, and they die earlier than people in high-income countries.

Conclusion

Only through concerted efforts and multisectoral actions—combined with targeted and sustained interventions, as well as local voices—may we succeed in putting LMICs firmly on the global PA agenda and thus create the inclusive change that is long overdue. Therefore, we present 5 compelling reasons for putting physical activity in low- and middle-income countries high up on the public health research agenda and we call for more commitment to inclusive and context-specific public health practices that are paired with locally relevant promotion and facilitation of PA practice, research, and policymaking. The 5 reasons include 1) Preconditions and varying awareness; 2) Limited opportunities; 3) Lifestyle changes; 4) Increased urbanization; and 5) Restricted support.

Purpose: Physical activity (PA) and reductions in sedentary time (SED) may mitigate cancer-related cognitive impairment (CRCI). The purpose of this study was to: a) examine the associations between changes in PA, SED, and cognitive function in cancer survivors during the pandemic; and b) examine clinical subgroups that moderate this association.

Methods: An online, cross-sectional survey was administered globally to adult cancer survivors. Cancer survivors self-reported demographic and clinical variables, regional COVID-19 restrictions, moderate-to-vigorous PA (MVPA) prior to and during the pandemic using the modified Godin Leisure Time Exercise Questionnaire, and cognitive function using the Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog). SED was measured using the Domain-specific Sitting Time questionnaire. Meaningful changes in MVPA (i.e., increase to ≥150 or decrease to <150 min/week) and SED (i.e., ≥60 min/day) were used to categorize cancer survivors with no change in behavior, a desirable change in behavior (i.e., increase MVPA to meet PA guidelines or decrease SED by ≥60 min/day) and an undesirable change in activity behaviors (i.e., decrease MVPA to <150 min/week or increase SED by ≥60 min/day). Analysis of covariance examined differences in FACT-Cog scores across the activity change categories in the total sample and clinical subgroups. Planned contrasts compared differences in FACT-Cog scores between cancer survivors with (1) no meaningful change vs. any change, and (2) a desirable change vs. undesirable change.

Results: Cancer survivors (N=372; M_age=48.7±15.3 years) were primarily female (71.7%), diagnosed with mainly breast (30.6%), gynecologic (14.2%) and hematologic (13.2%) cancer, and had a mean months since diagnosis of 87.8±83.1. There were no significant differences in FACT-Cog scores across activity change categories in the full sample. Cancer survivors diagnosed ≥5 years ago (t(165)=-2.00; p=.048) or received treatment ≥5 years ago (t(106)=-2.24; p=.03) that had a desirable change in activity reported better perceived cognitive abilities than those who had an undesirable change. No differences were found in the FACT-Cog for cancer survivors who had no meaningful change compared to those who did.

Conclusions: PA promotion efforts during the COVID-19 pandemic should consider reducing SED in addition to maintaining MVPA in long-term cancer survivors to mitigate CRCI.

Purpose: Customer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This presentation will describe the customer discovery process for Building Healthy Families (BHF) an evidence-based, family healthy weight program designed to be delivered in rural areas by trained community implementation teams.

Methods: The customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed.

Results: While BHF was designed to be flexible in the type of implementation organization due to different resources being available in different rural communities, a focus on rural health departments provided the most consistently supportive context for intervention adoption. These health departments prioritize childhood obesity but lack resources to implement effective programming. Several intervention funding approaches were also identified that included (1) program grants from local and national foundations, (2) local value-based care hospital systems and (3) regional employer groups.  Payment plans recommended included licensing fees and tiered payments based on level of implementation support (e.g., recruitment support, implementation consultation) at the organizational level and tiered fees at the participant level based on family ability to pay. Marketing a range of BHF outcomes (e.g., weight change, constructive family time, social & emotional support) and the use of a not-for-profit business model were also recommended during the customer discovery process to increase the likelihood of BHF scale up and sustainability.

Conclusions: Engaging in customer discovery was an important exercise to better understand the intended audience and the factors that could assist or hinder future scale up. These findings provide practical directions for BHF commercialization that will increase the likelihood of program adoption, implementation, and sustainment while also allowing the program to be low or no cost to eligible families.

Purpose
In the Dutch healthcare system, advice on lifestyle-related behaviour in consultation with a healthcare professional is hindered by limited time, insufficient motivational skills and insufficient knowledge on referral options. We propose a new care pathway in which lifestyle medicine related care is organized through a separated lifestyle front office (LFO) in the hospital in collaboration with community-based lifestyle initiatives. The aim was to identify barriers and facilitators for implementing a LFO in a hospital, and identify matching implementation strategies.

Methods
Semi-structured interviews were held with healthcare professionals (i.e. physicians (assistant), dieticians, physiotherapist, (specialized) nurses) from different departments (n=33) and with patients (n=27) under treatment in the hospital who had either a BMI of 25≥ kg/m² or who was a current smoker. Topics included experience with (i.e. providing or receiving) lifestyle-related care, and views, needs and preferences regarding design and implementation of an LFO in the hospital. An inductive thematic content analysis was conducted to identify barriers and facilitators. Barriers were matched to evidence-based implementation strategies with the CFIR-ERIC Implementation Strategy Matching Tool, resulting in an implementation plan that indicated strategies in three time-related phases: 1) preparation; 2) launch; 3) continuation.

Results
Barriers and facilitators were clustered according different organizational stages of the identified care pathway and patient journey: 1) Referral to the LFO (i.e. healthcare professional characteristics, health care professional motivation, patient motivation, resources); 2) Appointment at the LFO (i.e. fragmented care, lifestyle broker characteristics, time, case load, resources, perceived effectiveness); 3) Referral to community-based lifestyle initiatives (i.e. quality monitoring, patient motivation, patient behaviour, reimbursement structures, location); 4) Communication between patients and healthcare professionals (i.e. feedback, stakeholder characteristics, digital resources). Implementation strategies included identifying champions dedicated to supporting and marketing implementation of the LFO, recurrent training for professionals, and building a stakeholder network.

Conclusion
Insights from the current study are based on a relatively large and diverse stakeholder group and provide important insight for implementation of an LFO in the hospital. Future research should provide information on the effect of implementation strategies on actual implementation of an LFO in the hospital and if adaptations are necessary.

Purpose: The purpose of this mixed-methods intervention development study is to adapt an existing, feasible, smartphone-based cardiac rehabilitation programme (REMOTE-CR) for older adults LWBC. The overarching study addresses the development, modelling, and formative testing phases of the MRC Framework for Complex Intervention Development. In this abstract, we will focus on Part 1; which aims to explore the needs and preferences of older adults living LWBC and allied/healthcare professionals (A/HCPs) for a smartphone-based, tailored rehabilitation programme.

Methods: Recruitment is currently ongoing, however, we aim to recruit 30 older adults LWBC (10 in each age group; 65-74, 75-84, 85+) and 20 A/HCPs. Patient participants are interviewed via web-based video conference or telephone. A/HCPs participate in either focus groups of ~five people or individual interviews. These are held online where possible. Patient interviews ask, i) current mobile and internet use, supportive care needs, previous supportive care advice received during their cancer care pathway, and activity-related behaviour, ii) what they would want to get from (e.g. what they would want to see change in) and would need to be able to use a smartphone-based programme designed to increase physical activity. Examples of content and design from REMOTE-CR and previous research in physical activity counselling and programme preferences and online supportive care among older adult cancer survivors are discussed and apparent gaps explored. Topics for A/HCP focus groups include acceptability of a remote-delivered wellbeing programme, education needs for patients and clinicians for usage and content, supervision requirements, and ideas for potential scalability.

Analyses/Results: Interviews and focus groups are recorded and transcribed verbatim. Data is analysed using a thematic framework, using a deductive and inductive approach. We will report on emerging themes that will guide the mapping of intervention components to desired outcomes for Parts 2 and 3.

Conclusions: Part 1 will provide componenets that will lead to a cancer-specific version (Part 2: REMOTE-GO) of the cardiac programme. Part 3 of this stufy will be user testing the programme among an older adult cancer population. This study will deliver a co-adapted smartphone-based wellbeing programme with older adults LWBC ready for feasibility testing.

Purpose

In the last two decades, there have been many community-wide initiatives aiming to prevent or reduce childhood obesity, and promote healthier nutrition and activity behaviours, with mixed results. Combining primary data in a way that enables analysis across multiple studies and communities will enable us to gain greater insights into the combinations of factors associated with the greatest impact on child behaviours and weight status, and to understand differential effects across population sub-groups. This presentation aims to describe the data harmonisation framework and process used in the ‘PRECIS’ project, and present the pilot results using data from seven completed Australian initiatives.

Methods

Adapting existing best practice data harmonisation guidelines, we implemented a process combining ‘top down’ (theory-driven) and ‘bottom up’ (data-driven, iterative) approaches to classify and transform variables in each dataset. This process aimed to find a balance between the conceptual ideals and the pragmatic realities of existing datasets, and will be used to collate and harmonise the nutrition and physical activity data from the evaluations of over 20 diverse, international child obesity prevention initiatives.

Results/ findings

Pilot data harmonisation included seven Australian childhood obesity prevention interventions, conducted between 2003 and 2022. Combined, these studies included data from 34,342 children, who were each assessed between 1 and 3 times over 2 to 4 year intervention periods.

In total there were 94 different activity variables, and 121 diet variables collected across the seven studies, predominantly from child self-report surveys. Following the harmonisation process, there were 8 activity and 11 diet variables in the final dataset.  Key challenges included changing data collection practices over time, and adjudicating compromises between coverage and detail for specific concepts and variables.

Conclusions

Harmonisation of pre-existing data drawn from multiple complex intervention evaluations presents significant opportunities to advance our understanding of intervention effects and the influence of community, intervention and system variables. The process is, however, challenging and resource intensive and inevitably requires compromises.  Progressing toward development and use of core outcome sets for community interventions would contribute to ensuring that future evaluations can more readily contribute to a growing international evidence base.

Purpose: Engagement in a low amount of sedentary time and a high amount of light-intensity physical activity (LPA) and moderate-to vigorous-intensity physical activity (MVPA) is associated with increased physiological function in older adults. However, previous research did not examine the differences in physiological function when the different behavioral patterns were distributed. We aimed to examine the effects of replacing time in sedentary behavior (SB) with LPA and MVPA on frailty status using the isotemporal substitution (IS) models, taking into account the mixed share of different intensities of behaviors, in the older population.

Methods: A total of 201 adults aged 60+ years (mean age 80.7 years; 52.2% female) were analyzed. An accelerometer (ActiGraph GT3X+) was used to record each participant’s daily pattern of SB, LPA, and MVPA. Frailty status was assessed and categorized using the Clinical Frailty Scale (CFS). We conducted three different models – single-activity, partition, and IS models, to examine the associations of reallocating time in SB, LPA, and MVPA with frailty status.

Results: The single-activity models showed that more time spent in SB was associated with higher odds of frailty while more time spent in LPA and MVPA was associated with lower odds of frailty. The partition models showed contrary associations for SB but consistent associations for LPA and MVPA with frailty. Replacing 60 minutes of SB with an equivalent amount of LPA (odds ratio [OR] = 0.57; 95% confidence interval [CI] 0.33-0.97) or MVPA (OR = 0.01; 95% CI 0.00-0.34) was associated with lower odds of frailty. The lowest odds of frailty was estimated when the share was set at a sum of 5 minutes of LPA and 55 minutes of MVPA (OR= 0.00; 95% CI 0.00-0.06). No associations were found for the associations of SB, LPA, and MVPA with pre-frailty.

Conclusion: A reallocation of SB with an equivalent amount of LPA and MVPA, irrespective of engaging in one type of physical activity alone and two physical activities mixed, can contribute to a lower risk of frailty. The older population is suggested to engage in MVPA accompanied by LPA daily as a feasible approach to prevent frailty.

Purpose: To present the work of the Global Diet and Activity Research (GDAR) network, generating evidence to better understand the spatial distribution of urbanisation and climate-change related hazards for non-communicable diseases in low- and middle-income countries (LMICs).

Rationale: 

A focus on upstream determinants of diet and physical activity requires engaging with the complex and interlinked factors that influence these determinants. The concept of a ‘syndemic’ (‘synergistic epidemic’) describes the co-occurrence of interacting epidemics and risks. In GDAR, we are exploring the interaction of mass urbanisation, rapid climate change, and epidemics of poor diet and physical inactivity. 

Across LMICs, population epidemiological profiles are significantly influenced by urbanisation processes driving dynamic changes to landuse and consequently to risk factors in urban spaces. The nature of urbanisation informs the degree of exposure to, and impacts of risks associated with climate change.

Contextually appropriate data are therefore needed to inform strategies that adopt a syndemic approach to promote healthy diets and physical activity, cognisant of these urbanisation and climate risks. This will require a better understanding of the spatial distribution of exposure to syndemic hazards and diet and physical activity behaviours. But such evidence on food and built environments that shape eating and activity behaviours come mostly from high-income countries.

To this end, the GDAR network conducted both field-based and virtual environmental audits to measure syndemic constructs relevant to physical activity and diet considering spatial deprivation in four African cities. 

Objectives:

To discuss methodological and logistical considerations when conducting field-based environmental audits of the built and food environment.

To discuss the reliability and feasibility of virtual audits for the built environment.

To stimulate discussion on the integration of different methodologies to measure syndemic constructs relevant to physical activity and healthy diets.

To consider the implications of spatial deprivation across fast-growing cities in Africa.  

Summary:

This session will be moderated, and presented by the GDAR network. Bringing the experience of having undertaken field-based and virtual environmental audits in Cameroon, South Africa, and Nigeria, the network will present the methodological opportunities and adaptations for the data collection of syndemic constructs. This will be followed by a discussion on how relevant the spatial disparities are and the importance of a nuanced approach to addressing urban health challenges between and within African cities. Finally, unique data will be presented and integrated with geospatial data, demonstrating the potential of a syndemic approach to identifying and addressing interlinked health risks.

Purpose: To describe and discuss the methodological and logistical opportunities and adaptations of applying existing audit tools to measure environmental features relevant to physical activity and diet in four African cities. Additionally, we reflect on the adaptations required to collect meaningful data in a context underrepresented in the literature.

Methods: Environmental audits of small areas (approx. 4km2) were conducted during August and October of 2022 in Yaoundé, Cameroon; Soweto and Cape Town, South Africa; and Lagos, Nigeria. We used the Microscale Audit of Pedestrian Streetscapes (MAPS-Global) and the Environmental Profile of a Community’s Health Part 1 (EPOCH) to assess the built and food environments, respectively. Each site had one week of training and piloting in which local researchers discussed the adequacy, wording, and feasibility of each instrument. Data were collected using the REDCap mobile app. In the sampled small areas, 25% of the total street network was audited. 

Results: For Yaoundé, MAPS-Global and EPOCH were translated for the first time into French. The instruments were successfully introduced into REDCap, but concurrent paper-based data collection was necessary. As we were using both MAPS-Global and EPOCH, we used the same routes for both, from households to local points of interest (~500m length), rather than sampling exclusively around commercial areas for EPOCH. Some redundant sections of the tools were combined to improve efficiency. Adaptations or changes were kept to a minimum, but were sometimes necessary in order to collect meaningful information. For example, local understanding of what constituted fast food differed by country, the tools did not adequately account for unpaved roads, and questions regarding cycle lanes were retained but these were not present at any site.

Conclusions: The four cities which have all grown rapidly in the last decade, are economical hubs and are larger cities in their country. However, there are noticeable differences between them that make collecting comparable data difficult. The instruments were validated but they required local knowledge to be applied in the African context.

Purpose: To describe the features of the built and food environment relevant to unhealthy diets and physical inactivity at a small area level and their spatial heterogeneity by deprivation in four African cities.

Methods: Environmental audits conducted in small areas (approx. 4km2) were conducted during August and October 2022 in Yaoundé, Cameroon, Soweto and Cape Town, South Africa, and Lagos, Nigeria. We used the Microscale Audit of Pedestrian Streetscapes (MAPS-Global) and the Environmental Profile of a Community’s Health (EPOCH) to assess the built and food environments, respectively. Each site categorised their city's small areas into different levels of deprivation and selected a few, preserving deprivation variation (higher vs lower). We sampled 25% of the street network within each small area. We created routes from households to local points of interest (~500m in length) and audited MAPS-Global and EPOCH on the same routes. Data were collected using REDCap, statistically analysed in R, and spatially analysed using QGIS. The MAPS-Global items were grouped into subscales and classified into positive and negative effects on PA. ANOVA was used to analyse the differences among small areas. Each route was assigned a score for the built and food environments and mapped.

Results: A total of 23 small areas, 680 routes and approximately 180000 data points were collected from the four cities. Each audit took between one and two hours depending on the accessibility of the small area, with the assessment of the grocery store taking the longest to collect. In preliminary results for MAPS-Global,  the lack of parks in the small areas was noted. For example, in the ten small areas of Yaounde, only one park was recorded. Emerging findings suggest walkability features were less common in highly deprived small areas across cities. Restaurant data were collected only 50% of the time. 

Conclusions: The data showed the spatial distribution of environmental features relevant to  diet and physical activity behaviours, drawing attention to the inequalities faced by fast-growing cities. Representing large amounts of data in single maps could inform strategies of improving the environments to promote healthy diets and physical activity.

Purpose: Traditional methods of repeated field audits are resource intensive and virtual approaches are an alternative, particularly in resource-constrained settings. However, there is little evidence of the validity of virtual assessments of the built environment in LMICs, and existing studies are largely based on field audits. Valid and reliable virtual audit tools in these contexts would be a cost-efficient way to capture environmental changes. 

Methods: Field and virtual audits were conducted in small areas of Soweto, South Africa, and Cambridge, UK. Each small area was classified as higher or lower deprivation, preserving the variation in deprivation. The first phase consisted of field auditing 25% of the street network in small areas. We created routes from households to local points of interest (~500m in length) and audited them using Microscale Audit of Pedestrian Streetscapes (MAPS-Global). For the second phase, we used aerial imagery and Google Street View imagery to virtually audit a fraction of the routes previously audited. We followed the same route as for the field audits. The intraclass correlation coefficient (ICC) statistic was used to quantify the level of consistency between the MAPS-Global scores derived from the virtual assessment and the field audit. To assess the importance of local knowledge in virtual audits, the raters that conducted the field audits will perform the virtual in the other city (Soweto - Cambridge), and the results were compared with the local rater. 

Results: Virtual audits are currently in progress and study findings will be presented and reflected upon, with particular emphasis on the validity, according to area-level deprivation and by site.

Conclusions: Insights will be provided into the value of virtual audits as a cost-efficient method of understanding health related features of the built environment.

Purpose

Sharing experiences of co-creating interventions promoting sleep health of adolescents, by describing how a co-creation approach can be used to develop, implement and evaluate sleep health interventions with adolescents in a school context. As the school context is just one part of the sleep health system, also results will be presented on how participatory methods can be combined with a systems perspective to co-produce a whole systems approach promoting adolescent sleep health. 

Rationale

Inadequate sleep health is a major problem among adolescents with negative effects on mental and physical health. Therefore, effective interventions to improve sleep quantity and quality are needed. Co-creation is a promising approach for intervention development, as it maximizes the involvement of stakeholders by tailoring interventions to their needs. Schools are a setting in which adolescents, school staff and parents can be reached easily. The implementation of school interventions might be most successful if school staff are involved in the co-creation process. However, sleep health must be considered as a complex adaptive system, of which the school setting is only one of the subsystems of the wider sleep health system. To fit future interventions with adolescents' and other stakeholders' needs, taking a participatory approach seems essential.  

Objectives 

Presenters from Belgium and the Netherlands will share experiences of co-creating sleep health interventions.

This symposium aims to 

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   Share how co-creation can help to address the problem of inadequate sleep health among Belgian adolescents. 

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   Share how co-creation can help to successfully implement a sleep health intervention at a Belgian school.

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   Share the application of participatory system dynamics in designing a ‘whole systems approach’ promoting sleep health with Dutch adolescents. 

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Summary

Laura Belmon (chair, NL) will introduce the symposium and highlight its rationale and objectives (5 minutes). Lea Delfmann (BE, 15 minutes) reports findings of evaluating the upscaling of a sleep health intervention together with Belgium adolescents and includes adolescents' experiences during this co-creation process. Next, Janneke de Boer (BE, 15 minutes) will zoom in on the role of school staff as implementers of this participatory sleep health intervention in Belgium, including the results from co-creating the implementation plan together with the school staff. Danique Heemskerk (NL, 15 minutes) will share her work on participatory system dynamics in designing a ‘whole systems approach’ promoting sleep health together with Dutch adolescents. Professor Sebastien Chastin (UK/BE, discussant) opens the interactive discussion (25 minutes) and ends with take-home messages (5 minutes).

Purpose: Because of the high prevalence of poor sleeping behavior among adolescents, effective interventions are needed. Co-creation, i.e. knowledge production through collaboration with the target group and several key stakeholders, has been established as a promising approach to intervention development. However, co-created interventions are in nature localized and their development is time- and resource consuming. The cascade model to scale up co-created interventions suggests a shortened co-creation process to transfer interventions to another context, but it has yet to be investigated how adolescents experience this process. Therefore, this study evaluates the scaling up of an existing co-created healthy sleep intervention for adolescents (aged 11-13) to a new context using a shortened co-creation process.

Methods: Eight students from one secondary school in Flanders were selected to form an action group. The shortened co-creation process will consist of eleven sessions, starting with a needs assessment. Adolescents’ goals and expectations for the intervention will be discussed, after which the existing intervention will be introduced. The majority of sessions will be reserved for the adaptation of existing intervention components. The remaining sessions will be used to discuss the implementation plan together with other relevant stakeholders, i.e., school staff and parents. Lastly, one session will be used to discuss the evaluation of the scaled-up intervention. Adolescents’ experiences, feelings of ownership, empowerment, self-efficacy, and wellbeing will be assessed using interviews, focus groups, and questionnaires. Qualitative data will be analyzed in NVivo, and quantitative data will be analyzed using the statistical package R.

Results: The co-creation process started in October 2022 and will be finished in February 2023. Results of the process evaluation will be presented. Based on previous research, it is expected that adolescents participating in a co-creation process report increased feelings of empowerment, ownership, and self-efficacy.

Conclusion: If our hypotheses can be confirmed, this provides initial evidence that participation in a shortened co-creation process to scale up a healthy sleep intervention can increase feelings of ownership, empowerment, and self-efficacy in adolescents.

Purpose: The success of school-based interventions to promote health behaviour in youth partly depends on whether school staff feel capable to implement the intervention. Thus, successful implementation is determined by the degree of training school staff receive. This study compares two different approaches to implement a sleep intervention at school, i.e. co-creation of the implementation plan with school staff, and standard implementation plan. Moreover, it investigates how these approaches are experienced by school staff and whether they have an impact on the successful implementation of the intervention.

Method: A sleep intervention will be implemented in two secondary schools in Flanders, Belgium. In the co-creation school an action group of school staff (n=6) will be composed to develop an implementation plan using a co-creation approach. This enables school staff to tailor the implementation to their needs and embed the intervention in the school curriculum. In the standard implementation school, school staff will receive one training and a manual designed by researchers to implement the intervention. Questionnaires will be completed at different timepoints (baseline, pre-implementation, post-implementation) in both schools to measure changes in motivation, empowerment, barriers for implementation, and general knowledge about sleep in school staff educating students from the 6th and 7th Grade. Furthermore, focus groups will be conducted to evaluate the co-creation process and the implementation process including its specific intervention materials. Focus groups will be audio-taped and coded using NVivo 12, questionnaires will be analysed using R.

Results: We expect that active involvement of school staff during the co-creation of the implementation plan is beneficial for the implementation of school-based interventions, as it fulfills the needs of the implementers. This project will start in November 2022 and will finish in June 2023. The results from the co-creation process to design the implementation plan will be presented at the conference.

Conclusions: This study will indicate whether designing an implementation plan together with school staff using a co-creation approach is beneficial for successful implementation. Moreover it will highlight important aspects of the implementation process.

Purpose: Inadequate sleep health is a tremendous problem among Dutch adolescents which can have detrimental effects on their physical and mental well-being. Systems thinking is acknowledged as a promising approach to understand and respond to this complex health problem. This study aims to apply participatory system dynamics in designing a ‘whole systems approach’ promoting sleep health of Dutch adolescents, thereby expanding the knowledge on how to apply systems methodologies in designing health interventions in complex systems.

Methods:This study applied participatory system dynamic methods (i.e. combing system dynamics and participatory methods) to co-design actions based on points of leverage within the system influencing adolescent sleep health. Five (multi)stakeholder co-creation sessions were held with adolescents (N=40, 12-15 years), parents (N=11) and professionals (N=10). When co-designing actions, we used the Action Scale Model (ASM) to create a coherent whole systems approach that is evidence-based, feasable, has potential to change the system, and that can be sustainably implemented. Thereafter, three sessions with Public Health Services (GGD) from several Dutch regions as well as organizations that act on a national level were held using the World Café Methodology to identify agents of change and to create an implementation plan for the prospective whole systems approach promoting adolescent sleep health.

Results: The initial Causal Loop Diagram (CLD) of our previous study that was created to map the ‘system’ of adolescent sleep health was expanded with actions targeting potential leverages of change, end-products and agents of change that are able to influence those levers. These were distributed across the six identified subsystems within the CLD around the following themes: (1) School environment; (2) Mental health; (3) Screen use & social media; (4) Family & Home environment; (5) Lifestyle behaviors & Leisure activities; (6) Personal & biological determinants.  

Conclusions: This study expands knowledge on how participatory systems methodologies can be applied in designing a whole systems approach promoting sleep health. Combination of these approaches is recommended for designing health interventions in complex systems as it increases understanding in the needs of adolescents, parents, and professionals. The expanded CLD served as a logic model informing the development of a whole systems approach.

Purpose: This symposium seeks to identify opportunities for advancing implementation science research to support sustained delivery of nutrition and physical activity (PA) interventions in schools. The symposium will include the perspectives of implementation researchers and practitioners and will feature two case studies of interventions including strategies designed to enhance sustainment.

Rationale: Governments have internationally invested billions in the implementation and scale-up of nutrition and PA interventions in school settings. Implementation science methods have identified strategies capable of achieving initial implementation of such interventions at a population level. However, “initiative decay” is common for interventions in these settings. Without strategies to support sustained program implementation, the potential public health benefits of evidence based interventions (EBIs) cannot be achieved, the substantial investment in achieving initial implementation is wasted, and community trust and support for future programmes is diminished. Despite the importance of sustaining program implementation, little research has been dedicated specifically to identifying and developing strategies that support EBI sustainability, leaving policy makers and practitioners bereft of an evidence base of how best to support this.

Objectives: To: i) examine the extent to which PA and nutrition public health research has focused on sustainability and how this has changed over time; ii) identify strategies to enhance sustainment of a school wellness intervention and inform measurement; and iii) apply a theoretical framework to design a sustainability intervention to support school scheduling of PA.

Summary: First, Dr Alix Hall will present the findings of a review which explore the extent to which public health research, in particular studies focusing on PA and nutrition, assess sustainability and whether this has changed over time. Second, Dr Gabriella McLoughlin will describe a study that examined strategies to enhance sustainment of a large-scale school wellness intervention. Lastly, Dr Nicole Nathan will describe factors that influence sustainment of schools scheduling of PA and the application of theoretical frameworks in the development of an intervention to sustain its implementation. The symposium will include a discussant Dr Taren Swindle who will reflect on the presentations and facilitate a panel and audience discussion about the gaps in the current evidence-base and what research questions and methods are needed to advance sustainment research in nutrition and PA. 

Format: This symposium will include a chair, three presentations and a discussant. The introduction by the chair will be 10 minutes and help frame the presentations in the context of current available evidence (Dr Swindle), the three presentations (15 minutes each) and the chair will facilitate an interactive discussion (15 minutes). 

Purpose: To explore the extent to which public health research, in particular studies focusing on PA and nutrition, assess sustainability and whether this has changed over time.

Methods: We undertook a repeat cross-sectional bibliographic review of research published within a purposive sample of leading public health journals across three time periods (2010, 2015 and 2020/2021). Studies were eligible if they were: a databased study or review article and published in one of the 10 selected journals in one of the three time periods. Each study was assessed for whether it focused on sustainability, which could include issues relating to the long-term benefits or delivery of an intervention. Type of research, study design, setting, and public health focus were extracted. Logistic regression was used to assess whether there was an association between time period and the proportion of studies that focused on sustainability.

Results: 10,588 databased articles were identified, of which 1.3% (n=136) focused on sustainability. The percentage of original research articles that focused on sustainability increased slightly over time: 0.3% (95% CI: 0.1%, 0.7%) in 2010, 1.4% (95% CI: 1.0%, 1.9%) in 2015 and 1.6% (95% CI: 1.3%, 1.9%) in 2020/2021, with a statistically significant association identified between time period and sustainability research (p=0.0007). PA was the most predominant public health issue addressed in the studies assessing sustainability (n=30, 22%), followed by child/youth health and wellbeing (n=28; 21%) and then nutrition (n=25; 18%). The percentage of sustainability research addressing PA and nutrition increased from the earliest time period 2010 (17% and 0%, respectively) to the most recent time periods where rates seem to stabilise (26% and 14% in 2015; and 20% and 22% in 2020/2021). No studies that focused on PA or nutrition assessed the effect of sustainability strategies.

Conclusions: These findings suggest only a small amount of research has been dedicated specifically to sustainability and the percentage specific to PA and nutrition interventions remains low. More public health research on the sustainability of PA and nutrition interventions, particularly on identifying strategies effective in sustaining their implementation is needed.

Purpose: To provide two examples of how sustainability is being measured and evaluated in school wellness initiatives. Policies can be an effective way to enhance sustainability, but implementation of such policies is poorly understood, specifically the degree to which implementation disparities occur, posing implications for health equity.

Methods: For the empirical example, a mixed methods implementation study grounded in the Consolidated Framework for Implementation Research (CFIR) was conducted to evaluate key outcomes, determinants, and nuanced relationships between these factors among schools in the 2019–2020 cycle of SWITCH. Determinants were investigated through in-depth qualitative interviews and readiness surveys with implementation leaders. Evaluation approaches followed recommended data collection and analytic methodologies of the CFIR. The second example highlights how these steps are being integrated into a measures development study that aims to combine health equity with implementation science approaches in measurement of school wellness policy.

Results: Distinguishing factors between experienced and inexperienced schools were Readiness for Implementation (inner setting) and Self-efficacy (characteristics of the individuals) (p < 0.05). Strategies found to enhance sustainability of SWITCH programming were increasing student awareness/advocacy, focusing on a small number of key elements, and integrating programming into school culture.

Conclusions: Findings provide specific insights related to SWITCH implementation and sustainability but more generalised insights about the type of support needed to help schools implement and sustain school wellness programming. Further research is needed to operationalise sustainment and test the relative effectiveness of different strategies to enhance the sustainability of capacity-building interventions such as SWITCH. Implications and next steps for measuring sustainability will be discussed by providing an overview of the measurement tool development protocol.

Purpose: To describe factors that influence sustainment of a school PA program and the application of the Theoretical Domains Framework and Integrated Sustainability Framework (ISF) in the development of an intervention to sustain its implementation.

Methods: A multi-strategy intervention was co-developed with health and education policy makers and practitioners using the following steps:

1. Identification of barriers and facilitators to sustainment via: i) systematic reviews of the school staff barriers/facilitators to sustaining PA programs; ii) quantitative surveys with 240 classroom teachers; and iii) observations and interviews with school staff.

2. Identification of potential strategies: barriers were organised according to the ISF. Potential strategies to address these barriers were identified through surveys with over 200 teachers.

3. Strategies were then reviewed by key stakeholders to ensure their feasibility and acceptability to school communities. The final strategies were described according to the sustainment-explicit Expert Recommendations for Implementing Change (ERIC) glossary.

Results: The systematic review and surveys identified that the primary barriers to sustainment of the PA program were lack of organisational leadership and support, organisational readiness and resources, staff turnover, perceived policy alignment and workplace socio-cultural factors. Survey and interview data found strategies most accepted by teachers were: the provision of PA equipment packs that enable class time PA (85%); the provision of an information pack to upskill new staff (78%); and creating a whole school PA plan outlining the school’s steps to ensure PA policy adherence (78%). Following theoretical mapping a multi-component intervention was developed which included: (i) centralized support; (ii) reminders; (iii) principal mandates; (iv) sharing local knowledge; (v) building coalitions to share resources (vi) distributing educational materials; and (vii) involving end-users. The feasibility and acceptability of the strategies were reviewed by an advisory group which resulted in minor modifications of strategies.

Conclusions: This will be one of the first studies to test the effectiveness of a multi-component intervention to support the sustainment of a school PA program, creating seminal evidence for the field of sustainability science.

Purpose

Urgent solutions are needed to transform food and physical activity systems in the interests of human and planetary health. In this symposium, we will explore the significant research challenges of understanding and intervening in systems.

Rationale

Diets and activity patterns worldwide are increasingly suboptimal with regard to population health and planetary sustainability. The problem of suboptimal diet is driven by failures of the food system, and insufficient activity driven by failures of systems that enable active lifestyles. Such system failures drive widespread obesogenic environments. Non-communicable diseases and climate change are key consequences and represent significant external costs to society. System failures require systemic solutions. Relatively little is known about changing the diets and activity of whole populations by transforming systems. Mapping systems (e.g. using causal loop diagrams (CLDs) and system dynamics models (SDMs)) enables researchers and stakeholders to identify places in systems (i.e. leverage points) where interventions might have the greatest impact. But applying such methods in real-world contexts is challenging.

Objectives

1.       To explore the benefits of systems thinking for transformational research on diet, activity, health and sustainability

2.       To share recent examples of research on approaches to studying food and activity systems

3.       To share and critically appraise methods for engaging system actors, identifying leverage points and prioritising system interventions, and for studying the wider impacts of system change.

Summary

In this symposium, we will explore the challenges and outcomes of research programmes in the Netherlands and UK that explore how systems impact on diet and activity, and to identify transformative interventions in these systems to benefit health and sustainability. The LIKE programme in Amsterdam, the Netherlands, aims to generate solutions to childhood overweight and obesity in adolescents using a systems dynamics and participatory approach in collaboration with the Amsterdam Healthy Weight Programme. The Mandala programme aims to catalyse urban food system transformation, focusing on the City of Birmingham, UK, as a scalable case study, partnering with citizens and food system stakeholders to create a reproducible, collaborative change process, and generating evidence to support food system interventions leading to substantial health, environmental, economic and societal impacts.

Format

4.       Introduction by chair (9 min) Prof Martin White

5.       Presentation 1 (12 min) Dr Alexia Sawyer

6.       Presentation 2 (12 min) Dr Angie Luna Pinzon

7.       Presentation 3 (12 mins) Dr Wilma Waterlander

8.       Discussant (10 min) Prof Harry Rutter

9.       Open discussion (20 mins)

Purpose

Food systems generate huge external costs, including for the environment (e.g. climate change impacts) and health (e.g. non-communicable disease risks. Transformative interventions are urgently needed to reduce these negative externalities. The Mandala consortium aims to systematically generate evidence on urban food system transformation by co-producing interventions with stakeholders and undertaking rigorous evaluations of system impacts. Here we aim to share the complex methodological and practical challenges, and achievements of an emergent research process.

Methods

To identify interventions with transformative potential, we worked with food system actors in the city of Birmingham, UK. We used solution scanning to identify long-lists of potential food system interventions. We interviewed stakeholders to understand the opportunities and challenges of intervening in the food system. Working with stakeholders, we mapped food systems conceptually and generated a causal loop diagram (CLD), drawing on Group Model Building methods, for each food system sector, identifying leverage points and potential interventions. We developed and applied criteria to prioritise interventions with stakeholders, incorporating existing theory and evidence in our decision-making. We used qualitative methods to document processes and outcomes.

Results

Interviews with stakeholders yielded rich insights, which informed subsequent stages. We developed a set of criteria to prioritise interventions, including the importance of population reach, impacts on health-related food supply, dietary changes and sustainability outcomes, including carbon emission, water depletion and biodiversity loss, and the policy coherence and viability of interventions for stakeholders. We developed five CLDs for supply chains, grocery, out of home, institutional catering and informal food sectors, and identified multiple leverage points for interventions within each CLD. We explored the overlaps and connections between the five CLDs, and identified and prioritised interventions for delivery, working iteratively with stakeholders.

Conclusion

Understanding complex adaptive systems, such as urban food systems, and identifying and prioritising interventions for delivery demands close collaboration with stakeholders, interdisciplinary scientific inputs, and considerable time and resources. What seemed sensible in theory, did not necessarily work in practice. In particular, engaging commercial stakeholders in transformative interventions to promote health and sustainability is highly challenging, and demands a negotiated process that seeks common ground.

Purpose

There is growing recognition for the value of applying system dynamics approaches in public health research. To date, most of this research has focused on systems mapping. However, there is limited practical guidance available on what intervention programmes taking a system dynamics approach could or should look like as well as how system changes could be operationalised.

Methods

Using the Lifestyle Innovation based on Youth Knowledge and Experience (LIKE) programme as a case study; we illustrate how a previously obtained understanding of the pre-existing system of obesity-related behaviours in adolescents was used to operationalise the identification of leverage points and subsequently develop a widely supported action programme within a system dynamics approach. This case study was set in ethnically diverse neighbourhoods in the city of Amsterdam, the Netherlands. The identification of system levers and action development process was conducted from a stakeholders-led approach (representing academia, policy and practice) and an adolescents-led approach.

Results

In October 2022, the LIKE action programme consisted of a total of 26 actions. The action programme targeted a total of eleven leverage points which were roughly distributed over the different system levels ranging from system functioning (deeper levels of the system) to system structure (most visible levels of the system).

Conclusion

This study illustrates how a system understanding can be translated and operationalized into identifying leverage points which can subsequently inform the development of an action programme. We achieved this by building upon the previously developed understanding and analysis of the pre-existing system of obesity-related behaviours in adolescents

Purpose

Systems thinking embraces the complexity of public health problems and aids in understanding how factors are interrelated, and subsequently can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems.

Methods

Building on our previously published Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework, we applied Ripple Effects Mapping (REM) methods to measure the intended and unintended effects of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme in the City of Amsterdam, the Netherlands.  Three REM workshops were held in 2022; focusing on the overall LIKE programme and specifically focusing on the actions that were developed. Subsequently, in-depth interviews were held with involved stakeholders.

Results

REM provided in-depth insight into how actions developed over time within a system dynamics action programme. For example, actions that were initially developed to co-create a healthier food environment within supermarkets, evolved into a lobbying initiative to achieve policy impact within the food environment. Similarly, actions targeting the physical activity environment evolved into developing methods for co-creation of public spaces with youth. In particular, REM data revealed the importance of involving the right stakeholders as well as barriers and opportunities in targeting deeper levels of the system.

Conclusion

A dynamic action programme changes over time and it is difficult to measure its immediate impact. REM is a valuable method to identify intended and unintended consequences of such an action programme and thereby providing insight into its effectiveness as well as ways to further adapt the programme.

Purpose: This symposium examines food insecurity across different contexts to inform research, programming, and policy approaches for food security and nutrition equity. Presentations will highlight innovative, primarily qualitative, research featuring emic perspectives of individuals experiencing food insecurity and showcasing “i-poems” that amplify voices of people affected by food insecurity. Rationale: The COVID-19 pandemic and widening socioeconomic inequities add urgency to the need to address food insecurity among marginalized communities in high-income countries. Understanding contextual factors related to food access and eating behaviors is essential for creating and implementing solutions. Objectives: This symposium aims to (1) Describe commonalities and distinctions of food insecurity experiences and coping strategies across countries; (2) Highlight gaps and opportunities for improved measurement; and (3) Discuss implications for programming and policy to address food insecurity. Summary: Presentations will integrate theoretical and empirical insights from research capturing first-hand food insecurity experiences in three regions [Australia (AUS), Europe (EU), and USA]. The first presentation (Dean) will provide a foundation for understanding and addressing food insecurity, including consideration of varied sociocultural contexts within EU, alignment with sustainable food system values, and implications for measurement and policy. The second presentation (McClain), based on qualitative interviews with heritage-diverse Latinx caregivers of children in the U.S., will offer insights on the day-to-day challenges of feeding their families in culturally-appropriate ways, varied coping strategies and perspectives on relevant programs, and how these experiences can inform measurement, programming, and policy. The third presentation (Baker) will share findings from a qualitative project in AUS highlighting social and structural barriers to food security and participant-elicited policy solutions for addressing food insecurity holistically. Short (3-minute) i-poems from the AUS project (Gallegos) will be shared at intervals throughout the symposium to provide moving depictions of lived experiences of food insecurity, particularly participant experiences of social and financial shocks in childhood and adulthood, alongside descriptions of overcoming adversity and the sacrifices they are making to enable their children to have opportunities.

Format:

Introductions and presentations (Chair- Dickin): Introduces the symposium (5 minutes) and each presenter (~10 to 12 minutes each x 3 = 30 to 36 minutes), allowing a two-minute transition between presenters.

I-poems (Gallegos): Shares i-poems before, in between, and after each presentation (4 total, 12 minutes).

Discussion (Discussant- Johnson): Facilitates engaging, interactive discussion and invites questions from attendees (20 to 25 minutes).

Interaction: In-person symposium; Chair (Dickin) moderates interactions with remote attendees and includes their questions during discussion.

Purpose: The purpose of this study is to examine norms embedded in the concepts of food security and food insecurity, describe how socio-political context influences values, and identify implications for measurement and policy within the European Union (EU). Food insecurity is a multi-level concept that describes deficiencies in food supply, access, and affordability; food security “exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain (Anderson 1990).” Food insecurity is an explicitly normative concept. Normative language such as “availability”, “adequacy”, “safety”, and “acceptability” are embedded in concepts, and operationalization of the concepts in measurement constructs, and in policy implementation. For example, the long-standing measures of household food insecurity, used by FAO and USDA, define these norms as largely economic values. In turn, policies that employ these measures are framed to account for economic capabilities. Efforts to implement new measurements that are relevant to the EU context should account for values embedded in the EU policy framework, many which extend beyond accessibility defined in economic terms to include rights-based approaches. One place where these values are articulated is the European Commission’s Farm to Fork Strategy (F2F). Methods: Critical discourse analysis was used to identify the values embedded in this system-oriented conceptualization of food (in)security within the F2F framework and the varying interpretations of values on food access in the EU context, based on the nascent research literature. Results: Findings applied a contemporary lens to create a reimagined perspective on food (in)security and explored implications for the measurement of household food (in)security. Conclusions: This presentation will detail how the F2F framework and affiliated literature define food (in)security at all levels as the necessary outcome of a sustainable food system. The F2F vision of food access is embedded in a model that integrates agricultural production, distribution, food acquisition, and consumption practices into a systems framework. These are guided by ecological, economic, and social values including equitable and fair outcomes for actors at all stages of the food system, that are currently not operationalized as measures in public health.

Purpose: We aimed to elucidate the lived experiences of managing household food security among low-income, heritage-diverse Latinx caregivers of children (≤18 years) in the U.S and identify possible future directions for measurement and policy. Methods: We conducted in-depth exploratory cognitive interviews, based on the U.S. government food security survey instrument, via telephone or Zoom with 62 Latinx caregivers in rural, urban, and suburban areas of California, New York, and Texas. The multi-site research team recruited eligible caregivers through community partners and in-person events at partner sites. Verbatim transcripts were coded in NVivo to identify emergent themes related to food insecurity experiences, coping strategies, interpretation of the food security measure, and cultural perspectives. Results: Participants identified as Mexican, Dominican, Puerto Rican, Ecuadoran, and Central/South American heritage, and 58% reported being born outside the U.S. Similarities and distinctions in food insecurity experiences and coping strategies emerged across sites and by nativity and heritage. Participants across sites described challenges in maintaining food security due to the COVID-19 pandemic and inflation, including inability to leave the house to access food (i.e., quarantine), limited availability of food at stores, and increasing food and gas prices. Across sites, participants described prioritizing their children’s food security over their own and routinely relying on emergency food systems, such as food pantries, as a coping strategy even if they were unable to procure their preferred foods. As a result, many participants answered survey items as though their households were food secure, despite financial hardship and reliance on food assistance. Some participants described difficulties in qualifying and maintaining participation in government food assistance programs. Reliance on family members and desire to provide children with culturally-preferred foods appeared to vary by site and heritage. Conclusions: Heritage-diverse U.S. Latinx caregivers of children demonstrated similarities and distinctions in their experiences managing household food security status. Many reported coping strategies appeared to be normalized such that caregivers did not perceive their households to be food insecure, despite their descriptions suggesting otherwise. Findings underscore the need to consider the socioecological context of Latinx households in the U.S. to more accurately measure and address food insecurity.

Purpose: This paper describes a portfolio of solutions that inform policy and service delivery as recommended by adult carers of children aged 0-12 who struggle to put food on the table. Methods: Feeding Families in Tough Times (FFiTT) is a mixed-method program of research that aims to build a rich understanding of food insecurity in Australian families. Families were recruited primarily through food relief and community support organisations. 43 semi-structured interviews were carried out in person or via zoom. Interviews were informed by life narratives and the Family Adjustment and Adaptation model. Audio-recordings were transcribed and analysed using reflexive thematic analysis. Results: Participants identified key barriers to food security as cost-of-living increases, unstable housing, precarious income, domestic and family violence, racism, adverse childhood experiences, disability and chronic health problems, as well as difficulty navigating government systems. Parents identified solutions that were aimed at reducing the impact of financial hardship, cognitive load and food insecurity, at the individual, family, community and policy level. Solutions could be themed as: income optimisation; system navigation; in-time place-based health care; and food availability/affordability. Conclusions: The data provides insight into interactions with support networks and services and highlights policy level short falls and gaps in the Australian response to food insecurity. The interviews highlight the need for government-led action that addresses the underlying determinants of food insecurity. Solutions need to be multifaceted and should draw on the lived experience of families doing their absolute best to feed their families under extremely demanding circumstances.

Purpose: The purpose of this symposium is to justify the need for, and introduce, the 14 country GAC-PAQ project, share early developmental findings and lessons, and invite further participation.

 Rationale: Physical activity (PA) is beneficially associated with many health indicators in children and adolescents. Globally, ~80% of school-going children and adolescents are insufficiently active, but current global surveillance initiatives largely exclude young children and those who do not attend school [common in low- and middle-income countries (LMICs)]. Global surveillance of PA in children and adolescents is also limited by the use of questionnaires that 1) were developed in high-income countries (HICs) with limited efforts to adapt them to the socio-cultural context of LMICs; 2) do not cover all domains of PA; and 3) do not properly capture active play, an important source of PA. Addressing these limitations would improve within- and between country comparisons and promote the cross-fertilization of solutions. The aim of the GAC-PAQ project is to comprehensively address these limitations.

Objectives:

1.       Provide a critique of inter-continental child and adolescent physical activity surveillance initiatives, identifying inconsistencies and research gaps.

2.       Introduce and explain the process to develop and assess the reliability and validity of the app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) for the global surveillance of physical activity in 5- to 17-year-olds.

3.       Present early formative and cognitive assessment data from 14 countries participating in the GAC-PAQ project and lessons learned.

4.       Invite further participation in the final testing of the GAC-PAQ.

Summary: This symposium will share for the first time the details of the Canadian Institutes of Health Research funded GAC-PAQ project, including the rationale for its development, preliminary findings and lessons learned.

Format:

Chair: Prof. Mark Tremblay (Canada): GAC-PAQ Project Symposium Overview (5 minutes)

Presenter 1: Dr. Salomé Aubert (France): The Current State of Global Surveillance of Physical Activity Among Children and Youth (15 minutes)

Presenter 2: Dr. Richard Larouche (Canada): The Global Adolescent and Child Physical Activity Questionnaire Development Project (20 minutes)

Presenter 3: Prof. Olga Sarmiento (Colombia) – Early Findings from the GAC-PAQ Project Across 14 Countries (15 minutes)

Discussant: Dr. Adewale Oyeyemi (Nigeria) – discussant (5 minutes + 15 minutes Q+A)

Interaction: The Discussant will summarize and comment on the content of the presentations and facilitate discussion among the Chair, presenters and the audience.

Purpose: The enhancement of data systems and capabilities at national levels to support regular population surveillance of physical activity (PA) was identified as a priority in the World Health Organization Global Action Plan on Physical Activity 2018–2030. We reviewed the existing major international studies/surveillance initiatives on PA for children and adolescent to (i) summarize global findings; (ii) identify methodological limitations and inconsistencies, surveillance, and research gaps; (iii) propose recommendations for improvement.

 Methods: Intercontinental PA surveillance initiatives for children and adolescents were identified by experts and through non-systematic literature searches. Prevalence of meeting PA guidelines by country, gender, and age were extracted when available. Methods and prevalence meeting PA guidelines were compared across data/studies and against the methodological/validity/translation differences.

 Results: Methods and PA definition inconsistencies were observed across and within PA international surveillance initiatives, resulting in different estimated national prevalence of meeting PA guidelines, and initiatives contradicting each other’s cross-country comparisons. Three findings were consistent across international surveillance initiatives: insufficient level of PA of children and adolescents across the world; lower levels of PA among girls; and attenuation of PA levels with age. The dose (frequency, intensity, and duration) of children’s and adolescents’ PA domains (i.e., organized sport, active transportation, active play, physical education, chores and occupation) was generally not assessed. Resource-limited countries; younger children; and children and adolescents not attending school, with disability or chronic conditions, and from rural areas were generally under/not represented.

  Conclusions:  Substantial inconsistencies were observed across/within included initiatives, resulting in varying prevalence estimates of PA among children and adolescents at the global, regional, and national levels - questioning the validity of current PA surveillance systems. The development of a new PA measurement instrument that would be globally accepted and harmonized has become a global priority to help improve the validity and reliability of global surveillance and to inform the development of effective PA policies.

Purpose: Global efforts to address the physical inactivity crisis are limited by the use of questionnaires that do not capture all domains of physical activity (PA) and have not been sufficiently adapted to low- and middle-income countries (LMICs). This undermines between-country comparisons of PA indicators that could identify potential solutions to promote PA. In this context, we will develop and assess the reliability and validity of the new app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) among 5- to 17-year-olds and their parents from 14 low-, medium-, and high-income countries across 6 continents.

 Methods: This ongoing project involves 8 successive stages in all 14 countries: 1) review of the content coverage, strengths, and limitations of existing PA instruments; 2) development of the first version of the GAC-PAQ by our team of >25 researchers and knowledge users; 3) assessment of the content validity of the GAC-PAQ with expert groups; 4) cognitive interviews with children and parents; 5) development of the app and a revised version of the GAC-PAQ in English; 6) translation in the official languages of the participating countries; 7) pilot-study with 10 child-parent dyads per country; and 8) main study with a sex-balanced sample of 500 children and youth per country, stratified by age and level of urbanization. In the main study, participants will be recruited in schools and other settings (e.g., community centres, faith places), and asked to complete the GAC-PAQ twice to assess 1-week test-retest reliability, and to wear an ActiGraph accelerometer for one week (as comparison measure).

 Results: This presentation will provide a comprehensive overview of the GAC-PAQ methods. We developed an integrated knowledge translation plan to share study findings with researchers and knowledge users and facilitate its integration in PA surveillance studies.

  Conclusions: The GAC-PAQ project will facilitate the comparison of PA indicators between and within countries, which can highlight novel solutions to address the physical inactivity crisis. It will also help develop capacity to strengthen the surveillance of PA, particularly in LMICs. We anticipate that the app-based format will facilitate completion of the questionnaire by younger children and people with lower literacy levels.

Purpose: The purpose of this presentation is to discuss preliminary findings from the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) project across 14 low-, medium-, and high-income countries from all continents.

 Methods: We searched the literature to identify: 1) questionnaires employed in previous multi-country studies on PA in children and youth, and 2) systematic reviews on the psychometric properties of existing PA questionnaires. We extracted information about the location of individual studies, age group, validity, reliability, coverage of the domains of PA, and strengths and limitations.

 Results:  Our literature review revealed that the questionnaires used in previous multi-country studies did not capture all domains of PA. Furthermore, the majority of PA questionnaires have been developed in high-income countries, often with children in schools in urban samples, and tend to focus more extensively on the types of PA that are common in those countries (e.g., organized physical activity and sports, physical education, recess). Conversely, few questionnaires included items about active play, household-, and work-related PA. Previous reviews concluded that few questionnaires had good reliability and validity. The Physical Activity Questionnaire for Children was recommended in some previous reviews. Its format informed the initial structure of the GAC-PAQ, but the items were revised to enhance content coverage. The initial version of the GAC-PAQ was developed by our team of >25 researchers and knowledge users and will be shared for comment. Findings of the content validation with expert groups and the cognitive interviews (planned for the winter of 2023) will be presented at the symposium.

  Conclusions: The sequential and collaborative development process will generate a questionnaire that provides broader coverage of all the domains of PA and better represents the types of PA that are common in LMICs. This will help increase the validity and usefulness of global comparisons of physical activity indicators, such as the Active Healthy Kids Global Alliance’s Global Matrix project, as platforms to track changes over time in PA indicators and identify potential solutions to the childhood physical inactivity crisis.

Purpose: To evaluate and discuss the opportunities of cognitively enriched physical activity interventions to improve cognitive and physical health in older adults. 

Rationale: Globally, life expectancy has increased by more than six years between 2000-2019. However, not all of these additional years are spent in good health. Ageing is typically associated with limitations both physical and cognitive health. The development of preventive, evidence-based strategies to promote healthy ageing is therefore a global challenge and priority. Both physical activity (PA) and cognitive activity (CA) have been shown to have a beneficial impact on physical and cognitive health of older adults. Recently, it has been argued that even greater effects on these health outcomes can be obtained by innovative interventions combining PA and CA. 

Objectives: The aim of this symposium is to 1) demonstrate the importance of cognitively enriched physical activity for healthy ageing; 2) explain why this is novel and promising; 3) outline and discuss the effectiveness of three combined PA and CA interventions; and 4) summarize and compare the results and discuss how findings may inform future research. 

Summary: The concept and importance of cognitively enriched physical activity for healthy ageing will be introduced by the chair. This will be followed by three presentations focusing on combined PA and CA for the promotion of physical and cognitive health in older adults. The first presentation will elaborate on the effects of a supervised 12-month physical and cognitive training program on gait speed and cognition. The second presentation will present evidence from a six-month home-based individual PA and CA intervention on cognitive function, cardiorespiratory fitness and mobility. The third presentation will focus on the effects of a six-month cognitively enriched walking program on cognition and physical activity levels.

Format: The chair, Prof. Jannique van Uffelen, will introduce the general topic of the symposium, followed by three ten-minute presentations, each with a further five minutes allocated for questions/clarifications. These will be delivered by Prof. Dr. Sarianna Sipilä (Finland), Dr. Emma Dupuy (Canada), and Drs. Pauline Hotterbeex (Belgium). The discussant, Prof. Dr. Sebastien Chastin (Scotland), will provide an overview of the main issues and will facilitate the subsequent audience discussion for at least 15 minutes. 

Interaction: Interaction in the online symposium will be facilitated by the chair, Prof. Jannique van Uffelen. She will ask the online delegates if they have questions about the presentations or comments or remarks about the live discussion.

Purpose: Walking speed is a measure of health and functioning among older people. Physical and cognitive determinants of walking are amenable to interventions, but best practices remain still unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) intervention on walking speed, dual-task cost in walking speed, and executive functions (EFs) compared to physical training alone (PT) (ISRCTN52388040). 

Method: Community-dwelling older adults aged 70 to 85 and who did not meet physical activity recommendations were recruited from the population register of the city of Jyväskylä (n=314). PT included supervised walking and dynamic balance (once weekly) as well as resistance and balance training (once weekly), home exercises (2-3 times weekly) and moderate aerobic activity 150 minutes/week in bouts of >10 minutes. PTCT included the PT and computer training (CT) targeting EFs 15-20 minutes, 3-4 times per week. The primary outcome was walking speed. Secondary outcomes were 6-minute walking distance, dual-task cost in walking speed, and EF (Stroop and Trail Making B-A). 

Results: The mean age of the participants was 74.5 (SD3.8) and 60% were women. The trial was completed by 93% of the participants. Mean adherence to supervised sessions was 59-72% in PT and 62-77% in PTCT group. Home exercises and CT were performed on average 1.9 times per week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT group. No significant interactions were observed for walking speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; 95%CI -16.9, 9.3) or dual-task cost (-0.22; 95%CI -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; 95%CI -13.0, -0.8). 

Conclusions: Complementing physical training with EFs training is not essential for promotion of gait speed. For executive functions, complementing physical training with targeted cognitive training provides additional benefit.   

Purpose. Confinement during the COVID-19 pandemic increased physical inactivity and a sedentary lifestyle, which are known to negatively affect physical and mental health, including cognition. Physical activity and cognitive training could help prevent these collateral impacts, especially when combined within the same intervention, due to their potential synergetic effect on brain functions. However, little is known about how the interaction of cognition and physical fitness affects functional aging. Also, the added benefits of cognitive training on physical exercise for cognitive functioning need to be further addressed.

This work aims to document 1/ whether the level of cardiorespiratory fitness moderates the age-related interdependence between functional mobility and cognition and 2/ the added benefits of a home-based intervention involving cognitive training and physical exercise on cognition compared to physical exercise alone.

Methods. All analyses were performed on data from COVEPIC (NCT04635462), and COVEPICARDIO (NCT04661189) registered studies. Each trial enrolled 122 older adults (>50 years old), with and without cardiac diseases, randomly assigned to take part in one of the two following arms (1:1): 1/ Combined physical and cognitive home-based training intervention or 2/ home-based physical training alone. Participants completed videoconference assessments of their cognitive and physical functioning prior to the intervention (T0), mid-intervention (T1) (3 months), post-intervention (T2) (6 months), and 6-month follow-up (T3). 

Results. A three-way moderation analysis performed on baseline data demonstrated that cardiorespiratory fitness interacts with age to moderate the association between executive functioning and mobility. At lower levels of physical fitness (<19.16 ml/min/kg), executive functioning significantly influences the mobility of individuals more than 65 years old. Then, an ANOVA performed with follow-up data suggests that participants who completed the combined intervention showed larger improvements in dual-task performance, notably the task set cost between 0-3 months of training.

Conclusions. These results show that the interaction between physical fitness and cognition affects functional aging and demonstrate the complementarity of cognitive training and physical exercise intervention to improve specific aspects of cognition. Together, these observations suggest the added value of the multidomain approach to prevent age-associated loss of autonomy and support the idea of personalizing the proposed intervention to individual needs.

Purpose: Given the rising prevalence of dementia, developing preventive strategies to promote healthy cognitive ageing is considered a priority. Physical activity (PA) is a modifiable risk factor for dementia and experimental studies have demonstrated its effects on cognitive function. Interestingly, recent research has suggested that cognitive activity (CA) combined with PA can have even greater effects on cognitive functioning than PA alone. Studies of combined PA and CA have, however, mostly been conducted in controlled laboratory settings. There is thus a need for real-life, community-based interventions combining PA and CA. Therefore, we developed a cognitively enriched walking program for adults (65+ years) using co-creation. In a randomized controlled trial (RCT), we investigated the effectiveness of this program to boost cognitive functioning and mental wellbeing.

Methods: Cognitively and physically healthy older adults were recruited in two major cities in Belgium. Cognitive functioning (CANTAB test battery and Cognitive Failures Questionnaire), physical activity (accelerometer) and psychosocial wellbeing (questionnaires for depressive symptoms, positive wellbeing, social support and loneliness) were assessed at baseline, and three months, six months and twelve months follow-ups are planned. After the baseline measurements, participants were randomly assigned to one of three intervention arms: 1) cognitively enriched walking program (PA+CA), 2) walking program (PA only) or 3) passive control group. Both walking programs consist of bi-weekly supervised group-based walking sessions, for a duration of six months. Group session duration is one to one and a half hours in which distances of three to five kilometers are covered. Each PA+CA session includes two cognitive tasks targeting different cognitive functions. Participants in both the PA only and the PA+CA groups are additionally asked to complete one individual session a week.

Results: At baseline, 148 participants were included. The mean age of the participants was 70.18 and 71.8% was female. Preliminary results on the effectiveness of the program for cognitive function and wellbeing will be presented.

Conclusions: To our knowledge, this is the first real-life community based cognitively enriched walking program developed through a co-creation process. Findings will inform future programs simultaneously focusing on PA and CA for older adults in real-life settings.

Purpose: To present examples of patient-centred approaches for supporting healthy active lifestyles in patients living with and beyond cancer in the context of effective and sustainable health behaviour change.

Rationale: Living a healthy active lifestyle has positive health effects for individuals living with and beyond cancer. However, many patients do not comply with recommended healthy lifestyle guidelines, demonstrating a gap between evidence and practice. Patient-centred approaches are needed to successfully promote healthy active lifestyles in patients. Patient-centred strategies for supporting healthy active lifestyles are tailored to the needs and preferences of patients and aim to increase the likelihood of effective and sustainable health behaviour change.

Objectives:

1. To present examples of patient-centred strategies for supporting healthy active lifestyles in patients.

2. To discuss relevant pitfalls and challenges and to consider research priorities in the development, implementation and evaluation of patient-centred strategies.

Summary: This symposium is a collaboration between cancer researchers from England, the Netherlands and Belgium. The first presentation concentrates on a screening tool for healthcare providers, enabling them to refer patients to the most appropriate exercise setting with patient-tailored supervision. The second presentation focuses on the development of a toolkit which is specifically aimed at helping physical therapists to support exercise maintenance in oncology patients. The third presentation is centred on a co-designed intervention for supporting healthy active lifestyles (physical activity, healthy dietary choices) in patients recovering from breast cancer treatment. All included studies focus on patient-centred approaches for promoting healthy active lifestyles in oncology patients. The presenters will elaborate on the developmental process underpinning these strategies.

Format: The chair of the symposium (Vera Verbestel) will start with a short introduction of the topic, followed by three presentations:

1. To develop a screening tool for healthcare providers to refer patients living with and beyond cancer to the most appropriate exercise setting with patient tailored supervision. Presenter: Renée Bultijnck

2. STart Exercising, keeP exercisINg (STEP‐IN): A toolkit for physiotherapists to support exercise maintenance among cancer survivors after supervised exercise interventions. Presenter:  Meeke Hoedjes

3. Co-designed weight management intervention for women recovering from primary breast cancer treatment. Presenter: John Saxton

The symposium will be closed by the discussant (Cindy Forbes) with a facilitated audience discussion and a summary of the presentations and discussions.

Interaction: The remote audience will be involved by using Wooclap’s real-time interactions and message walls which allows participants to anonymously reply on polls and to ask questions.

Purpose 

To develop a screening tool for healthcare providers (HCP) enabling them to refer patients during and after cancer treatment to the most appropriate exercise setting with patient tailored supervision.

Methods 

A step-wise approach with a two round Delphi method was employed for development of this tool. Twenty experts were recruited via our TACTIC (Tailored Activity during and after Treatment In Cancer patients) project consortium and research network. REDCap, a web application for managing surveys and databases was used for our Delphi surveys. First, a provisional list of screening items was constructed based on literature review and expert opinion of our research team. This list was used during the first round and items were scored based on their relevance. The second round captured the items to score measures and corresponding actions to take. Consensus about final scoring items and actions was reached during a last expert meeting. Finally, a pilot test was conducted. Eleven HCP used the tool and based on their feedback the tool was further adjusted and optimised.

Results  

Twenty experts participated in our Delphi survey: seven physical therapists, one psychologist, three specialist cancer nurses and nine physicians from different specialties. The final tool consists of nine items that HCP should score: patient performance status, tumour location and stability, lymphoedema, cardiovascular and respiratory morbidity, diabetes, weight, fall risk and osteoporosis, feelings of anxiety and depression. Patients are scored to one of three categories, according to a traffic light system: green, meaning exercise can safely be performed in a primary care setting, without specialized physiotherapist; orange, exercise is preferably started with guidance of a specialized physiotherapist (either in hospital or community setting) and can be done without supervision after a positive evaluation, or red, meaning a medical screening is recommended on one or more items (comorbidities) before start of an exercise program under supervision.

Conclusion  

We developed a nine-item screening tool for HCP to refer patients during and after cancer treatment to physical rehabilitation. It is a dynamic traffic light system to support HCP in patient suitability for exercise. After evaluation patients can shift towards another category. 

Purpose:

Exercise has important health benefits for people living with or beyond cancer. Supervised exercise interventions are generally effective on short term outcomes. To maintain and further improve health benefits, physical activity behavior should be continued after the supervised program. Yet, cancer survivors experience difficulties to keep exercising after finishing supervised interventions. While current standards and professional guidelines for physiotherapists emphasize ‘exercise maintenance’ as a treatment goal, physiotherapists lack practical tools to guide patients in achieving this. Consequently, support of exercise maintenance is insufficient. STEP-IN aims to develop a toolkit for physical therapists, to support exercise maintenance of cancer survivors.

Methods:

The STEP‐IN project has a mixed‐method design and is guided by intervention mapping methodology and the double diamond design process. STEP‐IN started with a needs assessment, followed by a systematic review of the literature to identify targets for action and determinants of change, and selection of strategies to support exercise maintenance. Toolkit materials were then developed by the co‐creation team. A key element is the active engagement of cancer survivors and physiotherapists as a ‘co‐creation team’. Furthermore, each development phase is supported by an expert advisory board.

Results:

The main findings of the needs assessment indicated that physiotherapist typically lacked a strong theoretical basis related to behavior change techniques, and required practical support for integrating such techniques into their treatment. Also, physiotherapists valued easily accessible, reliable resources supporting behavioral change, for themselves and for their patients. The STEP-IN project has resulted in a ready‐for‐practice toolkit for physiotherapists to meet those needs. The cornerstone of this toolbox is a decision tool that aims to improve patient- therapist interaction for selecting (cognitive and/or behavioral) targets for treatment, which can be revisited and evaluated periodically.

Conclusions:

The STEP-IN toolkit provides practical instruments and resources for physiotherapists to help them support exercise maintenance among cancer survivors, which is essential for high quality care. The toolkit will be made available in print and electronic form, and courses will be organized to train physiotherapists in its use.

Background: Weight gain is commonly observed during and after breast cancer treatment and is associated with poorer survival outcomes, particularly in women with oestrogen receptor-positive disease. The aim of this study was to co-design (with patients) a programme of tailored, personalized physical activity and dietary support to help female breast cancer patients (BCPs) develop the skills and confidence for sustainable weight loss. 

Methods: 

Guided by the Behaviour Change Wheel, a theoretically-informed weight management intervention was developed on the basis of co-designed strategies to overcome physical and emotional barriers to physical activity and dietary behaviour change. A linked focus group study with BCPs (N=16) and healthcare professionals (HCPs; N=21) first explored the challenges of dietary and physical activity behaviour change during and beyond the breast cancer care pathway. Two groups of BCPs (N=4 and N=5) from different regions of the UK then participated in a two-stage co-design process. The stage 1 and stage 2 co-design workshops were held two weeks apart and were approximately 2 h in duration.

Results:

Four overarching themes were identified from the focus group study: Treatment; Support for lifestyle behaviour change; Information availability for BCPs; Knowledge of current evidence amongst HCPs. Building onto these themes through the co-design process, BCPs were instrumental in developing all key features of the intervention, in terms of Capability (e.g., evidence-based information, peer-support and shared experiences), Opportunity (e.g., flexible approach to weight management based on core principles) and Motivation (e.g., appropriate use of goal-setting and high-quality resources, including motivational factsheets) for behaviour change.

Conclusion: This co-design approach enabled the development of a theoretically-informed intervention with a content, structure and delivery model that has the potential to address the weight management challenges faced by BCPs. Future research is required to evaluate the effectiveness of the intervention for eliciting clinically-important and sustainable weight loss in this population. 

\r\n\r\nRationale: Eating behaviours (e.g., fussiness, satiety responsiveness, and) are associated with child weight. A common approach to understanding child eating behaviours is the CEBQ; a 35-item parent-reported survey tool. When combined with assessment of outcomes (e.g., dietary intake), high participant burden can be caused, therefore, there is a need for refinement of the CEBQ. Additionally, most research examines associations between child eating behaviours and health outcomes using a variable centred approach (single variable associations). However, eating behaviours do not occur in isolation, examining profiles of eating behaviours using person-centred analysis can inform personalised intervention programs. Finally, although it is known that eating behaviours have largely genetic origins, epigenetic factors are yet to be explored. Examining epigenetic factors could provide novel insights into the early developmental origins of childrens eating behaviours to help identify those at higher obesity risk. \r\nObjectives: 1) To summarise and discuss current measurement of child eating behaviours, and the evidence regarding the associations between child eating behaviours and weight status. 2) To refine the widely used CEBQ examining child eating behaviours. 3) To investigate the use of novel data analysis techniques to examine profiles of child eating behaviours, and their associations with weight. 4) To examine possible epigenetic pathways linked to child eating behaviours.

\r\n\r\nSummary: The session will begin with an overview of existing research regarding child eating behaviour measures, and associations between child eating behaviours and weight. This symposium will provide novel insights into the measurement and analysis of child eating behaviours, and their associations with child weight status. Additionally, epigenetic factors influencing the early development of child eating behaviours will be discussed.

\r\n\r\nInteraction: Discussion points that are of interest to the topic and the audience will be formed to guide a discussion.

\r\n\r\nFormat: 0-5: Introduction - Alissa Burnett (Australia)
\r\n5-20: Maria Somaraki (France): A novel methodology for the assessment of child eating behaviours: Applying the Rasch model on the Child Eating Behaviour Questionnaire (CEBQ) using samples from Australia and Sweden
\r\n20-35: Jennifer Fisher (USA): Use of person-centered eating behavior profiles to reflect the whole child
\r\n35-50: Holly Harris (Netherlands): An epigenome-wide association study of child eating behaviours and DNA methylation
\r\n50-75: Discussion - Georgie Russell (Australia)
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Purpose: Child eating behaviour is considered a key component of obesity-related behavioural profiles. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. While the Child Eating Behaviour Questionnaire (CEBQ) has undergone extensive psychometric evaluation and validation using classical test theory, the application of Rasch may identify and remove redundant items and, therefore, reduce participant burden. The present analyses aim to provide insights into the use of the CEBQ using the Rasch model and to assess child eating behaviours after obesity treatment.

Methods: First, Rasch-based fit statistics were applied on the CEBQ items as reported by Australian and Swedish mothers (n=1724) for their children aged 4-6 years. Secondly, changes in preschoolers’ eating behaviours were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) to standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time.

Results: The validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5–1.5), namely ‘My child gets full up easily’, ‘My child refuses new foods at first’, ‘My child is interested in tasting foods s/he hasn't tasted before’(reversed), and ‘My child decides that s/he doesn't like a food, even without tasting it’. The refined CEBQ was used in the RCT evaluation and no differences in parental reports of changes in children's eating behaviours were shown between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05).

Conclusion: The refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. A shorter version of the CEBQ can facilitate routine assessments of child eating behaviours in research and/or clinical settings, which can inform tailored interventions for childhood obesity.  Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.

Purpose: Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight.

Methods: A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status.

Results: LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles.

Conclusions: Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.

Purpose: Eating behaviours (or appetitive traits) are phenotypes expressed through complex gene-environment interactions and contribute to variability in weight-gain. Early-life epigenetic processes, such as DNA methylation, may be involved in the developmental programing of appetite regulation expressed in childhood. However, this is yet to be systematically explored. The current study is an epigenome-wide association study (EWAS) exploring associations between cord blood DNA methylation (DNAm) and child eating behaviours.

Methods: Data were from the population-based Generation R Study. Children with available cord blood DNAm and eating behaviour data at 4 years were included in the study (n=1086). DNAm profiles of autosomal methylation sites were generated using the Illumina Infinium HumanMethylation450 BeadChip. Parents reported on their child’s food responsiveness, emotional overeating, emotional undereating, satiety responsiveness and food fussiness using the Child Eating Behaviour Questionnaire. Multiple regression models were used to examine the association between DNAm (predictor) at the site- and regional- level and each eating behaviour (outcome), adjusting for covariates. Within each model, a Bonferroni-correction was applied based on the number of probes (p<1.20 × 10^-7).

Results: Mothers were on average 32.5 (± 4.0) years at study inclusion and most reported never smoking (80.5%). No associations were found between DNAm at the individual sites and any appetitive trait. Regional analysis showed DNAm at a region on chromosome 8 was associated with food responsiveness (p=5.00 ×10^-08). This region encompasses three CpG sites, cg04943741, cg11402303, and cg27657489, located in the gene body of VPS28. Further replication and meta-analysis of results in two other studies is planned and will be presented.

Conclusions: This is the first EWAS examining DNAm in cord blood and associations with child eating behaviours. Findings from this study provide preliminary support for early programming via DNAm processes in children’s expression of food responsiveness, which is consistently associated with higher weight status. In line with the Behavouiral Susceptibility Theory, this finding provides some initial evidence for behaviorally-mediated mechanisms linking genetic risk and environmental exposure to weight gain. Investigating differential DNA methylation associated with eating behaviours could be an important first step in identifying biological pathways underlying the development of these behaviours.

Purpose: The purpose of this symposium is to present and discuss the need for identification of time- and context-dependent determinants and their associations with physical activity (PA) in order to change behavior more effectively. Furthermore, the feasibility of using ecological momentary assessment (EMA) in older adults and just-in-time adaptive interventions (JITAIs) in patients with chronic conditions will be presented and discussed.

Rationale: Targeting the ‘right’ determinants at the ‘right’ time, taking into account the possible time- and context-dependent variations of determinants in interventions, might increase PA levels more effectively. Identification of such variations is possible with EMA and stimulating individuals to be active at the right time in the right context can be realized by JITAIs. Older adults as well as type 2 diabetes and prediabetes patients are among the most inactive and sedentary subpopulations, and therefore, are an appropriate target population for exploring these novel techniques in the research field of PA.

Objectives:

1.    To showcase the feasibility of using EMA and JITAIs in vulnerable groups

2.    To share the results of two EMA studies and a JITAI in vulnerable groups

3.    To initiate reflection and discussion about recent EMA research and using JITAIs in the research field of PA

Summary: The first presentation will focus on the associations between individual factors and contexts of PA in older adults, but also on practical considerations for future event-based EMA studies. In the second presentation within-day associations between several determinants and subsequent PA in older adults, using time-based EMA, will be presented. The third presentation will focus on the process evaluation of a JITAI in patients with type 2 diabetes and prediabetes.

Format:

5’ Introduction by chair Iris Maes

15’ Julie Delobelle: Event-based ecological momentary assessment to explore the environmental and social context of physical activity in older adults: results and lessons learned

15’ Iris Maes: Predictive within-day associations of emotions, physical complaints, intention and self-efficacy with subsequent accelerometer-assessed physical activity in older adults: a time-based EMA study

15’ Jan Novak: Implementation of a just-in-time adaptive intervention (JITAI) in patients with type 2 diabetes and prediabetes recruited in primary care: a process evaluation

25’ Discussion led by Tomas Vetrovsky

Interaction: During the discussion, the audience will be stimulated to ask questions. These will be summarized and presented by the discussant. The presenters and discussant will also prepare some questions in advance which can be used to start a discussion..

Background: 

Event-based ecological momentary assessment (EMA) is an innovative data collection method to assess experiences, emotions and contexts during or following a specific event (e.g., short bout of PA). The purpose of this study was to explore associations between individual factors and the environmental and social contexts of PA, using event-based EMA. Since this data collection method is novel within this research domain, the most important learned lessons to conduct event-based EMA studies will be provided.

Methods:

An observational event-based EMA study was conducted, using a convenience sample of 75 healthy older adults (65+). Each participant completed a questionnaire to assess socio-demographic variables. Participants were monitored using a Fitbit (i.e., Inspire 2 or Ionic), triggering a questionnaire on a smartphone application (i.e., Health React) after a short bout (5 consecutive minutes) of sustained walking (≥60 steps/minute). During seven consecutive days, participants answered smartphone-based questions regarding the environmental and social context, emotions and physical complaints they experienced during/immediately after PA. A maximum of 6 prompts per day was set, with minimum 60 minutes between two prompts. Afterwards, a semi-structured interview was conducted to assess how the participants experienced the study, which will be analyzed using a deductive approach in NVivo. Moreover, descriptive and regression analyses will be conducted to explore associations between individual factors (e.g., age, sex, loneliness, social support, physical complaints) and the contexts of PA.

Results: 

Preliminary analyses (N=35) showed that 79.5% of the prompts were triggered outdoors (36.42% in a public green environment) and when being alone (60.3%). In addition, older adults who felt lonely performed more PA alone (p<0.001). Importantly, 20% of the participants were never prompted during the entire study (due to physical inactivity, Fitbit synchronization delays or noncompliance with the prompting rules). Further quantitative and qualitative analyses will be conducted and results will be presented at the conference.

Conclusion: 

This study provides practical considerations for future event-based EMA studies. In addition, gaining insight in the association between individual factors and contexts of PA will have important implications for just-in-time adaptive interventions to increase PA by initializing real-time supportive messages adapted to an individual’s state.

Purpose. Health behavior change interventions often do not focus on contextual and time-varying determinants, which might limit their effectiveness. However, before dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with physical activity (PA) and how strong these associations are. In the research field of PA some research has been done to examine these associations, but research in older adults is limited. Therefore, the aim of the current study was to examine predictive within-day associations between multiple determinants of the COM-B framework assessed using ecological momentary assessment (EMA), and accelerometer assessed light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and total physical activity performed in the 15, 30, 60 and 120 minutes after the EMA trigger.

Methods. Observational data were collected in 64 older adults (56.3% men; mean age 72.1 ± 5.6 years). Participants were asked to answer an time-based EMA questionnaire 6 times per day which assessed emotions (i.e., relaxation, satisfaction, irritation, feeling down), the physical complaint fatigue, intention, and self-efficacy. An Axivity AX3 was worn to objectively capture participants’ PA. Multilevel regressions analyses in R were performed to examine these within-day associations.

Results. Satisfaction, irritation, feeling down, intention and self-efficacy were positively associated with subsequent LPA and/or MVPA in the 15, 30 and 60 minutes after the trigger, while relaxation and fatigue were negatively associated.

Conclusions. Multiple associations were found in the current study. This knowledge in combination with the time-dependency of the determinants is valuable information for future interventions, so that suggestions to be active can be provided when the older adult is most receptive.

Purpose: Just-in-time adaptive interventions (JITAIs) can potentially improve sedentary adults' physical activity levels. Whether JITAIs can be successfully applied to patients with chronic conditions in healthcare settings is unknown. This study aimed to develop and evaluate the implementation of a JITAI to increase physical activity and reduce prolonged sitting in type 2 diabetes and prediabetes patients recruited in primary care.

Methods: The JITAI was developed with the involvement of pre/diabetes patients according to the mHealth development and evaluation framework. The resulting JITAI consisted of prompts to interrupt sitting after 30 mins of zero steps (sedentary prompts) and to increase walking pace after 5 mins of 60–100 steps (walking prompts). The prompts were triggered by the HealthReact system contingent on step count detected by the Fitbit tracker and delivered as text messages. The evaluation of the JITAI's implementation was informed by the Medical Research Council guidance for process evaluation of complex interventions and included the intervention's reach, fidelity, and dose.

Results: Reach: Of 335 patients randomly selected from among 18 general practices, 59 (18%) were ineligible due to not being mobile phone users, and 25 (7%) declined to wear the Fitbit tracker. Fidelity: In the reference 7-day period, of 52 patients assigned to the JITAI, 16 (31%) did not sync their Fitbit data, mainly due to internet access difficulties and technical issues. Of the remaining 36 patients, 29 (81%) triggered at least one sedentary prompt, and 16 (44%) triggered at least one walking prompt. Irregular sync due to a lack of a mobile data plan was the principal reason for not triggering any prompt. Dose: Among those who received at least one prompt, the median was 4 (IQR 1–4) sedentary and 2 (IQR 1–3) walking prompts per week.

Conclusions: In pre/diabetes patients recruited in primary care, the JITAI had reasonable reach, with only 1 in 4 patients unable or unwilling to participate. Lack of internet access and technical issues remained the main obstacles to desired intervention fidelity in this population. Further analyses will explore the proximal effect of the JITAI's prompts and patients’ views of the intervention.

Purpose: To explore delivery personnel barriers and facilitators when translating an evidence-based physical activity intervention that was previously tested through in-person, synchronous delivery. 

Methods:  A learning collaborative consisting of human factors engineering and ergonomists, behavioral psychologist, exercise scientists, and LIFT instructors engaged in three iterative trials to answer distinct research aims: 1) LIFT delivered online was pilot tested (n = 88) for participant adherence and self-report physical activity; 2) qualitative data were collected via one-on-one interviews with instructors (n = 10) to determine barriers and facilitators; and 3) sensor data was collected on a subsample of older adults (n = 3) to determine compliance and acceptability of wearables. 

Results: In 2021, 88 older adults (95% female; 44% non-White; 71+9 years of age; average BMI 30.36(+6.4) kg/m2) participated in LIFT online across Arkansas, North Carolina, and Virginia who had significant improvements in lower body and upper body strength, upper body flexibility and aerobic endurance (p< 0.05). Agility, lower body flexibility, and balance improved, but not significantly (p>0.05). One participant shared, “The best part of LIFT was being able to exercise safely during the pandemic and winter weather.” Instructors shared challenges in facilitating social connection in the virtual space and concerns about ease of technology use, “Zoom is better than nothing….You know, in-person is, to me, the- the best form.” Finally, to inform gesture-based interfaces that can simplify instructor-participant communication without the need to share the camera feed, wearable inertial measurement unit (IMU) data were collected in one cohort of LIFT. Some participants shared difficulties in understanding the sensor interface and how to use the sensors correctly for data recording with written instructions. However, after providing a live video demonstration of the sensor data recording process, errors in data recording had a downward trend.  

Conclusions: Virtual exercise programs can be safe and feasible. Instructors need ongoing training and support for prompting virtual programming. This includes, but is not limited to: orientation calls to help guide participants with audio/visual best practices and adapting the objective functional fitness protocol to the virtual space.

Purpose: Leisure time physical activity (LTPA) has numerous health and social benefits for older adults. The aim of this study was to assess the relationship between different LTPAs and active ageing status (AGS) among older adults in Bangladesh, as well as the moderating role of socioeconomic factors in that relationship.

Methods: A cross-sectional survey was conducted among 348 older adults (73.9% males) aged 65 years and above from February to October 2021. LTPA and AGS were assessed using the Physical Activity Scale for the Elderly (PASE) and the University of Jyvaskyla Active Ageing Scale (UJACAS), respectively. Hierarchical multiple regressions were performed to determine the relationships between different types of LTPA and AGS, while adjusting for household and work-related activities. A moderation test was also performed using SPSS PROCESS (Version 4).

Results: Over half of the older adults aged 65-69 years (52.6%), lived in rural areas (51.7%), had a normal body weight (56.9%), were unemployed or homemaker (62.6%), had a lower level of education (55.5%) and had other sources of income or financial support (54.9%). AGS significantly differed according to sex, age, weight status, education level, employment status, and other sources of income or financial support among older adults. LTPAs, including walking outside of the home (β=0.24; 95% CI: 0.13, 0.35), light (β=0.20; 95% CI: 0.10, 0.30), moderate (β=0.10; 95% CI: 0.00, 0.20), and strenuous (β=0.14; 95% CI: 0.04, 0.24) sport or recreational activities, were positively associated with a higher score of AGS. Activities other than LTPAs, i.e., home repairs (β=0.14; 95% CI: 0.01, 0.27) and caring for another person (β=0.14; 95% CI: 0.03, 0.25), were positively, while paid or voluntary work (β=-0.10; 95% CI: -0.20, 0.00) was negatively, associated with AGS. Employment status moderated the relationship between LTPAs and AGS.

Conclusions: Higher levels of LTPAs were related to better AGS. Regular participation in the optimum level of LTPAs is highly advisable for older adults in Bangladesh in order to stay active, healthy, and have a better quality of life at a later stage.

Purpose: This study of middle-aged and older adults examined the associations between objectively- assessed features of the neighbourhood environment and physical and mental aspects of health-related quality of life (HRQoL), and the mediating effects of physical activity and sedentary behaviours in the associations.

Methods: We used data from the third wave of the Australian Diabetes, Obesity and Lifestyle survey (conducted in 2011-12) with relevant environmental exposures. Attributes of the built and natural environment were assessed using Geographic Information Systems data for 1-km residential buffers, while annual average concentrations of air pollutants were estimated using satellite-based land use regression models. Neighbourhood socio-economic status (SES) was obtained from census data. Physical activity (walking for different purposes, gardening and resistance training) and sedentary behaviours (leisure-time and transport sitting) were self-reported. HRQoL was measured using the SF-36. Generalised linear mixed models informed by directed acyclic graphs were used to estimate associations between environmental, behavioural and outcome variables.

Results/findings: Neighbourhood SES (positively) and annual average concentrations of PM_2.5 (negatively) were the only attributes associated significantly with HRQoL in the total- and direct-effect models. All neighbourhood environmental attributes were indirectly related to the physical and mental components of HRQoL via physical activity behaviours and leisure-time sitting. Indirect effects of most environmental features on HRQoL were inconsistent, i.e., positive through some behavioural pathways and negative through others.

Conclusions: Neighbourhood SES appears to have beneficial effects on HRQoL. Walkability-related built environment attributes appear to have beneficial associations with HRQoL via walking and resistance training which may displace some leisure-time sitting. However, some of these attributes may also contribute to more sitting by limiting mid-aged and older adults’ opportunities for household and gardening activities. Access to natural features may also provide support some activities (e.g., resistance training, less sitting) but limit opportunities for others (gardening). These findings highlight the importance of further examining the potential role of the neighbourhood environment in HRQoL through mediation analyses encompassing key inter-related neighbourhood environmental attributes and a variety of lifestyle behaviours theoretically linked to specific environmental features and HRQoL.

Purpose: This mixed-method systematic review aimed to identify the conceptualization and assessment of physical literacy, and summarize the potential health determinants across the multiple domains of physical literacy (physical, affective, cognitive and behavioural) for older adults aged 60 years and above.

Method: Six scientific databases, MEDLINE (Ovid), PsycINFO (ProQuest), Scopus, PubMed, Web of Science, and EMBASE(Ovid) were searched on 17 November 2022. Critical appraisal was conducted using Joanna Briggs Institute's Critical Appraisal tools and the Mixed Method Appraisal Tool. Inductive thematic analysis was used to synthesize health determinants related to physical literacy.

Results: 12 articles, including 2,106 participants from 6 countries and districts, were included. Physical literacy was assessed either qualitatively by using interviews, open-end questions, and observation, or quantitatively using psychometric scales for different physical literacy domains. Most of the studies measured the affective domain (67%; motivation, and confidence), followed by the physical domain (50%; physical competence, motor skill competence, fundamental movement skills, purposeful physical pursuit), cognitive domain (33%; knowledge and understanding of activities, knowledge and understanding of healthy and active lifestyles, and value and take responsibility for physical activity), behaviour domain (17%; physical activity engagement), and general physical literacy (25%). Five health determinants have been investigated in their relationships with physical literacy domains: (1) individual characteristics and behaviours: physical well-being, previous exercises experience, staying active and diet, (2) health services: physical activity program, (3) education: instructor, education attainment, knowledge and awareness of the physical activity and pedagogical strategies, (4) social support network: social engagement, and (5) gender.

Conclusion: A comprehensive assessment of physical literacy for older adults is lacking. There was some evidence showing that intrapersonal factors and participating in physical activity programs were positively associated with physical literacy in older adults. Future studies should examine a wide range of health determinants of multiple domains of physical literacy in older adults.

Purpose:          Cooking is a physical activity that declined at the beginning of frailty. Poorer cooking status may contribute to unhealthy eating, leading to the progress of frailty status. This study aimed to examine the associations between spending time in the kitchen, healthy diet intake, and frailty status, and barriers to kitchen use were also explored among older women.

Methods:         An online cross-sectional survey was conducted with 600 community-dwelling older Japanese women aged ≥65 years in January 2023. Frailty status was assessed using the Kihon Check List. Healthy diet intake was assessed using the balanced-meal intake frequency, asking the days of having ≥2 meals including a staple, a main, and a side dishes in a week. Kitchen use was evaluated using the weekly frequency of using the kitchen and time spent in the kitchen a day. Barriers to kitchen use were identified by asking about inconvenient things in the kitchen with 16 options. Kruskal-Wallis and Fisher’s exact tests were used to examine associations of frailty status with demographic characteristics, balanced-meal intake, kitchen use, and barriers to kitchen use. Moderation analysis was used to test the conditional effect of time spent in the kitchen on frailty status and balanced-meal intake.

Results/findings:  The prevalence of pre-frailty and frailty were 34.0% and 21.1%, respectively, and 95% used their kitchen every day. Participants with frailty were older (p=<0.001), had larger BMI (p=0.010), and were more likely to have lower household income (p=0.002) and receive caregiving (p=<0.001), compared to robust participants. While participants who spent a longer time in the kitchen consumed more balanced-meals in each frailty status, the conditional effect of time spent in the kitchen on balanced-meal intake was stronger among those with pre-frailty or frailty, compared to robust participants (p=0.012). Participants with frailty were more likely to report three inconveniences: a strain in their low back (p=<0.001), a strain on their neck (p=0.017), and a distant storage yard for garbage and dish soap (p=<0.001).

Conclusions:     These findings support that kitchens should be redesigned for older women with frailty, which may contribute to spending longer time in the kitchen and improving their diet.

Purpose: Previous studies have reported changes in physical activity and self-rated health during retirement transition, but the results have been inconclusive, and these two variables have not been studied simultaneously. The aim of the study was to evaluate concurrent changes in physical activity and self-rated health during retirement transition by multivariate trajectory analysis and to examine, whether sociodemographic and lifestyle factors predict the probability of being classified to a certain subgroup of observed changes.

Methods: 3,550 participants of the ongoing Finnish Retirement and Aging (FIREA) study answered annual surveys prior to and after retirement, in five possible study waves. Participants were asked to estimate weekly hours spent on different types of activities, then converted to MET-h/week. Self-rated health was assessed on a 5-point Likert-like scale from poor to excellent and dichotomized as suboptimal and optimal. Multivariate trajectory analysis was used to distinguish different subgroups of trajectories of concurrent changes in physical activity and self-rated health. Multinomial regression analysis was used to describe the associations between covariates and the probability of being classified to a certain trajectory group.

Results: Three trajectory groups were identified, all displaying increasing activity during retirement transition with a simultaneous decrease in perceived suboptimal health. The improvement was temporary for most participants, except for 9% of participants who had high physical activity which only increased during follow-up, with low percentage of suboptimal health. Male gender, professional occupation, being married or co-habiting, normal or overweight, not smoking and using alcohol below risk levels were associated with higher activity and better self-rated health.

Conclusion: Changes in physical activity and perceived health during retirement transition were found to be interconnected. Both were improved during retirement transition, but the change was temporary. Longer follow-up studies are required to further assess the changes over longer period of time after retirement.

Purpose: This study aimed to systematically review all available evidence on lifestyle factors influencing body weight and body composition trajectories as women go through menopause, including both experimental and observational studies that measured outcomes at least twice.

Method: A search strategy was developed and adapted based on Jull et al.’s (2014) systematic review of lifestyle interventions for menopausal weight change. Database searches were conducted, including Scopus, Cochrane, Embase, PubMed (Ovid), and CINAHL Plus, as well as hand-searching. Eligible studies were longitudinal interventions, including randomized, non-randomized, and cross-over trials, as well as observational studies (cohorts and cross-sectional) that investigated lifestyle factors’ effect on body weight and/or body composition changes. Studies had to target women across their menopausal age, specifically those who transitioned from pre- or peri-menopausal to peri- or post-menopausal, or remained perimenopausal throughout the study period. Additionally, studies needed to measure variables related to body weight and/or body composition at two or more time points. Data collection and quality assessment were conducted using a standardized form, the revised Cochrane Risk-of-Bias (RoB2) tool, and the Newcastle-Ottawa scale for experimental and observational studies, respectively.

Results: Of 12,260 articles after deduplication, twenty-four studies were included in this review, comprising 10 controlled trials, 13 cohorts, and one cross-sectional study (including retrospective body weight data). Because of the heterogeneity in intervention/exposures and outcome details, conducting a meta-analysis was not feasible, and a descriptive analysis was conducted. The findings of four out of ten interventional studies demonstrated that study groups following an aerobic and resistant exercise intervention, a low-fat, high-carbohydrate dietary intervention, a healthy lifestyle educational intervention, or a combined dietary and exercise intervention had significant, favourable differences in changes in weight, BMI, gynoid, and/or android fat mass. Nine of 14 observational studies identified statistically significant relationships between longitudinal adiposity measurements and factors such as diet quality, smoking cessation, sitting time, physical activity level, and consumption of full-fat milk products (milk, sour milk, or cheese).

Conclusion: While further research is needed, the present findings suggest that lifestyle and behavioural modifications could be a useful strategy for preventing weight gain and adiposity in women transitioning through Menopause.

Purpose

As there is currently no effective treatment for dementia, it is important to identify contributors to cognitive decline from midlife to delay onset of clinical symptoms. Low physical activity (PA) and nightly sleep duration outside 6-8 hours are two interrelated factors thought to contribute to cognitive decline and dementia risk. Nonetheless, how PA and sleep combine to influence trajectories of cognitive ageing is still not well-explored. To investigate this, we examined longitudinal associations of different combinations of PA and sleep duration with 10-year cognitive trajectories.

Methods

Linear mixed models were used to examine independent and joint associations of PA (low, high) and sleep duration (short [<6 hours], optimal [6-8 hours], long [>8 hours]) with cognitive performance at baseline, 10 years, and cognitive decline in cognitively healthy adults aged ≥50 years from the English Longitudinal Study of Ageing (N=8991). Models were adjusted for sociodemographic and socioeconomic covariates, health behaviour indicators, chronic conditions, and depressive symptoms.

Results

Low PA was independently associated with worse cognitive performance at baseline (p<0.001), while short sleep was independently associated with faster cognitive decline (p=0.04). At baseline, high PA/optimal sleepers had higher cognitive scores than all sleep categories in the low PA category (e.g. difference high PA/optimal-low PA/optimal at age 50=0.10 [0.06, 0.15] standard deviations), while there was no difference in cognitive performance between sleep categories within the high PA category. Differences remained consistent over 10 years of follow-up, except high PA/short sleepers who declined faster than high PA/optimal sleepers, such that their cognitive scores at 10 years were commensurate with those in the low PA category (difference high PA/optimal-high PA/short=0.20 [0.05, 0.34]; high PA/optimal-low PA/short=0.28 [0.15, 0.41]).

Conclusions

PA and sleep duration combine in complex ways to influence cognitive trajectories from middle age; for example, the cognitive benefit at baseline provided by high PA was insufficient to blunt the rapid cognitive decline associated with short sleep. While WHO already identify PA as a target for maintaining cognitive function, effective PA interventions should also consider sleep habits to maximise potential benefits of PA for cognitive health and delay onset of dementia.

Purpose: Prolonged sedentary time poses health risks for older adults. Older adults in assisted living spend more time sedentary than community dwelling peers and reducing passive sedentary time could be beneficial. The purpose of this study was to examine the feasibility of Stand When You Can (SWYC), a sedentary behaviour intervention based on the social ecological model, for assisted living.

Methods: SWYC aims to reduce sedentary time through individual behaviour change and modifications to the social and physical environment. A toolkit is provided to staff and residents so the intervention can be implemented without researcher involvement. SWYC was tested in four assisted living residences in three Canadian provinces. Each site had a staff person identified as a “SWYC Ambassador”; residents (n = 68, 84.9 ± 6.5 years; 81% women) volunteered for pre- and post-intervention testing. Before and 12 weeks after SWYC was introduced, participants wore activPAL^TM inclinometers for seven days to measure sedentary time. Lower body function and quality of life were assessed with repeated chair stands and the EQ-5D, respectively. Changes were analyzed using paired sample t-tests. Onsite observations and checklists at 6 weeks were used to examine intervention fidelity.

Results: Observations revealed substantial variability in implementation, with only one site demonstrating good intervention fidelity. There was significant participant attrition (>50%) at 12 weeks. Sedentary time increased from pre- to post-intervention (681 ± 129 vs 721 ± 142 min/day; p=0.016). There was no significant difference (p > 0.05) in time spent in sedentary bouts (173 ± 85 vs 183 ± 73 min/day), sit-to-stand transitions (50 ± 14 vs 51 ± 14), or standing time (196 ± 78 vs 190 ± 77 min/day). There were no significant changes in quality of life or lower body function.

Conclusions: Developing strategies to reduce sedentary time and maintain function among residents of assisted living is a priority. SWYC is a novel, evidence-informed intervention, however it may not be feasible for most assisted living residences. It is unknown what role COVID-19 measures played in poor intervention fidelity and participant attrition, but it was clear that staff engagement is crucial to intervention success.

Purpose: Walking Football (WF) is one type of recreational football increasing in popularity, targeting older adults. Further knowledge on the intensity and physical workload of WF, characteristics of the players, the social context, and reasons for playing WF is needed. Thus, the aim of the study was to characterize the individuals that regularly play WF and their experience of WF, and the physiological characteristics of the sport.

Methods: Sixty-three players from three clubs taking part in organised WF in Sweden were included. The players underwent performance tests consisting of a balance test, estimation of cardiorespiratory fitness, strength, and a vertical jump test as well as answering a written questionnaire regarding sociodemographic, health experiences, physical activity habits and experiences of WF. The included players participated in up to four WF-games wearing a GPS-unit and heart rate monitor.

Results: The participants mean age was 70.9 years, ranging from 63 to 85 years with 71% (n=27) of the men and 68% (n=13) of the women having a BMI >25. Fifty-one percent (n=27) of the players had hypertension, and 73 % (n=39) regularly used prescription drugs due to illness. During WF, the players covered on average 2409 meters (2509 m for men and 2205 m for women). Expressed in percentage of their age-estimated maximal heart rate, mean heart rate represented 80 ± 9  and 80 ± 8% of max for men, and 78 ± 9  and 79 ± 9% of max for women in the first and second half, respectively, hence WF can be considered a moderate intensity activity for older adults.

Conclusions: Individuals regularly playing WF show similar cardiovascular risk profile as the general population but show somewhat better physical fitness profile. The main reason for WF participation were linked to socializing with others and having fun. WF includes a considerable number of accelerations and decelerations, which makes the sport more energetically and mechanically demanding than e.g., walking or running. As our results show that WF mainly is a moderate intensity aerobic activity, it may be a relevant alternative in physical activity prescription for health in clinical practice.

[Title]

The Occurrence of Frailty in Continued Group Exercise among Japanese Elderly People: A Follow-up Study during COVID-19

[Objective]

The purpose of this study was to clarify the association between continued group exercise and the development of frailty among elderly Japanese before and during the COVID-19 epidemic.

[Methods]

From August to November 2018 (Baseline [BL]), 4102 community-dwelling older adults participating in a senior club in Fujisawa, Kanagawa, Japan participated in a mailed survey. Of these, 2,283 participated in a mailed survey from September to November 2020 (follow-up [FL]) during the COVID-19 pandemic. 1,241 of the elderly who were not frail in the BL and had no missing data for analysis were included in the analysis. Frailty scores were assessed with the Kihon checklist (KCL). Group exercise continuation was questioned in BL and FL, and the subjects were divided into 4 groups according to continuation status: continuation group (n = 474), discontinuation group (n = 164), initiation group (n = 118), and non-initiation group (n = 485). In univariate and multivariate analyses, descriptive statistics were used to characterize each group, and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between the four groups and new onset of flail.

[Results/findings.]

Of the elderly who were not frail in 2018, 249 (20.1%) had developed frailty in 2020. 64 (13.5%) in the continuation group, 49 (29.9%) in the discontinuation group, 19 (16.1%) in the initiation group, and 117 (24.1%) in the non-initiation group developed new flail, with the discontinuation group having the highest rate of flail development compared to other groups.

Analysis showed that the discontinuation group had a significantly higher rate of new onset of flail compared to the continuation group (OR: 1.73 [95%CI 1.16-2.6]). The initiation and non-implementation groups showed no significant difference in the rate of new onset of flail compared to the continuation group (OR: 0.88 [95%CI 0.57-1.36], OR: 1.25 [95%CI 0.93-1.69]).

[Conclusion]

Continuation of group exercise was associated with the onset of frailty, suggesting that continuation of group exercise without discontinuation may prevent frailty.

Purpose: The aim of this qualitative longitudinal study was to investigate changes in food intake when one ages and identify opportunities for healthy aging. Food is essential to older adults’ quality of life, and adequate nutrition is necessary for healthy aging. Staying healthy longer and being able to live at home is an overarching aim for both society and older adults. In our experience, there are no longitudinal studies showing the development and changes in older adults' diets focusing on the foods and food products they consume.

Methods: The study used a phenomenological research design to gain deeper insights into the experience with food among older adults. The data collection was carried out in 2011 and 2020/21 using semi-structured interviews. The interview guide developed in 2011 was updated in 2020 to capture a longitudinal perspective. The age to participate in the first study was 67 – 84 years. Efforts were made to recontact all previous participants for the second study. Out of 15 participants from 2011, nine of the older adults were willing to participate in a follow-up interview. The data were analyzed using a thematic approach. By combining and analyzing the data from 2011 and 2021, we will present the data and results from the study. 

Results: The findings show both continuity and changes. Meals and eating habits were linked to both eating healthfully and enjoying the food. Overall, the changes observed were related to a more health-focused approach to the respondents’ food intake. A main finding was how the older adults coped with their changing life situation. Food habits and food context will be presented. 

Conclusions: The importance of food as a health factor is a discourse that has existed for a long time, and the food eaten should also be healthy. A focus on food behavior with recommendations particularly aimed at older adults' lives in their own homes could contribute to healthy, active, and social aging. It will also contribute to more knowledge for governments and stakeholders from a public health perspective, about what older adults need when it comes to food behavior and healthy eating. 

Purpose: Changes in physical function (PF) are an important aspect of ageing. A range of laboratory /clinic-based performance measures of PF are predictive of adverse future health outcomes in older adults. Remote health monitoring, through wearable devices, may allow the detection of declines in PF, earlier in the life course, before people perceive changes, and before presentation in clinic. If so, there is evidence that structured physical activity (PA) interventions can improve or delay losses in PF. Nevertheless, the strength of the association between wearable device-measured features of PA and performance-based measures of PF is unclear. This review examines the association between device-measured PA and performance-based measures of (PF) in adults.

Methods: A systematic review of observational studies reporting cross-sectional or prospective associations between wearable device-measured PA and PF outcomes in non-clinical adults. Meta-analyses were performed on included studies where a standardised regression coefficient was available or could be calculated.

Results: Forty-two studies with a pooled sample of 27276 participants were eligible, with 34 studies reporting a standardised regression coefficient (β) between at least one of four PA measures and one of six PF outcomes. All measures of PA were positively associated with all measures of PF, except for step count with grip strength. Strongest associations were seen with lower-body PF tests; gait speed (βs = 0.11 to 0.27), walk tests (βs = 0.18 to 0.43), chair-rise test (βs = 0.10 to 0.26), balance (βs = 0.07 to 0.25) and timed up-and-go (βs = 0.10 to 0.24) all p<0.01. Weak or no association was seen with PA grip strength (βs = 0.02 to 0.07).

Conclusion: In observational studies of general adult populations, there were associations between multiple dimensions of PA and a broad range of PF measures. The findings provide provisional support for the use of device-measures of movement to remotely monitor declines in PF in community-dwelling adults in mid-life/early old age. Prospective designs are needed to determine the direction of the relationship and future studies should also explore a broader range of PA metrics, including postural transitions and the temporal distribution of activity.

Purpose: Describe a new community-engaged model for innovating senior nutrition programs through technology with the NUEVA project (Nutrition for Underserved Elders Via Application). Older adults (60 years+) have unique needs related to food and nutrition to ensure food security and support socialization, but the existing U.S. Senior Nutrition Program has had limited reach and effectiveness with congregate sites and home delivered meal programs.

Methods: A socioecological framework and principles from community-engaged research and user-centered design (UCD), informed development of multifunctional app/website. The prototype includes four modules: sign-up, referral, meal selection (for home delivered meals), and assessment. The team solicited feedback from stakeholders (Advisory Board and community partners) during concept generation, iterative development, and prototype testing. Stakeholders provided in-depth consultation of processes to sign-up, program qualification, meal selection, and initial program participant assessment. Validated measures were selected for the assessment module (e.g., food security and loneliness scales). All finding were applied to build the prototype.

Results:  A new model was created to facilitate the PSE (policy, system, or environmental) changes including pathways linking community meal providers, food security partners, and health/ social service providers, Area Agencies on Aging, older adults, and their families. Twenty-four community stakeholders, representing 11 organizations have engaged in the development phases NUEVA. Stakeholders have shared strengths of the NUEVA app including providing connection between the program, older adults and their family, and meal delivery personnel. Stakeholders have been excited to discuss opportunities to automate and optimize the program and empower the volunteer workforce to provide observational data to improve outcomes. Concerns have included technology acceptance, intention to use long-term, and reading level/ functional limitations. Threats have included cyber security concerns, access to technology (devices, data-plans, broad band), and competing priorities for meal and service providers.

Conclusions: Preliminary results have highlighted benefits of a community engaged and UCD approach, such as designing features to reflect sociocultural values and existing community assets. Findings will inform prototype modification, including the addition of new modules (e.g., nutrition education, grocery delivery), and subsequent testing in collaboration with stakeholder groups. Ongoing research will identify opportunities to maximize impact of senior nutrition programs.

Purpose: Toward development of a core outcome set for randomized controlled trials (RCTs) of physical activity (PA) interventions for older adults, the purpose of this study was to identify outcome domains and subdomains (‘what’ was measured) in previously published RCTs of PA for older adults.

Methods: We conducted a rapid review and searched Ovid MEDLINE for recently published (2015-2021), English-language, RCTs of PA interventions for older adults (mean age 60+ yrs). We limited to articles published in Web of Science top-10 journals in general and internal medicine, geriatrics and gerontology, rehabilitation, and sports science. Two reviewers independently completed eligibility screening; two other reviewers abstracted trial descriptors and study outcomes. We classified study outcomes according to the standard outcome classification taxonomy endorsed by the Core Outcome Measures in Effectiveness Trials Initiative.

Results: Our search yielded 548 articles; 67 articles were eligible to be included. Of these, 82% were efficacy/effectiveness trials, 85% included both male and female participants, and 84% recruited community-dwelling older adults. Forty percent of articles reported on interventions that involved a combination of group and individual PAs, and 60% involved a combination of PA modes (e.g., aerobic, resistance). Trial sample size ranged from 14 to 2157 participants, with median (IQR) of 94 (57-517); 28,649 participants were included across all trials. We identified 21 unique outcome domains, spanning 4/5 possible core areas (physiological/clinical; life impact; resource use; adverse events). The five most commonly reported outcome domains were physical functioning (included in n=51 articles), musculoskeletal and connective tissue (n=30), general (n=26), cognitive functioning (n=16), and emotional functioning/wellbeing (n=14). Under these five outcome domains, we further identified 10 unique outcome subdomains (e.g., fall-related; body composition; quality of life). No outcome domains or subdomains were reported consistently in all RCTs.

Conclusions: We found extensive variability in outcome domains and subdomains used in RCTs of PA for older adults, reflecting the broad range of potential health benefits derived from PA and also investigator interest to monitor a range of safety parameters related to adverse events. This study will inform development of a core outcome set to improve outcome reporting consistency and evidence quality.

Purpose: To determine factors associated with participation of older Australians in community-based exercise classes during the COVID-19 pandemic. A secondary aim was to investigate the association between participation in exercise classes and changes in physical activity levels.

Methods: This pre-post study included community-dwelling older adults (≥65 years) from across Australia. The intervention consisted of 12 low to moderate-intensity exercise classes, delivered weekly by university-trained accredited exercise scientists or physiologists (AESs/AEPs). Negative binomial regression was used to determine factors associated with the primary outcome (number of classes attended/12). Physical activity levels were self-reported using a modified version of the International Physical Activity Questionnaire Short Form. To assess the change in physical activity levels (pre-test to post-test), three outcomes (total weekly MET minutes, active days/week, hours sitting/day) were modelled using mixed-effects linear regression.

Results: Of 6,949 participants recruited, 6,626 attended >1 class and were included in the primary analysis (95%). 49% of participants attended all 12 classes. Higher class attendance was associated with yoga/flexibility/mobility classes, attendance at a free trial class (adjusted incidence rate ratio [95% CI]: 1.05 [1.03, 1.08]) and online classes (1.19 [1.11, 1.26]). Lower class attendance was associated with state of residence, living in inner regional areas (0.95 [0.93, 0.98]) and having >2 comorbidities (0.97 [0.95, 0.99]). 3,505 participants were included in secondary analyses (53%). Participants who attended >1 exercise class increased physical activity by 447.0 (95% CI: 417.6, 476.3) METmins/week, were active on 0.9 (0.8, 1.0) additional days/week and reduced their sitting time by 0.5 (-0.6, -0.5) hours/day (pre-test to post-test). For each additional class attended, there was an increase in physical activity of 25.2 (2.4, 48.0) METmins/week.

Conclusions: High class attendance suggests the Exercise Right for Active Ageing program was well-received by older Australians, particularly in states less impacted by COVID-19 lockdowns. Classes attendance was associated with a significant increase in self-reported physical activity levels and active days, and a significant decrease in self-reported sitting time, suggesting that group exercise classes played an important role in promoting physical activity in older Australians during the pandemic.

Background: Few studies have examined depression after a cancer diagnosis and before initiating adjuvant or neoadjuvant systemic treatments. In this study, we present baseline data on device-measured physical activity, sedentary behaviour, depression, and positive affect in newly diagnosed breast cancer survivors.

Purpose: To examine associations of accelerometer-assessed physical activity and sedentary time with depression symptom severity and depression prevalence.

Methods: Shortly after diagnosis, 1,425 participants completed depression, happiness, and satisfaction with life measures and wore an ActiGraph® device and the activPAL™ inclinometer on their thigh for seven days to measure sedentary time (sitting/lying) and steps (1,384 completed both device measures). ActiGraph® data were analyzed using a hybrid machine learning method (R Sojourn package, Soj3x), and activPAL™ data using activPAL™ algorithms (PAL Software version 8). We used linear and logistic regression to examine associations of physical activity and sedentary time with depression symptom severity and depression prevalence, happiness, and satisfaction with life. For logistic regression analysis, we compared participants with none-minimal depression (n=895) to participants with some depression [i.e., mild, moderate, moderately-severe, or severe depression (n=530)].

Results: Mean depression symptom severity score was 4.3 (SD=4.1), mean satisfaction with life score was 25.7 (SD=7.2), and mean happiness score was 70 (SD=21.8). Depression symptom severity was negatively associated with moderate-to-vigorous physical activity (MVPA) (β=-0.51, 95% CI: -0.88 to -0.14, p=0.007). MVPA was associated with a significantly reduced odds of at least mild or worse depression [Odds Ratio (OR) =0.78, 95% CI: 0.63 to 0.97, p=0.026). Depression symptom severity was also negatively associated with average daily steps (β=-0.17, 95% CI: -0.24 to -0.10, p<0.001). Perceptions of happiness was significantly associated with MVPA (β=2.17, 95% CI: 0.18 to 4.17, p=0.033) and steps per day (β=0.50, 95% CI: 0.13 to 0.87, p=0.008). Sedentary time was not associated with depression but was inversely associated with perceptions of happiness (β=-0.79, 95% CI: -1.48 to -0.11, p=0.024).

Conclusions: Physical activity was inversely associated with depression symptom severity and odds or having mild or worse depression. Sedentary time was not associated with depression symptom severity or odds of having depression, but was inversely associated with perceptions of happiness.

Purpose:       The benefits of exercise for cancer patients throughout the cancer continuum has been well established. Further, the vast majority of patients and cancer care clinicians-CCCs (e.g., oncologists) believe that exercise is an important adjunct therapy and should be embedded as part of standard practice. Yet, CCCs do not routinely discuss exercise with their patients, nor do they regularly refer them to exercise professionals (e.g., exercise physiologists-EPs) who may provide appropriate exercise advice and prescription. The purpose of this study was to evaluate the feasibility and acceptability of an evidence-based approach to improving exercise communication between CCCs and their patients, including an exercise referral pathway.

Methods:      Implementation and testing of the Exercise Communication and Referral Pathway (ECRP) occurred over a 3-month period in Sydney, Australia. The ECRP included a brief structured oncology-initiated communication exchange with patients, inclusive of CCC exercise referral to an EP, followed by EP-initiated telephone consultation with patients concerning tailored exercise advice. Upon completion, semi-structured interviews were conducted with CCCs (n=3), cancer patients (n=21), and an EP (n=1). Data were analysed using inductive thematic analysis.

Findings:      Analysis generated three themes: (1) Navigating the role of CCCs in the ECRP, suggesting that oncology-initiated communication is a cue to action, however there was a lack of role clarity regarding exercise referral and prescription; (2) Implementing Patient-Orientated Care within a Standardised Pathway, highlighting the need for tailored information and advice for patients that reflects individual disease, socio-cultural, and environmental factors, and; (3) Taking Steps Towards Action, revealing the need for structural (i.e., formal integration of CCCs and exercise specialists, EP initiated contact with patients) and policy changes (i.e., changes to Medicare, including direct oncologist referral) to engage patients and better integrate exercise as part of standard care.

Conclusions: The ECRP was perceived by many to be an important addition to cancer care. Important considerations must be made to individual (e.g., experience, knowledge) and contextual factors (e.g., time, resources) when implementing an ECRP. Findings provide important insights into improving oncology-patient exercise communication and developing an exercise referral pathway to increase engagement and patient reach.

Purpose:

Active Together is an evidence-based multi-modal rehabilitation service for patients with a cancer diagnosis in Sheffield, embedded within the clinical care pathway, providing support to help patients prepare both physically and psychologically before treatment and to recover well after treatment. The purpose of the evaluation is to determine the impact of this multi-modal rehabilitation service on patients’ physical and psychological state, as well as their clinical treatment outcomes and economic benefits to the wider healthcare system.

Methods:

The outcome evaluation comprises a single group, longitudinal design to determine the impact of the Active Together service on patient outcomes measured throughout the service pathway, including physical capacity, psychological state and dietetic need. A one-way repeated measures (within-group) analysis of variance will be used to determine both the statistical and clinical significance of changes in patient outcome measures throughout the service pathway. Health resource usage and clinical treatment outcomes for patients that have received support from the Active Together service, will be compared to patients who previously underwent treatment for cancer without receiving rehabilitation support, to assess the impact of the service from an economic perspective.

Results/findings:

To date, 145 male patients and 104 female patients have received support from the Active Together service during their cancer treatment. Preliminary data shows that patients exhibit clinically significant improvements in measures of physical capacity (6-minute walk test and 30 second sit-to-stand), psychological state (quality of life, depression, anxiety) and levels of dietetic need, both during prehabilitation before starting treatment and during rehabilitation following treatment. Patients have improved outcomes from their treatment, leading to a reduction in mean hospital length of stay and reduced overall cost to the healthcare system compared to patients that did not receive rehabilitation.

Conclusions:

Evidence to support the role of multi-modal rehabilitation for patients at all stages of their cancer treatment journey is growing. The translation of that evidence into practice is less advanced. The results of this evaluation will contribute to the growing evidence base of the real-world effectiveness of cancer rehabilitation on both patient outcomes and the health economic landscape.

This systematic review investigated qualitative and quantitative studies exploring patient and healthcare professionals (HCP) experience of nutrition care throughout the cancer journey. Five databases were systematically searched for studies reporting on patient and healthcare professionals experience of nutrition advice. Fifteen studies including 374 patients and 471 healthcare professionals were included. Five themes were identified (current provision of nutrition advice; optimal provision of nutrition advice; tension between patient values and nutritional or HCP priorities; providing evidence-based nutrition care; and practical barriers to nutrition advice provision). Findings indicate that patients desire more specific nutrition advice supported by members of the multidisciplinary team and delivered in appropriate and understandable language. Healthcare professionals have highlighted a lack of time, funding, dietetic roles and knowledge as barriers to integrating nutrition as a standard part of cancer care. Further work is essential to better understand and address identified barriers and improve the provision of nutrition advice to this population.

Purpose: cancer survivors (CS) present low levels of physical activity (PA), and high levels of sedentary behavior and cancer related-fatigue. Commonly there are no programmed interventions to empower them towards a more active lifestyle. The aim of this study was to test different methods that engage CS to PA in a community setting. Also, we aimed to know  needs, barriers and facilitators for the practice of PA.

Methods: 20 CS were recruited from the Institut Catala d’Oncologia (ICO, L´Hospitalet, Spain). A 4 weekly program with active meetings were conducted combining talks on educational concepts related to PA and active sessions using different community resources such as parks, public sports facilities or walking city tracks. Every meeting a weekly PA challenge was established and agreed with the participants. CS used a private whatsapp group to share their achievements. A photo elicitation was also carried on by the participants to detect the barriers and facilitators perceived when doing community PA. 

Results/findings: finally 17 (80% women,aged 45-64 years), mostly breast, ovarian, prostate and lung CS finished. A video recorded their impressions about the conducted actions (https://www.youtube.com/watch?v=0VthnV3y7wg). The general response was very positive to the interventions and the challenges. They feel more energy, good mood. They have the possibility to achieve the challenges, to share the same feelings and limitations with pairs, the feeling of belonging to a group with similar problems. They look for similar solutions, the freedom to practice PA elsewhere and without an established time and program, etc.  

Regarding 1) barriers to exercise: fear, pain, cancer related-fatigue, lack of social support; lack of facilities or knowledge about the type of recommended activities. 2) facilitators to exercise: availability of green spaces,  professional support, group activities with other CS. The main demand was to get the opportunity of more community PA programs that consider their particularities and needs as CS.

Conclusions: This pilot study provides relevant information regarding CS perspectives in relation to PA practice. Including a patient centered approach in the design of PA interventions will be necessary to increase adherence and engagement.

Purpose: About 75% of breast cancer diagnoses are hormone-receptor-positive (HRP). After active treatment, breast cancer survivors (BCS) with HRP undergo 5–10 years of hormonal therapy (HT). One of the most used HT regimens is blocking estrogen biosynthesis with aromatase inhibitors (AIs).

Although HT improves disease-free survival rates, treatments are often related to several adverse side effects, which can adversely affect BCS’s quality of life (QoL). One side effect that has been consistently reported in the literature is chronic pain, especially arthralgia. Ultimately this can lead to premature therapy discontinuation, and eventually, lower treatment efficacy and increased mortality.

The improvement of physical function (PF), through physical activity (PA), has been shown to significantly ameliorate pain in most chronic pain diseases. However, there is limited evidence regarding this approach as a part of pain treatment among BCS.

Therefore, the aim is to characterize pain and PA and analyze the associations between pain, QoL and PF in this population.

Methods: A group of BCS doing HT with AIs (n = 75, mean age 56.2 years ± 7.7) completed pain measures using the Brief Pain Inventory and the Pain Disability Index, QoL measures with EORTC, PA assessed with the International Physical Activity Questionnaire short form and PF assessed with time up and go (TUG), strength (handgrip and 10 RM) and flexibility (ROM) tests.

Results/findings: 92% reported usual pain and 50% did not meet PA adult recommendations for aerobic exercise. Bivariate correlation analysis adjusted for BMI and time on AIs revealed negative and significant correlations with pain and PF (TUG, strength and flexibility; all p_s < 0,05) and several QoL dimensions (Global Health, Physical Functioning, Role Functioning, Social Functioning, Fatigue, Insomnia, Financial Difficulties, Body Image, Systemic Therapy Side Effects, Arm Symptoms and Musculoskeletal Symptoms; all p_s < 0,01).

Conclusions:

These findings confirm the detrimental association between pain and QoL and are aligned with previous research regarding the potential benefit of PF in pain. Nevertheless, further pain management investigation involving different methods for improving PF, namely PA interventions, is needed in this population.

Purpose: Liver cancer in the US has tripled since 1940 and Texas has the highest incidence of liver cancer and mortality rate. Latinos in Central and South Texas counties have a higher incidence of liver cancer and prevalence of obesity demonstrating a disproportionate incidence of liver cancer. Risk factors for liver cancer include obesity, aflatoxin, alcohol, and hepatitis. The purpose of this scoping review is to provide an analysis of risk factors including obesity and liver cancer disparities among Latinos in Texas.

Methods: Several electronic databases were searched (CINAHL, Pubmed, and Medline) for articles published until March 2023. Studies were selected according to inclusion and exclusion criteria. Article screening and data extraction will be conducted by two independent reviewers. Eligible studies will include Latino adults ≥18 years, who have liver cancer, NASH, and risk factors including obesity, aflatoxin, and alcohol exposure.

Results: Data collection, analysis, and summary of available evidence is ongoing and planned to be completed in June 2023.

Conclusions: There is a critical need to understand the disparities of hepatocellular carcinoma, health outcomes, and obesity-related risk factors among Latinos in Texas. Investigating the underlying etiologies associated with increased risk of liver cancer in Texas is necessary to identify prevention and intervention strategies to improve cancer outcomes among Latinos. The findings from the scoping review will identify opportunities for relevant lifestyle interventions to reduce the burden of liver cancer.

Background and purpose: Robust evidence shows that regular exercise plays an important role in improving the quality of life, physical function, and psychological health, and in managing common cancer-related side effects for cancer survivors. However, the challenge is being able to provide cancer survivors with easily accessible, high-quality exercise support and programs. Consequently, we need to develop easily accessible exercise programs that draw upon the current evidence base that can be delivered to as many as possible and determine if these programs are effective. EX-MED Cancer Sweden is a supervised, distance-based group exercise program providing cancer survivors with access to evidence-based exercise medicine, delivered through community gyms, by upskilled exercise specialists. This study aims to examine the effectiveness of EX-MED Cancer Sweden for survivors of breast, prostate, and colorectal cancer.

Methods: Adults that have completed curative treatment for breast, prostate, or colorectal cancer (n = 200) are recruited to participate in a single centre, single-blind, two-armed randomised controlled trial. Participants are randomly allocated to an exercise group or a routine care control group. The exercise group will participate in a supervised, distanced-based exercise program delivered by a personal trainer who has undertaken specialised exercise oncology education modules, twice per week for three months. The primary outcome is health-related quality of life assessed at baseline, 3- (end of intervention and primary endpoint) and 6-months post-baseline. Secondary outcomes are physiological (cardiorespiratory fitness, muscle strength, physical function, body composition) and patient-reported outcomes (cancer-related symptoms, fatigue, self-reported physical activity), and self-efficacy of exercise. Furthermore, the study will explore and describe the experiences of participation in the exercise intervention.

Conclusion: The EX-MED Cancer Sweden trial will provide evidence regarding the effectiveness of a supervised, distance-based exercise program for survivors of breast, prostate, and colorectal cancer. If successful, it will contribute to the implementation of flexible and effective exercise programs as part of standard of care for people following cancer treatment, which is likely to contribute to a reduction in the burden of cancer on the individual, health care system and society.

Purpose: Early childhood educators (ECEs) can have substantial influence on young children’s movement behaviors in childcare and psychosocial factors have been found to influence their teaching practices in this setting. The purpose of this study was to determine which personal characteristics predicted ECEs’ self-efficacy, behavioral intention, and perceived behavioral control (PBC) to promote active childcare settings. 

Methods: Canadian ECEs (n = 390) completed an online survey to collect demographic information (10 items) and ratings of their physical activity, sedentary behaviour, and outdoor play-related self-efficacy (30 items), behavioral intention (28 items), and PBC (28 items); composite scores were calculated. Latent profile analysis was conducted to identify subgroups of participants based on self-efficacy, behavioral intention, and PBC. Univariate differences in independent variables among profiles were explored and multinomial logistic regression was used to determine multivariate predictors of profile membership. 

Results: In general, ECEs rated their self-efficacy, behavioural intention, and PBC similarly, except for one item related to engaging children in their care in 120 minutes of physical activity each day, where ECEs reported lower behavioural intention and PBC ratings compared to self-efficacy ratings. Most ECEs fit into profiles with high to very high ratings across all psychosocial variables. Being female, employed in centre-based childcare, not having a bachelor’s degree, having completed an outdoor play professional development course, and achieving the adult physical activity guideline were associated with being in profiles with the highest ratings across all psychosocial variables. 

Conclusion: Knowing which factors predict ECEs’ confidence, intentions, and PBC to promote healthy active childcare environments will help researchers and practitioners develop resources and provide support for ECEs in such endeavours. Future research is needed to determine if ECEs’ self-efficacy, behavioural intention, and PBC directly influence their teaching practices or their children’s movement behaviours in childcare settings. 

Purpose: Early childhood educators (ECEs) play a valuable role in childcare settings with respect to promoting physical activity and outdoor play and minimizing sedentary behaviour among young children. Assessing psychosocial variables among ECEs, such as their behavioural intention and perceived behavioral control (PBC), is one way to explore their motivation and ability to support these health behaviours. The ECE Movement Behavioural Intention and Perceived Control (ECE-MBIPC) questionnaire (n = 56 items) was developed via expert consensus to fill the noted gap in tools available to measure these constructs among ECEs in the context of physical activity, sedentary behaviour, and outdoor play. 

Methods: A test-retest approach, via an online survey administered twice (one-week apart) was adopted to evaluate the reliability and factorial validity of the questionnaire with ECEs in Canada (n = 165). Seven behaviours (3 relating to physical activity, 2 relating to sedentary behaviour, and 2 relating to outdoor play) were included in the questionnaire, with 4 items used to assess intention and PBC for each of the 7 behaviours, respectively. Cronbach’s alpha and test-retest statistics were used to assess reliability, while exploratory factor analysis (EFA) was used to examine factorial validity. 

Results: The ECE-MBIPC questionnaire demonstrated high internal consistency (Cronbach’s alpha > 0.85 across behaviour category subscales) and acceptable temporal stability (r > 0.70). A 7-factor solution was proposed by the EFA, with each of the 7 behaviours loading onto their own factor; this solution explained 71% of the variability in the data. 

Conclusion: As the first reliable and valid tool to measure ECEs’ behavioural intention and PBC to promote physical activity and outdoor play and to minimize sedentary behaviour in childcare, the ECE-MBIPC questionnaire will help to standardize how these psychosocial variables are measured in early years research. Standardizing the measurement of these important variables will enable comparisons across studies to provide a more fulsome understanding of how behavioural intention and PBC may influence ECEs’ teaching practices and children’s movement behaviours in childcare.

Methods: Menus (n=271) collected remotely from 148 ELS between November 2020-March 2021 were analysed for their nutritional quality (percentage of ‘green’, ‘amber’, and ‘red’ menu items) using a scoring system based on the MoH guidance. Points were awarded based on the availability of healthy (green) menu items and the exclusion of unhealthy (red) menu items.

Results/findings: Overall, of all menus 2.6% met the MoH Healthy Food and Drink Guidance and a fifth (18.5%) met the MoH Choking guidance. Menus for over two-year-olds (over-2s) scored, on average, 12% higher than menus for under two-year-olds (under-2s; p<0.01). Services with a Heart Foundation Healthy Heart Award provided more green items to over-2s (p=0.04) and under-2s (p=0.01), and less red items to over-2s (p=0.04). Providing more green menu items was inversely correlated with providing less high choking risk foods (p<0.01). Menu scores did not vary by service location, neighbourhood socioeconomic deprivation or type (services operating independently versus those part of an education group chain).

Conclusions: Alignment of menus with MoH nutritional guidance was low, particularly in ELS caring for very young children (under-2s). The low compliance of ELS menus with the MoH guidance in this sample suggests that children’s healthy eating exposures are lacking, whilst exposure to energy-dense, nutrient-poor foods and drinks is excessive. ELS who provided more healthy foods and beverages also provided less high-choking-risk foods may be more aware of the MOH Guidance. Greater uptake of the Healthy Heart Awards scheme could assist ELS to provide healthier food and drinks.

Purpose: Being physically active at moderate-to-vigorous intensity is favorably associated with several health indicators in early childhood, including improved motor development (FMS) and physical fitness (FIT). However, children's lack of physical activity (PA), and thus suboptimal levels of FMS and FIT, is a global public health concern. The Active Learning Norwegian Preschool(er)s (ACTNOW) study investigated the effects of an 18-month cluster randomized controlled preschool-based trial with staff professional development on FMS, FIT, and PA in 3-5-year-old preschoolers. Methods: A total of 1265 preschoolers (4.3 yr, 52% boys) from preschools in Sogn og Fjordane County were cluster-randomized by preschool to either an intervention (n=23) or a control group (n=23). Intervention preschools participated in a PA intervention in 2019-2022 delivered by preschool staff, consisting of four core components: moderate-to-vigorous PA, motor-challenging PA, cognitively engaging PA, and physically active learning. PA was measured with accelerometry (ActiGraph GT3X+). FMS was evaluated by a process-oriented test battery (9 items) across three domains: locomotor, object control, and balance skills. FIT was assessed through motor fitness, handgrip strength, and standing long jump. Data from baseline, 7-months, and 18-month follow-up were analyzed using a linear mixed model with child and preschool as random effects. Effect estimates were derived from testing the main effect of group on change in FMS, FIT, and PA. Results: During preschool hours, findings showed significant improvements in vigorous PA at 7- (ES=0.15; p=0.041) and 18 months (ES=0.16; p=0.015) and a significant reduction in sedentary time at 7 months (ES=-0.12; p=0.031) and light PA at 18 months (ES=-0.14; p=0.026) in favor of the intervention group. Significant increases were found for the intervention group in locomotor skills at 18 months (ES; 0.22; p=<0.001) and object control skills at 7 months (ES; 0.17; p=0.006). Significant reductions were found for balance skills (ES=-0.15; p=0.003) and handgrip strength (ES=-0.3; p=0.01). Conclusion: The ACTNOW intervention increased vigorous PA, locomotor-, and object control skills and reduced sedentary time in preschool children. However, further research is needed to investigate how to stimulate balance skills and fitness in early childhood. These findings show that PA promotion in early childhood can benefit child development.

Introduction: Evening-chronotype, which refers to an innate preference for later periods of the day, has been found to pose as a risk factor for socioemotional problems in children. Research has also shown that children with evening-chronotype are more prone to sleep problems compared to peers with morning-chronotype. Evidence from studies in school-aged children suggest that sleep problems lie on the pathway between chronotype and socioemotional problems. However, it remains unknown whether sleep problems during earlier stages of childhood may mediate the relationship between chronotype and socioemotional problems at school-age. It is important to identify the mechanisms underlying the development of socioemotional problems at early ages as they may escalate into more severe behavioral and emotional problems later in life. Hence, we conducted mediation analyses with longitudinal models to investigate how sleep problems earlier at preschool-age may mediate the relationship between chronotype and socioemotional problems at school-age.

Methods: We included 587 typically-developing children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study. Children’s diurnal preferences were identified with the Children’s Chronotype Questionnaire and corroborated by objective actigraphy at 4.5 years of age, while sleep problems were assessed using the Children’s Sleep Habits Questionnaire when they were 4.5 and 6 years old. Children’s socioemotional problems were evaluated with the Child Behavioral Checklist when they were 7 years old. All questionnaires administered were caregiver-reported.

Results: After controlling for potential confounders, greater eveningness in children was significantly associated with increased sleep problems at 4.5 and 6 years of age, as well as greater internalizing, externalizing and total behavioral problems at 7 years old. Further mediation analyses revealed that sleep problems at both 4.5 and 6 years of age significantly mediated the association between chronotype and later internalizing, externalizing and total behavioral problems at 7 years old.

Conclusions: Our study is amongst the first to demonstrate the mediating effects of sleep problems at earlier ages on the relationship between chronotype and socioemotional problems at school-age. An important implication of our results is that sleep problems in preschool serve as targets for early interventions for socioemotional problems, especially among evening-chronotype children.

Purpose Early Childhood Education and Care (ECEC) teachers at urban preschools are potential key figures to promote healthy behaviours in disadvantaged young children and to engage parents in lifestyle-related topics. An ECEC teacher-parent partnership regarding healthy behaviours may support parents and stimulate their children’s development. A preschool-based intervention (CO-HEALTHY) was developed to promote an ECEC teacher-parent partnership regarding healthy eating, physical (in)activity and sleeping behaviours in young children. The intervention consists of a toolkit with parent-child activities and an associated training for ECEC teachers. The activities were composed using the Intervention Mapping protocol. Intervention materials were accessible for families with different sociocultural and socioeconomic backgrounds (e.g. simple vocabulary and cultural sensitive images). This study describes the process evaluation of the intervention.

Methods Semi-structured interviews with ECEC teachers (n=16) and parents (n=16), and a questionnaire for ECEC teachers (n=33) served as input for the process evaluation of the intervention. The process evaluation addressed topics like the reach of the intervention and experience of participants with the intervention. Interviews were transcribed non-verbatim and thematically analysed in MAXQDA. Questionnaires were distributed via the survey software Qualtrics and descriptive statistics were calculated using IBM SPSS Statistics.

Results The intervention was carried out at n=20 preschools in Amsterdam, the Netherlands. ECEC teachers said that the toolkit was fun and accessible as it were activities that children and parents could do during the standard walk-in play time at preschool. The activities were a good opportunity to start a conversation about the lifestyle-related topics. Parents indicated that it was fun and informative to do the activities together with their child. Most of the ECEC teachers thought that the intervention materials were convenient for their group of parents/children, also for less linguistic parents. The intervention materials were also received positively by parents (e.g. the use colourful A5 information cards). The ECEC teachers evaluated the intervention with an average score of 7.8 (scale 1-10) in establishing a teacher-parent partnership.

Conclusions The intervention was positively received. A majority of the participants thinks the toolkit benefits the ECEC teacher-parent partnership regarding healthy eating, physical (in)activity and sleeping behaviours in young children.

Purpose: Efficacious interventions that improve children's eating habits are desirable to implement in real-world settings and in a larger scale. Core components required for effective implementation is end-user involvement and adapting the interventions to the users' needs. Previously we have evaluated a digital “healthy eating” resource for ECEC staff. The purpose of the current qualitative study was to explore perception of needs of such a resource, and to identify facilitators and barriers related to implementation of the resource in staff.

Methods: Twelve individual semi-structured interviews and two focus group interviews were conducted with ECEC teachers in a selected municipality in Norway. Focus group interviews were conducted to stimulate teachers to reflect on preliminary results from the individual interviews. Data were transcribed verbatim and subjected to thematic analysis, to summarise the subjective experiences and sense-making of the teachers.

 Results: Perceptions of needs from a digital “healthy eating” resource in ECEC included: 1) Recipe bank and menus; 2) Ideas for educational food activities with children; 3) Link to the national curriculum for ECEC and highlighting research, 4) Access for, and training of parents and facilitator for implementing was 5) Newsletter with seasonal tips. Barriers included: 1) Lack of tradition for using information from the internet at work; 2) Lack of intentions to use since a new web resource is primarily associated with cooking 3) Likely short time use; 4) Knowledge-based feeding style and practices, a blind spot and 5) Different organizational cultures for training and meetings.

Conclusions: This study provided information on how to adapt a digital expert-led “healthy eating” intervention to be more relevant for the ECEC staff, by e.g., providing links to national curriculum for ECEC and research. We also identified barriers (e.g., lack of tradition in use of digital resources) and facilitators for implementation (e.g., newsletter prompts), that will be used in an upcoming scaling of the digital intervention.

There is a growing internationally research interest in how physical education (PE) and PE teacher education (PETE) may contribute to the education for sustainable development (SD) agenda. Although it has been suggested that some of the contents of PE are related to education for SD, one critical question is that of prioritizing teaching and learning of content and challenge the way it is taught. The overall aim of this participatory action research (PAR) study is to explore what PE teacher (PET) educators perceive to be critical aspects on education for SD in PETE. More specifically, we explore how PET educators perceive and conceptualize SD, and what aspects on education for SD they perceive to be critical to implement in PETE courses, as well as what arguments and support that are put forward in relation to this. The PAR study draws on the principles of collaborative learning and involves 10 PET educators from one higher education institution in Sweden. They have different employment and academic positions, including adjunct lectures and professors, who together prepare PETs in compulsory and upper secondary schools. The PET educators took part in a series of audio recorded workshops and seminars (6 sessions × 180 minutes) encountering and problematizing the conceptualizing of education for SD. Data was also collected through logbooks. The analytical process is structured in three layers: individual responses and reflection, collegial responses and reflections, and thematical analyses of recordings from workshops and logbooks. The analytical attention is directed towards subjectivities, positionalities, and motivations. Data collection from the first part of the PAR study have been analysed, and preliminary results will be presented from the recorded workshops and seminars, and logbooks. The finalization process of findings and conclusions will focus on what education for SD can mean individually and as part of a collective understanding, and in relation to the individual PET educators’ understandings and courses of various character in PETE.

Purpose: The purposes of this study were to study changes in health behaviors and factors influencing health behaviors of office workers (OW) living in Bangkok during the Covid-19 pandemic.

Methods: The online survey was designed to collect data of physical activity (PA), sedentary behavior (SB), stress, healthy food consumption, and sleep quality from 494 OW (199 males, 295 females), aged 28.82 (6.4) years. Multinomial logistic regression was used to determine the factors influencing health behaviors due to the pandemic.  The fully adjusted models were mutually adjusted for the other factors (gender, age, education, income, marital status, type of residence, and the number of people living together).

Results/findings: During the pandemic, OW reported having good health, healthy food consumption, good sleep quality, and moderate PA; but their stress and SB were increased. Undergraduate OW reported being 4 times healthier than those with postgraduate education (OR = 4.30). Those with bachelor's degrees reported 3 times less stress than OW with postgraduate degrees (OR = 3.54). The PA of OW who earn 20,000-30,000 Baht/month was 3 times lower compared to higher earners (OR = 3.11). Younger and female OW had 2 times increase in SB (OR = 2.01 and 2.30, respectively). Officers who lived in single-family homes and apartments reported consuming 3 times less and twice as many healthy foods as those who lived in dorms, consequently, (OR = 2.57 and 2.40, respectively). The OW who lived in a single house and condominiums reported 2 and 4 times less good sleep quality compared to those who lived in dorms (OR = 2.16 and 4.71, respectively). If returned to normal, OW wants to work as a hybrid, be more physically active, eat a nutritious diet, put greater emphasis on sleep and reduce SB.

Conclusions: Changes in health behaviors as a result of an epidemic depend on a number of factors, including age, education, and accommodation. After the pandemic, Bangkok OW increased their desire to take care of their health. Organizations should take into account the factors that influence health behaviors and have policies in place to promote better health of their workforce.

Purpose: Interventions incorporating wearable technology and eHealth applications encourage participants to self-regulate physical activity (PA) and sedentary behaviour (SB). In 2020, a Calgary (Canada) recreational facility developed and implemented the ‘Vivo Play Scientist (VPS)’ program, which provided participants with a free wearable activity tracker (WAT; Garmin Vivofit4) with the option of connecting to a customized eHealth dashboard. Objective: To evaluate the effectiveness of the VPS program on PA and SB.

Methods: Our concurrent mixed-method study included a single-arm repeated-measures design with semi-structured interviews. Participants (≥18 years; n=87) completed three self-administered online surveys (T₀, before receiving WAT/dashboard; T₁, 4-weeks; T₂, 8-weeks). The surveys captured sociodemographic characteristics, PA behaviour, motivation, SB, WAT and eHealth use and perceived usefulness. Some participants (n=23) completed semi-structured telephone interviews on their program experiences. PA and SB were compared between the three time points using Friedman’s tests and the interview data was analyzed used thematic methodology.

Results/findings: The mean age of participants was 39.8 (SD 7.4) years and 74.7% were female. Approximately half of all participants had used wearable technology (46.0%) or an eHealth application (49.4%) prior to the intervention. On average, participants wore the WAT on 6.4 (SD 1.7) days in the past week at T₁ and on 6.0 (SD 2.2) days in the past week at T₂. On average participants used the dashboard on 1.6 (SD 2.1) days in the past week at T₁ and 1.0 (SD 1.8) days in the past week at T₂. Average levels of perceived usefulness and ease of use for the Vivofit4 and dashboard remained high during the 8-week program (T₁ to T₂).The average time spent walking at 8-weeks was significantly higher compared with baseline (T₀ 180.34 vs. T₂ 253.79 min/week, p=.005). Compared to baseline, the mean time spent sitting was significantly lower at 8-weeks (T₀ 334.26 vs. T₂ 267.13 min/day, p<.001). Participants described how the WAT output and “move” notifications encouraged them to modify their PA and SB.

Conclusions: Providing adults with a free WAT and eHealth application has the potential to facilitate improvements in PA and SB in the short-term, even under COVID-19 pandemic public health restrictions.

Background: Latinos on the U.S.-Mexico border have a higher risk of obesity-related cancers than their non-border and non-Hispanic white counterparts. However, culturally-tailored programs that target this population focus on diabetes, cardiovascular, and other metabolic disease prevention. Pasos Para Prevenir Cancer is a obesity-related cancer prevention program using tailoring to implement evidence-based curricula delivery to Latinos living in the U.S-Mexico border region.

Methods: Participants from the education program were recruited to take part in an evaluation study. Nutrition behavioral data was collected at baseline and 6-months. Analysis was conducted to assess change in attitudes towards healthy eating and nutritional behaviors.

Results: Participants attitudes towards healthy eating were favorable at baseline and did not change at follow-up with the exception of viewing healthy lifestyle more difficult and healthy foods being more expensive  and inconvenient at follow-up. Consumption of fruits and vegetables were high at baseline and changed moderately at follow-up. Participants primarily reported eating apples, pears, bananas, pineapple and grapes for fruit. In general, vegetable intake was higher than fruits, participants primarily consumed greans, carrots, broccoli, onions, peppers and cucumbers. There, was however, a significant shift in consumption of higher fat and sugar content to light and low fat foods. For example, participants decreased their consumption of regular cheese and increased light cheese, and, increased consumption of frozen yogurt, light ice cream and light sour cream. Finally, participants consumed more ground chicken, lean red meat and seafood at follow-up.  

Discussion: Latinos on the U.S.-Mexico border ascribe to a healthy living mindset. In general, frequently eating fruits and vegetables. Participation in our tailored intervention increased perceived barriers of healthy living around cost and convenience. Additionally, decision making around healthier options improved with participation. Potential cost and convenience barriers around healthier options may need to be address at policy levels to support nutrition decision making as part of healthy living.

Actual and perceived motor competence are important associates of various health related behaviors. As such, numerous studies have examined the relationship between both constructs in children. The aim of this review was to systematically examine, analyze and summarize the scientific evidence on the relationship between perceived and actual motor competence in children.   This article reviews 46 refereed journal articles published between 2000 and 2020. All of the articles attempt to establish the relationship between perceived and actual motor competence in children. The strength of the association between actual motor competence and perceived motor competence in children is low to moderate, with current data demonstrating that the strength of association does not differ by age, sex, developmental status, or alignment between measurement instruments. However, this review highlights the lack of clarity on the relationship between actual motor competence and perceived motor competence/physical self-perception. Future research should address issues surrounding the design of studies and measurement of actual motor competence and perceived motor competence/physical self-perception as well as explore other potential confounding variables (i.e., product- versus process-oriented assessments, race, and culture) that might affect the relationship between these two constructs

Physical activity specifically in relation to Physical Education (PE) forms a crucial part of total education of primary and secondary school learners.  The aim of this paper is to explore various challenges in promoting PE and sport activities in Zimbabwean primary and secondary schools. This paper reviewed and content examined curriculum documents for the determination and identification of the challenges of teaching PE in Zimbabwean primary and secondary schools as well as possible solutions for the identified challenges. Content breakdown identified main thematic areas which can clarify the challenge Educators face in teaching PE in various Zimbabwean schools. There need to be an increase in the knowledge of the teachers and the learners, and to see the important benefits of PE.

There is well-documented scientific evidence indicating that mobile health (mHealth) applications (apps) for health behavior change can improve the quality of life, relieve symptoms and restore health for patients. In addition to improving patients’ health outcomes, mHealth apps also reduce health care utilization and the cost burdens associated with disease management. Currently, patients and healthcare providers (HPs) have a wide variety of choices among commercially available mHealth apps. However, due to the high resource costs and low user adoption of mHealth apps, the cost-benefit relationship remains controversial. When compared to traditional expert-driven approaches, applying human-centered design (HCD) may result in more useable, acceptable, and effective mHealth apps. After reviewing the current HCD practices in the mHealth for health behavior change domain, we made recommendations on HCD practices when developing mHealth apps. These recommendations focus on employing cultural considerations, applying iterative evaluation, incorporating novelty in design outcomes, and considering privacy and reliability across the entire HCD process. To guide the development of mHealth apps, we also suggest a sociotechnical lens toward HCD practices to promote the sustainability of mHealth apps. Future research should consider standardizing the HCD practice to help mHealth researchers and developers avoid barriers associated with inadequate HCD practices.

Purpose: Several quantitative studies have found a decline in physical activity in response to COVID-19 pandemic restrictions. The aim of the present study was to use large-scale free text survey data to qualitatively gain a more in-depth understanding of the impact of the COVID-19 pandemic on physical activity, then map barriers and facilitators to the Capability, Opportunity, Motivation, and Behaviour (COM-B) Model of Behaviour to aid future intervention development.

Methods: Data was gathered from the COVID-19 Social Study, a large scale, longitudinal, observational, panel study of adults living in the UK during the COVID-19 pandemic. 17,082 participants provided a response to the free text module, and data from those who mentioned a physical activity related word in any context were included in the analysis. Data were analysed using thematic analysis using an inductive approach, and key themes identified.

Results: 5396 participants provided 7490 quotes related to physical activity. The sample were predominately female (84%), white (British/Irish/Other) (97%) and aged <60 years (57%). Seven key themes were identified: the importance of outdoor space, changes in daily routine, COVID-19 restrictions prevented participation, perceived risks or threats to participation, the importance of physical health, the importance of physical activity for mental health and the use of technology.

Conclusion: Future physical activity interventions could encourage people to walk outdoors, which is low cost, flexible, and accessible to many. Developing online resources to promote and support physical activity provides a flexible and accepted way to deliver quality content to a large audience. Online resources can provide activities that can easily be undertaken both outdoors and indoors e.g. in the home environment to facilitate year-round participation.

Background: Variation in where youth spend their time within and across days can have an impact on their 24hr movement behaviors. Current methods to capture time-use often sample a limited number of days and are burdensome for participants. This presentation describes the development of an electronic time-use diary which allows contextual data to be collected over multiple, consecutive days via smartphone and mapped onto accelerometry data to create contextually rich, time-segmented data for understanding contextual influences on youth 24hr movement behaviors.

Methods: Initial considerations during the development of the time-use diary were: 1) ease of completion by parent (time to complete), 2) contextual comprehensiveness (programs, settings, events, and activities linked to youth 24hr movement behaviors), and 3) the ability to capture duration of events (start and end times of activity contexts in 15min increments). We contracted with the open-source R package GGIR to create a novel day-segment analysis package for backend processing.

Results: The time-use diary was created in Qualtrics.  The time-use diary was deployed in a cohort study of US children’s school/summer behaviors using a 14-day accelerometer wear protocol. The diary was distributed at 7:30PM each night to a parent’s smartphone via an automated texting service developed by our research team. The time-use diary involved parents completing a series of questions about their child’s previous 24hrs, starting with bedtime the previous night, waketime, meal timing, snack consumption, accelerometer wear time compliance, and the setting-specific contexts of their child’s activities (e.g., afterschool program, sports, friend’s house). Each completed time-use diary had time/date stamped information which was used to map onto accelerometry data for segmentation within and across days. An average of 6,671 time-use diaries were completed on an average of 614 children across five, 14-day periods (2021-2022). The average duration to complete the time-use diary was 6.7min (3.3-12.3min 25^th to 95^th quantile). Children had on average 11 time-use diaries completed per 14-day measurement period.

Discussion: The creation of a participant-friendly time-use diary facilitates capturing important contextual information that can be used to further the understanding of how youth spend their time and the impact of context on 24hr movement behaviors. 

Purpose:

To investigate (1) How physical activity (PA) and loneliness are interrelated, (2) What predicts PA over and beyond loneliness – both in community-dwelling older adults and Long-Covid Patients participating in an RCT empowering them to self-manage their disease. The innovative contribution about this research is to combine primary and secondary prevention perspectives (older healthy adults, Long-Covid patients).

Methods:

Two studies were conducted with a longitudinal research design. Measures were taken by means of interviews; analyses performed with SPSS employing binary and multivariate analyses as well as MPlus running a structural equation model.

In study 1 with older adults, three-measurement survey was conducted over 6 years (n=5,002 in T1, n=2,501 in T2, n=1,561 in T3). Participants were aged 54-70 years. Of the sample 55% was female.

In study 2 with Long-Covid patients were assessed also three times and randomized to Intervention Group (Self-management support by Counselors and via web-based services, Assessment at a clinic, n=51), a Control Group (CG, same as IG but no Assessment; n=62) and a Comparison Group which only was measured by questionnaires (n=63). Participants were aged 20-61 years. The sample consisted of 63% women.

Results:

In older adults, the proportion of physically active individuals increased over time (T1 53.8%; T2 58.6%; T3 66.4%). Loneliness was partially correlated with PA. In the path model, subsequent PA was predicted by previous PA, self-rated physical and mental health, but not loneliness. Lonely individuals appeared more likely to report poor self-rated health, high neuroticism, low extraversion, and low conscientiousness. Long-Covid patients’ PA was significantly correlated with the risk factor adiposity but not with loneliness directly but indirectly. However, more sleeping problems were associated with more loneliness and less PA.

Conclusions:

Helping lonely individuals and Long-Covid patients to become adequately physically active and thereby managing health limitations could be an important target for future PA interventions. Taking behavioral nutrition and sleep routines into account can help as well becoming sufficiently physically active. Implications are tailored approaches also based on to multiple behavior change theory taking loneliness into account.

Keywords: Loneliness, physical activity, path analysis, big five, behavior change.

Purpose: Family-based approaches have been identified as an effective way to promote child health and prevent childhood obesity. The “Healthy Habits, Happy Homes” intervention involves health educators trained in motivational interviewing providing home visits with participating families to support them in improving self-selected family health behaviours. The intervention has been found effective in North America and will be tested for feasibility and acceptability in Germany. To assure its relevancy, we aimed to contextually adapt the intervention by conducting focus groups with parents and stakeholders in Germany.

Methods: Parents were recruited through local community centres. Stakeholders, health educators currently working in schools and communities in the local area, were recruited through existing contacts. Focus groups were arranged either face-to-face or online, depending on participants' preferences. Semi-structured topic guides were employed to obtain views on the relevancy of the target intervention behaviours and materials and to discuss recruitment and communication. Focus groups were audio-recorded, transcribed and analysed using thematic analysis.

Results: Three focus groups were conducted with parents (n=15 mothers) and two focus groups with stakeholders (n=14) lasting approximately 90 minutes in length. Participants generally deemed the intervention useful and relevant for the German context and agreed with the selected range of health behaviours. Suggestions were made to additionally plan for ‘family time’ and ‘family communication’ within visits. Some participants identified that home visits could make families feel controlled or judged, suggesting that a ‘neutral’ meeting space should be offered in addition to home visits. Visits with families should be provided depending on the family’s availability, which might likely involve weekends. Contact with families is best kept through mobile phone or WhatsApp and all intervention material should be in easy-to-understand, simple language.

Conclusions: Results contributed to the adaption of the “Healthy Habits, Happy Homes” intervention materials and study processes for the German context. Being flexible and providing families with an element of choice were seen as important aspects when working with families in health promotion activities. Study results also helped inform the design of the planned feasibility study of the intervention in Germany, which is the next step in this research project.

Purpose: To our knowledge, few studies have integrated multiple m-health approaches to promote physical activity (PA) and health in elderly cancer survivors. Therefore, the purpose of this project was to examine the effects of a multi-component intervention (personalized exercise prescription and social media) on cancer survivors’ PA and other health outcomes, compared to prescription only, Facebook only, and attention control conditions.

Methods: A total of 126 cancer survivors (X̅ age = 60.37 ± 7.41 years) were recruited from the U.S. for this 6-month study. They were randomly placed to 4 groups with each receiving a Fitbit tracker and installing its companion app: 1) received weekly personalized exercise prescriptions via email, 2) received weekly Facebook health education and interacted with one another, 3) received both conditions 1 and 2, and 4) control condition: adopted usual care. Cancer survivors’ PA daily steps, quality of life (i.e., physical health and mental health), and PA determinants (e.g., self-efficacy, social support) were measured at baseline, 3 months, and 6 months.

Results: Final sample size included 123 cancer survivors with only 3 dropouts. The results revealed the 3 intervention conditions had greater improvements in PA daily steps than the control group over time (all p < 0.05; partial eta-squared = 0.05-0.12 with small, medium, and large effect sizes classified as 0.01, 0.06, and 0.14). Notably, Cancer survivors in the multi-component condition demonstrated more improvements (+1,514 steps/day) in steps than personalized exercise prescription only arm (+420 steps/day) and Facebook only arm (+419 steps/day). Similarly, those in the multi-component condition had the most improvement in physical health as compared with other 3 conditions and in mental health as compared to the 2 other intervention conditions (p < 0.05). Also, those in the intervention conditions showed greater increased self-efficacy and enjoyment than those in the control condition (p < 0.05). No other significant difference were identified. 

Discussions: The study findings suggested that the implementation of multi-component mobile health intervention had positive effects on cancer survivors’ PA, quality of life, and certain PA determinants. Also, offering sole m-health intervention may be beneficial to cancer survivors’ PA and certain PA determinants.

Purpose: FI exists when there is inadequate access to sufficient, safe, nutritious foods to meet dietary needs/preferences for healthy lives. FI removes individuals “healthy diet choices”. FI prevalence in HICs is increasing, particularly among young women and children; life course stages with increased nutritional demands. This symposium provides an overview of completed and on-going systematic review evidence from HICs on FI during life course stages around pregnancy.

Methods: Quantitative evidence from global HICs reports associations between FI and maternal diet/nutrition in pregnancy, gestational weight gain (GWG) and pregnancy health outcomes. Qualitative evidence reports experiences of FI and nutritional health/wellbeing amongst childbearing-age women in European HICs, women’s pregnancy-specific experiences of FI among global HICs, and UK newspaper portrayal of maternal FI.

Results: Seven studies reported associations between maternal FI and diet/nutrition outcomes, including reduced fruit, vegetable and Vitamin E intake and diet quality, and increased red/processed meat intake. Nine studies reported mixed results for FI and GWG which showed both increased and reduced GWG, and inadequate GWG. Twenty-two qualitative studies reported European women’s experiences of attempting to access sufficient food, inability to meet nutritional needs, how FI was embedded into their everyday lives, and embodied unhealthful physical, social, nutritional and mental health. There were 254 UK newspaper articles, which portrayed the government as the main driver of FI, and mothers and children suffering the health consequences and requiring access to food aid strategies. The reviews exploring FI and pregnancy outcomes and pregnancy-specific experiences in global HICs are on-going.

Conclusions: Women experiencing FI around pregnancy life course stages have poorer nutritional health and wellbeing, and the psychosocial impact is substantial. As FI is a determinant of diet behaviour, which removes individual agency, interventions to reduce health inequalities are required to support healthy nutrition in this population. News media is powerful at shaping public perceptions and framing health issues, which could influence government response to public demands for change. The empathetic newspaper portrayal of maternal FI suggests there is public support for policy and intervention in this population to address health inequalities and improve health and well-being of women and their children.

Background: Physical activity (PA) prevents chronic disease yet a majority of developed countries’ populations do not meet PA guidelines.  This highlights the importance of understanding a broad range of psychosocial PA correlates such as autonomous motivation. In addition, married partners are concordant in their PA, which is an additional factor to consider beyond individual-level motivation. Further, most research uses self-reported PA specific to exercise when assessing correlates. Understanding how motivation relates to a broad range of PA measured objectively is an important next step to identify target points for future interventions. This study examined the associations of motivation with self-report and objective PA among husbands and wives. The associations of partner’s PA is also examined.

Methods: Two community samples (n=74 couples; age range 25-74 years) were recruited to study PA in the context of committed relationships. Motivation was assessed with the relative autonomy index (RAI) derived from the Behavioral Regulation in Exercise Questionnaire-3. Self-report moderate-to-vigorous PA (MVPA) was measured with the Godin Leisure Time Exercise questionnaire. Objective MVPA was assessed with Actigraph™ accelerometers. Bivariate correlations and multiple regression analyses, adjusting for accelerometer wear time, body mass index, age, self-rated health, and partner MVPA, were conducted.  

Results: Husbands’ and wives’ self-reports and objective MVPA were correlated (r=.36-.43; p<.01) and their RAI were weakly correlated (r=.26; p<0.10). For wives’, RAI was significantly associated with self-report MVPA (β=.48; p<0.01) but not objective MVPA (β=.06; p>0.10).  In husbands, RAI was also significantly associated with self-report MVPA (β=.33; p<0.01) but not objective MVPA (β=.05; p>0.10).  Husbands’ and wives’ objective MVPA was significantly associated with spouses’ MVPA (β=.40-.43; p<0.01).

Conclusions: Findings suggest RAI is associated with self-reports of MVPA for exercise but not with overall MVPA measured objectively, which includes exercise and non-exercise activity. Motivation is likely associated with PA for health purposes (such as leisure time activity) rather than all forms of activity measured by accelerometry. In couples, PA participation may not be solely an individual endeavor but also linked to the PA of the spouse. These results highlight the importance of considering the interpersonal context of marital partners when assessing PA factors.

Purpose: Active transportation (AT) can be an important source of physical activity in children, but most previous research has focused on the trip to/from school. This study investigated whether parents’ travel mode to school as a child, current travel mode to work, and parental accompaniment on the trip home from school are associated with their children’s AT to/from multiple locations.

Methods: Grade 4-6 children were recruited from urban, suburban, and rural schools in the regions of Vancouver, Ottawa and Trois-Rivières. Parents reported their current travel mode(s) to work, school travel mode as a child, and how many days they accompanied their child home from school. During 7 consecutive days, children self-reported the number of active trips that they took to and from different locations (school, houses of friends and relatives, parks, shops, sport venues, etc.) in a diary. The analytic sample included 1699 children (55% girls) and multiple imputation was performed to replace missing data. Generalized linear mixed models based on a negative binomial distribution were used to investigate the association between parental behaviours and their child’s AT. The models were stratified by gender and adjusted for child age, parent gender, level of urbanization, and school-area socioeconomic status.

Results: Children whose parents took the bus to school as a child reported 12% less active trips (95%CI 0.79-0.99). For each day a parent accompanied their child home from school, children participated in 7% less active trips (95%CI for girls 0.90-0.97, boys 0.90-0.96). Boys living in Vancouver had 51% more active trips compared to Ottawa as a reference site (95%CI 1.13-2.04). There were no significant associations for parent’s current travel mode.

Conclusions: Our findings suggest that children may have more opportunities for AT if parents allow them to come home from school unaccompanied. Given that parents may drive their child to/from school on the way to work, interventions to promote children’s AT should address the perceived convenience of driving and encourage active commuting to work among parents. More research is needed to investigate why children engage in less AT if their parents took the bus as children.

Purpose: Digital dietary assessment tools have improved the efficiency of data collection, however, improving their accuracy and ease of use are necessary. This study determined the most frequently consumed foods and beverages (foods) by the Australian population in order to guide recommendations for improving the design of dietary assessment and surveillance technologies.

Methods: Analysis was conducted on the first 24-hour recall of the Australian National Nutrition and Physical Activity Survey. This cross-sectional survey used a sampling frame inclusive of 97% of the population with sampling weights from the ABS applied to make data representative of the Australian population. The most commonly consumed foods by energy (kJ) and frequency were calculated. 

Results: There were 4515 unique foods and beverages reported by 12,153 people. Overall, the top 10 foods by energy contribution were full-fat milk, beer, white rice, white bread, red wine, cola, bananas, red apples, wholewheat breakfast cereal and white sugar. The five most frequently consumed foods were tap water, black tea, full-fat milk, black instant coffee, and sugar. The largest category of foods was discretionary accounting for 25% of the top 100 foods consumed – popularity ranking included sugar (5th), butter (11th), vegemite (14th), ham (15th) and cola (18th). Based on this data, recommendations include refining food databases and search functionalities in digital dietary assessment tools to prioritise popular foods (e.g. alcohol, refined grains and discretionary foods), which could reduce user burden when logging data. Digital technologies require features that prompt for popular but commonly omitted foods and beverages (e.g. milk and sugar) to reduce under-reporting and improve validity of these tools. Innovations in automated identification and analysis of image-based records could also be derived from machine learning and algorithms that are guided by the most popular foods consumed.

Conclusions: The methods in this study could be applied to other countries’ national nutrition surveys to inform development of country-specific digital dietary assessment and surveillance technologies. Together with improvements in the design of these digital technologies, dietitians and digital public health campaigns and interventions should target popular foods that improve diet quality and individual and population health. 

Background and purpose: Understanding the relative importance of determinants of changes in eating behavior throughout pregnancy and postpartum is crucial when developing interventions aiming to improve eating behavior in this lifechanging phase. We aimed to investigate to what extent determinants of changes in eating behavior affect expecting and first-time parents’ eating behavior, taking sex into account. A second aim was to involve experts in the field of maternal health and/or nutrition/physical activity and/or public health prioritizing the determinants.

Methods: A list of 54 determinants was rated by first-time parents on a scale of 1 (no impact) to 10 (very high impact). Descriptive statistics were used to describe each determinant, independent samples t-tests to examine sex differences. Experts rated the determinants on a level of modifiability, relationship strength and population-level effect, after which a ‘priority for research’-score was generated based on these ratings.

Results: During pregnancy, the top three determinants receiving the highest scores for women were at the individual level, namely ‘health concerns’, ‘physiological changes’ and ‘fatigue’. For men the three most important determinants were at the individual level, namely ‘health concerns’ and ‘health consciousness’, and at the interpersonal level, namely ‘influence of the pregnant partner’. Postpartum, the three highest rated determinants by women were related to the baby (interpersonal), namely ‘adaptation to the rhythm of the baby’, ‘baby becomes priority’ and ‘practical constraints because of the baby’. For men, ‘adaptation to the rhythm of the baby’ (interpersonal) received the highest score, followed by ‘fatigue’ and ‘(lack of) anticipation’ (both at the individual level). According to the experts, the determinants ‘professional support’ (interpersonal), ‘food knowledge’ (individual) and ‘home food availability’ (environmental) were of highest priority for both sexes and during both periods, as these were rated as highly modifiable, strongly related to eating behavior and having a high populationlevel effect.

Conclusions: During pregnancy and postpartum, research priority should go to interventions supported through health professionals, aimed at both parents, and with a focus on food and health education. Postpartum, an additional focus towards supporting balance between one’s own health and care for the baby is advised.

Background and Objective: Prior research indicates associations between controlling food parenting practices (e.g., pressure-to-eat, restriction) and factors that increase risk for cardiovascular disease in children (e.g., low diet quality, obesity). However, little is known about whether these associations depend on food security status, race/ethnicity, or sex/gender. This study aimed to examine associations between real-time parental stress and depressed mood, food parenting practices, and child eating behaviors within the context of food insecurity.

Methods: Children ages 5-9 and their families (n=631) from six racial/ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited for this study through primary care clinics in Minneapolis/St. Paul, MN in 2018. Ecological momentary assessment was carried out over seven days with parents at two time points, 18 months apart. Generalized estimating equations with a binomial variance family and logistic link to account for multiple daily observations for each family/child were run. To examine moderation, interaction terms between the predictor variables and child race/ethnicity, sex, and food security status at the data collection time point, were added separately to each model.

Results: High levels of parental stress and depressed mood experienced earlier in the day were associated with controlling food parenting practices and child food fussiness at dinner the same night. Results were dependent on food insecurity status, race/ethnicity, and child gender. Specifically, parents from immigrant/refugee households were more likely to engage in restrictive food parenting practices in the face of stress, whereas Black and Native American parents were more likely to engage in pressure-to-eat food parenting practices. In addition, the association between high stress and engaging in controlling food parenting practices was dependent on being a daughter and from a food insecure household.  

 Conclusions: Health care professionals may want to consider screening, or continue screening, parents for stress, depressive symptoms, and food insecurity during well child visits and discuss the influence of these factors on every day food parenting practices and child eating behaviors. Additionally, future research should consider using real-time interventions such as ecological momentary intervention to reduce parental stress and depressed mood to promote healthy food parenting practices and child eating behaviors.

Purpose:

This systematic literature review aims to identify attributes of geographical environments investigated in relation with walking and cycling behaviors, using Virtual Reality technologies. This study further aims to report on the impacts of environmental correlates of physical activity on people’s attitudes and emotional experiences.

Methods:

PubMed, Scopus, EBSCO, IEEE Xplore, and Cochrane Library were explored for articles published between January 2010 and February 2022. The search strategy was based on three keywords and their synonyms and types, which include: a) Virtual Reality (VR), b) Active behavior, and c) Built environment. The articles were limited to the English-language, reporting information relating to adults (+18), and were published in journals. There was no restriction for gender. Studies on indoor environments, driving simulation, disease-specific groups, interventions related to other disciplines (e.g. Military, Emergency evacuation, and Education), and studies that optimized the methodology or software were excluded. The full protocol is available from PROSPERO (ID=CRD42022308366).

Results:

In total 75 out of 8992 original studies met the selection criteria. Expected results will consider different population characteristics (e.g. age ranges, socio-economic status, and participants' previous experience with VR), different study designs, and experiment session information (e.g. duration of experiment, length of exposure). It will also account for the different attributes of the walking and cycling behaviors, like walking speed, heart rate, heart rate variability and environmental characteristics of the built and natural environments; for instance, greenness and crowdedness. Expected results will identify and summarize the effects of geographical environment on walking and cycling in Virtual Reality experiments, and excavates the advantages and disadvantages of utilizing Virtual Reality in these studies, providing details on the consistency and limitations of the existing literature.

Conclusions:

The findings of this review will identify the gaps in the literature and will provide valuable recommendations for future research to implement effective policy interventions to increase physical activity.

Keywords: Virtual Reality, Walking, Cycling, Experiment, Geographical environments

Purpose: Rapid weight loss (RWL) has been traditionally practiced in judo. Potential performance and health detriments have been extensively studied, but less attention is dedicated to acute psychological effects of RWL in judo athletes.

Methods: PubMed and Web of Science were searched for the relevant literature. Only original studies investigating the magnitude of RWL in judo athletes while jointly using Profile of Mood States questionnaire were eligible.

Results: Studies varied vastly in their design (time allocated to RWL and the degree of RWL), but the common trait in virtually all studies was a significant increase in tension and significant drop in vigor following RWL. It appears that when  ≥5% RWL per week is prompted, mood states greatly exacerbate in judo athletes. There were minor differences between males and females regarding mood states following RWL. In a sample of French judo athletes, the mood states of confusion in male judo athletes, and tension and confusion in female judo athletes, increased significantly from the pre-post (p˂0.05). Also, vigor decreased significantly in both male and female athletes in the EG (p˂0.05). In contrast, quite unforeseen results were found in Japanese judo athletes. Namely, within EG, males showed significantly higher scores in tension (p˂0.05), fatigue (p˂0.01), vigor (p˂0.05) and TMD (p˂0.05) following RWL. However, female EG actually showed a marked decrease in anger, confusion, depression, tension, and TMD when compared to baseline, although the changes were not significant. Though, females had the higher values in all mood states prior to the study when compared to males. In another study on Japanese judo athletes, no differences in mood states following RWL were identified.

Conclusions: To our knowledge, this is the most concise evidence on RWL and mood states in judo athletes to date. Overall, data showed that mood states aggravated in judo athletes after RWL with no significant difference between males and females. Future studies should explore the long-term effects of weight cycling on mental health of judo athletes and in other athletes participating in weight classified sports.

Purpose: School meals play a critical role in promoting child nutrition and advancing equity. However, in the United States (US) many students do not participate in the National School Lunch Program or the School Breakfast Program. To increase student participation in school meals, a better understanding of evidence-based strategies that increase participation rates is warranted.

Methods: A systematic review was conducted to understand which interventions, initiatives, and policies increase school meal participation. Four electronic databases were searched (PubMed, Academic Search Ultimate, Education Resources Information Center, and Thomson Reuters’ Web of Science) to identify peer-reviewed and government studies conducted in the US and published in English through January 2022. Study quality (i.e., risk of bias) was assessed using the Newcastle-Ottawa Scale for cross-sectional and cohort studies. 

Results/findings: Thirty-four articles met inclusion criteria. This review found strong evidence to support alternative breakfast models (e.g., breakfast in the classroom or grab-and-go breakfast) increase participation. Specifically, alternative breakfast models in combination with universal free school meals had greater effects on improving participation than either strategy alone. There is also strong evidence that restrictions on competitive foods (i.e., foods sold outside the school meal program through vending machines, à la carte, or school stores) increase school meal participation. Restrictions on competitive foods may also promote equity in schools by eliminating a two-tiered system of food service inaccessible to many children from households with low incomes. There is promising evidence that stronger nutrition standards do not negatively impact meal participation, and in some cases, may promote meal participation. There was limited high-quality evidence on the effect of taste tests, modified menu options, changes to the meal period length, changes to the cafeteria environment, and wellness policies.

Conclusions: Several interventions and policies may shape meal participation, such as alternative breakfast models, strategies to increase student enrollment in free and reduced-price meals and policies that ban meal shaming. Additional rigorous research is needed to explore these and other strategies to promote meal participation, including school-based interventions and local and state policies.

Purpose: Infant well-child visits offer multiple opportunities to deliver evidence-based guidance on movement behaviors that promote health and well-being. This includes time in physical activity (e.g., active play, tummy time), sedentary behavior (e.g., screen time, restrictive devices), and sleep. However, the extent to which these topics are discussed in clinical settings is unknown, particularly during infancy. This study conducted an in-depth qualitative analysis of patient-provider conversations around movement behaviors during well-child visits to understand guidance parents receive and their questions/concerns regarding these behaviors within the first months of life.

Methods: Mother-infant dyads (N=20) were enrolled in this longitudinal pilot study. For each dyad, well-child visits at 2, 4, and 6 months of age were audiorecorded. Patient-provider conversations were transcribed and analyzed using thematic analyses. Themes around physical activity, sedentary behavior, and sleep were derived. Within each theme, dialogue was further conceptualized into pediatrician-initiated guidance and parent-initiated questions/concerns. Themes were compared across ages, and percentages were derived for the frequency of initiated topics discussed.

Results/findings: Sleep was the most discussed movement behavior. Discussions centered around: 1) safe sleep practices (e.g., Sudden Infant Death Syndrome), 2) sleep duration and timing, and 3) parenting practices at bedtime and night wakings (e.g., sleep training). Pediatricians provided the most guidance around safe sleep and parenting practices at 2-months (45% and 70% of visits, respectively), while parents had the most questions/concerns about sleep duration and timing (initiated in 15-25% of visits across ages). Physical activity was discussed less often, and themes included: 1) active play (e.g., tummy time), 2) reaching motor milestones (e.g., rolling over), and 3) safe movement (e.g., baby proofing). Active play guidance was most commonly provided at 2-months (30% of visits), with safe movement guidance provided mostly at 6-months (55% of visits). Sedentary behaviors of screen time and restrictive devices were almost never discussed (5% of visits).

Conclusions: Although sleep was commonly discussed during infant well-child visits, guidance on physical activity and sedentary behaviors was minimal. These findings can inform enhancements to clinical care and identify opportunities for providing additional guidance, particularly regarding reducing sedentary behaviors to support healthy habits early in life.

Purpose: Unhealthy lifestyle behaviours including insufficient physical activity (PA) and high screen time (ST) have been frequently reported among urban adolescents in developed countries. Knowledge about those behaviours among adolescents living in less urbanized areas and rural settings is limited. This study compared PA and ST among New Zealand adolescents attending schools across different settlement types.

Methods: Adolescents (n=2,113) from 23 of 27 secondary schools in the Otago region, New Zealand participated in the Built Environment and Active Transport to School (BEATS) Studies between 2014 and 2018. Adolescents self-reported their PA and recreational ST in an online questionnaire completed at school under supervision of research staff. The proportion of adolescents meeting PA (≥60 min of moderate-to-vigorous PA/day) and recreational ST guidelines (≤2 hrs/day) was calculated. Based on school location, participants were categorized into four groups: ‘large-urban’ area (n=1,125; 11 schools), ‘medium-urban’ area (n=260; 3 schools), ‘small-urban’ area (n=562; 5 schools) and ‘rural’ setting (n=166; 5 schools). Differences between the groups were compared using ANOVA and Chi-square tests.

Results: Overall, few adolescents met recommendations for PA (20.0%) and ST (14.1%). Differences across settlement types were observed for PA (‘large-urban’, ’medium-urban’, ’small-urban’, ’rural’: 16.8%, 16.5%, 26.3%, 25.3%; p<0.001), motorised transport to school (66.5%, 56.6%, 48.6%, 54.8%; p<0.001) and sport participation at school (67.6%, 63.8%, 53.7%, 66.3%; p<0.001) and outside school (49.4%, 54.2%, 59.4%, 61.4%; p<0.001).  Average daily ST outside school was significantly higher for adolescents living in the large urban areas compared to rural settlements (5.5±3.0 vs. 4.8±3.2 hours/day; p=0.040). Weekend day average ST was higher for adolescents living in large and medium urban areas (6.9±3.5 hours/day for both areas) compared to rural settlements (5.8±3.4 hours/day; p<0.05). Weekday average ST was not different across settlement types (5.0±2.9, 5.0±2.8, 5.0±2.9, 4.4±3.0; p=0.112).

Conclusions: Overall, few New Zealand adolescents met recommended PA and ST guidelines and unhealthy behaviours were more common among those living in large urban areas compared to rural settings. Therefore, health promotion interventions for adolescents should be comprehensive and tailored to urban and rural settings.

Purpose: Unhealthy dietary behaviours and sedentary lifestyle among Indian adolescents poses a significant public health challenge. The mounting prevalence of  adolescent obesity and its associated adverse consequences are top concerns for policy makers and public health professionals. Family diet is viewed as a primary contributor to these health adversaries, with parents influencing their adolescents’ food intake. Yet, much of the existing research exploring parenting influences on adolescents’ diet focuses on mothers while fathers’ involvement in shaping eating and physical activity behaviours of their young ones is underreported in the literature, more so in the LMIC context. Therefore, this qualitative inquiry aimed to describe Indian fathers’ perceptions of developing healthy behaviours in adolescents.

Methods: Convenience sampling was used to recruit 36 fathers of adolescents aged 10-19 years from Kolkata, India. Based on the study aim and literature review, an interview guide with a series of open-ended questions was prepared and pre-tested. In-depth, semi-structured interviews were conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. All interviews were digitally recorded, transcribed verbatim, and translated to English. Underpinned by the Template Analysis technique, transcribed data were analysed both manually as well as using the NVivo software program. This study received ethical approval from the Institutional Ethics Committee of Banaras Hindu University (Dean/2021/EC/3006).

Results: Five themes were identified during thematic analysis which included (i) Limited engagement of fathers in food related tasks particularly cooking for adolescents; (ii) Fathers can play a crucial role in setting food rules e.g. restricting television viewing during mealtime (iii) Challenges to developing healthy dietary behaviour in adolescents e.g. fussy eating i.e. dislike of green vegetables, love of junk food; (iv) Fathers’ engagement in adolescents’ physical activity was mostly restricted to weekends; (v) Barriers to routine involvement in adolescent upbringing e.g. full-time paid employment, poor financial status.

Conclusions: This growing understanding of paternal parenting behaviour highlights the need to engage fathers in lifestyle-based interventions to promote health and wellbeing in vulnerable Indian adolescents while alleviating the risk of triple burden of malnutrition.

Purpose: Insufficient physical activity (PA), high screen time (ST), unhealthy dietary patterns and clustering of these behaviours among adolescents in developed countries were reported prior to the COVID-19 pandemic. While emerging international evidence suggests these health behaviours worsened during the pandemic, data from many countries are lacking. This study compared PA, ST and dietary behaviours in New Zealand adolescents five to six years prior to (T1) and during (T2) the COVID-19 pandemic.

Methods: Adolescents (n=2,085; age: 15.2±1.4 years; 51.8% female) from all 12 secondary schools in Dunedin, New Zealand, participated in the Built Environment and Active Transport to School (BEATS) studies in 2014/2015 (T1; n=1,266) and 2021/2022 (T2; n=819). Participants self-reported PA, recreational ST (TV/computer/video games) and dietary behaviours in an online survey. The proportion of adolescents meeting guidelines for PA (≥60 minutes of moderate-to-vigorous PA/day), recreational ST (≤2 hours/day) and fruit and vegetable (F&V) intake (>1/day each for both fruit and vegetables) was calculated. Data were analysed using ANOVA and Chi-square tests.

Results: At both time points, few adolescents met health behaviour guidelines. Compared to T1, a greater proportion of adolescents at T2 met guidelines for PA (16.7% vs 23.1%; p<0.001) and ST (13.3% vs. 18.3%; p<0.002) while no significant difference was observed for F&V intake (29.6% vs. 27.0%; p=0.193) and all three health behaviours (2.1% vs. 2.1%; p=0.106). At T2, average daily ST outside school was lower on weekend days (6.9±3.5 vs. 6.1±3.6 hours/day), but higher on weekdays (5.0±2.9 vs. 5.6±2.9; p<0.001) compared to T1. Higher weekly intake of sweets (3.1±3.1 vs. 3.5±3.2 times/week; p=0.005) and lower weekly intake of fruit (8.1±4.9 vs. 7.7±4.9 times/week; p=0.027) and sugary soft drinks (2.6±3.2 vs. 1.8±2.8 times/week; p<0.001) were found at T2 versus T1.

Conclusions: In 2021-2022, New Zealand adolescents self-reported higher levels of PA, weekday ST and consumption of sweets, and lower weekend ST and intake of fruit and sugary soft drinks compared to pre-pandemic levels. Worsening of health behaviours, particularly related to weekday screen time and consumption of fruit and sweets during the COVID-19 pandemic, reinforces the need for comprehensive health promotion for adolescents.

Purpose

Live online yoga classes (teleyoga) for older participants are known to be acceptable and feasible, but little is known about which strategies optimise engagement. This paper identifies practical lessons learnt in the delivery of the Successful Ageing (SAGE) yoga trial. We 1) explore challenges and opportunities experienced by the yoga instructors when moving the SAGE yoga program online and 2) describe how yoga instructors adapted to manage these challenges and leverage opportunities presented by teleyoga. We provide transferable information for health and exercise professionals who want to deliver, or who are already delivering, online classes for older people.

Methods

The SAGE yoga trial is a novel randomised controlled trial testing the effect of a yoga-based exercise program on falls among 700 community-dwelling people aged 60+ years. Our realist process evaluation sought to explain outcomes of high satisfaction and adherence described by most participants, focusing on what was working for whom, and conditions which supported this. This study draws on focus groups, semi-structured interviews and participant observation with four SAGE yoga instructors. Multiple data sources enabled analytic triangulation. Data were analysed using six previously developed program theories, combined with inductive coding and an analytical workshop.

Results

The SAGE yoga instructors identified four concerns about delivering teleyoga for older people: threats to safety, altered interpersonal dynamics, challenges to facilitating mind-body connection and difficulties with technology. The instructors used eight modifications to manage these challenges: a 1:1 participant interview prior to program commencement, more descriptive verbal instructions, increased focus on interoception, increased attention and support, slower more structured class flow, simplifying poses, adapting the studio environment and IT support. Teleyoga required the development of new skills and adaptive teaching strategies.

Conclusions

This study provides unique insights into the challenges of delivering teleyoga to older people from the perspective of the yoga instructor and identifies pragmatic strategies instructors developed to overcome these challenges and maximise engagement with teleyoga, presenting them in a typology of transferable lessons.  These manageable strategies could be applied to a wide range of telehealth classes, improving the uptake and adherence of beneficial online programs and services.

Purpose: Screen use in young children has long raised considerable concern for its potential negative impact on overall cognitive development. However, little is known regarding screen time and drawing ability, a specific dimension of cognition. We aim to assess the associations between screen time and drawing ability, and examine whether these are confounded by family socioeconomic status and children’s activities competing with screen time.

Methods: We used data from the Elfe birth cohort, which enrolled 18,329 new-borns in 2011, across 349 randomly selected maternity units in France. At age 3.5 years, children underwent the Draw-a-person test during home visits; drawings were collected and scored using the 12-point McCarthy score. Data on total and device-specific screen time, household sociodemographic characteristics and children’s competing activities were collected from parents in phone interviews at 3.5 years. Among 7,577 children with valid data on screen time and drawing score, we examined the associations between screen time and the McCarthy score using multivariable zero-inflated Poisson regression models. Analyses were controlled for household socioeconomic characteristics (model 1) and competing activities (e.g. drawing/painting practice, playing outdoors, sleep time) (model 2) separately. Analyses were stratified according to child sex.

Results: In unadjusted models, total screen time was associated with drawing score. Increased total screen time was associated with a higher likelihood to obtain a null score for boys (OR=1.15, 95 % CI=1.07-1.23) and girls (OR=1.13, 95 % CI=1.03-1.24). In girls only, increased total screen time was associated with a higher drawing score above zero (coef=-0.02, 95 % CI=-0.04; -0.01). Overall, estimates were slightly stronger when considering TV time only. After adjusting for SES characteristics, associations were no longer observed. When controlling for competing activities only, total screen time and TV time remained associated with drawing score in boys and girls.

Conclusion: The associations between screen time and drawing score in 3.5-year-old children was confounded by family SES, not by activities competing with screen time.

This study aims to investigate the feasibility for scale-up of Football Cooperative (FC), a community based recreational ‘pick-up’ football intervention for men using a Social Return on Investment (SROI) framework.  

A mixed-methods approach that adhered to the principles of SROI evaluation was adopted.  Step 1: A stakeholder map was developed and 5 stakeholder groups were identified; a) participants (P; n=107), b) volunteer coordinators (VC; n=6), c) significant others (SO; n=107), d) community partners (CP; n=2) and e) community sports club (CSP n=1).  Step 2: Interviews (P; n=14; 23-50mins:  SO n=2; 21-23mins) and focus groups (VC; n=3; 64mins: CP/SCP; n=2; 25 mins) were held with each stakeholder group via Zoom. These methods ascertained motivation for involvement in FC (P, VC) and the impact of participation on them personally, their family (P, VC, SO) and their organisation (CP/CSP).  All data was recorded, transcribed verbatim and analysed inductively via thematic analysis.  Step 3: Theories of change (TOC) were validated for each stakeholder group via focus group on Zoom (P; 2FG * 60mins, n=17:  VC; 1FG*65mins, n=3: SO 1FG *45 mins, n=4: CP/SCP 1FG*45min, n=2). Step 4: Outcomes were measured for each stakeholder group. Anthropometric and fitness tests and self-report surveys were administered to participants at baseline (B), 3M, 6M and 12M while self-report surveys were administered to all other groups at 12M.   Steps 5 & 6:  All outcomes were both valued and ranked by stakeholders in 12M surveys.  Step 7: The calculation of the SROI of FC games is ongoing.  

Preliminary data suggests the following outcomes: For P, improvements in physical, mental and social health and an increase in injuries; for VC, greater self-esteem, social connection and a reduction in stress; for SO, improved partner and family dynamic, physical health and mental health; for CP, increased self-worth, time commitment; and for sports club, increased revenue. Full findings will be included in the presentation of this work which will compute an SROI for FC. 

The findings of this study will inform a) the decision to scale-up FC nationally and b) the implementation strategy for such a scale up. 

Purpose:

Healthy eating is vital in reducing adolescent obesity and future non-communicable diseases. While family influence on adolescent eating habits is well-studied in Western populations, little is known in Chinese families. Exploring family facilitators, barriers and strategies of healthy eating among adolescents in Chinese families can provide directions for future interventions in local setting.

Methods:

A theoretical framework of dietary knowledge, attitudes and practices was applied to guide the qualitative semi-structured interviews with each parent-adolescent dyad. The dyads were purposively sampled by age, gender, dietary intake and household income. The transcripts were coded by thematic analysis to identify the key family factors.

Results:

Twenty-five adolescents (aged 12 to 19 years) and their mothers participated. Thirteen adolescents were female, and eight reported healthy eating of 5 or more servings of fruit and vegetables (FV) per day. A total of fourteen themes under five domains were identified: A) Family health with 1) Illness experience in the family; B) Parental knowledge on 2) Dietary recommendations, 3) Preparation of healthy food, and 4) Healthy food choice; C) Parental attitudes towards 5) Importance of healthy eating, and 6) Priority of family health; D) Socioeconomic factors of 7) Time concern, and 8) Cost concern; and E) Food parenting practices in 9) Nutrition education, 10) Role modelling, 11) Food provision, 12) Child involvement, 13) Parental supervision, and 14) Cultivation of food preference. Parenting styles had an influence on themes 12 to 14. Families reported useful strategies such as incorporating healthy ingredients in adolescents’ favourite recipes, provision of a variety of FV at home, and involvement of adolescents in meal preparation. 

Conclusions:

Positive parental attitudes towards healthy eating, healthy food provision, and authoritative parenting style were key facilitators, where deficiency in dietary knowledge in parents, time and cost concerns, and limited family discussion on food-related issue were key barriers. There is a need to resolve the barriers through public education to empower parents with practical nutrition knowledge; to adopt an authoritative style in food parenting practices; to discuss more on healthy eating; and to acquire practical skills on time- and cost-saving healthy cooking.

Purpose: A large proportion of children globally are not meeting dietary and movement recommendations. School-based interventions have shown promising results but should be multicomponent to be effective.  As part of a multicomponent intervention programme (Promoting hEalthy Diet and Active Lifestyle, PEDAL), we co-developed a package of interactive health education lessons and take-home activities with health and education professionals to improve children’s diets, reduce sedentary behaviours, and introduce habit formation. Prior to the full-scale PEDAL programme, the feasibility of the health education package was assessed qualitatively, focusing on the implementation (e.g., adherence and barriers) and acceptability (e.g., satisfaction and appropriateness) among students and teachers.

Methods: Ten teachers underwent a training workshop and conducted the lessons and activities with Primary 5 students (aged 10 to 12 years old) in two primary schools (n=404). Upon lesson completion, 16 students (n=8 girls) and 5 teachers (n=1 female) took part in five semi-structured focus group discussions (FGD). The FGDs were audio-recorded, and data was extracted using the scribing approach and analysed inductively using thematic analysis.

Findings: Teachers found the lessons easy to implement as the videos and slides were provided to them, and the lessons were generally pitched at an appropriate level to students. However, some found teaching the topic of habit formation challenging to less academically inclined students. Teachers also struggled to complete all lessons in the package within the intended 3-month period due to other school activities and suggested more time for completion. The students reported that they enjoyed the PEDAL lessons more than the typical health education lesson as they were entertained by the educational videos and the quiz games which require them to answer with body movements. They also liked the variety of take-home activities but faced challenges in completing them due to the lack of parental support at home. Overall, students and teachers expressed that the information on habit formation and the activities increased their awareness and skills in forming healthy habits.

Conclusions: Feedback from this study is valuable to inform the roll-out of the full-scale multi-component PEDAL programme involving parental engagement and improving the school canteen environment. 

Purpose

A healthy balance of movement behaviours, namely physical activity, sedentary behaviour and sleep across a 24-hour day has been associated with positive growth and health in children. However, less is known about the adherence to 24-hour movement guidelines among school children in a multiethnic Asian context. To address this knowledge gap, this study aims to examine the prevalence of meeting 24-hour movement guidelines among schoolchildren in Malaysia.

Methods

My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess diet and movement behaviour of Asian schoolchildren. A total of 297 Malaysian children (51% girls) aged 10.7 ± 0.6 years from seven primary schools in Kuala Lumpur self-reported their daily activities on MEDAL for four days, including a weekend day. Based on self-reported moderate-to-vigorous physical activity (MVPA), screen viewing and sleep, adherence to movement guidelines were calculated. Adherence to movement guidelines was defined as ≥60min MVPA/day, ≤2h screen-viewing/day, and 9–11h of sleep/night.

Results / findings

On average, children spent 42 ± 54min on MVPA, 3.4 ± 2.0h on screen activities and 10.1 ± 1.9h sleeping daily.  Approximately 25%, 27%, and 45% of children met MVPA, screen and sleep recommendations respectively. Only 3% of children met all recommendations, while 32% did not meet any recommendation. The prevalence of meeting at least one of the recommendations was highest among Indian children, but did not differ by sex.

Conclusions

While two-in-three children met at least one of the movement guidelines, adherence to all three guidelines was very low in this sample of urban schoolchildren. Greater emphasis should be given to increase overall physical activity and reduce sedentary behaviours, especially screen time, among schoolchildren in Malaysia.

Purpose: Digital interventions in real-life home settings that support health behavior are needed, especially in Switzerland. This study aimed to develop and evaluate the feasibility of using a mobile application in Swiss households, and compare dietary behavior and food acceptability between children who cooked with limited parental support with children who were not involved in cooking. 

Methods: A 10-week randomized controlled trial was conducted between August and December 2020. Parents in both groups were given access to a mobile-app which delivered easy-to-follow recipes weekly. Each recipe emphasized one of two generally disliked foods (Brussels sprouts or whole-meal pasta). Children in the intervention group were involved in the meal preparation of the recipes with limited parental support, while the control group were only served parent-prepared meals. Parents were asked to photograph and weigh the food components from the child’s plate before and after consumption. After each meal, parents were asked to report whether their child liked the meal and the target food, and how the appetite of the child was that day.

Results: Of 24 parents who completed the baseline questionnaires and fulfilled the inclusion criteria, 18 parents and their children completed the evaluation phase. The median (range) age of the children was 8 (7 to 9) years. For the total child sample, mean baseline Brussel sprouts and whole-meal pasta intakes were 19 grams (SD=24.2) and 86 grams (SD=69.7) per meal, respectively. No meaningful differences in Brussels sprouts and whole-meal pasta intake were found post-intervention or between intervention groups. More children reported a neutral or positive liking towards the target foods in the intervention group compared to those in the control group. 

Conclusion: This was the first evidence-based mobile application developed to reach and support Swiss families during the height of the COVID-19 pandemic. This study demonstrated that integrating digital interventions in the home environment and promoting meal preparation has the potential to improve child reported acceptance of healthy foods. Using such technology is important, as it can play a key role in improving children’s dietary behavior, saving time for parents, and engaging families in cooking and consuming healthier meals.

Background: Social norms (subjective and descriptive) refer to the perception of what other significant people think about me performing a behaviour, as well what other significant people are doing (respectively). These social norms have been reported as important determinants for parents’ intentions to let their child use active commuting to and from school, because parents ultimately decide how their children commute to and from school.

Purpose: The aims of this study were to describe the social norms of Spanish parents and their children's mode of commuting to and from school, and to analyse the associations between the social norms of Spanish parents and their children's active commuting to and from school.

Methods: A total of 410 parents (74.6% mothers) and their children (49.8% girls) from Spain were included in this cross-sectional study. Social norms of parents, and children's mode of commuting to and from school were self-reported by parents. Two binary logistic regression models were used to analyse the associations between social norms of parents (independent) and the mode of commuting to and from school (dependent), separately in each model. The models were adjusted for child's age and distance to school.

Results/findings: The average for social norms of parents was 1.80 ± 0.81 (ref. scale from 1 [low social norms] to 4 [high social norms]), and most of their children used active commuting (i.e., walking and cycling) to school (60.0%), and from (61.7%) school. When parents reported higher social norms, their children tended to actively commute to school (Odd Ratio [OR]: 1.92; CI95%: 1.30-2.83; p<0.001), and from school (OR: 2.40; CI95%: 1.56-3.69; p<0.001), compared to parents who reported lower social norms.

Conclusions: This study has identified that social norms of Spanish parents are a key factor to increase their children’s active commuting to and from school. Therefore, if parents perceived greater visibility in the neighbourhood of significant people walking or cycling, their children will be more likely active in their trip to and from school, and they will obtain multiple health benefits. 

Purpose: Improving food literacy among children may lead to healthier eating behaviours. While some school-based cooking or culinary programs have shown positive outcomes on students’ knowledge or cooking confidence or skills, few have assessed the impact of these programs on multiple components of food literacy, and even fewer have done so using a gender lens. Therefore, this study assessed the impact of the “Apprenti en Action” school-based culinary program on Grade 4 and 5 students’ food literacy, including food knowledge, food skills and cooking skills, as well as their vegetable, fruit, and breakfast consumption, and to determine the program’s impact on boys and girls separately.     

Methods: This cluster quasi-experimental trial compared 88 Grade 4 and 5 students who took part in the “Apprenti en Action” program to 82 students who did not.  The program included 45-minute culinary workshops offered once a week during school hours, for 6 weeks. Students’ vegetable, fruit, and breakfast consumption, cooking skills, food skills, and food knowledge were assessed with an online self-administered questionnaire completed before and after the program. Multivariate analysis of variance was used to assess the impact of the program on vegetable and fruit consumption, cooking skills, food knowledge, and food skills. Logistic regression was used to measure the impact of the program on breakfast consumption. Separate gender analyses were also performed.

Results: Students who participated in the “Apprenti en Action” program reported greater increases in their cooking skills (p = 0.013) and food knowledge (p = 0.028) than students in the control group. No effect was found on food skills, vegetable, fruit, or breakfast consumption (p > 0.05). When assessed separately, boys improved their cooking skills (p = 0.025) and their food knowledge (p = 0.022), but girls did not.

Conclusions: The program effectively improved students’ cooking skills and food knowledge, especially among boys. However, it had no impact on vegetable, fruit and breakfast consumption, nor food skills. Culinary programs such as “Apprenti en Action” may be needed to be modified to improve students’ food skills and eating behaviours, and be tailored to positively impact both boys and girls. 

Purpose: A higher level of food literacy among children is associated with higher diet quality. Nutrition education in schools is a key strategy to establish food literacy and promote healthy eating habits. Nutrition is a component of Canadian elementary school curricula; however, limited research assessing the factors that impact the implementation of nutrition education in schools exists. This study explored elementary school teachers’ views, attitudes, practices, barriers and drivers related to teaching nutrition.

Methods: A qualitative descriptive study involving online focus groups (n=2, 6 participants, each session averaged 90-minutes) and individual interviews (n=2, 2 participants, each interview averaged 30-minutes) was conducted among Canadian elementary teachers (Grades KG-8). Recruitment occurred via social media. The Consolidated Framework for Implementation Research informed the semi-structured interview guide that contained probes, which was pilot tested before use. Interviews were audio-recorded and verbatim transcripts prepared. An anonymized summary of each focus group or individual interview was sent to participants for member checking. Two researchers independently and inductively coded the transcripts using content analysis.

Findings: Participants (n=8) considered nutrition to be an important curriculum subject for children; albeit they had mixed feelings about how nutrition has impacted their own personal lives. There were several barriers when teach nutrition including insufficient availability of nutrition-specific resources, training, support from the school boards and time to prepare lesson plans. The cost of procuring classroom materials was considered a barrier. Participants strongly agreed that nutrition is not prioritized in the provincial school curriculum, nor is its instruction standardized. When teaching nutrition to higher-level grade students (i.e., 7^th - 8^th grades), participants cautiously provided content to avoid triggering mental or eating disorders among students. Importantly, integrated, hands-on, interactive activities, like cooking activities and field trips were recognized by participants as among the best strategies to teach nutrition to children, regardless of the grade.

Conclusion: This study revealed several barriers that impact the implementation of nutrition curricula in schools, including lack of time, training, and resources; as well as costs. This research highlights the complexity and pressure of teaching nutrition in Canadian elementary schools and the need to better support teachers.

Purpose: Research demonstrates that habitual light physical activity (LPA) in later life may contribute towards preventing muscle losses and disability in older adults. This study explored associations of diurnal patterns of light physical activity and performances of physical function. Methods: A cross-sectional analysis was conducted among 202 older adults (≧65 years). Objectively measured light physical activity is defined where the triaxial accelerometer registers 100-2019 counts per minutes. The overall and percentage of timing-specific (morning: 06:00-12:00; afternoon: 12:00-18:00; evening: 18:00-24:00) duration of light physical activity were assessed using an Actigraph software. Four performances of physical function, including handgrip strength, gait speed, basic functional mobility (timed up and go test), and lower limb strength (five time sit to stand test), were evaluated. Multiple linear models were performed to examine the associations. Results: There was an average of 4.1 hours of light physical activity for each individual during the day, with a significantly lower duration (1.0 hours) in the evening than in the morning (1.4 hours) and afternoon (1.5 hours). After adjusted potential confounding variables, higher overall duration of LPA during the day was associated with better performances of all physical function tests in older adults independent of moderate-to-vigorous physical activity (MVPA). Timing-specific analysis showed that only a higher percentage of LPA duration during evening was associated with less time on the performance of five time sit to stand test (B= -9.45; 95% CI: -17.87, -1.03). Conclusions: Our findings inform implications that the overall LPA was more important than timing-specific LPA to physical function performances of older adults. Strategies for accumulating duration of LPA in any time is more practical than encouraging to engage in LPA in specific timing for maintain muscle strength among older adults.

Purpose: SUNRISE is an international study of movement behaviours in the early years. In Japan, the main study started in October, 2021 and will continue until 2024. We examined adherence to the World Health Organization’s (WHO) Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age in Japan as an interim analysis. Methods: Data on 3 to 4-year-old children from urban and rural areas in Japan obtained by the beginning of November, 2022 were used for analysis. Physical activity was measured using a triaxial accelerometer (ActiGraph GT3X). Screen time and sleep duration were assessed via parent questionnaire. Meeting the WHO guidelines was defined as participating in, over a 24-hour period: ≥180 mins of total physical activity, of which at least 60 minutes was of moderate-to vigorous-intensity physical activity, ≤1 hr of sedentary screen time, restrained for ≤1 hr at a time, and 10-13 hrs of sleep (including naps). Results: Participants included 185 children (4.2±0.5 years old, girls n=91, boys n=94; urban n=57, rural n=128). The proportions of children meeting physical activity, sedentary behaviour, sleep and all guidelines were 68.6%, 29.1%, 87.6% and 16.2%, respectively. There were no significant differences in the proportions between urban and rural children. A higher proportion of boys than girls met the physical activity guideline (78.7% vs, 58.2%), with average total physical activity and moderate-to vigorous-intensity physical activity in girls (195.2±40.6 min/day and 80.6±26.5 min/day) shorter than in boys (217.5±36.6 min/day and 104.3±28.1 min/day), even after adjustment for age and sector (urban or rural). There were no significant differences in sedentary behaviour or sleep between girls and boys. Conclusions: Japanese 3 to 4-year-old girls were less active than boys. Continuing the survey and increasing the number of participants will provide more information to confirm or refute these initial findings.

Purpose: Research has shown a physical inactivity epidemic in India, which has critical implications for both long-term health outcomes and the global economy. To date, physical activity among Indian children and youth has not been well-studied. The 2022 India Report Card (IRC) aimed to assess 11 indicators of active living to address existing data gaps and inform active living programs and policies. 

Methods: As part of the Active Healthy Kids Global Alliance (AHKGA), 57 countries (including India) participating in the Global Matrix 4.0 Report Card initiative assessed 10 indicators of active living among children and youth: Overall Physical Activity, Organized Sport, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and Built Environment, Government Strategies, and Physical Fitness. Yoga was added to the IRC given its cultural significance. A systematic search of peer-reviewed and grey literature published since the 2018 IRC was conducted. Studies were appraised based on representativeness, sample size, and data quality. Each indicator was assessed with an evidence-based and globally standardized rubric developed by AHKGA to assign grades (A+ to F).   

Findings: Although a major proportion of Indian children and youth appear to participate in Active Transportation (B-), they are not meeting recommended Physical Activity (C) and Sedentary Behaviour guidelines (D-), and not practicing Yoga (D-) regularly. Based on the grades assigned to Community and Built Environment (D), and Government strategies (C+), some of the active living challenges faced by Indian children and youth could be attributed to the dearth of progressive urban planning policies. Organized Sport, Active Play, Family and Peers, and Physical Fitness were all graded incomplete due to lack of data.

Conclusions: The 2022 IRC reiterated the need for nationally representative active living research and renewed government investments to facilitate active living among children and youth. Although most children and youth are not accumulating recommended levels of physical activity, there are encouraging signs of active transportation—a phenomenon that needs to be explored further. Evidence generated by the 2022 IRC suggests opportunities for improvement not only in India, but also the 56 other countries taking part in Global Matrix 4.0.

Purpose: Limited evidence suggests inequality in children’s physical activity and screen time by non-English speaking background (NESB). However, factors associated with these behaviours among NESB children are understudied. This study identified the prevalence and correlates of meeting guidelines (physical activity, screen time, and both) among English-speaking background (ESB) and NESB children.  

Methods: In the MatCH study, mother’s provided information on physical activity and screen time behaviours of up to three children (aged 2-13 years) using validated questions. Age-specific Australian guidelines were used to classify children as meeting or not meeting physical activity and screen time guidelines. Being born in a non-English speaking country or primarily speaking a non-English language at home was considered ‘NESB’. Multivariable-adjusted logistic regression analyses accounted for family-level clustering were used to examine correlates.

Results: Data were from 3914 children (mean age 7.9±2.5 years, 6.6% NESB). Around 15% of NESB children met physical activity guidelines (vs 21% ESB, p=0.010), 65% met screen time guidelines (vs 61% ESB, p=0.180), and 9% met both guidelines (vs 13.5% ESB, p=0.026). Upon adjustment for sociodemographic confounders, NESB children had lower odds of meeting physical activity guidelines (OR (95% CI): 0.63 (0.41-0.97)). NESB children living in multiple children households had higher odds of meeting physical activity (3.17 (1.32-7.63)) and both guidelines (4.67(1.40-15.61)). NESB children in secondary school were at lower odds of meeting screen time guidelines (0.43 (0.20-0.90)) than those in lower grades. Among ESB children, girls were at lower odds of meeting physical activity and both guidelines and at higher odds of meeting screen-time guidelines. Having multiple (>5) play equipment at home was positively associated and having a screen device in the bedroom was inversely associated with meeting all guidelines among ESB children only.

Conclusions: NESB children were less likely to meet physical activity and screen time guidelines, particularly children without siblings and children in secondary schools. For ESB children, sex and home environment were associated with the odds of meeting guidelines. This suggests interventions may need to be tailored based on ESB background with NESB children being a higher priority for intervention given their lower prevalence of meeting guidelines.

Purpose:

Behaviour change interventions have shown promise for improving physical activity (PA) but the underlying mechanisms by which the interventions promote behaviour change are rarely identified. Behavioural science tools such as the COM-B (capability, opportunity, motivation – behaviour) and the Theoretical Domains Framework (TDF) can help in understanding behaviour change and inform intervention development. The aim of this study was to identify the enablers and barriers to PA among insufficiently physically active adults that completed a PA telephone coaching intervention.

Methods:

We conducted semi-structured interviews with a purposive sample of participants who completed a telephone coaching intervention designed to increase PA. Thematic analysis were conducted using an interpretive description approach. Emerging themes were mapped against the COM-B and TDF. Participants’ responses were analysed for descriptions of behaviour change techniques and microskills used during the telephone coaching intervention.

Results:

We interviewed 18 participants (72% women) with a mean age of 54 ± 5 years. Four theme were identified that mapped directly onto five components of COM-B, and 10 domains of the TDF. Participants highlighted that the strength-based and autonomy-supportive intervention helped to evoke their own reasons for change, which influenced PA behaviour change. Participants noted how they were encouraged to reflect on their individual social and/or professional strengths, and how these skills were transferred to set appropriate PA goals and self-regulate PA behaviour. A number of relational components (e.g., collaboration, supporting self-efficacy) were deemed influential for promoting change, and should be considered when designing future behaviour change interventions.

Conclusions:

This study provides a first-hand understanding of how participants viewed a PA telephone coaching intervention and identified some of the factors that influenced PA change. The findings support the beneficial effect of using theory-informed behaviour change techniques, and delivering them in a relational style that promotes autonomy and collaboration. The lived experiences of participants should play a key role in the design and implementation of behaviour change interventions that aim to increase PA in insufficiently active adults.

Introduction: Adherence to dietary sodium and fluid restriction are key to improving heart failure (HF) outcomes. Mobile apps may be a promising and novel way to support patients with adherence through education and monitoring. Despite the growing number of apps to support HF management, most focus solely on symptom monitoring. Few have dedicated features to support dietary education and adherence.

Purpose: To describe the development of a mobile app designed to support dietary education and adherence among HF patients. 

Methods: Guided by the Obesity-Related Behavioural Intervention Trials model, our interdisciplinary team (4 Registered Dietitians, 1 patient representative, 1 PhD student, and 1 industry partner) iteratively developed a mobile app for HF patients to provide education about dietary sodium and fluid restriction. The Discovery phase of the app development included qualitative interviews with patients and healthcare providers (i.e., HF cardiologist and nurses) to identify needs, motivations, and challenges of app use for HF management; as well as background research in mHealth app development, behaviour change, and nutrition pedagogy. Insights from the discovery phase informed the systematic development of app content and design, grounded in the Theoretical Domains Framework, and aligned with established HF guidelines. Behaviour change techniques (BCTs) and gamification elements from mHealth and nutrition literature, and those mentioned within the qualitative interviews were identified and selected for app development. 

Results: Five learning modules were developed that provide information on dietary sodium recommendations in HF, contributors of sodium in the diet, nutrition labelling, lowering dietary sodium, and fluid restriction. Seven BCTs were integrated into the app, including shaping knowledge, information about health consequences, information on antecedents, feedback on behaviour, behavioural practicel/rehearsal, goal setting, and action planning. Gamified components of the app included the use of an avatar and point-system to engage patients in their learning. The next step of the app development process involves user-testing sessions among HF patients to optimize app content and features. 

Conclusions: Results from this study can produce a feasible intervention that may support dietary education and adherence in the HF population to improve self-care, quality of life, and HF outcomes. 

Purpose: The pandemic instigated a hybrid paradigm among office-based jobs, resulting in increases of employees sitting time, especially when working from home. Although sedentariness at work is closely related to the evolution of technology, the potential of digital solutions has been highlighted as an opportunity in the previous literature (up to 2017). The purpose of this systematic review was to assess the effectiveness of digital interventions to reduce sitting behaviours in (home-) office employees.

Methods: A systematic literature search was conducted in five databases (PubMed, Web of Science, Scopus, CINAHL and PsycINFO) between September 2017 and September 2022 using a combination of keywords related to office work, sedentary behaviour, and technology. Randomised controlled trials of digital interventions conducted in computer or screen-based jobs were included. Data regarding the study and intervention characteristics, outcomes and main findings were extracted, and a qualitative synthesis was performed.

Results:  A total of 21 articles met the inclusion criteria. Most of the studies focused on office-workers (60.4% female; 41.2 years old). The duration of the intervention ranged from 2 weeks to 12 months. Using digital media for delivering information (e.g., digital text or videos to present educational materials or tips) and mediated organisational support and social influences through digital communication features (e.g., emails conveying managers’ approval and competition or challenges) were the most represented intervention techniques (n=20). While 11 studies used passive data collection through a mobile phone based application or external activity tracker (e.g., W@W-App, FitBIT, Garmin watch, Darma cushion), only two studies self-reported sedentary behaviours with a digital log (i.e., online diary). Overall, seven studies reported significant differences between groups, with the intervention group showing significant decreases in occupational sitting time (from -0.17 to -1.35 hours/workday). Two studies reported significant differences between groups in total daily sitting time (-0.98 and -4.66 hours/day).

Conclusions: Findings reported large variability of digital and behavioural change features that may enhance work and daily sitting time reductions. However, more research is needed to contribute to the understanding of digital solutions for reducing sitting behaviour among (home-) office workers in this new hybrid paradigm.

Purpose Malnutrition is highly prevalent in hospitals and has a major negative impact on overall recovery in older adults (55+). During and after hospitalization older adults have an inadequate dietary protein intake and are physically inactive, and therefore they are at higher risk for loss of muscle mass, muscle strength, physical performance, and quality of life. Within current transmural care not all malnourished patients receive dietetic treatment or very limited. Intensified transmural dietetic care may increase protein intake and promote physical activity during and after hospitalization and consequently improve overall recovery. The aim is to evaluate the impact of an intensive dietetic transmural treatment during hospitalization and three months post-discharge on physical performance and protein intake for better overall recovery and quality of life in older patients.

Methods This multicenter, individually randomized, controlled trial in five hospitals in Amsterdam region included patients, aged 55 years and older, who were at risk of malnutrition. The intervention consisted of intensive dietetic care during hospitalization and up until three months post-discharge that included transmural guidance by trained dietitians, supportive materials and a mobilization program. The control group received regular care and were followed-up over the same period of time. Multilevel analyses were used to assess changes in physical performance, measured with the Short Physical Performance Battery, from hospital admission to three months post-discharge. Secondary outcomes included changes in protein intake, muscle mass, muscle strength, length of hospital stay and quality of life.

Results Currently, over 2500 patients were screened of which approximately 50% were at risk of malnutrition. Of those, 69 patients are included in the trial. Final inclusions are still ongoing, but during the conference we expect to present our first data on the impact of the intensive dietetic care on our primary and secondary outcomes.

Conclusion This study provides insight in the effects of intensive dietetic transmural treatment for older patients at risk of malnutrition on overall recovery. We hypothesize that the intervention group will have better physical performance, protein intake and quality of life compared to the control group.

Purpose: This study was designed to test the feasibility of utilizing a tailored suite of mobile health (mHealth) components to augment an existing evidence-based in-person pediatric weight management program.

Methods: The intervention consisted of six mHealth components designed to increase patient/caregiver exposure to traditionally delivered clinical content: (1) a mobile-enabled website, (2) dietary/physical activity tracking, (3) caregiver podcasts, (4) animated videos for adolescent patients, (5) interactive messaging, and (6) tailored clinical feedback informed by a web-based dashboard. Target enrollment was 80 youth with obesity (13-18 years) and caregiver dyads to be randomized to standard care (Brenner FIT) or standard care plus mHealth components (Brenner mFIT). Only enrolled participants who completed baseline measures were randomized, and follow-up measures were completed at 3- and 6-months. Feasibility was assessed in terms of screening, recruitment, randomization, retention, fidelity, and the assessment process. The number of patients screened per month, the number enrolled per month, the proportion of those enrolled who are eligible, and the number who remain enrolled in the study by condition were all tracked.

Results/findings: Most measures of feasibility were low. Overall, 1162 dyads were pre-screened for eligibility based on age criteria. Of those, 435 were screened for full eligibility by study staff. Of 435, 173 dyads were eligible for enrollment based on inclusion criteria. Twenty-five dyads (50 participants) consented. Thirty-three participants completed baseline psychosocial questionnaires, 16 participants completed at least two 24-hour dietary recalls, and 20 (youth) participants returned accelerometers. Of the 15 consenting dyads, fifteen completed baseline measures, with seven randomized into the intervention group and eight were randomized into the control group. Ten dyads were retained at three months, with seven retained at six months. All seven of dyads randomized to the intervention logged into the website, all seven set at least one goal, six linked their activity tracker, and four youth downloaded at least one video and seven caregivers downloaded a podcast.

Conclusions: Overall, our results suggest that the assessment protocol was overly burdensome, the intervention had moderate acceptability, and the study as designed was not feasible to complete, at least in the context of a global pandemic.

Purpose: While breast cancer is the most prevalent cancer type among females, the survival rate has increased tremendously in the past decades due to early detection and improved cancer treatments. However, living with and beyond cancer can be distressing. A large volume of physical activity (PA) interventions have been implemented to improve breast cancer survivors (BCS)’ quality of life (QoL). Despite the importance of QoL, previous studies have not yet investigated the primary research topics and trends in this area of inquiry. Thus, this study aims at examining the major topics and recent 5-year trends in research related to BCS’ PA and QoL.

Methods: A total of 743 research titles and abstracts were retrieved from the Web of Science database based on the following keywords: breast cancer survivor, quality of life, and physical activity/exercise. The search was restricted to English articles and Science Citation Index Expanded or Social Sciences Citation Index from 2001 to November 2022. The text-mining package (i.e., yTextminer) was used to analyze the top 10 topics and research trends. In detail, this study used topic-modeling techniques (i.e., Latent Dirichlet allocation and Dirichlet-multinomial regression).

Results: The results demonstrated that the key topics as follows: (1) prevalence, predictors, and association of comorbid conditions (e.g., fatigue, pain, and depression); (2) intervention effect on fatigue, muscle strength, and aerobic capacity (e.g., home-based); (3) facilitators and barriers (e.g., social cognitive theory); (4) intervention effect on psychological health (e.g., community-based); (5) weight intervention (e.g., risk factor); (6) diet intervention (e.g., health eating); (7) survivorship care (e.g., menopausal symptom and bone); (8) Tai-Chi intervention (e.g., mental health) ; (9) yoga intervention (e.g., fatigue, pain, depression, and sleep); and (10) rehabilitation intervention (e.g., shoulder and motion). In addition, topics 4,6,7,8, and 10 presented trends upward (hot topics), whereas topics 1,2,3, and 5 demonstrated downward trends (cold topics).

Conclusions: Findings from this study provide empirical evidence to support an understanding of current and future research trends in BCS’ PA and QoL.   

Purpose: Previous studies have revealed a positive association between active commuting to school (ACS), physical fitness (PF), and body composition. The existing evidence has focused mainly on school children and adolescents; however, little is known about preschoolers. This study aimed to compare physical fitness (PF) and body composition in a large sample of Spanish preschool children (3- to 5-year-old) according to the habitual mode of commuting to and from school. Methods: A total of 2,571 Spanish preschool children from 10 towns/cities of Spain participated in this study (4.53 ± 0.84 years; 47.3% girls). Participants' parents or guardians completed a questionnaire at home reporting their children’s habitual mode of commuting to the school, afterward categorized into active or passive commuters. PF level was assessed with the validated PREFIT battery, including cardiorespiratory fitness (CRF) (20m shuttle-run test), upper-body muscular strength (handgrip strength test), lower-body muscular strength (standing long-jump test), speed-agility (4x10m shuttle-run test), and balance (one-stand leg test). Percentiles of the participant’s PF were calculated according to these fitness categories: very low (X< P10), low (P10 ≤ X< P25), medium (P25 ≤ X< P75), and high (P75 ≤ X). Body composition was also analyzed through the calculation of the Body Mass Index (BMI) (body weight (Kg)/ and height (m)²). Half of the participants (50.1%) were passive commuters (primarily boys, 52%). Most participants (74.4%) showed normal weight, and  ≈50% presented a medium PF level in all fitness components. No differences were found between active and passive commuters regarding BMI. However, active commuters showed higher CRF levels (19.8 ± 11.3 vs. 18.9 ± 11.1 shuttles; p=0.04) compared to passive commuters. No differences were observed in other PF components. Conclusion: Most of the Spanish preschoolers evaluated showed a normal weight and a medium PF level. Also, those who actively commuted to school presented better CRF levels than passive commuters. Further studies are needed to investigate the relationship between active commuting to school behavior and health variables such as fitness and body composition in preschool children.

PURPOSE. Low back pain (LBP) is a prevalent musculoskeletal disease that affects a large percentage of the working population, including teachers. The WHO has identified the school as an effective environment for improving child health. For this reason, the figure of the teacher is a fundamental piece in the process of knowledge acquisition about postural education and prevention of LBP among schoolchildren. The present study aims to determine the effect of a telematic postural education program on back care knowledge in primary school teachers.

METHODS. The PEPE study (Proyecto de Educación Postural en la Escuela) was performed in Majorca (Spain), with 85 primary school teachers, of whom 17.6% were physical education teachers and 82.4% were classroom teachers. The sample was selected from different clusters (schools) using convenience sampling and randomly distributed into an experimental group (5 schools) or a control group (5 schools). Participants were evaluated two times, at baseline and after 16 weeks of intervention. The study was based on two different structured and self-administered questionnaires: Low Back Pain Knowledge Questionnaire (LKQ), to investigate into specific knowledge about LBP; and COSACUES-AEF Questionnaire, that aims to measure the knowledge that young people have about health and back care related to the practice of activity and physical exercise. The effects of intervention between groups on the outcome were analysed by using the SPSS General Linear Model (GLM) for the repeated measure procedure.

RESULTS. The knowledge of participants at baseline was 17.3 in LKQ (range scale 0–24) and 4.3 in COSACUES (range scale 1–10). Type of teacher group (physical education teachers vs. classroom teachers) showed significant differences in COSACUES (p=0.011) and no differences in LKQ (p=0.217). The knowledge of participants improved after the intervention in both groups, but no significant differences were achieved.

CONCLUSIONS. Our results further strengthen the evidence of the need to enhance knowledge related to LBP and postural education in primary school teachers. Nevertheless, this telematic intervention has not managed to improve back care knowledge in schoolteachers.

Purpose: Breakfast is commonly considered one of the most important meals of the day and an essential part of a healthy diet. In fact, children who have breakfast before going to school show better academic results, have more engagement, and improvements in memory and attention during lessons. Currently, there are several methodologies to analyze young people's breakfast habits. Short food questionnaires seem to be the most appropriate because they are quick and easy to administer or self-administer. Therefore, the aim of the study was to assess the reliability (i.e., constancy, coherence, and consistency) of the Breakfast Consumption Spanish Questionnaire (BCS-Q) in a sample of Spanish children and adolescents.

Methods: A total of 239 participants, 92 were children (10.7±0.7 years old; 48%girls) and 154 adolescents (14.1±1.7 years old; 48%girls) completed twice a questionnaire separated 14 days on the same days of the week and the same schedule between March-April 2018. The BCS-Q included 21-questions where they were asked about the habitual intake of typical foods for breakfast in Spain, which were categorized into (1) dairy group, (2) meat and protein group, (3) dried fruits group, (4) vegetable group, (5) fruit group, (6) cereal and sugar group, and (7) oil and fats group. The reliability of the BCS-Q was analyzed by the test-retest calculating the kappa coefficient (κ) and the Spearman correlation coefficient (Rho) for the seven food categories. In addition, the analysis was performed separately for children and adolescents.

Results: Children showed a poor-to-moderate agreement in the dairy group (κ:0.16-0.52; Rho: 0.16-0.52) and an acceptable-to-good agreement in the rest of the food groups (κ:0.37-0.72; Rho: 0.36-0.72). On the other hand, adolescents showed a poor-to-good agreement in the meat and protein group (κ:0.05-0.61), a moderate-to-very good agreement in the dairy group (κ:0.44-0.83; 0.45-0.83), and an acceptable-to-good agreement in the rest of food groups (κ:0.29-0.69; Rho:0.29-0.69).

Conclusion: The Breakfast Consumption Spanish Questionnaire is a reliable tool for assessing breakfast habits in Spanish children and adolescents. Future studies focused on the analysis of breakfast habits of Spanish youth will be able to use this easy and self-administered tool to simplify the comparison between studies.

Purpose

Research has demonstrated that individuals who perceive themselves as overweight have increased psychological stress and are less likely to engage in healthy promoting activities including eating a healthy diet and engaging in physical activity. Yet, there is a lack of understanding of what factors contribute to perception of weight. The purpose of this study was to explore factors related to self-perceived weight among a sample of diverse middle school students in the United States.

Methods

A national convenience sample of American adolescents ages 11 to 14 was recruited through Qualtrics to participate in an onlien survey. Models were built to explore the relationships between self-perceived weight and various other variables (family meals, screentime, peer influences on physical activity and nutrition). Data were analyzed separately for males and females.

Results/findings

The largest race/ethnicity represented in this sample was White/European (33%) followed by Black/African American (22%). Just under half of all participants were eighth grader and there were slightly more males than females that participated in the survey (58%).

More than 70% of participants perceived themselves as being overweight or obese. Self-perceived overweight was associated with the importance of family meals among females. As the importance of meals within their families increased, the likelihood of self-perception of being overweight went down (p=0.0002). Self-perceived overweight was associated with screen time for males. As screen time increased, self-perceived weight decreased (p<.0001)

Conclusions

This study showed that family meals are protective of self-perceived weight status for females. This demonstrates the importance of continuing to encourage family meals to reduce psychological stress and enhance engagement with health promoting activities, like physical activity and healthy dietary intake. Interestingly, higher screen time was associated with decreased odds of perception of being overweight/obese, despite being well-documented in the literature that screentime increases overweight and obesity risk.  

Purpose: eHealth literacy was used to evaluate skills in finding, accessing, and using health information online to enhance one’s level of knowledge, competence, and behavior in relation to a healthy lifestyle. Previous studies have shown that promoting eHealth literacy can facilitate healthy behaviors, such as nutrition and sleep. However, there’s an unclear correlation between college students' eHealth literacy and physical activity (PA) or sedentary behavior (SB), and few research has investigated the moderating effect of individual factors. This study was to examine the relationship between eHealth literacy, PA, and SB among college students with majors in health (Chinese medicine, sports science) and non-health (science, social science).

Methods: A snowball sampling method was adopted to recruit 1210 students to complete questionnaire surveys online. Individual factors (e.g., gender, university major, age, education level, birthplace), International Physical Activity Questionnaire - Short Form, and Chinese version of the eHealth Literacy Scale were assessed. A path analysis was conducted using Mplus 8.3 to determine correlations between eHealth literacy, PA, and SB with a potential influence of individual factors.

Results: 1124 participants, aged 18 to 28 (male: 56.58%), responded to survey with a response rate of 93%. The mean eHealth literacy score was 32.63 (SD 6.40), and scores differed significantly with major. 22% of young adults were physically inactive without adherence to WHO guidelines, and male college students had higher PA and lower SB than females (p<.001).

A path analysis showed that the total effects of eHealth literacy on walking were 0.1, 0.15 on moderate to vigorous physical activity (MVPA), and -0.08 on SB. There was a correlation between PA and SB (β=-0.18, p<.001). Higher eHealth literacy predicted students' MVPA for social science (β=0.28, p<.01) and science students (β =0.15, p<.01) significantly. But there’s no significance of the relationship of eHealth literacy, MVPA, and SB in health-related majors.

Conclusions: College students with higher eHealth literacy were more active and less sedentary. Majors and gender were associated with eHealth literacy and PA. Hence, more health education programs at universities are needed for non-health majors and female students.

Purpose: To: i) describe the weight management strategies used by a sample of Australian adults; ii) examine whether use of weight management strategies was associated with weight change over 12 months; and iii) examine the psycho-sociodemographic characteristics of those who used each strategy.

Methods: Data were from a 12-month cohort study, involving a community-based sample of Australian adults (n=368, mean age=40.1, SD=5.8). Demographic characteristics were self-reported at baseline. Participants were encouraged to weigh themselves, preferably daily but at least weekly using Fitbit Aria body weight scales (Aria 2 or Aria Air scales, Fitbit Inc., San Francisco, CA). Data were remotely gathered using custom-developed “FitnessLink” software. The use of weight management strategies were obtained using a self-report survey at eight timepoints during the 12-month period. The relationship between weight management strategies, change in weight over the 12-month period and psycho-sociodemographic characteristics was assessed using linear mixed effect models and univariate multinomial logistic regression.

Results: Most participants (81%) reported using as least one weight management strategy over the 12 months. The most common weight management strategies were being physically active or exercising (reported by 77%), restricting calories (63%), fasting (41%), counting calories (28%), using supplements (24%) and using diet pills (6%). Exercising or being physically active for weight control was the only strategy significantly associated with weight change (between group difference relative to those not reporting the strategy: -1.2 kg, p<0.01). Participants who reported accepting their bodyweight were less likely to report the use of weight management strategies (OR=0.38, p<0.01). Compared with females, males were less likely to count calories (OR=0.49, p<0.01).

Conclusions: Overall, the use of weight management strategies was common in a sample of Australian adults. Public health weight management approaches should include strategies that are associated with effective weight management, and also address the perceptions that individuals have about their bodyweight.

Purpose

Currently little is known about what parents think about the different ways that food is provided in schools around the world. There are no systematic reviews synthesising parent/caregiver views on lunchbox and school provided meal service models. To ensure school food systems cater to the needs of families, these perspectives should be understood. This mixed papers systematic review aimed to identify parents/caregivers perspectives on system characteristics of importance within school food provision models internationally.

Methods

A systematic search was performed in May 2022 across three databases, screened by one reviewer. Qualitative, quantitative and mixed-methods studies were eligible if they reported parent perspectives on the food environment or provision during school hours. Results were collated according to the Bayesian methods to translate quantitative results to qualitative findings and summarised narratively.

Results/findings

Eighteen studies, including eight qualitative, four quantitative and six mixed methods studies were included in the review. Studies were predominantly from Australia (n=5), US (n=3), UK (n=3) and Europe (n=2). Studies described perspectives on lunchbox provision and school meal models. Regardless of the school food provision model, key themes included financial cost, adequate nutrition, meeting child preferences and the influence of peers. These characteristics influenced the model adopted and the food provided by families. Challenges of policy and monitoring, school food environments and food preparation were additionally described by parents as challenges in lunchbox food provision. Further, parents positioned themselves as responsible for ensuring their child is fed well and considered lunchboxes an enabler for monitoring intake. Compromise was also a consistent theme discussed throughout the studies, with parents making compromises between certain aspects according to their family priorities.

Conclusions

While parents have different priorities, cost, nutrition, and enjoyment of food by children are common parent priorities for school food internationally. Challenges were identified throughout the lunchbox literature, demonstrating the difficulties which can be experienced in this model. School food systems should strive to prioritise low cost, quality food options in a positive food environment to facilitate acceptable food provision, while striving to alleviate provision barriers experienced by parents through providing nutritious, affordable meals in all schools.

Purpose: Strength recommendations have been embedded within the UK’s Chief Medical Officers’ physical activity guidelines since 2011. In 2019, the strength recommendations were given a more prominent position in the accompanying infographic. However, there is limited evidence that these recommendations underpin strength prescription in the older adult population. This study aimed to explore exercise providers’ engagement with the guidelines to gain a nuanced understanding of their awareness, knowledge, and implementation of evidence-based strength training prescription to their older adult clientele. Methods: Fifteen exercise providers working with older adults in the UK participated in one online interview. A general inductive approach was used to generate themes from the data. Five major themes were found – 1. The strength guidelines, 2. Building strength, 3. The motivators and barriers to working with the older adult population, 4. The interpretation of evidence-based strength training, and 5. The future of strength training. Findings: Most (n=9), but not all, exercise providers were familiar with the guidelines, however, other sources of exercise information seemed to be preferred. Only one provider had implemented the guidelines into their practice, as guidelines were generally felt to be irrelevant to their clientele. The words ‘strength’ and ‘exercise’ were avoided, as they were known to intimidate older adults. Job satisfaction was notably high in our participants, but financial barriers to evidence-based prescription were mentioned throughout our conversations. Strength training took on a variety of meanings and resulted in exceptionally varied prescription. The future of strength training prescription needs to overcome a number of barriers in order for evidence to become widely adopted in practice. Conclusions: From our interviews, the strength programmes described are likely not optimised for strength gain and other important outcomes and benefits to the older adult population. Since increased strength has been shown to decrease individual and societal burden of age-associated disease, multi-morbidity, and all-cause mortality, we hope these findings continue to draw attention to, and further the debate, research, and drive for practical change in the way we promote and disseminate evidence-based strength training to the older adult population and the ones who provide this service.  

Purpose: Community-Engaged Dissemination and Implementation Research (CEDI) emphasizes the importance of partner engagement in effective implementation projects. Examples of effective CEDI projects in nutrition research are limited. The purpose of this presentation is to describe two CEDI projects that advanced the implementation of evidence-based nutrition practices in the early care and education (ECE) setting. We illustrate common methods for identifying and prioritizing determinants of implementation with community partners, selecting and specifying implementation strategies as aligned with community priorities, and evaluating the success of our strategies using Effectiveness-Implementation Hybrid Designs.

Methods: Project 1 aimed to increase uptake and fidelity of 4 evidence-based practices (EBPs) for nutrition promotion in ECE. Project 2 aimed to decrease (i.e., de-implement) use of inappropriate feeding practices and increase use of EBPs at nutrition lessons and meals.  For both projects, we identified determinants of implementation through in-depth interviews with front-line implementers who were high and low (i.e., deviant) on EBPs. Next, we sorted identified barriers and facilitators into high, medium, and low priority using a card sort activity with a panel of community partners. The research team aligned the prioritized determinants with potential implementation strategies and presented them to the panel.  The panel then rated each potential strategy on its importance and feasibility for achieving the desired goals of the project and provided input on the specification of selected strategies before testing. Finally, both projects deployed a Hybrid Type III implementation trial to evaluate success. Implementers provided qualitative feedback on their experiences to inform further iteration of strategies.

Results: Both projects impacted targeted implementation outcomes in the desired direction. Project 1 demonstrated significantly improved fidelity to 3 of 4 targeted EBPs as well as improvements in implementers’ perceived appropriateness of the practices and their organizational readiness for change.  Project 2 demonstrated significantly decreased inappropriate feeding practices and increased EBPs at both nutrition lessons and meals. Qualitative feedback provided specific ways to improve each of the implementation strategies for both projects (e.g., reminders of resources).

Conclusions:  CEDI approaches can improve the relevance and success of implementation projects for advancing the use of nutrition research evidence in community settings.

PURPOSE

Reducing the disease burden of unspecific low back pain (LBP) in children is of major public health relevance, as children with episodes of LBP tend to experience chronic back pain in adulthood. The aim of the present study is to investigate the effect of a telematic postural education program on postural knowledge and its effects on LBP.

METHODS

The PEPE study (Proyecto de Educación Postural en la Escuela) was performed in Majorca (Spain), with 281 primary school children at follow-up, aged between 10 and 12 years. The sample was selected from different clusters (schools) using convenience sampling and randomly distributed into an experimental group (5 schools) or a control group (5 schools). The research group trained the schools’ teaching staff, both physical education teachers and classroom teachers. Therefore, the intervention is not carried out directly on children, but in their school environment, the teachers were those who developed the intervention on postural habits with the children. Participants were evaluated two times, at baseline and after 16 weeks of intervention. The study was based on the Hebacknown validated self-reported questionnaire, to investigate specific knowledge bout LBP and postural education in children. The effects of intervention between groups on the outcome were analysed by performing an ANOVA, using Stata.

RESULTS

The postural education knowledge of schoolchildren at baseline was mean 9.66, standard deviation (SD) 3.85; and 9.75 and SD of 4.12 in the follow-up, in a range of 0-24, measured with the Hebacknown questionnaire. No significant differences were found between groups at baseline (p= 0.348). The sum of the squared deviations (SS) between the baseline and follow-up in the whole sample was 260, p-value = 0.583. Although the intervention group had a slightly higher score on the follow-up postural education knowledge questionnaire (intervention group: mean   9.96, SD   4.40; control group: mean 9.60, SD   3.93), no significant differences were found between groups at follow-up (p=0.473).

CONCLUSIONS

Our results further strengthen the evidence of the need to enhance knowledge related to LBP and postural education in primary schoolchildren. Nevertheless, this telematic intervention has not managed to improve significantly postural knowledge in schoolchildren.

Background:Whether screen use is related to children’s cognitive development lacks evidence from longitudinal studies. We aimed to investigate screen use trajectories from 2 to 11-12 years in association with cognitive development at age 11-12 years in children from the French EDEN birth cohort.

Methods:Parents reported whether TV is on during family meals (4-point Likert: never, sometimes, often, or always) at ages 2, 3, 5-6, and 8 years, and their child’s screen time at the same ages and up to 11-12 years. Overall, verbal and non-verbal abilities of children were derived from subtests of the Peabody Picture Vocabulary scale and the Wechsler Intelligence Scale for Children (4^th Edition) at 11-12 years, and standardized (mean=100, SD=15). Screen time and TV-on during family meals trajectories were identified by latent profile and latent class analyses, respectively. Their associations with cognitive development at age 11-12 years were assessed by linear regression models adjusted for baseline sociodemographic, behavioral confounders at age 11-12 years (outdoor play time and sleep duration), and children’s cognition at age 2 years. Multiple imputations were performed among children (N=459) with ≥1 screen use information and ≥1 outcome measurement.

Results:Children’s screen time trajectory from age 2 to 11-12 years was classified into 4 groups: low-user (11.8%), average-user (31.2%), later-user (40.7%), and high-user (16.3%). TV-on during family meals trajectory from age 2 to 8 years was classified into 3 groups: never (41.0%), sometimes (33.3%), and often/always (25.7%). Regarding screen time trajectories, there were no differences between groups in overall, verbal and non-verbal abilities. TV-on during family meals was consistently associated with lower cognitive abilities: compared to never, having TV sometimes or often/always on during family meals was associated with lower overall (sometimes: β [95% CI]: -4.1 [-7.5, -0.7]; often/always: -1.6 [-5.6, 2.4]), verbal (sometimes: -1.5 [-4.9, 1.9]; often/always: -1.3 [-5.3, 2.8]), and non-verbal (sometimes: -5.1 [-8.6, -1.6]; often/always: -1.0 [-5.2, 3.1]) abilities.

Conclusion:Our study shows that TV-on during family meals, but not screen time, is associated with lower children’s cognitive development. Future studies need to better account for the context of screen use, not only screen time.

Purpose

During the project “QueB 2 – developing quality with and through physical activity (PA)” fourteen childcare centres in Bavaria developed their setting to activity friendly environments by themselves. In the second phase different strategies to empower multipliers in spreading awareness for PA were tested. Currently, the aim is to involve teachers at vocational schools for early childhood education in order to reach out and sensitize prospective educators for PA. Therefore, the integration of project planning tools in the curriculum to ensure high qualitative and sustainable interventions is essential.

Methods

Educational materials for teachers at vocational schools were developed in three steps: (1) To train future educators in planning PA interventions four workshops in two schools with 80 students were implemented. (2) A theoretical model for project planning then helped to categorize the collected recommendations and sample projects from the students and, based on this, to create a manual for project development. (3) After testing the materials in class, utilisation and acceptance were reflected with the help of a short questionnaire.

Results

The categorized results of the second step were summarized in a manual for planning PA interventions in childcare centres. Additionally, a short tutorial by video was designed. These two variations form the basis of the educational materials to enable teachers to disseminate PA promotion in class. Both instructional materials were published on a website and provided for free in order to be used by the interested target group. In step three, teachers tested the proceeding in class and filled in the short questionnaire. The majority of teachers perceived the training material as useful, appreciated its clear structure and appealing design. An increased awareness of factors concerning PA in childcare centres was also emphasized by the teachers.

Conclusions

Teachers at vocational schools considered the materials as useful to embed parts of planning PA interventions in childcare settings in the curriculum. Transferring developed manuals to multipliers by providing suitable training modules seem to be a successful and sustainable way to ensure quality in planning processes.

Purpose

Many colorectal cancers (CRC) could be prevented by modifying individual risk behaviors (sedentary lifestyle, overweight, diet, alcohol). The time of CRC screening is an opportunity to promote and educate about CRC risk factors. The PRECÔTION project proposes an innovative digital program, using informative, motivational and community-based approaches to raise awareness and initiate individual prevention actions according to individual risk. The main objective is to evaluate the feasibility of the program in each risk group. The study will also assess the acceptability of the device, compliance and preliminary effects on lifestyle, physical activity level and knowledge of CRC risk factors.

Methods

Participants will be assessed to identify their individual risk factors (physical activity, nutrition, body composition) and their motivation to change their behaviors. The evaluation will determine their CRC risk level and assign them to one of 3 groups (low, moderate, high risk) to benefit from an adapted and personalized intervention.

All participants, will receive physical activity and dietary support via digital media (videos and podcasts) based on a motivational approach. Each video addresses a specific topic, with practical exercises that allow participants to practice immediately and over time.

Participants will be provided an application allowing them to interact with each other. Monthly, participants will have the opportunity to take part in a discovery session of physical activity in community. They will be welcomed to come accompanied by a relative. Participants will also be given an interactive logbook to record their participation in the different tools and to reinforce the motivational dimension. Participants with a moderate to high risk will also benefit from a collective health education session. Participants with a high risk level will receive three individual motivational coaching sessions and a connected watch to track their daily step count.

Findings

Ongoing recruitment

Conclusion

Our project is a first step to test these different tools and to adapt them if needed. In a second phase, we intend to develop a larger scale study to measure the effects of this personalized intervention on health and its impact in terms of prevention to reduce the number of avoidable cancers.

Purpose: Transition to retirement is an important turning point in life, which is accompanied by changes in many aspects of life. These changes may also predispose or lead to changes in food habits, but this is scarcely studied. The aim of this study was to examine changes in fish, read meat, vegetables and fruit consumption, as indicators of recommended food habits, before and after retirement transition over a 32-year follow-up.

Methods: The data were from the Whitehall II study, a cohort of 10,308 British civil servants aged 35 to 55 years at study induction (years 1985–1988). Since then, data collection have taken place every 2-3 years. The participants reported their employment status at each phase and data was organized into pre-retirement (max. 16 years prior) and post-retirement (max. 16 years after) periods. Food consumption was assessed by the Food Frequency Questionnaire. Changes in food consumption before and after retirement were assessed using liner regression analyses with generalized estimating equations adjusting for gender, retirement age, occupational status, marital status and financial hardship.

Results: Before retirement, fish was consumed on average 1.79 (SD 1.75), red meat 5.49 (SD 3.74), vegetables 25.25 (SD 12.42) and fruit 16.50 (10.67) times per week. Fish consumption differed between pre- and post-retirement periods (p=0.02) by decreasing before retirement especially among those with financial hardships and staying at the same level after retirement. Weekly red meat consumption differed between pre- and post-retirement periods (p=0.02) by staying even before retirement and increasing markedly after retirement, especially among people in the lowest occupational group Vegetables and fruit consumption increased both pre- and post-retirement, but more strongly during pre-retirement than post-retirement (p<0.001 for both). Single participants increased more vegetable consumption during post-retirement compared to married participants.

Conclusion: The transition to retirement was associated with increased consumption of vegetables and fruits. No association was found for the consumption of fish, but slight increase of red meat consumption was observed. There is a need for further studies that more thoroughly investigate the effects of retirement on diet and underlying factors in order to develop health guidance targeted at retiring employees.

Purpose: Yoga is growing in popularity and provides benefits for physical and mental health outcomes, including balance, mobility, mental well-being and quality of life. The Successful AGEing trial (ACTRN 12619001183178) is the first trial internationally to evaluate the effect of yoga-based exercise on falls among people aged 60+. We aim to describe the characteristics of the SAGE trial participants and provide insight into the attributes of older people who are attracted to yoga programs, to inform future implementation.

Methods: Community-based participant recruitment occurred between October 2019 and October 2021 in NSW, Australia. Inclusion criteria were: aged 60+; living independently at home; not currently participating in yoga or had not regularly participated during the past year; able to travel to an intervention location for face-to-face classes or able to access online classes via the internet. Exclusion criteria were: cognitive impairment (scoring ≤ 4 on the Memory Impairment Screen); insufficient English; inability to walk 10 metres unassisted; progressive neurological disease (eg, Parkinson’s disease) or a medical condition precluding exercise (eg, unstable cardiac disease). Participants were randomly allocated to either: (1) the group-based, supervised, 80-session SAGE yoga exercise program, emphasising standing balance postures, or to (2) a seated yoga relaxation program, delivered in two group-based sessions and then carried out independently at home. The primary outcome was the rate of falls in 12 months after randomisation, measured via monthly surveys.

Results: 700 people (mean age 66, SD 5.8) were recruited for the trial. 572 (82%) participants were female and 367 (52%) had taken part in yoga previously. In terms of their general health and reported medical conditions, participants were healthier than the broader Australian population at this age: they took an average of 2 medications (SD 1.8), 178 (25%) participants reported no medical conditions, 40 (6%) had diabetes, 80 (11%) had asthma and 19 (3%) had heart disease. However, 178 (25%) participants self-rated their balance as fair/poor, and 229 (33%) reported 1 or more falls in the past year, which is consistent with population estimates.

Conclusions: This trial of yoga recruited a relatively healthy sample of older people, most of whom were female.

Purpose: University students spent approximately 10 hours per day in sedentary behaviour (SB), which is associated with chronic diseases and academic achievement. Awareness of unhealthy behaviour is a precondition for behaviour change. In order to systematically develop interventions aimed at interrupting SB, we explored awareness of university students of SB using in-depth interviews.

Methods: This qualitative, in-depth study explored four aspects of awareness, i.e. knowledge, risk perception, cues and cognizance, in six full-time university students at Maastricht University of 21±1 years via interviews grounded in the I-change model. The interviews assessed these four aspects of awareness in relation to SB. To further explore cognizance, participants wore an activPAL3 accelerometer continuously for 7 consecutive days. The time spend sedentary and occurrences of prolonged sedentary bouts were compared with data from the interview. Interviews were transcribed ad verbatim, and coded in NVivo using a coding tree.

Results: Three of six students did not know the term SB. Two students were aware of the advice to interrupt SB. All students had a low risk perception of developing physical diseases related to SB. In general, environmental characteristics in university buildings and homes were identified as cues for SB. The workload was mentioned as an internal cue to sit by three students. On average, students self-reported a lower average sedentary time and a higher number of sedentary bouts longer than 30 minutes compared to objective data. Educational activities at university were perceived as promoting SB by all students. Main strategies to reduce SB were planning breaks in studying time and educational activities, exercising in the evenings, walking with pets, and using standing desks.

Conclusions: Some university students are aware of the definition of SB, but generally not aware of their own SB and associated risks. Strikingly, after being told by the interviewer that the negative effect of SB might not be compensated with long bouts of PA, students still proposed exercising after studying as a strategy to reduce the risks of SB. This, and the low cognizance level imply that interventions with feedback and guided goal setting may be required to promote interruptions in SB.

Purpose: Osteoarthritis (OA) is a highly prevalent degenerative joint disorder, accounting for a significant burden at the patient level and societal level. International guidelines recommend the use of lifestyle-related treatment modalities (LRTMs) aimed at increasing physical activity and weight reduction. However, it has been demonstrated that LRTMs are currently underutilized as OA treatment. To gain more insight into this evidence-practice gap, previous work of our research team identified influencing factors for applying LRTMs from the perspective of healthcare professionals (HCPs). The aim of the current study was to identify within these influencing factors which are perceived as the main barriers and facilitators to the opinion of various primary and secondary HCPs for implementing LRTMs in patients with hip and/or knee OA.

Methods: A cross-sectional study. Data were collected using an online survey, distributed among primary and secondary HCPs: general practitioners (in-training), physiotherapists, orthopedic surgeons (in-training), nurse practitioners or physician assistants orthopedics (in-training), exercise therapists, dieticians, lifestyle counselors and other HCPs in general practice. The survey section on barriers and facilitators consisted of thirty-two research-derived statements about implementing LRTMs. Based on participants’ responses to these statements, ‘barriers’ and ‘facilitators’ were presented as factors with ‘major agreement’ (≥75%), ‘minor agreement’ (60-75%) or ‘no agreement’ (<60%).

Results: The survey was completed by 213 participants. Seven ‘barriers’ and twenty ‘facilitators’ were identified. Two of three ‘major agreement barriers’ were related to the social, political, and legal context (i.e. organization of Dutch healthcare system (84.5%) and lifestyle climate in Dutch society (78.4%)), and the other to capacity for organizational change (i.e. audits within organization (81.2%)). The total number of ‘barriers’ differed per subgroup of HCPs, with the highest number (12) among orthopedic surgeons (in-training) and the lowest number (4) among dieticians, physiotherapists and lifestyle counselors.

Conclusions: The results suggest that the implementation of LRTMs within OA care could be improved by focusing on societal factors rather than individual HCP factors. National preventive policies on health promotion seem required to counteract the expected increase in healthcare demand and costs due to OA. Future research is needed to match relevant implementation strategies to all barriers identified.

Purpose: Identification of commonly used dishes suitable for protein enrichment by older adults in a home setting.

Background: The risk of undernutrition is a major problem for older adults as they have similar nutritional requirements per/kg bodyweight as younger adults but are typically smaller eaters. Older adults have a higher need for protein and so developing nutritional interventions that increase protein intake are essential. Considering that older people do not change their food habits that easily, fortifying their regular meals with protein provides a relevant and flexible strategy to improve the nutritional value of their diet. A first step towards successfully enabling older adults to enrich their own foods is to identify dishes that are commonly prepared and consumed by older people spanning different food cultures.

Methods:  During autumn 2021, 65 older adults across England, France and Norway, (aged 70-90 years, 20 in each country), were asked to complete food diaries for four days (three weekdays, and one weekend day) in the span of two weeks. Respondents lived in their own home, cooked their own meals, did not follow very restricted diets, or suffer from allergies. Data collected were type and amount of food, drinks, and condiments consumed, time of food consumption, and cooking methods.

Results: Many similar dishes were reported by the respondents in the three countries, although it varied for which meal the dishes were most commonly consumed. Based on summaries of the most frequently mentioned dishes in the three countries and for different meals, the following food matrices were selected for recipe optimization: for breakfast, lunch, afternoon tea, evening meal, dessert, snack products (Granola, oat-meal porridge, pancakes, French toast, cake/muffins), and for lunch, dinner (pureed soup, Bolognese, mashed potatoes).

Conclusion: The dishes selected for recipe optimization should cover foods consumed throughout the day to provide older adults at risk of undernutrition a means to enrich their meals without compromising sensory or usage characteristics of the dish. In addition, the recipes should cover different food matrices to cater for different preferences of the older adults.

Purpose:

Studies of the relationships between breakfast intake and academic achievements among adolescents are scarce. The research questions are:

1) How has students’ prevalence of breakfast intake changed between 2015 and 2019 and how has teachers’ perceptions of students’ lacking basic nutrition changed between 2015 and 2019?

2) What are the associations between breakfast skipping and academic achievements in mathematics and science in 2015 and in 2019, and what are the associations between teachers’ perceptions of students’ lack of basic nutrition and academic achievements in these topics, in 2015 and in 2019?

3) To what extent may breakfast skipping explain changes in achievement in science and mathematics from 2015 to 2019?

Methods:

A representative sample of Norwegian 9^th graders based on Trends in International Mathematics and Science Study (TIMSS), N= 4499 (2015) and N=4685 (2019) and their teachers. This study is a trend study using structural equation modelling, triangulation and mediation analysis.

Results/findings:

We found that the prevalence of breakfast intake among students have worsened (27%) from 2015 to 2019; fewer students eat breakfast. The teachers’ perceptions of students’ lacking basic nutrition have also worsened (7%) from 2015 to 2019. We found a significant association between breakfast skipping and lower achievements in both mathematics and science among Norwegian 9^th graders, both in 2015 and 2019. This was reported both by the students themselves and their teachers. Further, mediation analyses showed that being hungry when arriving at school explained 4.1 out of 13 points of the decrease in science achievement and 4.7 points out of 8 points in mathematics achievement. The associations are still significant when adjusted for gender, SES, and minority. Conclusions:

This study revealed a significant positive association between breakfast intake and school achievements among Norwegian 9^th graders. This was found for both mathematics and science achievements, in 2015 and 2019, reported both by the students and their teachers. Mediation analyses showed that breakfast skipping explained 1/3 of the decrease in science achievement and more than half of the decrease in mathematics achievement from 2015-2019. Actions from the educational - and health system to address these issues are warranted.

Purpose
To promote the protein transition that enhances public and planetary health, it seems crucial that prevailing meat consumption norms shift towards more plant-based norms in Western societies. Social and personal norms are considered a barrier to meat consumption reduction. The perception of these norms may vary across meat consumers. Therefore, understanding the current perceptions of meat consumption norms is important, particularly by acknowledging meat consumer heterogeneity. This study aims to investigate the extent to which different meat consumers types perceive social norms and personal meat consumption norms, and dynamic meat reduction norms.  

Methods
British meat eaters (n=1205, 25-65 years) participated in an online cross-sectional survey. Meat (substitute) consumption was measured with the adapted Oxford Meat Frequency Questionnaire. Descriptive, injunctive and personal norm perceptions were measured for meat consumption (e.g.,” It is likely that others would choose meat at the [supermarket/restaurant/worksite cafeteria])”. Dynamic norm perceptions (e.g., \"An increasing number of people around me are starting to lower their meat consumption) were measured for meat reduction. All norm perceptions were measured with two items, on a 7-point Likert scale. Two-step cluster analysis was conducted to identify types of meat consumers. ANOVAs were conducted to assess differences in norm perceptions between meat consumer types.

Results
Based on meat (substitute) consumption, four types of meat consumers were identified: Meat lovers (n=398), Exceeders (n=103), Flexitarians (n=158), Moderates (n=546). Significant (p<.001) differences were found in descriptive (F(3, 1291)=14.5, partial η²=0.04), injunctive (F(3,1 201)= 11.2, partial η²=0.03), personal (F(3,1201)= 19.6, partial η²=0.05), and dynamic (F(3,1201)= 28.4, partial η²=0.07) norm perceptions between the meat consumer types. Flexitarians portrayed the lowest meat consumption norms and the highest dynamic norms, Meat Lovers and Exceeders opposite to Flexitarians, and Moderates perceive norms stronger than Flexitarians but weaker than Meat Lovers and Exceeders (p=<.05). To illustrate, Flexitarians indicated the highest dynamic norm perception (M=5.1, SD=1.3), followed by Exceeders and Moderates (M=4.2, SD=1.5; M=4, SD=1.6), and Meat Lovers (M=3.7, SD=1.6).

Conclusion
Findings show that normative perceptions about meat eating differed across meat consumers. This heterogeneity across meat consumers should be acknowledged in future social norm interventions aiming for meat reduction.

Purpose:

To compare the effectiveness and appeal of delivering a virtual and in-person health promotion program regarding eating competence, interest and enjoyment in physical activity, and confidence related to consuming and providing fruits and vegetables for low-income food pantry users.

Methods:

Non-experimental design comparing a text message and an in-person ten-week Whole Body Approach (WBA) program delivered to two convenience, purposive samples of Northern Illinois Food Bank users. The text message group (TMG) recruited 156 participants from Northern Illinois Food Bank’s mobile food pantry, My Pantry Express (MPX). The in-person group (IPG) recruited 19 participants from Northern Illinois Food Bank’s pantry, Winnebago Community Market in Rockford, Illinois. The maximum capacity for the IPG was 20 participants due to classroom size restrictions. The text message program was delivered from February to April 2021, and the in-person program was delivered from February to April 2022. The topics discussed in both programs included stress management, relationship with food, mindful eating, healthy body image, and enjoyable movement. Outcome measurement tools included Eating Competence Satter Inventory 2.0 (ecSI 2.0), fruit and vegetable Self-Efficacy Questionnaire, and the Interest/Enjoyment subscale of the Motives for Physical Activity Revised (MPAM-R). Independent samples t-test was used to compare post-intervention outcome measures in participants who completed both the pre- and post-surveys for the text message program and in-person program.

Results:

There was a significant difference in post-intervention outcomes between the TMG and IPG programs for eating attitudes (p = 0.007), food acceptance (p = 0.030), internal regulation (p = 0.030), eating context (p = 0.032), and overall eating competence (p = 0.006). There was also a significant difference (p = 0.004) for motives for physical activity between the two intervention groups. There was not a significant difference between the two intervention groups for their overall self-efficacy for consumption of fruits and vegetables (p > 0.05).

Conclusion:

Post-intervention outcome measures were significantly better for IPG compared to TMG for all variables of overall eating competence and motives for physical activity. Future studies may include comparing the effectiveness of the TMG and IPG with a hybrid (50% in-person and 50% virtual) WBA group. 

Purpose

In 2021, six regions in the Netherlands received a grant to stimulate an integral system approach for implementing evidence-based interventions in their local community. In this study, we evaluate the implementation process. The lessons learned were evaluated on three levels - practice, policy and governance - in order to develop a practical tool to support other regions in implementing an integral system approach.

Methods

We conducted desk research on the knowledge that was developed within the six regions to inform the development of the interview guide. We interviewed at least three project members per consortium to get insight into the success factors and barriers for implementation. We interviewed representatives of the practice, policy and governance level. The analysis were based on a codebook using a thematic approach.

Following the interviews, co-creation sessions were organized with representatives of the six regions. The first aim of these sessions was to assess the representativeness of the overarching findings. Next, a practical tool to support future integral system approaches for implementing evidence-based interventions was co-designed with the representatives of the six consortia.

Results

We will present the lessons learned within the six local consortia: a broad variety of evidence-based interventions was implemented through the integral system approaches. Using a systematic approach to develop the implementation plan was deemed helpful. It was deemed important to have representatives of practice, policy and governance involved as stakeholders throughout implementation. Furthermore, tailoring of evidence based interventions to the local context was essential for optimal uptake. Lastly, while considerable effort was put into establishing the local consortia, many of the consortia were under pressure because of the discontinuation of funding beyond the project.

Furthermore, we will present the practical tool to support future integral system approaches for the three levels of interest: practice, policy and governance.

Conclusions

Conducting overarching evaluation studies on factors that impact the implementation of evidence-based interventions are important to generate generalizable knowledge regarding the implementation processes. This knowledge then needs to be translated into practical tools to support stakeholders from practice, policy and governance in future efforts to implement interventions into their local systems.

Purpose:

Interest in digital technologies and health apps has rapidly increased in research, clinical practice, and consumer markets. Digital tools that support physical activity (PA), such as fitness trackers and smartwatches, have great potential to be incorporated into behavior change interventions. However, there is a knowledge gap in epidemiological research on the use of digital tools for PA in the real world. This study investigated the prevalence, attitudes, and characteristics of users of digital tools for PA in Germany.

Methods:

Two cross-sectional telephone-interview surveys were conducted in October 2020 and November 2022. Nationwide panels of 1000 internet users selected from the general population living in Germany reported their sociodemographic characteristics, perceived eHealth literacy (on the eHEALS scale), and their use of and attitudes toward digital technologies for health promotion. The responses on each item were analyzed in IBM-SPSS24 and summarized using relative frequencies.

Results:

The participants in the first survey were 1014 internet users, 52% were female, with an average age of 45 years, and 61% completed up to secondary education. Most participants were employed and lived in 1-2 person, urban households with a country-average income. Only 21% (n=220) of participants reported using digital media or software to support PA. The majority (85%) agreed that using such digital tools for PA is easy for them. Most (77%) believed digital tools could assist them in being active, and 64% reported using digital tools for PA at least once a week. Although over 80% reported high perceived eHealth literacy, 57% felt confident using information from the internet to make health decisions. Once the second survey data are available, we aim to compare the pattern of use and attitudes toward digital tools for PA between both surveys.

Conclusions:

Internet users in Germany perceive digital tools are useful for PA and easy to use. However, the actual use of such technologies was low in 2020. Digital interventions aiming at behavior change in PA should be tailored toward the general population. Future studies should evaluate if using digital tools improves PA outcomes in the real world.

Background: Packaging program materials and training resources as well as the use of community learning collaboratives (LC) have been proposed as methods to improve community implementation capacity to address obesity among rural children.

Purpose: To test the hypothesis that the use of a turn-key, train-the-trainer, implementation package with a community LC can improve program coordinator learning outcomes and family program attendance to a greater degree when compared to coordinators that receive the turn-key package alone.

Methods: Communities were assigned to either a LC (n=4) or Package Only (PO, n=3) study condition. LC communities received the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resources) and attended bimonthly sessions to discuss and collaboratively resolve implementation barriers while PO communities only received access to the BHF Resources. As part of BHF, coordinators complete overall and role specific (e.g., program logistics, nutrition, lifestyle, physical activity) training modules with video guidance and detailed lesson plans, PowerPoints, handouts, and objectives for each program component. Knowledge checks (KC) followed each training module that focused on core BHF principles and session specific content to improve implementation fidelity. Coordinators completed an overall KC, which required a score of 80% or higher to unlock weekly educational session guides which included optional KCs.

Results: Scores on the overall KCs ranged from 73% to 100% and did not differ based on condition. There was a significant difference in the percentage of KCs completed between LC (79.8%) and PO (56.3%) communities (p<0.05). The LC communities scored significantly higher on the session specific KC’s ( 95.2% v 89.3%, p<0.05). Average attendance across program sessions was 58.8% and differed by LC (72.7%) and PO (40.1%, p<0.05). Interestingly, a strong

relationship (r=0.82, p<0.05) was found between KC percent completed and participant attendance.

Conclusion: These findings demonstrate the benefit of a LC in supporting the community implementers in the completion of, and performance on, KCs. These findings also support the hypothesis that attendance is related to implementation team preparation as measured by KC completion and performance.

Purpose: To identify and compare the costs of implementing SCRAM via two delivery models (centralised and satellite) in routine healthcare services.

Methods: This study was conducted as part of the SCRAM randomised controlled trial to evaluate the effects of a smartphone-delivered cardiac rehabilitation program across three sites (Sunshine hospital, University Hospital Geelong, and Bendigo Hospital) in Victoria, Australia, in 2019. We proposed two delivery models: centralised involving delivery from a single location, and satellite, involving – delivery from 17 local healthcare sites. The cost items (human resource – salary of exercise physiologist, registered nurse, administrative officer, logistics – polar heart rate sensor, laptop, and smartphone, and utilities – office rent, server hosting and stationery) were obtained from SCRAM trial records, and review of published data followed by expert consultation. We used publicly available sources for cost estimation, such as PayScale for salary. Eligible consumers were estimated using cardiovascular disease prevalence data and existing referral and utilisation rates to centre-based programs. Sensitivity analysis assessed the impact of cost variation of the input variable on the output, while budget impact analysis assessed affordability.

Results: The average annual cost of delivering SCRAM for 2,350 consumers via the centralised and satellite models was AUD 1,006,353 and AUD 1,267,449, respectively. The satellite model was more expensive than the centralised model by AUD 261,096. The cost per consumer was AUD 428 for the centralised model and AUD 537 for the satellite model. Salary for an exercise physiologist and office rent were the two major cost items contributing nearly 75% of the annual cost.

Conclusions: This study showed that a satellite delivery model was more expensive than a centralised delivery for a smartphone-based cardiac rehabilitation program. Both programs offer utility for service delivery, but this information will inform policymakers and CR providers for planning and budgeting resources required for implementing cardiac telerehabilitation in Victoria, Australia and similar settings offering flexibility. 

Intro  The Combined Lifestyle Intervention (CLI), covered by the basic health insurance since 2019, aims to achieve and maintain a healthy lifestyle through behavior change. However, the implementation is not yet reaching its potential. The purpose of this study was to evaluate facilitators and barriers for setting up new- or strengthen existing local stakeholder collaboration in order to ultimately foster better implementation of the CLI.

Methods  The qualitative design included stakeholder interviews, field notes from network meetings and document analyses of implementation plans. Thematic analysis was used to code the interviews and documents resulting in 4 themes. 

Results In the collaboration with different stakeholders, it was important everyone’s interest was known and aligned. In setting up new collaborations performing a needs assessment was therefore essential. It was also critical to set preconditions before starting to implement the CLI, which included setting up contracts with health insurers, making agreements on overhead costs and finding a suitable referral and declaration system. The third topic was communication, which indicated the need for more visibility of the CLI for healthcare professionals as well as the target group to stimulate the referral process. Lastly, the need for tailoring the CLI to different target groups was expressed.  

Conclusion/disc. The study showed that strong collaboration between key stakeholders contributed to the implementation of the CLI. However, these collaborations require structural investment from all parties. In addition, preconditions and a communication plan (as a part of a implementation plan) are also needed to support implementation of the CLI.

Purpose: The objective of this study is to examine whether risk factors, especially the body mass index (BMI), predict if the subjects belong to the disordered eating (DE) group or to the prepubertal anorexia nervosa (PAN) group. To our knowledge, this is the first study which addresses the question for better understand the continuum of eating attitudes and behaviors, especially in children. This is important, because this developmental stage is a key period to prevent eating disorders. 

Methods: Data was collected from a sample of 222 children (mean age : 11.1; s.d. : 1.3) who took part of two longitudinal studies which used the same measures. One of the studies was conducted in specialized care program for eating disorders. The other study aimed to examine the risk factors of DE in children. For this study, the participants were divided into 3 groups: the no DE/PAN group, the at risk of DE group, and the PAN group. ChEAT and EDI were used to assess DE group. The PAN group was diagnosed based on DSM-5 and Tanner criteria. Multinomial logistic regression analyses was used to predict the groupings (no DE/PAN, at risk of DE, PAN) from measures (percentile BMI, EDI-3, CDI, MASC) related to some risk factors (depression, anxiety, feeling of ineffectiveness, etc.). 

Results: In univariate models, depressive and anxious symptoms, inefficacity, affective and interpersonal problems and need to control are risk factors which significatively (p £ 0,05) increase the risk (OR between 1.03 to 1.21) of DE or PAN. But, in the adjusted models for percentile BMI, the groups at risk of DE and PAN were not differentiated on the majority of risk factors. More important, it seems that BMI percentile was the principal factor which influence the groupings. 

Conclusions: This study contribute to emphasize the importance of nutrition (and BMI) like risk factors to make the distinction between DE and PAN. Our results show that the percentile BMI explains in part the effect of psychosocial risk factors. These results are coherent with the fact that starvation increases the depression or anxiety in anorexia nervosa. 

Purpose: Little is known about disordered eating (DE) in children but results of some research shows that it is almost as prevalent in boys as girls. Moreover, actual studies do not focus on other differences between boys and girls, except for the fact that boys do more compulsive exercise than girls to control their appearance. The first aim of this study is to examine the distinctions between boys and girls with symptoms of DE, especially with physical activity. The second objective is to analyze the distinctions between the sexes concerning risk factors of DE in children. 

Methods: The sample is composed of 201 children: 94 boys (mean age : 11.8, s.d. 0.9) and 107 girls (mean age : 11.6, s.d. 1.0). Children were recruited in elementary schools with their parent’s consent to the research. The children complete a series of questionnaires (EDI-3, CDI, MASC) with research auxiliaries. Anova and binary logistic regression was performed to test the difference between sex and examined the risk factors which explained the risk for DE in each sex.  

Results: For the first objective, results showed that for children who present DE, the drive for thinness and body dissatisfaction was the most important symptoms of DE in boys and girls. No distinctions were discovered between sexes for muscle dysmorphia. These results showed that boys and girls exhibited similar symptoms of DE and this emphasized that physical activity to control their appearance is not only present in boys. The results of the second objective showed that feelings of ineffectiveness and overcontrol were the most important risk factors of DE in boys (20.9% of variance). For girls, the principal risk factors were overcontrol and anxiety (45.6% of variance). 

Conclusions: These results demonstrated that risk factors are quite different according to sex, and that little is known for risk factors of DE in boys. Also, future studies should focus on the role of physical exercise in DE.

Purpose:  Implementation facilitation has been described as a “black box” with over 72 distinct roles and 22 complex skills. Tools to inform implementation facilitation can offer tangible approaches for demystifying the process and inform selection of key community partners (i.e., Champions) to increase the uptake of health-based interventions. The current study sought to: (1) describe development of a novel classification approach for types of end users and (2) apply the approach to identify implementation champions in an early care and education (ECE) nutrition promotion trial focused on the We Inspire Smart Eating (WISE) curriculum. 

Methods: Expanding on Diffusions of Innovation, three key factors (attitude, fidelity, influence) were identified and used to develop the Fidelity, Attitudes, and Influence Typologies (FAIT). (1) Development of FAIT occurred initially in a small-scale, cluster randomized Hybrid Type III implementation trial conducted in 38 early care and education classrooms implementing WISE. External facilitators (N=3) and a data collection supervisor used a modified Rapid Assessment Procedure Informed Clinical Ethnography to complete immersive observations and thematic content analyses of interviews to identify characteristics of teachers’ behavior at varying levels of implementation fidelity. (2) For application of FAIT constructs to identity ECE Champions, teachers’ (N=89) attitude and influence were measured on self-report surveys using Likert scales at baseline of an implementation trial (attitude=14 items; influence=3 items); 82% of teachers invited to be champions agreed and were trained.

Results: (1) FAIT includes 8 typologies delineated by combinations of characteristics: (a) achieving fidelity targets or not (i.e., Adopting vs. Non-Adopting), (b) valence of attitudes toward the innovation (i.e., Supporter vs. Resister), and (c) influence in the context (i.e., Active vs. Passive). Potential Champions were identified after the WISE training based on their attitude toward WISE and their self-reported organizational and/or peer influence. (2) A total combined attitude and influence score was calculated (N=89, M=69.35, SD=9.91), and teachers with higher scores (e.g., more positive attitudes toward WISE and higher influence) were invited to be Champions.

Conclusions:  FAIT provides a guide to target the efforts of implementation facilitation and identify strong community partner Champions to increase fidelity to evidence-based practices of nutrition interventions.

Purpose: In January 2022, New Orleans, LA (NOLA) became the first city in Southern United States (US) to pass an ordinance requiring restaurants to offer healthy default beverages (HDB) with children’s meals, to curb SSB consumption in this high-risk population for obesity and related conditions. This study is a baseline assessment of sugary beverage intake among NOLA children 2-12 years of age, caregiver attitudes, and associated demographic characteristics prior to the implementation of the ordinance in January 2023.

Methods: Data were collected via surveys administered through an online panel in September 2022 among NOLA caregivers of children between the ages of 2-12 who eat restaurant meals (eat-in, delivery, or take-out) at least once a month (n=516). This preliminary analysis applied bivariate procedures (Chi-squared, Spearman correlation) to examine the associations between child SSB intake, frequency of restaurant meals, parent/caregiver demographic characteristics (gender, income, race/ethnicity, and education), and attitudes associated with SSB intake and restaurant regulation.  Further multivariate analysis will incorporate child demographics (age, sex).

Findings: Most children consumed SSBs on a weekly basis (11% 1/week, 24% 2-3/week, 14% 4-6/week), with a higher frequency of SSB consumption associated with a higher occurrence of restaurant meal consumption, lower income, and lower education (p<0.05). More than half of the caregivers (53.6%) reported children consumed restaurant meals on a weekly basis (1-3/week), with higher frequencies associated with being a male parent/caregiver and having higher income and education (p<0.05). One-fifth of the respondents (21%) agreed that SSBs are an important part of family meals and 24% agreed that restaurants should not offer SSBs with children’s meals. Perceptions of SSB importance in family meals and disagreement about restaurant restrictions in SSB provisions with children’s meals were associated with a higher frequency of SSB intake.

Conclusions: Our results found a high frequency of SSB consumption among children and significant associations between SSB consumption and restaurant meals.  These findings support the need for HDB regulations in restaurants to decrease the frequency of SSB consumption among children, especially in areas where rates of childhood obesity and overweight are high, as in the case of Louisiana and the Southern US.

Purpose: Muscle function (MF), which is closely linked with physical fitness, is crucial to promoting bone health and preventing osteoporosis and sarcopenia – two major contributors to global non-communicable disease burden. However, the association of MF and body composition on bone health has not been investigated in Indian children and adolescents. This study aims to assess the relationship between MF measured by Jumping Mechanography (JM) and key indicators of bone health measured by Dual energy X-ray Absorptiometry (DXA).

Methods: A cross-sectional study was conducted in Pune, India with 717 (360 boys; 357 girls) urban students aged between 5 – 19 years. Students were recruited from 2 schools belonging to similar socioeconomic strata, with parental consent. Objective data on the following measures were collected by trained research staff: MF parameters (maximum power [Pmax], maximum voluntary force [Fmax]), anthropometry (height, weight), bone health indicators (bone mineral content, bone area, bone mass and areal bone mineral density), and body composition parameters (lean mass, fat mass, fat-free mass, total mass). To determine the association between MF and bone health, Pearson’s correlation analyses and hierarchical linear regression were performed using IBM SPSS (version 26.0.0).

Results:  Mean age of the group was 12.4 ± 3.9 years. Mean height, weight and body mass index (Z score) were 144.6 ± 17.8cm (-0.1 ± 0.9), 38.7 ± 15 kg (-0.2 ± 0.9) and 17.7 ± 3.7 kg/m² (-0.2 ± 1), respectively. Positive association of Pmax and Fmax was observed with all bone parameters (p<0.01). Significant factors associated with bone health also included age, height, lean mass and Fmax (p<0.05 for all).

Conclusions: MF was consistently associated with bone health as measured by a range of objective indicators. MF in children and adolescents needs to be improved by physical activity and nutrition that promotes physical fitness. To optimize bone health by facilitating MF of Indian children, research and policy needs to shift its focus towards equitable physical activity and nutrition programming in schools. 

Purpose: Building Healthy Families (BHF), a Family Healthy Weight Program (FHWP) that is an adaptation of Epstein’s Traffic Light Diet (TLD) and has been implemented in a Midwestern micropolitan city and successfully achieved clinically and statistically significant reductions in child BMIz scores. FHWP’s reduce child weight status, but for families living in micropolitan cities (<50,000) and rural areas, the availability of inter-disciplinary healthcare teams recommended to deliver FHWPs is low—so adapted interventions with well packaged materials and training resources are necessary to fit the needs of families, and organizations interested in reducing obesity in these regions. The purpose of this project is to describe the development of BHF Online Training and Resource Program package for implementation in micropolitan/rural communities.

Methods: We packaged a FHWP for “turn -key” implementation by creating the BHF Online Training Resources and Program package by incorporating several instructional design features and adoption and implementation strategies to focus on effectiveness across all user groups. Online training modules were created for each implementation team role including; program coordinator and nutrition, physical activity, lifestyle and recruitment coordinators. These modules use instructional design focused on ensuring the content elements of the FHWP are followed. Additionally, the packaged program includes presentation materials, handouts, and lesson plans that increase the likelihood that the delivery of the program will be consistent across communities. Finally, a data portal was built to allow users to track local program effectiveness.

Results: The result is an Online Training Resources and Program package that includes a modular approach providing training modules for program facilitators, knowledge checks to ensure mastery of program components, recruitment resources for community, school and clinical settings, all delivery materials, embedded fidelity assessments for quality assurance, and a data portal to track participant success.

Conclusion: The development of the FHWP resources was the result of focusing on the prioritized outcomes of multiple end users. The resources and program package allows users to implement a FHWP in their communities without the need for expert implementation teams. The Online Training Resources and Program package allows for broad dissemination of FHWPs in micropolitan/rural communities.

Health-related behavior is often effortful and energy-consuming without much positive experience at the moment. The current study aims to provide a theoretical framework for changing the experience accompanying health behavior in a more positive direction. Based on proactive theory and literature, we propose a theoretical model that individuals could improve the experiences of health-related behavior by working on (1) environmental factors, (2) health-related activities, and (3) personal states. Importantly, we identify concrete health-related proactive strategies that can be used for specific health-related behavior based on the taxonomy of health behavior (Nudelman & Shiloh, 2015). Moreover, we take into account the dynamic process (i.e., the short run) process for inducing rewarding experiences as well as cultivating intrinsic motivation in the long run. We identify environmental (e.g., barriers and facilitators) and individual factors (e.g., personality, personal states) that may relate to health proactive strategy. Lastly, we discuss the implications for interventional design and provide agenda for future research.

Purpose: Current public health advice regarding children’s eating is generic and does not tackle the considerable variability in children’s appetite traits and eating behaviour. Behaviours that characterise avid eating have been linked to child overweight and obesity (e.g., greater enjoyment of, and responsiveness to, food). Parent feeding practices are modifiable components of a child’s food environment and thus may be key levers for behaviour change in tailored interventions to support the development of children’s healthy eating. This qualitative study aimed to explore primary caregivers’ experiences of feeding children with avid eating behaviour and to understand any challenges that caregivers experience in this context.

Method: Fifteen semi-structured interviews were conducted with primary caregivers of a preschool child (3-5 years) who was identified by responses on a questionnaire as having avid eating behaviour. Interviews explored how children’s avid eating manifests and any challenges that caregivers face when feeding their child. Interviews also examined which feeding strategies caregivers use to limit their child’s food intake, and whether they perceive these strategies to be effective.

Results: Interview data has been collected and transcribed, and results will be discussed. Due to the novelty of qualitative research in this area, analysis will focus on understanding the core concepts and themes which are present in the data and will illuminate the experiences and challenges of parenting a child with avid eating behaviour.

Conclusion: This study will provide an in-depth understanding of caregivers’ experiences of feeding children with avid eating behaviour. These findings will help to determine targets for the development of tailored interventions to support caregivers with children who are at greater risk of the development of obesity in food abundant environments.

Purpose: This study was to evaluate a theory-based eHealth intervention, called Healthy Online Parental Education (HOPE), aimed at improving child fruit and vegetable intakes and parental feeding practices in families with low-income backgrounds in West Texas, USA.

Methods: An 8-week randomized control and intervention pilot study was conducted among 73 parents with young children (12-36 months) between October 2021 and February 2022. The HOPE intervention was informed by the Social Cognitive Theory and utilized multicomponent strategies. The intervention group (n = 37) received weekly educational videos and text messages and completed three online cooking activities. The control group (n = 36) received printed materials about general dietary recommendations for children. Child consumption of fruit and vegetables (servings/day) was captured by an electronic 24-hour dietary record. Parental feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire. Linear models were performed to assess mean changes in the study outcomes from baseline to post intervention using R version 4.1.1.

Results/findings: At post intervention, children in the intervention group significantly increased their mean fruit (from 0.57 to 1.47, p = 0.0000000006) and vegetable (from 0.45 to 0.98, p = 0.00005) intakes than baseline. There were no changes in daily fruit (from 0.47 to 0.46, p = 0.92) and vegetable (from 0.44 to 0.27, p = 0.17) intakes in the control group. Children in the intervention group showed greater increases in the mean changes of daily fruit (p = 0.00057) and vegetable (p = 0.0037) intakes than the control group. Parents in the intervention group showed significantly greater improvements in comprehensive feeding practices than the control group (p = 0.0069). At post intervention, parents in the intervention group reported higher parent modeling (p = 0.00005) and lower overt control practices, such as use of food as a reward (p = 0.0013), pressure-to-eat (p = 0.0016), and food restriction (p = 0.00053) than baseline.

Conclusions: Empowering families through eHealth interventions is a promising approach for increasing child fruit and vegetable consumption and changing parental feeding practices. Further testing in a full-scale trial is needed to determine whether behavior changes are sustainable over time.

Purpose Despite the proven advantages of a healthy lifestyle, discussing lifestyle is currently not implemented in routine clinical practice in hospitals. Therefore, the aims of this study were twofold: 1) to get insight in the current practice of discussing lifestyle by healthcare professionals in two Dutch university medical centers and 2) to identify barriers and facilitators for discussing lifestyle in routine clinical practice among healthcare professionals.

Methods Semi-structured interviews were conducted with healthcare professionals (i.e. physicians (in training), dieticians, physiotherapist, (specialized) nurses) from different departments (Orthopedics, Internal Medicine, Cardiology and Nephrology) of two Dutch university medical centers. Interviews were audio recorded and transcribed. An inductive thematic analysis was conducted by three researchers independently to identify the barriers and facilitators for discussing lifestyle.

Results Thirty-three healthcare professionals were interviewed. The findings show that majority of healthcare professionals have a positive attitude towards discussing lifestyle. A variety in methods exists in approaching and motivating patients, but also in discussing lifestyle with patients which they try to tailor to the knowledge, preferences and medical issues of the patients. Barriers and facilitators were categorized into three themes: 1) patient-related factors (e.g., knowledge and skills, motivation, previous experiences, financial factors), 2) healthcare professional-related factors (e.g., knowledge and skills, motivation, collaboration referral options, feedback after referral, responsibility, time, previous experiences, necessity lifestyle change) and 3) hospital related factors (e.g., general attitude, organizational structure).

Conclusions This study showed that the majority of healthcare professionals have a positive attitude towards discussing lifestyle in clinical practice. However, this is not yet routinely done and a variety of methods exists in how this is conducted. In order for healthcare professionals to discuss lifestyle more routinely in clinical practice, strategies should focus on educating healthcare professionals in discussing lifestyle with patients with different backgrounds, setting up collaborations with referral options, and imbedding lifestyle medicine in hospital care.

Purpose: Easier recognition and enhanced visibility of healthy options supposedly increase healthy choices, but real-world evidence remains scarce. Addressing this knowledge gap, we promoted healthy foods in a workplace cafeteria with three choice architectural strategies—priming posters, point-of-choice nutrition labels, and improved product placement—and assessed effects on visual attention and food choices.

Methods: Following a quasi-experimental pre–post design, the study comprised 5-day control and intervention conditions with identical menus. We monitored visual attention (i.e., the number and duration of fixations on posters/labels, healthy foods, and less healthy foods) and food choices (i.e., the number of total, healthy, and less healthy items chosen) with mobile eye tracking, interviewed customers about perceived influences on food choices, and weighed cafeteria-level food consumption (i.e., the amount of total, healthy, and less healthy foods taken from the serving line). Individual-level data represents 22 control participants (M 43 years, 64% men) and 19 intervention participants (M 46 years, 53% men) recruited at the cafeteria entrance. Cafeteria-level data represents 556/589 meals sold over the study conditions. As the samples included partly same and partly different individuals, we examined between-condition differences in visual attention and food choices with partially overlapping samples t-test and its non-parametric counterpart. The consumption analysis compared total, % healthy, and % less healthy food consumption between study conditions. Perceived influences on food choices were analysed with deductive qualitative content analysis informed by the Food Choice Questionnaire.

Results: Posters/labels captured participants’ visual attention (~13% of fixations on defined areas of interest before food choices), but the intervention had insignificant effects on visual attention to foods and on food choices (ps > .05). Similarly, cafeteria-level consumption remained unchanged. Interviews revealed 17 perceived influences on food choices, the most common being sensory appeal, familiarity, and healthiness. Healthiness, however, often was an unspecified motive that could lose to competing influences.

Conclusions: the intervention proved capable of attracting visual attention, yet ineffective in increasing healthier choices among working age consumers who prioritised sensory appeal and familiar foods. The work contributes with a unique, mixed-methods approach and a real-world setting that enabled a multi-dimensional effects evaluation with high external validity.

Purpose:                      Children learning cooking skills may have a positive influence on dietary, psychosocial and wellbeing outcomes¹. However, this is an under-researched area, and it is unknown what factors contribute to children’s perceived cooking competence. This is important to understand as perceived competence, an individual’s self-efficacy for undertaking a specific task, in this case cooking, is a significant predictor for performing a behaviour². Furthermore, parental influence has shown to impact children in other areas, such as parental education influencing children’s educational attainment³ and cooking confidence influencing children’s intake⁴. Therefore, this research aims to investigate different factors, including parental aspects, on children’s perceived cooking competence.

Methods:                     Matched data for parents and children from the baseline surveys of the Cook Like A Boss Online intervention⁵ will be used for this analysis. Parents completed questions relating to their sociodemographic characteristics as well as their cooking skills confidence⁶. Children’s surveys include information around their demographics, previous experience of cooking, as well as their perceived cooking competence⁷. Bivariate Correlations and Hierarchical multiple regression modelling will be conducted using SPSS to understand the relationships between the variables and the predictors of children’s cooking competence.

Results/findings:         Full findings will be presented. Matched data from 242 parent-child dyads will be used to understand the predictors of children’s perceived cooking competence. Preliminary findings indicate that was not a significant correlation between parental cooking confidence and children’s perceived cooking competence. Results of the hierarchical regression to determine predictors of children’s perceived cooking competence will be presented.

Conclusions:               Understanding the different influences on children’s perceived cooking competence is essential to ensure the best methods for increasing perceived competence to enable cooking behaviours.

¹Lavelle, F. 2022. Nutrition Bulletin, doi: 10.1111/nbu.12596.

²Harter, S. 1978. Human Development, doi: 10.1159/000271574.

³Eccles, J.S. 2005. London review of education, doi: 10.1080/14748460500372309.

⁴Martins et al. 2020. Appetite, doi: 10.1016/j.appet.2019.104452.

⁵Hollywood et al. International Journal of Behavioral Nutrition and Physical Activity (IJBNPA), accepted

⁶Lavelle et al. 2017. IJBNPA, doi: 10.1186/s12966-017-0575-y.

⁷Dean et al. 2021. IJBNPA, doi: 10.1186/s12966-021-01089-9.

Purpose: Physical inactivity remains a global public health challenge today. Determining why people stop habitually participating in sports is significant to develop targeted intervention strategies for sports promotion and healthy living. However, most previous studies on sports dropout are cross-sectional in nature and focus on adolescents. As sports participation is dynamic throughout life, a life-course perspective is needed to provide a more comprehensive understanding. This study adopts a life-course perspective to explore the determinants that trigger the transition from active participation in sports to becoming inactive.

Method: An online survey was developed to collect retrospective longitudinal data on life trajectories and habitual sports behaviours in the Netherlands. Participants were 629 adult panellists from an existing representative panel of the Dutch population. Based on previous sports participation theories and life-course approaches, 26 determinants in 4 categories, including socio-demographics, sports motivations, life events, and neighbourhood characteristics, were identified as potential explanatory variables. A two-level binary logistic regression model was estimated to capture the effects of these determinants on sport dropout.

Results: Results show that dropout from sports is age-specific, with those aged 13-23 more likely to stop sporting. Also, individuals who are less educated or who work less than 20h/w are more likely to quit sports. Another finding is that people are less likely to discontinue sports participation when they have health and weight loss goals. Life events have different effects. Stop living with physically active people appears the most important event to make people stop sporting, followed by having a baby, and then owning the first car. Compared with education-related events, work-related events are more likely to cause people to stop sporting. Moreover, the probability of dropout from sports may increase with the unsafe feeling of doing physical activities in the neighbourhood and decrease with the lack of green spaces.

Conclusions: Determinants from socio-demographics, sports motivations, life events, and neighbourhood characteristics appear to play differential roles in sports discontinuance over the life course. The findings have implications for supporting sports participants to continue exercising by addressing the barriers.

Purpose

Food is an important part of our everyday life, identity, and wellbeing. Food can create social ties and enhance belonging to a new place. Immigrant populations often encounter social and health challenges in their resettlement process. Promoting food related initiatives among immigrant populations may facilitate integration and adoption of healthier diets in a new food environment. The aim of this project was to use the “Healthy Start” food and nutrition communication in a Norwegian as second language course for immigrants population striving to enter the labor market to improve language skills and familiarity with nutrition recommendations.

 Methods

A class consisting of 11 women and 1 man, aged 19-55 years participated in a 5-week nutrition education programme, divided of 10 classes. In addition to using theoretical parts of the Healthy Start education material we invited the class to share recipes of dishes that common in their homes and to participate in creating a recipe booklet in Norwegian. We used participant observation and qualitative interviews in the Healthy Start to evaluate outcomes of participating in the course.

 Results

Food was a topic that all participants could relate to and sharing their experiences with food enhanced participation and learning. By sharing their food and recipes the participants seemed to strengthen their language and communication skills. “Healthier adaptation” of their original recipes and awareness about use of healthier alternatives emerged. Sharing their own food culture with others created stronger networks between the participants to the course.

 Conclusions

Combining nutrition and language education can enhance language skills awareness on healthy eating. Replicating and scaling up this or similar initiatives may contribute to build capacity in a supportive learning environment and faciliate intercultural coomunication and integration. 

Background: Physical activity (PA) is becoming recognized as an essential component of supportive care for cancer survivors given that it mitigates the effects of cancer treatment. However, many cancer survivors do not meet PA guidelines (≥150 minutes/week of moderate-to-vigorous PA [MVPA]). PA identity is an important predictor of long-term PA maintenance as it helps to buffer against environmental and self-regulation challenges to PA. Nevertheless, little is known about the contributors to strong PA identity in cancer survivors. Accordingly, the purpose of this study was to understand the demographic, medical, and social cognitive correlates of PA identity in cancer survivors.

Methods: An online, cross-sectional survey was administered to cancer survivors worldwide. Questionnaires were used to assess demographic and medical information; PA using a modified version of Godin Leisure-Time Exercise Questionnaire; and M-PAC processes for instrumental attitudes, affective judgements, perceived capability and opportunity, self-regulation, habit, and identity. Using four identity statements scaled 1 (strongly disagree) – 5 (strongly agree) with an identity score of 12 as the mid-point, cancer survivors were classified as having ‘high PA identity’ (i.e., score >12) or ‘low PA identity’ (i.e., score <12). Binary logistic regression analysis was used to examine demographic, medical, and social cognitive correlates of PA identity across high and low PA identity classifications while controlling for MVPA participation.

Results: Cancer survivors (N=318;M_age= 48.90 ± 15.92 years) were mainly female (69.2%), White (89.9%), had some higher education (82.7%), diagnosed with breast cancer (28.0%), and had completed treatment (79.9%). Controlling for meeting MVPA guidelines, higher PA identity was significantly associated with higher positive affective judgement (OR=1.13, 95% CI=1.02-1.25, p=0.03), higher PA intention (OR=1.49, 95% CI=1.19-1.87, p<0.001), better self-regulation (OR=1.08, 95% CI= 1.02-1.15, p=0.009), and greater PA habit (OR=1.28, 95% CI=1.17-1.40, p<0.001).

Conclusion: Social cognitive processes (i.e., affective judgment), self-regulation (e.g., planning), PA intention, and habit were significant predictors of higher PA identity. Future research is needed to investigate the reflexive and regulatory mechanisms through which PA identity contributes to long-term PA maintenance. Interventions should target these M-PAC processes and strengthen PA intention and habit to enhance PA identity and participation in cancer survivors. 

Purpose Community- based physical activity interventions are beneficial for patients suffering from cardiovascular diseases (CVDs). However, the implementation of these interventions remains a challenge. Therefore, the aim of this scoping review is to explore the barriers and facilitators for participation in community-based PA interventions among patients suffering from CVDs.

Methods An electronic search was performed in PubMed and Cochrane for all studies published up to July 1st, 2021. Articles with a quantitative or qualitative design were eligible for inclusion if: (a) patients with CVDs were included; (b) the intervention included community-based PA; and (c) the article reported information on barriers and facilitators for (non-)participation and/or adherence. Articles not published in English were excluded. Subsequently, identified barriers and facilitators were categorized into five levels, using the social-ecological framework (SEF).

Results Thirteen studies were included, of which 3 qualitative and 10 quantitative studies. These studies identified various barriers and facilitators related to participation at multiple levels of the SEF: (a) intrapersonal (e.g., personal factors, employment, psychological factors, body functions), (b) interpersonal (e.g., social support), (c) institutional (e.g., program factors), and (d) policy (e.g., transportation, costs).

Conclusions This scoping review provides a comprehensive overview of barriers and facilitators for participation in community-based PA interventions among patients suffering from CVDs. This overview is useful to guide clinicians and researchers in future development and implementation of community-based PA intervention specifically for patients with CVDs. Strategies to improve participation and adherence to community-based physical activity interventions in this group should start with more education and proper instructions to improve knowledge and self-efficacy. Additionally, interventions could be improved by for example providing a tailored approach or group-based interventions in the own neighborhood of the patient. Finally, costs of interventions should be lowered or reimbursed to increase participation and adherence.

Purpose: School-based food education programs are an increasingly common strategy to promote fruit and vegetable (FV) intake among children and shape dietary habits that persist into adulthood. Evidence points to modest program influence on children's FV intake in the short-term, but little is known about effects on broader dietary habits through adolescence. We therefore sought to understand current and alumni participant perspectives on 1) their experiences with a food education program in elementary school, 2) translation of the program to their home environment, and 3) program impact on dietary habits over time.

Methods: We used an instrumental case study approach, with the program serving as the unit of case analysis, illustrating the experience of participation in a comprehensive food education program over multiple years. We conducted semi-structured focus groups with current elementary students and alumni participants now in secondary school or university, recruited through purposive and network sampling. Focus groups were audio-recorded, transcribed verbatim, manually coded, iteratively analyzed, and distilled into nine emergent themes supported by analysis of class observations, informal interviews with program staff, and field notes.

Results/Findings: Nine focus groups were held with n=39 current participants (9.6 ± 1.1 years, 41% female) and n=39 program alumni (14.4 ± 2.5 years, 56% female) from urban settings. Three emergent themes were identified in each of three time periods of program impact: immediate, medium-term, and long-term. Participant perceptions of immediate program impact were characterized by enjoyment, experiential learning, and fostering community. In the medium term, participants attributed program participation to changes in individual and family food intake, involvement in household food practices, and desire for more fresh food options at school. Among alumni participants, the following enduring themes emerged: appreciation for fresh, homemade food, openness to trying new foods, and confidence to make informed food choices.

Conclusions: Our findings provide deeper understanding of how participants in a school-based food education program view their experience and a first look into salient program influences that endure into adolescence. Many themes closely align with the domains of food literacy, indicating opportunities for developing assessment tools to quantitatively capture near and long-term program impact. 

Determinants of long-term physical activity participation in New Zealand adolescents across sociodemographic groups: a descriptive study

Tom Bergen*^1,2, Alice Kim¹, Anja Mizdrak¹, Louise Signal¹, Geoff Kira^2,3, Justin Richards^2,3

¹ University of Otago, New Zealand, ² Sport New Zealand (Ihi Aotearoa), ³ Victoria University of Wellington, *Presenting Author.

Purpose

The purpose of this study was to describe the nature of physical activity participation in Aotearoa New Zealand (NZ) adolescents by exploring relevant variables that are determinants of long-term physical activity across different sociodemographic groups.

Methods

Data was collected on from the Active NZ Young People’s survey which uses a complex survey design utilising household clusters and stratification by region, ethnicity, and age groups. Sociodemographic characteristics (age, gender, ethnicity, deprivation, physical disability status) were assessed in samples of adolescents (12-17 years old) between 2017 and 2020 in Aotearoa, New Zealand. The determinants chosen for analysis were total weekly time spent physically active, physical literacy, social support levels, number of settings participated in, number of physical activity participations and physical activity accessibility levels. All variables were weighted to create national estimates with 95% confidence intervals. Numeric determinants for each sociodemographic group were summarised as mean values and categorical determinants were summarised into population proportions.

Results

As age increased, physical activity participation levels decreased alongside all other determinants of long-term physical activity. Māori and Pacific populations scored consistently higher in each determinant category than European, Asian, and other ethnicities. Determinant values were on average lower than the population mean in those that were aged 15-17 years, Female or Gender Diverse, Asian, living with medium to high deprivation levels or physical disabilities.

Conclusions

This study reveals that determinants of long-term physical activity vary greatly across all adolescents and that certain sociodemographic groups have much lower levels than the average. Tailoring future public health interventions towards enhancing a wide range of these determinants simultaneously, especially for those in late adolescence, may prove influential to enhancing nationwide physical activity participation and wellbeing across the lifespan.

Keywords

Physical activity, behaviour, trajectory, predictors, adolescent, wellbeing.

Green physical activity (GPA), or any physical activity that takes place among natural elements, is a leisure-time activity with myriad benefits (e.g., physical health, mental health and wellbeing, active citizenship). Less than half of U.S. individuals participated in GPA in the last year—with knowledge and social support as common barriers. Social media (SM) is widely used and a potential health communication tool that may act as a way to remove these barriers, increase self-efficacy for GPA and, perhaps, increase GPA itself.   

PURPOSE: Describe SM use in a sample of U.S. adults interested in or currently participating in GPA and explore associations between SM use and GPA.

METHODS: A survey queried participants who follow GPA-related SM (N=179) on sociodemographics, SM use (hours/week), SM importance (via Social Media Use Integration Scale), GPA-specific self-efficacy (via Outdoor Recreation Self-Efficacy Scale), and GPA (via Godin-Sheperd Leisure Time Exercise Questionnaire modified for GPA [i.e., “exercise” was replaced with “green physical activity”]). Using SAS 9.4, sociodemographic and SM variables were summarized. Multiple linear regression models were used to examine associations between SM use and GPA while controlling for gender, sexual identity, race, education, and employment.

RESULTS: Average SM use across the sample (age=33.0 + 8.8; 86.0% non-cis-gender male) was 13.6+8.6 hours/week, while average total GPA was 5.4+4.1 hours/week. The sample had a high overall self-efficacy score for GPA (156.9+20.3, out of a possible 187) and a moderate SM importance score (36.4+9.5, out of a possible 60). There was an association between SM use and GPA self-efficacy (p=0.001). Additionally, for every hour of SM use per week is, on average, associated with almost 7 more minutes of GPA per week (p<0.01).

CONCLUSION: Seven minutes of GPA over the course of a week is a small effect and, for this sample who engages in a high level of GPA, not clinically significant. However, general SM use was measured instead of GPA-specific SM, due to the lack of a reliable way to measure topic-specific exposure. The statistically significant results indicate further examination of GPA-specific content on SM and its effect on GPA self-efficacy and GPA is warranted.

Objective: The digital food environment represents a growing exposure to unhealthy food. The present study aims to map the digital food environment on social media by exploring users’ characteristics and interactions with two sources of (unhealthy) food content: food advertisements (ads) and food posts. The following questions will be investigated: How do users’ interactions with food content relate to the frequency of unhealthy food content exposure, and whether food companies play a role in it? Are people with specific characteristics more likely to be exposed to unhealthy food content?

Methods: We will implement a survey study combined with a novel data donation approach, which allows participants to download their social media data and share it for research purposes. Participants will donate their YouTube data regarding video ads and posts viewing, likes, searches, subscribed channels, and a company list showing which food companies users are targeted as potential customers. Participants will also complete questionnaires regarding their (social) media algorithm awareness, perception of food norms, experience with personalized ads, and demographics.

Analysis plan: We will recruit 300 participants, and the results will be ready around May 2023. We will code the videos as healthy or not healthy, and the likes, searches, channels, and companies on the list as food-relevant or not food-relevant. We will perform correlation analyses among the interactions (e.g., frequency of the likes), unhealthy food video exposure (i.e., the viewings), the number of food companies that targeted users as customers, and the score of questionnaires and follow-up regression analyses for answering the first question. We will do a latent class analysis to reveal groups with specific characteristics that may be more likely to be targeted by food companies and exposed to the food content.

Implications: The implications of the present study are twofold. First, it may provide insight into the characteristics of the digital food environment on social media. These insights may be important for regulations of food content, such as Ads from food companies. Second, it may shed light on how researchers can utilize social media data based on the data donation approach to investigate food-relevant topics.

Purpose:  Effective interventions to increase and sustain Hispanic women’s objectively-measured physical activity (PA) are lacking. This review synthesizes existing literature to determine the behavior mechanisms that drive Hispanic women’s PA, which is critical for intervention development.  

Methods:  Searches were conducted in January/February 2022 using terms related to Hispanic AND female AND (exercise OR physical activity) in PubMed, CINAHL, SSCI, Cochrane Library and PsychINFO databases. Studies with 100% Hispanic women and an intervention to increase objectively-measured PA published in English in peer-reviewed journals were included without date limitations. Studies with pregnant women and/or chronic conditions were excluded.

Results/Findings:  Searches resulted in 4,374 records after 3,567 duplicates were removed. Seventy-three full-text studies were assessed for eligibility after titles were screened, and one study was identified via reference lists. Thirteen studies met inclusion criteria; however, 9 were unique and 4 provided additional findings (i.e., short-term, long-term, mediation). Sample sizes totaled 2,303 Hispanic women with mean ages ranging 28.4-44.6 years. Most studies included a wide age range for inclusion (18-65 years) and only two limited the range (i.e., 18-40, 35-64 years). Seven studies (78%) included author-specified behavior mechanisms targeted by the intervention and 4 studies (44%) measured and tested for change in 11 different behavior mechanisms. Two studies included mediation analyses (22%) to determine if family participation, family rewards and punishments, friend participation, social support (combined family and friend support), self-efficacy, behavior processes, cognitive processes, and PA enjoyment mediated an increase in PA at 6-months. Family participation, family rewards and punishments, and friend participation were tested again at 12-months. None of the behavior mechanisms included in a mediation analysis were in >1 study. Only family participation and self-efficacy mediated PA at 6-months (p<.05) and none mediated PA at 12-months.

Conclusions:  There was limited evidence that family participation and self-efficacy may mediate short-term improvements in PA among Hispanic women. Future PA interventions should be designed to target, measure, and test behavior mechanisms to determine which mediate short-and long-term improvements in PA. Otherwise, it is impossible to optimize PA interventions to include only the critical intervention components necessary to effectively increase Hispanic women’s PA.

Purpose: This study applies self-determination theory to test the relationships amongst basic psychological needs, level of self-determined motivations and physical activity in Chinese college athletes.

Methods: A total of 301 Chinese college athletes aged between 18 to 25 completed a test battery on motivational aspect based on self-determination theory. International physical activity questionnaire was used to measure the physical activity in leisure-time and exercise training. The Exercise Regulation Questionnair-2 and the Psychological Needs Satisfaction Scale are completed to access exercise motivations and three basic psychological needs in sports context.

Results: Structural Equation Model analyse results indicate that self-determined motivations mediate the relationships between basic psychological needs satisfaction and physical activity. For leisure-time physical activity, autonomy (β=0.056, p=0.019; Bootstrap 95% CI= 0.012－0.102), competence (β=0.043, p=0.019; Bootstrap 95% CI = 0.005－0.098) and relatedness (β=0.029, p=0.019; Bootstrap 95% CI = 0.005－0.061) positively predict  physical activity in leisure time through autonomous motivation.

For training exercise, autonomy (β=0.043, p=0.004; Bootstrap 95% CI = 0.013－0.082) positively predicts physical activity in training exercise through controlled motivation, and competence (β= -0.025, p=0.049; Bootstrap 95% CI = -0.063－0) and relatedness (β= -0.043, p=0.004; Bootstrap 95% CI = -0.078－-0.012) negatively predict physical activity in training exercise through controlled motivation.

Moreover, multi-group analysis results reveal that relationship between autonomous motivation to leisure-time physical activity (△χ2=3.877, df=2, p=0.049) is stronger for male college athlete (β=0.179, P<0.05) than female college students (β= -0.038, P>0.05), and the relationship between relatedness to controlled motivation (△χ2=3.2947, df=4, p=0.007) is stronger for low competition level college athletes (β=0.197, P<0.01) than high competition level athletes (β=0.136, P>0.05).

Conclusions: Our findings support the applicability of SDT in understanding the physical activity in Chinese college athletes, and further distinguish the different SDT process in physical activity between leisure-time and training contexts. Gender and competition level difference also moderated mechanisms among SDT process. Future recommendations are related to the further examination of potential differences in various sports contexts, as well as the different mechanism on the other demographic characteristics. 

Purpose: To develop and psychometrically evaluate a self-report measure of determinants influencing sustainment of evidence-based public health interventions in the early childcare setting from the executive perspective.

Methods: The measure was developed across two phases: (1) item development, face and content validity; and (2) psychometric evaluation:

Phase 1: Measure domains were informed by constructs from the Integrated Sustainability Framework. The initial item pool was based on review evidence and an iterative process involving eight content experts in the fields of implementation science, psychometrics and education. Item reduction occurred until a comprehensive item list covering relevant framework domains was achieved. Ten content experts, independent of those involved in developing the initial item list assessed content validity. Face validity was assessed by five service delivery experts responsible for implementing public health programs in educational settings, four educators and two educational executives. Items underwent pre-testing by five representatives of the target population to minimise misunderstanding and measurement error through ensuring item clarity, comprehensibility and relevance to the target population.

Phase 2: A cross-sectional, national Computer Assisted Telephone Interview survey was conducted with managers or executive staff from early childcare centres across Australia. Participants answered the 29-item measure using a five-point Likert scale, with response options ranging from 1=”Completely disagree” to 5=”Completely agree”. Structural validity, concurrent validity, known groups validity, internal reliability, and floor and ceiling effects will be assessed.  

Results:

Phase 1 (complete): The initial measure contained 29 items covering four domains of the Integrated Sustainability Framework. Average Scale Content Validity Index was 0.91 indicating high content validity.

Phase 2 (in progress): We obtained 482 completed surveys. Full completion of items was 84% (n=405). Preliminary descriptive data found that the lowest scoring domains were Processes (mean=3.8 [0.86]); and Outer Contextual Factors (mean=3.90 [0.96]). Inner Contextual Factors (mean=4.1 [0.77]), and Characteristics of the Intervention (mean=4.2 [0.62]) ranked the highest. Psychometric testing is currently underway. 

Conclusions: This measure will facilitate more accurate assessment of factors influencing sustainment of interventions in early childcare settings. Such data is essential for developing sustainment strategies and monitoring possible influences of intervention sustainment. 

Purpose

Food pantries play a key role in addressing food insecurity and food access challenges in the United States. The covid-19 pandemic exacerbated many limitations of the charitable food system, including the need to offer safer means of food distribution, vulnerability of older pantry volunteers, and key gaps in situational awareness by emergency managers. We sought to identify: (1) what forms of support food pantry workers need in order to safely and effectively do their jobs; (2) what digital strategies food pantry directors currently use for pantry management; and (3) what mobile app features would support food pantries, and address other food supply chain/donor challenges?

Methods

We report on three interrelated activities: (1) a food pantry intervention conducted mostly pre-COVID-19 (Fresh Shelves, Healthy Pantries (FSHP)) in Baltimore; (2) a scoping review that explored the current status of digital applications for food pantries; and (3) a recently funded intervention trial to develop a mobile app for food pantries. Within each phase of the 3-part RCT FSHP intervention (n=7 pantries), a combination of multi-modal change strategies focusing on the target food group for the phase was implemented, including policy, staff education and engagement, and client education and environmental changes.  We followed up with a scoping review of digital strategies used to support food assistance programs.  Finally, we were recently funded to develop and pilot an app to support food pantries in management of volunteers, client needs, and communications with emergency management officials.

Results

FSHP demonstrated feasibility; mean healthfulness scores for intervention client bags significantly increased from 58.2 to 74.9 (p<0.001).  Our review identified 19 desirable digital features; the most popular feature was online shopping (n=14), followed by inventory management, and client tracking.  We have been funded to develop a mobile app and to pilot and evaluate its feasibility and impact on food pantry staff preparedness, stocking, and client uptake of healthful foods and beverages, in 20 food pantries and 360 pantry clients in a RCT. 

Conclusion

The work of our team with food pantries will support improvements in the charitable food system, potentially leading to improved dietary quality and reduced food insecurity.

Purpose: The aim of this exploratory study, which has not yet been conducted, is to investigate the perceptions and experiences of a group of standing desk intervention participants that dropped out of the trial.

Methods: The site of study will be the University of the Witwatersrand, South Africa. The participants will be convenient sample of adult office workers recruited from the standing desk trial underway at the University of the Witwatersrand, as and when they withdraw from the study. We assume that at least ~40 participants would have dropped out of the intervention arm in the next 6-months. A final sample of 40 would be sufficient to gain insight into the reasons for drop-out from the standing desk intervention. The study has been approved by the Human Research Ethics Committee (Medical), University of the Witwatersrand (ethics certificate number: M190224). The in-depth interviews will be conducted in the early quarter of 2023. Participants will be invited to participate in the in-depth interviews by telephone and email invitation. The researchers will inform the participants of the study’s purpose during the telephonic recruitment. We will record the number of participants that are recruited and those participants that are not interested in contributing. During the in-depth interviews, participants will be encouraged to think about facilitators and barriers to participating in the standing desk intervention in their place of employment. A series of interviews will take place until sufficient participant perceptions have been recorded. All in-depth interviews will be recorded with verbal and written consent of the participants on a portable recorder. Transcribed documents will be analysed using Atlas.ti 9, applying the revised coding framework. Codes will be allocated to the transcripts, while the text will be read and reviewed line-by-line for interpretation.

Conclusions: We intend to use the data to inform the development of strategies that will more effectively increase the adherence to standing desk interventions and thereby address the problem of prolonged sitting in the South African workplace.

Purpose: Current sleep hygiene recommendations advise against engagement in moderate-vigorous physical activity (MVPA) in the evening; however, few studies have examined how engagement in MVPA in the evening relates to sleep among youth. This study examined whether participation in MVPA in the evening (6-10pm) had an effect on sleep quality among 12-17-year-olds who met daily MVPA guidelines (accumulate at least 60 minutes of daily MVPA).

Methods: This cross-sectional study is a secondary analysis of data from the FLASHE(1) study. Web-based survey data regarding sleep quality and MVPA timing were collected from 1661 US youth. The analytical sample (N=1416) retained the youth who met the daily MVPA guidelines and the group was split into those who engaged in MVPA in the evening at least 1 night/week versus those who did not. Sleep quality, classified as good or poor, measured whether youth typically slept through the night or were awake for part of the night, respectively. Covariate-adjusted logistic regression models with multiple imputation were used to determine the effect of engaging in MVPA in the evening on sleep quality. Sensitivity analysis examined whether the number of nights youth engaged in MVPA in the evening had a differential impact on sleep quality.

Results: The majority (77%) of youth reported participating in evening MVPA at least 1 evening/week and 87% typically experienced good sleep quality. The evening MVPA group included more males (p=0.006) and a greater proportion of youth with “almost none or a little” reported sedentary behavior (p<0.001). Sleep quality did not significantly differ among those who reported engaging in MVPA at least 1 night/week versus those who did not do any MVPA in the evening. The results did not differ when the number of nights youth reported engaging in MVPA at night was varied (2, 3, 4+ evening MVPA).

Conclusion(s): Our study did not find evidence to restrict opportunities for youth to engage in MVPA to specific times of day. Further work is required to understand the effects of evening MVPA on other objective and subjective sleep attributes in youth and to determine specific behavioural interventions to improve sleep in this population.

Purpose: Australia is one of only a few high-income countries that has not implemented comprehensive, universal school meals. Historically the issue is divisive but as concerns over the growth and wellbeing of children and young people continue, school meals are being viewed as an opportunity to support both health and education outcomes. Creating a paradigm shift in policy approaches requires an understanding of public attitudes. This research explores the discourses circulating on online media sites in response to increasing calls to provide school meals in Australia.

Methods: Reader comments on ‘comment boards’ attached to school meal relevant articles published on Australian news and current affairs websites, and their reposting on social media, were analysed for public discourses. The primary question was “How do readers represent the ‘solution’ of school meals?” and “Are school meals encouraged or rejected?”. Articles were reviewed from January 2017 to December 2022. Analysis included preliminary coding of comments for major themes using the Framework method.  These themes were further analysed using critical discourse analysis and interpretive affective-discursive analysis for the presence of emotion.

Results/findings: Preliminary findings indicate predominant themes related to “shifting responsibility for feeding children from parents to state”; “impacts on children”; and “protecting child, parent and teacher agency”. Like school food in general, the implementation of school meals in Australia remains divisive.

Conclusions: Transformational policy change faces many barriers, not least the elusive synergy between public and political will. This research highlights the need to understand the underpinning public discourse and to specifically address these when promoting national debate regarding school meals. For school meals in Australia to be implemented the concerns of the public, including students, parents, teachers, tax-payers need to be taken into consideration. 

The present research examined food fussiness in middle childhood with an aim to investigate the possible relevance of a dual processing model. In this model, food fussiness is assumed to be associated with bottom-up reactive or automatic avoidance responses together with top-down regulatory processes such as inhibitory control that are not powerful enough to overcome the avoidance. Parents reported their child’s fussiness on the Children’s Eating Behavior Questionnaire fussiness subscale containing 6 items and child’s temperament using the Children’s Behavior Questionnaire (CBQ) subscales of impulsivity, fear, shyness and inhibitory control.  It was expected that food fussiness would be associated with bottom-up avoidance as indicated by lower impulsivity (more behavioral inhibition or overcontrol), higher fear and shyness together with lower top-down inhibitory control. The study included 1188 Australian children (619 boys, 569 girls) aged 5 to 12 years. A total of 43% children were classified as “fussy” (32% severe and 11% moderate fussiness). The results were analyzed using hierarchical linear regression to predict food fussiness, investigating main effects and interactions. The final model showed that food fussiness was negatively associated with both impulsivity and inhibitory control. There was a significant interaction between impulsivity and inhibitory control, suggesting that higher food fussiness is associated with a combination of low impulsivity (more behavioral inhibition) and low inhibitory control. Although relatively small amounts of variance were explained and there are limitations in the chosen measures, the results suggest that an analysis of food fussiness in terms of higher bottom-up avoidance in tandem with lower top-down regulatory control warrant further research.

Purpose To summarise the evidence of benefits of sport for health among people aged 60+.

Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs). Data Sources included Medline, CINAHL, SPORTDiscus, the Physiotherapy Evidence Database from inception to April 2021. Studies were selected for inclusion if they were RCTs investigating the effect of any type of sport on health-related outcomes in people aged 60+ compared to non-active control, no intervention or usual care. The outcomes of interest included physical activity, social functioning (participation), physical functioning, cognitive and emotional functioning, well-being and quality of life. We calculated pooled effect sizes using random-effects models. Standardised mean differences (SMD) and mean difference (MD) were calculated. The GRADE system was used to assess the certainty of the evidence for analyses with ≥3 studies.

Results Nine trials (628 participants) reported in 15 articles were included. Participation in sport improved cardiorespiratory fitness (n=5 trials; MD=2.07ml.kg/min, 95% CI 0.89ml.kg/min to 3.25ml.kg/min; low certainty evidence), physical function (n=4; SMD=0.62, 95% CI 0.05 to 1.18; very low certainty evidence), fat mass (n=6; MD=0.99kg, 95% CI 0.30kg to 1.39kg; low certainty evidence) and mental health (n=2; SMD=0.28, 95% CI 0.06 to 0.51) among older people. We found no significant effects of sport on overall physical activity participation, strength, balance, lean mass, and bone mineral density (BMD). One study investigating quality of life reported a positive, but non-significant effect of sport. No studies investigated social functioning as an outcome. Three trials reported no adverse events (AEs), but most trials reported AEs and sport injuries (67% trials), and the average incidence was 249 injuries per 1000 hours of exposure, which is high but expected for older population. 

Conclusions Sport may have a positive impact on health outcomes in people aged 60+. There was uncertainty on the effect of sport on strength, balance, lean mass and BMD. Further research is needed to investigate the optimal type and dose of sport to maximise the long-term benefits among older people. Sport organisations should take into consideration appropriate injury prevention strategies when promoting sport participation among older people.

Purpose

To our knowledge, very few long-term or longitudinal studies have examined the association of psychosocial factors and physical activity (PA) in healthy older adults of 65 years and above. The purpose of this study was to determine the long-term association of psychosocial factors such as vitality, mental health, anxiety, and depression with PA duration and intensity of >3 MET in older adults using multilevel modeling.

Methodology

Healthy participants from Nakanojo, Japan, aged 66-90, who could walk were included and followed from 2008 to 2013. The study design was repeated cross-sectional. The exclusion criteria were dementia and depression. The independent variables were age, sex, and psychosocial variables, such as the HADS depression score. The dependent variable was the daily duration of PA intensity at a level greater than 3 MET, which was measured by an accelerometer. A multilevel model was created using these variables, and the Akaike Information Criteria was used to select the final model.

Results

The study included 1108 records from 319 participants. In the multilevel model, age (coefficient = -0.106, 95% confidence interval [CI] = -0.127 to -0.086, p <0.001) and the HADS depression scores (coefficient = -0.019, 95 % CI = -0.036 to -0.002, p = 0.026) were negatively associated with PA, and the mean effect of male sex (coefficient = 0.343, 95% CI = 0.115 to 0.571, p = 0.003) was positively associated with PA.

Conclusion

Depressive symptoms might be related to less PA among healthy older adults of 65 years and above. The relationship between depressive symptoms and PA, with a particular focus on older adults of 65 years and above, should be further explored in more longitudinal studies with objective measures.

Purpose:

Responders to the 9/11 World Trade Center (WTC) disaster suffer from overweight/obesity and high levels of post-traumatic stress disorder (PTSD). This study examines participant reported changes in nutrition knowledge, home food availability, sedentary behaviors, and physical activity among WTC responders in the WTC-Nutrition intervention with physical activity education.  

Methods:

Longitudinal analysis of data from the WTC Nutrition study, a 10-week pilot randomized controlled trial (MedDiet n=31 vs. Control usual counseling n=31), among WTC responders (age 45-65 years) with PTSD and overweight or obesity (N=62; males: 87%). Data were collected at baseline, post-intervention, and 3-month follow up. Participants completed an online survey assessing multiple psychosocial factors and 14-item Mediterranean diet survey; height/weight and waist circumference were measured and body mass index (BMI) was calculated. For continuous outcomes, between-group comparisons were conducted using nonparametric Wilcoxon rank sum tests, and pre-post within-group comparisons were conducted using Wilcoxon signed rank tests.

Results:

Both groups experienced significant increase in median Mediterranean Diet score and improvements in waist circumference and body mass index. At baseline, only about one third of participants were knowledgeable about the recommended intake of trans fats or saturated fats and only 6% about fruits and vegetables. The largest improvement from baseline to post-intervention was knowledge about recommended unsaturated fat consumption (14% to 20%). Only 20% and 15% responded correctly on MyPlate recommendations for starchy foods and fruits and vegetables, respectively. At baseline, participants reported spending 6.5 hours/day watching TV with a decrease of 1.5 hours at post intervention. Participants reported spending on average 180 minutes/week engaging in moderate exercise with an increase of 60 minutes/week at follow up.

Conclusion:

The WTC-HP Nutrition study involved a high-dose remote communication/education coupled with personal counseling targeting nutrition-related personal, behavioral, and home environmental factors including physical activity tips. Both groups showed improvements in their MedDiet score, waist circumference, BMI, nutrition knowledge, healthy food availability at home, and time watching TV and engaging in moderate exercise. A larger study is needed to confirm the findings and examine potential moderating factors.

Funding Source: CDC/NIOSH U01OH012057

Background

International guidelines recommend identification, screening, and referral to behavioural programmes for those at high risk of developing diabetes. Despite evidence that type 2 diabetes can be prevented or delayed in those at high risk, many eligible participants are not referred to, or do not participate in diabetes prevention programmes (DPPs). Healthcare professionals (HCPs) can influence a person’s decision to participate in DPPs and are pivotal to the referral and recruitment processes.

The purpose of this study is to identify, appraise and synthesise the evidence on barriers and facilitators to referral and recruitment to DPPs from the perspective of HCPs.

Methods

A ‘best fit’ framework synthesis method will be used to synthesise qualitative, quantitative, and mixed methods evidence on factors that affect HCPs referral and recruitment to DPPs, with the Theoretical Domains Framework (TDF) as the a priori framework. Peer reviewed publications will be searched for in MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus. Reference lists and citation searches will be performed. Eligible are studies published in English that focus on the HCP perspective of their experiences of referral or recruitment to DPPs. Year of publication will be restricted to the last 25 years (1997 – 2022) when the first of the landmark diabetes prevention studies was published. Quality will be assessed using the Mixed Methods Appraisal Tool. One author will screen, extract, appraise and synthesise the literature while a second author will independently verify a 20% sample at each stage. A third author will be consulted if consensus is required. A mix of deductive coding using the TDF and inductive coding of data that does not fit the TDF will be synthesised into themes representing the whole dataset. The relationships between the final set of themes will be explored to create a new model to understand HCP perspectives on referral and recruitment in DPPs. Sensitivity analysis will be carried out on the conceptual model that is developed.

Discussion

Participation in DPPs is key for programme impact. Understanding the HCPs’ perspectives of the barriers and facilitators to identifying, screening, referring and recruiting will inform future implementation of DPPs.

Purpose: The failure of physical activity (PA) interventions in the implementation and scale-up in the real world, previously found effective under controlled conditions, may be attributed to the different priorities of stakeholders and scientists. Therefore, the aim of our study was to understand the priorities and criteria for selecting suitable PA interventions among scientists and local stakeholders.

Methods: We conducted a three-round repeated Delphi study with local stakeholders (n=7) and international scientific PA experts (n=6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scores for the unique criteria and synthesize criteria into overarching categories.

Findings: The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria for selecting PA interventions being ‘free of costs’, ‘longevity’ and ‘integration into everyday school life’. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being ‘efficacy’, ‘potential for reach’ and ‘feasibility’. The top-ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to ‘evidence’. Synthesizing the priorities and rankings of both groups, we propose the following set of seven key criteria for the selection process of PA interventions in primary school children:  cost, sustainability, feasibility, potential for reach, efficacy, acceptability and social development.

Conclusions: Stakeholders and scientists demonstrated a fair overlap of criteria when selecting PA interventions, however, they substantially differed in their characterization and ranking which limited the agreement between both groups. PA interventions that incorporate a focus on the social development of children, that are low cost, feasible and acceptable, that are evidence-based with potential to reach many children and to be sustainable are most likely to be chosen by scientists and stakeholders. Keeping in mind these seven key criteria established will ensure that PA interventions are fit-for-purpose and potentially being implemented long-term in the real world.

Purpose: This study explores women’s experience of empowerment four years after completing Next Level Health (NLH), a 6-month holistic health program that worked in partnership with women to develop small health-promoting behaviours across the areas of physical activity, sleep, nutrition, eating behaviour, self-care and stress management. Findings from this study respond to the global agenda for women’s empowerment and lacking evidence regarding holistic health programs designed for women.

Methods: Past participants of NLH (n=55) were contacted 4-years post-intervention and invited to participate in the follow-up study. Participants completed a series of questions as either an online survey (Qualtrics) or interview (Zoom) and received a $40.00 NZD voucher of their choosing for their time. The questionnaire included 15 open-ended questions that addressed four topics: health, wellbeing and related behaviours; empowerment over health; evaluation of NLH; and any current barriers/needs regarding their health. Women’s responses were analysed by thematic analysis guided by the research question, “How have women experienced health-related empowerment since completing NLH?”. The survey responses were first reviewed and coded (Nvivo) to identify preliminary themes. The preliminary themes were then further deepened and refined upon reviewing and coding the interview transcripts. This study was approved by the Victoria University of Wellington Human Ethics Committee (#28812).

Findings: 44 women participated in the follow up study including 34 survey respondants and 10 interviewees. Three themes emerged regarding women’s experience of empowerment after NLH: Strengthening their support networks, ongoing development of health literacy, and constructing their own definition of health.

Conclusions: The resulting themes highlight the importance of women’s active role in designing behavioural goals and applying a holistic health perspective. The findings from this study contribute to a small pool of evidence that reports on the long-term impacts of empowering health programmes for women.

Purpose

There is limited surveillance of the 24 hours movement behaviours in Mexico among children under 10 years of age. Monitoring these behaviours is necessary for evidence-based decision-making for the promotion of healthy lifestyles. This study aims to implement the Mexican Movement Observatory (OMM), a system for monitoring children’s physical activity, sleep, and sedentary time through primary schools in Mexico. This work reports the pilot study protocol and preliminary results. 

Methos

The study comprises two phases: 1) A pilot study to assess the feasibility of the OMM within a diverse sample of schools, and 2) Improvement and upscaling at the national level. For phase 1, a cross-sectional study will be conducted on 12 public primary schools in central regions of Mexico. Children from grades 1 to 6 along with their caretakers will be asked to answer a self-completed short online survey on the child’s movement behaviours. Head teachers will be asked to report the school’s social and built environments conducive to physical activity. Data from these questionnaires will be mapped and openly available through the OMM website. An international board of experts on movement behaviours and population surveillance systems will guide the decisions about the Observatory. 

Results

Preliminary results on the percentage of children meeting movement behaviour guidelines will be presented. Information regarding the barriers and facilitators for implementing the OMM will also be presented, along with the required adaptations of the instruments and procedures for the following feasibility study and national scaling up. 

Conclusions

Through the Observatory, it is expected to generate evidence at the regional and/or national level on the movement behaviours of school-age children. Lessons learned from this pilot study will provide evidence to improve the OMM and facilitate its upscaling process and may provide relevant information for school-based observatories on other places sharing socio-contextual conditions.

Purpose: Physical activity (PA) is a key behaviour associated with both physical and psychosocial health. Research in older children suggests a potential beneficial association of PA with self-regulation, with findings also indicating that PA may be differentially associated with the different domains of self-regulation. However, evidence remains unclear in toddlerhood, which is a crucial period for the development of both PA and self-regulatory behaviours. This study aimed to examine the cross-sectional associations between PA and the cognitive, emotional, and behavioural domains of self-regulation and global self-regulation in toddlers.

Methods: Parents of toddlers (2-3 years?) were recruited to the Thinking Tots study via social media. Parents reported on their toddlers’ daily total PA (TPA) using a 4-item questionnaire adopted from the Let’s Grow randomised controlled trial.  Daily TPA was calculated using the weighted average of weekday and weekend TPA. Parents also reported on the frequency and duration of their toddlers’ different activities of moderate- to vigorous-intensity PA (MVPA) during a typical week (7 days) using the Early Years Physical Activity Questionnaire (EYPAQ; 6 items). Toddlers’ daily MVPA was then calculated using the EYPAQ norms. Parents reported on their toddlers’ self-regulation using the Early Years Toolbox – Child Self-regulation and Behaviour Questionnaire (17 items). After reverse scoring relevant items, global self-regulation and cognitive (5 items), emotional (6 items) and behavioural (6 items) self-regulation subscale scores were created by summing relevant items; higher scores indicated better self-regulation. Data collection is currently underway; data will be available by March 2023. Unpaired t-tests will be used to examine differences in PA and self-regulation between boys and girls. Linear regression models will be used to examine the associations between PA and the individual domains of self-regulation and global self-regulation, adjusting for child age, sex, and parental education.

Conclusion: This will be the first study to examine associations between PA and the different domains of self-regulation and global self-regulation. Understanding how different types of PA are associated with each domain of self-regulation may inform toddler-specific PA guidelines and intervention strategies to promote functional self-regulation skill development in toddlers. 

Purpose: Usually, school-based PA promotion is conducted by providing one specific intervention to schools. In contrast, the ACTIvity PROmotion via Schools (ACTIPROS) approach provides a set of 12 evidence-based PA interventions (the ACTIPROS toolbox) where schools can select interventions according to their prerequisites and have the option to replace unsuitable interventions within the school year. In this study, we tested the feasibility and acceptability of the toolbox approach at primary schools.

Methods: A two-arm cluster-controlled feasibility trial at primary schools (n=5 intervention schools, n=5 control schools) located in a city of Northern Germany was conducted. Children’s habitual PA (GENEActiv, Activinsights Ltd.) and motor skills (Deutscher Motorik Test; DMT) were measured at the beginning (t0: Sept and Oct 2021) and at the end of the school year (t1: June and July 2022). Between Nov 2021 and July 2022, the ACTIPROS toolbox was implemented at intervention schools. Action teams within intervention schools, consisting of children and teachers, were free to choose interventions from the toolbox. Teachers documented intervention choices and implementation within a short questionnaire (SIQ) at t1.

Results: In total, 20 classes (N=429 students) were recruited to take part in the study. The mean consent rate was 75.1% (n=322). At t0 and t1, n=304 (94.4%) and n=256 (79.3%) of consented children took part in the DMT, respectively. Half of the participating classes received accelerometers (t0: n= 166 students; t1: n=151 students). At t0, n=133 (80.1%) and n=106 (70.2%) valid records could be retrieved, respectively. Intervention schools successfully implemented at least one intervention, whereby two schools replaced the intervention during the school year. 7/10 intervention classes completed the SIQ. Intervention classes tended to choose similar interventions but implementation frequency was highly different. In intervention schools, accelerometry indicated a mean increase of 15.5min (95%CI: 4.5,26.6) in MVPA compared to controls.

Conclusions: All intervention classes were able to implement at least one intervention from the toolbox, and unsuitable interventions were successfully replaced in a timely manner. We achieved good response rates for accelerometer and motor skills data. The remarkable trend towards an increase in MVPA will be tested in a subsequent randomized controlled trial.

Purpose:

Sustainable development and transformational change have become more critical than ever. Higher education for sustainable development (ESD) aims to achieve that students not only understand sustainability problems but find solutions for them. The purpose of the present study was to increase knowledge on facilitators and barriers of pro-environmental behavior and the impact on experiential learning activity (ELA) for ESD on students learning.

Methods:

Reports from 39 students on their two-weeks behavior change for SD project were analyzed by the means of thematic content-analysis.

Results/findings:

Four main areas of behavior change were identified: increased physical activity (connected to less car driving), saving resources (e.g. recycling or less consumptions), sustainable food (e.g. ecological products or less meat consumption) and less screen time. Barriers and facilitators could be internal or external factors and were behavior specific. While lack of alternatives was most common barrier for changing food behavior (27%), sickness and weather were most common barrier for increasing physical activity (27%). Strategy/thoughtful planning was important facilitators for all behavior but mostly named in relation to physical activity and food behavior change (27 and 30%). Social factors (e.g. friends, families) could be both facilitating and hindering for almost all behaviors.

Conclusions:

Through experiential learning with a two-weeks individual behavior change project, students got novel insight and understanding on their individual behavior not only in relation to SD, but also understanding facilitators and barriers for making behavior change happens. This experiential learning project stimulated especially the development of self-awareness competency and not only capacity for change but the actually performance of change.

Despite the well-recognized benefits of physical activity (PA), only 29% of European youth meet recommended guidelines of at least 60 minutes of daily moderate-to-vigorous PA. if the prevalence of physical inactivity does not change by 2030, 499·2 million new cases of preventable major non-communicable diseases would occur globally. The school setting provides an ideal environment to promote healthy lifestyles among young people as initiatives can target all students and the whole school community. The main goal of the EUMOVE project is to design and implement a comprehensive set of strategies and resources to enable the educational community to promote healthy lifestyles in order to reduce risk factors for non-communicable diseases.

The EUMOVE project (https://eumoveproject.eu/) is a 3-year project delivered by a collaboration between academic and non-governmental institutions from Spain, Portugal, France, Italy, Belgium, and the United Kingdom. The direct beneficiaries of the project will include school leaders, teachers, and parents, and the indirect beneficiaries will be primary and secondary students. The EUMOVE project will develop a set of strategies and resources such as a Physically Active Lessons Toolkit, a Real-Time Active Breaks Platform, an Active School Commuting Toolkit, Learning Units about healthy lifestyles promotion, School Leaders and Parents Toolkits for promoting healthy lifestyles, and a Mobile phone APP. Project dissemination will be implemented across each partner region and includes online dissemination through a learning platform, scientific events aimed at teachers and researchers, workshops with teachers including training on how to use the teaching resources, and Workshops with parents providing recommendations for promoting a healthy lifestyle in their children.

Thus, the EUMOVE project offers evidence-based and innovative resources to be applied by the educational community in the real-world setting to promote PA levels, appropriate diet, and sleep habits, and reduce sedentary time amongst children and adolescents across a number of European countries.

Purpose:

This study sought to analyse the perspectives of participants on physical activity in general and the Active Women over 50 information and support program to optimise the design of physical activity interventions for this demographic.

Methods:

Twenty women who completed the Active Women over 50 trial were purposively recruited for maximum variation in age, employment, carer responsibility, medical conditions and physical activity. Individual semi-structured interviews explored their perspectives on physical activity, program components and suggestions for future iterations of Active Women over 50. Data were analysed thematically.

Results:

Our analysis found that participants’ capacity to be physically active was shaped by an interplay of factors operating at individual, social and systemic levels. Four themes relating to physical activity in general and to the program were identified: Age and gender matters, Physical activity is social, Strategising for physical activity and the Self-responsibility discourse. Taking these themes together it seems at this midlife stage, physical activity and program participation was challenged by personal, life-stage, cultural factors and the tension between those factors and a self-responsibility discourse. Social support and finding a suitable strategy for generating and sustaining motivation were deemed integral aspects of being active. Physical activity programs for women aged 50+ need to adopt an integrative approach to promote physical activity as part of overall health and life.

Conclusions:

A range of strategies is key to supporting women over 50 to be more physically active reflecting the variety of circumstances and levels of agency experienced. Programs could address the diversity of individual circumstances and motivators for physical activity by offering a range of flexible strategies and options, facilitating physical activity social networks, and building in accountability and feedback for being active. Sensitive program framing is critical to engage women supportively in addressing contextual challenges and taking responsibility that avoids self-blame. Such strategies do not need to be resource-intensive but could be incorporated into a scaled program.

Purpose:  The objectives of this project were: 1) systematically conduct need and priority assessments of the RE-AIM website (re-aim.org) usability; 2) iteratively improve the RE-AIM website structure based on testing input, and guidance from end-users and RE-AIM experts; and 3) compare RE-AIM website usability before and after modifications.

Methods: We applied a mixed-methods approach to obtain user feedback on the RE-AIM website among dissemination and implementation (D&I) science researchers and practitioners. Through survey questionnaires, we assessed usability (i.e., System Usability Scales [SUS]) and interactivity (i.e., Interactivity Scale) in a convenience sample of 24 participants at baseline and after two iterative rounds of website modifications (i.e., Round 1, Round 2). Qualitative assessments of usability through participant interviews were also at baseline, Round 1 and Round 2. We examined the changes in the SUS (0-100 scale, higher is better) and Interactivity scales from baseline (pre assessment) to Round 1 and Round 2 (post assessment) using a t-test. 

Results/findings:   We found significant improvements on system usability score (pre mean= 64.1, post mean =81.5, p<0.05) and interactivity (pre mean=3.5, post mean =4.0, p<.05) from pre to post assessment. 

Conclusion: A mixed methods, iterative approach led to significantly increased usability and interactivity. Primary qualitative findings from baseline and Round 1 included: the need to simplify the accessibility of information; to provide concrete guidance on RE-AIM framework for planning, implementation, and evaluation; and to clarify how contextual factors related to RE-AIM constructs. These findings resulted in online modifications including a new webpage with a tour guide, welcome video, new interactive planning tool, and a video introduction of contextual factors that influence RE-AIM outcomes.  Round 2 qualitative results suggested that the user experience was improved, the website contained useful information, and it was easy to use and navigate. While the update of the REAIM website is continuous, the key domains (i.e., homepage, grant writing resources, and resources and tool sections) realized from the present project may be salient to others seeking to build implementation science capacity through online resources.

Purpose

Despite the well-known benefits of physical activity, participation is low and declines with age. Promotion of physical activity by health professionals is effective in increasing participation.  We sought to inform the development of implementation strategies to support person-centred physical activity promotion by health professionals. This was achieved by exploring older people’s views and experiences of participation in physical activity, and its promotion by health professionals.

Methods

We conducted telephone or video interviews with 14 people aged 50+ years. Participants were recruited from rheumatology departments at two hospitals in Sydney, Australia and from a consumer panel at the University of Sydney.  Interviews were recorded and transcribed. Thematic analysis involved three authors developing codes independently, then working to agree on a framework which was used to code all transcripts. Themes were developed collaboratively between authors by reviewing codes and discussing overarching concepts.

Results

Five main themes were identified: 1) staying active to maintain a healthy body and mind; 2) searching for suitable options in the face of deteriorating health; 3) enjoyment and social aspects of activity as motivators; 4) staying active - motivation, routine and accessibility; and 5) COVID-19 impacts. All participants agreed that health professionals should routinely promote physical activity to their clients but several queried whether this was feasible given they were overburdened and short of time. Some participants reported advice about physical activity was regularly provided and highly valued, others felt that it was unnecessary because they were already active. Some reported that advice focused only on specific exercises, rather than holistic advice about incorporating physical activity in their daily lives. Preferred strategies to enhance promotion of physical activity by health professionals included better listening skills, collaborative goal setting and better knowledge of and connections to local, age-appropriate physical activity opportunities.

Conclusion

Positive health outcomes, enjoyment, social interaction, motivation, routine and accessibility were critical influences to physical activity participation over time. Promotion of physical activity by health professionals was valued. Health professionals could enhance physical activity in older people by employing person-centred behaviour change approaches and providing information and referral to suitable local opportunities.

Purpose: In this research, a model of the relationships of cognitive and physical function with health literacy that contributes to the health-related quality of life of older adults in Hong Kong was developed. The hypothesis that health literacy (HL) may act as a partial mediator between cognitive function (CF) together with physical functions (PF) and health-related quality of life (HRQoL) was tested.

Methods: Subjects were older adults, between the age of 50 and 80 years, who were recruited through local community centers and social media forum from March to July 2021. Totally, 490 older adults completed the survey. Four survey instruments included the 12-item Short-Form Health Literacy Survey Questionnaire (HLS-SF12) for HL assessment; Montreal Cognitive Assessment (MoCA) for CF; the Senior Fitness Test (SFT) for PF; and the 12-item Short Form Health Survey version 2 (SF-12v2) for HRQoL. Path analysis was conducted to test for the mediating effects of HL on the relationship of CF and PF towards HRQoL, based on the proposed theoretical model.

Results: Results indicated that three significant direct effects, including CF predicting PF (β=.115, SE=.012, p <.001), PF predicting HL (β=.101, SE=.022, p<.001), and HL predicting HRQoL (β=.457, SE=.049, p<.001), were observed. Meanwhile, the direct effect of PF for predicting HRQoL (β=.150, SE=.025, p<.001) as well as its indirect effect for predicting CL (β=.046, 95% CI [.028, .067]) were significant.

Conclusion: In conclusion, the hypothesized mediational model highlighted the effect of health literacy on improving older adults’ health-related quality of life under the influences of both cognitive and physical functions together was supported. Further empirical research and health promotion intervention programs that aim to improve health literacy that leads to better quality of life for the elderly population are viable.

Purpose: The proliferation of clinically available, evidence-based interventions (EBIs) that effectively help people eat better, move more, lose weight, and prevent chronic disease has increased the challenges, from patient and provider perspectives, in determining the best fit of an intervention for a given patient. We conducted a co-production strategy to facilitate the mapping of patient and provider needs to characteristics of research tested recruitment strategies with a goal of developing a prototype tool to promote access to, and utilization of, available lifestyle EBIs.

Methods: A Comprehensive Participatory Planning and Evaluation (CPPE) strategy was implemented across a sequence of 3 collaborative meetings each with primary care providers (n=8) and patients (n=15). The meetings included (1) the development of user-centered causal maps of facilitators and barriers to enrollment in lifestyle EBIs, (2) a review, prioritization, and adaptation of research-tested strategies to increase patient enrollment based on the causal maps, and (3) prototype development for recruitment strategy implementation in primary care settings. Qualitative data was interpreted collaboratively by the providers, patients, and researchers.

Results: Causal maps included shared and unique barriers and facilitators for patients and providers. Key factors to address were a lack of awareness of available EBIs, provider time to refer, and that patients expressed a strong interest in personalized referrals from providers, while providers felt overwhelmed with the number of potential referrals. Population health management (PHM), community wide, and mass media marketing strategies were assessed for degree of fit with patient and provider causal maps. PHM that leveraged automation within the electronic health record, gave providers autonomy, and allowed flexibility in how patients received personalized referrals was acceptable to patients and providers. Community-wide strategies were also positively reviewed, but that it may cast too wide a net and increase clinical workload fielding self-referrals. Prototype materials for both the population health management and community wide recruitment strategies were developed, revised, finalized, and approved by patient and provider groups.

Conclusions: The CPPE process resulted in the development a prototype recruitment system that addressed patient and provider concerns and preferences and has strong potential to improve access to, and utilization of, lifestyle EBIs.  

Purpose:

South West Sydney (SWS) with around 900,000 people has many migrant and refugee families and high socioeconomic (SE) disadvantage. With no reliable, comprehensive information available, a population-based cross-sectional telephone survey of parents/carers of children 5-16 years gathered data on overweight and obesity, child and family healthy lifestyle behaviours, perceptions and attitudes, to inform an eight-year community-based intervention.

Methods:

The survey identified SWS families with children 5-16 years using a randomly generated mobile telephone sample frame.  1815 parents/carers answered 70 questions, and 692 of these 30 additional questions about: child’s weight and height, demographics, child and family lifestyle behaviours, perceptions and attitudes. Descriptive analyses using SAS examined associations of BMI and demographic factors with attitudes, perceptions and behaviours. Data were weighted to the SWS population.

Findings:

Overweight was 19.7%, obesity 17.6%, and combined 37.3%, significantly higher than the NSW average (23%). 51.1% of children were a healthy weight. Low SE status was associated with higher obesity, and overweight and obesity combined: 53% in lowest income household, 32.7% for highest income (95% CI: 27.3-38%)). No SES differences were found for overweight.

88% of parents reported their child’s diet as healthy but 39% of children ate packaged snack foods >=1 per day and 18% drank >=1 cup discretionary drinks per day, higher for low SES children. Obese children were more likely to be offered snacks as a reward and their parents more likely to report intending to reduce child’s snacks and drinks. 50% of parents of obese children reported that the child was a healthy weight.

76% of children did not meet physical activity guidelines and overweight children were the least active. 79% met screen guidelines but data may be limited by parent self-report. Only 12% of obese and 9% of overweight children had attended an appointment for weight issues.

Conclusions:

Rates of overweight and obesity, and unhealthy lifestyle behaviours are high, particularly among low SES SWS children and families. The results have informed the ‘Growing Healthy Kids in SWS’ intervention, designed to provide more support for parents and work with communities to improve children’s healthy eating and physical activity behaviours.

Purpose: The gut microbiota (the trillions of microorganisms present in the digestive tract) has the ability to shape metabolism, influence other organs and affect several physiological processes. Its composition and functionality change throughout the lifespan and, as the host ages into older adulthood, its composition deviates towards a less healthy one, with higher abundance of pathogens and reduced abundance of health-related bacteria (dysbiosis).  Previous studies have shown that physical activity (PA)/exercise can alter the gut microbiome composition towards a healthier one, however, little is known about its effects in older adults, healthy or otherwise. Therefore, the aim of this study was to compare the gut microbiome of physically active vs physically inactive healthy older adults and to observe if there are any associations between body composition, active lifestyle and the gut microbiome composition.

Methods: This observational, cross-sectional study involved 100 healthy, community dwelling, UK older adults aged between 65- 85 years. Participants completed two questionnaires: a health questionnaire and a Food Frequency Questionnaire (FFQ). They then visited the laboratory and a series of tests were undertaken: a fasted fingerprick blood sample was taken to analyse the plasma lipidic profile, C-Reactive Protein, and glucose homeostasis; a faecal sample to assess the lower gut microbiota composition using 16s rRNA sequencing; several functional tests and a 6-minute walking test to assess physical function, mobility and cardiorespiratory fitness. Participants then wore an accelerometer for 7 days to monitor their physical activity levels and sedentary time.

Results: Data analysis is underway and will be presented at the conference.

Conclusions: The results of this study will add to our understanding of whether an active lifestyle is associated with the gut microbiota composition of older adults. The ultimate aim of this research theme is to determine if we can use PA as a tool to promote healthy ageing via the gut microbiome, therefore improving the quality of life of this population.

Introduction: In 2018, 50 million people were affected with dementia and this is forecasted to triple by 2050. An important way to “curb this tidal wave of dementia” is to prevent cognitive decline in high-risk groups such as older adults with mild cognitive impairment (MCI). Recent work has shown that the combination of PA and cognitive activity may have beneficial effects on older adults’ cognitive health, but studying new and effective ways to do so in MCI-patients is needed in dementia prevention. An intergenerational program (IGP) involving old and young generations together in one program might be an innovative and effective strategy. Only a few IGPs have been used to promote PA and most of them lack a theoretical basis or do not sufficiently meet the target groups’ needs. This study aims to develop and pilot-test a novel IGP for MCI-patients to improve their cognitive, physical and psychosocial health.                                                                 

Methods: The IGP will be developed using a theoretical framework in combination with a co-creation approach, actively involving MCI-patients in the intervention development. More specifically, ten interviews will be conducted with MCI-patients in which two existing interventions will be presented and evaluated: (1) an intergenerational PA lifestyle intervention for grandparents (65+) and their grandchildren, (2) a cognitively enriched walking intervention for older adults. Based on the information gathered in these interviews, one of these two interventions (or a combination of both) will be adapted to MCI-patients, using the ADAPT guidance as the theoretical framework. Qualitative data-analysis in NVivo will be conducted to evaluate the interviews. Thereafter, the program will be pilot-tested which will provide in depth information on its feasibility and acceptability. In this way, the program can be further fine-tuned and optimized before conducting an RCT. 

Results: No results are available yet, as the development and pilot-testing of the intervention will take place in February-March 2023 and May-June 2023, respectively. The first results will be available in April 2023.   

Conclusion: This study aims to develop and pilot-test an intervention that aims to improve cognitive, physical and psychosocial health in MCI-patients which might have important implications for future research.

Purpose: Online social platforms are potentially useful for disseminating public health interventions, especially to parents who seek child nutrition information online. However, to optimise social media interventions, health professionals need to understand how to reach and engage the target audience. The Parents in Child Nutrition Informing Community (PICNIC) peer-education nutrition program uses social media to educate parents/carers of young children (0-2 years) about feeding practices that influence children’s eating behaviours. Four or five posts per week are shared on the PICNIC Facebook page (>2’000 followers in Apr-2022). This study aimed to describe PICNIC’s social media post characteristics, and identify features that determine post performance in terms of organic (non-paid) reach and engagement.

Methods: Post performance data were exported from the PICNIC Facebook page for posts uploaded from Jan-2020 to Apr-2022. Intervention posts (n=436) were evaluated in an iterative coding process using an eleven-domain social media coding framework adapted from existing frameworks/tools to fit PICNIC’s content and strategies. Associations between coded post characteristics and organic reach (number of users reached) and engagement (comments/shares/reactions/clicks) were explored using the Least Absolute Shrinkage and Selection Operator (LASSO) regression method in R. Page followers at time of posting were included in the analyses to account for program growth over time.

Results: Photo format posts reached more users than video posts, but video posts drew 36% more silent engagement (clicks) than photo posts. Posts based on original content had higher reach than re-posted or re-shared posts. Posts linking to the PICNIC website were associated with lower reach. Post characteristics that were independent positive predictors of user engagement included original posts, instructive communication techniques, and feeding messages about food restriction or fussy eating. Instructive posts (using illustrative ‘how-to’ messages) had 22% higher total engagement compared to informative posts.

Conclusion: This study identified that parents in an online child feeding program engaged more with social media posts that were instructive or in video-format, with content relating to food restriction or fussy eating. Social media platforms evolve constantly, so eHealth interventions utilizing these platforms require continuous post performance evaluation to optimise reach and engagement with the target audience.

Purpose

Interactive electronic devices (IEDs), such as tablets and smartphones, are standard in young children’s lives. Evidence on the benefits and adverse impact of IEDs amongst young children is inconsistent. A positive association with literacy development, problem‐solving, and self‐efficacy has been reported in young children, mainly when the content is co-viewed with parents. However, the evidence on socio-emotional, self-regulatory, and behavioural problems is inconclusive. The aim of this study is to understand and contrast the views of early years practitioners working from nurseries in low and high-income areas on the use of IEDs.  

Methods

We conducted semi-structured interviews with four early years practitioners (EYP) from two nurseries located in low (n=2) and high (n=2) income areas in the Northwest of England. Managers and EYPs with more than 20 years of teaching experience took part in the interview. The data were analysed thematically using a framework approach.

Results

EYPs from both nurseries agreed that interactive electronic devices could be a valuable resource for early years learning to improve vocabulary, particularly for children with special education needs, and to illustrate learning. However, they argued that it should not be used in isolation and requires interaction with humans.

EYPs, particularly from the nursery in the low-income area, felt that interactions between parents and children are “not as high quality” as they used to be, as parents are constantly on their phones. An EYP stated that children learn from parents and the environment, and the lack of interconnection could affect their development. They were concerned that IEDs are used as a “babysitter” when children are distressed rather than “talking through” an emotion. Other concerns were the impact on school readiness and sleep. They highlighted the need for understanding the effect of IEDs on early years development and training for EYPs and parents.

Conclusion

EYPs suggest that although IEDs might benefit some areas of children’s learning, frequent parent use of these devices and lack of interaction with the world might affect children’s social and emotional development. Further studies should focus on understanding IEDs on development outcomes in the early years.

Purpose

Physical activity (PA) has beneficial effects on physical and mental health outcomes in older adults. However, a consistent decline in PA participation has been noted with increasing age, with older adults consistently being reported as the least physically active population. Previous evidence showed that dance is an appropriate form of PA in older adults as It integrates body’s movement with physical, cognitive, and social elements. This study investigated the feasibility and efficacy of a weekly dance programme over a 12-month period on PA levels and wellbeing.

Methods

A mixed-method intervention design was used. Community-dwelling older adults aged 55+ years were recruited from local community groups in Yorkshire (UK). The programme comprised of a 60-minute mixed genre dance class per week. Changes with carried forward data in self-reported measures of PA (min/week) and wellbeing with EuroQol visual analogue scale (EQ VAS) across four different time points (baseline, 3, 6 and 12 months) were assessed using the Friedman test. Feasibility was also assessed through class attendance and focus groups (N=6-9) with participants. A thematic analysis of qualitative data was conducted.

Results

A total of 685 participants (589-89.1% females and 72-10.9% males) took part in the study. The mean age was 75 ± 10 years, and 38% of the participants were classed as highly deprived as per the index of multiple deprivation. There was a statistically significant increase in both PA (X2(3) = 192.42, P<0.001) and EQ VAS scores across the four time points (X²(3) = 19.66, P<0.001). The mean adherence rate was consistent across the 12-month period of intervention (70%). Themes from the focus groups included reasons for participating in the programme, perceptions of how the dance programme affected the participants, and facilitators to participation in the programme.

Conclusions

The good adherence and favourability indicate that the dance programme is feasible as an intervention in community-dwelling participants from socially economically diverse communities. The dance intervention showed a positive effect on PA levels and wellbeing. A randomised-controlled trial with a control group is required to test this intervention further.

Purpose

Physical activity may improve children’s mental health and well-being. However, globally, 81% of youth are not meeting the recommended 60 minutes of moderate-to-vigorous physical activity per day. Despite schools being an ideal setting to improve children’s physical activity, many children are forced to wear traditional school uniforms (e.g., dresses, black leather shoes) that may limit their opportunities to be physically active at school. The aim of this study was to explore the impact of an activity-enabling uniform intervention on primary school-aged children’s subjective well-being and Health-Related Quality of Life (HRQoL).

Methods

A cluster randomised controlled trial was conducted in 13 primary schools in New South Wales, Australia with children in grades 4-6. Schools were allocated to either intervention or control groups (i.e., usual practice) following baseline data collection. Children from intervention schools were asked to wear their existing sports uniform each day at school. Children’s self-report subjective well-being was assessed using the 5-item World Health Organisation (WHO) Five Well-Being Index. Raw scores range from 0 (i.e., absence of well-being) to 25 (i.e., maximal well-being), which are converted into a percentage scale. Children’s self-report HRQoL was measured using the Child Health Utility 9D (CHU9D), whereby generated scores range from full health=1 to dead=0. Linear mixed models will be used to compare children’s subjective well-being and HRQoL between intervention and control groups. Analyses will be performed following intention-to-treat principles. Data is scheduled to be analysed on completion of final data collection (December 2022).

Results

Baseline data were collected from 684 children from 13 schools; 637 of which completed data for the well-being and 581 for the quality of life outcomes. The mean age of children (SD) was 9.83 (0.77). At baseline, the mean (SD) score for children’s subjective well-being and HRQoL was 65.96 (20.46) and 0.72 (0.22), respectively. Planned analyses will demonstrate differences in subjective well-being and HRQoL between the intervention and control schools at follow-up.

Conclusions

Activity-enabling school uniforms is a simple approach that may lead to important benefits for children’s school-day physical activity levels as well as broader well-being and HRQoL outcomes.

Purpose: While goal setting research has traditionally suggested that challenging and specific goals are beneficial for performance, contemporary evidence has suggested that other goal types might be advantageous under some conditions, such as when pursuing goals related to new, complex tasks. Furthermore, the motivation underpinning goal pursuit (i.e., autonomous and controlled goal motives) has consistently been related to different outcomes relating to goal pursuit.

The present study addresses a gap in existing research by examining the interaction between goal types and goal motives, in relation to outcomes such as performance outcomes during a simple and complex task.

Methods: Using a between-within (goal type: specific, open, learning x task complexity: simple vs complex) study design, participants, (n = ~90), will complete the Corsi Block Tapping test (CBT) and the Walking Corsi test (WalCT). The CBT will be completed first to establish a baseline performance score to be pursued during the WalCT. Participants will subsequently be randomly allocated to a specific, open, or learning goal to be pursued in the WalCT, in which they will complete both simple and complex conditions in a counterbalanced order. Before each attempt at the task, participants will report their motives for their goal, perceptions of goal difficulty, importance, efficacy, and expected goal attainment. Following each trial will be completed measures relating to challenge/threat appraisal, future interest to participate, and perceived complexity.

Results/findings: Data collection is ongoing. The data will be analysed using a MANOVA to assess the effects of goal types and motives on WalCT performance, future interest to participate, challenge/threat appraisal, and an ANOVA repeated measures, within-between interaction to assess the effect during the simple and complex condition.

Conclusions: As one of the first studies to examine goal types in relation to goal motives, the outcomes of this study will enhance how to better performance through effective goal setting. Additionally, the assessment of the interaction between goal types and goal motives under a simple and complex condition offers novel insight into how the context of a task influences goal attainment and one's belief in themselves to complete the task.

Purpose: Effective methods are needed to promote mental well-being, prevent mental health problems and to improve cognition in schools. Therefore, the aim of this study was to evaluate the effects of a school-based intervention on cognitive functions and mental health in Swedish adolescents.

 Methods: This cluster-randomised controlled pilot trial included adolescents aged 14-15 years from six schools (2 intervention/4 control) around Stockholm, Sweden with a variation in socioeconomic background. The intervention was performed during an extended school day, 60 minutes three times per week, during one school year and included: a) physical activities, b) homework support with activity breaks and c) walking and listening to audiobooks. Outcomes were measured at baseline in the autumn 2021 (n=193) and after the intervention in the spring 2022 (n=172). The mental health outcomes, health-related quality of life (HRQoL) and psychosomatic health were measured with questionnaires (KIDSCREEN-27 and Psychosomatic Problems Scale). Cognitive functions (working memory, episodic memory and perceptual speed) were measured by a computer-based test battery. Group differences were analysed with ANOVA analysis, adjusted for baseline values.

 Results: There was a significant difference between the intervention and control group in perceptual speed for the whole group (p=0.036, mean difference (MD=18.8), n=171) and for boys (p=0.049 MD=35.2, n=83) after the intervention. There were no significant differences between groups in mental health outcomes for the whole group, after the intervention. However, for boys there was a significant difference between groups in psychosomatic health problems (p=0.02, MD=-2.3, n=76). There were no significant differences between groups in the other variables.

 Conclusions: This pilot study shows positive intervention effects on perceptual speed and psychosomatic health, in particular among boys. A larger randomised study is needed in order to evaluate intervention effects further. Also, the intervention components need to be adapted to better suit girls’ needs and preferences.

Purpose

The Centre Léon Bérard (CLB), a member of the UNICANCER federation, has created a digital platform dedicated to Adapted Physical Activity (APA), with the main objective of facilitating the follow-up of patients throughout their care and putting them in touch with other patients and the establishment's sports partners in order to develop a community and motivational approach to physical activity.

Methods

To carry out this project, we set up three groups of users of the future platform: patients, CLB professionals and sports partners.

We then carried out brainstorming sessions with each group to gather their expectations and needs with regard to the platform. Then, two scoping workshops were set up with digital health experts, motivation experts and representatives of each user group to prioritise the needs.

·         → Patients: to have a better visibility on their APA programme, to carry out exercises in autonomy (videos, games, challenges, ...) and to be able to interact with each other, with CLB professionals and partners

·         → CLB professionals: develop a tool to facilitate the follow-up and personalisation of the patient's APA programme

·        → Partners: to facilitate the transition from hospital to city in the management of the patient, with better communication with CLB professionals and to be more visible to patients

Results

The launch of the platform is planned for January2023.

·        → Patients will have more resources to be actors of their APA pathway and they will also have the possibility to exchange with their peers according to their needs. 

·     → For CLB professionals, this tool will facilitate the coordination of the patient's pathway. It will also be a way to encourage patients to practice.

·        → Partnerships will be more visible to patients and will have access to patients' previous activity data

The platform will improve the follow-up of patients over time, with a patient file fed directly by the patient and by external partners.

This platform is supported by the Ministry of Health and Sports and will be used by the 17 other UNICANCER establishments.

Conclusions

This was developed with an inclusive approach, involving the different users, and opens a new era of digital support in cancer care.

Purpose:

In Amsterdam – the Netherlands – we know that children living in low-income households have a lower health status and report lower physical activity levels than their peers in middle- or high-income households. Seven primary schools located in neighborhoods with a low social-economic status are currently developing their own active school using the ‘Creating Active Schools Framework’.

This study was conducted to assess the current physical activity and sedentary behavior patterns during and after school of the pupils in these seven primary schools.

Methods:

In this cross-sectional study, we collect data in seven schools located within an Amsterdam neighborhood with a low social economic status score. Within each school, 4 classes are eligible for participation. Children wear an accelerometer from Monday morning until Friday afternoon to assess physical activity levels. Parents of participating children are asked to complete a questionnaire on baseline characteristics, wellbeing and out of school physical activity behaviors. The mean sedentary time (ST), low physical activity (LPA) time and Moderate to Vigorous physical activity (MVPA) time will be calculated. The association between the outcomes of the accelerometer data and gender and health related outcomes reported by parents will be assessed. 

Results/findings:

The data will be collected between March and May 2023. We will present the average LPA and MVPA during and after school time. The duration of the ST bouts during and after schooltime. And associations between ST, LPA and MVPA and gender and health related outcomes.

Conclusions:

The results of this study will be used to support local school teams in the development and implementation of local action plans towards a school day that involves less sitting and more physical activity. 

Background: Universal provision of preventive health services for families is a key to optimise health outcomes and prevent the onset of overweight and obesity in the first 2000 days of a child life. Whilst services such as Child and Family Health Nursing Services (CFHNS) are available to support young children’s development, ongoing engagement with face-to-face services declines significantly over time. Interventions delivered direct to parent/carer mobile phones (mHealth) presents a significant opportunity to supplement usual face-to-face care and revolutionise delivery of health care at a population level. Despite this, there are currently no mHealth interventions targeting child health and development covering the first 2000 days, implemented as part of routine care in Australia. This presentation outlines the development of an mHealth initiative being delivered universally to parents/carers to support the prevention of overweight and obesity across the first 2000 days. Phase 1 seeks to evaluate the acceptability, feasibility, appropriateness and cost of a highly scalable mHealth service from the perspective of clinicians and parents/carers when delivered as a service embedded within a health organisation.

Methods: Designed using the COM-B model of behaviour change, an mHealth (text-message) service has been co-designed by a multidisciplinary team to support parents/carers to make informed health choices aligned to age and stage milestones and consistent with best practice and policy guidelines. The intervention currently supports sustained breastfeeding, introduction of solids, sleep behaviours, developmental and immunization reminders and maternal wellbeing (0-6month phase).

Results: Commencing in 2021 as a pilot in five CFHNS the program has been delivered to ~2000 families, capturing 96% of parents/carers of newborn infants. Semi-structured interviews (clinicians) and cross-sectional phone surveys (parents/carers) are in progress to evaluate implementation. Preliminary data indicates high acceptability from a clinician and parent perspective

Implications: Following formal evaluation the service will be scaled-up at a regional level and expanded to address multiple key health and development outcomes to prevent overweight and obesity from birth to 5 years, with significant potential to tailor content and support screening/early intervention via the mHealth service.

Purpose:

Obesity in adolescence is associated with increased risk of obesity in adulthood and many other adverse health consequences. Physical activity is a modifiable lifestyle behaviour towards prevention of these complications. However, many overweight and obese adolescents are physically inactive due to various personal, social and environmental factors. While there are numerous interventions targeting physical activity in adolescents, few were grounded by underlying behavioural change mechanisms which could determine their effectiveness. Behavioural tools such as the Theoretical Domains Framework (TDF) and COM-B model have been used to understand behaviours for intervention development in order to increase its effectiveness. This study aimed to identify perceived barriers and enablers to physical activity in overweight and obese adolescents using these behaviour change strategies.

Methods:

Semi-structured interviews were conducted with a purposive sample of thirteen overweight and obese adolescents recruited through social media platforms. Interviews were recorded and transcribed into Atlas.Ti software. Thematic analysis and framework approach were used for data analysis, in which the key themes identified were deductively mapped to the TDF domains and the COM-B constructs.

Results:

Ten out of fourteen domains of the TDF were found to influence physical activity behaviour in overweight and obese adolescents. Within these domains, important barriers to engage in physical activity behaviour were lack of energy due to excess weight, perceived lack of competence in physical activity, competing interests such as preoccupation with digital devices, lack of family and peer support, lack of motivation to be physically active and environmental influences which limits their participation in physical activity. Important factors reported to enable engagement with physical activity behaviours were having social opportunity to engage in physical activity, enjoyment towards physical activity, having goals and motivation to be physically active and prioritizing time for exercise.

Conclusion:

Overweight and obese adolescent’s capability, motivation and opportunity to engage in physical activity were influenced by a wide range of barriers and enablers, with “social influences” being the most often reported barrier. This study provides a theoretical evidence base towards informing the development of a theory-informed behaviour change intervention to improve physical activity levels among overweight and obese adolescents.

Purpose: Greater nutrition knowledge is associated with healthier dietary intake. Yet, few studies have employed objective measures of nutrition knowledge to understand patterns among youth, including little cross-country comparisons. Using a simple, functional measure of nutrition knowledge based on level of food processing, this study investigated associations between objective and self-reported measures of nutrition knowledge and indicators of dietary intake among youth in six countries.

Methods: National surveys were conducted in 2020 with 12,489 youth aged 10-17 in Canada, Australia, United Kingdom, United States (US), Mexico, and Chile. Participants were shown two products in random order, corresponding to “minimally processed” (apple) and “ultra-processed” (apple-flavoured fruit drink) foods under NOVA classification system, and asked to rate the healthiness of each. Respondents who rated the apple higher than the fruit drink were assigned a “correct” score. Binary regression models examined differences in “correct” responses between countries, and associations with perceived nutrition knowledge, perceived diet healthiness, fruit/vegetable and less healthy (e.g., sugary cereal) food intake.

Results: Mexican (96.5%) and Chilean (94.3%) youth were most likely to correctly identify minimally processed food items as “healthier”; whereas correct responses were lower among US (79.6%) youth compared to all other countries (p<.001 for all contrasts). Differences in correct responses were also observed by sex, income adequacy, and BMI (p<0.01). Across countries, perceived nutrition knowledge was inversely associated with correct scores (F 83.10, p<0.001). Similarly, respondents at the highest (AOR 0.43 p<0.001) and lowest (AOR 0.57 p<0.05) ends of perceived diet healthiness had lower odds of obtaining correct scores than those in the middle. Higher intake of less healthy foods (AOR 0.70, p<0.001) and fruits/vegetables (AOR 0.87 p<0.001) were likewise associated with lower odds of correct scores.  

Conclusions: In a simple, functional test, substantial proportions of youth were unable to identify a minimally processed apple as healthier than an ultra-processed apple drink, with notable differences across countries and sociodemographic groups. The observed dissonance between perceived and objective measures highlights the poor reliability of self-reported nutrition knowledge, warranting further refinement of simple objective measures to investigate the complex interplay of nutrition knowledge and dietary behavior.  

Purpose: When children engage in adequate levels of physical activity (PA) and limit sedentary behaviour (SED), they are likely to experience many health-enhancing benefits. Sports can promote higher levels of PA and can displace SED, promote positive youth development and other social and psychological benefits, while also being fun for children. Children can play sport at different levels, with higher competitive levels being associated with higher training loads and expectations of performance, yet, it is unclear if sport level is associated with higher PA levels and lower SED levels. We explored the associations between the level of sport engagement and accelerometer-measured PA and SED of children from Northeastern Ontario.

Methods:169 students (50.9% male, M_age = 9.25 years old) wore GENEActiv accelerometers for 7 days on their non-dominant wrist. They reported the level of sport they engaged in (parent-reported for children in Grade 5 or younger). SED, moderate and vigorous PA (MVPA), and sleep duration were estimated using GGIR. Associations were tested with linear regressions.

Results: Participants engaged, on average, 77.8±30.6 min/day in MVPA, 216.0±42.0 min/day in LPA, and 602.0±83.8 min/day in SED. 16.6% reported not participating in sports, 43.8% participated in school intramurals or recreational sports, 11.2% were part of schools sport team, and 16.6% were part of provincial or club competitive teams, with 11.8% reporting engaging in other non-sport PA. Being on a school sports team (β= 25.4, 95%CI 9.0; 41.8) and school intramurals or recreational sports (β= 15.0, 95%CI 2.6;  27.4) was associated with higher MVPA and lower SED (β= -66.6, 95%CI -104.1; -29.2; and  β= -38.5, 95%CI -67.0; -10.1, respectively) compared to not engaging in sports. LPA was higher among those who participated in school intramurals or recreational sports, participated on schools sports team, and those in provincial or club competitive levels compared to not engaging in sports.  

Conclusions: Sports are an important way to promote PA and limit SED among children. Even at a recreational level, the levels of MVPA are as high as more competitive sports levels.

Purpose: Exercise referral schemes (ERS) reduce depression but the additional effect of web-based behavioural support is unknown. e-coachER was a web-based support programme aimed at increasing MVPA for people with chronic conditions. e-coachER comprised 7 'Steps to Health’ and aligned with Self-Determination Theory (SDT) and behaviour change techniques (BCTs). This secondary analysis reports the effects of e-coachER on depression, anxiety and MVPA in the trial participants with elevated depressive symptoms and investigates whether these were influenced by key processes linked to the intervention logic model.

Methods: Of the original 450 adults recruited into the e-coachER trial, 205 had at least mild depression, based on the Hospital Anxiety and Depression Scale (HADS), and were included in the present analysis. Data collected included the HADS, accelerometer measured and self-reported MVPA and survey items on key processes. Linear mixed models were used to compare groups for change in depression and anxiety at 4 and 12 months. We also examined whether changes in physical activity and process variables at 4 months mediated changes in depression and anxiety at 12 months.

Results/findings: At four months, those randomised to e-coachER reported improved levels of depression (-1.36, 95% CI: -2.55 to -0.18) but not anxiety, or MVPA, compared with controls. No differences were observed at 12 months for depression, anxiety or MVPA. Intervention effects on MVPA did not mediate improvements in depression or anxiety. However, intervention effects on confidence (-0.40, 95% CI: -0.82 to -0.04), competence (-0.33, 95% CI: -0.82 to -0.004) and self-monitoring (-0.29, 95% CI: -0.65 to -0.02) at four months significantly mediated the reduction in depression at four months. Intervention effects on competence (-0.33, 95% CI: -0.77 to -0.02) and self-monitoring (-0.26, 95% CI: -0.61 to -0.02) at four months also significantly mediated improvements in anxiety at four months.

Conclusions: Web-based support leads to greater reductions in depression at 4 months compared to exercise referral schemes alone. Changes in depression and anxiety can be influenced by changing people’s motivational regulations toward physical activity. e-coachER may represent a low-cost option to reduce the burden of depression and anxiety in the context of exercise on referral.

Purpose: The benefits of physical activity across the cancer continuum for many adult cancers are well established. Previous advice for patients to rest during cancer treatment is now redundant and physical activity during and after treatment has been endorsed by the World Health Organisation. However, physical activity is yet to be routinely implemented into cancer care in many health services around the world. This study explored patients’ and healthcare professionals’ views about integrating conversations and support for physical activity into routine care during treatment for cancer.

Methods: Using semi-structured interviews this study explored the perceptions and practicalities of integrating the routine promotion of physical activity by healthcare professionals within cancer care. Healthcare professionals including oncologists, surgeons and cancer nurses, and patients living with or beyond breast cancer, were invited to take part in online interviews. Snowballing sampling methods were used to recruit both healthcare professionals and patients across the UK. The study was advertised via social media, cancer support groups and newsletters. Data were analysed using inductive thematic analysis.

Findings: Four themes captured current practice, perspectives and barriers to integrating conversations and support for physical activity among 12 health care professionals and 15 patients. These were: (1) healthcare professionals feared discussing physical inactivity with all patients without having evidence based resources and knowledge for a solution to the problem; (2) physical activity is only discussed if physically active patients are seeking approval to continue; (3) healthcare professionals and patients had concerns regarding the logistics and practicalities of attending in-person  physical activity sessions during cancer treatment; (4) physical activity was perceived as a lifestyle change, rather than having an impact on cancer treatment related outcomes and the potential to reduce risk of recurrence.  

Conclusion: Many healthcare professionals who offer cancer care are reluctant to raise the topic of participation in physical activity with their patients. Providing healthcare professionals with education regarding the ability of physical activity to reduce the risk of recurrence, along with evidence based, low-cost, remote interventions would allow them to more readily integrate conversations about physical activity within routine cancer care for all patients.

Background: Social media holds promise as an intervention platform to engage youth in healthy weight management and target racial inequities in obesity.

Objective: This pilot study aimed to examine social media habits, preferences, and obesity-related behaviors (e.g., diet, physical) among adolescents of color and identify their preferences for a healthy weight management intervention delivered via social media.

Methods: This mixed-methods pilot study comprised of a cross-sectional online survey and a series of virtual focus groups. Study participants (English-speaking youth of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous online survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45-60 minute virtual group discussions assessing social media habits, preferred social media platform, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach.

Results: A total of 101 adolescents completed the survey and N=20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (e.g., content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet.

Conclusions: Findings from this pilot study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media-based interventions to engage adolescents of color in healthy weight management content and test intervention efficacy.

Purpose: The objective of this study was to determine the effectiveness of a 6-month mHealth behavior change program on healthy diet, physical activity, and sleep in adults over 18 years of age. 

Methods: This was a Quasi-experimental, repeated measures, mHealth study conducted over six months.  All adults over the age of 18 years were eligible to participate.  Key components of the study included: 1) direct access to experts in nutrition and exercise sciences, 2) a focus on physical activity and behavior change, 3) personalization to the individual/community, 4) social support through virtual interactions and weekly challenges, and 5) multimedia format to increase accessibility and usability of information.  The program was based on Self-Determination Theory (SDT), goal setting theory and the socioecological model. All participants completed an online survey at baseline, 3 and 6 months. The questionnaire was administered via Qualtrics and included previously validated questionnaires on diet (adapted FFQ), physical activity (iPAQ), and sleep (PSQI). To assess the change in behaviors mixed models to account for multiple assessments within individuals were used. 

Results/Findings: 60 people signed up to participate and 21 completed the full study (age 44.3 + 15.8; Sex (F) 17 (81%); BMI 30 + 7.2; number of preexisting health conditions 2.5 + 1.9).  Of those completing the full study, 20 participants reported they were ready to make changes in eating and physical activity behaviors at the start of the study. Participants completing the study increased self-reported physical activity (total metmin/week) from 4,479.4 + 1,669.4 at baseline to 6,394.6 + 2,590.6 at 6 months, although not significant (p=0.680).  Fruit intake (servings/day) increased from baseline (0.24 + 0.09) to 6 months (0.57 + 0.11; p<0.05). However, there was no change in vegetable and junk food intake. Self-reported sleep also improved from baseline (5.8 + 0.7) to 6 months (4.4 + 0.7; p<0.05) with higher scores indicating poorer sleep quality.

Conclusions: Multi-media mHealth programs have potential to change behavior to improve dietary patterns, physical activity, and sleep. Additional research is needed to ensure engagement of participants in long-term behavior change programs.  Future research will focus on healthy habits throughout the lifespan.

Purpose

Interventions to increase physical activity (PA) in adolescence face major challenges. In addition to the difficulty of influencing PA behavior of adolescents due to increasing autonomy, PA behavior is often not maintained for a long period of time. The aim of this study is to understand the variation and dynamics of lived experiences of adolescents around the barriers and facilitators of maintained PA. This study is a first step in moving beyond one-size-fits-all interventions towards more tailored approaches.

Methods

Thirty high school students, aged 14 – 18, were recruited for interviews in Rotterdam, The Netherlands. Based on Q methodology, participants were asked to sort and rank two decks of cards according to personal relevance for a physical activity that they had maintained for longer. Each deck represented barriers or facilitators of adolescent PA behavior, based on previous interviews and systematic reviews. After ranking the items, participants were interviewed about how the items had changed and influenced their PA behavior over time. Next to thematic analysis of the interviews, the ranked items were analyzed using inverted factor analysis to explore the barriers and facilitator clusters.

(Preliminary) findings

Our preliminary results show that adolescents have common and divergent barriers and facilitators to maintain their PA behaviors. For example, ‘having fun’, ‘being able to be yourself’ are recurring facilitators, while life factors such as ‘other responsibilities’, ‘having too many things on my mind’ were recurring barriers in the sample. Using inverted factor analysis, we also explore the variety of barriers and facilitators of PA by identifying clusters of barriers and facilitators of adolescents who share similarities. The initial results suggest that the barrier and facilitator clusters are distinct and focus on different domains such as performance, social environment, personal development, and health reasons.

Conclusions

The initial findings suggest that some facilitators and barriers for maintaining PA are more universal between adolescents, but others are only relevant to specific groups. The results of this study will be used to design a tailored PA intervention for adolescents. Data analysis is ongoing and the final results will be presented during the event.

Purpose: There has been strong theory-driven and empirical literature demonstrating the association between facilitating health beliefs and vegetable consumption. However, these associations have been rarely explored simultaneously with program participation in interventions such as produce prescription programs. The purpose of this study was to examine if theory-informed facilitating health beliefs were associated with meeting vegetable consumption recommendations and/or continued program participation in a produce prescription program.

Methods: This study was a cross-sectional data analysis of baseline survey and refill data among participants in a produce prescription program at a federally qualified health center in Waco, Texas in 2019 (n=1,679). The baseline survey included seven questions regarding facilitating health beliefs (informed by the Theory of Planned Behavior) of vegetable consumption that were averaged to develop a composite measure. Vegetable consumption was self-reported, and a binary variable was created for meeting United States dietary guideline recommendations. Age, language, and whether the participant obtained refills were also collected. Summary statistics and logistic regression models were used to examine the associations between: 1) facilitating health beliefs and meeting vegetable consumption guidelines; 2) facilitating health beliefs, meeting vegetable consumption guidelines, and obtaining a refill.

Results: Participants were, on average, aged 49.66 years (S.D.=19.32), predominantly only English speaking (89.34%), 28.53% met vegetable consumption guidelines, and 11.20% obtained a refill. Individuals with high facilitating health beliefs had greater odds of meeting vegetable consumption guidelines at baseline (aOR:1.43, CI:1.21-1.69, p<0.001). Participants who met vegetable consumption guidelines had greater odds of obtaining a refill (aOR:1.85, CI:1.34-2.54, p<0.001) than those who did not meet vegetable consumption guidelines. There was no statistically significant association between facilitating health beliefs at baseline and obtaining a refill. Additionally, participants who spoke a language other than English had an indirect association with meeting vegetable consumption guidelines (aOR:0.55, CI:0.37-0.81, p=0.003), but a direct association with obtaining a refill (aOR:1.79, CI:1.16-2.77, p=0.009) when compared to solely English-speaking participants.

Conclusions: This study highlights that dietary interventions, such as produce prescription programs, should be mindful of theory-informed facilitating health beliefs as potential antecedents for nutritional behaviors of interest and sustained program participation.

Purpose: Previous studies suggest that adolescents with ADHD may have unhealthy food habits and that they engage in insufficient physical activity. The thoughts and experiences of adolescents with ADHD are of great importance in search of knowledge essential for promotion of healthy lifestyle habits, but their perspectives are absent from the scientific literature. The aim is to explore how adolescents with ADHD experience their daily encounters with food, meals and physical activity, and to identify challenges and positive aspects related to these areas.

Method: A purposeful sample of 10 adolescents aged 11-15 with ADHD in Sweden participated in an exploratory, child-centred, photo-elicitation interview study. Participants provided photographs of their encounters with food, meals and physical activity for two days which were used subsequently in 45 minute-interview sessions to facilitate their communication.  A background questionnaire completed by the adolescent’s caregiver, provided a descriptive layer of information on food, meals and physical activity in the adolescents’ daily lives.

The analysis was two-levelled and focused on positive aspects and challenges on intrapersonal, interpersonal, institutional, community and public policy levels. Each interview was regarded as a case of its own on which a within-case analysis was performed separately to allow an in-depth exploration. Thereafter, a joint-case analysis followed where patterns were searched for between the different cases, to identify which experiences cases have in common, as well as what attributes are unique. A qualitative thematic analysis was used to generate themes and patterns within the data, and the socio-ecological model was applied as the guiding framework.

Anticipated results: The presentation will focus on the perspectives of the adolescents and their everyday encounters with food, meals and physical activity. Specifically, positive experiences and challenges will be presented. We exemplify how adolescents ‘experiences of food, meals and physical activity are influenced by many diverse factors and there for suggest that a comprehensive approach is suitable from a health promotion perspective. 

Contribution: Drawing on the result of this study, the perspectives of adolescents with ADHD on daily encounters with food, meals and physical activity can help to better inform meaningful health promoting strategies on multiple levels.

Purpose: As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. Saga Stories is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health conversations with children and parents. The aim of this pilot study is to explore how CHC nurses experience the usability of the 'Saga Stories in health talks' material.

Methods: This study used a qualitative design. The material Saga Stories in health talks was pilot- tested by 33 nurses working in 11 centers in three regions in Sweden. All nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.

Results: Three themes and eight sub-themes emerged. The themes were: 1) A focus on healthy living habits directed to children and their families, 2) The health conversations: to capture the child’s interest and involve the parents and 3) Challenging structures. Saga Stories was experienced by the nurses as a relevant and sought-after initiative by the nurses, since it had a focus on healthy lifestyle habits. The nurses described the material as well- designed as it helped them to capture the child´s interest and increase children´s participation in the health talks. In the health talks, the nurses intended to capture the child´s interest and involve the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.  

Conclusions: This pilot-study highlights how the material Saga Stories facilitated the health talks with families in CHC with a focus on the children’s participation. To use the material at the 5- year routine visit could be as a better option to overcome some identified challenges.

Purpose

A virtual Couch to 2k programme was run across Ireland in partnership with 8 Local Sports Partnerships (LSPs).   The influence of team size and team composition on programme engagement, completion and exercise outcomes with a focus on encouraging inactive participants to complete physical activity (PA) programmes was explored

Method

863 participants were randomly assigned to 105 teams across eight concurrent Couch to 2k programmes. Teams were first constructed based on size (small: 4-6 members vs. large: 18-24 members). The random assignment of team members produced teams that were either majority inactive, majority active or balanced between active and inactive members

Participant activity levels were defined using the single item question for physical activity (M1).  Participants were defined as inactive if they responded as M < 2 at sign up.

Both team and individual step counts were displayed daily through intra- and inter- team leaderboards. Users also had the ability to communicate with team members via a chat function but few made use of this option.

Results

1)      In general, being in a predominantly active team had no effect on programme completion.

2)      For inactive participants, being in a team with mostly active participants significantly reduced average daily step count by 1,117 steps. However, we found no significant effect on participants’ exercise duration.

3)      When active participants (with fitness devices) were placed in teams with mostly participants of similar profiles, they exercised for a longer duration (by 9 minutes per day).

Conclusion 

The findings from this RCT provide several actionable insights that are most relevant for app-based programmes that provide public feedback on performance (e.g. leaderboards). Importantly, our results suggest that inactive participants should not be placed in teams with primarily active participants.

Through post-hoc analysis, we also found that being inactive correlated with drop out across sign up, onboarding and programme delivery. The impact of device type (i.e., wearable fitness device vs. smartphone) on exercise levels and on programme drop out across the programme was also found to be significant. 

Purpose: The aim is to define developmental physical activity (PA) profiles and their correlates in older adults from pre-COVID-19 through the pandemic. The research questions are: 1) What kind of PA profiles exist, and 2) which individual and environmental characteristics relate to PA profiles? No previous reports on these exist.

Methods: Participants were from population-based sample of 75, 80, and 85-year-old community-dwelling people (n=773, mean 78.6 years, 58% women) living in a medium-sized city in Finland. Time in vigorous physical activity (VPA) [min/day] and leisure walking (LW) [min/day] were calculated from self-report Yale Physical Activity Survey pre-COVID-19 (2017-2018), during the Emergency Powers Act (EPA) at-COVID-19 (05-06/2020), and after the EPA (2021-2022). Pre-COVID-19 individual characteristics were collected from registers (age, sex), interviews (number of diseases, depression symptoms (CES-D)) and measurements (lower extremity performance (SPPB)). Environmental characteristics were defined at home location (urban area type (walking/public transport/car-dependent)) or within 1000 meters (residential density) using geospatial datasets. Latent profile analysis generated PA profiles based on combination of VPA and LW in the three successive time-points. Equality of means or probability of categories in the correlates pre-COVID-19 were tested across PA profiles using the modified Bolck-Croon-Hagenaars approach.

Results: We found five distinctive PA profiles covering the time-period from pre-COVID-19 through the pandemic: P1 sedentary (46% of participants), P2 walker (9%), P3 moderately active (24%), P4 exerciser (9%), and P5 active (12%) people. PA profiles P3,P4,P5 had a peak value in VPA and P2,P3,P5 in LW during the EPA at-COVID-19. PA profiles with middle/high VPA (P3,P4,P5) had fewer depression symptoms than profiles with low VPA (P1,P2) (overall p<.001). SPPB scores were the highest with high VPA (P4,P5) and the lowest in P1 (overall p<.001) with more diseases (overall p<.001). Of participants with low VPA profiles (P1,P2), P2 (high LW) lived in higher residential density, more walkable, and less car-dependent areas than P1 (low LW) (both p<.05).

Conclusions: During the EPA at-COVID-19 in Finland, older adults with higher physical capability and fewer depression symptoms reported temporarily higher VPA. Older adults with poorer physical capability accumulated more LW when living in area with more walking supportive infrastructure.

Purpose: We studied the association between external food access and intake quality of middle and low-income children living in similar external food environments in Santiago during the Covid-19 lockdown and how characteristics of their domestic environment affected this relationship. To better understand relations between diet quality and food access, we must consider how people experience their food environments. Could intra-household dynamics (food management, gender and time) be affecting these relationships?

Methods: This was a longitudinal study. 999 households from two longitudinal cohorts participated in online surveys during two periods of the Covid-19 pandemic. External food access profiles were developed by Latent Class Analysis. Their domestic environments were characterized by logistical multinomial regressions with food management and routine modifications (produced by Covid-19) variables. The association of food access profiles with children's intake was estimated using logistic and linear regressions adjusted by children’s sex and age. These models were adjusted by significant food management and routine modification variables to assess a possible effect of the domestic environment on these relationships. The effects of the crude and adjusted regressions were compared.

Results: We identified three external food access profiles: Classic, Multiple, and Supermarket. Compare with the Classic profile, the Multiple profile gathered female heads household’s (RRR=1.51; p:0.058) and the Supermarket profile higher income household’s (RRR=12.30; p: 0.001) and concentrated the diet protective variables from the domestic environment. The profile’s routines were impacted by the Covid-19 lockdown. Children presented poor diet quality (high daily UPFs consumption (mean=4.4), and low compliance with national DGA recommendations (mean=1.2)). The food access profiles were poorly associated with children's diet quality (only to the Supermarket profile compared to the Classic profile, for fish consumption (OR=1.77; p:0.048), and marginally with the overall compliance of DGA (coef.=0.17; p:0.109)). When adjusting the regressions by the routine modification variables we observed that in the Supermarket profile the likelihood of compliance with the DGA increased (overall: coef.=0.22; p:0.049 and fish: OR=1.96; p:0.024).

Conclusions: The external food environment cannot explain the quality of children's diets. To better understand barriers to healthy eating, we must consider intra-household behaviors, particularly addressing time issues from a gender perspective.

Purpose:

High school physical education (PE) in Canada, is optional after grade 9, however little research has examined how PE participation impacts physical activity behaviours over time. This study aimed to identify the patterns of physical activity behaviours among high school aged youth in Canada. 

Methods:

Using data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada, Ontario youth who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917) using a repeated measures latent class analysis. Physical activity behaviours which defined the latent classes included PE participation, guideline adherence (≥60 minutes/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics.

Results:

Three distinct latent classes were identified for females, and four were identified for males. These classes were: 1) Guidelines (defined by high probability of guideline adherence; females: 44%; males: 16%), 2) PE & Sports (defined by high probability of PE and sport participation; females: 33%; males: 43%), 3) Guideline & Sports (defined by high probability of guideline adherence and sport participation; females: 23%; males: 23%), and 4) Inactive (defined by low probability of all physical activity behaviours; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethnicity, weekly spending money, strength training, and English and math grades were associated with class membership among males.

Conclusions:

These findings suggest that latent class patterns of physical activity behaviours differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sports was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these actives alone may not be providing sufficient levels of physical activity that aligns with current recommendations for Canadian youth.

Purpose:

The purpose of this study was to evaluate the longitudinal impact that physical education (PE) participation had on moderate-to-vigorous physical activity (MVPA) levels among high school students in Canada, controlling for differences in observed individual characteristics using propensity scores.

Methods:

This study utilized linked longitudinal data from grade 10-12 students in Ontario over three waves of the COMPASS study. COMPASS is a school-based prospective cohort study (2012-2021) of youth in Canada. Linear mixed models were used to examine associations between PE participation and minutes of MVPA over time, stratified by sex. Models were adjusted using doubly robust propensity score methodology accounting for observed covariates known, or suspected, to influence PE participation. Propensity scores were applied as weights, through inverse probability of treatment weighting. Standardized mean differences were used to assess covariate balance before and after weighting.

Results:

Overall, 988 female and 872 male students were included. Female and male students who participated in PE during the semester of data collection reported on average 27 (95% confidence interval (CI): 21 to 34) and 36 (95% CI: 29 to 43) additional minutes of MVPA per day, respectively, compared to those who did not participate in PE that year. Female and male students who participated in PE during the opposite semester of data collection report, on average, 10 (95% CI: 3 to 17) and 15 (95% CI: 7 to 22) additional minutes of MVPA per day, respectively, than students who did not participate in PE that year. Female and male students in grade 12 report on average 6 (95% CI: -11 to -1) and 10 (95% CI: -15 to -4) fewer minutes of MVPA per day, respectively, than grade 10 students.

Conclusions:

Findings suggest that PE participation in high school has a significant impact on MVPA levels over time. Effects appear to be more pronounced among male youth and are greatest during the semester of PE participation. However, effects are still present even when PE participation is not concurrent with data collection. Canadian schools should consider mandating annual PE courses throughout high school to improve physical activity levels among youth.

Purpose: Being outdoors has potential to reduce stress and outdoor office work (OOW) may be an innovative way to decrease workplace stress and offices' sedentary behaviour. This study aims to assess stress among office workers that are working in their normal indoor office and then starts practicing OOW. Additionally, study participants identified facilitators and barriers for doing OOW.

Methods: In a feasibility study conducted in October 2022, nine office workers were instructed to do usual indoors work during the first week and then work outdoors for at least 30 minutes per day during the second week.  They wore a Heart Rate Variability (HRV) monitor called FirstBeat BG3 (HRV-FB) for two weeks while at work to assess objective stress.  Subjective stress was assessed by sending short daily surveys throughout the 2 weeks of the intervention, using a Likert scale of 1 to 10 from “not stressed at all” to “extremely stressed”. Also, they were instructed to use the app “Stanford Healthy Neighborhood Discovery Tool” to take photos of facilitators or barriers to practicing OOW.

Self-reported stress data was analysed using paired sample t-test in SPSS 28, whereas analysis of HRV time and frequency parameters are currently being undertaken.  The photos were categorised into themes.

Results: Preliminary findings show that daily self-reported stress decreased on group level when comparing week 1 to week 2 when OOW was performed.

Categories from picture analysis included themes related to “convenience”, “comfort”, equipment/facilities”, “urban” and “weather” in identified barriers. Out of 76 pictures almost all those themed “nature”, both indoor and outdoor, were marked as positive experiences.

Conclusion: Reduction in self-reported stress from week 1 to week 2 suggests OOW could potentially be a useful method to reduce work-related stress. Furthermore, by walking outdoor, the office workers increase their physical activity as compared to being sedentary indoors, which adds another health aspect to OOW.

Picture analysis suggests, to ensure a healthier milieu for office workers, conditions conducive to OOW such as outdoor work facilities in tandem with green spaces in offices' vicinity may need to be facilitated by employers.

Purpose: Parent’s eating behaviours and feeding styles shape how their child eats but there is a lack of data on the associations between parent and child eating behaviours. We aimed to examine concordance between parental appetitive traits and intuitive eating with children’s appetitive traits.

Methods: Canadian parents (n=154, 37.9±5.5 years, 97% female) of children aged 5 to 11 (7.1 ±1.9 years) completed a cross-sectional survey with validated questionnaires. The Adult Eating Behavior Questionnaire and Child Eating Behavior Questionnaire were used to describe appetitive traits with the constructs and subscales: “Food Approach” (Food Responsiveness, Enjoyment of Food, Emotional Overeating and Desire to Drink for children and Hunger for adults) and “Food Avoidance” (Satiety Responsiveness, Slowness of Eating, Emotional Undereating and Food Fussiness). Parental intuitive eating was surveyed using the Intuitive Eating Scale 2 with subscales: Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues and Body-Food Choice Congruence. Pearson correlations were conducted between adult and child eating behavior subscales and between child eating behavior and parent intuitive eating subscales.

Results: Concordance between appetitive traits were significantly correlated for Enjoyment of Food (r=0.23; p < .01), Emotional Overeating (r=0.27; p < .001), Emotional Undereating (r=0.36; p < .001), and Food Responsiveness (r=0.16; p < .05) as were parents’ Emotional Overeating with child Emotional Undereating (r=-0.16; p < .05). In parents, the intuitive eating construct, Unconditional Permission to Eat, was correlated with children’s Emotional Overeating (r=-0.26; p < .01) and Food Responsiveness (r=-0.17; p < .05). Parental Eating for Physical rather than Emotional Reasons and child Emotional Overeating (r=-0.16; p < .05) were also correlated. Reliance on Hunger and Satiety Cues in parents was correlated with child Enjoyment of Food (r=0.16; p < .05) whereas Body-Food Choice Congruence was correlated with child’s Slowness in Eating (r=-0.20; p < .05) and Food Fussiness (r=-0.19; p < .05).

Conclusions: This study found that self-reported parental eating behavior constructs are correlated to similar constructs in children. Thus, parental eating behaviors should be accounted for when addressing child eating behaviors. Larger studies should explore how these factors are moderated.

Purpose: The purpose of the current cross-sectional study was to investigate differences between obese, and severely obese children, with regard to food intake, physical activity level, lifestyle-related problems, their parents’ confidence, and feeding and physical activity parenting practices.

Methods: Participants were 76 parents (92% mothers) of obese (BMI z-score > 2, n = 48) and severely obese (BMI z-score > 3, n = 28) children (58% girls) aged 5-11 years, attending an outpatient pediatric care unit in a Portuguese University Hospital. All participants were enrolled in a longitudinal trial on the efficacy of a parenting intervention targeting childhood overweight and obesity. The current study presents baseline data. Pediatricians collected children´s anthropometric data during hospital appointments. Parents completed the following measures: Food Intake Diary, Food Frequency Questionnaire, Physical Activity Parenting Practices Questionnaire, Comprehensive Feeding Practices Questionnaire, and the Lifestyle Behavior Checklist. Children used an accelerometer for five days. To compare differences across groups T-Student tests were performed.

Findings: 24% of the children achieved the recommended daily levels of vegetable and fruit consumption (≥ 400gr/day) and moderate to vigorous physical activity (≥ 60min/day), whereas 18% ate more than four grams of salt. No differences were found regarding physical activity or food intake between the two groups, except that parents of severely obese children reported lower levels of children’s daily consumption of salty snacks (p = .029), cakes and sweets (p = .002), and higher levels of light physical activity (p = .048). Parents of severely obese children also reported higher use of food as reward (p = .007), and less confidence to address overeating (p = .038). All effect sizes were medium, except for the consumption of cakes and sweets, which had a large effect size.

Conclusions: These findings inform research and practice on childhood obesity as they contribute to a better understanding of the specific characteristics and needs of obese children and their parents. Although no differences were found regarding children's lifestyle-related problems, severely obese children were found to have different food intake and physical activity characteristics, with their parents reporting different parenting practices than those of obese children.

Purpose: Childhood obesity caused partially by unhealthy diet is a growing public health concern in Sweden and globally. Since children adopt many of their parents’ attitudes and behaviors towards food, parent-child interactions, and parental feeding practices shape children’s health-related behaviors. Therefore, parental feeding practices are useful targets for childhood obesity prevention interventions. We investigated parental feeding practices and associations with parent’s sex, education and children’s weight status.

Methods: Data are from the baseline of the Healthy School Start Plus (HSSP) intervention study from 2017 to 2019, a cluster-randomized control trial in 17 schools in the region of Stockholm, Sweden, where the proportion of parents with university education was less than 50 percent. Parents completed the Comprehensive Feeding Practices Questionnaire (CFPQ) regarding parental behaviors at mealtimes and behaviors related to their child’s food intake. Validation of the scale in the Swedish context resulted in five factors: monitoring, pressure to eat, restriction for health and weight, emotional regulation, and healthy eating guidance. Wilcoxon rank sum test were used to investigate associations between parental feeding practices and parental sex, education, and child’s weight status.

Results/Findings: The study included 263 parents (154 mothers) with 173 individual children. Monitoring of food intake was higher among mothers compared to fathers (p=0.05). No significant differences were found for the other factors or different education levels. Pressure to eat and restriction for health and weight were significantly different between parents of children who were overweight or obese versus normal or underweight (p<0.001). Pressure to eat was higher in parents of children with normal or underweight. Restriction for health and weight was higher in parents of children with overweight or obesity. No other parental feeding practices were significantly different between parents of children differing in weight status. 

Conclusion: The parental feeding practices differed between children with different weight status in the expected direction. It could suggest that parental feeding practices are responsive to the child's weight status. Understanding the direction of the association could help guide future interventions. Further research is needed to examine potential causal relationships and mediating factors.