International Journal of Behavioral Nutrition and Physical Activity最新文献

Background: Despite extensive research on physical activity behaviour (PAB), consensus is lacking on related terms and definitions, thereby hindering the ability to compare findings between studies and to develop reliable assessment tools. This study therefore aimed to establish consensus on the definitions of key PAB determinants.

Methods: First, an international expert steering committee was established, comprising members of the European Cooperation in Science and Technology (COST) action "DEterminants of Physical ActivitieS in Settings" (DE-PASS). Recently published review-level studies were used to identify key determinants of PAB. Two independent reviewers systematically reviewed the literature to catalogue the range of definitions used for key determinants of PAB (steps 1-2). A two-round modified Delphi survey was conducted online from February to September 2023, to determine the optimal definition for each determinant. In round 1, experts selected the most suitable definition for each of the 41 initially identified determinants. In round 2, experts ranked the appropriateness of the definition selected from round 1 on a 5-point Likert scale. Consensus was defined a priori as ≥ 75% agreement on the definition (i.e., ratings of ≥ 4 points). A professional English language expert ensured concise, coherent wording and high-quality editing of the definitions (steps 3-6).

Results: Eighty-five experts in PAB research participated in round 1, and sixty-nine experts in round 2. Consensus of definitions was achieved for 39 of the 41 determinants (88.4%-98.6% agreement). The consensus threshold was not achieved for two determinants: genetic profile and regulation (69.6%) and backyard access/size (73.9%).

Conclusions: The findings of this study offer a consensus-based set of definitions for 39 key determinants of PAB. These definitions can be used homogenously in academic research on physical activity.

Background: Inadequate sleep health is a public health problem among Dutch adolescents with detrimental effects on their physical and mental well-being. System approaches are increasingly being used to understand and address public health problems. Therefore, a recent study created a comprehensive Causal Loop Diagram (CLD) that integrated all relevant determinants of adolescent sleep health, underlying system dynamics and potential leverage points. Building on that, the current study aims to design a 'whole systems action plan' to promote sleep health of Dutch adolescents, combining systems science with a participatory approach.

Methods: Five (multi)stakeholder sessions with adolescents (N = 40, 12-15 years), parents (N = 14) and professionals (N = 13) were organized to co-create actions addressing preselected leverage points derived from the previously mapped CLD. Subsequently, three sessions with multidisciplinary representatives of regional and national oriented (health) organizations (N = 27) were held using the World Café Methodology to identify intervention actions as well as potential implementers. The Action Scales Model (ASM), a tool to understand and change the system at different levels (i.e., event, structure, goal, belief) of the system, was used to create a coherent whole systems action plan.

Results: The created whole systems action plan consisted of 66 (sets of) actions across different ASM levels (i.e., event, structure, goal, belief) targeting 42 leverage points across five subsystems: school environment N = 24; mental wellbeing N = 17; digital environment N = 9; family & home environment N = 9; personal system N = 7. Per action potential implementers were identified, which included amongst others schools and public health services. The previously mapped CLD visualizing system dynamics shaping adolescent sleep health were supplemented with how dynamics can be changed via the actions identified.

Conclusions: The resulting whole systems action plan provides a subsequent step in applying a whole systems approach to understand and promote adolescent sleep health. Combining a systems approach, using the ASM, and a co-creation approach was found to be mutually reinforcing and helpful in developing a comprehensive action plan. This action plan can guide strategic planning and implementation of actions that promote systemic change. With this, it is important to ensure coherence between actions being developed and implemented to increase the potential for lasting systems change.

Background: University students incur significantly elevated levels of stress compared to the general population and their non-student counterparts. Health risk behaviours are important modifiable determinants for the onset and aggravation of various mental health disorders, in which, university students generally exhibit poor engagement. Thus, this study aims to determine the efficacy of health behaviour interventions in relation to change in health behaviour and mental health outcomes, the impact of interventions (i.e., penetration, fidelity, and implementation), intervention characteristics associated with improved outcomes (efficacy) and the economic evaluation of interventions.

Methods: Six electronic databases were searched for randomised controlled trials (RCT) published from the 1st January 2012 to 11th July 2023. Eligible RCTs included university students, evaluated behavioural interventions targeting health behaviours (i.e. dietary intake, physical activity, sedentary behaviour, alcohol use, substance use, smoking, and sleep) and reported a change in both health behaviour and mental health outcomes.

Results: Twenty-two RCTs met the study inclusion criteria. Overall, only seven studies were effective in improving both health behaviour and mental health outcomes, with most (n = 4) focused on improving sleep behaviours. Insufficient evidence was found regarding intervention impact, intervention characteristics associated with improved outcomes and the economic evaluation of interventions to guide future implementation of health behaviour interventions in universities due to inadequate reporting of outcomes.

Conclusions: There is limited evidence regarding the efficacy of health behaviour interventions in improving both health behaviour and mental health outcomes. There is also insufficient evidence regarding intervention impact, intervention characteristics associated with improved outcomes and economic evaluation to guide the implementation of these interventions in the university setting.

Background: Frailty has become an important health problem in the middle-aged and older people population. Physical activity (PA) is a key intervention for frailty prevention and management. However, studies of the association between COVID-19 pre-pandemic PA and the worsening or improvement of frailty during the pandemic remain unclear.

Methods: This longitudinal cohort study used data from the English Longitudinal Study of Ageing (ELSA), including participants aged 50 and over. Three intensities of PA (vigorous, moderate, and mild) were categorized as less than once per week and at least once per week, respectively, based on participant self-report. The frailty index (FI) assessed the frailty status, defining frailty as FI ≥ 25. Logistic regression was applied to examine the association between PA and frailty, estimating odds ratios (OR) and 95% confidence intervals (95% CI).

Results: Of the 4379 non-frail participants at baseline (median age 67, 54.9% female), 8.1% developed frailty during a mean follow-up of 3.5 years. Among 564 frail participants at baseline (median age 71, 66.5% female), 17.9% regained health. Compared to those engaging in PA less than once per week, participants who engaged in vigorous (OR: 0.47 [95% CI: 0.35-0.62]), moderate (OR: 0.37 [95% CI: 0.29-0.48]), or mild (OR: 0.38 [95% CI: 0.26-0.56]) PA at least once a week had a lower risk of frailty worsening. Additionally, participants who engaged in moderate (OR: 2.04 [95% CI: 1.29-3.21]) or mild (OR: 2.93 [95% CI: 1.54-5.58]) PA at least once a week had a higher likelihood of frailty improvement. Sensitivity analyses based on comprehensive PA levels confirmed these findings. Participants who maintained at least one PA per week had lower frailty worsening (Vigorous, OR: 0.20 [95%CI: 0.12-0.33]; Moderate, OR: 0.13 [95%CI: 0.09-0.19]; Mild, OR: 0.20 [95%CI: 0.11-0.38]) and higher frailty improvement rates (Moderate, OR: 3.43 [95%CI: 1.93-6.11]; Mild, OR: 4.65 [95%CI: 1.90-11.42]). In addition, individuals (Vigorous, OR: 0.35 [95%CI: 0.20-0.60]; Moderate, OR: 0.36 [95%CI: 0.22-0.56]) who transitioned from inactive to active also exhibited a lower risk of frailty.

Conclusions: This study emphasized the critical role of PA in preventing and improving frailty in middle-aged and older people, especially during the COVID-19 pandemic. Our study also highlighted the importance of maintaining PA habits to reduce frailty risk and promote its improvement. Also, the study indicated that individuals who transitioned from inactive to active had a lower risk of frailty. These findings enriched the understanding of the association between PA and frailty and provided valuable insights for addressing the health impact of future pandemics on middle-aged and older people.

Background: To design effective tailored interventions to promote physical activity (PA) among older adults, insights are needed into the contexts in which older adults engage in PA and their affective and physical experiences. Sensor-triggered event-based ecological momentary assessment (EMA) is an innovative method for capturing real-life contexts, as well as affective and physical states, during or immediately after specific events, such as PA. This study aimed to (1) describe the physical and social contexts, and the affective and physical states during PA among older adults, (2) evaluate how these constructs fluctuate during PA episodes, and (3) describe affective states during PA according to the context.

Methods: An intensive longitudinal sensor-triggered event-based EMA study was conducted with 92 Belgian older adults (65 + years). During seven days, participants were monitored using a Fitbit, which triggered a smartphone-based questionnaire on the event-based EMA platform 'HealthReact' after a five-minute walk. Participants reported on contexts and affective (positive/negative valence) and physical states (pain and fatigue) during the PA event. Descriptive statistics and generalized mixed models were used for data analysis.

Results: Older adults predominantly engaged in daily physical activities, such as walking for transport, leisure walking, and gardening, rather than structured exercise. They consistently reported high positive affect, low negative affect, and minimal physical complaints during PA. Furthermore, older adults mainly engage in physical activities alone, particularly in outdoor settings. Variations in contexts, affect, and fatigue were mostly driven by within-subject differences. The model showed significant differences across times of day, with negative affect being highest in the evening and fatigue lowest in the morning. Additionally, the physical and social context influenced negative affect (but not positive affect), with outdoor activities performed alone and indoor activities performed with others being associated with lower negative affect.

Conclusions: While these findings could enhance the effectiveness of tailored PA interventions, it remains unclear whether the observed affective and physical states are causes or effects of PA, and whether the contexts in which the activities were performed align with older adults' preferences. Further research is needed to explore these relationships and to better understand older adults' preferred PA contexts.

Background: To examine whether adolescent sport and exercise participation is associated with adulthood moderate-to-vigorous physical activity (MVPA), body fat, skeletal muscle mass, and body mass index (BMI), and to explore whether the association between sport and exercise participation and adult body composition depends on adulthood MVPA level.

Methods: Prospective study of 4603 adolescents aged 13-18 year (57.2% female) in the Norwegian Young-HUNT Study and follow-up ~ 11 or ~ 22 years later. Linear regression was used to estimate mean differences in accelerometer-measured MVPA and bioimpedance-measured body fat, muscle mass, and BMI in adulthood according to self-reported sport and exercise participation in adolescence.

Results: Adolescents participating in sport/exercise every day accumulated more MVPA (48 min/week, 95% CI 23 to 73), had less body fat (-4.4%, 95% CI -5.4 to -3.2), more muscle mass (2.6%, 95% CI 2.0 to 3.2), and lower BMI (-1.1 kg/m², 95% CI -1.7 to -0.5) as adults, compared to adolescents participating < 1 day/week. Joint analysis showed that adolescents who participated in sport/exercise ≥ 4 days/week, and who accumulated 150-299 min/week MVPA in adulthood, had less body fat (-5.8%, 95% CI -7.4 to -4.3) and more muscle mass (3.4%, 95% CI, 2.5 to 4.3) compared to those participating in sport/exercise ≤ 1 day/week and who accumulated < 150 MVPA min/week as adults. Compared to the same reference group, these associations were further strengthened among those who accumulated ≥ 300 min/week MVPA in adulthood and reported ≥ 4 days/week of sport/exercise for both body fat (-8.8%, 95% CI -10.3 to -7.4) and muscle mass (5.1%, 95% CI 4.3 to 5.9).

Conclusions: Adolescent sport and exercise participation is positively associated with MVPA, and skeletal muscle mass, and inversely associated with body fat and BMI in adulthood. These associations remained significant after adjusting for adult MVPA levels. A higher MVPA level in adulthood strengthens the association between adolescent sport/exercise participation and adult body composition.

Background: The experience sampling method (ESM), also known as ecological momentary assessment, is gaining popularity in physical activity research. This method involves assessing participants' behaviors and experiences repeatedly over time. One key advantage of ESM is its ability to temporally separate the dependent and independent variable of interest, reducing the risk of reverse causality. However, temporal separation alone is insufficient for establishing causality. This methodology paper illustrates the importance of the identification phase in drawing causal conclusions from ESM data. In the identification phase the causal effect of interest (or estimand) is specified and the assumptions under which a statistical association can be considered as causal are visualized using causal directed acyclic graphs (DAGs).

Methods: We demonstrate how to define a causal estimand and construct a DAG for a specific ESM research question. The example focuses on the causal effect of physical activity performed in real-life on subsequent executive functioning among older adults. The DAG development process combines literature review and expert consultations to identify time-varying and time-invariant confounders.

Results: The developed DAG shows multiple open backdoor paths causing confounding bias, even with temporal separation of the exposure (physical activity) and outcome (executive functioning). Two approaches to address this confounding bias are illustrated: (1) physical control using the within-person encouragement design, where participants receive randomized prompts to perform physical activity in their natural environment, and (2) analytic control, involving assessing all confounding variables and adjusting for these variables in the analysis phase.

Conclusions: Implementing the identification phase enables ESM researchers to make more informed decisions, thereby enhancing the validity of causal inferences in studies aimed at answering causal questions.

Background: Understanding the factors that influence school travel mode choice is essential for promoting active travel among adolescents. Currently, there is a lack of research that effectively investigates the interactions between demographic and environmental factors on travel behavior. We aimed to investigate the associations between various demographic and environmental characteristics and the choice of school travel modes-walking, cycling, or motorized transport-among adolescents, across the winter and summer seasons.

Methods: Data from 1409 Norwegian adolescents, aged 14-15 years, who participated in the School In Motion project were analyzed. Self-reported travel modes and demographic characteristics were collected via questionnaires, while environmental characteristics were determined using Geographic Information Systems (GIS). A decision tree analysis was conducted utilizing the chi-squared automatic interaction detection algorithm to discern patterns in the data. The present study has a cross-sectional design.

Results: During summer, the predominant travel modes were cycling (39%), walking (37%), and motorized transport (24%). Gender was associated with travel mode choices over short distances (< 1.6 km), with girls favoring walking and boys favoring cycling. For longer commutes, steep inclines were associated with reduced walking and cycling, while higher traffic exposure was associated with increased cycling. During winter, walking (50%) was the most common mode, followed by motorized travel (36%) and cycling (14%). Living near peers was associated with increased walking and cycling among girls. For commutes exceeding 2 km, factors such as available bus transit, more streetlights, the absence of steep hills, and higher urban centrality were linked to increased walking and cycling.

Conclusions: The findings indicated a complex pattern of demographic and environmental factors influencing active travel, with environmental factors becoming increasingly important as commuting distances increased. These findings highlight the importance of considering the interactions of various factors to effectively promote active travel, especially for adolescents undertaking longer commutes.

Trial registration: Clinicaltrials.gov ID no: NCT03817047. Registered on: January 25, 2019 (retrospectively registered).

Background: Geophagia or soil-eating behavior is common among pregnant women in sub-Saharan Africa, however its relationship with nutritional status demands further investigation. Using a prospective pregnancy cohort from north-eastern Tanzania, we examined the characteristics of geophagia and its association with nutritional status parameters (mid-upper arm circumference (MUAC), vitamin B12, folate, ferritin, and hemoglobin) before conception and throughout the gestational period.

Methods: Pregnant women (n = 530) were interviewed in each trimester regarding their soil-eating habits. Serum concentrations of vitamin B12, folate, ferritin, and hemoglobin, and MUAC were measured before conception and in each trimester. Cross-sectional comparisons between women who ate and did not eat soil were analyzed using Welch's t-test for continuous variables and χ2-test for categorical variables. The association between changes in nutritional status parameters and the initiation of geophagia was investigated using multivariable logistic regression.

Results: The prevalence of geophagia in this cohort was 27% (n = 143) with most women initiating geophagia in the third trimester. Pregnant women that ate soil had significantly lower ferritin (p = 0.001) prior to conception and at concentrations diagnostic of iron deficiency (p = 0.022) compared to women who did not eat soil. Geophagia was associated with lower ferritin (p ≤ 0.001) and lower hemoglobin (p < 0.05) in each trimester and lower folate in the third trimester (p = 0.007). A smaller decline in hemoglobin and folate across the gestational period was associated with reduced odds of initiating geophagia in the third trimester (hemoglobin: OR 0.71, p = 0.008; folate: OR 0.97, p = 0.008). There was no significant association between a change in MUAC, serum B12 or ferritin and the initiation of geophagia during pregnancy.

Conclusions: Prenatal geophagia is closely related to iron and folate status. A greater decrease in hemoglobin and folate is associated with the initiation of geophagia during pregnancy. These findings are particularly relevant to low- and middle-income settings where geophagia is practiced and the prevalence of anemia in pregnancy is high.

Background: The time spent physically active outside of school (e.g., extracurricular physical activity) is an important contributor to children's total daily physical activity for health and well-being. Little is known about the opportunities available to children to engage in extracurricular physical activity from low- to middle-income countries. This study aims to answer the question: What are the main perceived barriers and facilitators of extracurricular physical activity among school-age children in Mexico?

Methods: A multi-method cross-sectional study was performed. Six focus groups with children (aged 9-12 years), six focus groups with parents, 10 one-on-one interviews with parents, 12 interviews with teachers, and six interviews with head teachers were conducted across Campeche, Morelos, and Mexico State, Mexico. A questionnaire was applied to explore children's physical activity frequency and preferences for time inside and outside of school. Qualitative data analyses were performed with inductive thematic analysis supported with NVivo software. Quantitative data were analysed with descriptive statistics using IBM SPSS 26.

Results: Three main themes summarise the study's findings: (1) how children spend their time outside of school, (2) the places that children access, and (3) the social environment for physical activity outside of the school. The data suggest that children in Mexico dedicate their spare time to screen, work, do housework, or perform unstructured physical activity mostly at home instead of playing sports or actively outdoors. Family support, enjoyment of physical activity, access to programs and facilities, time, living in a housing complex with open common areas, and mild weather were important facilitators identified. 69.4% of children engage in extracurricular physical activity, none of which was provided by schools. More children commute by walking than riding a bike to and from school. Children living inland spent three times more time at home compared to those in seafront areas.

Conclusions: Children rely on their families to partake in extracurricular structured physical activity. Policies targeting children's health and well-being should include school-based extracurricular physical activity programs.