International Journal of Behavioral Nutrition and Physical Activity最新文献

Background: To ensure the large number of school-based physical activity and nutrition programs have a lasting positive impact on the health and wellbeing of students, it is essential that such programs are sustained long-term. However, there is limited research assessing the duration of such programs and the determinants that are related to their sustainment. This study investigates the duration of, and determinants to the sustainment of physical activity and nutrition programs in Australian primary schools.

Methods: A cross-sectional study with 207 Principals (one from each school) from a nationally representative sample of randomly selected Australian primary schools. Principals completed a survey online or via telephone, which included items assessing the determinants of program sustainment categorised based on the domains of the Integrated Sustainability Framework (inner contextual factors; outer contextual factors; characteristics of the intervention; and processes). Schools were randomised to answer survey items relating to either physical activity or nutrition programs. We collected data on the number and type of programs, their duration, and factors influencing the sustainment of one selected program. Descriptive statistics were used to assess the duration and prevalence of programs. Regression analysis was used to assess the association between sustainment determinants and the duration of program delivery.

Results: Schools randomised to physical activity programs implemented on average, 5.4 of the nine physical activity programs assessed. Schools randomised to nutrition implemented on average, 2.8 of the seven nutrition programs assessed. Physical activity programs had a mean duration of 6.9 years and nutrition programs had 7.4 years. Nutrition programs had 3.27 times the odds of being sustained longer than physical activity programs (95% CI: 1.57, 6.83; p = 0.002). The only domain from the Integrated Sustainability Framework that was statistically significantly associated with the sustainment for both physical activity and nutrition programs was outer contextual factors. This domain includes the alignment of the program with the priorities of the school, partnerships between the school and external organisations, and the existence of a governing body policy or guideline related to the program. The highest ranked determinant from this domain for both physical activity and nutrition programs was the alignment of the program with the priorities of the school.

Conclusion: This study highlights the need for targeted strategies to support the sustainment of health programs in schools, particularly focusing on outer contextual factors. Specifically, the alignment of the program with the priorities of the school. Policymakers and practitioners should prioritise targeting these outer contextual determinants to enhance the sustainment of physical activity an

Background: Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach successfully are not well understood. The R = MC² heuristic, which defines readiness for implementation as a combination of an organization's motivation and capacity to implement, can enhance our understanding of implementation in the school setting. This study examines associations between constructs from the R = MC² heuristic and schools' implementation of a WOS approach.

Methods: We conducted a secondary analysis of cross-sectional data from U.S. elementary schools participating in the NFL PLAY60 FitnessGram Project during the 2022-23 school year. From surveys administered to school staff, we created a WOS index (range = 0-12) comprising six physical activity practices: physical education, recess, before and after-school programs, classroom-based approaches, and active transport. We also assessed how six constructs from the R = MC² heuristic (i.e., culture, implementation climate, leadership, priority, resources utilization, resource availability) impact physical activity implementation using a series of questions measured on a 5-point Likert scale. We used linear regression models to determine associations between R = MC² constructs (independent variables) and WOS index scores (dependent variable), controlling for school-level characteristics (student enrollment, percentage of race/ethnicity and economically disadvantaged students served) and state-level clustering.

Results: The analytic sample consisted of 132 schools across 18 states. On average, school staff rated leadership (mean = 4.1, range = 1.5-5) and organizational culture (mean = 4.0, range = 2.25-5) the highest. The mean WOS index score was 6.1. Partially adjusted models indicated significant positive associations between each R = MC² construct and WOS index scores. Fully adjusted regression models revealed priority (b = 0.88; p = 0.010; 95% CI = 0.19-1.56) and implementation climate (b = 0.69; p = 0.047; 95% CI = 0.07-1.32) were positively and significantly associated with WOS index scores.

Conclusions: Our study provides insights into key implementation constructs associated with providing school-based physical activity opportunities. These findings can support the development of resources and implementation strategies which, in turn, can help schools address implementation-related disparities. This will help schools improve the quality and accessibility of opportunities for physical activity provided to students across the United States.

Background: Rapid technological advancements have rendered many prior reviews of technology-integrated physical activity (PA) interventions in K-12 schools obsolete. A comprehensive analysis examining both the effects of these interventions and the specific roles that technology plays has been notably lacking. This review aimed to systematically examine the effects of technology-infused PA interventions and identify the specific types, roles, and contextual applications of technology within K-12 schools.

Methods: This systematic review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A thorough search across seven electronic databases (CINAHL, ERIC/EBSCOhost, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science) included studies published up to May 20, 2024. Only randomized controlled trials (RCTs), cluster-RCTs, or rigorous quasi-experimental designs with matched/statistically controlled comparisons (N-RCTs) examining technology-infused PA interventions for school-aged children and adolescents were considered.

Results: Fifty-eight studies met inclusion criteria. Wearable devices (e.g., accelerometers) were the most used for PA measurement. Other technologies like web-based platforms, mobile applications, and exergaming served as educational tools, communication platforms, or core intervention components. Interventions occurred primarily in classrooms, followed by physical education spaces, and extended to home/online environments, school breaks (e.g., recess), and before-school time. Overall, interventions positively affected PA levels and related outcomes (e.g., PA enjoyment), though effectiveness varied by technology type, design, and context.

Conclusions: Technology holds substantial potential to enhance PA promotion in schools, but its effectiveness hinges on well-designed interventions that consider the specific types and applications of technology.

Background: It is well established that all types of movement behaviors, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behavior (SB), and sleep, are associated with the risk of incident dementia, all-cause mortality, and premature death. However, it remains unclear whether reallocating time from one type to another is associated with these outcomes. In addition, the extent to which genetic susceptibility modifies the association between physical activity and dementia risk still warrants further investigation.

Methods: This study included 94 086 dementia-free participants from the UK Biobank with valid accelerometer and genomic data. Time spent MVPA, LIPA, SB, and sleep were derived from wrist-worn accelerometers. Genetic susceptibility of dementia was assessed by polygenic risk score (PRS) consisting of 82 single nucleotide polymorphisms. The isotemporal substitution model was applied to explore how reallocating time between movement behaviors was associated with incident dementia, mortality, and premature death.

Results: Of 94 086 included participants, 52 853 (56.2%) were female, and the mean (standard deviation, SD) age was 62.3 (7.8) years. Reallocating 1 h/day to MVPA from LIPA, SB, and sleep was associated with a 19%, 26%, and 18% lower risk of incident dementia (adjusted hazard ratios [HRs] and 95% confidence intervals [CIs]: 0.81 [0.68, 0.95], 0.74 [0.63, 0.87], and 0.82 [0.69, 0.96], respectively). A 22%, 30%, and 29% reduced risk of mortality were observed when reallocating 1 h/day from LIPA, SB, and sleep to MVPA (0.78 [0.72, 0.84], 0.70 [0.65, 0.75], and 0.71 [0.66, 0.77], respectively). Replacing 1 h/day of SB with MVPA, LIPA, and sleep was associated with a 26%, 8%, and 9% lower risk of incident dementia (0.74 [0.63, 0.87], 0.92 [0.87, 0.97], and 0.91 [0.85, 0.97], respectively), and reallocating 1 h/day from SB to LIPA (0.89 [0.87-0.92]) or MVPA (0.70 [0.65-0.75]) was associated with reduced risk of mortality. Similar results could be seen in premature death. Participants with high levels of MVPA and low genetic risk showed 72% lower risk of dementia comparing to participants with low levels of MVPA and high PRS (0.28 [0.17-0.50]).

Conclusions: Reallocating time to MVPA from any behavior and substituting physical activity of any intensity for SB were associated with decreased risks of incident dementia, mortality, and premature death, suggesting the significance of maintaining a physically active lifestyle among old adults. Moreover, increasing MVPA level could partially attenuate the strength of association between genetic susceptibility and the risk of dementia.

Background: Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption across meso- and macro-system levels using data from the 2018-2022 state-wide hybrid effectiveness-implementation trial of TransformUs Primary, a whole-school physical activity intervention. Aims were to: (1) assess differences in contextual characteristics between adopting and non-adopting schools and implications for equity, and (2) assess associations between macro-level events and dissemination events with program adoption over time.

Methods: Descriptive statistics (number and %) and chi-squared tests were used to assess differences in contextual characteristics between adopting and non-adopting schools (Aim 1). A time-series analysis of daily data was used to explore associations between the number of dissemination events promoting program awareness (e.g., media, newsletters), macro-level policy events (e.g., education department policies), COVID-19-related remote/on-site learning periods, school term dates (i.e., during/outside of school term) and program adoption (i.e., the number of TransformUs Primary registrations per day) (Aim 2).

Results: No differences in either school type (i.e., primary, combined, or special) or community level socio-educational advantage between adopting (n = 519) and non-adopting schools (n = 1,423) were identified. A higher proportion of adopting schools were located in major cities (71.7% vs. 54.5%; chi-square p < 0.001) and were government (public sector) schools (80.0% vs. 63.1%; chi-square p < 0.001). Time-series analysis results indicated that the likelihood of adopting TransformUs Primary decreased from the date of program launch to the end of the scale-up period (IRR 0.999, 95% CI 0.999-1.000; p < 0.005). Both school term date (IRR 5.95, 95% CI 4.78-7.41; p < 0.001) and dissemination events (IRR 3.30, 95% CI 2.67-4.06; p < 0.001) increased the likelihood of adopting TransformUs Primary. Results provided little evidence of an association between the number of policy events or COVID-19-related remote and on-site learning periods and adoption.

Conclusions: Select meso- and macro-level factors had an impact on TransformUs Primary adoption. Findings inform the need to work with stakeholders in scale-up to prioritize dissemination strategies that have a discernible impact on adoption above others and consider targeted efforts to reach regional/rural and non-government schools.

Background: Close social ties are known to increase survival, reduce chronic diseases, and promote healthful eating. Little research has explored whether adverse changes in these relationships lead to less healthful eating in older adults, with attention to gender differences.

Methods: Prospective study using 3 waves of the Canadian Longitudinal Study on Aging (CLSA) in a sample of middle-age and older adults (45-85 y) reporting daily intake of fruit or vegetable (F/V) intake (at least one time per day) at baseline using dietary data collected by CLSA's Short Diet Questionnaire. We used multivariable multilevel logistic regression with interaction terms (social tie x gender) to determine whether adverse changes in close social ties (marital status and living arrangement) between baseline (2011-2015) and follow-up 1 (2015-2018) led to developing less healthful eating measured by non-daily intake of F/V at follow-up 2 (2018-2021) (n = 15,672); models adjusted for biological, behavioural, socioeconomic, and socio-political confounders.

Results: Distinct transitions by gender precipitated a change from daily F/V intake (healthful eating) to less frequent intakes (unhealthful eating). Compared to women remaining partnered, women remaining non-partnered over 3 years had 21% higher odds of reducing healthful intake of vegetables at 6-year follow-up (OR 1.21 [95% CI: 1.07, 1.38]). Becoming divorced increased the odds of reducing healthful intake of fruits among women (1.76 [1.16, 2.66]) compared to referent. Women remaining lone-living were less likely to reduce healthful fruit intake (0.86 [0.74, 0.99]), compared to remaining co-living. Compared to men remaining partnered, men who became divorced or widowed had 91% greater odds of reducing healthful vegetable intake (1.91 [1.25, 2.92] and 1.91 [1.17, 3.13], respectively). Men who remained non-partnered or became widowed were also more likely to reduce healthful fruit intake (1.20 [1.03, 1.41] and 1.99 [1.26, 3.15], respectively), compared to referent. Finally, men who became lone-living and co-living were more likely to reduce healthful intakes of vegetables (1.42 [1.06, 1.91] and 1.55 [1.04, 2.32]) and fruits (1.48 [1.11, 1.96] and 1.48 [1.00, 2.18]), compared to men remaining co-living.

Conclusions: Findings showed that adverse changes in close social ties led to the development of less healthful eating among aging adults in Canada, and these prospective associations appeared to be gendered. Public health and nutrition interventions should consider the social context as a risk factor to address gender disparities in food intake in the aging population.

Background: Compliance with 24-hour movement behaviours (24-h MB) guidelines, which encompass moderate-to-vigorous physical activity (MVPA), recreational screen time (ST), and sleep, is associated with various health and developmental outcomes in children and adolescents. Despite growing research interest, a comprehensive synthesis of global research focusing on school-aged youth (5-17 years) is lacking. This systematic review mapped global research on 24-h MB guidelines in youth aged 5-17 years, charted publication trends, geographical spread, and summarised reported outcomes to inform research priorities.

Methods: A systematic search (June 2016-July 2024) across six databases (PubMed, Scopus, Web of Science, SPORTDiscus, APA PsycInfo, Embase) identified 32,832 articles. Overall, 148 articles from 32 countries met inclusion criteria. Extracted data covered publication details, movement behaviours measures, article focus, and headline conclusion. 'Compliance' was defined as simultaneous adherence to all 24-h MB guidelines. Guided by the Behavioural Epidemiology Framework, articles were classified as prevalence, health and well-being, correlates, academic performance, intervention focused. Article quality was assessed with National Institute of Health tools.

Results: Global research on 24-h MB guidelines has grown rapidly since 2016 but remains methodologically modest, with 68% articles (n = 132) originated on six high- or upper-middle-income countries. Most articles were cross-sectional (n = 128, 87%) and investigated prevalence (n = 141, 95%) or health and well-being (n = 79, 53%), followed by correlates (n = 40, 27%), academic performance (n = 8, 5%), and interventions (n = 3, 2%). Only 3% of observational and no intervention articles were rated high quality. Globally, compliance rates with 24-h MB guidelines were low (0-53.6%), with 87% (n = 122) articles reporting below 10%. Compliance with 24-h MB guidelines was associated with lower likelihood of obesity, mental health and cardiometabolic problems, and higher physical fitness, academic performance, and cognitive function. Correlates of 24-h MB guidelines compliance included age, gender, weight status, socioeconomic status, environmental pollution, parental support, and in-person schooling. Interventions promoting 24-h MB guidelines showed promising outcomes.

Conclusions: Current research on 24-h MB guidelines is geographically skewed, with only 7% of articles on low- and middle-income countries data. Most evidence was cross-sectional, and no article achieved high methodological quality Future research should focus on under-represented regions, use longitudinal and experimental designs, and assess key outcomes such as academic performance to inform policy and practice for improving youth health and well-being globally.

Although moderate-to-vigorous physical activity (MVPA) is a widely used construct in physical activity (PA) research, the lack of standardized assessment methods- particularly with the growing use of consumer-grade wearable activity trackers- poses challenges for comparability. Consumer-grade devices tend to rely on heart rate (HR)-based estimation methods to classify PA intensity, which contrasts with traditional research-grade accelerometers that use count- or raw-acceleration metrics. Comparability issues are particularly salient across individuals with varying weight status. In this commentary, we discuss systematic discrepancies between HR-based (relative intensity) and acceleration-based (absolute intensity) classifications of MVPA among individuals with differing weight statuses. Using Fitbit data from the Adolescent Brain Cognitive Development Study, we illustrate how HR-based PA intensity classification may indicate higher MVPA in youth with greater adiposity despite lower step counts and light PA levels. We highlight implications for research design, public health surveillance, messaging, policy, and interventions. We also call for greater transparency, standardized methodologies, and integrative measurement approaches to ensure more accurate assessment of PA behavior.