Changing the environment to promote health-enhancing physical activity

Supportive environments have been used to change and influence health behaviours like smoking. While psychological and ecological theories and models demonstrate the possible influences of the environment on health-enhancing physical activity (HEPA), little is known about the effectiveness of the environmental interventions. This paper presents the results of a systematic review of studies that used environmental interventions to increase health-enhancing physical activity. Two groups of studies were found, studies that changed the physical environment by creating new HEPA facilities, policies and supporting mechanisms, and studies that used the elements of the environment as an active or sedentary 'point of choice', via educational materials to promote stair use. Environmental change studies showed a small increase on HEPA behaviour, but the relative impact of environment changes was not evaluated. A number of before and after studies have observed a weak effect of a simple environmental change to stimulate stair climbing while travelling or shopping. Current national policy has embraced the environment as an option for promoting health-enhancing physical activity, especially active travel, in spite of the lack of effectiveness data. It is recommended that existing or planned public health environment and HEPA initiatives should use appropriate evaluation methods to assess their efficacy and effectiveness. Further developmental research into the nature of the relationship of the environment to particular HEPA behaviours is strongly recommended before developing new environmental interventions.     

Exploring the covariates of sport participation for health: an analysis of males and females in England

Increasing sport participation has been identified as a key vehicle for achieving World Health Organisation guidelines for health-enhancing physical activity (HEPA). A policy challenge is to promote this changed behaviour. Making use of the Active People Survey, a zero-inflated ordered probit model is used to identify the covariates of sport participation for males and females with respect to the related decisions to either participate in sport or not, and to participate at either lower or higher than desired intensity. To inform current policy emphases, the Active Places Survey is also used to examine the causal impact of facility provision on these behaviours. Results indicate that females are more likely to adopt less intensive activity even with time available. Families could place most constraints on females, but also reduce the intensity of male participation. Education has a greater association with higher intensity female activity. The largest effects are identified for sport club membership and facility satisfaction. Both of these affect male intensity of activity most. The main policy challenges facing sport in contributing to HEPA are shown to involve retaining male intensity of participation when ageing and encouraging greater female intensity of participation, with more appropriate matching of facilities.     

促进身体锻炼行为的社会生态理论模型研究述评

身体锻炼行为转变的研究源自促进个体健康的研究，身体锻炼行为研究是健康促进研究的一个重要领域。促进身体锻炼行为的研究是这一领域的重要内容。为了解释身体活动行为或者为了说明身体锻炼行为受哪些因素影响，研究人员提出了一些身体锻炼行为的理论模型，社会生态行为理论主要考察人和它所处物理环境和社会文化环境的相互关系。行为的社会生态学模型主要研究社会文化和物理环境对个体行为的影响，考虑个体在行为改变过程中的环境支持。     

Health-enhancing physical activity and sedentary behaviour in children and adolescents

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.     

Health-enhancing physical activity and sedentary behaviour in children and adolescents

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.     

Evaluating quality of implementation in physical activity interventions based on theories of motivation: current challenges and future directions

The evidence base pointing towards the maladaptive health consequences of an inactive lifestyle highlights the need for interventions that are effective in changing and maintaining physical activity behaviours. Theories of motivation are frequently applied to inform the content and delivery of such interventions. Systematic monitoring and evaluation of the quality of intervention implementation is therefore an important step in understanding if and how theories of motivation can be adopted and effectively applied to promote and/or sustain physical activity behaviours. However, intervention implementation quality in studies that aim to apply motivation theory to promote physical activity is often under-reported. The purpose of this article is, first, to review contemporary approaches used to monitor and evaluate intervention implementation; we outline the degree to which these methods have been used effectively in research concerned with applying theories of motivation to impact physical activity behaviours. Second, we identify and discuss specific challenges in effectively measuring quality of implementation faced by researchers who adopt a motivation theory basis to their work. Finally, recommendations for methods to monitor and evaluate intervention implementation in future trials aiming to promote physical activity based on theories of motivation are also proposed.     

促进身体锻炼行为的阶段性改变理论研究述评

身体锻炼行为转变的研究源自促进个体健康的研究，身体锻炼行为研究是健康促进研究的一个重要领域。促进身体锻炼行为的研究是这一领域的重要内容。为了解释身体活动行为或者为了说明身体锻炼行为受哪些因素影响，研究人员提出了一些身体锻炼行为的理论模型，行为的阶段性改变理论是其中重要的理论之一。行为的阶段性改变模式把行为阶段和过程的概念应用到为了行为的改变而设计的可变程序活动中。这些阶段通过一系列修正行为的活动与行为改变联系在一起，认为修正行为的活动过程就是行为改变的过程。     

Effect of Active Lessons on Physical Activity,Academic, and Health Outcomes: A Systematic Review

Purpose: The purpose of this study was to conduct a systematic review of classroom-based physical activity interventions that integrate academic content and assess the effectiveness of the interventions on physical activity, learning, facilitators of learning, and health outcomes. Method: Six electronic databases (ERIC, PubMed, Google Scholar, Science Direct, Cochrane Library, and EMBASE) and reference lists were searched for English-language articles, published January 1990 through March 2015, reporting classroom-based interventions that deliberately taught academic content using physically active teaching methods for at least 1 week duration, with physical activity, health, learning, or facilitators-of-learning outcomes. Two authors reviewed full-text articles. Data were extracted onto an Excel spreadsheet, and authors were contacted to confirm accuracy of the information presented. Results: Fifteen studies met the inclusion criteria. Six studies reporting on physical activity levels were found to have medium-to-large effect sizes. All 4 studies reporting learning outcomes showed positive effects of intervention lessons. Teachers and students were pleased with the programs, and enhanced on-task behavior was identified (n = 3). Positive effects were also reported on students’ body mass index levels (n = 3). Conclusions: Physically active academic lessons increase physical activity levels and may benefit learning and health outcomes. Both students and teachers positively received and enjoyed these teaching methods. These findings emphasize the need for such interventions to contribute toward public health policy.     

The transtheoretical model in the context of physical activity in a school-based sample of German adolescents

Abstract

Physical activity in adolescents is an important public health issue. Regular participation in physical activity is associated with various health benefits. However, problems with motivational adherence to physical activity have been documented. The transtheoretical model is a model of behaviour change. This model, which consists of stages of change, self-efficacy, decisional balance, and processes of change, has not been extensively investigated in youth. In addition, the health-enhancing physical activity concept has rarely been applied in this context.

A cross-sectional design was used. A random sample of seven junior high schools from Bremen (Germany) resulted in a sample of 588 adolescents (50.5% males, mean age=15.0 years, s=0.67). Respondents completed a self-administered questionnaire assessing stages of change, self-efficacy, decisional balance, and processes of change. Univariate analyses of variance were used to identify which constructs differed significantly across the stages of change. Discriminant analysis was used to determine which variables best discriminate the stages.

Distribution of the sample across the stages was: precontemplation, n=175 (29.8%); contemplation, n=135 (22.0%); preparation, n=63 (10.7%); action, n=20 (3.4%); and maintenance, n=195 (33.2%). Significant effects of stages of change were found for self-efficacy, pros, and seven of the ten processes of change. In general, scores of these constructs increased across the stages. Cons did not differ significantly across the stages.

The results provide support for some of the assumptions of the transtheoretical model in a German sample of adolescents. Some of our findings raise questions about the usefulness of five discrete stages. From a public health viewpoint, tailored interventions based on motivational readiness to change would be fruitful, but further research is warranted.     

The Validity and Reliability of the Back Saver Sit-and-Reach Test in Middle School Girls and Boys

The purpose of this article was to highlight important research needs related to physical activity in 3- to 5-year-old children. We identified research needs in 3 major categories: health effects, patterns of physical activity, and interventions and policies. The top research needs include identifying the health effects of physical activity, the effects of physical activity on the development of healthy weight, the effects of physical activity on learning and behavior, and the health implications of sedentary behavior. Research questions concerning patterns of physical activity include determining the prevalence of 3- to 5-year-olds meeting the current physical activity guidelines; the social and environmental factors that influence physical activity in home, preschool, and community settings; and how physical activity tracks into later childhood, adolescence, and adulthood. Research questions about interventions and policies include identifying the most effective strategies to promote physical activity in home, child care, and community settings and to reach diverse populations of young children, identifying effective intervention implementation and dissemination strategies, and determining the effectiveness of national, state, local, and institutional policies for increasing physical activity. In conclusion, research is needed to establish a full understanding of the health implications of physical activity in 3- to 5-year-old children, to better understand the nature of physical activity behavior in this group, and to learn how to promote physical activity in young children.     

How acceptable do older adults find the concept of being physically active? A systematic review and meta-synthesis

Despite the significant health benefits of regular physical activity for older adults, only a minority achieve recommended levels. To develop effective interventions, the reasons for the low levels of physical activity in this population must be understood. The present review identifies and synthesizes qualitative studies concerning the acceptability of physical activity to community dwelling older adults. A systematic search of four electronic databases identified 10 studies meeting inclusion criteria. These were appraised, and findings were combined and compared using thematic synthesis. Older adults construed physical activity as a by-product of other activities, rather than as a purposeful activity within itself. This seemed to be linked to their self-perception as an ageing member of society, with physical activity considered irrelevant, and competing roles and responsibilities (e.g., family) taking precedence. Additionally, older adults appeared to experience conflict between maintaining their autonomy and accepting the physical and social vulnerabilities associated with ageing. As older adults do not see physical activity as purposeful within itself, interventions promoting moderate or vigorous physical activity are likely to have limited success. As even small increases in physical activity benefit older adults, future interventions may wish to target the reduction of sedentary behaviour in this population.     

Changing the way people think about health-enhancing physical activity: do mass media campaigns have a role?

Mass media campaigns are conducted to influence community norms around health behaviours, including physical activity. Campaigns can reach large populations at relatively low cost, to influence awareness, knowledge and beliefs through to intention and behaviour change. We reviewed 15 campaigns with an explicit focus on physical activity, and explored impacts upon a range of proximal and distal variables. Campaigns achieved high recall, with a median of 70% of the target group aware of the campaign. Increases in knowledge or attitudes to physical activity were found among half the campaigns that reported this measure. Few campaigns reported other proximal variables, such as saliency, beliefs, self-efficacy or behavioural intention. Increases in physical activity were reported among motivated sub-groups of volunteers, but few campaigns reported population increases in activity. Campaigns increase awareness of the issue of physical activity but may not have a population-level effect on behaviour. Campaigns should focus more on influencing proximal variables, such as social norms, to bring about long-term behaviour change. This should be seen as part of a broader strategy, including policy and environmental change. Evaluation designs that measure the full range of variables are preferred to an over-concentration on behaviour alone.     

Changing the way people think about health-enhancing physical activity: do mass media campaigns have a role?

Mass media campaigns are conducted to influence community norms around health behaviours, including physical activity. Campaigns can reach large populations at relatively low cost, to influence awareness, knowledge and beliefs through to intention and behaviour change. We reviewed 15 campaigns with an explicit focus on physical activity, and explored impacts upon a range of proximal and distal variables. Campaigns achieved high recall, with a median of 70% of the target group aware of the campaign. Increases in knowledge or attitudes to physical activity were found among half the campaigns that reported this measure. Few campaigns reported other proximal variables, such as saliency, beliefs, self-efficacy or behavioural intention. Increases in physical activity were reported among motivated sub-groups of volunteers, but few campaigns reported population increases in activity. Campaigns increase awareness of the issue of physical activity but may not have a population-level effect on behaviour. Campaigns should focus more on influencing proximal variables, such as social norms, to bring about long-term behaviour change. This should be seen as part of a broader strategy, including policy and environmental change. Evaluation designs that measure the full range of variables are preferred to an over-concentration on behaviour alone.     

Physical activity patterns of ethnic children from low socio-economic environments within the UK

Many children fail to meet physical activity (PA) guidelines for health benefits. PA behaviours are complex and depend on numerous interrelated factors. The study aims to develop current understanding of how children from low Socio-economic environments within the UK use their surrounding built environments for PA by using advanced technology. The environment was assessed in 96 school children (7–9 years) using global positioning system (GPS) monitoring (Garmin Forerunner, 305). In a subsample of 46 children, the environment and PA were assessed using an integrated GPS and heart rate monitor. The percentage of time spent indoor, outdoor, in green and non-green environments along with time spent in moderate-to-vigorous PA (MVPA) in indoor and outdoor environments were assessed. A 2-by-2 repeated measures analysis of covariance, controlling for body mass index, BF%, assessed the environmental differences. The findings show that 42% of children from deprived wards of Coventry fail to meet PA guidelines, of which 43% was accumulated during school. Children engaged in more MVPA outdoor than indoor environments (P < 0.01) and a greater amount of time was spent in non-green environments (P < 0.01). Increased time outdoors was negatively associated with BF%. In conclusion, outdoor environments are important for health-enhancing PA and reducing fatness in deprived and ethnic children.     

Physical exercise in the prevention and treatment of Alzheimer's disease

Dementia is one of the greatest global challenges for health and social care in the 21st century. Alzheimer's disease (AD), the most common type of dementia, is by no means an inevitable consequence of growing old. Several lifestyle factors may increase, or reduce, an individual's risk of developing AD. Much has been written over the ages about the benefits of exercise and physical activity. Among the risk factors associated with AD is a low level of physical activity. The relationship between physical and mental health was established several years ago. In this review, we discuss the role of exercise (aerobic and resistance) training as a therapeutic strategy for the treatment and prevention of AD. Older adults who exercise are more likely to maintain cognition. We address the main protective mechanism on brain function modulated by physical exercise by examining both human and animal studies. We will pay especial attention to the potential role of exercise in the modulation of amyloid β turnover, inflammation, synthesis and release of neurotrophins, and improvements in cerebral blood flow. Promoting changes in lifestyle in presymptomatic and predementia disease stages may have the potential for delaying one-third of dementias worldwide. Multimodal interventions that include the adoption of an active lifestyle should be recommended for older populations.     

Population physical activity behaviour change: A review for the European College of Sport Science

Abstract

The academic study of sport and exercise science has expanded greatly into the arena of public health over the past 20 years or more and Europe has played a significant role in this. It is opportune to review evidence concerning ways to change population levels of physical activity for health. This paper summarises such evidence by using a lifespan approach with physical activity behaviour change for children and adolescents, adults and older adults. Correlates of physical activity are identified and the outcome of interventions is discussed. Intervention success has been variable often due to weak fidelity and short-term implementation, and process evaluation is missing from many such studies. Nevertheless, evidence points to possible behaviour change across all age groups and through multiple settings, including schools, worksites and the community.     

Optimising physical activity engagement during youth sport: a self-determination theory approach

Research suggests participation in youth sport does not guarantee physical activity (PA) guidelines are met. Studies indicate few children achieve recommended levels of moderate-to-vigorous physical activity (MVPA) during their youth sport involvement, and habitual levels of MVPA are below the recommended 60 min per day. Informed by self-determination theory, this study examined whether the coach-created social environment and related player motivation predict variability in objectively measured MVPA within the youth sport setting. Seventy three male youth sport footballers (Mean age = 11.66 ± 1.62) completed a multisection questionnaire assessing their perceptions of the social environment created in youth sport (autonomy supportive and controlling) and motivation towards their football participation (autonomous and controlled). Intensity of PA during youth sport was measured using accelerometers (GT3X, ActiGraph). Results supported a model in which perceptions of autonomy support significantly and positively predicted autonomous motivation towards football, which in turn significantly and positively predicted youth sport MVPA (% time). A significant indirect effect was observed for perceptions of autonomy support on youth sport %MVPA via autonomous motivation. Results have implications for optimising MVPA engagement during youth sport and increasing daily MVPA towards recommended and health-enhancing levels on youth sport days.     

The ABC of Physical Activity for Health: A consensus statement from the British Association of Sport and Exercise Sciences

Absract

Our understanding of the relationship between physical activity and health is constantly evolving. Therefore, the British Association of Sport and Exercise Sciences convened a panel of experts to review the literature and produce guidelines that health professionals might use. In the ABC of Physical Activity for Health, A is for All healthy adults, B is for Beginners, and C is for Conditioned individuals. All healthy adults aged 18–65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each week, or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Moderate-intensity activities are those in which heart rate and breathing are raised, but it is possible to speak comfortably. Vigorous-intensity activities are those in which heart rate is higher, breathing is heavier, and conversation is harder. Aerobic activities should be undertaken in bouts of at least 10 min and, ideally, should be performed on five or more days a week. All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence. Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults. Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, or 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities. Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5–16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.