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Charting a Course: Navigating Rigor and Meaning in Global Health Research

Tiago Canelas, Motlatso Godongwana, Feyisayo A. Wayas, Estelle Victoria Lambert, Yves Wasnyo, and Louise Foley

In the rapidly evolving landscape of global health research, the tension between scientific rigor and contextual meaning presents a critical challenge. Drawing on our work with the Global Diet and Physical Activity Network, this commentary explores the complexities of conducting environmental audits for physical activity and diet in 4 rapidly urbanizing African cities: Yaoundé, Lagos, Cape Town, and Soweto. We illustrate the competing demands and tensions that researchers face in balancing rigor and meaning. We discuss the adaptation of internationally validated audit tools to local contexts and the importance of area-level deprivation in interpreting data. We also examine the feasibility of virtual assessment tools, emphasizing the value of local expertise. We argue for a balanced approach that marries research rigor with contextual meaning, advocating for transparency, humility, and meaningful community engagement.

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Participant Bias in Community-Based Physical Activity Research: A Consistent Limitation?

Iris A. Lesser, Amanda Wurz, Corliss Bean, Nicole Culos-Reed, Scott A. Lear, and Mary Jung

Physical activity is a beneficial, yet complex, health behavior. To ensure more people experience the benefits of physical activity, we develop and test interventions to promote physical activity and its associated benefits. Nevertheless, we continue to see certain groups of people who choose not to, or are unable to, take part in research, resulting in “recruitment bias.” In fact, we (and others) are seemingly missing large segments of people and are doing little to promote physical activity research to equity-deserving populations. So, how can we better address recruitment bias in the physical activity research we conduct? Based on our experience, we have identified 5 broad, interrelated, and applicable strategies to enhance recruitment and engagement within physical activity interventions: (1) gain trust, (2) increase community support and participation, (3) consider alternative approaches and designs, (4) rethink recruitment strategies, and (5) incentivize participants. While we recognize there is still a long way to go, and there are broader community and societal issues underlying recruitment to research, we hope this commentary prompts researchers to consider what they can do to try to address the ever-present limitation of “recruitment bias” and support greater participation among equity-deserving groups.

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Effect of Yoga or Physical Exercise on Muscle Function in Rural Indian Children: A Randomized Controlled Trial

Sonal Kasture, Anuradha Khadilkar, Raja Padidela, Ketan Gondhalekar, Radhika Patil, and Vaman Khadilkar

Background: Synergistic effects of yoga or physical exercise (PE) along with protein supplementation on children’s muscle function in rural India have not been studied. Hence, we aimed to study the effect of yoga and PE along with protein supplementation on muscle function in healthy 6- to 11-year-old rural Indian children post 6 months of intervention. Methods: A randomized controlled trial on 232 children, recruited into 3 groups, each receiving 1 protein-rich ladoo (148 kcal, 7 g protein/40 g ladoo–an Indian sweet snack) daily and performing (1) yoga (n = 78) for 30 minutes 5 times per week, (2) PE (n = 76) for 30 minutes 5 times per week, or (3) control group (n = 78) no additional exercise. Maximum power, maximum voluntary force (Fmax), and grip strength (GS) were measured. Data were analyzed using paired t tests and a 2-way mixed analysis of variance with post hoc Bonferroni adjustment. Results: GS, maximum power, and Fmax within yoga group increased significantly (P < .05) from baseline to endline. GS and Fmax increased significantly within PE group postintervention (P < .001). In controls, GS increased (P < .05) at endline. No significant effect of the intervention was observed on the change in maximum power (P > .05) postintervention. The 2 exercise groups showed significant increase in Fmax compared with the control group (P < .05). Similarly, increase in GS was significantly higher in both the exercise groups compared with the control group (P < .05). No significant difference was observed in change in muscle function between the 2 exercise groups (P > .05). Conclusions: Structured physical activity along with protein supplementation resulted in improved muscle function in children. Yoga and PE showed a comparable impact on muscle force.

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Volume 20 (2023): Issue 11 (Nov 2023)

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Association Between Children’s and Parents’ Physical Activity During the COVID-19 Pandemic: A Cross-Lagged Analysis

Monika Szpunar, Matthew Bourke, Leigh M. Vanderloo, Brianne A. Bruijns, Stephanie Truelove, Shauna M. Burke, Jason Gilliland, Jennifer D. Irwin, and Patricia Tucker

Background: COVID-19 caused closures of movement supporting environments such as gyms and schools in Canada. This study evaluated the association between Ontario parents’ and children’s physical activity levels across time during COVID-19, controlling for variables that were identified as significant predictors of children’s and parents’ physical activity (e.g., children’s age, parents’ employment status). Methods: Parents (n = 243; mean age = 38.8 y) of children aged 12 and under (n = 408; mean age = 6.3 y) living in Ontario, Canada completed 2 online surveys, the first between August and December 2020 and the second between August and December 2021. At baseline, parents were asked to recall prepandemic physical activity levels. To determine the association between parent and child physical activity during COVID-19, a cross-lagged model was estimated to determine the cross-sectional and longitudinal associations between parents’ and children’s physical activity across time. Results: Bivariate associations revealed that parents’ and children’s physical activity levels were significantly related during lockdown and postlockdown but not prelockdown. The autoregressive paths from prelockdown to during lockdown were significant for children (β = 0.53, P < .001) and parents (β = 1.058, P < .001) as were the autoregressive paths from during lockdown to postlockdown for children (β = 0.61, P < .001) and parents (β = 0.48, P < .001). In fully adjusted models, the cross-lagged association between parents’ physical activity prelockdowns was significantly positively associated with their children’s physical activity during lockdowns (β = 0.19, P = .013). Conclusions: Resources are needed to ensure that children and parents are obtaining sufficient levels of physical activity, particularly during a pandemic.

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Clustering of Multilevel Factors Among Children and Adolescents: Associations With Health-Related Physical Fitness

Shan Cai, Yunfei Liu, Jiajia Dang, Panliang Zhong, Di Shi, Ziyue Chen, Peijin Hu, Jun Ma, Yanhui Dong, Yi Song, and Hein Raat

Background: To identify the clustering characteristics of individual-, family-, and school-level factors, and examine their associations with health-related physical fitness. Methods: A total of 145,893 Chinese children and adolescents aged 9–18 years participated in this cross-sectional study. The 2-step cluster analysis was conducted to identify clusters among individual-, family-, and school-level factors. Physical fitness indicator was calculated through sex- and age-specific z scores of forced vital capacity, standing long jump, sit-and-reach flexibility, body muscle strength, endurance running, and body mass index. Results: Three, 3, and 5 clusters were automatically identified at individual, family, and school levels, respectively. Students with low physical fitness indicator were more likely to be in the “longest sedentary time and skipping breakfast” cluster (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.12–1.24), and “physical inactivity and insufficient protein consumption” cluster (OR = 1.07; 95% CI, 1.02–1.12) at individual level, the “single children and high parental education level” cluster (OR = 1.15; 95% CI, 1.10–1.21), and “no physical activity support and preference” cluster (OR = 1.30; 95% CI, 1.25–1.36) at family level, and the “physical education occupied” cluster (OR = 1.06; 95% CI, 1.01–1.11), and “insufficient physical education frequency” cluster (OR = 1.16; 95% CI, 1.08–1.24) at school level. Girls were more vulnerable to individual- and school-level clusters, while boys were more susceptible to family clusters; the younger students were more sensitive to school clusters, and the older students were more susceptible to family clusters (P-interaction < .05). Conclusions: This study confirmed different clusters at multilevel factors and proved their associations with health-related physical fitness, thus providing new perspective for developing targeted interventions.

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Household Food Insecurity Is Associated With Physical Activity in Youth and Young Adults With Diabetes: A Cross-Sectional Study

Lauren A. Reid, Marco Geraci, Jason A. Mendoza, Anwar T. Merchant, Beth A. Reboussin, Russell R. Pate, Lawrence M. Dolan, Katherine A. Sauder, Eva Lustigova, Grace Kim, and Angela D. Liese

Background: Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study. Methods: HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression. Results: YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure. Conclusions: Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.

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Leisure-Time Physical Activity in a Southern Brazilian City (2004–2021): Applying an Equity Lens to Time-Trend Analyses

Andrea Wendt, Alan G. Knuth, Bruno P. Nunes, Mario Renato de Azevedo Jr, Helen Gonçalves, Pedro C. Hallal, and Inácio Crochemore-Silva

Background: This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. Methods: Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. Results: We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = −11.1 [95% confidence interval, CI, −14.4 to −7.8], SII2021 = −10.7 [95% CI, −13.7 to −7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was −24.5 (95% CI, −31.1 to −17.9) in 2004 and −18.8 in 2021 (95% CI, −24.2 to −13.4). Conclusions: Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.

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The Impact of a Lifestyle Intervention on Postpartum Cardiometabolic Risk Factors Among Hispanic Women With Abnormal Glucose Tolerance During Pregnancy: Secondary Analysis of a Randomized Trial

Kathryn A. Wagner, Christine W. St. Laurent, Penelope Pekow, Bess Marcus, Milagros C. Rosal, Barry Braun, Joann E. Manson, Brian W. Whitcomb, Lynnette Leidy Sievert, and Lisa Chasan-Taber

Background: Women with abnormal glucose tolerance during pregnancy are at risk for cardiovascular disease (CVD), with higher rates among Hispanics. However, studies on the impact of lifestyle interventions on postpartum CVD profiles are sparse. Methods: This is a secondary analysis of a controlled trial among a subsample of Hispanic women with abnormal glucose tolerance participating in Estudió PARTO (Project Aiming to Reduce Type twO diabetes; mean age = 28.2 y, SD: 5.8) who were randomized to a culturally modified Lifestyle intervention (n = 45) or a comparison Health and Wellness intervention (n = 55). Primary endpoints were biomarkers of cardiovascular risk (lipids, C-reactive protein, fetuin-A, and albumin-to-creatinine ratio) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment, leptin, tumor necrosis factor-alpha, and adiponectin) measured at baseline (6-wk postpartum) and 6 and 12 months. Results: In intent-to-treat analyses, there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year. In prespecified sensitivity analyses, women adherent with the Lifestyle Intervention had more favorable improvements in insulin (intervention effect = −4.87, SE: 1.93, P = .01) and HOMA-IR (intervention effect = −1.15, SE: 0.53, P = .03) compared with the Health and Wellness arm. In pooled analyses, regardless of intervention arm, women with higher postpartum sports/exercise had greater increase in HDL-cholesterol (intervention effect = 6.99, SE: 1.72, P = .0001). Conclusions: In this randomized controlled trial among Hispanic women with abnormal glucose tolerance, we did not observe a significant effect on postpartum biomarkers of CVD risk or insulin resistance. Women adherent to the intervention had more favorable changes in insulin and HOMA-IR.

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Striking a Balance: Physical Activity and Planetary Health

Katja Siefken and Karim Abu-Omar