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Is Scotland Walking in the Right Direction? A Cross-Sectional Analysis of Trends in Walking by Socioeconomic Status

Tessa Strain, Paul Kelly, Rona Gibb, Mary Allison, Nanette Mutrie, and Marie Murphy

Background: Walking is a key target behavior for promoting population health. This paper charts the 30-year history of walking policy in Scotland. We assess whether population walking levels among adults in Scotland have changed in recent years and identify the characteristics of those least likely to report any walking. Methods: We pooled 9 years (2012–2019 and 2021) of data from adult (≥16 y) respondents of the Scottish Health Survey (n = 41,470). The outcomes of interest were the percentage reporting (1) any walking and (2) any walking with an average pace that is of at least moderate intensity. We also investigated the contribution of walking to total nonoccupational moderate to vigorous physical activity. We used linear and logistic regressions to test linear trends over time and to identify inequalities by age, sex, and the Scottish Index of Multiple Deprivation quintile. Results: There was an increase in all measures of walking over the period 2012–2021; for example, the percentage reporting any walking increased by 7 percentage points (81.4%–88.4%). Inequalities still exist by age, sex, and the Scottish Index of Multiple Deprivation but have not grown over time. Inequalities by sex and age are most pronounced in the least affluent Scottish Index of Multiple Deprivation quintiles; less affluent older women are least likely to report any walking. Conclusions: Scotland appears to be walking in the right direction. Surveillance data support a positive trend after decades of policy and promotion efforts. The policies do not appear to be exacerbating existing inequalities, but narrowing them will require more concentrated efforts.

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Isotemporal Substitution Modeling on Sedentary Behaviors and Physical Activity With Mortality Among People With Different Diabetes Statuses: A Prospective Cohort Study From the National Health and Nutrition Examination Survey Analysis 2007–2018

Zhaojun Chen, Lishan Cai, Qianni Qin, Xiang Li, Shaoyou Lu, Litao Sun, Yang Zhang, Lu Qi, and Tao Zhou

Background: To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses. Methods: This prospective cohort study included 21,637 participants (mean age, 48.5 y) from the National Health and Nutrition Examination Survey 2007–2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks. Results: We found significant protective associations between replacing 30 minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77–0.95) to 0.96 (0.94–0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70–0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80–0.94) to 0.89 (0.81–0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63–0.83) to 0.96 (0.92–0.99). Conclusions: Replacing sedentary behaviors with 30 minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.

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“It’s a Very Good Second Option”: Older Adults’ Experience of Telehealth

Brett D. Buist, Ben E. Kramer, Kemi E. Wright, Peter K. Edwards, Alyssa M. Petrofes, and Bonnie J. Furzer

Introduction: The growing ability to provide online services has enabled the proliferation of exercise-based telehealth interventions; however, adoption in older adults may be impacted by low digital literacy and “technophobia.” Objectives: The aim of this study was to explore the experience of community and aged-care dwelling older adults following exercise-based telehealth services to provide insights that could guide future telehealth exercise delivery. Design: Semi-structured interviews for qualitative analysis. Methods: Participants (age ≥60) who had completed at least one online exercise session from a registered health professional were recruited through a combination of purposeful and snowball sampling methods via their exercise facility or provider. A semi-structured interview guide was used by 2 interviewers to investigate participants’ experiences and a “critical friends” approach used to identify common themes. Results: Thirteen interviews with 21 participants were conducted from 2 different facilities. Analysis identified meaning units within 3 themes and subthemes. Technology subthemes related to digital confidence prior to telehealth and changes during interventions, as well as the usability of technology for telehealth. Clinical practice subthemes described the different motivations to exercise, perceived benefits of telehealth, important implications for practitioners, and perceptions of safety. The social connection theme related to the social benefits of telehealth. Conclusions: Older adults in our sample were technologically confident and capable of performing exercise sessions delivered via telehealth. They notice benefits from this form of exercise delivery however, prefer face-to-face exercise delivery.

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Is It Possible to Decolonize the Field of Physical Activity and Health?

Alan G. Knuth, Giulia Salaberry Leite, Sueyla Ferreira da Silva dos Santos, and Inácio Crochemore-Silva

Is it possible to decolonize the field of physical activity and health? Decoloniality presupposes a body-geopolitical location, such as in the Brazilian and Latin American context, where it is crucial to use social identity lenses related to race, gender, sexuality, and other social markers that affect the body. Understanding health and physical activity from a decolonial perspective would bring the oppressions that connect capitalism, patriarchy, and racism to the center of the discussion. For a “physical activity other,” we challenged the general recommendation of physical activity in the 4 domains. Physical activity should be understood as an end in itself, as a right, and as human development. Approaches that advocate physical activity at work, at home, and while commuting use other human activities to relate these domains to health without considering the inequalities and oppressions that constitute them in most parts of the world. Is it fair to apply “global recommendations” for physical activity to scenarios such as Brazil and Latin America, using models that are inappropriate to the context and history of these places, people, and cultures? Perhaps it is time to socially reorient and reposition physical activity from a decolonial perspective. We need Black, Indigenous, Latino, African, and other people from the Global South to move the research agenda, recommendations, and policies on physical activity from “any” health to a fair health.

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Physical Activity at Different Life Stages and Its Consequence on the Initial Immunization and Inflammatory Response Against COVID-19

Priscila Almeida Queiroz Rossi, Regis Gomes, Teresa Cristina do Nascimento Salazar, Esmeralda Maria Lustosa Barros, Silvia Vasconcelos, Adalberto Socorro da Silva, Ester Miranda Pereira, Vitoria Braga Melo, Marcela Helena Gambin Fonseca, Clarissa Romero Teixeira, Gilvan Pessoa Furtado, Larissa Queiroz Pontes, Ricardo Khouri, Beatriz Vasconcelos, Sandro Soares de Almeida, Guilherme Loureiro Werneck, Fabrício Eduardo Rossi, and Marcos Antonio Pereira dos Santos

Background: To evaluate the influence of previous physical activity (PA) during childhood, adolescence, and current PA practice on the production of antibodies and inflammatory response between the first and second doses of the COVID-19 vaccine. Methods: Fifty-nine men and 56 women were evaluated before the first vaccine, and 12 weeks later, blood samples were taken to quantify production of anti-severe acute respiratory syndrome coronavirus-2 immunoglobulin G antibodies and cytokines. Previous PA during childhood and adolescence was self-referred, and current PA was assessed using the International Physical Activity Questionnaire. Results: A positive and significant association was observed only between PA practice during adolescence and an increase in antibody production in adulthood (β = 2012.077, 95% confidence interval, 257.7953–3766.358, P = .025). Individuals who practiced PA during adolescence showed higher production of antibodies between the first and second vaccine dose compared to nonpractitioners (P = .025) and those that accumulated ≥150 minutes per week of current moderate–vigorous PA (MVPA), and presented higher antibody production in relation to who did <150 minutes per week of MVPA (P = .046). Individuals that were practitioners during childhood produced higher G-CSF (P = .047), and those that accumulated ≥150 minutes per week of current MVPA demonstrated lower IP-10 levels (P = .033). However, PA practitioners during adolescence presented higher G-CSF (P = .025), IL-17 (P = .038), IL-1RA (P = .005), IL-1β (P = .020), and IL-2 (P = .026) levels. Conclusion: Our results suggest that adults that accumulated at least 150 minutes of MVPA per week or practiced PA during adolescence developed an improved immune and inflammatory response against COVID-19 vaccination.

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Examining Ableism Through the Physical Activity Experiences of Blind and Visually Impaired Women

Lindsey E. Ball and Justin A. Haegele

Purpose: This study examined how ableism influences blind and visually impaired women’s experiences accessing and engaging in exercise, physical activity, and sport. Methods: Ten women between the ages of 27 and 45 years completed a one-on-one audio-recorded virtual interview where they reflected on the meaningfulness of their exercise, physical activity, and/or sport experiences, as well as described any experiences related to direct, indirect, systemic, or internalized ableism within or when attempting to access those physical activity experiences. The interview transcripts were analyzed using reflexive thematic analysis. Findings: The analysis resulted in the construction of 2 themes that depicted the participants’ experiences: (1) “It’s exhausting”: navigating inaccessibility and (2) “You feel like a fish out of water”: internalized ableism. Discussion: The themes highlight the participants’ experiences which were largely focused on being forced to navigate inaccessible environments which resulted in exhaustion and expressions of internalized ableism. These findings provide insight into what makes and does not make a physical activity space accessible and welcoming for blind and visually impaired adults.

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Barriers to Participation in Organized Physical Activity Among LGBTQ+ Youth: Differences by Sexual, Gender, and Racial Identities

Benjamin Parchem, Jonathan Poquiz, Ryan L. Rahm-Knigge, Elizabeth Panetta, Ryan J. Watson, and G. Nic Rider

Background: LGBTQ+ youth engage in organized physical activity to a lesser degree than their cisgender and heterosexual counterparts. Existing literature on this organized physical activity disparity is limited, particularly with LGBTQ+ youth samples. The current analysis examined individual and systemic barriers to organized physical activity for LGBTQ+ youth across sexual, gender, and racial identities. Methods: A subsample of LGBTQ+ students (N = 4566) from the 2021 Dane County Youth Assessment completed items that measured barriers to organized physical activity and systemic factors (ie, family money problems and bias-based bullying) associated with access to organized physical activity. Latent class analysis discerned patterns of individual and systemic barriers to organized physical activity. Latent class regression modeling tested gender, sexual, and racial identities as correlates of latent class membership. Results: More than half of the sample did not participate in organized physical activity. Four profiles of LGBTQ+ youth were discerned based on self-reported barriers: high barrier (8%), bullied (16%), low interest or perceived skills (28%), and low barrier (48%). The low-barrier class included a greater proportion of LGBTQ+ youth who identified as White, or cisgender, or heterosexual as well as youth self-reporting higher organized physical activity. The high-barrier and bullied classes comprised more marginalized gender and sexual identities. Conclusions: LGBTQ+ youth experience individual and systemic barriers to organized physical activity, including inequitable access and bullying, and barriers are uniquely experienced across sexual, gender, and racial identities. Physical activity promotion among LGBTQ+ youth would be strengthened by policies that address inequitable access to opportunities and bias-based bullying.

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The Role of Physical Literacy in the Association Between Weather and Physical Activity: A Longitudinal Multilevel Analysis With 951 Children

Johannes Carl, Paulina S. Melby, Mette L. Kurtzhals, Glen Nielsen, Peter Bentsen, and Peter Elsborg

Background: Numerous studies showed an effect of weather on physical activity (PA) levels in children. However, no study has yet examined the relevance of personal factors in this relationship. Therefore, this study analyzes (1) whether there are systematic interindividual differences in the extent to which weather affects the PA behavior and (2) whether physical literacy (PL) moderates the weather–PA association in children. Methods: A total of 951 children in 12 Danish schools (age 9.76 [1.59] y; 54.3% girls) completed objective PA assessments via accelerometry (moderate to vigorous PA, light PA, and sedentary behavior). Local weather data (precipitation, wind speed, temperature, and sunshine duration) were provided by the Danish Meteorological Institute. Participants’ PL was measured employing the Danish version of the Canadian Assessment of Physical Literacy-2. The 4116 accelerometer days underwent longitudinal multilevel analyses while considering their nesting into pupils and school classes (n = 51). Results: Fluctuations in all PA indicators were significantly explained by variations in weather conditions, especially precipitation (P ≤ .035). Significant interindividual differences were found for 9 of 12 analytical dimensions, suggesting that weather changes influence PA behavior differently across individuals (especially moderate to vigorous PA, χ2[4] ≥ 11.5, P ≤ .021). However, PL moderated the relationship between weather and PA in only 2 of the 48 analytical constellations. Conclusions: Despite the varying impact of weather on PA across individuals, the present study favors a main effect model in which weather and PL exert independent effects on children’s PA. The insufficient support for PL as a moderating factor calls for future studies to test alternative mechanisms in the weather–PA association.

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Walking Activity and Physical Function Among Mexican American Older Adults Over 9 Years of Follow Up

Nicholas Tahmassi and Soham Al Snih

Background: Walking activity has been associated with reduction in the development of chronic disease, cognitive and physical function impairment, disability, and mortality. The objective of this study was to examine the relationship between walking activity and physical function over 9 years of follow-up among Mexican Americans aged 78 years and older. Methods: Participants (N = 998) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2007–2016). Measures included walking activity duration and frequency, socio-demographics, body mass index, medical conditions, pain, depressive symptoms, limitation in activities of daily living, and the Mini-Mental State Examination. Low physical function was defined as scoring <7 on the Short Physical Performance Battery. At baseline, participants were grouped into nonwalkers (n = 653), walked <150 minutes/week (n = 144), and walked 150 minutes/week or more (n = 201). A Generalized Estimating Equation model was used to estimate the odds ratio and 95% CI of low physical performance as a function of walking activity status. Results: Compared with nonwalkers, participants walking < 150 minutes/week had lower odds (odds ratio = 0.66, 95% CI, 0.51–0.86) of low physical function over time, after controlling for all covariates, as did those walking ≥ 150 minutes/week (odds ratio = 0.54, 95% CI, 0.41–0.71). Conclusions: Mexican American older adults who engage in any walking activity are at reduced risk of low physical function, even those with disability. Interventions at the individual and community level are recommended to reduce physical function impairment, even in those with preexisting medical conditions or disability.

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Accelerometer-Based Estimates of Physical Activity and Sedentary Time Among Samoan Adults

Nicola L. Hawley, Parmida Zarei, Scott E. Crouter, Mayur M. Desai, Alysa Pomer, Anna C. Rivara, Take Naseri, Muagututia Sefuiva Reupena, Satupaitea Viali, Rachel L. Duckham, and Stephen T. McGarvey

Background: The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult Samoans. Using wrist-worn accelerometer-based devices, this study aimed to characterize physical activity among Samoan adults. Methods: Samoan adults (n = 385; 55% female, mean [SD] age 52 [10] y) wore Actigraph GT3X+ devices for 7 to 10 days. General linear models were used to examine mean daily minutes of sedentary time, light physical activity, and moderate to vigorous physical activity by various participant characteristics. Results: Time spent in moderate to vigorous physical activity did not differ statistically between men (88 [5] min; 95% confidence interval [CI], 80–97) and women (78 [4] min; 95% CI, 70–86; P = .08). Women, however, spent more time than men in light physical activity: 380 (7) minutes (95% CI, 367–393) versus 344 (7) minutes (95% CI, 329–358; P < .001). While there were no differences in physical activity by census region, education, or occupation among women, men in urban areas spent significantly less time in moderate to vigorous physical activity than those in peri-urban and rural areas (P = .015). Women with class II/III obesity spent more time in sedentary activities than those with healthy weight or overweight/class I obesity (P = .048). Conclusions: This study characterizes physical activity among Samoan adults and highlights variation by sex, urbanicity, and weight status. In providing initial device-measured estimates of physical activity in Samoa, this analysis establishes a baseline from which the success of future attempts to intervene on physical activity may be assessed.