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Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis

Amirali Hajebi, Maryam Nasserinejad, Sina Azadnajafabad, Erfan Ghasemi, Negar Rezaei, Moein Yoosefi, Azin Ghamari, Mohammad Keykhaei, Ali Ghanbari, Esmaeil Mohammadi, Mohammad-Mahdi Rashidi, Fateme Gorgani, Mana Moghimi, Alireza Namazi Shabestari, and Farshad Farzadfar

Background: We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures. Methods: Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran. Results: All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%–47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%–64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively. Conclusions: The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.

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2022 French Report Card on Physical Activity and Sedentary Behaviors in Children and Youth: From Continuous Alarming Conclusions to Encouraging Initiatives

Alicia Fillon, Jeremy Vanhelst, Pauline Genin, Benjamin Larras, Michéle Tardieu, Marion Porcherie, Maxime Luiggi, Salomé Aubert, Charlotte Verdot, Olivier Rey, Lena Lhuisset, Julien E. Bois, Guillaume Y. Millet, Martine Duclos, and David Thivel

Background: Scientific evidence and public health reports keep highlighting the continuous and alarming worldwide progression of physical inactivity and sedentary behaviors in children and adolescents. The present paper summarizes findings from the 2022 French Report Card (RC) on physical activity for children and youth and compares them to the 2016, 2018, and 2020 RCs. Methods: The 2022 edition of the French RC follows the standardized methodology established by the Active Healthy Kids Global Matrix. Ten physical activity indicators have been evaluated and graded based on the best available evidence coming from national surveys, peer-reviewed literature, government and nongovernment reports, and online information. The evaluation was also performed in children and adolescents with disabilities. Indicators were graded from A (high level of evidence) to F (very low level of evidence) or INC for incomplete. Results: The evaluated indicators received the following grades: overall physical activity: D−; organized sport participation and physical activity: C; active play: F; active transportation: C; sedentary behaviors: D−; family and peers: D; physical fitness: C; school: C−; community and the built environment: F; government: B. Conclusions: While this 2022 French RC shows progression for 7 out of the 10 indicators considered, it also underlines the continuous need for actions at the local, regional, and national levels to develop better surveillance systems and favor a long-term improvement of youth movement behaviors.

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Associations Between Adolescent Sport and Exercise Participation and Device-Assessed Physical Activity in Adulthood: Evidence From the 1970 British Cohort Study

Nicholas Scicluna, Mark Hamer, and Joanna M. Blodgett

Background: Adolescence is a critical period filled with life changes. Early implementation of effective health promotion strategies could help alleviate the morbidity and mortality associated with inactivity. This study investigated whether adolescent participation in exercise and sport is associated with device-assessed physical activity (PA) levels in midlife. Methods: A total of 2984 participants (41.2% male) from the 1970 British Cohort Study were included. Participants were surveyed at age 16 years on 5 indicators of exercise and sport participation. Total daily PA and moderate to vigorous PA (MVPA) at age 46 years were measured using a thigh-worn accelerometer, worn for 7 days. Associations between each adolescent exercise or sport indicator and adulthood total daily PA and MVPA were examined using linear regressions, adjusting for sex, wear time, body mass index, smoking, disability, malaise, alcohol consumption, social class, education, and self-rated health. Results: In fully adjusted models, adolescents who reported exercising “much more” than others (8.6 min/d; 95% confidence interval, −0.1 to 17.1), who played sports at the park/playground more than once a week (8.5 [3.0–14.0] min/d), and who exercised on the most recent Saturday (3.8 [0.7–6.9] min/d) had higher adult total PA levels than those who reported the lowest activity levels. There was no evidence of an association between greater sport and exercise participation at age 16 y and MVPA at age 46 y. There was no association between sports at school and either measure of adult PA. Conclusion: Active adolescents, particularly those who engaged in out-of-school exercise, had higher total daily PA levels, but not MVPA levels, in midlife. This highlights the potential of early PA interventions to improve PA levels in adulthood.

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Associations Between Type and Timing of Physical Activity and Sedentary Behavior With Mental Health in Adolescents and Young Adults

Bruno G.G. da Costa, Antonius J. Van Rooij, Anouk Tuijnman, Travis J. Saunders, and Jean-Philippe Chaput

Background: This cross-sectional study analyzed the association of leisure-time physical activity (PA) and sedentary behavior (SB), nonleisure PA and SB, and total PA and SB in different time segments of the day with mental health among Dutch adolescents and young adults. Methods: A total of 881 participants aged 16–25 years completed an online survey. Mental health was assessed using the Mental Health Inventory-5, and participants also reported sex, age, and income. They filled out a questionnaire of types of PA and SB for each hour of the day. Activities were categorized into nonleisure and leisure, during the morning, afternoon, evening, and for the whole day. Results: Participants (52.8% female, on average 20.8 y) generally engaged in more leisure-time PA and SB during weekends compared with weekdays, and more nonleisure activities on weekdays. Associations varied between time segments and days of the week. Positive associations of leisure-time and total PA during the whole day and evenings with mental health were observed on weekdays. Total, leisure-time, and nonleisure-time SB were associated with worse mental health. Nonleisure PA was not associated with mental health. Conclusions: Leisure-time PA was found to have a favorable association with mental health, particularly in the evenings of weekdays and afternoons of weekend days. On the other hand, leisure SB was associated with poorer mental health in most of the time segments analyzed, and nonleisure SB in the evenings was also related to worse mental health. The type and timing of PA and SB behaviors play an important role in the relationship with mental health.

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Physical Activity and Sitting Time Patterns and Sociodemographic Correlates Among 155,790 South American Adults

André O. Werneck, Raphael H.O. Araujo, Cecilia Anza-Ramírez, Javier Brazo-Sayavera, Christian García-Witulski, Nicolas Aguilar-Farias, Se-Sergio Baldew, Kabir P. Sadarangani, Robinson Ramírez-Vélez, Antonio García-Hermoso, Gerson Ferrari, Felicia Cañete, Ramfis Nieto-Martinez, and Danilo R. Silva

Background: To estimate the prevalence of different physical activity (PA) domains and sitting time (ST), and to analyze the association with sociodemographic indicators. Methods: Data from the most recent nationally representative survey from each of the South American countries, comprising 155,790 adults (18–64 y), were used. Data on leisure-time, transport, and occupational PA (all 3 domains as nonzero), total PA (≥150 min/wk), and ST (≥8 h/d) were assessed by specific questionnaires in each survey. Gender, age group (18–34, 35–49, and 50–64 y), and education (quintiles) were used as sociodemographic factors. Random effect meta-analysis of the association between sociodemographic factors and PA and ST were conducted. Results: The prevalence of PA guidelines compliance and elevated ST in South America was 70.3% and 14.1%, respectively. Women were less likely to achieve the recommended levels of total and domain-based PA. Participants in the highest quintile of education were more likely for elevated ST (2.80, 2.08–3.77), lower occupational PA (0.65, 0.44–0.95), but higher leisure-time PA (3.13, 2.31–4.27), in comparison with lowest quintile. Older adults were less likely to participate in total and leisure-time PA. Conclusion: Our findings highlight the urge to tackle the inequalities in PA practice in South America, especially gender and education inequalities, for leisure-time PA.

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Association Between Domain-Specific Physical Activity and Cardiometabolic Factors in a Multiethnic Asian Population: A Longitudinal Study

Lixia Ge, Saima Hilal, Falk Müller-Riemenschneider, and Chuen Seng Tan

Aims: To examine the association between domain-specific physical activity (PA) and cardiometabolic factors with longitudinal data, which is limited in current literature. Methods: Participants who attended the Singapore Multi-Ethnic Cohort and follow-up surveys were included in this study (N = 3950, mean age: 44.7 y, female: 57.9%). Self-reported moderate- to vigorous-intensity PA (MVPA) for each domain (leisure-time, transportation, occupation, and household) was categorized into 4 levels: no, low, middle, and high MVPA. The longitudinal associations of domain-specific MVPA with cardiometabolic factors including systolic and diastolic blood pressures, low-density and high-density lipoprotein cholesterols, triglycerides, and body mass index were examined using Generalized Estimating Equations, accounting for confounding factors and repeated measurements. Results: There were 5.2% participants who had no MVPA. For each domain, this rate ranged from 22.6% (household) to 83.3% (occupation). Leisure-time and occupation MVPAs had positive and linear associations with high-density lipoprotein cholesterols, corresponding to 0.030 (95% confidence interval, 0.015 to 0.045) mmol/L (leisure-time) and 0.063 (95% confidence interval, 0.043 to 0.083) mmol/L (occupation), when compared high with no respective MVPA. Occupation and household MVPAs were associated with low-density lipoprotein cholesterol. Transportation and occupation exhibited a positive and linear relationship with diastolic blood pressure. None of the domains were associated with body mass index, systolic blood pressures, or triglycerides. Conclusions: This study showed that each domain had differential association with individual cardiometabolic risk factors. As occupation, transportation, or household PA had unfavorable associations with low-density lipoprotein cholesterol or diastolic blood pressure, the overall beneficial impact of higher PA levels may not necessarily hold in the context of domain-specific PA and cardiovascular health. Further investigation is needed to corroborate our findings.

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Longitudinal Association of Changes in Parental Correlates With Screen Time in Chinese Preschoolers

Yan Wu and Sunyue Ye

Background: This study aimed to explore the relationship between the changes in parent-related factors and preschoolers exceeding screen time (ST) recommendations. Methods: A longitudinal analysis using 2-year follow-up data from 4 kindergartens (n = 409) was conducted in Zhejiang, China, from 2019 to 2021. Multivariate logistic regression models were used to determine the potential parental modifiable predictors. Results: The significant associations of baseline ST, change in screen accessibility, and the interaction of preschooler ST with maternal ST change with preschooler follow-up ST were observed. For preschool-aged children with baseline ST ≤ 1 hour per day, the follow-up of preschoolers with ST > 1 hour per day increased significantly when parental clarity of their ST rules decreased or remained low. For preschool children with baseline ST > 1 hour per day, follow-up ST increased significantly when their father kept ST >2 hours per day, when the screen accessibility became or remained easy, or when parental awareness of the ST decreased. Conclusions: Changes in parental correlates played an important role in preschooler ST based on 2-year longitudinal data. Early interventions should focus on improving the clarity of parental rules and perceptions, as well as on reducing parental ST and accessibility of home screens.

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Physical Education for Health Among School-Aged Children and Adolescents: A Scoping Review of Reviews

Virgílio Viana Ramires, Priscila Cristina dos Santos, Valter Cordeiro Barbosa Filho, Alexsandra da Silva Bandeira, Maria Cecilia Marinho Tenório, Edina Maria de Camargo, Fabrício Cesar de Paula Ravagnani, Paula Sandreschi, Victor José Machado de Oliveira, Pedro Curi Hallal, and Kelly Samara Silva

Background: Physical education (PE) classes in schools are considered relevant to implement interventions, especially focused on physical activity. However, evidence overviews on how PE classes contribute to general health (physical, social, affective, and cognitive domains) are still needed. Thus, we summarized evidence synthesis (eg, systematic reviews) that addressed the contribution of PE classes to the health of school-aged children and adolescents. Methods: We performed a scoping review with searches in 8 databases and institutional websites to find systematic reviews or meta-analyses that answered this review’s research question. Data charting form included the identification of the study, health outcomes, and PE classes’ strategies (policies and environment, curriculum, appropriate instructions, and evaluation). An interactive process was performed to build the evidence summary. Results: An initial search yielded 2264 titles, and 49 systematic reviews (including 11 with meta-analysis) were included in this review. Most documents reported the main benefits of PE classes on physical domain outcomes (eg, physical activity, cardiorespiratory fitness, body mass index, and fundamental motor skills). However, evidence on the benefits of PE classes in affective (eg, enjoyment, motivation, and autonomy); social (eg, cooperation, problem-solving, and making friends); and cognitive (eg, memory, attention, concentration, and decision making) domains were found. Strategies on PE classes for health benefits were highlighted. Conclusions: These elements were detailed in the evidence summary, which may be considered to guide researchers, teachers, and practitioners to define research and practice priorities on PE class interventions for health in the school context.

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Impact of Physical Activity and Sedentary Behavior on Spontaneous Female and Male Fertility: A Systematic Review

Alison K. Brinson, Shana G. da Silva, Kathryn R. Hesketh, and Kelly R. Evenson

Background: Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility. Method: PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men. Results: Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case–control studies, 5 randomized controlled trials, and one case–cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association. Conclusions: The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored.

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Longitudinal Analysis of Patterns and Correlates of Physical Activity and Sedentary Behavior in Women From Preconception to Postpartum: The Singapore Preconception Study of Long-Term Maternal and Child Outcomes Cohort

Anne H.Y. Chu, Natarajan Padmapriya, Shuen Lin Tan, Claire Marie J.L. Goh, Yap-Seng Chong, Lynette P. Shek, Kok Hian Tan, Peter D. Gluckman, Fabian K.P. Yap, Yung Seng Lee, See Ling Loy, Jerry K.Y. Chan, Keith M. Godfrey, Johan G. Eriksson, Shiao-Yng Chan, Jonathan Y. Bernard, and Falk Müller-Riemenschneider

Objective: Longitudinal changes in physical activity (PA) and sedentary behavior patterns from preconception to postpartum are not fully characterized. We examined changes and baseline sociodemographic/clinical correlates of PA and sedentary behavior in women from preconception to postpartum. Methods: The Singapore Preconception Study of Long-Term Maternal and Child Outcomes cohort recruited 1032 women planning pregnancy. Participants completed questionnaires at preconception, 34 to 36 weeks gestation, and 12 months postpartum. Repeated-measures linear regression models were used to analyze changes in walking, moderate to vigorous PA (MVPA), screen time, and total sedentary time, and to identify sociodemographic/clinical correlates associated with these changes. Results: Of the 373 women who delivered singleton live births, 281 provided questionnaires for all time points. Walking time increased from preconception to late pregnancy but decreased postpartum (adjusted means [95% CI]: 454 [333–575], 542 [433–651], and 434 [320–547] min/wk, respectively). Vigorous-intensity PA and MVPA decreased from preconception to late pregnancy but increased postpartum (vigorous-intensity PA: 44 [11–76], 1 [−3–5], and 11 [4–19] min/wk, MVPA: 273 [174–372], 165 [95–234], and 226 [126–325] min/wk, respectively). Screen time and total sedentary time remained consistent from preconception to pregnancy but decreased postpartum (screen: 238 [199–277], 244 [211–277], and 162 [136–189] min/d, total: 552 [506–598], 555 [514–596], and 454 [410–498] min/d, respectively). Individual characteristics of ethnicity, body mass index, employment, parity, and self-rated general health significantly influenced women’s activity patterns. Conclusion: During late pregnancy, walking time increased, while MVPA declined significantly, and partially returned to preconception levels postpartum. Sedentary time remained stable during pregnancy but decreased postpartum. The identified set of sociodemographic/clinical correlates underscores need for targeted strategies.