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Physical Activity of Children and Adolescents in Croatia: A Global Matrix 4.0 Systematic Review of Its Prevalence and Associated Personal, Social, Environmental, and Policy Factors

Željko Pedišić, Melanija Strika, Tena Matolić, Maroje Sorić, Sanja Šalaj, Ivan Dujić, Marija Rakovac, Branko Radičević, Hrvoje Podnar, Zrinka Greblo Jurakić, Marjan Jerković, Hrvoje Radašević, Jelena Čvrljak, Tin Petračić, Sanja Musić Milanović, Maja Lang Morović, Slaven Krtalić, Mirjana Milić, Alma Papić, Nataša Momčinović, Marjeta Mišigoj-Duraković, Stjepan Heimer, and Danijel Jurakić

Background: The previous review of physical activity (PA) among Croatian children and adolescents was conducted a decade ago. Therefore, the aim of this study was to summarize recent evidence on PA of Croatian children and adolescents and associated personal, social, environmental, and policy factors. Methods: Eighteen experts reviewed the available evidence and provided ratings (from the lowest grade “F” to the highest grade “A+”) for the 10 Global Matrix indicators. A systematic search with 100 keywords was conducted in Hrčak, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science for documents published from January 01, 2012, to April 15, 2022. We also conducted internet searches and secondary analyses of data (relative frequencies) from 6 studies. Results: After assessing 7562 references, we included 90 publications in the review and 18 studies (83.3% of medium-to-good quality) in evidence synthesis. We found a high prevalence of insufficient PA (especially among girls) and excessive screen time (especially among boys). PA participation of children and adolescents in Croatia has declined over time. The following grades were assigned to the indicators for Croatia: B− for overall PA, C− for organized sport and PA, C for active play, C− for active transportation, D+ for sedentary behavior, inconclusive for physical fitness, D+ for family and peers, B− for school, B− for community and environment, and D+ for government. Conclusions: Coordinated actions are needed across sectors to improve PA promotion, with a focus on increasing PA among girls, reducing sedentary screen time among boys, improving parental support for PA, and further development of national PA policies.

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The Relationship Between Policy Strength and Physical Activity Practices in Arizona Public Elementary Schools

Kahyun Nam, Kylie Wilson, Marissa Schulke, Pamela Hodges Kulinna, and Allison Poulos

Background: Many school-based physical activity statutes and regulations have been enacted, with the expectation that schools will comply. However, policy alone does not equate to implementation, and many policies fail for a variety of reasons. The purpose of the study was to determine whether the strength of reported state, district, and school-level physical activity policies were associated with reported recess, physical education, and other school-based physical activity practices at elementary schools in Arizona. Methods: A modified Comprehensive School Physical Activity Program (CSPAP) Questionnaire was administered to staff at elementary schools across Arizona (N = 171). Summative indices of the number of school physical activity policies and best practices at the state, district, and school levels were created. Relationships between policy strength and best practices were examined using linear regression analyses stratified by recess, physical education, and other school-based physical activity practices. Results: Stronger physical activity-related policies were associated with a greater number of recess (F 1,142 = 9.87, P < .05), physical education (F 4,148 = 4.58, P < .05, Adj. R 2 = .09), and other school-based physical activity (F 4,148 = 4.04, P < .05, Adj. R 2 = .07) best practices at all levels while controlling for school-level demographic factors. Conclusions: The strength of policies may improve opportunities for comprehensive physical activity for children in schools. Strengthening policy language (eg, specifying duration and frequency) may contribute to better physical activity practices in schools, improving children’s health at the population level.

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Resistance Training Behavior Is Enhanced With Digital Behavior Change Coaching: A Randomized Controlled Trial With Novice Adults

Justin Kompf, Jessica Whiteley, Julie Wright, Philip Brenner, and Sarah Camhi

Background : Approximately a third of US adults meet the physical activity guidelines of engaging in resistance training 2 times per week, yet few studies have examined how to increase participation rates. The present randomized control trial compared a remotely delivered coaching intervention with an education only control group. Methods: Eligible participants completed 2 remotely delivered Zoom-based personal training sessions during a 1-week run-in period. Participants randomized to the intervention group received synchronous weekly behavioral video coaching sessions over Zoom, whereas the control group received no further contact. Days of resistance training completed were assessed at baseline (pre), 4 weeks (post), and 8 weeks (follow-up). Linear mixed models were used to examine group differences at each time point and within-group differences over time. Results: There were significant between-group differences favoring the intervention, at posttest for both the previous week (b = 0.71, SE = 0.23; P = .002) and the previous 4 weeks (b = 2.54, SE = 0.87; P = .003) but not at the follow-up period for either the last week (b = 0.15, SE = 0.23; P = .520) or the last 4 weeks (b = 0.68, SE = 0.88; P = .443). Conclusion: The present study showed that by providing participants with equipment, skill, and in the case of the intervention group, a remote coaching intervention, resistance training participation increased.

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The Relative Contributions of Center Demographic, Director, Parental, Social, Environmental, and Policy Factors to Changes in Outdoor Play in Childcare Centers During the COVID-19 Pandemic

Yeongho Hwang, Madison Boyd, Cody Davenport, and Valerie Carson

Background: The primary objective of this study was to investigate the relative contributions of factors from multiple social-ecological levels in explaining outdoor play changes in childcare centers during the COVID-19 pandemic. Methods: In Alberta, Canada, licensed childcare center directors (n = 160) completed an online questionnaire. For outcomes, changes in the frequency and duration of outdoor play in childcare centers during COVID-19 compared to before COVID-19 were measured. For exposures, center demographic, director, parental, social, environmental, and policy-level factors were measured. Hierarchical regression analyses were conducted separately for winter (December–March) and nonwinter months (April–November). Results: In most instances, factors at each social-ecological level explained a statistically significant amount of unique variance in changes in outdoor play in childcare centers during COVID-19. Full models accounted for more than 26% of the variance in the outcomes. Changes in parental interest in outdoor play was the most consistent correlate of changes in the frequency and duration of outdoor play in both winter and nonwinter months during COVID-19. In terms of changes in the duration of outdoor play, social support from the provincial government, health authority, and licensing, and changes in the number of play areas in licensed outdoor play spaces were also consistent correlates in both winter and nonwinter months during COVID-19. Conclusions: Factors from multiple social-ecological levels uniquely contributed to changes in outdoor play in childcare centers during the COVID-19 pandemic. Findings can help inform interventions and public health initiatives related to outdoor play in childcare centers during and after the ongoing pandemic.

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Exploring Work-Time Affective States Through Ecological Momentary Assessment in an Office-Based Intervention to Reduce Occupational Sitting

Guy Faulkner, Katie A. Weatherson, Markus J. Duncan, Kelly B. Wunderlich, and Eli Puterman

Background: The aim of this study was to examine whether a low-cost standing desk intervention that reduced occupational sitting was associated with changes in work-time cognitive–affective states in real time using ecological momentary assessments at the start and end of the trial. Methods: Forty-one office employees (91.7% female, mean age = 39.8 [10.1] y) were randomized to receive a low-cost standing desk or a waitlist control. Participants received 5 surveys each day for 5 workdays via smartphone application prior to randomization and at trial’s end. Ecological momentary assessment assessed current work-time psychological states (valence and arousal, stress, fatigue, and perceived productivity). Multilevel models assessed whether changes in work-time outcomes over the course of the intervention were significantly different between treatment groups. Results: There were no significant differences in outcomes between the groups except for fatigue, with the control group reporting a significant decrease in daily fatigue following the intervention (P < .001). The intervention group reported no significant changes in any of the work-time outcomes across the study period (P > .05). Conclusions: A low-cost standing desk intervention to reduce occupational sedentary behavior did not negatively impact work-time outcomes such as productivity and fatigue in the short term.

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Association of Early Sports Participation With Sedentary Behavior in Community-Dwelling Adults—The Role of Sociodemographic Factors in a Retrospective Epidemiological Study

William R. Tebar, Luan O. Borges, Leandro D. Delfino, Jorge Mota, Raphael M. Ritti-Dias, and Diego G.D. Christofaro

Background: The role of sociodemographic factors in the association between early sports participation (ESP) and sedentary behavior is unclear. We analyzed the association of ESP with sedentary behavior and identified the influence of sociodemographic factors in adulthood. Methods: A sample of 264 community-dwelling adults was randomly assessed (42.6 [17.0] y old, 57.6% women). Sociodemographic factors (age, gender, and socioeconomic status) and ESP (retrospectively) were assessed by questionnaire. Sedentary behavior was measured by accelerometer and self-reported for domains identification. The association between ESP and sedentary behavior domains and sociodemographic factors was analyzed by Poisson regression and presented in prevalence ratio (PR). Sociodemographic factors were separately included as covariates to identify their role in the main association analysis. Results: The ESP prevalence was 56.4% (n = 149). ESP participants included a higher proportion of men (59.7% vs 20.0%), had a lower age (36.8 [15.3] vs 50.8 [15.9]), and included a smaller proportion of individuals with low socioeconomic status (24.8% vs 43.5%) compared with those without ESP. The ESP was inversely associated with older age (PR = 0.58, P < .001 for middle aged; PR = 0.34, P < .001 for older participants), female gender (PR = 0.79, P < .001), low socioeconomic status (PR = 0.63, P = .036), and TV watching (PR = 0.67, P = .011). ESP was associated with driving (PR = 1.50, P = .028), office/paper work (PR = 1.63, P = .012), and using a cellphone (PR = 1.60, P = .009). The age was the main confounding factor of association between ESP and sedentary behavior, followed by socioeconomic status. No mediation role was identified. Conclusion: The ESP was associated with mentally active behavior domains and inversely associated with mentally passive sedentary behavior domains, but this association was majorly affected by sociodemographic factors, mainly by age.

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Cost-Effectiveness of the ENJOY Seniors Exercise Park for Older People: A Pre–Post Intervention Study

Natasha K. Brusco, Keith D. Hill, Terry Haines, Jeremy Dunn, Maya G. Panisset, Briony Dow, Frances Batchelor, Stuart J.H. Biddle, Gustavo Duque, and Pazit Levinger

Background: The Exercise interveNtion outdoor proJect in the cOmmunitY (ENJOY) Seniors Exercise Park program uses specialized outdoor equipment and a physical activity program to engage older people in physical activity, with multiple health benefits. We determined the cost-effectiveness of the ENJOY program. Methods: The economic evaluation compared health care utilization costs 6 months prior to and 6 months post ENJOY program participation. Incremental cost-utility analysis for the primary aim (quality of life) and incremental cost-effectiveness analysis for the secondary aim (falls) were used. Analyses took a societal perspective inclusive of Australian government-funded health care and pharmaceuticals in addition to hospitalizations, community-based nursing and allied health, and community services. Productivity costs were also calculated. Results: Fifty participants (average age 72.8 y [SD 7.4] and 78.0% [n = 39/50] women) were included. Participation in the ENJOY program reduced health care costs in the 6 months following the program: preintervention, $9764.49 (SD $26,033.35); postintervention, $5179.30 (SD $3826.64); observed postintervention reduction −$4.585.20 (95% confidence interval, −$12,113.99 to $2943.59; P = .227) without compromising quality of life (mean difference [MD] 0.011; 95% confidence interval, −0.034 to 0.056; P = .631) or increasing the likelihood of a fall (−0.5; 95% confidence interval, 0.00 to −0.50; P = .160). The ENJOY intervention is likely cost-effective. Conclusions: Planning for shared community spaces should consider the benefits of a Seniors Exercise Park as part of the built environment.

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Disability Type and Constraints to Leisure-Time Physical Activity in Türkiye

Dilara Ebru Uçar, Günay Yıldızer, and İlker Yılmaz

Background: Little is known about the effect of disability type on perceived physical activity (PA) constraints. Investigating the leisure-time PA constraint differences across disability groups would increase the possibility of PA participation, and reverse the physical inactivity trend for disabled populations. Objective: The purpose was to examine perceived PA constraint differences between individuals with 3 different disability types, which are visual, hearing, and physical disabilities. Methods: The study sample comprised 305 individuals with a visual disability, 203 individuals with a physical disability, and 144 individuals with hearing loss. Leisure Time PA Constraints Scale-Disabled Individuals Form, consisting of 32 items and 8 subscales, was used as for data collection. Data were analyzed with a 3 × 2 two-way multivariate analysis of variance. Results: Findings indicated a significant main effect of the disability group (Pillai V = 0.025; F 16,639 = 10.132, P < .001, η 2 = .112), gender (Pillai V = 0.250; F 8,639 = 2.025, P < .05, η 2 = .025), and interaction between the disability group and gender (Pillai V = 0.069; F 161,280 = 2.847, P < .001, η 2 = .034). The follow-up analyses of variance indicated significant differences in facility quality, social environment, family, willpower, time, and ability perception scores between disability groups, P < .05. Conclusions: People with different disabilities have different perceived leisure-time PA barriers with respect to environmental, social, and psychological factors; generally, disabled females perceived more barriers to leisure-time PA. Policies and intervention protocols for disabled individuals should directly address the disability-specific need of individuals to increase leisure-time PA participation.

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Physical Activity Level and Specific Type of Exercises Among US Middle-Aged and Older Adults: Findings From the Behavioral Risk Factor Surveillance Survey

Ashley Kuzmik, Marie Boltz, Kyungha Kim, Yining Ma, Xingran Weng, and Li Wang

Background: This study aimed to assess physical activity level and identify specific types of exercises by sex, race/ethnicity, and age for adults 50 years and older. Methods: Behavioral Risk Factor Surveillance System 2013, 2015, and 2017 data were used to study US adults 50 years and older on their specific types of exercises, stratified by sex, race/ethnicity, and age. Weighted logistic regression was used to model physical exercise level and specific types of exercises. Results: The sample included 460,780 respondents. Non-Hispanic Black and Hispanic were less likely than non-Hispanic White to meet the recommended physical activity level (Odds ratio [OR] = 0.73, P < .0001 and OR = 0.96, P = .04, respectively). Walking was the most participated type of exercise, followed by gardening, for both men and women, all racial/ethnic groups, and all age groups. Non-Hispanic Blacks were more likely to participate in walking (OR = 1.19, P = .02) and less likely to participate in gardening (OR = 0.65, P < .0001) than non-Hispanic Whites. Men were more likely to engage in strenuous exercises than women. The average number of minutes on walking was the longest among all types of specific exercises. Conclusions: The types of exercises were mostly walking and gardening for adults aged 50 and older. Non-Hispanic Black adults had less physical activity than non-Hispanic White and were less likely to engage in gardening.

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Volume 20 (2023): Issue 4 (Apr 2023)