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Exploring the Interplay Between Climate Change, 24-Hour Movement Behavior, and Health: A Systematic Review

Eun-Young Lee, Seiyeong Park, Yeong-Bae Kim, Mikyung Lee, Heejun Lim, Amanda Ross-White, Ian Janssen, John C. Spence, and Mark S. Tremblay

Background: Given the emergence of climate change and health risks, this review examined potential relationships between varying indicators of climate change, movement behaviors (ie, physical activity [PA], sedentary behavior, and sleep), and health. Methods: Seven databases were searched in March 2020, April 2023, and April 2024. To be included, studies must have examined indicators of climate change and at least one of the movement behaviors as either an exposure or a third variable (ie, mediator/moderator), and a measure of health as outcome. Evidence was summarized by the role (mediator/moderator) that either climate change or movement behavior(s) has with health measures. Relationships and directionality of each association, as well as the strength and certainty of evidence were synthesized. Results: A total of 79 studies were eligible, representing 6,671,791 participants and 3137 counties from 25 countries (40% low- and middle-income countries). Of 98 observations from 17 studies that examined PA as a mediator, 34.7% indicated that PA mediated the relationship between climate change and health measure such that indicators of adverse climate change were associated with lower PA, and worse health outcome. Of 274 observations made from 46 studies, 28% showed that PA favorably modified the negative association between climate change and health outcome. Evidence was largely lacking and inconclusive for sedentary behavior and sleep, as well as climate change indicators as an intermediatory variable. Conclusions: PA may mitigate the adverse impact of climate change on health. Further evidence is needed to integrate PA into climate change mitigation, adaptation, and resilience strategies.

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The Role of Grandparents in Facilitating Children’s Physical Activity

Michelle I. Jongenelis, Timothy Budden, Hayley Christian, David A. Coall, Ben Jackson, Andrea Nathan, and Emma Glassenbury

Background: Research suggests there is considerable opportunity to improve children’s movement behaviors while they are being cared for by their grandparents. An understanding of the extent to which grandparent practices facilitate children’s engagement in physical activity is critical to the development of health interventions targeting grandparent caregivers. This study examined the activity-related beliefs and practices of grandparents and their association with grandchildren’s engagement in various movement behaviors while in grandparental care. Methods: Australian grandparents (N = 1190; 60% women) who provided regular care to a grandchild aged 3–14 years were recruited via a web panel provider to complete an online survey. The survey assessed grandparents’ physical activity-related beliefs (eg, perceived importance) and practices (eg, support and social control) and their grandchildren’s engagement in physical activity (unstructured, structured, and outdoor play) and screen-based activities while in grandparental care. Results: The importance of grandchildren’s physical activity was rated highly by grandparents. Grandparents’ support for their grandchildren’s physical activity was positively associated with their grandchildren’s engagement in structured physical activity, unstructured physical activity, and outdoor play. Negative social control was associated with greater engagement in screen-based activities. Other correlates of grandchildren’s physical activity and screen-based activities included grandparents’ own engagement in these activities. Conclusions: Findings highlight the importance of reinforcing the beliefs and practices that positively influence children’s movement behaviors and addressing those that have unintended consequences. Encouraging grandparents to support their grandchildren’s physical activity and discouraging forms of negative social control are likely to be important in efforts to promote physical activity in children.

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Association of Accelerometer-Measured Physical Activity With College Student Success and Retention

Myra J. Bloom, Gladys Y.X. Chen, Victor R.C. Gomes, Scarlet R. Jost, Andrew S.I.D. Lang, Nancy V. Mankin, Jonathan A. Merheb, Jingee Mok, Philip P. Nelson, Deborah A. Skinstad, and Enrique F. Valderrama-Araya

Background: This study examined the relationship between physical activity (PA) and academic performance and retention among college students using accelerometer data while controlling for sex and socioeconomic background. Methods: Data were collected from 4643 first-year college students at a private university in the south-central United States who began their studies in the Fall semesters between 2015 and 2022. Daily step counts were collected using accelerometers worn as part of the institutions PA requirements. The expected family contribution was calculated based on information provided on the Free Application for Federal Student Aid. Grade point average (GPA) and retention data were collected directly from official university databases. Results: Female students generally had lower median age and steps count and a higher median GPA than males. The retention rates from fall to spring and fall to fall were 95.9% and 83.8%, respectively, with no significant difference in retention rates between males and females. GPA was significantly positively correlated with steps, expected family contribution, and age, and negatively correlated with being male and having an expected family contribution of zero. The fall to spring retention rate was significantly positively correlated with steps and GPA. Conclusions: The study’s findings suggest that increasing levels of PA, as measured by daily step counts, may be effective in promoting academic performance and retention, even when controlling for sex and socioeconomic background. The use of device-based measures of PA in this study contributes to the literature on this topic, and policymakers and educational institutions should consider interventions focused on academic performance and physical activity to help students persist.

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The Effects of Sport Participation for Adults With Physical or Intellectual Disability: A Scoping Review

Leanne Hassett, Anne M. Moseley, Marnee J. McKay, Jenni Cole, Sakina Chagpar, Minke P.J. Geerts, Wing S. Kwok, Connie Jensen, Catherine Sherrington, and Nora Shields

Background: Adults with physical or intellectual disability are less active than those without disability. Objective: To review literature regarding sport participation in adults with physical or intellectual disability. Specifically, to examine characteristics of available studies including participants, interventions, outcomes, and impact. Methods: A scoping review was completed. Searches of 6 databases and a trial registry plus citation tracking were undertaken. Two independent reviewers screened items for eligibility and extracted data about the studies, participants, interventions, and outcomes. A single reviewer extracted data to quantify impacts of sport participation, classified as favorable, insignificant, or unfavorable. Results: 164 studies involving 11,642 participants were included. Most studies (128/164) used a cross-sectional design. Most participants were men (81%) with physical disability (135/164), and spinal cord injury was the most prevalent underlying health condition (54%). Most studies evaluated a mix of sports (83/164) in a disability-specific context (159/164), with basketball or wheelchair basketball being the most common individual sport (28/164). Physical impairment was the most frequently reported outcome domain (85/334 results). Sports participation impact was classified as 55% favorable, 42% insignificant, and 3% unfavorable. Conclusions: There were many favorable and few unfavorable outcomes for participation in sport for adults with physical or intellectual disability. More research is needed to address the evidence gaps of gender, health condition, and type of sport, and to use more rigorous research designs to evaluate the effects of sport participation. While new evidence is generated, we suggest adults with physical or intellectual disability be encouraged to engage in sport. Registration: PROSPERO registration number CRD42018104379.

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Assessing the Accuracy of Activity Classification Using Thigh-Worn Accelerometry: A Validation Study of ActiPASS in School-Aged Children

Claas Lendt, Pasan Hettiarachchi, Peter J. Johansson, Scott Duncan, Charlotte Lund Rasmussen, Anantha Narayanan, and Tom Stewart

Background: The ActiPASS software was developed from the open-source Acti4 activity classification algorithm for thigh-worn accelerometry. However, the original algorithm has not been validated in children or compared with a child-specific set of algorithm thresholds. This study aims to evaluate the accuracy of ActiPASS in classifying activity types in children using 2 published sets of Acti4 thresholds. Methods: Laboratory and free-living data from 2 previous studies were used. The laboratory condition included 41 school-aged children (11.0 [4.8] y; 46.5% male), and the free-living condition included 15 children (10.0 [2.6] y; 66.6% male). Participants wore a single accelerometer on the dominant thigh, and annotated video recordings were used as a reference. Postures and activity types were classified with ActiPASS using the original adult thresholds and a child-specific set of thresholds. Results: Using the original adult thresholds, the mean balanced accuracy (95% CI) for the laboratory condition ranged from 0.62 (0.56–0.67) for lying to 0.97 (0.94–0.99) for running. For the free-living condition, accuracy ranged from 0.61 (0.48–0.75) for lying to 0.96 (0.92–0.99) for cycling. Mean balanced accuracy for overall sedentary behavior (sitting and lying) was ≥0.97 (0.95–0.99) across all thresholds and conditions. No meaningful differences were found between the 2 sets of thresholds, except for superior balanced accuracy of the adult thresholds for walking under laboratory conditions. Conclusions: The results indicate that ActiPASS can accurately classify different basic types of physical activity and sedentary behavior in children using thigh-worn accelerometer data.

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Developing a Framework to Evaluate the Validity of Longitudinal Accelerometer-Based Indicators of Physical Activity Maintenance

Genevieve F. Dunton, Wei-Lin Wang, Jixin Li, Donald Hedeker, Stephen S. Intille, and Alexander J. Rothman

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Barriers and Facilitators for Physical Activity Among Children and Youth With Autism—A Scoping Review

Ingrid Okkenhaug, Magnus Rom Jensen, and Solvor Solhaug

Background: The purpose of this scoping review was to systematically synthesize barriers and facilitators for physical activity (PA) among children and youth with autism spectrum disorders (ASD) across the socioecological model. Methods: Five electronic databases were searched in March 2022 for studies examining barriers and facilitators for PA among children and youth with ASD. An updated search was performed in April 2024. The framework synthesis method was utilized, and the socioecological model was the chosen framework. Results: Fifty-four studies published from 2008 to 2024 were included. Among the included studies, 57% included the perspectives of children and youth with ASD alone or together with proxies (eg, parents, teachers, and coaches), while 43% included only the perspectives of proxies. Barriers and facilitators on the intrapersonal and interpersonal levels were most substantial. The analysis led to 2 main categories of barriers and facilitators, those unique to children and youth with ASD, and those similar to what had been identified through research on children and youth, both typically developing and with other disabilities. Conclusions: This comprehensive scoping review shows the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and highlights both the factors unique to this population and more general factors affecting PA participation. The findings from this synthesis might be used to guide the development of inclusive PA in physical education, organized sports, and other community PA arenas.

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Embedding Multimodal Rehabilitation Within Routine Cancer Care in Sheffield—The Active Together Service Evaluation Protocol

Anna Myers, Liam Humphreys, Michael Thelwell, Katie Pickering, Gabbi Frith, Gail Phillips, Carol Keen, Robert Copeland, and on behalf of the Active Together Clinical Advisory Group

Background: Approximately 3 million people in the United Kingdom are currently living with or beyond cancer. People undergoing treatment for cancer are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) in enhancing psychological and physical well-being in patients with cancer and improving outcomes. Active Together is an evidence-based, multimodal rehabilitation service for patients with cancer, providing support to help patients prepare for and recover from treatment. This paper presents the evaluation protocol for the Active Together service, aiming to determine its impact on patient-reported outcomes and clinical endpoints, as well as understand processes and mechanisms that influence its delivery and outcomes. Methods: This evaluation comprises an outcome and process evaluation, with service implementation data integrated into the analysis of outcome measures. The outcome evaluation will assess changes in outcomes of patients that attend the service and compare health care resource use against historical data. The process evaluation will use performance indicators, semistructured interviews, and focus groups to explore mechanisms of action and contextual factors influencing delivery and outcomes. Integrating psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service. Conclusions: Evidence to support the role of multimodal rehabilitation before, during, and after cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world impact of cancer rehabilitation and strengthen the case for widespread adoption of rehabilitation into routine care for people with cancer.

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Independent, Stratified, and Joint Associations of Sedentary Time and Physical Activity With Cardiovascular Disease: A Systematic Review

Charles Phillipe de Lucena Alves, Otávio Amaral de Andrade Leão, Felipe Mendes Delpino, Gregore Iven Mielke, Ulf Ekelund, Eduardo Caldas Costa, and Inácio Crochemore-Silva

Background: Recent statistics highlight cardiovascular diseases (CVD) as a major global cause of death. This review examines the methodological approaches and the main results of independent, stratified, and joint association of sedentary time (ST) and physical activity (PA) on CVD outcomes. Methods: We searched PubMed, Embase, Web of Science, and Scopus for prospective cohorts that examined the independent, stratified, or joint associations of ST and PA with CVD outcomes. Independent associations were defined as analyses mutually adjusted for PA and ST. Stratified associations were considered when there was a reference group in each stratum of PA or ST, and joint associations were defined by a single reference group for all other combined categories of ST and PA levels. Results: Of 45 articles, 69% explored independent association of ST or PA on CVD outcomes, while 31% using a stratified/joint approach. Most studies used self-reports for ST and PA and focused on CVD mortality. Mutually adjusted analyses identified ST positively and PA inversely associated to CVD outcomes. Stratified studies showed higher ST’s pronounced impact on CVD for lower PA levels. High PA mitigated but did not eliminate ST’s negative impact. Joint analyses revealed highest CVD risk in those with both high ST and low PA, and elevated risk in various intermediate combinations. Conclusions: Employing independent, stratified, and joint association approaches can yield distinct and complementary public health messages aimed at promoting cardiovascular health. Recommendations should aim to not only to encourage boosting PA levels, but also, concurrently decrease ST.

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Factors Associated With Leisure-Time Bicycling Among Adults in the United States: An Urban–Rural Comparison

Eugene C. Fitzhugh, Carissa Smock, Laura E. Balis, Jeanette Gustat, Debra Kellstedt, James N. Roemmich, Zachary Townsend, and Christiaan Abildso

Background: Bicycling is a healthy form of physical activity that can be performed by most adults as part of leisure-time (LT) activity. However, little is known about LT bicycling behaviors, especially in the rural areas of the United States. This study sought to contrast the prevalence and factors associated with LT bicycling in populations living in urban settings with those living in rural settings. Methods: The 2019 Behavior Risk Factor Survey, which contains information regarding LT physical activity behaviors among adults (N = 396,261) in the United States, was used to determine the prevalence, demographic profile, and likelihood of meeting the physical activity guidelines of LT bicyclists. The 2013 National Center for Health Statistics Urban/Rural Classification Scheme was used to classify respondents living in rural and urban settings. Results: Among US adults, 3.8% (95% CI, 3.7–3.9) reported LT bicycling activity, the sixth most common physical activity. Adults living in urban counties compared with rural counties had a greater prevalence of LT bicycling (3.9% vs 2.3%, respectively), with adults living in rural counties having a 34% lower probability of LT bicycling. Rural bicycling prevalence rates were lower across all demographics. Urban bicyclists, compared with rural bicyclists, cycled more months of the year. Overall, 85.5% of all bicyclists met the aerobic physical guidelines, with no differences between urban and rural bicyclists. Conclusions: Bicycling remains an important LT physical activity among adults in the United States. However, a rural–urban difference in the prevalence does exist for LT bicycling. The reasons for this disparity warrant further investigation.