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Challenges and Future Directions for Promoting Intersectional Quantitative Studies in Physical Activity Research

Mari Sone, Teatske M. Altenburg, and Mai J.M. ChinAPaw

Understanding health inequalities is essential for improving social justice. Intersectionality refers to a theoretical framework for studying the intersection of multiple social categorizations that create unique experiences and related social inequalities. Currently, the majority of the intersectional studies in the physical activity field have a qualitative design; thus, there is a need for quantitative intersectional studies. This commentary aims to explore primary obstacles impeding intersectional quantitative research and provide recommendations for overcoming these obstacles in physical activity research. In the commentary, we discuss that the lack of accessibility of large-scale and diverse data sets, and suboptimal social categorizations and intersectionality-related questions may contribute to the scarcity of intersectional quantitative research in the field. To facilitate intersectional quantitative analyses, we advocate for making large-scale data sets accessible for intersectional secondary analyses, diverse sampling, standardizing questions and categories related to intersectionality, promoting inclusive research designs and methods, and using the appropriate questions and social categorization that reflect the distinct experiences of each subgroup. By addressing these challenges, researchers may gain new insights into health disparities, making physical activity research more inclusive and contributing to more equitable health outcomes.

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A Holistic Way to Understand the Determinants of Physical Activity in Urban New South Wales, Australia: A Codesigned Systems Mapping Project

Mengyun Luo, Binh Nguyen, Tracy Nau, Simon K. Chiu, Adrian Bauman, Louise Freebairn, William Bellew, Lucie Rychetnik, David T. Burns, Elizabeth A. Calleja, Lucy Corbett, Jennifer L. Kent, David R. Lubans, Anthony D. Okely, Catherine Sherrington, Anne Tiedemann, and Ding Ding

Background: To meet the World Health Organization goal of reducing physical inactivity by 15% by 2030, a multisectoral system approach is urgently needed to promote physical activity (PA). We report the process of and findings from a codesigned systems mapping project to present determinants of PA in the context of urban New South Wales, Australia. Methods: A participatory conceptual mapping workshop was held in May 2023 with 19 participants working in education, transportation, urban planning, community, health, and sport and recreation. Initial maps were developed and refined using online feedback from the participants. Interviews were conducted with 10 additional policymakers from relevant sectors to further refine the maps. Results: Two systems maps were cocreated, identifying over 100 variables influencing PA and their interconnections. Five settings emerged from the adults’ map—social and community, policy, built environment and transportation, health care, and workplace—and 4 for the young people’s map—family, school, transportation, and community and environment. The maps share similarities, such as regarding potential drivers within the transportation, community, and built environment sectors; however, the young people’s map has a specific focus on the school setting and the adults’ map on workplace and health care settings. Interviews with policymakers provided further unique insights into understanding and intervening in the PA system. Conclusions: This codesigned participatory systems mapping process, supplemented by stakeholder interviews, provided a unique opportunity to bring together stakeholders across sectors to understand the complexity within the PA system and begin to identify leverage points for tackling physical inactivity in New South Wales.

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Community-Based Physical Activity Programs for Blood Pressure Management in African Americans: A Scoping Review

Dennis Miezah, Julie A. Wright, and Laura L. Hayman

Background: Hypertension is a significant risk factor for cardiovascular disease, with a higher prevalence among African Americans (AA) than other racial groups. The impact of community-based interventions on managing blood pressure (BP) in AA communities is not fully understood. The purpose of this review was to synthesize literature on community-based physical activity (PA) programs designed to manage BP in AA populations. Methods: We conducted a scoping review by searching 4 databases (PubMed, CINAHL, MEDLINE, and APA PsycInfo) and reference lists of studies. Search terms included community PA, community-based, hypertension, high BP, AA, Black Americans, PA, and exercise. Inclusion criteria were studies (1) conducted in the United States and (2) published in English language from January 2013 to September 2023, with community-based interventions that included PA for BP management among AA aged ≥18 years. Results: Search results yielded 260 studies, of which 11 met the inclusion criteria. BP decreased over time in studies that incorporated PA, faith-based therapeutic lifestyle changes with nutritional education. The duration of the PA interventions varied, with moderate to vigorous PAs implemented for 12 weeks or longer having a greater impact on BP management. Conclusions: Evidence suggests that community-based PA programs can potentially reduce BP among AA. PA programs incorporating faith-based therapeutic lifestyle change with nutritional education appear to reduce BP. Practitioners should consider multicomponent community-based PA initiatives to improve BP outcomes in AA communities.

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Content Validation and Pilot Testing of the Promoting Active Lifestyle Among Children With Disability Questionnaire in Filipino and English

Mary-Grace Kang, Gabriella Isabel Tablante, Kristofferson Mendoza, Aila Nica Bandong, Roselle Guisihan, Audrey Anne Lim, Frances Rom Lunar, Carlos Dominic Olegario, Esmerita Rotor, and Yves Palad

Background: Primary carers, school teachers, and administrators are key influencers in promoting active lifestyle among children with disabilities (CWD). Guided by the Capability, Opportunity, Motivation, Behavior Model, the Promoting Active Lifestyle among CWD (PALS) Questionnaire aims to determine these influencers’ perceptions, capabilities, opportunities, and motivations in active healthy lifestyle promotion. This study evaluated the content validity and feasibility of the PALS Questionnaire in Filipino and English. Methods: Six experts rated the relevance of the items in the Filipino and English versions of the PALS Questionnaire. Item and scale content validity indices and agreement among raters (modified kappa k*) were computed. The questionnaires were revised and pilot tested among 11 participants comprising primary carers, and special education teachers and administrators using 3 methods of administration: online survey, phone interview, and pen-and-paper survey. Results: Scale-level content validity index indicated excellent content validity (0.96–0.97). Item-level content validity index ranged between 0.67 and 1.00. Interrater agreement on the relevance of all items was excellent (k* = .82–1.00), except for the item on teaching assistants (k* = .56). Most participants found the items easy to understand. The average time needed to complete a questionnaire was 30 minutes. The online version of the questionnaire was identified as the most feasible mode of administration. Conclusion: The PALS Questionnaire is a useful instrument for understanding Filipino primary carers’ and educators’ perceptions on promoting CWD’s active healthy lifestyle. Information from the PALS Questionnaire could inform initiatives toward better CWD health and quality of life.

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Achieving Advocacy Success—The International Society for Physical Activity and Health’s Long-Term Strategy to Advance Physical Activity as a Priority in Global Health Policy

Trevor Shilton and Karen Milton

Background: In 2011, physical inactivity was described as the Cinderella risk factor for noncommunicable diseases. This metaphor was used to highlight the disjunct between the advancing evidence on physical inactivity as a risk factor for ill health, its high prevalence, and the paucity of global policy response or priority afforded to physical activity. This paper describes the strategic actions of the International Society for Physical Activity and Health (ISPAH) to raise the profile of physical activity as a global public health priority. Methods: From 2008, ISPAH coordinated a long-term advocacy strategy to advance the status of physical activity and promote its presence as a priority within global health policy. The society employed an advocacy mix that reflected contemporary advocacy theory and models. Results: Through 6 advocacy deliverables, aligned to the global calendar of United Nations and World Health Organization policy developments, ISPAH seized the opportunity to advance physical activity policy and strategies to inform global noncommunicable disease action planning and align with the Sustainable Development Goals. ISPAH’s successful execution of global advocacy for physical activity highlights the importance of leadership, clear objectives, progressive action, timeliness, partnerships, and persistence. Conclusion: As a result of strategic global advocacy since 2008, the field in 2024 is better positioned in relation to global professional mobilization, policy, and technical support for physical activity. However, despite impressive progress across more than 12 years, and the innovation of the Global Action Plan on Physical Activity, the work of global advocacy for physical activity is far from complete.

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Volume 21 (2024): Issue 9 (Sep 2024)

Open access

Dose–Response Relationships of Moderate to Vigorous Physical Activity and Sedentary Time With Renal Function Indices in Adolescents With Reduced Renal Function: A Cross-Sectional Study

Zisai Wang, Qiuwei Tian, Yujie Xu, Marady Hun, Lin Hu, Mingyi Zhao, and Qingnan He

Background: This study aimed to explore the associations between moderate to vigorous physical activity (MVPA) and sedentary time with renal function indices in adolescents with kidney disease. Methods: A cross-sectional study was conducted on 719 adolescents (median age 15 y, 40.6% female) with kidney disease from the National Health and Nutrition Examination Survey 2007–2016. The exposures were MVPA time and sedentary time. Renal metabolic parameters included serum uric acid (SUA), creatinine, blood urea nitrogen, the estimated glomerular filtration rate (eGFR), and the albumin creatinine ratio. Weighted multivariate regression analysis was used to estimate associations between exposures and outcomes. Results: After stratifying MVPA time, the regression effect values β (95% CI) for MVPA on SUA (Q2: −0.22 [−0.41 to −0.03]; Q3: −0.32 [−0.53 to −0.11]) and creatinine (Q2: −0.08 [−0.15 to −0.01]; Q3: −0.04 [−0.11 to 0.03]) gradually decreased with increasing MVPA time. In males (−0.76 [−1.19 to −0.32]), MVPA time was significantly associated with lower SUA levels compared with females (−0.14 [−0.38 to 0.10]). Notably, female adolescents who had an MVPA time exceeding 420 minutes exhibited lower albumin creatinine ratio (−75.37 [−146.63 to −4.11]). In addition, both recreational MVPA time (−0.26 [−0.45 to −0.06]) and sedentary time (−3.15 [−5.83 to −0.46]) were negatively associated with eGFR. Conclusions: Our study found an association between MVPA and lower levels of SUA in male adolescents with kidney disease and albuminuria in female adolescents with kidney disease. In addition, MVPA was also negatively associated with creatinine and eGFR, whereas sedentary time was only associated with eGFR. Further studies are needed to confirm these findings.

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Effects of Physical Activity Interventions on Physical Self-Perception in College Students: A Systematic Review and Meta-Analysis

Zhiling Yang, Zhiying Yang, Wengling Ou, Qing Zeng, and Jiafu Huang

Background: Although the physical activities have demonstrated efficacy in improving physical self-perception, the findings of available studies in college students were conflicting. This review aimed to examine the effects of physical activity interventions on physical self-perception in college students. Methods: Web of Science, PubMed, Cochrane Library, EBSCOhost, Embase, Scopus, CNKI, WanFang, and Chinese Technical Periodicals were searched from inception to April 2024. Studies were included if they were randomized controlled trials (RCTs) or non-RCTs (non-RCTs) that examined the effects of physical activity interventions on college students’ physical self-perception. Random-effects models were used in meta-analyses to synthesize effect sizes. Results: Forty studies (17 RCTs and 23 non-RCTs) with 4955 participants were included in this meta-analysis. Overall, physical activity interventions had small to moderate significant effect on physical self-worth (standardized mean difference [SMD] = 0.44, P < .00001), perceived sports competence (SMD = 0.60, P < .00001), perceived physical condition (SMD = 0.45, P < .00001), perceived physical strength (SMD = 0.53, P < .00001), and perceived body attractiveness (SMD = 0.54, P < .00001). Significant differences were observed in study design (P = .031–.039), intervention type (P = .003–.031), and intervention duration (P = .002–.036) for some aspects of physical self-perception, such as perceived physical strength and perceived body attractiveness. Conclusions: Physical activity interventions have beneficial effects on physical self-perception in college students, especially those conducted for 12 weeks, 3 times or more per week, lasting 90 minutes or more per session. Large, high-quality RCTs are required to further confirm these findings.

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The Energetic Saver Profile From Sit-to-Stand Does Not Persist During Very Low-Intensity Physical Activity in Healthy Men and Women

Laurie Isacco, Terry Guirado, Carole Brun, Bruno Pereira, Halim Moore, David Thivel, Martine Duclos, and Lore Metz

Background: It is essential to better characterize the energetic profile of individuals during very low-intensity physical activity. The objectives of the present study were to determine whether the saver profile from sit-to-stand persists during light physical activity and characterize patterns in substrate utilization from sit-to-stand and during very low-intensity physical activity in healthy men and women. Methods: Sixty-two healthy adults (38 women) performed an experimental sequence that corresponded to 15-minute sitting (SIT1), followed by 15-minute standing (STAND), 15-minute sitting again (SIT2), and finally 15 minutes of light cycling. Continuous indirect calorimetry was allowed to calculate energy expenditure (EE) and respiratory quotient through the entire sequence. Savers and nonsavers (<5% and ≥ 5% increase in EE from sitting to standing, respectively) were determined. Results: There was an interaction effect in EE between savers and nonsavers through the whole sequence (P = .008). Only nonsavers (71%) exhibited a significant increase in EE from SIT1 to STAND (P < .001). Nonsavers and savers significantly increased EE during 15 minutes of light cycling relative to sitting or standing (P < .001), without any difference between groups. The percentage of change in respiratory quotient from SIT1 to STAND was significantly different between the 2 groups, with increased values in savers and decreased values in nonsavers (P = .03). Significantly lower values in respiratory quotient and EE were found during 15 minutes of light cycling in women compared with men (P < .001). Conclusions: It is essential to determine individuals’ energetic phenotype to determine those who may benefit more from strategies such as standing or light physical activity. The sexual dimorphism in terms of substrate use during such exercise should be considered.

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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.