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Volume 21 (2024): Issue 6 (Jun 2024)

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Erratum. Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines

Journal of Physical Activity and Health

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Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines

Sarah T. Ryan, Anthony D. Okely, Kar Hau Chong, Rebecca M. Stanley, Melanie Randle, Gade Waqa, Ashley B. Yamanaka, Rachael Leon Guerrero, Patricia Coleman, Leslie Shallcross, Lynne R. Wilkens, Jonathan L. Deenik, and Rachel Novotny

Introduction: Limited data on 24-hour movement behaviors of children aged 5–8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region. Methods: Cross-sectional representative data from 1192 children aged 5–8 years living in the US-Affiliated Pacific region were drawn from the baseline 2012–2014 Children’s Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60 min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11 h/d) and ST (≤2 h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables. Results: Twenty-seven percent (95% confidence interval, 24.6–30.0) of children met integrated guidelines; 98% (96.2–98.0) met PA, 78% (75.4–80.0) met sleep, and 35% (32.6–38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence interval, 1.03–1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49–3.54]) were more likely to meet ST guidelines. Overweight children (0.62 [0.40–0.96]), those aged 8 years (0.39 [0.22–0.69]), and children with caregivers of an education level of high school or beyond (0.44 [0.29–0.68]) were less likely to achieve ST guidelines. Children from midrange annual household incomes were less likely to meet combined guidelines (0.60 [0.39–0.92]). Conclusions: Three-quarters of children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed.

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Follow the Arrows: Using a Co-Created Causal Loop Diagram to Explore Leverage Points to Strengthen Population Physical Activity Promotion in British Columbia, Canada

Lori Baugh Littlejohns, Geoffrey McKee, Drona Rasali, Daniel Naiman, Jennafer Mee, Tanya Osborne, Phuc Dang, Meghan Winters, Scott A. Lear, Diane Nelson, Steve McGinley, and Guy Faulkner

Background: Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1) used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2) identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. Methods: Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. Results: Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering “vicious” cyclical patterns to increase coordinated multisector PPAP are key. Conclusions: The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points.

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Changes in Accelerometer-Measured Physical Activity and Sedentary Time Across Retirement Transition as a Predictor of Self-Rated Health

Andreas Fröberg, Lawrence Sacco, Kristin Suorsa, Tuija Leskinen, Pasan Hettiarachchi, Magnus Svartengren, Sari Stenholm, and Hugo Westerlund

Background: Retirement transition has been shown to associate with changes in physical activity (PA) and self-rated health (SRH), but their interrelationship is less studied. The aim was to investigate changes in accelerometer-measured total PA, moderate to vigorous PA (MVPA), and sedentary time across retirement transition as a predictor of SRH. Methods: Data from the Swedish Retirement Study and the Finnish Retirement and Aging study were harmonized and pooled. Data from 3 waves (about 12 mo apart) were included: 1 preretirement (wave 1) and 2 postretirement follow-ups (wave 2–3). A totally of 245 participants (27% men) were included. Thigh-worn accelerometers were used to collect data for PA variables (wave 1–2), and SRH was obtained from the questionnaire (wave 1–3). Results: Between wave 1 and 2, total PA decreased with 11 (CI, −22 to −1) minutes per day, MVPA was stable (0 [CI, −3 to 3] min), and sedentary time decreased nonsignificantly with 9 (CI, −20 to 1) minutes. SRH changed between all 3 waves (all P < .001). At preretirement, 10 more minutes of MVPA was associated with greater odds of better SRH when adjusting for accelerometer wear-time, cohort, sex, age, and occupational status (odds ratio: 1.11 [95% CI, 1.02–1.22]). This association was no longer statistically significant when additionally adjusting for marital status, body mass index, and smoking. No significant associations were observed between changes in the PA variables during retirement transition and SRH at postretirement follow-ups. Conclusions: This study showed a cross-sectional association between MVPA and greater odds of reporting better SRH before retirement. No longitudinal associations were observed between changes in the PA variables from before to after retirement and later changes in SRH.

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Volume 21 (2024): Issue 5 (May 2024)

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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.