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Open access

Scoping Review of Population-Based Physical Activity and Sedentary Behavior in Saudi Arabia

Kelly R. Evenson, Noara Alhusseini, Christopher C. Moore, Mariam M. Hamza, Ada Al-Qunaibet, Severin Rakic, Reem F. Alsukait, Christopher H. Herbst, Reem AlAhmed, Hazzaa M. Al-Hazzaa, and Saleh A. Alqahtani

Background: Saudi Arabia is experiencing rapid development of the built environment and implementing policy changes to promote physical activity (PA) and reduce sedentary behavior (SB) among its population. In light of these developments, this scoping review systematically summarized population levels of PA/SB in Saudi Arabia. Methods: The authors searched 6 databases on December 13, 2021, for articles published in English or Arabic from 2018 to the search date. Studies using population-based sampling in Saudi Arabia and measuring PA/SB were included. Results: Of the 1272 records found, 797 were screened, and 19 studies (9 on children/adolescents age 6–19 y and 10 on adults age 15–75 y) were included. All studies were cross-sectional in design, and 18 studies collected data at only one point in time, ranging from 2009 to 2020. A total of 18 studies relied on self-reporting to assess PA/SB using a variety of questionnaires. Among children/adolescents, approximately 80% to 90% did not attain at least 60 minutes per day of moderate to vigorous PA and 50% to 80% engaged in ≥2 hours per day of screen time or SB. Among adults, approximately 50% to 95% had low or insufficient PA (eg, less than meeting PA guidelines) and about half had a sitting time of ≥5 hours per day. Population-based studies were not found among children <10 years and adults >75 years. Conclusions: A high proportion of participants in the reviewed studies did not meet PA recommendations and spent excessive time in SB. Ongoing surveillance efforts for all ages may help identify target populations for interventions and prioritize the national strategy on PA/SB in Saudi Arabia.

Open access

Impact of the COVID-19 Pandemic on the Socioeconomic Inequality of Health Behavior Among Japanese Adolescents: A 2-Year Repeated Cross-Sectional Survey

Akira Kyan and Minoru Takakura

Background: Although disparities in socioeconomic status in health behaviors have been highlighted globally, they are not well understood in Japanese adolescents. The purpose of this study was to clarify the changes in socioeconomic disparities in adolescents’ fundamental health behaviors, such as physical activity, screen time (ST), sleep, breakfast intake, and bowel movement before and during COVID-19. Methods: This was a repeated cross-sectional study which used data from the 2019 and 2021 National Sports-Life Survey of Children and Young in Japan. Data of 766 and 725 participants in 2019 and 2021, respectively, were analyzed. Favorable health behaviors were defined as daily moderate to vigorous physical activity (MVPA) of at least 60 minutes, ST of less than 2 hours, sleep of 8 to 10 hours, daily breakfast intake, and bowel movement frequency of at least once in every 3 days. We calculated the slope index of inequality and relative index of inequality in each health behavior for equivalent household income levels for assessing absolute and relative economic inequalities. Results: Compliance with MVPA and ST recommendation significantly declined from 20.1% and 23.0% in 2019 to 11.7% and 14.9% in 2021, respectively. The slope index of inequality and relative index of inequality increased in MVPA for income levels, but decreased in daily breakfast in 2019 to 2021. Although the widening and narrowing of the disparity were inconclusive for ST, it exacerbated for the higher-income groups. Conclusions: Our study revealed widening of economic disparities in the achievement of recommended MVPA and narrowing of it in breakfast intake among adolescents before and during COVID-19.

Free access

Beyond Individual Cognitions: Time for Intervention Science to Focus on Health Context and Audience

Aïna Chalabaev, Boris Cheval, Silvio Maltagliati, Ilyes Saoudi, and Falko F. Sniehotta

Intervention science faces a hazardous paradox: on the one hand, vulnerable populations (eg, patients, people from low socioeconomic background, older adults) are those for whom adoption of healthy behaviors is most urgent; on the other hand, behavior change models are less predictive, and interventions less successful, in these populations. This commentary presents 4 reasons that may explain this issue: (1) research mostly focuses on what causes behavior and how to change it, at the expense of investigating among whom and under what conditions models are valid; (2) models put an undue emphasis on individual cognitions; (3) most studies are not conducted on vulnerable populations; and (4) most researchers are from high-income countries. Several avenues are proposed to address this issue: (1) providing a central place to the context and audience in health behavior change modelization, through collaborations with researchers from other disciplines and countries, and with members of the targeted audience; (2) better reporting samples’ sociodemographic characteristics and increasing samples’ diversity; and (3) using more rigorous and innovative designs (eg, powered randomized controlled trials, N-of-1 trials, intensive longitudinal studies). In conclusion, it becomes urgent to change the way we do research: the social utility and credibility of intervention science depend on it.

Free access

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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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.

Open access

A Protocol for a Local Community Monitoring and Feedback System for Physical Activity in Organized Group Settings for Children

Ann M. Essay, Michaela A. Schenkelberg, Mary J. Von Seggern, Marisa S. Rosen, Chelsey R. Schlechter, Richard R. Rosenkranz, and David A. Dzewaltowski

Background: Communities are wellness landscapes of geospatially and temporally bound settings where children spend their time. Improving population physical activity (PA) requires investigating available community settings for children, such as classrooms and sport teams, and the dynamic social interactions producing PA. This protocol describes a multiscale community wellness landscape monitoring and feedback system of adult-led organized group settings and PA outcomes for children. Methods: The data system assessed organized groups for third- through sixth-grade children in 2 rural communities within seasons (fall 2018–2019). Within each season, groups were identified, sampled, and recruited. Sampled group meetings were assessed for children’s PA (accelerometry) and meeting routines (video observation). A data processing protocol time-segmented data into meetings and meeting routines into smaller units (sessions). A purpose code was assigned to each meeting (eg, classroom, sport) and session (eg, academic, PA). Group accelerometer data were paired with the coded segments. Multiscale metrics (season, meeting, and session) were generated and provided to the communities in tailored reports. Results: A total of 94 groups were recruited, and 73 groups with 1302 participants were included in the data system. Data were collected from 213 meetings and 844 sessions. Most participants (83.1%) consented to link their accelerometer data with demographic data from school enrollment records. Conclusions: The community data system identified available organized group settings for children and collected video and PA data from these settings. Incorporating setting data into local data systems provides detailed accounts of whole-of-community PA social systems to inform population health improvement efforts.

Free access

The Physical Activity Policy to Practice Disconnect

Michael Pratt, Andrea Ramirez Varela, and Adrian Bauman

Free access

Journal of Physical Activity and Health’s 2022 in Review

Pedro C. Hallal

Open access

A Case for Unifying Accelerometry-Derived Movement Behaviors and Tests of Exercise Capacity for the Assessment of Relative Physical Activity Intensity

Mark W. Orme, Phoebe H.I. Lloyd-Evans, Akila R. Jayamaha, Winceslaus Katagira, Bruce Kirenga, Ilaria Pina, Andrew P. Kingsnorth, Ben Maylor, Sally J. Singh, and Alex V. Rowlands

Albert Einstein taught us that “everything is relative.” People’s experience of physical activity (PA) is no different, with “relativism” particularly pertinent to the perception of intensity. Markers of absolute and relative intensities of PA have different but complimentary utilities, with absolute intensity considered best for PA guideline adherence and relative intensity for personalized exercise prescription. Under the paradigm of exercise and PA as medicine, our Technical Note proposes a method of synchronizing accelerometry with the incremental shuttle walking test to facilitate description of the intensity of the free-living PA profile in absolute and relative terms. Our approach is able to generate and distinguish “can do” or “cannot do” (based on exercise capacity) and “does do” or “does not do” (based on relative intensity PA) classifications in a chronic respiratory disease population, facilitating the selection of potential appropriate individually tailored interventions. By synchronizing direct assessments of exercise capacity and PA, clearer insights into the intensity of PA performed during everyday life can be gleaned. We believe the next steps are as follows: (1) to determine the feasibility and effectiveness of using relative and absolute intensities in combination to personalize the approach, (2) to determine its sensitivity to change following interventions (eg, exercise-based rehabilitation), and (3) to explore the use of this approach in healthier populations and in other long-term conditions.

Free access

More Than Ever, It Is Time to Ensure Regular Opportunities for Physical Activity Among Children and Adolescents: The Potential of Structured Settings

Rafael Tassitano