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A Conceptual Primer on the Potential of Adaptive Policies to Reduce Physical Inactivity

Karen Milton, Harry Rutter, Harriet Koorts, and Leandro Garcia

Background: Despite the existence of physical activity policies across many countries, insufficient physical activity remains a major global public health problem. Physical inactivity is an emergent feature of complex systems; it results from a wide range of factors at multiple levels that interact to influence behavior. Traditional approaches to public policy often fail within complex systems, largely due to unpredictability in how the system will respond. Adaptive policies, which are designed to allow for uncertainty about future system behavior and to change over time, may offer a promising solution. In this paper, we introduce the concept of adaptive policies and illustrate how this innovative approach to policy making may be beneficial for reducing physical inactivity. Design: Drawing on existing literature and guiding principles for policy making, we provide 3 examples to illustrate how the concept of adaptive policies can be applied to address physical inactivity. Discussion: The examples illustrate how changes to the way policies and interventions are developed, implemented, and evaluated could help to overcome some of the limitations in existing practices. A key challenge will be engaging policymakers to take a broader perspective of the physical activity system, develop policies that are designed to be adaptable across a range of different future scenarios, and embrace uncertainty and long-term adaptability. Conclusion: Adaptive policies may support decision makers globally to achieve the widespread and sustained changes necessary to increase population levels of physical activity.

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Physical Activity and Mental Health: A Little Less Conversation, a Lot More Action

Brendon Stubbs, Ruimin Ma, Felipe Schuch, James Mugisha, Simon Rosenbaum, Joseph Firth, and Davy Vancampfort

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Pickleball Participation and the Health and Well-Being of Adults—A Scoping Review

Kim Stroesser, Adam Mulcaster, and David M. Andrews

Background: Pickleball has grown tremendously in recent years, yet little evidence exists regarding pickleball-related injuries. This scoping review extends current work on pickleball participation by identifying positive and negative health effects associated with the sport. We summarize how pickleball impacts the health and well-being of adult participants. Methods: Searches were conducted on MEDLINE, CINAHL, ProQuest Nursing, ERIC, SPORTDiscus, PsycINFO, Scopus, CBCA Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses. Selected studies considered aspects of health and/or well-being of adult pickleball participants. Using the population/concept/context framework, participants were healthy, able-bodied adults 18 years of age or over, who had played pickleball at least once. The positive and negative outcomes of pickleball on participants’ health and well-being (concept) within the context of pickleball participation were examined. Full-text articles written in English since 2013 were included. Extracted data were tabulated, and a descriptive summary with thematic analysis was completed. Results: This scoping review comprised 27 articles that met the inclusion criteria. Pickleball is promising as an exercise intervention for all adults, and there is evidence of positive social and psychological effects, and health and fitness benefits to participating in pickleball by older adults. Conclusions: Although we are still in the early stages of studying pickleball, there have been some documented health benefits of using the sport as a physical exercise intervention for adults. More research is needed on the types, prevalence, and severity of pickleball injuries and the sport’s impact on younger players.

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Automated Classification of Manual Exploratory Behaviors Using Sensorized Objects and Machine Learning: A Preliminary Proof-of-Concept Study

Priya Patel, Harsh Pandya, Rajiv Ranganathan, and Mei-Hua Lee

Manual exploratory behaviors during object interaction that form the basis of tool use behavior, are mostly qualitatively characterized in terms of their frequency and duration of occurrence. To fully understand their functional and clinical significance, quantitative movement characterization is needed alongside their qualitative analysis. However, there are two challenges in quantifying them—(a) reliably classifying the type of movement and (b) performing this classification on a time series automatically. Here, we propose a machine learning-based classification method to address these challenges. We measured three common exploratory behaviors (object rotation, fingering, and throwing) in college-aged adults using “sensorized objects” that had wireless Inertial Measurement Units embedded in them. We then calculated several statistical features based on linear acceleration and angular velocity data to train machine learning classifiers to identify these behaviors. All classifiers identified the behaviors with a substantially higher accuracy (average accuracy = 84.95 ± 4.16%) than chance level (33.33%). Of all models tested, Support Vector Machine Quadratic, Support Vector Machine Medium Gaussian, and Narrow Neural Network were the best models in classifying the three behaviors (average accuracy = 89.34 ± 0.12%). This classification method shows potential for automating movement characterization of exploratory behaviors, thereby may aid early assessment of neurodevelopmental disorders.

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Physical Fitness as a Predictor of Disability Retirement: A 9-Year Register Linked Follow-Up Study

Markus Kuusela, Valtteri Pohjola, Katariina Sarttila, Matti Munukka, Riikka Holopainen, Mikko Laaksonen, Annamari Lundqvist, and Jouni Lahti

Background: To prospectively examine the association between physical fitness and risk of disability retirement in a large population-based cohort. Methods: This study utilized data from Health 2011 survey Physical Activity subsample (n = 4898), combined with information on disability retirement derived from 2 national registers. In total, 2455 individuals aged 18–74 years underwent the physical fitness test protocol concerning measures of cardiorespiratory fitness, muscle strength, and balance. The outcome variable was disability retirement, during the follow-up period of 9 years. After excluding those not at risk of disability retirement (ie, age ≥63 y) or who had already been granted disability pension, and those who had not completed the fitness protocol, the analytical sample included 1381 participants. Data were analyzed using Cox regression model with SPSS (version 29). Results: During the 9-year follow-up period, 61 individuals (4.4%) transitioned to a disability retirement. Cox regression analysis showed an association between the various physical fitness subdomains and the risk of disability retirement. In model 1, all fitness tests were associated with the risk of disability retirement, except the one-leg stand test with hazard ratios ranging from 1.69 (95% CI, 0.86–3.34) to 5.75 (95% CI, 1.84–17.90). Further adjustment for sociodemographic, health behavior, and health-related covariates attenuated the associations and statistical significance was lost, except for the vertical jump test (hazard ratio = 4.33; 95% CI, 1.32–14.10) and 6-minute walk test (hazard ratio = 3.81; 95% CI, 1.35–10.70). Conclusion: These findings highlight the importance of physical fitness for preventing work disability.

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What’s Your Poison? Is Sitting Always Health Hindering and Moving Always Health Promoting?

Leon Straker, Charlotte Lund Rasmussen, Nidhi Gupta, and Andreas Holtermann

The clear public messaging from international health authorities is that individuals should “sit less and move more.” While it is acknowledged that this guidance needs to be tailored to the age of people and also to their health, and abilities, the guidance is not tailored to their current level of physical behaviors. This opinion piece aims to highlight that although people with excessive sitting and insufficient moderate-to-vigorous physical activity should sit more and move less, for other people their health would be promoted by sitting more and moving less. Thus, physical behaviors are not always “poison” or “medicine,” but rather the health impact of changes in physical behaviors depends on people’s initial levels. Policy, research, and practice implications of this realization are presented. Only tailoring messaging to age and health status could be far from optimal for people with very different current levels of physical behaviors. Policy, research, and practice will be enhanced when the potential for physical behaviors to be either health hindering or health promoting is adequately considered.

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Community Group-Based Physical Activity Programs for Immigrant Older Adults: A Systematic Realist Review

Jordana Salma, Alesia Au, Sonam Ali, Stephanie Chamberlain, John C. Spence, Allyson Jones, Megan Kennedy, Hongmei Tong, Salima Meherali, Philile Mngomezulu, and Rachel Flynn

Physical activity program interventions often lack sensitivity to the needs of older immigrant adults. The objective of this systematic realist review is to explain how, why, for whom, and under which circumstances community group-based physical activity programs work for immigrant older adults. The initial program theory was developed using prior research, team expertise, social cognitive theory, and knowledge user consultations. The program theory was tested and refined via a systematic review of the literature. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, Sports Medicine and Education Index, and SPORTDiscus. A total of 22 sources of evidence met inclusion criteria and included intervention studies, systematic reviews, and a discussion paper. Intervention studies were appraised using the Mixed Methods Appraisal Tool. The final program theory constituted eight context–mechanism–outcome configurations that highlight the importance of facilitator characteristics, access to safe spaces, group dynamics, and social support. A limitation was the small number and variable quality of included evidence. Physical activity programs that target immigrant older adults must strengthen physical and psychological safety and maximize opportunities for role modeling and socialization. This research was supported by the Alberta Health Services Seniors Health Strategic Clinical Network and is registered in PROSPERO (ID#258179).

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How Can We Equitably Scale-Up Physical Activity Interventions to Ensure Everyone Has Opportunities to Thrive?

Gabriella M. McLoughlin and Jo Salmon

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The Secret Sauce? Taking the Mystery Out of Scaling-Up School-Based Physical Activity Interventions

Heather A. McKay, Sarah G. Kennedy, Heather M. Macdonald, Patti-Jean Naylor, and David R. Lubans

Over the last 4 decades, physical activity researchers have invested heavily in determining “what works” to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.

Open access

Measuring Active Transportation on National Health Surveys in Canada From 1994 to 2020

Parya Borhani, Kathryn L. Walker, Gregory P. Butler, Valérie Lavergne, Gisèle Contreras, and Stephanie A. Prince

Background: Active transportation (AT), described as self-powered modes of travel (eg, walking and cycling), is an important source of health-promoting physical activity. While AT behaviors have been measured on national health surveys in Canada for over 2 decades, historic prevalence has not been previously reported. We aimed to document the measures of AT on Canada’s various national health surveys, examine AT over time, and interpret them within the context of evolving methods of assessment. Methods: We compiled and summarized the questions used to measure AT among Canadians on 4 national health surveys: National Population Health Survey (1994–1998), Canadian Community Health Survey (2000–2020), Canadian Health Measures Survey (2007–2019), and the Health Behaviour in School-aged Children Study (2010–2018). Among youth and adults (12+ y), we summarized over time: (1) the prevalence of AT participation and (2) time spent in AT (in hours per week) among those who report any AT participation. Where possible, we reported separate estimates of walking and cycling and produced an aggregate estimate of total AT. We stratified results by age group and sex. Results: Changes in AT survey questions over time and between surveys limit the interpretation and comparability of temporal trends. Nevertheless, a consistently higher proportion of females report walking, while a higher proportion of males report cycling. Irrespective of mode, males report spending more total time in AT. Participation in AT tends to decrease with age, with youth reporting the highest rates of AT and young adults often spending the most time in AT. Conclusions: Monitoring trends in AT can help assess patterns of behavior and identify whether promotion strategies are needed or whether population interventions are effective. Our evaluation of AT over time is limited by questions surveyed; however, consistent differences in AT by age and sex are evident over time. Moving forward, ensuring consistency of AT measurement over time is essential to monitoring this important behavior.