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Physical Activity Interventions in Latin America: What Value Might Be Added by Including Conference Abstracts in a Literature Review?

Christine Hoehner, Jesus Soares, Diana C. Parra, Isabela C. Ribeiro, Michael Pratt, Mario Bracco, Pedro C. Hallal, and Ross C. Brownson

Background:

This review assessed whether conference abstracts yield useful information on the types and effectiveness of community-based physical activity (PA) interventions in Latin America, beyond that from interventions included in a recent systematic review of peer-reviewed literature.

Methods:

Abstracts from 9 conferences were searched for community-based interventions to promote PA in Latin America and summarized. Three reviewers classified and screened abstracts. Evaluated interventions that were not included in the previous review were assessed.

Results:

Search of abstracts from 31 proceedings of 9 conferences identified 87 abstracts of studies on community-based interventions focused on increasing PA. Only 31 abstracts reported on studies with a control group and an outcome related to PA. Ten of these abstracts represented interventions that had not been included in the previous review of peer-reviewed literature, but the abstracts were insufficient in number or detail to make a practice recommendation for any single intervention.

Conclusions:

This review highlighted the challenges and low added value of including conference abstracts in a systematic review of community PA interventions in Latin America. Stronger evaluation design and execution and more published reports of evaluated interventions are needed to build an evidence base supporting interventions to increase PA in Latin America.

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Association Between Perceived Environmental Attributes and Physical Activity Among Adults in Recife, Brazil

Pedro C. Hallal, Rodrigo S. Reis, Diana C. Parra, Christine Hoehner, Ross C. Brownson, and Eduardo J. Simões

Background:

To evaluate the association between perceived environmental factors and leisure-time and transport-related physical activity.

Methods:

A random-digit-dialing telephone cross-sectional survey in Recife, Brazil, was conducted among individuals aged 16 years or older (n = 2046). Leisure-time and transport-related physical activity were measured using the long version of the International Physical Activity Questionnaire. Three outcome variables were used: leisure-time physical activity (min/wk), transport-related physical activity (min/wk), and walking for leisure (min/wk). A cutoff of 150 min/wk was used for all outcome variables. The environmental module of the questionnaire was based on the short version of the Neighborhood Environment Walkability Scale (A-NEWS), and included 12 environmental items.

Results:

The proportions of subjects reaching the 150-minutes per week threshold were 30.6% for leisure-time physical activity, 26.6% for transport-related physical activity and 18.2% for walking for leisure. Lack of sidewalks and low access to recreational facilities were associated with a lower likelihood of performing 150 minutes per week or more of leisure-time physical activity. Lack of sidewalks was associated with low levels of walking for leisure. Neighborhood aesthetics was inversely associated with transport-related physical activity.

Conclusions:

Lack of sidewalks and low access to recreational facilities were predictors of low levels of leisure-time physical activity, suggesting that policy strategies aimed at improving these environmental features may be warranted.

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Project GUIA: A Model for Understanding and Promoting Physical Activity in Brazil and Latin America

Michael Pratt, Ross C. Brownson, Luiz Roberto Ramos, Deborah Carvalho Malta, Pedro C. Hallal, Rodrigo S. Reis, Diana C. Parra, and Eduardo J. Simões

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Validity and Reliability of the Telephone-Administered International Physical Activity Questionnaire in Brazil

Pedro C. Hallal, Eduardo Simoes, Felipe F. Reichert, Mario R. Azevedo, Luiz R. Ramos, Michael Pratt, and Ross C. Brownson

Purpose:

To evaluate the validity and reliability of the telephone-administered long IPAQ version.

Methods:

The questionnaire was administered by telephone to adults on days 1 and 6. On day 1, the same questionnaire was administered by face-to-face interview, and accelerometers were delivered to subjects. Reliability was measured by comparing data collected using the telephone questionnaire on days 1 and 6. Validity was measured by comparing the telephone questionnaire data with (a) face-to-face questionnaire and (b) accelerometry.

Results:

Data from all instruments were available for 156 individuals. The Spearman correlation coefficient for telephone interview reliability was 0.92 for the leisure-time section of IPAQ, and 0.87 for the transport-related section of IPAQ. The telephone interview reliability kappa was 0.78. The Spearman correlation between the telephone-administered and the face-to-face questionnaire was 0.94 for the leisure-time and 0.82 for the transport-related section. The kappa was 0.69. There was a positive association between quartiles of accelerometer data and total telephone-administered IPAQ score (P < .001). The Spearman correlation was 0.22.

Conclusions:

The telephone-administered IPAQ presented almost perfect reliability and very high agreement with the face-to-face version. The agreement with accelerometer data were fair for the continuous score, but moderate for the categorical physical activity variables.

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Using Logic Models as Iterative Tools for Planning and Evaluating Physical Activity Promotion Programs in Curitiba, Brazil

Isabela C. Ribeiro, Andrea Torres, Diana C. Parra, Rodrigo Reis, Christine Hoehner, Thomas L. Schmid, Michael Pratt, Luiz R. Ramos, Eduardo J. Simões, and Ross C. Brownson

Background:

The Guide for Useful Interventions for Activity in Brazil and Latin America (GUIA), a systematic review of community-based physical activity (PA) interventions in Latin American literature, selected the CuritibAtiva program for a comprehensive evaluation. We describe the process of developing logic models (LM) of PA community interventions from Curitiba, Brazil, and discuss influential factors.

Methods:

The year-long process included engaging stakeholders involved in the promotion of PA in Curitiba, working with stakeholders to describe the programs and their goals, and developing LMs for the 2 main secretaries promoting PA in the city.

Results & Conclusions:

As a result of stakeholder interviews and discussion and the development of the LMs, local officials are coordinating programming efforts and considering ways the programs can be more complementary. The process has prompted program managers to identify overlapping programs, refine program goals, and identify gaps in programming. It also helped to frame evaluation questions, identify data sources, describe realistic outcomes, and reinforce the importance of intersectoral alliances for public health impact. Developing LMs proved to be feasible in the Latin American context, therefore adaptable and useful for other PA promotion programs in the region.

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Correspondence Between Perceived and Observed Measures of Neighborhood Environmental Supports for Physical Activity

Tegan K. Boehmer, Christine M. Hoehner, Kathleen W. Wyrwich, Laura K. Brennan Ramirez, and Ross C. Brownson

Background:

Neighborhood environmental supports for physical activity are assessed via telephone surveys (perceived) and environmental audits (observed), but the correspondence between methods is not known.

Methods.

Surveys (N = 1068) and audits were conducted concurrently in four diverse urban settings to measure recreational facilities, land use, transportation environment, and aesthetics. Agreement was assessed with kappa (κ) statistics.

Results.

Kappa values ranged from –0.06 to 0.47 for the 28 item-pairs: 17 item-pairs were classified as poor agreement (κ ≤ 0.20), 10 as fair (κ = 0.21-0.40), and 1 as good (κ = 0.47). The highest agreement was observed for proximity to parks, trails, and various land-use destinations, presence of sidewalks, and measures of neighborhood maintenance and cleanliness.

Conclusions.

Methodological issues and/or the likelihood of capturing distinct aspects of the environment may explain the generally low correspondence between survey and audit measures. Our findings should help researchers make informed decisions regarding measurement of environmental supports for physical activity.

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Development and Reliability and Validity Testing of an Audit Tool for Trail/Path Characteristics: The Path Environment Audit Tool (PEAT)

Philip J. Troped, Ellen K. Cromley, Maren S. Fragala, Steven J. Melly, Hope H. Hasbrouck, Steven L. Gortmaker, and Ross C. Brownson

Background:

To determine how trail characteristics may influence use, reliable and valid audit tools are needed.

Methods:

The Path Environment Audit Tool (PEAT) was developed with design, amenity, and aesthetics/maintenance items. Two observers independently audited 185 trail segments at 6 Massachusetts facilities. GPS-derived items were used as a “gold standard.” Kappa (k) statistics, observed agreement and intraclass correlation coefficients (ICCs) were calculated to assess inter-observer reliability and validity.

Results:

Fifteen of 16 primary amenity items had k-values ≥ 0.49 (“moderate”) and all had observed agreement ≥ 81%. Seven binary design items had k-values ranging from 0.19 to 0.71 and three of 5 ordinal items had ICCs ≥ 0.52. Only two aesthetics/maintenance items (n = 7) had moderate ICCs. Observed agreement between PEAT and GPS items was ≥ 0.77; k-values were ≥ 0.57 for 7 out of 10 comparisons.

Conclusions:

PEAT has acceptable reliability for most of its primary items and appears ready for use by researchers and practitioners.

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The Effectiveness of Urban Design and Land Use and Transport Policies and Practices to Increase Physical Activity: A Systematic Review

Gregory W. Heath, Ross C. Brownson, Judy Kruger, Rebecca Miles, Kenneth E. Powell, Leigh T. Ramsey, and the Task Force on Community Preventive Services*

Background:

Although a number of environmental and policy interventions to promote physical activity are being widely used, there is sparse systematic information on the most effective approaches to guide population-wide interventions.

Methods:

We reviewed studies that addressed the following environmental and policy strategies to promote physical activity: community-scale urban design and land use policies and practices to increase physical activity; street-scale urban design and land use policies to increase physical activity; and transportation and travel policies and practices. These systematic reviews were based on the methods of the independent Task Force on Community Preventive Services. Exposure variables were classified according to the types of infrastructures/policies present in each study. Measures of physical activity behavior were used to assess effectiveness.

Results:

Two interventions were effective in promoting physical activity (community-scale and street-scale urban design and land use policies and practices). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess transportation policy and practices to promote physical activity.

Conclusions:

Because community- and street-scale urban design and land-use policies and practices met the Community Guide criteria for being effective physical activity interventions, implementing these policies and practices at the community-level should be a priority of public health practitioners and community decision makers.

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Reliability of 2 Instruments for Auditing the Environment for Physical Activity

Ross C. Brownson, Christine M. Hoehner, Laura K. Brennan, Rebeka A. Cook, Michael B. Elliott, and Kathleen M. McMullen

Purpose:

To understand the relationships between street-scale environments and rates of physical activity, it is crucial to develop reliable methods of measurement. Community audits are commonly used to test the walkability and bikability of environments, yet few have been tested for reliability.

Methods:

Audit tools were collected from the peer-reviewed literature, the Internet, and experts from a variety of backgrounds. Two versions of an audit instrument were created: an “analytic” (with Likert-scale and ordinal-response choices) and a “checklist” (with dichotomous response choices) audit tool. Audits were conducted in St Louis, MO for 147 street segments, representing both higher and lower income neighborhoods. The same segments were re-audited to assess interrater reliability.

Results:

Characteristics of the physical environment varied considerably across lower and higher income segments. For example, in the checklist audit, physical disorder was present for 67 segments in lower income segments, compared with 0 segments in higher income segments. Among 8 questions from each audit tool designed to broadly capture environmental attributes, most had moderate to poor agreement. Most of the transportation and land-use items demonstrated high (substantial or perfect) agreement, and the aesthetics and social environment items showed reliability in the moderate to fair range.

Conclusions:

A community audit tool can be relatively easy and quick to administer and, for many domains, is reliable. Our audit tools appear particularly well suited for capturing elements in the transportation and land-use environments.

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Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity

Andrea Ramírez Varela, Natalicio Serrano, Juliana Mejía Grueso, Anita Nguyen, Deborah Salvo, Ross C. Brownson, Adrian Bauman, Rodrigo Reis, Pedro Hallal, and Michael Pratt

Background: A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice. Methods: Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice. Results: When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms. Conclusions: To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts.