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The Role of the Public Health Sector in Promoting Physical Activity: National, State, and Local Applications

Gregory W. Heath

Background:

Regular physical activity has been demonstrated to protect against coronary heart disease, Type 2 diabetes mellitus, selected cancers, hypertension, obesity, and other chronic conditions. Therefore, the public health significance of promoting physical activity and preventing inactivity has become a well-established agenda for public health agencies at all levels.

Methods:

A secondary search of the literature, focusing on existing evidence reviews, was conducted to identify effective or promising public health physical activity interventions. Further examination of published evidence-based programs also was carried out to supplement the known evidence base. Intervention strategies were selected using criteria prescribed by each of the systematic reviews to yield categories of intervention effectiveness.

Key recommendations:

The selected physical activity interventions conformed to the domains identified by The Guide to Community Preventive Services. Recommended evidenced-based strategies from within the domain of informational approaches include 2 exemplary community-wide campaigns; mass media campaigns, represented by VERB; and an emerging practice of delivery of short physical activity messages at key community sites. Exemplary representative behavioral/social interventions include social support through organized walking clubs/partners within communities. Exemplary environmental/policy approaches include creating/enhancing access to places for physical activity with informational outreach activities and the emerging strategy of community-wide policies and planning.

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Evolution and Devolution of National Physical Activity Policy in Canada

Cora Lynn Craig

Background:

Low levels of physical activity (PA) and fitness have long been a government concern in Canada; however, more than half of adults are inactive. This article examines factors influencing policy development and implementation using Canadian PA policy as a case study.

Methods:

Current and historical PA policy documents were amassed from a literature review, audit of government and non government websites and from requests to government officials in each jurisdiction directly responsible for PA. These were analyzed to determine policy content, results, barriers, and success factors.

Results:

The national focus for PA policy in Canada has devolved to a multilevel system that meets most established criteria for successful strategies. Earlier PA targets have been met; however, the prevalence of PA decreased from 2005 to 2007. Annual per capita savings in health care associated with achieving the earlier target is estimated at $6.15 per capita, yet a fraction of that is directed to promoting PA.

Conclusion:

Evidenced-based strategies that address multiple policy agendas using sector-specific approaches are needed. Sustained high-level commitment is required; advocacy grounded in metrics and science is needed to increase the profile of the issue and increase the commitments to PA policies in Canada and internationally.

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Are the Physical Activity Parenting Practices Reported by US and Canadian Parents Captured in Currently Published Instruments?

Louise C. Mâsse, Teresia M. O’Connor, Andrew W. Tu, Allison W. Watts, Mark R. Beauchamp, Sheryl O. Hughes, and Tom Baranowski

Background:

The purpose of this study was to compare the physical activity parenting practices (PAPPs) parents report using with the PAPPs incorporated in the published literature.

Methods:

PAPPs in the literature were identified by reviewing the content of 74 published PAPP measures obtained from current systematic reviews supplemented with a literature search. The types of PAPPs used by parents were identified by surveying a stratified sample of 134 Canadian and US parents of 5- to 12 year-old children. Items from the literature and parent responses were coded using the same coding scheme. Differences between the PAPPs emphasized by the parents and the literature were examined.

Results:

Parents significantly emphasized different issues than what is measured in the literature (P < .001). Parents emphasized more control (13.6% vs. 6.9%), modeling and teaching (13.2% vs. 9.2%), and structural strategies (32.2% vs. 28.6%) and less autonomy support (11.8% vs. 14.0%), logistical support (9.9% vs. 12.8%), and responsiveness strategies (19.3% vs. 28.5%).

Conclusions:

Physical activity practices most often employed by parents are not the ones emphasized in current measures. The extent to which putting more emphasis on the areas identified by parents will increase the predictive validity of the measures warrants further examination.

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Feasibility and Effectiveness of a Web-Based Physical Activity Intervention for Working Mothers

Emily L. Mailey, Jennifer Huberty, and Brandon C. Irwin

Background:

The purpose of this study was to examine the feasibility and effectiveness of a web-based intervention to promote physical activity and self-worth among working mothers.

Methods:

Participants (N = 69) were randomly assigned to receive a standard web-based intervention or an enhanced intervention that included group dynamics strategies to promote engagement. The 8-week intervention was guided by self-determination theory. Each week, participants were instructed to complete 3 tasks: listen to a podcast related to well-being, complete a workbook assignment, and communicate with other participants on a discussion board. Participants in the enhanced condition received an additional weekly task to enhance group cohesion. Data were collected at baseline, week 8, and week 16.

Results:

Physical activity (P < .001, η2 = 0.35) and self-worth (P < .001, η2 = 0.39) increased significantly in both groups following the intervention, and introjected (P < .001, η2 = 0.30) and external motivation (P = .04, η2 = 0.10) decreased. Website use declined across the 8-week intervention in both groups (P < .001, η2 = 0.48); however, discussion board use was higher in the enhanced condition (P = .04, η2 = 0.21).

Conclusions:

These findings suggest web-based interventions can improve physical activity and self-worth among working mothers. Group dynamics strategies only minimally enhanced user engagement, and future studies are needed to optimize web-based intervention designs.

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Women Bound to Be Active: Differences in Long-Term Physical Activity Between Completers and Noncompleters of a Book Club Intervention

Jennifer L. Huberty, Diane Ehlers, Jason Coleman, Yong Gao, and Steriani Elavsky

Background:

Ideal approaches to increasing long-term physical activity (PA) adherence in women remain unclear. This study used a longitudinal mixed-methods approach to 1) determine the effectiveness of an 8-month book club intervention for increasing PA participation and self-worth, and reducing barriers at 1-year follow-up; and 2) identify reasons why completers and noncompleters did or did not maintain PA.

Methods:

One year after the cessation of Women Bound to be Active (WBA), completers (participated in posttesting; n = 30) and noncompleters (did not participate in posttesting; n = 22) responded to questionnaires and interviews assessing their body mass index (BMI), current PA participation, barriers, and global self-worth.

Results:

Compared with noncompleters, completers reported decreases in BMI, higher motivation for PA, higher ratio of benefits to barriers, and more consistent PA. Both groups still reported barriers to PA, especially time; however, completers more often reported strategies for overcoming these barriers. Completers more directly discussed the impact of their improved self-worth on their PA participation.

Conclusions:

In the future, a greater focus on time management and self-regulation strategies should be emphasized in PA interventions, specifically those that focus on women. This may help to prevent program and long-term PA attrition.

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Exploring Attitudes, Perceived Norms, and Personal Agency: Insights Into Theory-Based Messages to Encourage Park-Based Physical Activity in Low-Income Urban Neighborhoods

Lisa Groshong, Sonja A. Wilhelm Stanis, Andrew T. Kaczynski, J. Aaron Hipp, and Gina M. Besenyi

Background:

Public parks hold promise for promoting population-level PA, but studies show a significant portion of park use is sedentary. Past research has documented the effectiveness of message-based strategies for influencing diverse behaviors in park settings and for increasing PA in nonpark contexts. Therefore, to inform message-based interventions (eg, point-ofdecision prompts) to increase park-based PA, the purpose of this study was to elicit insights about key attitudes, perceived norms, and personal agency that affect park use and park-based PA in low-income urban neighborhoods.

Methods:

This study used 6 focus groups with youth and adults (n = 41) from low-income urban areas in Kansas City, MO, to examine perceptions of key attitudinal outcomes and motivations, perceived norms, key referents, and personal agency facilitators and constraints that affect park use and park-based PA.

Results:

Participant attitudes reflected the importance of parks for mental and physical health, with social interaction and solitude cited as key motivations. Of 10 themes regarding perceived norms, influential others reflected participants’ ethnic makeup but little consensus emerged among groups. Social and safety themes were cited as both facilitators and constraints, along with park offerings and setting.

Conclusions:

Information about attitudes, perceived norms, and personal agency can increase understanding of theoretically derived factors that influence park-based PA and help park and health professionals create communication strategies to promote PA.

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Understanding the Demographic Differences in Neighborhood Walking Supports

Susan A. Carlson, Kathleen B. Watson, Prabasaj Paul, Thomas L. Schmid, and Janet E. Fulton

Background:

Information about how presence and usefulness of neighborhood supports for walking differs by demographic characteristics can help guide community strategies to promote walking.

Methods:

Reported presence and usefulness of neighborhood supports (shops, transit stops, sidewalks, parks, interesting things to look at, well-lit at night, low crime rate, and cars following speed limit) were examined in 3973 U.S. adults who completed the 2014 SummerStyles survey.

Results:

Percentage reporting neighborhood supports as present ranged from 25.3% (SE = 0.8) for interesting things to 55.8% (SE = 1.0) for low crime rate. Percentage who reported a support as useful ranged from 24.6% (SE = 1.4) for transit stops to 79.0% (SE = 1.1) for sidewalks among those with the support. This percentage ranged from 13.4% (SE = 0.8) for transit stops to 52.8% (SE = 1.1) for shops among those without the support. One or more demographic differences were observed for the presence of each support, and the presence of all supports differed by education and metro status. Demographic patterns were less clear when examining usefulness and patterns often differed by support type and presence.

Conclusions:

Presence and usefulness of neighborhood supports for walking can differ by type and demographic characteristics. Recognizing these difference can help communities plan and implement strategies to promote walking.

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Fitness Equipment in Public Parks: Frequency of Use and Community Perceptions in a Small Urban Centre

Jennifer L. Copeland, Cheryl Currie, Ali Walker, Erin Mason, Taura N. Willoughby, and Ashley Amson

Background:

Providing freely accessible exercise facilities may increase physical activity at a population level. An increasingly popular strategy is outdoor fitness equipment in urban parks. Few studies have evaluated the effectiveness of this intervention in smaller cities. This study examined fitness equipment use, perceived effectiveness, and ways to increase use in a city of 100,000 people in 2015.

Methods:

Two parks with fitness equipment and 4 without were directly observed. Interviews with 139 adults in active parks or living nearby were also conducted.

Results:

Only 2.7% of adult park users used the fitness equipment over 100 hours of observation across 3 seasons. In contrast, 22.3% of adults interviewed reported monthly or more use of the equipment, highlighting the limitations of self-report methods. Adults interviewed perceived the equipment as potentially beneficial and suggested strategies to increase public use, including increased advertising, the introduction of programming to teach and encourage use, improved equipment quality, and improved maintenance of the equipment and surrounding area.

Conclusions:

In a low density city, park fitness equipment may not be an effective public health practice without additional efforts to market, introduce programming, and maintain these sites.

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Associations of Parental Rules and Socioeconomic Position With Preschool Children’s Sedentary Behaviour and Screen Time

Katherine L. Downing, Trina Hinkley, and Kylie D. Hesketh

Background:

There is little current understanding of the influences on sedentary behavior and screen time in preschool children. This study investigated socioeconomic position (SEP) and parental rules as potential correlates of preschool children’s sedentary behavior and screen time.

Methods:

Data from the Healthy Active Preschool Years (HAPPY) Study were used. Participating parents reported their child’s usual weekly screen time and their rules to regulate their child’s screen time. Children wore accelerometers for 8 days to objectively measure sedentary time.

Results:

Children whose parents limited television viewing spent significantly less time in that behavior and in total screen time; however, overall sedentary behavior was unaffected. An association between parents limiting computer/electronic game use and time spent on the computer was found for girls only. SEP was inversely associated with girls’, but not boys’, total screen time and television viewing.

Conclusions:

As parental rules were generally associated with lower levels of screen time, intervention strategies could potentially encourage parents to set limits on, and switch off, screen devices. Intervention strategies should target preschool children across all SEP areas, as there was no difference by SEP in overall sedentary behavior or screen time for boys.

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Correlates of Trail Use for Recreation and Transportation on 5 Massachusetts Trails

Stephanie L. Orstad, Meghan H. McDonough, David B. Klenosky, Marifran Mattson, and Philip J. Troped

Background:

Promoting use of community trails is a recommended strategy for increasing population levels of physical activity. Correlates of walking and cycling for recreation or transportation differ, though few studies have compared correlates of trailbased physical activity for recreation and transportation purposes. This study examined associations of demographic, social, and perceived built environmental factors with trail use for recreation and transportation and whether associations were moderated by age, gender, and prior trail use.

Methods:

Adults (N = 1195) using 1 of 5 trails in Massachusetts responded to an intercept survey. We used multiple linear and logistic regression models to examine associations with trail use.

Results:

Respondents’ mean age was 44.9 years (standard deviation = 12.5), 55.3% were female, and 82.0% were white. Age (longer-term users only), trail use with others, travel time to the trail, and trail design were significantly associated with use for recreation (P < .05). Age, gender, trail safety (longer-term users only), travel time to the trail, trail design (younger users only), and trail beauty were associated with use for transportation (P < .05).

Conclusions:

Some common correlates were found for recreational and transportation trail use, whereas some variables were uniquely associated with use for 1 purpose. Tailored strategies are suggested to promote trail use for recreation and transportation.