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Monitoring Global Progress of Physical Activity: The Role and Progress of Civil Society in Holding Governments to Account
Fiona Bull
Development of WHO Guidelines on Physical Activity, Sedentary Behavior, and Sleep for Children Less Than 5 Years of Age
Juana Willumsen and Fiona Bull
Background: Physical inactivity is a leading risk factor for global mortality and a contributor to the increase in overweight and obesity. The Commission on Ending Childhood Obesity identified the need for guidance on physical activity, particularly for early childhood (<5 y), a period of rapid physical and cognitive development. Methods: The World Health Organization (WHO) has developed the first global guidelines on physical activity, sedentary, and sleep behaviors, building upon high-quality systematic reviews. The WHO guideline process is a rigorous, systematic, and transparent method for the development of recommendations, using the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework. It takes into consideration the strength of the evidence as well as values and preferences, benefits and harms, equity and human rights. Results: The authors summarize the first global guidelines on time spent in physical activity, sedentary behavior (including screen time and time spent restrained), and sleep patterns in infants (birth to 1 y of age), toddlers (1–2.9 y of age), and preschoolers (3–4.9 y of age). Conclusions: WHO is actively disseminating and supporting implementation of these guidelines by national adoption and adaptation, through links with early childhood development and the Global Action Plan on Physical Activity 2018–2030.
National Policy on Physical Activity: The Development of a Policy Audit Tool
Fiona C. Bull, Karen Milton, and Sonja Kahlmeier
Background:
Physical inactivity is a leading risk factor for noncommunicable disease worldwide. Increasing physical activity requires large scale actions and relevant, supportive national policy across multiple sectors.
Methods:
The policy audit tool (PAT) was developed to provide a standardized instrument to assess national policy approaches to physical activity. A draft tool, based on earlier work, was developed and pilot-tested in 7 countries.
Results:
After several rounds of revisions, the final PAT comprises 27 items and collects information on 1) government structure, 2) development and content of identified key policies across multiple sectors, 3) the experience of policy implementation at both the national and local level, and 4) a summary of the PAT completion process.
Conclusions:
PAT provides a standardized instrument for assessing progress of national policy on physical activity. Engaging a diverse international group of countries in the development helped ensure PAT has applicability across a wide range of countries and contexts. Experiences from the development of the PAT suggests that undertaking an audit of health enhancing physical activity (HEPA) policy can stimulate greater awareness of current policy opportunities and gaps, promote critical debate across sectors, and provide a catalyst for collaboration on policy level actions. The final tool is available online.
Test-Retest Reliability of Transport-Related Physical Activity Performed During the Lifetime
Terry Boyle, Jane Heyworth, Fiona C. Bull, and Lin Fritschi
Background:
One of the convenient ways to achieve recommended levels of physical activity is through ‘active transport,’ such as walking or cycling to and from work or school. Although studies have shown that participants can reliably recall information about recent transport-related physical activity, it is not known if the reliability remains high when asking about lifetime behavior. This study tested the reliability of questions that collect information about transport-related physical activity performed over the lifetime.
Methods:
Participants were asked to complete self-administered questions about transport-related physical activity on 2 separate occasions. The questions asked about cycling and walking to and from work and/or school during 3 age periods: 15−24 years, 25−39 years, and 40 years and above. A lifetime average was also calculated for cycling, walking, and total activity.
Results:
There was fair to good test-retest reliability of the age-period specific questions for transport-related cycling (ICCs from 0.65−0.74), walking (ICCs from 0.44−0.58), and total activity (ICCs from 0.57−0.66). The reliability of the lifetime averages were also fair to good (ICCs from 0.58−0.70).
Conclusions:
The questions tested in this study have moderate reliability, and appear to be useful questions for measuring lifetime transport-related physical activity.
Global Physical Activity Questionnaire (GPAQ): Nine Country Reliability and Validity Study
Fiona C. Bull, Tahlia S. Maslin, and Timothy Armstrong
Purpose:
Instruments to assess physical activity are needed for (inter)national surveillance systems and comparison.
Methods:
Male and female adults were recruited from diverse sociocultural, educational and economic backgrounds in 9 countries (total n = 2657). GPAQ and the International Physical Activity Questionnaire (IPAQ) were administered on at least 2 occasions. Eight countries assessed criterion validity using an objective measure (pedometer or accelerometer) over 7 days.
Results:
Reliability coefficients were of moderate to substantial strength (Kappa 0.67 to 0.73; Spearman's rho 0.67 to 0.81). Results on concurrent validity between IPAQ and GPAQ also showed a moderate to strong positive relationship (range 0.45 to 0.65). Results on criterion validity were in the poor-fair (range 0.06 to 0.35). There were some observed differences between sex, education, BMI and urban/rural and between countries.
Conclusions:
Overall GPAQ provides reproducible data and showed a moderate-strong positive correlation with IPAQ, a previously validated and accepted measure of physical activity. Validation of GPAQ produced poor results although the magnitude was similar to the range reported in other studies. Overall, these results indicate that GPAQ is a suitable and acceptable instrument for monitoring physical activity in population health surveillance systems, although further replication of this work in other countries is warranted.
Methods for Researching the Physical Activity Impacts of ‘Natural Experiments’ in Modifying the Built Environment
David Ogilvie, Billie Giles-Corti, Paula Hooper, Lin Yang, and Fiona Bull
Modifying the built environment is increasingly recommended as a means of increasing physical activity, but there is currently little evidence from intervention studies to support this approach. From a discussion of 3 natural experiments in this area (RESIDE, iConnect, and Commuting and Health in Cambridge), several common lessons emerged. First, researchers should anticipate delays in the implementation of interventions that are outside their control, and research funders need to exercise a degree of flexibility to accommodate changing research timetables. Second, new built environments develop and evolve over time, and so do their effects on human behavior. Study designs and exposure measures should take account of this, and long term outcomes should be measured wherever possible to allow for potential sleeper, snowball, or threshold effects emerging over time. Third, it may be difficult to identify suitable control areas for a conventional parallel-group intervention–control design, and it may be necessary to draw on other study designs to provide a counterfactual comparison. Fourth, the effort and cost required to recruit, retain and obtain repeated measurements from participants over a period of years should not be underestimated. Finally, comprehensive process evaluation measures may be required to assess the level and quality of interventions.
Promotion of Physical Activity in the European Region: Content Analysis of 27 National Policy Documents
Signe B. Daugbjerg, Sonja Kahlmeier, Francesca Racioppi, Eva Martin-Diener, Brian Martin, Pekka Oja, and Fiona Bull
Background:
Over the past years there has been increasing interest in physical activity promotion and the development of appropriate policy. So far, there has been no comprehensive overview of the activities taking place in Europe in this area of public health policy.
Methods:
Using different search methods, 49 national policy documents on physical activity promotion were identified. An analysis grid covering key features was developed for the analysis of the 27 documents published in English.
Results:
Analysis showed that many general recommendations for policy developments are being followed, for example: general goals were formulated, an implementation plan was included, a timeframe and a responsible body for the implementation was often specified. However, limited evidence for intersectoral collaboration was found. Quantified goals for physical activity were the exception. Population groups most in need such as people with low levels of physical activity were rarely specifically targeted. Most policies emphasized the importance of an evaluation. However, only about half of them indicated a related intention or requirement.
Conclusion:
In recent years there has been a noticeable development of national policy documents on physical activity promotion. Following principles for policy development more closely could increase the effectiveness of their preparation and implementation further.
The Toronto Charter for Physical Activity: A Global Call for Action
Fiona C. Bull, Lise Gauvin, Adrian Bauman, Trevor Shilton, Harold W. Kohl III, and Art Salmon
Assessment of Sedentary Behavior With the International Physical Activity Questionnaire
Dori E. Rosenberg, Fiona C. Bull, Alison L. Marshall, James F. Sallis, and Adrian E. Bauman
Purpose:
This study explored definitions of sedentary behavior and examined the relationship between sitting time and physical inactivity using the sitting items from the International Physical Activity Questionnaire (IPAQ).
Methods:
Participants (N = 289, 44.6% male, mean age = 35.93) from 3 countries completed self-administered long- and short-IPAQ sitting items. Participants wore accelero-meters; were classified as inactive (no leisure-time activity), insufficiently active, or meeting recommendations; and were classified into tertiles of sitting behavior.
Results:
Reliability of sitting time was acceptable for men and women. Correlations between total sitting and accelerometer counts/min <100 were significant for both long (r = .33) and short (r = .34) forms. There was no agreement between tertiles of sitting and the inactivity category (kappa = .02, P = .68).
Conclusion:
Sedentary behavior should be explicitly measured in population surveillance and research instead of being defined by lack of physical activity.
Global Public Health Guidelines on Physical Activity and Sedentary Behavior for People Living With Chronic Conditions: A Call to Action
Paddy C. Dempsey, Christine M. Friedenreich, Michael F. Leitzmann, Matthew P. Buman, Estelle Lambert, Juana Willumsen, and Fiona Bull
Background: In 2020, the World Health Organization (WHO) released global guidelines on physical activity (PA) and sedentary behavior, for the first time providing population-based recommendations for people living with selected chronic conditions. This article briefly presents the guidelines, related processes and evidence, and, importantly, considers how they may be used to support research, practice, and policy. Methods: A brief overview of the scope, agreed methods, selected chronic conditions (adults living with cancer, hypertension, type 2 diabetes, and human immunodeficiency virus), and appraisal of systematic review evidence on PA/sedentary behavior is provided. Methods were consistent with World Health Organization protocols for developing guidelines. Results: Moderate to high certainty evidence (varying by chronic condition and outcome examined) supported that PA can reduce the risk of disease progression or premature mortality and improve physical function and quality of life in adults living with chronic conditions. Direct evidence on sedentary behavior was lacking; however, evidence extrapolated from adult populations was considered applicable, safe, and likely beneficial (low certainty due to indirectness). Conclusions: Clinical and public health professionals and policy makers should promote the World Health Organization 2020 global guidelines and develop and implement services and programs to increase PA and limit sedentary behavior in adults living with chronic conditions.
