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Mary B. Waterman and Patience H. White

The Environmental and Policy Strategies to Increase Physical Activity Among Adults with Arthritis report focuses on the ways to make physical activity more convenient and accessible for adults with arthritis. The report is designed to engage 6 important sectors, which were adapted from the National Physical Activity Plan, as partners with a mutual interest in increasing physical activity among adults with arthritis using environmental and policy strategies. It serves as a call to action for each of these sectors to collaborate and focus more attention on helping people live well with arthritis and be a productive part of our society.

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Lawrence Frank and Sarah Kavage

Background:

Evidence shows significant relationships between aspects of the built environment and physical activity. Land use and transportation investments are needed to create environments that support and promote physical activity.

Methods:

The policy relevance of recent evidence on the built environment and physical activity is discussed, along with an assessment of near, medium, and longer term pricing and regulatory actions that could be considered to promote physical activity. These actions are evaluated based on their consistency with the current evidence on what would support and promote physical activity.

Results:

A wide range of pricing and regulatory strategies are presented that would promote physical activity. There is an unmet demand for activity friendly, walkable environments. Creating more walkable places is an essential component of a national plan to increase physical activity levels of Americans.

Conclusions:

The built environment is an enabler or disabler of physical activity. Creating more walkable environments is an essential step in averting what is currently a market failure where the supply and demand for walkable environments is misaligned. The desire to be more physically active would be supported through investments in walking, biking, and transit. Concentration of development within existing urban areas supported by transit and implementing pricing strategies can support physical activity.

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Genevieve F. Dunton, Michael Cousineau and Kim D. Reynolds

Background:

Policy strategies aimed at modifying aspects of the social, physical, economic, and educational environments have been proposed as potential solutions to the growing problem of physical inactivity. To develop effective physical activity policies in these and other areas, greater understanding of how and why policies successfully impact behavior change is needed.

Methods:

The current paper proposes a conceptual framework explaining how policy strategies map onto health behavior theoretical variables and processes thought to lead to physical activity change. This framework is used to make hypotheses about the potential effectiveness of different policy strategies.

Results:

Health behavior theories suggest that policies providing information may be particularly useful for individuals who are not yet considering or have only recently begun to consider becoming more physically active. Policies that provide opportunities may be less effective for individuals who do not find physical activity to be inherently fun and interesting. Policies that offer incentives or require the behavior may not be particularly useful at promoting long-term changes in physical activity.

Conclusion:

Exploring possible connections between policy strategies and theoretical constructs can help to clarify how each approach might work and for whom it may be the most appropriate to implement.

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Ronald B. Mitchell, Todd Crosset and Carol A. Barr

Popular and academic discourse typically analyze the strategies used to induce compliance with sport association policies and rules within a framework that shoehorns a diverse array of strategies into two categories: sanctions or compensation, This article proposes a taxonomy that goes beyond the “logic of consequences” inherent in the behavioral models of sanctions and compensation. Sport managers and scholars can encourage compliance through six ideal-type strategies: punitive, remunerative, generative, preventive, cognitive, and normative. These six categories provide the foundation for systematically evaluating the relative effectiveness of different strategies at altering the behavior of league members. This article delineates the different paths by which these different policy strategies influence behavior. Five questions designed to guide managers in the selection of strategies are offered. Although the National Collegiate Athletic Association is used as a case example throughout, the framework has applicability to all sport associations.

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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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Lisbeth Runge Larsen, Jens Troelsen, Kasper Lund Kirkegaard, Søren Riiskjær, Rikke Krølner, Lars Østergaard, Peter Lund Kristensen, Niels Christian Møller, Bjørn Friis Neerfeldt Christensen, Jens-Ole Jensen, Charlotte Østergård and Thomas Skovgaard

Background:

The first Danish Report Card on Physical Activity (PA) for Children and Youth describes Denmark’s efforts in promoting and facilitating PA and PA opportunities for children and youth.

Methods:

The report card relies primarily on a synthesis of the best available research and policy strategies identified by the Report Card Research Committee consisting of a wide presentation of researchers and experts within PA health behaviors and policy development. The work was coordinated by Research and Innovation Centre for Human Movement and Learning situated at the University of Southern Denmark and the University College Lillebaelt. Nine PA indicators were graded using the Active Healthy Kids Canada Report Card development process.

Results:

Grades from A (highest) to F (lowest) varied in Denmark as follows: 1) Overall Physical Activity (D+), 2) Organized Sport Participation (A), 3) Active Play (INC; incomplete), 4) Active Transportation (B), 5) Sedentary Behaviors (INC), 6) Family and Peers (INC), 7) School (B), 8) Community and the Built Environment (B+), and 9) Government strategies and investments (A-).

Conclusions:

A large proportion of children in Denmark do not meet the recommendations for PA despite the favorable investments and intensions from the government to create good facilities and promote PA.

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Richard Tyler, Marianne Mannello, Rebecca Mattingley, Chris Roberts, Robert Sage, Suzan R Taylor, Malcolm Ward, Simon Williams and Gareth Stratton

Background:

This is the second Active Healthy Kids Wales Report Card. The 2016 version consolidates and translates research related to physical activity (PA) among children and youth in Wales, and aims to raise the awareness of children’s engagement in PA and sedentary behaviors.

Methods:

Ten PA indicators were graded using the Active Healthy Kids—Canada Report Card methodology involving a synthesis and expert consensus of the best available evidence.

Results:

Grades were assigned as follows: Overall PA, D+; Organized Sport Participation, C; Active and Outdoor Play, C; Active Transportation, C; Sedentary Behaviors, D-; Physical Literacy, INC; Family and Peer Influences, D+; School, B; Community and the Built Environment, C; and National Government Policy, Strategies, and Investments, B-.

Conclusions:

Despite the existence of sound policies, programs, and infrastructure, PA levels of children and youth in Wales are one of the lowest and sedentary behavior one of the highest globally. From the 2014 Report Card, the Family and Peer Influences grade improved from D to D+, whereas Community and the Built Environment dropped from B to C. These results indicate that a concerted effort is required to increase PA and decrease sedentary time in children and young people in Wales.

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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.

Open access

Mohamed G. Al-Kuwari, Izzeldin A. Ibrahim, Eiman M. Al Hammadi and John J. Reilly

Background:

The first Qatar Active Healthy Kids (QAHK) Report Card was developed in 2015–2016. It is a synthesis of the available evidence on physical activity in children and youth in the state of Qatar—an assessment of the state of the nation. The report card is important for future physical activity advocacy, policy, and program development.

Methods:

The QAHK Report Card was inspired by the Active Healthy Kids Scotland 2013 Report Card. The methodology used in Scotland’s report card was adapted for Qatar. A Working Group identified indicators for physical activity and related health behaviors, and evaluated the available data on these indicators. The card grades were determined by the percentage of children meeting guidelines or recommendations.

Results:

The 2016 QAHK Report Card consisted of 9 indicators: 6 Physical Activity and Health Behaviors and Outcomes, and 3 Settings and Influences on these health behaviors and outcomes. The indicator National Policy, Strategy, and Investment was assigned the highest grade (B). Four indicators were assigned D grades: Sedentary Behavior, Dietary Habits, Organized Sports Participation, and Family and Peer Influence. Physical Activity and Obesity were both graded F. Two indicators could not be graded due to insufficient data and/or absence of a recommendation: Active and Outdoor Play, and Community and School Influence.

Conclusions:

The QAHK Report Card identified weaknesses and gaps in the evidence on physical activity and health in children and youth in Qatar. The quality of evidence was poor for some indicators, with some data collection methods of limited validity and reliability, or only available for a limited age range, so the grades are best estimates of the current situation in Qatar. Future surveys and research using objective physical activity measures will support the development of a second QAHK Report Card by 2018.

Open access

Monika Uys, Susan Bassett, Catherine E. Draper, Lisa Micklesfield, Andries Monyeki, Anniza de Villiers, Estelle V. Lambert and the HAKSA 2016 Writing Group

Background:

We present results of the 2016 Healthy Active Kids South Africa (HAKSA) Report Card on the current status of physical activity (PA) and nutrition in South African youth. The context in which we interpret the findings is that participation in PA is a fundamental human right, along with the right to “attainment of the highest standard of health.”

Methods:

The HAKSA 2016 Writing Group was comprised of 33 authorities in physical education, exercise science, nutrition, public health, and journalism. The search strategy was based on peer-reviewed manuscripts, dissertations, and ‘gray’ literature. The core PA indicators are Overall Physical Activity Level; Organized Sport Participation; Active and Outdoor Play; Active Transportation; Sedentary Behaviors; Family and Peer Influences; School; Community and the Built Environment; and National Government Policy, Strategies, and Investment. In addition, we reported on Physical Fitness and Motor Proficiency separately. We also reported on nutrition indicators including Overweight and Under-nutrition along with certain key behaviors such as Fruit and Vegetable Intake, and policies and programs including School Nutrition Programs and Tuck Shops. Data were extracted and grades assigned after consensus was reached. Grades were assigned to each indicator ranging from an A, succeeding with a large majority of children and youth (81% to 100%); B, succeeding with well over half of children and youth (61% to 80%); C, succeeding with about half of children and youth (41% to 60%); D, succeeding with less than half but some children and youth (21% to 40%); and F, succeeding with very few children and youth (0% to 20%); INC is inconclusive.

Results:

Overall PA levels received a C grade, as we are succeeding with more than 50% of children meeting recommendations. Organized Sports Participation also received a C, and Government Policies remain promising, receiving a B. Screen time and sedentary behavior were a major concern. Under- and over-weight were highlighted and, as overweight is on the rise, received a D grade.

Conclusions:

In particular, issues of food security, obesogenic environments, and access to activity-supportive environments should guide social mobilization downstream and policy upstream. There is an urgent need for practice-based evidence based on evaluation of existing, scaled up interventions.