7th International Society for Physical Activity and Health Congress

doi:10.1123/jpah.2018-0535

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7th International Society for Physical Activity and Health Congress

in Journal of Physical Activity and Health

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DOI:: https://doi.org/10.1123/jpah.2018-0535

In Print:: Volume 15: Issue s1

Page Range:: S1–S249

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London, England

15–17 October 2018

Contents
Symposia: Monday 15 October	S1
Symposia: Tuesday 16 October	S9
Parallel Oral Sessions: Monday 15 October		S16
Parallel Oral Sessions: Tuesday 16 October		S42
Parallel Oral Sessions: Wednesday 17 October		S67
Oral ePosters		S91
ePosters		S169

7^th ISPAH Congress Committees

Organising Committee

Co-Chairs

Dr Michael Brannan, National Lead for Physical Activity, Public Health England

Dr Karen Milton, Lecturer in Public Health, University of East Anglia

Sarah Ruane, Strategic Lead—Health, Sport England

Members

Beelin Baxter, Senior Policy Manager, Department of Health and Social Care

Dr Nick Cavill, Director, Cavill Associates

Anna Chalkley, Postdoctoral Researcher, Loughborough University

Nick Clarke, Physical Activity Programme Manager, Public Health England

Dr Catherine Draper, Senior Research, University of the Witwatersrand

Suzie Gittus, Senior Programme and Relationship Manager, Tackling Inactivity, Sport England

Dr Sjaan Gomersall, Lecturer in Physiotherapy, The University of Queensland

Dr Steve Harris, NCSEM Programme manager, Loughborough University

Dr Sonja Kahlmeier, Senior Researcher, Head of Unit, University of Zurich

Jacqueline Mair, Lecturer, Edinburgh Napier University

Professor Marie Murphy, Dean of Postgraduate Research and Director of the Ulster University Doctoral College, Ulster University

Anushka Naidoo, Communications Officer, Public Health England

Zjan Shirinian, Head of Editorial and Content, Sport England

Rachel Weeden, 7th ISPAH Congress Manager, Public Health England

Scientific Advisory Committee

Co-Chairs

Dr Charlie Foster, Reader in Physical Activity and Public Health; Director of MPhil/PhD Research; UK Chief Medical Officers Expert Committee for Physical Activity, University of Bristol; President 2017-2018, International Society for Physical Activity and Health

Andrew Spiers, Strategic Lead—Data and Market Innovation, Sport England

Members

Dr Nana Anoke, Director of Research, Department of Clinical Sciences, Brunel University London

Dr Laurence Carmichael, WHO Collaborating Centre for Healthy Urban Environments, University of the West of England

Nick Clarke, Physical Activity Programme Manager, Public Health England

Professor Robert Copeland, Director, National Centre for Sport and Exercise Medicine, Sheffield Hallam University

Professor Diane Crone, Professor of Exercise Science, University of Gloucestershire

Professor Joan L Duda, Professor of Sport and Exercise Psychology, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham

Dr Benjamin Gardner, Senior Lecturer, King’s College London

Professor Mark Hamer, Professor of Exercise as Medicine, Loughborough University

Dr Melvyn Hillsdon, Associate Professor, University of Exeter

Dr Ruth Hunter, Lecturer, Queen’s University Belfast

Professor Russ Jago, Professor of Paediatric Physical Activity and Public Health, University of Bristol

Professor Tess Kay, Dean of Research, Brunel University London

Professor Mark Lewis, Professor of Musculoskeletal Biology and Dean The School of Sport, Exercise and Health Sciences, Loughborough University

Dr Jacqueline Mair, Lecturer, Edinburgh Napier University

Dr Karen Milton, Lecturer in Public Health, University of East Anglia.

Marie Murphy, Dean of Postgraduate Research; Director Ulster University Doctoral College, Ulster University

Dr Niamh Murphy, Lecturer and Researcher, Waterford Institute of Technology

Professor Nanette Mutrie, Chair in Physical Activity for Health; Director of PAHRC, University of Edinburgh

Professor Harry Rutter, Professor of Global Public Health, University of Bath

Professor Brett Smith, Head of Research, University of Birmingham

Dr Afroditi Stathi, Reader in Active Ageing Promotion, University of Birmingham, United Kingdom

Professor Gareth Stratton, Deputy Pro-Vice Chancellor Physical Activity, Sport, Health and Well Being; Deputy Head of College; Head of School Sport and Exercise Sciences, Swansea University

Rachel Weeden, 7th ISPAH Congress Manager, Public Health England

Dr Katrien Wijndaele, Senior Investigator Scientist, MRC Epidemiology Unit, University of Cambridge

Symposia: Monday 15 October

Session: Acting locally to promote activity-friendly environments globally: Leveraging citizen science to foster health equity

Utilising the Our Voice citizen science model to support and promote active environments at schools and universities in Colombia, New Zealand, South Africa, and the USA

Erica Hinckson¹, Margaret Schneider², Olga Sarmiento³, Estelle Lambert⁴, Camilo Triana³, Ann Banchoff⁵, Sandra Winter⁵, Abby King⁵

¹Aukland University of Technology ²University of California, ³Universidad de los Andes, ⁴University of Cape Town, ⁵Stanford University

Introduction: Evidence worldwide suggests that the built environment must be reshaped to improve and sustain engagement in physical activity across communities to secure associated health benefits. Our Voice, an evidence-based community participatory approach, was used to directly engage school staff and students as “citizen scientists” in assessing their physical activity and food environments.

Methods: Through the Our Voice process of Discovery, Discussion, Activation and Change, citizen scientists analyse their own data, create realistic action plans, and engage with local stakeholders to advance activity-supportive changes in their educational environments. To enable useful, standardized data collection, citizen scientists used a simple GPS-enabled mobile app capable of collecting geocoded visual and auditory data about walking routes and relevant environmental features.

Results: The Our Voice framework is being utilised in educational settings in four international regions: Bogotá Colombia, Auckland, New Zealand, Cape Town, South Africa, and Irvine and Santa Clara County, CA, USA. Each citizen scientist used the mobile app to identify environmental features that hindered or facilitated physical activity and food environments, or that influenced choice of stairs versus elevators. In group discussions, citizen scientists reviewed their collected data, prioritized issues, and generated practical solutions with relevant stakeholders. Major qualitative and quantitative data from each project will be presented.

Conclusion: These Our Voice projects have been successful in generating direct student, parent, staff, and stakeholder engagement in developing realistic environmental and policy solutions in differing school contexts and populations.

External funding details: Robert Wood Johnson Foundation Grant-ID#73344

Employing the Our Voice citizen science model to support age- and activity-friendly communities in Chile, Brazil, Canada, England, and USA

Afroditi Stathi¹, Nicolas Aguilar-Farias², Michelle Porter³, Diane King⁴, Ann W Banchoff⁵, Sandra J Winter⁵, Abby C King⁶

¹University of Bath, ²Departamento de Educación Física, Deportes y Recreación, Universidad de La Frontera, ³University of Manitoba, ⁴Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska, ⁵Stanford Prevention Research Center, Stanford University, ⁶School of Medicine, Stanford University

Introduction: Engaging older people as citizen scientists may empower them to become agents of change and improve the age- and activity-friendly features of their communities.

Methods: The four principles of the Our Voice model--Discover, Discuss, Evaluate, Change--guided the design of citizen science projects in four countries. These programmes employed a range of objective (accelerometers, GIS and GPS systems) and subjective (quality of life, built and natural environment evaluation) data collection methods. The innovative mobile application, the Stanford Healthy Neighborhood Discovery Tool, which enables citizens to document local environmental features through geo-referenced photographs, audio narratives and walking routes, was employed in each project.

Results: All projects recruited older people in a wide range of settings, including towns, cities, and university campuses. They were actively involved in discovering environmental features influencing active ageing in their communities, analysing their collected data, and discussing their research findings. This approach led to an in-depth evaluation of how age-friendly their communities are and in some cases initiated active collaborations with key policy makers and service providers to introduce changes in their local environments which could enhance their age- and activity-friendly profile. Key qualitative and quantitative data from each project will be summarised and presented.

Conclusion: Employing the Our Voice model in community-level initiatives worldwide through engaging older people as citizen scientists to advance relevant data collection and local advocacy is a promising strategy for supporting communities in becoming more age- and activity- friendly.

External funding details: Robert Wood Johnson Foundation Grant - ID#73344

Acting locally while thinking globally to promote physical activity, address inequalities and achieve population change

Sandra Winter¹, Lisa Rosas², Matthew Buman³, Jylana Sheats⁴, Deborah Salvo⁵, Randi Garber⁶, Olga Lucia Sarmiento⁷, Bonnie Broderick⁸, Ann Banchoff², Abby King²

¹SPRC, ²Stanford University, ³Arizona State University, ⁴Tulane University, ⁵University of Texas, Texas Medical Center, ⁶JDC Israel Eshel, ⁷Universidad de los Andes, ⁸Santa Clara County Public Health Department

Acting locally while thinking globally facilitates the application of lessons learned from a variety of settings to address inequalities and achieve population change. The Our Voice (OV) Global Network fosters the implementation and dissemination of evidence-based approaches to promote physical activity (PA) by expanding the reach of community-engaged research and optimizing its impacts. OV Network members work collaboratively with community resident “citizen scientists” who use a simple mobile app (the Discovery Tool) to document aspects of their community that impact PA; meet with other citizen scientists to discuss their findings and agree on priorities for action; present their data to local decision-makers; and advocate for positive changes in local environments. This presentation will highlight OV Global Network projects that target improvement of neighborhood environments to better support PA. USA projects include inter-generational groups of Latino residents working to increase neighborhood walkability; efforts to promote park access and usage in under-resourced areas; African-American women conducting walkability assessments across multiple urban areas to inform community improvement plans; and open-street evaluations. The Discovery Tool has been translated into 7 languages and the OV model has been adapted for use in Chile, Colombia, Israel, South Africa, Taiwan, China, Mexico, Brazil, Australia, New Zealand, Canada, and the U.K. The Network is committed to building a scientific road map; identifying and sharing measurement tools to track impact; coordinating cross-site comparisons; and generating, refining, and disseminating best practices. Network processes and outcomes will be reviewed.

External funding details: Robert Wood Johnson Foundation Grant-ID#73344

Session: Adapted, adaptive and adapting physical activity

Higher education in Europe on ‘adapted, adaptive and adapting physical activity’

Aija Klavina, Latvian Academy of Sport Education

While Physical Education is a compulsory part of education in most European countries, there is high variability across Europe in amount of allocated teaching hours for PE, the approach to curricula, and the competencies of PE teachers. While students with disabilities are included in general education settings with growing frequency across Europe, there is a lack of guidelines related to functions, knowledge, and skills for APE professionals who work with school-aged students with SEN.

Two large-scale European projects were implemented during the last decade that defined the APA in higher education in Europe. The Thematic European Network on Adapted Physical Activity involved more than 30 experts from 28 EU countries, while the European Standards in APA (EUSAPA) project (2008-2010) involved more than 20 APA experts from 10 EU countries.

Two international study programs in Europe offer specializations in APA. The first is the International Master in Adapted Physical Activity (IMAPA), a two-year Master’s program (120 credits) offered jointly by the organizing universities and associate partners. The IMAPA aims to educate students for both professional careers and in a specialized discipline. The second international program, the European University Degree in Adapted Physical Activity (EUDAPA), is located at the Haaga-Helia University of Applied Sciences (Finland).

The development of a global policy implementation framework (G-PIF) to support UNESCO’s International Charter of Physical Education, Physical Activity and Sport (2015).

Niamh Elizabeth Mourton, UNESCO Chair in Inclusive PE Sport Recreation and Fitness, Institute of technology, Tralee

UNESCO’s Charter (2015) engages in a comprehensive manner the need to explore the arena of physical education, physical activity and sport (PEPAS) more fully and inclusively. Literature suggests that in totality, there has been very little analysis of policy in this field and much of this research regarding this especially relates to doping, harassment and violence (Houlihan, 2005). Furthermore, the specific mention of disability and inclusion in policies related to PEPAS is very limited.

To ensure global coverage and a magnitude of relevant data generated across a range of sources, we proposed a multi-method and pluralistic qualitative approach to data collection and analysis for this study. This paper presents the core aims of this research around reviewing the main policy monitoring parameters: legislation, national policy strategies and plans, with focus on input, output, outcome and indicators, self-evaluation and other assessment tools/initiatives; in particular with reference to people with disabilities and/or the inclusion of people with disabilities. The research focus on the views of those involved at a policy and practitioners level within the field of PEPAS will also be discussed. These views are inclusive of policy to practise (and vice versa), as well as views on the actual implementation of the UNESCO Charter (2015). It will also highlight the development of a policy implementation framework for policy makers and practitioners to help bridge the perceived gap between policy and practice in this field.

Protocol for converting physical activity surveys for children with special needs

Kwok Ng¹, Niko Leppä², Piritta Asunta², Pauli Rintala²

¹University of Limerick, ²University of Jyvaskyla

National self-report physical activity and health surveys have been informing health promotion practices, public health policies and driving interventions for several decades. Until recently, the majority of surveys excluded children with disabilities and according to the UN convention on the rights of persons with disabilities, such actions breaches those rights (Article 31). It can be challenging to create a universal study design that enables all children to take part. Hence, a set of transformative procedures are needed to allow all children to participate in such important studies.

Several existing survey packages (Health Behaviour in School-aged Children – HBSC; Finnish School-aged Physical Activity (SPA) study; Washington Group and UNICEF Child Functioning Module) were combined and adapted for use amongst children with disabilities. Two rounds of pre-pilot testing as well as a larger pilot study were conducted.

The survey packages were refined (HBSC – 121 questions, SPA – 60 questions; 29 items overlapped). In pre-test 1, 19 pupils (11-15 y old) from a special school answered the questions without complications, but the survey was took too much time. A panel met select 40 questions and was tested on 5 different pupils (14 y old). The time it took to complete the questionnaire ranged between 15-30 minutes. The pilot test included visual images.

Creating modifications of self-reported surveys for children with disabilities was an important step towards a universal design that gives the possibility for all children to take part in surveys. There are differences in to take in account when creating the modifications.

External funding details: Ministry of Education, Finland

Research ‘with’ not ‘on’: Using participatory research to explore sport and physical activity with young people who have Learning Disabilities

Janine Coates, Peter Harrison Centre for Disability Sport, Loughborough University

Children and young people with learning disabilities are underrepresented in research relating to sport and exercise. This, in part, is due to the perceived difficulties of including this population in research using traditional methods of data collection, leading to the experiences of these children and young people being recounted by those who support and care for them (parents, teachers, etc) rather than the young people themselves. Innovative research methods, such as participatory research, presents an opportunity to engage young people with a range of support needs to engage meaningfully in research. This paper presents reflections from one such piece of research. Adopting the Mosaic Approach (Clark & Moss, 2011), the study engaged five young people, aged 17-19 years of age, at a special school in England in a co-produced piece of research developed over an eight week period. This paper will consider the importance of direct consultation with young people with learning disabilities in the development of research questions and methods. It will also highlight some of the barriers to inclusive sport outside of school and consider the role of schools and families in supporting physical activity participation for children and young people with complex needs.

Adaptation of the NETFIT^® to children with intellectual disabilities and other declared psychological developmental disorders

Anita Kir ly, Mónika Kaj, Katalin Kälbli, Tamás Csányi, Hungarian School Sport Federation

Introduction: From the school year 2014/2015, implementation of the Hungarian National Student Fitness Test (NETFIT^®) was mandatory in all schools in Hungary. It was developed to examine the health-related fitness of typically developing children (TDC). The application of the battery was difficult for students with special educational needs (SEN). The purpose of this nationally representative research (on students with mild intellectual disability (MID) and other declared psychological developmental disorders (ODD)) was to evaluate the applicability and reliability of the NETFIT^® test in the given population.

Methods: 10-18 year-old children with MID (N = 429) and ODD (N = 440) were investigated, with no other disabilities, cardiovascular problems affecting motor activity or orthopedic lesions. NETFIT^® was assessed and the healthy fitness zone (HFZ) achievement rates were compared for TDC, children with MID and ODD. The correlation between the results and IQ was analyzed.

Results: Both students with MID and ODD had lower levels of HFZ achievement rates than TDC based on the existing health standards for the musculoskeletal fitness tests. The percentile ranks of the standards in musculoskeletal test were on average 20 percentile lower than those measured for the TDC. The results show a significant negative correlation between the standing broad jump test and IQ, for children with MID (r = −0.213, p < 0,05).

Conclusion: Based on the experience of the study it can be stated, that the adaptation and revision of the standards was necessary to realistically evaluate the fitness status of children with SEN and therefore establish a health-related fitness assessment for this population.

Session: Are all METs the same? The role of posture, intensity, time-pattern, domain and measurement of physical activity for health

How important is the intensity of physical activity for population health gains?

Emmanuel Stamatakis, University of Sydney

Despite the increasing public health focus on the lower end of the physical activity spectrum there has been a resurgent scientific and general public interest on higher intensities. Self-reported epidemiological literature has paid relatively little attention to the role of intensity when total activity volume is held constant. Further, self-reported measures of intensity has been a limiting factor because of the inability of such measures to capture potentially health enhancing short and sporadic higher intensity bouts. Questionnaires rarely capture incidental higher exertion activities such as stair climbing. Advanced measurement technologies employing motion sensors that are already implemented in large cohort studies allow both objective characterisation of short bouts of any activity intensity and pattern recognition. Grounded on past, recent, and current epidemiological studies, this presentation will discuss physical activity intensity in relation to population health outcomes. The differential role of intensity in the occupational and recreational domains will also be explored.

Posture versus movement: Can we stand it? Or should we be sitting?

Pieter Coenen, VU University Medical Center

There is a growing body of evidence suggesting that exposure to excessive sitting is associated with a number of chronic diseases. As a result of this, office workers have recently been encouraged to replace sitting with standing during their work day. There is a general perception that metabolic equivalents are the main driver of physical activity related health effects. According to this notion of “the more, the healthier” one would indeed expect health benefits from replacing sitting with standing.

On the other hand, however, there is evidence showing excessive standing to be associated with several adverse health outcomes. Based on this evidence, standing has been recognised as an occupational hazard, and workers exposed to excessive standing have for example been provided perching stools at their workplaces.

As a result, it remains unclear whether sitting should be replaced with standing, and if so, to what extent. Moreover, it is imaginable that this differs between occupational groups. For example, for office workers who sit during the majority of their work time, standing seems a reasonable intervention for health improvement. However, for workers in service sector who stand a lot at work, standing can impair cardiovascular and musculoskeletal health. These complex and seemingly contradictory phenomena impede our ability to communicate clear messages to the public. An overview of the evidence on health outcomes associated with sitting, standing and variation between sitting and standing will be provided. Here, a clear distinction between posture and movement will be made.

Can the daily time-pattern differentiate the health effects of physical activity?

David Hallman¹, Andreas Holtermann²

¹University of Gävle, ²National Research Centre for the Working Environment

Abundant research demonstrates beneficial effects of sufficient levels of physical activity (PA) on health. However, the time-pattern of PA is rarely taken into account in epidemiological research. The time-pattern of PA can be defined as the temporal variation of physical activities (e.g. walking and running) and postures (e.g. sitting and standing). Studies show that more variation in PA is beneficial for health, while insufficient variation may be detrimental. For instance, it is well established in exercise science that variation in type and intensity of PA is a key to optimal effects on performance and health. In contrast, performing the same PAs over and over again can result in poor recovery and eventually to overload and injury. Experimental studies on sedentary behavior and health have demonstrated that interruptions in prolonged sitting by intermittent bouts of standing or walking have favorable effects on cardio metabolic biomarkers, even with marginal increase in total energy expenditure. Also, observational studies have shown that associations with musculoskeletal and obesity outcomes depend on whether sitting time is accumulated in shorted or longer periods. Thus, the time-pattern of PA is likely to be of importance to health irrespective of changes in total energy expenditure. As the development of technical devices makes it feasible to collect accurate and precise data of the time-line of PA even in large cohorts, there are immense opportunities for epidemiological studies to investigate the extent to which different time-patterns of PA can influence health.

Why does occupational physical activity not provide same health benefits as leisure?

Andreas Holtermann, National Research Centre for the Working Environment

Moderate to vigorous physical activity (PA) is well documented to be beneficial for health. However, this documentation is mainly restricted to leisure time physical activity (LTPA; e.g. sports, recreation, transportation and exercise).

For a considerable fraction of the adult population, work constitutes the main setting for PA. This mainly applies for disadvantaged socioeconomic groups being physically active for large parts of their working days, such as construction, cleaning, elderly care and manufacturing.

Despite of being physically active for several hours 5 days per week at work, these workers have relatively poor health and fitness. This indicates that occupational PA (OPA) does not provide the same health benefits as LTPA, termed the PA health paradox. Increasing evidence actually supports that high levels of OPA can be detrimental for health, even after extensive adjustments for other risk factors and socioeconomic status.

However, the potential mechanisms behind the PA health paradox remain to be established. The different typical characteristics of OPA and LTPA can be potential causes to the PA health paradox. For example, LTPA often includes dynamic movements at intensity levels sufficient to improve cardiorespiratory and muscular fitness, and is mostly performed voluntarily over short time periods with enough recovery time. In contrast, work often constitutes static loading, heavy lifting and awkward working postures at intensities not improving fitness over very long periods with insufficient recovery time.

An improved understanding of the mechanisms behind the PA health paradox can be an important step for reduction of the large socioeconomic health inequalities.

Objective measurements of physical activity in the Norwegian HUNT Study

Paul Jarle Mork, Norwegian University of Science and Technology

The fourth round of The Nord-Tréndelag Health Study (HUNT4) started in September 2017 and will include one week of objective measurement of physical activity (PA) in about 40,000 adults (≥20 years) and 10,000 adolescents (13-19 years). PA is measured by small, lightweight tri-axial accelerometers placed at the lower back and on the front of the thigh. Heart rate (HR) is recorded with a chest-band in a random sub-sample. Vocationally active participants report daily work hours in a diary along with the PA and HR measurements. A validation study has been carried out to develop a machine-learning model for classification of PA types, such as sitting, standing, shuffling, walking, running and cycling. The sensor set up also allow the identification of transition time between postures (e.g., sit-to-stand) as well as identification of body movements and postures while lying down (prone, supine and on right/left side). An ongoing validation study is investigating if nocturnal body movements and/or changes in body position can be used to identify the sleep-wake cycle as recorded by polysomnography. The objective measurements of physical activity in HUNT4 will make it possible to address some of the questions currently debated, such as the influence of PA intensity, posture (e.g. sitting vs. standing), time-pattern, and domain of PA (work vs. leisure) on health outcomes. This presentation will i) describe lessons learned from the planning and implementation of PA recording in the HUNT Study, and ii) discuss some of the future perspectives for research based on the HUNT data.

Session: Evidence on effectiveness and feasibility of physical activity in the school setting: Bridging the gap between evidence and practice

Effects of physical activity interventions on cognitive and academic performance in children and adolescents: A systematic review

Amika Singh¹, Emi Saliasi¹, Vera van den Berg¹, Leonie Uijtdewilligen², Renate de Groot³, Jelle Jolles⁴, Mai Chinapaw¹

¹VU University Medical Center, ²Saw Swee Hock School of Public Health, ³Open University of the Netherlands, ⁴VU University

Objective: To summarize the current evidence on the effects of physical activity (PA) interventions on cognitive and academic performance in children.

Design: Systematic review (following PRISMA guidelines) with a methodological quality assessment. We based the evaluation of the consistency of the scientific evidence on the findings reported in studies rated as of high methodological quality.

Data sources: PubMed, PsycINFO, Cochrane Central, Web of Science, ERIC, and SPORTDiscus. Eligibility criteria for selecting studies: PA-intervention studies in children with at least one cognitive or academic performance assessment.

Results: Eleven (19%) of 58 included intervention studies received a high quality rating for methodological quality: four assessing effects of PA interventions on cognitive performance, six assessing effects on academic performance, and one on both. All high quality studies contrasted the effects of additional/adapted PA activities with regular curriculum activities. For cognitive performance ten of 21 (48%) constructs analysed showed significant beneficial intervention effects of PA, while for academic performance, 15 of 25 (60%) analyses of the high quality studies found a significant beneficial effect of PA. Across all five studies, assessing PA effects on math, beneficial effects were reported in six out of seven (86%) outcomes.

Conclusion: There is currently inconclusive evidence for beneficial effects of PA interventions on cognitive and overall academic performance in children. We conclude that there is strong evidence for beneficial effects of PA on math performance.

External funding details: The Netherlands Organisation for Scientific Research (NWO)

A systematic review of acute physically active learning and classroom movement breaks on children’s physical activity, cognition, academic performance and classroom behaviour; understanding critical design features.

Andy Daly-Smith¹, Stephen Zwolinsky¹, Jim McKenna¹, Phillip Tomporowski², Margaret Defeyter³, Andrew Manley¹

¹Leeds Beckett University, ²University of Georgia, ³Northumbria University

Introduction: to examine the impact of acute classroom movement breaks (CMB) and physically activity learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour.

Method: Systematic review, PROSPERO number CRD42017070981. Data sources: PubMed, EBSCO, Academic Search Complete, ERIC, Psychinfo, SPORTDiscus, SCOPUS and Web of Science. Eligibility criteria for selecting studies: studies investigating school-based acute bouts of CMB or PAL on PA, cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias.

Results: Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or MVPA dependant on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 mins), or shorter more intense (5 mins), CMB/ PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies.

Conclusion: Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time-on-task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies.

Does exercise during the school day boost children’s attention and memory?

Trish Gorely¹, Josie Booth², Naomi Brooks³, Ross Chesham³, Colin Moran³

¹University of the Highlands and Islands, ²University of Edinburgh, ³University of Stirling

Introduction: Short physical activity (PA) breaks may have a positive effect on cognition in children but the optimum intensity is unknown. The purpose was to explore the impact of PA at two intensities on affect and cognition.

Method: Primary school classes/groups (n = 503) volunteered as part of the BBC Terrific Scientific scheme. Participants completed short breaks from the classroom in three conditions: self-paced PA for 15 mins (SPA); maximal effort running task (bleep test (BT)); and, no exercise (control). Conditions were completed on different days and in any order. Before and after each condition participants completed the Children’s Feeling Scale and Felt Arousal Scale, plus computer-based tasks assessing attention/inhibition, visual-spatial working memory and verbal working memory.

Results: Over 7,300 children (10.2 ± 0.7 years; 50% female) provided information on at least one key measurement, and 1040–1212 provided data across all conditions. Compared to the control condition, children: (1) felt more awake after doing either exercise condition, but most awake after SPA; (2) felt better after SPA; (3) responded quicker to the attention task after SPA; (4) were better at controlling their responses after both SPA and BT; and (5) were better at remembering words in sentences after SPA (all ANOVA p < 0.001). Overall effect sizes were small (0.06-0.21 SD).

Conclusion: For most tasks, participating in SPA was more beneficial than BT.; BT was mostly no different from the control activity. Children should be encouraged to exercise at their own pace during short breaks from class.

External funding details: University of Edinburgh, Physiological Society

Frequency, mode or duration? An overview of 3 experimental studies on acute effects of PA breaks in the school setting

Vera van den Berg¹, Emi Saliasi¹, Renate de Groot², Jelle Jolles³, Mai Chinapaw¹, Amika Singh¹

¹VU University Medical Center, ²Open University of the Netherlands, ³VU University

Purpose: Recent studies indicate that a single bout of physical activity (PA) can have immediate positive effects on children’s cognitive performance. However, the specific PA features that benefit cognition most are largely unknown.

Methods: In three separate experimental studies, we examined the acute effects of 1) three types of 12-minute classroom-based exercise (i.e. aerobic, coordination and strength), 2) three durations of moderate to vigorous exercise (10, 20 and 30 minutes) and 3) two frequencies (1x20 or 2x20 minutes) of PA bouts. We examined effects on performance across three cognitive domains: selective attention, using the d2, test of everyday attention for children (TEA-Ch) and the Attention Network Test (ANT), information processing speed using the Letter Digit Substitution Test and working memory using the n-back. Statistical models included repeated measures ANOVA and generalized estimating equation models.

Results: There was no effect of light to moderate PA on cognitive performance and this effect was not modulated by PA type. Exercising at moderate to vigorous intensity, for either 10, 20 or 30 minutes, resulted in a slight improvement in performance on the ANT. Children who performed two 20 minute bouts of moderate-intensity PA had significantly better scores on the TEA-ch test compared to children who performed one PA bout or remained seated.

Conclusions: Our findings suggest that PA type or duration does not differentially affect cognitive performance in children. Exercising for a minimum of 10 minutes at moderate to vigorous intensity was found to improve selective attention.

External funding details: The Netherlands Organisation for Scientific Research (NWO)

Acute effects of active learning on academic performance in primary school children: A randomised control trial

Andy Daly-Smith, Jim McKenna, Stephen Zwolinsky, Andrew Manley, Leeds Beckett University

Purpose: To investigate the acute effects of a physically-active lesson (PAL) on moderate-to-vigorous physical activity (MVPA) and academic performance (AP) in primary school children.

Methods: Ninety-eight pupils from Year 2 (N = 43; Mage = 6.7 ± 0.30 yrs; nGirls = 23) and Year 5 (N = 55; Mage = 9.7 ± 0.32 yrs; nGirls = 20) were recruited. Following familiarisation, pupils were randomly allocated to a 45-minute PAL (n = 50) or standard classroom lesson (SCL, n = 48). One week post familiarisation, immediately before, and 10-mins after each lesson, pupils completed the Maths Addition and Subtraction, Speed and Accuracy Test (MASSAT) and Wide Range Achievement Test (WRAT4, Year 5 only). MVPA data was measured in 15-second epochs using accelerometers and Evenson cutpoints. A two-way ANOVA with repeated measures assessed changes in academic outcomes; MASSAT processing score (PS: total correct answers – total incorrect answers), WRAT4 Total Score (TS- total correct answers).

Results: Eighty-seven participants (nPAL = 42, nSCL = 45) completed assessments. Significantly more MVPA was accumulated in PALs (10.09 ± 4.09 mins, range 4.75 mins to 22.25 mins) compared to SCL (0.97 ± 1.00 mins; p = 0.001). Thirteen pupils (31%) achieved ≥12 mins MVPA in PALs. No significant interaction effects were observed in PALs compared to SCLs for either MASSAT-PS (p = 0.085) or WRAT4-TS (p = 0.519). Although non-significant, greater, improvements in MASSAT-PS scores were observed for PAL ≥ 12 (2.62 ± 4.14) compared SCL (-0.36 ± 5.58; p = 0.084, Partial Eta = 0.052).

Conclusion: PAL led to substantial increases in MVPA with no significant change in AP. PAL resulted in a large variation of MVPA accumulation at the individual level. Aligned with previous literature, higher levels of MVPA in the PALs may lead to higher AP.

Session: Physical activity promotion in health care settings: Recent developments in Europe

Life style counselling for the health care and the social sector

Eva Martin-Diener¹, Tommi Vasankari²

¹University of Zurich, ²UKK Institute for Health Promotion Research, Tampere

In Finland one of the Government’s key projects focuses on lifestyle counseling (physical activity, diet and sleep) for the health care and the social sector (VESOTE project). The project operates in 11 of the 19 hospital districts in Finland. The aim of the project is to create a new form of lifestyle counseling in Finnish health care.

The key components of the project are:

•Commitment from directors of hospital districts, towns, the third sector, etc
•Strong multisectoral collaboration from health care to cities / third sector / private sector
•eLectures and webinars on lifestyle counseling
•Virtual lifestyle policlinic to every hospital district
•Creation of patient “paths” from specialised hospitals to third sector
•Measuring lifestyle factors objectively (physical activity, sedentary behaviour, sleep)
•Interactive accelerometer + smart phone application + cloud (personal goals) – same information to patient and health care professionals

The program is based on objective measurement of physical activity, sedentary behaviour and sleep. The patients will get personalized target for these behaviours and they can follow their lifestyle online using an interactive accelerometer + smart phone application + cloud system, and the same objectively measured information is delivered to health care from the cloud.

The effectiveness of the project will be evaluated by two different randomized controlled trials, with physical activity counseling for diabetics and counseling for coronary artery patients, respectively.

The impact of the Care Sport Connector in the Netherlands

Eva Martin-Diener¹, Annemarie Wagemakers², Liesbeth Preller³, Eva Smit⁴, Karlijn Leenaars⁵, Gerard Molleman⁵

¹University of Zurich, ²Wageningen University & Research Centre, Department of Social Sciences, Health and Society, ³Knowledge Centre for Sport Netherlands, Ede, ⁴Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, Nijmegen, ⁵3.Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, Nijmegen.

In 2012, the Ministry of Health, Welfare and Sports introduced Care Sport Connectors (CSCs), who are ascribed a broker role to connect the primary care and physical activity (PA) sector and to guide primary care patients towards PA facilities. The aim of this study was to assess CSCs’ impact on 1) connecting both sectors and 2) activities organized, reach and health of participants.

Methods include three rounds of in-depth interviews with 13 CSCs in 9 municipalities, 14 focus groups with professionals collaborating with CSCs and monitoring of 405 participants of PA programs. At the start, after 6 months and after 1 year participants performed a fitness test and filled in a questionnaire about PA behaviour, motivation, and experienced health.

CSCs function as referrer, organiser and broker to connect different sectors. The number of collaborating organisations increased from 8.3 (2014) to 19.8 (2016). CSCs arranged multiple PA programs and used different strategies for recruitment: PR, a personal letter or referral by a (welfare or primary care) professional. Participants who were referred scored lower on fitness tests, PA behaviour and experienced health than those in other groups.

The CSC is successful in connecting the primary care and PA sector and leads to a better potential for referral and more PA programs. To reach primary care patients, collaboration with the welfare or primary care sector is a prerequisite. Whether CSCs really improve the target groups’ PA level needs to be studied further.

External funding details: Funding by ZonMw (Netherlands Organisations for Health Research and Development) (525001002).

Moving healthcare professionals: A multi-component Physical Activity programme to engage, educate and change behaviors of health professionals

Eva Martin-Diener¹, Nick Clarke², Mike Brennan²

¹University of Zurich, ²Health Improvement Directorate, Healthy People Division, Adult Health and Wellbeing Team, Public Health England, London

Public Health England published the national physical activity framework Everybody Active, Every Day in 2014. It set out the need for action across four domains to increase and sustain physical activity levels across England and embraces a Making Every Contact approach across the health care workforce.

One of the domains ‘Moving Healthcare Professionals’ is a multi-component programme developed with Sport England that aims to educate and upskill healthcare professionals to deliver physical activity advice to demonstrate a cross cutting approach to Physical Activity promotion.

The programme consists of a number of activities:

1.Physical Activity Clinical Champions training scheme.
2.ELearning modules,
3.Physical Activity ‘prescription pad’ pilot,
4.Updating and dissemination of physical activity and health evidence base,
5.Pilot Sport and Exercise medicine integration in secondary care,
6.Promote and increase uptake of medical undergraduate resources.

This presentation will highlight the results from Phase 2/3 of the pilot clinical champions training programme - where 245 sessions were delivered by clinical champions to 3240 participants (>82% GP’s). With the evaluation stating that the programme was successful in meeting its learning objectives, highlighted the positive impact that a one-time training session can have on primary care professional’s confidence and the follow-up results showed that it had a positive effect on the participants’ confidence to motivate patients to increase physical activity.

In addition, we will reflect on the next phase of the programme and the effectiveness of a ‘making every contact count’ approach to engaging health care professionals.

Mainstreaming physical activity within health and social care

Eva Martin-Diener¹, Flora Jackson²

¹University of Zurich, ²Health Improvement Manager Physical Activity, NHS Health Scotland, Edinburgh

In order to create effective leadership, coordination and delivery of physical activity (PA) within Health and Social Care in Scotland, the national Health and Social Care Physical Activity (HSCPA) Delivery Group has been established to oversee the development and delivery of strategic actions, devised to enable people in contact with Health and Social Care services to experience the benefits of a more active life.

These actions build on evidence based practice, focused on increasing opportunities for staff, visitors, patients and the wider community to be physically active. More recently, the Health and Social Care Delivery Plan (Scottish Government, 2016), details actions to enhance health and social care services, enabling people to live longer, healthier lives and aspires to embedded the National Physical Activity Pathway (NPAP) into all appropriate clinical settings across the health care system by 2019.

Collectively, this involves the co-ordinated delivery of four work streams identified to enable and enhance delivery of the National Physical Activity Pathway:

1.National Physical Activity Pathway Infrastructure
2.Education and Workforce Development
3.Activating the Outdoor Estate
4.Creating an Active Workplace.

Quality improvement methodologies such as the improvement journey, coupled with an assets based approach have been adopted. Thereby enabling work streams to translate evidence into practice through small scale tests of change, through which solutions reflective of local needs can be developed, existing resources maximised and long term transformational change achieved.

Joint efforts to establish health behaviour counselling in Switzerland

Eva Martin-Diener¹, Jacques Cornuz², Stefan Neuner³, Raphael Bize⁴, Carlos Quinto⁵, Brian Martin⁶

¹University of Zurich, ²Department of Ambulatory Care and Community Medicine, University Hospital Lausanne, ³Swiss College for Primary Care Medicine, Fribourg, ⁴Institute of Social and Preventive Medicine, University of Lausanne, ⁵Health Promotion and Prevention Section, Swiss Medical Association, ⁶Chief Medical Officer, Canton of Zurich, Department of Health, Zurich; University of Zurich

Switzerland is a multicultural country with federalist structures, and a strong tradition of initiatives from individuals and groups such as professional associations. Within this context, a number of approaches for health counselling in primary care have been developed. Three of them have grown into programmes and are now in different phases of implementation: “Vivre sans Tabac” (“Living without Tobacco”), PAPRICA (Physical Activity promotion in PRImary CAre) and “Health Coaching” a programme addressing health behaviours in the order and priority chosen by the patient. They are using the same communication tools established with physicians, namely the principles of motivational interviewing.

Under the lead of the Swiss Medical Association, the programmes are currently preparing an even closer collaboration, including also EviPrev, a programme documenting the evidence for the effectiveness of all prevention approaches through the health care system. Within the context of the Swiss national strategy for the prevention of noncommunicable diseases NCD, the joint programme will aim to further establish prevention in the health care system, by taking into account the needs of health professionals, by providing new and possibly combined training formats and by developing the capacity to integrate further dimensions of health behaviour as well as new groups of health professionals.

This presentation will reflect on challenges and key success factors for scaling up programmes, based on the experiences gained with these four programmes. Furthermore, it will describe the status of the joint efforts to integrate the support for health behaviour change into the implementation of the NCD strategy.

Session: Physical activity research in vulnerable populations using Ecological Momentary Assessment (EMA)

Sex differences in associations between daily affect and accelerometer-derived physical activity patterns in children

Genevieve Dunton¹, Eldin Dzubur², Chih-Hsiang Yang¹, Britni Belcher¹

¹University of Southern California, ²Cedars-Sinai Medical Center

Introduction: Research typically examines affective factors in relation to total volume of physical activity during childhood, a vulnerable period of life. However, daily physical activity patterns, not just volume of physical activity, may be important for physical and mental health. Research examined sex differences in day-level associations between children’s affect and accelerometer-derived physical activity patterns.

Methods: Children (N = 163; M_age = 9.6 years; 46% boys) reported positive and negative affect through Ecological Momentary Assessment (EMA) and wore an accelerometer across seven days. The following pattern metrics were calculated for light and moderate-to-vigorous physical activity (LPA, MVPA): total duration (min), energy (METs), and number of events for short (<10 min) and long (≥10 min) bouts; and distribution/dispersion of bouts across the day.

Results: For boys and girls, mean positive and negative affect on any given day were unrelated to total volume of MVPA (min) on that day. However, compared to boys, on days when girls reported higher mean positive affect than their own average, they accumulated more MVPA (min) and (METs) through short bouts (<10 min) (p’s < 0.01), engaged in a larger number of LPA and MVPA bouts (p’s < .05), and engaged in LPA and MVPA bouts that were more evenly distributed in length across the day (p’s < .01).

Conclusions: Compared to boys, girls may experience more acute positive affective benefits from sporadic activity (occurring in shorter and more evenly distributed bouts across the day). Examining physical activity pattern metrics (in addition to volume) can elucidate more nuanced relationships between affective experiences and physical activity in children.

Response patterns and predictors of compliance to Ecological Momentary Assessment in university students: Results from the MovingU study

Matthew Kwan¹, Chloe Bedard¹ Scott Veldhuizen¹, John Cairney³

¹McMaster University ³University of Toronto

Introduction: The transition out of high school represents a major life transition, corresponding with significant declines in physical activity (PA) behaviors. To date, the extant literature is largely based on cross-sectional or infrequent longitudinal studies, limiting our understanding of contextual and intra-individual factors impacting PA during this transitory period. The purpose of the current study was to describe the utility of using ecological momentary assessment (EMA) in first-year university students and to examine the predictors of EMA compliance.

Method: Our sample included 86 recent high school graduates (Mage =18.30 ± .54; males = 45%), whom were asked to wear an accelerometer and complete EMA prompts 7x/day for five days. Each prompt included a very-brief survey assessing context, acute feelings, mood states, and PA cognitions.

Results: Fifty-five participants (68%) met minimal acceptable compliance (answering >3 prompts on >3 days), of which 47% had excellent compliance (answering >5 prompts for >4 days). Findings did not show any person-level factors being related to compliance; however, results from the mixed effects logistic model found a significant time-of-day (Coefficient = −5.10 SE = .75, p < .001) and day-of-week effect (Coefficient = −.29 SE = .03, p < .001).

Conclusion: Overall, compliance to EMA prompts was modest among first-year students, underlining the importance of investigating potentials for non-response biases. Results suggest prompts in the afternoons/early evenings were more likely adhered to, but that responses waned over time. Current findings suggest that future EMA studies may require a smaller sampling frame for emerging adults vulnerable to steep declines in PA behaviors.

External funding details: Funded by Social Sciences and Humanities Council of Canada

Affective responses to a multi-day, charity cycling event of people with depression and anxiety symptoms

Amanda Rebar¹, Simon Rosenbaum²

¹Central Queensland University, ²University of New South Wales

Introduction: The feelings experienced during exercise are a major contributor of exercise motivation. It may be that because of a deregulation of the brain’s reward system, feelings experienced during exercise are unique for people experiencing depression and/or anxiety.

Method: An ecological momentary assessment was conducted during a week-long charity cycling event. Cyclists (N = 37, 81% male) reporting their depression and anxiety symptoms prior to the ride and their affective feeling states twice daily throughout the ride. Multilevel regression was used to test whether the feeling states experienced were different as a function of symptom severity.

Results: For people with depression, strength and attentiveness increased and hostility decreased more during the event than for people without depression (p’s < .05). For people with anxiety, feelings of distress, irritability, nervousness, fear, and fatigue reduced more during the event and interest, pride, guilt and activeness increased more during the event than for people without anxiety (p’s < .05). For people with depression and anxiety, interest, pride and guilt increased during the event, and distress and irritability decreased more during the event than for people without depression and anxiety (p’s < .05).

Conclusion: People with depression and anxiety symptoms tended to have more reactive feeling state responses to the cycling event, especially in regards to self-conscious emotions such as pride and guilt. It may be that the self-focus that accompanies depression and anxiety impact feelings experienced during exercise. Future research is needed to determine whether this impacts motivation.

Feasibility and validity of assessing older adults’ physical activity and sedentary behavior through Ecological Momentary Assessment

Jaclyn Maher¹, Amanda Rebar², Genevieve Dunton³

¹University of North Carolina at Greensboro, ²Central Queensland University, ³University of Southern California

Introduction: Ecological Momentary Assessment (EMA) can yield new insights into the prediction and modeling of physical activity (PA) and sedentary behavior (SB). This study was designed to determine the feasibility and validity of an EMA protocol to assess PA and SB in older adults, the least active and most sedentary segment of the population.

Method: Over 10 days, participants (n = 104; 60-98 years) received 6 randomly-prompted EMA questionnaires on a smartphone each day and wore an ActivPAL monitor to provide a device-based measure of PA and SB.

Results: Older adults were compliant with the EMA and ActivPAL protocol on 92% of occasions. EMA compliance did not differ for monitor-based PA or SB in the 15 minutes before versus the 15 minutes after the EMA prompt, suggesting that these behaviors did not influence likelihood of responding and responding did not influence these behaviors (ps > 0.05). When PA was reported through EMA, participants engaged in more monitor-based PA in the 15 minutes after compared to the 15 minutes before the EMA prompt (p = 0.01), suggesting possible reactance. EMA-reported PA and SB were positively associated with higher device-based PA and SB in the ±15 minutes, respectively, supporting criterion validity (ps < 0.05).

Conclusion: Assessment of older adults’ PA and SB through EMA is feasible and valid, although there may be PA reactance to EMA prompting. EMA represents a significant methodological tool that can aid in our understanding of the environmental, social, and psychological processes regulating older adults’ PA and SB in the context of everyday life.

Symposia: Tuesday 16 October

Session: Air pollution and physical activity

Are long-term benefits of physical activity on health modified by exposure to air pollution?

Zorana Jovanovic Andersen, University of Copenhagen

Introduction: Physical activity reduces, whereas exposure to air pollution increases the risk of cardiovascular and respiratory disease and premature mortality. Physical activity amplifies respiratory uptake and deposition of air pollutants in the lung, which may augment acute harmful effects of air pollution during exercise. We examined whether long-term benefits of physical activity on morbidity and mortality are moderated by long-term exposure to air pollution in an urban setting.

Methods: 57,000 subjects (50–65 years) from the Danish Diet, Cancer, and Health cohort, recruited in Aarhus and Copenhagen between 1993 and 1999, reported data on lesiure-time and utilatarian physical activity. We linked the cohort to Danish natiowide registers to extract data on overall- and cause-specific mortality, incidence of asthma and chronic obstructive pulmonary disease (COPD). We used modeled NO₂ levels at the residence at the cohort baseline year as proxy for air pollution exposure during physical activity. We modeled assocaition of participation in sports, cycling, gardening, and walking with the above mentioned health outcomes by Cox regression, and then introduced NO₂ as an interaction term.

Results: Of ca. 53,000 subjects in analyses, 5,534 died until 2010, 1,151 developed asthma and 3,225 COPD until 2013. Participation in sports, cycling, walking and gardening was associated with reduced risk of premature mortality (18-22%), incident asthma (15-18%) and COPD (15-19%), and these were not modified by NO₂.

Conclusions: Increased exposure to air pollution during exercise does not outweigh long-term beneficial effects of physical activity on the risk of premature mortality, or risk of asthma and COPD.

Air pollution exposures while walking and cycling

Audrey de Nazelle, George Northover, Shahram Heydari, Imperial College London

Introduction: Travel microenvironments are often the most polluted places people encounter in their daily lives. Encouraging walking and cycling may increase physical activity in the population, but also lead to higher intakes of pollutants (due to high inhalations rates in highly contaminated environments). Quantification of exposure contrasts between travel modes is needed to estimate potential risks and benefits of walking/cycling.

Method: A systematic review of global literature comparing exposures while walking and cycling to other modes (car, bus, overground/underground rail) was conducted. Data from the disparate set of studies was harmonized to estimate ratios of concentrations in active travel vs motorized travel modes for fine particulate matter (PM2.5), ultrafine particles (UFP), black carbon (BC) and carbon monoxide (CO). Comparisons were made for ratios obtained in different continents.

Results: Of 280 articles examined, 27 responding to inclusion criteria were retained for analyses. Most were derived from European studies although all continents except Antarctica were represented. Globally, walking was amongst the least exposed travel modes for BC and CO, with more inconsistent results for PM2.5 and UFP. Cycling was amongst the most exposed for UFP, and the least exposed for BC (other than walking). Results varied by continent.

Conclusion: A large variety of study designs and settings makes a unified picture of air pollution contrasts between travel modes difficult. Nevertheless the ratios and associated confidence intervals obtained provide useful metrics for health impact modelling, enabling a comprehensive analysis of risk and benefit tradeoffs of walking and cycling policies in urban environments.

External funding details: MRC

Impact of ambient fine particulate matter air pollution on physical activity: A longitudinal study of university students in Beijing, China

Ruopeng An¹, Hongjun Yu²

¹University of Illinois at Urbana-Champaign, ²Tsinghua University

Objectives: This study examines the impact of ambient fine particulate matter (PM2.5) air pollution on physical activity among college students in Beijing, China.

Methods: Health surveys were repeatedly administered among 12,000 newly admitted students at Tsinghua University during 2012–2015 over their freshman year. Linear individual fixed-effect regressions were performed to estimate the impacts of ambient PM2.5 concentration on physical activity-related health behaviors among survey participants, adjusting for various time-variant individual characteristics and environmental measures.

Results: Ambient PM2.5 concentration was found to be negatively associated with total minutes of walking and vigorous physical activity in the last week, but positively associated with daily average hours of nighttime/daytime sleep among survey participants. An increase in ambient PM2.5 concentration by one standard deviation (47.5 µg/m³) was associated with a reduction in weekly total minutes of walking by 21.9 (95% confidence interval = 19.6-24.2) and a reduction in weekly total minutes of vigorous physical activity by 5.2 (3.4-7.0), but an increase in daily average hours of nighttime/daytime sleep by 2.3 (2.3-2.4). Ambient PM2.5 concentration was not found to be associated with daily average hours of sedentary behavior.

Conclusions: Our previous systematic review found PM2.5 concentration to be associated with increased physical inactivity in the US. This study added to the literature by revealing that PM2.5 air pollution discouraged physical activity among Chinese college students. Policy interventions are urgently called to reduce air pollution level in China’s urban areas.

External funding details: This study was funded by Beijing Federation of Social Science, National Social Science Foundation, and Tsinghua University.

Challenge for public health: Should you avoid cycling and walking in high pollution days?

Marko Tainio¹, Giorgos Giallouros², Panayiotis Kouis², John S. Evans³, Stefania I. Papatheodorou², James Woodcock¹

¹University of Cambridge, ²Cyprus University of Technology, ³Harvard T. H. Chan School of Public Health

Introduction: Regular active commuting (cycling, walking) is associated with reduced all-cause mortality through increased physical activity (PA). However, active commuting may increase intake of fine particles (PM2.5), causing negative health effects. In this study we estimate the combined risk of PA and PM2.5 for all-cause mortality among active commuters who, in days with high PM2.5 levels work from home.

Method: We modelled the changes in all-cause mortality by combining risks (PM2.5) and benefits (PA) for six cities (Helsinki, London, Sao Paulo, Warsaw, Beijing, New Delhi) using daily PM2.5 concentrations as an input. In each day with PM2.5 concentration above the threshold current active travelers were assumed to stay home.

Results: Everyday cycling to work resulted in RRs from 0.80 (cycling) and 0.84 (walking) in Helsinki to 0.86 (cycling) and 0.88 (walking) in New Delhi. Restricting active commuting in high PM2.5 days had a minimal effect on combined risk in Helsinki, London, Sao Paulo and Warsaw. However, in Beijing and New Delhi restricting cycling in days with PM2.5 concentration over 150 µg/m3 resulted in slightly lower combined RR than cycling every day.

Conclusions: Replacing cycling and walking for working from home in days with high air pollution days could lower all-cause mortality risk in Beijing and New Delhi.

External funding details: British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust (though the UK Clinical Research Collaboration), and Cyprus University of Technology.

Session: Increasing physical activity in overweight football fans: From developing and evaluating intervention programs to wider implementation in practice

Implementation of the successful weight loss and healthy living football fans in Training program in the UK and Germany

Kate Hunt¹, Cindy Gray², Chriss Bunn², Craig Donnachie², Sally Wyke²

¹University of Glasgow/University of Stirling, ²University of Glasgow

Introduction: The prevalence of overweight and obesity in men has been rising in many countries in recent decades, yet men have often been proven difficult to engage in weight management and other health-promoting programs. In response to this challenge, we developed the Football Fans in Training (FFIT) program, a 12 week weight management and healthy living intervention, which was gender sensitised in context, content and style of delivery. FFIT was designed originally to be delivered by community coaches at professional football clubs in Scotland, in partnership with the Scottish Professional Football League Trust (SPFLT). A randomised controlled trial (RCT) demonstrated that FFIT was effective (primary outcome - objectively-measured weight loss 12 months post pre-randomisation baseline measures) and cost effective.

Developing a sustainable implementation model: We will describe how we worked in partnership with the SPFLT to develop a ‘Train-the-Trainers’ program and a licensing and audit model which is designed to allow FFIT to be delivered with fidelity to the program as evaluated. This includes training for pre-post program measurement for monitoring purposes, which enable SPFLT, the original research team and program funders to monitor the outcomes of FFIT participation. We also describe the adaptation and delivery of FFIT towards a women’s only program, in response to demand within the delivery clubs.

Conclusion: In partnership with SPFLT, we have developed an implementation model which has proved feasible and sustainable in the UK (over 5+ years post RCT evaluation) and other countries.

Development and implementation of the EuroFIT intervention program in 15 professional football clubs across Europe

Femke Van Nassau¹, Chris Bunn², Eivind Andersen³, Cindy Gray², Kate Hunt⁴, Judith Jelsma¹, Nanette Mutrie⁵, Ria Nijhuis-vanderSanden⁶, Hugo Pereira⁷, Glyn Roberts³, Marlene Silva⁷, Marit Sorensen³, Pedro Teixeira⁷, Shaun Treweek⁸, Theo van Achterberg⁹, Irene van de Glind⁶, Hidde van der Ploeg¹, Willem van Mechelen¹, Sally Wyke²

¹VU University Medical Centre, ²University of Glasgow, ³Norwegian School of Sport Sciences, ⁴University of Glasgow/University of Stirling, ⁵University of Edinburgh, ⁶Radboud University Medical Center, ⁷University of Lisbon, ⁸University of Aberdeen, ⁹KU Leuven

Introduction: Based on the success of the Scottish Football Fans in Training (FFIT) weight loss intervention, European Fans in Training (EuroFIT) was developed. EuroFIT primarily focusses on increasing physical activity and decreasing sedentary behaviour. The aim of this presentation is to describe the development and implementation of the EuroFIT intervention in 15 football clubs across 4 countries.

Methods: We collected process evaluation data from intervention participants (n = 560 overweight male football fans aged 30-65 years) of the EuroFIT randomized controlled trial. During implementation coaches completed attendance sheets and coach logs. After the 12-week intervention ended, both participant and coaches completed process evaluation questionnaires.

Results: Recruitment of participants went very well – expressions of interest exceeded the number needed three times. EuroFIT participants attended on average 9.9 (SD2.3) of the 12 sessions. Participants were satisfied with the intervention and coaches as they scored 8.8 (SD1.4) and 9.2 (SD1.4) on a ten point scale, respectively. Fidelity was overall good, but varied by club. In addition, we explored combining different process measures (i.e. fidelity, dose and quality) into a delivery score and linked this to lifestyle outcomes.

Conclusion: Implementation of EuroFIT was very good. Participants liked the coaches and the intervention, and coaches delivered the intervention with high fidelity. As a result, exposure to the EuroFIT intervention was high and resulted in positive changes in lifestyle outcomes (as described in the EuroFIT effectiveness presentation in this symposium). Evaluation of implementation of EuroFIT outside the research setting is needed to determine if this can be replicated.

Effectiveness of the EuroFIT lifestyle program delivered to male football fans across Europe

Hidde van der Ploeg¹, Femke van Nassau¹, Kate Hunt², Marlene Silva³, Sally Wyke⁴

¹VU University Medical Centre, ²University of Glasgow/University of Stirling, ³University of Lisbon, ⁴University of Glasgow

Introduction: The primary aim of the randomized controlled trial of the European Fans in Training (EuroFIT) lifestyle program is to determine whether EuroFIT can help men aged 30-65 years with a self-reported BMI ≥27 kg/m² to increase their physical activity and decrease their sedentary time 12 months after baseline.

Method: A pragmatic, randomised controlled trial was conducted in 15 professional football clubs in the Netherlands, Norway, Portugal and the UK (England). Participants were measured at baseline, post-program and 12 months after baseline. Primary outcomes were changes in total physical activity (i.e. steps/d) and total sedentary time (i.e. min/d spent sitting) objectively assessed with the activPAL.

Results: 1113 male football fans were recruited across the 15 participating clubs. 560 men were allocated to the intervention group and received the 12-week intervention program. 553 men were randomized to the waiting list comparison group. The intervention group increased their steps by 1163 steps/d (95%CI 774-1551) post program and by 633 steps/d (95%CI 284-981) at 12 months compared to the control group. Changes in sedentary time were not significantly different at 12 months between the groups. The intervention did result in significant improvements in many of the secondary outcomes (body weight, BMI, waist circumference, resting blood pressure, several cardio-metabolic blood biomarkers and food intake).

Conclusion: The EuroFIT intervention program effectively improved physical activity but not sedentary time in male football fans. EuroFIT has good potential for wider roll out to help improve public health through the football setting.

The role of motivational theory in promoting physically active lifestyles in the EuroFIT program

Marlene Silva¹, Pedro Teixeira¹, Glyn Roberts², Jennifer Laguardia¹, Cindy Gray³, Kate Hunt⁴, Hidde van der Ploeg⁵, Chris Bunn³, Femke van Nassau⁵, Eivind Andersen², Marit Sorensen², Irene van de Glind⁶, Hugo Pereira¹, Judith Jelsma⁵, Nanette Mutrie⁷, Sally Wyke³

¹University of Lisbon, ²Norwegian School of Sport Sciences, ³University of Glasgow, ⁴University of Glasgow/University of Stirling, ⁵VU University Medical Centre, ⁶Radboud University Medical Centre, ⁷University of Edinburgh

Introduction: Interventions reported as theory-based often do not describe the strategies and behavior change techniques used, neither measure changes in constructs that predict behavior. Such description and measurements are critical for improving theory and practice. This presentation seeks to: i) Describe how constructs from motivational theory (Self-Determination and Achievement Goal Theories) were used to inform EuroFIT intervention strategies; ii) Report on whether the program impacted motivational targets.

Methods: 1113 men participated in a pragmatic randomised controlled trial, comprising a gender-sensitized 12-week behaviour change program (12-month follow-up), at 15 football clubs in the Netherlands, Norway, Portugal, and the UK. Coaches, at club facilities, led the program. Club affiliation was leveraged to promote adaptive motivation, by increasing group relatedness, interest in the program, and, gradually building mastery through optimally challenging opportunities and a toolkit of self-regulation strategies for behaviour change.

Results: The intervention was successful in affecting theory-driven mediators, increasing the internalization of autonomous-motivation both post-program and at 12-months (ES = 0.37;0.26, p < 0.001). Associations between theoretical-constructs matched the expected patterns (p < 0.001) and were related with the use of self-regulatory strategies (e.g. goal-setting, overcoming setbacks) (p < 0.001), and also with average step count both post-program and at 12 months (r = 0.16;0.23, p < 0.001), and self-reported sitting less and becoming more active by making small changes to everyday life (p < 0.001).

Conclusion: Results indicate that the EuroFIT intervention properly affected the proposed-mediators, which demonstrated to be associated with the use of self-regulatory strategies and a more physically active lifestyle, both short and longer-term. Future analyses will assess specific mediation paths.

Session: Integrating health effects into transport planning: Achievements, pitfalls and lessons learned from 10 years of the WHO Health Economic Assessment Tool (HEAT) for walking and cycling

How does it work? Introduction to the methodological approaches of the new HEAT 4.0

Sonja Kahlmeier¹, Thomas Goetschi¹, Nick Cavill², Alberto Castro-Fernandez¹, Christian Brand², David Rojas-Rueda³, James Woodcock⁴, Paul Kelly⁵, Christoph Lieb⁶, Pekka Oja⁷, Charlie Foster⁸, Harry Rutter⁹, Francesca Racioppi¹⁰

¹University of Zurich, ²Oxford University, ³ISGlobal, Barcelona Institute for Global Health, ⁴Cambridge University, ⁵University of Edinburgh, ⁶Ecoplan, ⁷UKK Institute for Health Promotion Research, ⁸Bristol University, ⁹London School of Hygiene and Tropical Medicine, ¹⁰WHO Regional Office for Europe

Introduction: Initially launched in 2007, the WHO Health Economic Assessment Tools (HEAT) for walking and cycling are online tools to estimate the value of reduced mortality that results from regular walking or cycling. They are designed to meet the needs of an audience with limited access to extensive sets of inputs required for complex impact assessment models in terms of epidemiological, transport-related and economic data, and/or have limited experience of how to perform these assessments.

Method: The HEAT is developed through an open-ended, evidence- and multidisciplinary based approach. A core group reviews latest evidence, identifies next development steps and proposed possible approaches, which are then decided by consensus meetings with ad hoc invited international experts from various fields.

Results: HEAT assessments are based on only 2 input values (volume of walking/cycling and population number) and default values, which are based on best-available evidence or expert judgement and can be changed by the user. Initially only including reduced mortality from regular physical activity, the latest version also allows taking into account negative effects from air pollution, road crashes as well as carbon effects.

Conclusions: The main challenge of the HEAT approach is constant balancing of scientific robustness versus usability, supported by involvement of a wide range of experts. More systematic user feedback will further strengthen this successful tool and hopefully foster wider application, especially in the policy arena

The WHO Health Economic Assessment Tool (HEAT) for walking and cycling: How is it used?

Nick Cavill¹, Sonja Kahlmeier²

¹Cavill Associates Ltd, ²University of Zurich

The HEAT recently celebrated its tenth birthday: it has been available online since 2007. In that time it has been used by a wide variety of people from a range professional groups, including policy makers, researchers, professionals and students from all over the world. The HEAT is mainly used in the European region, but uses have been recorded by countries as far away as New Zealand, India or Mexico. The HEAT website was launched in May 2011. Since then, it has received almost 600.000 page views by over 34.000 users, or a weekly average number of visitors of about 170.

This presentation will give examples of varying uses of the HEAT from around the world. It will draw on research conducted for the European Cyclists’ Federation on how to increase the use of the HEAT. This used a survey of users and semi-structured interviews to explore the use of the HEAT and attitudes to its application. It will also draw on interviews conducted in 2017 with users from across Europe. The presentation will provide a unique insight into the ways the HEAT is being used, and introduce some challenges for future development of the tool.

Mainstreaming HEAT in a large transport authority

Lucy Saunders, Transport for London

Introduction: Transport for London - the strategic transport authority for Greater London in the UK - has been embedding public health in the organisation since 2013. This included a commitment in their Transport Health Action Plan (2014) to use the WHO HEAT for walking and cycling in business cases.

Method: A training programme was delivered to over 150 relevant staff across the organisation on how to use the tool. The training was accompanied by local implementation manual and standard data inputs to support use of the tool.

Results: A review was undertaken in 2018 to assess the extent to which the WHO HEAT was being used appropriately in business cases. This highlighted a number of challenges in embedding the use of this tool. There was reluctance among practitioners to ascribe a locally observed uplift in active travel with a net population physical activity benefit. There was an insufficient evidence base for proposing the likely uplift in active travel as a result of interventions. These factors among others were barriers to widespread use of the tool.

Conclusions: To ensure the WHO HEAT is used by practitioners to influence decision making a package of supporting measures is required.

The use of the HEAT to strengthen a town’s physical activity policy

Susanna Aznar Lain, Universidad de Castilla-La Mancha

Toledo is a municipality and a city in Spain, capital of the autonomic community of Castilla-La Mancha. It has around 83,000 citizens (2015) and it is the second most populated municipality in the province. A major part of Toledo’s action plan was focused on the building of a new cycle path from Toledo city to the Santa Mª de Benquerencia neighbourhood. The HEAT was therefore used to estimate the health benefits of the path, assuming different levels of usage. It also helped to compare the benfits to the cost of building the path (€400,000). The presentation will describe the process taken and how the HEAT findings helped to influence policy.

Examples and references to how the Health Economic Assessment Tool (HEAT) for walking and cycling has been used in Finland

Tanja Onatsu, Fit for Life Program, Finland

Introduction: the WHO Health Economic Assessment Tools (HEAT) for walking and cycling was first published in 2007 and officially launched in 2009. In 2011 an updated online version of the HEAT for cycling and walking were published. Since the HEAT-tools have been published it has been promoted widely in Finland which has resulted in its diverse usage.

Method: HEAT documents have been translated and published by Fit for Life Program in 2013. To further promote the HEAT-tools Fit for Life Program published case study application from the town of Joensuu. In 2014 was held two-day Mobility Management seminar and workshops seminars in 2015 which also promoted the tools. The usage of the HEAT was also promoted heavily through the network of cycling municipalities.

Results: As a result of this national-level promotion HEAT analyses have been carried out in national and local level. HEAT tool has been used in Ministry of Transport and Communication’s Programme on promoting walking and cycling as well as in many metropolitan and rural areas. Even some employees have done their own HEAT calculations in their promotion for active commuting. This presentation will give examples and references of uses of the HEAT in Finland.

Conclusions: HEAT tools have been widely used in Finland and its utilization is established in promotion for walking and cycling.

Session: Physical activity and social inequality: Using ethnography to make disadvantaged voices heard and inform interventions

Nature’ as an affordable ‘activity space’? The importance of attending to embodied space-time-income constraints.

Sarah Bell¹, Cassandra Phoenix²

¹University of Exeter, ²University of Bath

Recent years have seen growing efforts across research, policy and practice to counter our increasingly sedentary lifestyles, with a plethora of interventions emerging to increase physical activity levels across the population. Such interventions are often underpinned by health promotion messages that encourage people to ‘move more’ and to ‘move faster’. Yet, such efforts often overlook the dynamic spatio-temporal contexts and embodied experiences that shape people’s opportunities to be active in this way on a routine basis. We address this here, drawing on insights from two in-depth qualitative research studies; a geo-narrative doctoral study conducted with residents of two Cornish towns in 2013 to understand how and why people engage with their local ‘green’ and ‘blue’ spaces to gain a sense of wellbeing (or otherwise) through the life course, and a more recent ‘Sensing Nature’ study exploring how and why nature features in the everyday lives of people living with varied forms and severities of sight impairment. In this presentation, we focus specifically on the experiences of a sub-set of study participants whose opportunities to gain a sense of wellbeing through active encounters with their local nature settings are often undermined by long-term time-income and/or impairment-income constraints. By grounding opportunities to be active in the fine-grained spatio-temporal details of people’s everyday lives, we argue that future health promotion policy and messaging around physical activity and sedentary behaviour could better reflect the realities of those it intends to serve.

External funding details: Funding: European Social Fund and Economic and Social Research Council.

Negotiating physical activity and mobility in a disadvantaged urban area: an ethnographic study with young people

Stephanie Morris, University of York

Evidence suggests that young people are more active when outside. However, their access to outdoor public spaces can be constrained because such spaces are associated with ‘risk’; young people are often considered in danger or a danger to others. This study adopted a critical ethnographic approach to explore daily physical activity in 13-21-year-olds attending two youth centres in a disadvantaged urban area, using extensive participant observation and interviews, including go-along interviews. Findings show that the young people negotiated their sense of risk in their local environments in order to be mobile. Due to feelings of intimidation or fear, many of the young people avoided certain spaces at certain times of day, or moved around the area with friends for safety and enjoyment, whilst some young men presented themselves as fearless and tough. Many of the young people etched out spaces for fun and friendship, using outdoor spaces and props in the material environment to engage in informal physical activity practices such as “hardcore parkour” or ‘childhood’ games. The youth centres helped the young people develop social connectedness needed for mobility, and provided less ‘risky’ and socially supportive spaces for unstructured or self-directed physical activity. Hence, for young people living in disadvantaged areas, engaging in youth centres may aid mobility and daily physical activity outside of PE, school, and organised sport club contexts.

External funding details: Funding: Economic and Social Research Council

How can school-based interventions make more of a difference?

Gareth Wiltshire, University of Bath

As social inequalities continue to significantly impact public health, physical inactivity in low socio-economic groups has become a particular concern. In recent years, children and young people have been targeted for physical activity promotion and schools have been positioned as important sites for intervention. Amidst a growing interest in conceptualising health behaviours as ‘social practices’ situated within cultural and material contexts, this presentation highlights how ethnographic research can help reveal the meaning and experience of school-based physical activity for young people as it relates to socio-economic status. Drawing on qualitative research from a range of methods (ethnography, visual methods, walking interviews and focus groups) from both primary and secondary schools, it is argued that socio-economic status provides important social conditions through which physical (in)activity is realised. Not only is it possible to see how young people in different socio-economic circumstances engage in different kinds of physically activity practices, but also that physical activity is understood and experienced in different ways. This raises concerns over the potential incommensurability between low socio-economic status pupils’ dispositions and the school contexts in which much health promotion is implemented. Data also highlight the complex interplay between pupils, school staff, parents and the physical environment in which physical activity is practised suggesting that interventions and policies aimed at reducing inequalities might benefit from being designed to reflect and accommodate these complexities. In seeking ways that this may be achieved in practice, the presentation concludes with findings from the School Culture Intervention Project pilot study.

Understanding women’s participation in walking groups in deprived areas: An ethnographic approach

Tessa Pollard¹, Stephanie Morris², Cornelia Guell³

¹Durham University, ²University of York, ³University of Exeter

Walking groups are promoted as an accessible and effective intervention to increase activity levels. However, there are concerns that walking group schemes may contribute to health inequalities because of higher levels of participation by advantaged groups. Our aim was to explore how walking groups located in deprived areas find a place in women’s lives. We conducted participant observation with five walking groups in north-east England, and interviews with 21 women, most of them members of these groups. Most study participants were aged over 60. All walks started in deprived areas, but many group members lived in less deprived neighbourhoods. Group members welcomed the experience of sociality, “fresh air” and “nature” associated with group walking. Many women had come to their walking group after retirement, unemployment, bereavement, or in the context of chronic illness or caring responsibilities. Women’s recruitment to walking groups also often depended on their links to resources such as friends or networks with links to walking groups. Thus, participation was often a result of a conjunction of three factors: positive experiences and understandings of walking, life circumstances that created a space for walking, and social resources that linked women with walking groups. These factors are often patterned by socioeconomic status, which may result in higher levels of participation by those who are already advantaged. Walking groups should not be seen as a magic bullet for all, but can become embedded into some people’s “life projects” in beneficial ways.

Session: Tackling inactivity: improving the evidence base for the effectiveness of sport and physical activity in improving health and wellbeing

Evaluation of a national workplace physical activity and sport initiative in England: the CSP Network Workplace Challenge

Emma Adams¹, Hayley Musson¹, Andrew Watson²

¹Loughborough University, ²County Sports Partnership Network

Introduction: This study evaluated participation in, and the impact of, the Workplace Challenge, a multi-component intervention promoting sport and physical activity in employed adults. Intervention components include: logging activities online; activity challenges; and sports events/competitions.

Methods: A mixed methods evaluation was undertaken using: 1) online surveys (baseline; 3, 6 and 9 month follow-up); 2) activities logged on the programme website; and 3) focus groups/interviews with participants. Descriptive analysis of quantitative data was undertaken, along with using paired t-tests (continuous data) and McNemar’s test (categorical data) to assess changes in sport and physical activity. Qualitative data were analysed thematically.

Results: Overall, 63,653 employees registered for the programme (October 2013 - April 2017); of these 14,848 (23%) were inactive at baseline. Barriers to activity participation included ‘no time’, ‘not being motivated’, ‘young children/family’, ‘not the sporty type’ and ‘workplace culture/environment’. For inactive participants, the top five activities logged were walking (44.1%), road cycling (11.9%), running (9.7%), gym (4.4%) and swimming (2.9%). Increases were observed in the proportion of individuals participating in sport (baseline: 29.8%; 3 months: 51.6%; p = <0.001) and total minutes per week physical activity (baseline: 270.4 ± 476.8 minutes; 3 months: 452.1 ± 573.2 minutes; p = <0.001).

Conclusions: Workplace Challenge engaged large numbers of employees and increased sport and physical activity participation. To support future physical activity promotion in the workplace, barriers to activity and changes to workplace culture need to be addressed, along with providing activities suitable for inactive individuals.

External funding details: Workplace Challenge was funded through Sport England’s Lottery Funded Get Healthy Get Active portfolio.

How effective is community physical activity promotion in areas of deprivation for inactive adults with cardiovascular disease risk and/or mental health concerns?

Fiona Deans, Herts Sports Partnership / University of Hertfordshire

Introduction: A challenge all physical activity interventions face is targeting those members of the population who face the greatest barriers to becoming more active; these include those with lowest physical activity levels and those from socio-economically deprived neighbourhoods with little opportunity for participation in recreational activity. The prevention paradox proposed by Geoffrey Rose suggest that approaches that target whole-populations may be most efficacious to engage these groups, and this approach has been adopted by the Active Herts programme which targets the residents of four deprived areas in the county of Hertfordshire, England.

Method: A mixed-method approach combining quantitative outcomes evaluation and qualitative process evaluation. The evaluation is targeting the key delivery components including delivery staff training, the effects of activity socialisation and the long terms on participant physical activity and well-being.

Results: Evidence from the first 24-months of programme evaluation suggests that Active Herts is achieving its goals, with high levels of uptake from the most deprived communities and statistically significant improvements in participant physical activity and mental well-being 6 months post baseline. The use of skilled delivery staff who understand the barriers in this group has been key to the programme success. An unexpected benefit has also come from ‘Conversation Cafés’ which were originally run to gain evaluation feedback from participants but have turned into important opportunities for them to socialise together.

Conclusions: Using a range of approaches, Active Herts illustrates how a community focussed physical activity intervention can successfully reach those who are often overlooked by such programmes.

The Health and Sport Engagement Project: Findings from the design, outcome, process and economic evaluation of complex community sport intervention to increase physical activity and enhance health and wellbeing

Louise Mansfield¹, Nana Anokye², Tess Kay², Julia Fox-Rushby³

¹Brunel University, ²Brunel University London, ³King’s College London

The HASE Project focused on tailored complex community sport provision and included a mixed methods outcome, process and economic evaluation. It engaged previously inactive people in sport for 1 x 30 minutes / week. This presentation outlines the methods and findings from participatory focus groups (n = 32 x 1 hour) intended to ensure HASE activities met the needs of local inactive people. It explains how a bespoke package of public health training was delivered to sport coaches (n = 15) to maximise the quality of relevant workforce knowledge in designing, delivering and engaging inactive people in community sport. The findings are presented and show that a total of 550 people engaged in the HASE project. There were large and significant increases in vigorous and moderate physical activity and sport during the design and training phase). There was a statistically significant increase over time in the degree of happiness felt by participants. Quality adjusted life years were slightly higher over time but not statistically significant. Costs of the project varied depending on the character of the inactive population and the delivery requirements. Overall, the HASE project showed that with the right support and provision, barriers to participating in sport can be overcome. Previously inactive people can take part in community sport activity, enjoy doing so, and potentially gain health and wellbeing benefits from participation.

External funding details: Sport England Get Health Get Active funding

Improving the evidence base for the effectiveness of sport and physical activity in improving health and wellbeing.

Amy Roden¹, Gabriella Frith²

¹Rotherham Metropolitan Borough Council, Public Health, ²Sheffield Hallam University

Active for Health is a robust physical activity & sport programme linking rehabilitation to community activity. The aim is to improve long term health & identify how physical activity pathways can contribute to the recovery from a long term condition (LTC), including Cancer, Stroke, Cardiac, Heart Failure, COPD, lower back pain, a recent fall or fracture. The programme is a three step pathway which links rehabilitation services & primary care to long term condition specific physical activity sessions.

The project involves health professionals & exercise specialists by developing a pathway that bridges the gap between NHS rehabilitation and community physical activity opportunities. A commissioned service model was implemented at the programme’s inception, ensuring specialist and quality assured delivery by level 4 exercise providers. Additional mechanisms supporting the referrals, delivery and sustainability of the programme include; physical activity workshops, community buddies & clinical contact time.

To date there have been 1062 patients engaged (2015–2017), completing 13,407 visits. Self-reported physical activity levels were measured using IPAQ, with an increase in moderate activity from baseline (166.33) to 3 months (283.75). QALY has shown a significant improvement (p < 0.05) from 0.6761 at baseline to 0.7598 at 12 months. Active for Health currently offers over 50 sessions weekly, 28 community buddies have been recruited (2015 – 2017) to support sessions. The programme aims to revolutionise the role that physical activity plays in rehabilitation & recovery, by providing safe, effective & quality assured services in local communities, resulting in notable improvements in health & well-being.

The design principles

Sarah Ruane, Sport England

Tackling inactivity is one of the key areas of work that underpins Sport England’s new strategy, Towards an Active Nation. It follows on from our previous work to explore the ways to engage and support inactive people to become active. The Get Healthy, Get Active fund was launched in 2012 to learn whether sport and physical activity projects can be designed to tackle inactivity, improve public health, reduce health inequalities and manage or prevent long-term health conditions. The investment held the specific aim to improve the evidence base for the effectiveness of sport and physical activity in improving population level health.

We have invested £13.8 million into 33 independently-evaluated pilot projects across England from 2013 – 2018, supporting over 134,694 inactive adults to move into physical activity and sport. The interventions test everything from the role of healthcare professionals and volunteers to how we change attitudes to physical activity.

A thematic analysis of this insight highlighted 10 key principles for developing projects and services to tackle inactivity. The Design Principles include; the importance of understanding the nature of inactivity, the role of behaviour change theories, audience insight, reframing messages away from ‘sport’, working in quality partnerships, supporting and measuring behaviour change, and scaling up what works.

This section will explore the key learnings and principles across the GHGA programme which can be utilised in future interventions to tackle the complex nature of inactivity and support population health and well-being in both the prevention and treatment of long term conditions.

Session: Walking and health: How much and how fast is enough?

What speed do adults walk? A systematic review and meta-analysis

Marie Murphy¹, Jacqueline Mair², Elroy Aguiar³, Catrine Tudor-Locke³, Elaine Murtagh⁴

¹Ulster University, ²Edinburgh Napier, ³University of Massachusetts, ⁴Mary Immaculate College

Walking has become the cornerstone of physical activity promotion for public health. One of the attractions of this form of activity is that it can be recommended by health professionals but done with little or no supervision. The health benefits of walking depend at least in part, on the relative exercise intensity, determined by walking speed. Where walking is undertaken without supervision, self-selected walking speed is an important determinant of health benefit. This talk will present the findings of a systematic review of studies which have measured self-selected walking speed of apparently healthy adults. We will present a meta-analysis with standardised mean difference and 95% confidence intervals. Where sufficient data are available we will analyse walking speed and intensity by age, gender, BMI and activity status (e.g. inactive, habitual exercise walker) to describe habitual walking speeds in a range of populations.

Dose response of walking and CVD risk factors: frequency, intensity, bout duration, length and volume

Pekka Oja¹, Paul Kelly², Elaine Murtagh³, Marie Murphy⁴, Charlie Foster⁵, Sylvia Titze⁶

¹UKK Institute, ²University of Edinburgh, ³Mary Immaculate College, ⁴Ulster University, ⁵Bristol University, ⁶University of Graz

Walking interventions in healthy populations show improvements for many cardiovascular disease (CVD) risk factors. As the dose-response characteristics between walking and the risk factors are of relevance for population interventions we assessed the relationships between the changes in CVD risk factors and the frequency, intensity, bout duration, length and volume of supervised walking interventions based on a systematic review of 37 randomized controlled trials.

Pooled meta-analyses showed statistically significant favorable effects of walking interventions for seven CVD risk factors: body mass, BMI, body fat, systolic and diastolic blood pressure, fasting glucose, and VO₂max. Despite testing 91 possible dose-response relationships, meta-regression analysis indicated only seven statistically significant associations.

Our findings suggest that the CVD benefits are largely independent of the frequency, intensity, bout duration, length and volume of walking interventions. These observations will be discussed with the perspective of promoting walking for population health.

Walking and health: How much and how fast is enough?

Emmanuel Stamatakis, University of Sydney

Walking is perhaps the most accessible form of physical activity for the large majority of the population. Interventions commonly recommend total volumes of walking at any pace but public health guidelines usually refer to walking of at least moderate intensity, which is often conveyed as a “brisk” pace for most adults. There is relatively little evidence on the association between self-reported walking pace and mortality at the population level. This talk will present the results of a prospective analysis included in the ISPAH 2018 BJSM Special Issue on walking and health that examined the association between self-reported walking pace and all-cause, cardiovascular, and cancer mortality among 50,022 British adults. These findings and the relevant recent literature will be discussed in the context of whether any observed associations are causal or predictive, and what role measured and unmeasured confounding may play in shaping these associations.

Walking cadence (steps/min) and intensity in adults

Catrine Tudor-Locke¹, Ho Han², Elroy Aguiar¹, Tiago Barreira³, John Schuna⁴, Minsoo Kang⁵, David Rowe⁶

¹University of Massachusetts Amherst, ²Oklahoma State University, ³Syracuse University, ⁴Oregon Statte University, ⁵The University of Mississippi, ⁶University of Strathclyde

Cadence (steps/min) has been suggested as a reasonable proxy-indicator of ambulatory intensity. A summary of current evidence is needed for cadence-based metrics supporting benchmark (standard or point references) and threshold (minimums associated with desired outcomes) values that are informed by a systematic process. Therefore, a comprehensive search strategy was conducted to identify relevant studies focused on walking cadence and intensity for human adults. Identified studies (n = 38) included controlled (n = 11), free-living observational (n = 18), and intervention (n = 9) designs. There was a strong relationship between cadence (as measured by direct observation and objective assessments) and intensity (indirect calorimetry). Despite acknowledged inter-individual variability, ≥100 steps/min is a consistent heuristic (e.g., evidence-based, rounded) value associated with absolutely-defined moderate intensity (3 metabolic equivalents; METs). Emerging evidence suggests that >130 steps/minute may be similarly useful as a threshold value indicative of vigorous intensity (i.e., ≥6 METs) ambulatory activity. Peak cadence indicators may prove useful for capturing “best natural effort” in free-living behavior, but the evidence supporting benchmark and threshold values is immature at this time. The prescription and/or evaluation of cadence-based metrics in interventions is preliminary.

External funding details: This work was supported by a grant from the National Institute on Aging, National Institute of Health: CADENCE-Adults, 5R01AG049024-03.

Parallel Oral Sessions: Monday 15 October

Monday, 12:00–13:00

Session: Advocacy, policy and monitoring frameworks

A brief history of global physical activity policy measures and why they matter.

Michael Pratt, Global Observatory for Physical Activity GoPA!, University of California San Diego

Physical inactivity accounts for as many as 5 million deaths per year globally but has yet to be addressed effectively by most governments or the World Health Organization (WHO). Reasonable evidence for effective strategies exist, and several countries have implemented consistent public health policies and programs that have increased population prevalence of regular physical activity. Understanding why and how a few countries have developed sound public health programs for physical activity while most have not requires monitoring and evaluating policy, programmatic, and perhaps even research indicators in addition to more traditional surveillance of physical activity participation at the population level. Physical activity has lagged behind other equivalently important global public health issues as a priority for WHO and most countries. This may in part reflect inadequate measurement of key factors related to physical activity such as population prevalence, burden and cost, policies, programs, and recommendations. The aphorism “what gets measured gets done” may well apply here. It may also reflect insufficient evidence based advocacy for more effectively addressing physical inactivity as a public health priority. In this symposium we will address several key questions. Is it feasible to track physical activity policy for children and adults at the country level? Is the existence of “good” physical activity policy associated with less physical inactivity? How can policy indicators best be used for advocacy and to guide policy and programs? What organizations can or should monitor and evaluate physical activity policies globally? Are there lessons to be learned from global tobacco policy?

Learning from the tobacco/nutrition/obesity experience

Adrian Bauman, Global Observatory for Physical Activity GoPA!, University of Sydney

Introduction: This presentation examines the relevance of tobacco, alcohol and obesity policies on promoting population physical activity (PA). Much rhetoric surrounds tobacco policy successes, and is assumed transferable to PA.

Methods: Reviews / commentaries that described policy frameworks for food, tobacco and alcohol were extracted from Google, Scopus and Medline. A narrative synthesis considered key themes and successes, and their applicability to PA.

Results: Effective tobacco policy instruments include legislation, taxation, environmental regulation, incentives, social norms-changing campaigns, capacity building and clinical settings. Together these have diffused into many affluent countries, but policy progress remains slow in LMICs. For obesity policy, some countries report repeated sequences of policy frameworks, incompletely implemented without sustainable government resourcing. However, strategies for obesity prevention appear more effective as “upstream” policies (primordial prevention), although downstream health system strategies may be politically more acceptable. For reducing sugar sweetened beverages, regulatory and taxation frameworks are effective, as are reformulation strategies and media campaigns. Similar approaches are effective for alcohol regulation and environmental restriction.

Conclusions: The multisectoral, complex aetiology of physical inactivity makes the policy context challenging. No single policy instruments can solve the cross-sectoral challenge of inactivity. Policy diffusion and policy emulation have not occurred nationally. Even clinical policies, such as the “Exercise is Medicine” framework remain to be adopted at scale. The 2004 WHO Strategy for Diet and Physical Activity increased policymakers awareness but resulted in limited implementation. The 2017 GAPPA holds promise for building a better inter-sectoral case to promote government action.

From ‘car-dependency’ to ‘desirable walking’- trend in policy relevant indicators

Dafna Merom¹, Jacob Humphries², Ding Ding³, Grace Corpuz⁴, William Bellew³, Adrian Bauman⁵

¹University of Western Sydney, ²Biostatistics Training Program, NSW Health, ³University of Sydney, ⁴Office of Quality and Performance, Western Sydney University, ⁵University of Sydney

Background: Reducing car dependency in favour of health-enhancing active travel can address the issues of prolonged sitting and physical inactivity. This study utilises transportation-sector population surveys to develop interdisciplinary policy relevant indicators for benchmarking and progress tracking.

Methods: The continuous Sydney Greater Metropolitan Household Travel Survey (2000-June 2015) was analysed in 2017. The prevalence of adults (≥15 years old) who i) travelled by car for distances amenable for walking (≤1.5 km); ii) only drove a car and did not walk, including no walks that link to other modes (i.e, CD: ‘car-dependency’); and iii) walked ≥30 minutes, or ≥3 kms, or > 3 walking trips (i.e., DW: ‘desirable walking’) in the past 24 hours were examined including prevalence ratios for CD/DW by geographical regions.

Results: The adjusted yearly decline in the prevalence of CD was small (0.3%) but significant, from 40.3% (95% CI: 39.6 - 41.1) in 2000/3 to 39.3% (38.1-40.1) in 2012/14. DW remained unchanged, from 20.6% (95% CI:20.0; 21.2) to 21.2% (95%CI: 20.6-21.9). The adjusted yearly ratios of CD/DW presented a declining trend from 1.42 to 1.13. The CD/DW prevalence ratio varied greatly by distance from CBD, with medians ratios 0.86, 1.86 and 3.25 in short, medium and long distance categories, respectively. Across all periods 21% travelled by car for ≤1.5 kms, of those travellers 44% were car dependent.

Conclusion: These indicators can serve both transportation and health sectors wherever transport surveys exist, for benchmarking, monitoring and setting area- specific goals that are aligned with public health and transport policies.

Policy lessons learned through the Active Healthy Kids Global Alliance Report Cards

Mark S. Tremblay, Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada, Canada

Introduction: The Active Healthy Kids Global Alliance was created to help power the movement to get kids moving around the world by recruiting and mentoring countries from around the world to develop and release a Report Card on the “state of the nation” of the physical activity of children. Report Cards follow a harmonized framework and process and include grades for “indicators” of individual behaviours and settings and sources of influence. A “Global Matrix” was developed to aggregate and compare Report Card grades across countries to identify best practices, success stories, and provide future guidance to “improve the grades”.

Methods: This presentation discusses findings from the Global Matrix with a focus on policy-related lessons learned from the grades.

Results: Overall, the results suggest a complex network of strengths and limitations across countries, with some global patterns emerging when comparing countries clustered by continent, Human Development Index, or inequality indices. A paradox of higher physical activity and lower sedentary behaviour in countries reporting poorer policy and environmental infrastructure, and lower physical activity and higher sedentary behaviour in countries reporting the opposite, suggests that autonomy to play, travel, or chore requirements and/or fewer attractive sedentary pursuits, rather than infrastructure and structured activities, may facilitate higher levels of physical activity. A policy–implementation disconnect or socio-cultural variation may partially explain this paradox.

Conclusions: International cooperation and cross-fertilization is encouraged to address existing challenges, understand underlying determinants, conceive innovative solutions, challenge conventional dogma, and mitigate the global childhood inactivity crisis.

Policy lessons learned through the Global Observatory for Physical Activity – GoPA!

Andrea Ramirez Varela, Global Observatory for Physical Activity GoPA!, Federal University of Pelotas

Introduction: Increasing physical activity (PA) is a global priority. Multiple distal and proximal determinants beyond individual choice are involved in explaining this modifiable risk factor. High quality resources to inform government policy and actions are essential for increasing PA. In 2013, WHO reported that 80·0% of countries had plans for addressing PA. However, only 55% of the plans were implemented, and only 42% of these were operational and funded. In response, there have been global calls for greater commitment to promote PA, most recently the 2017 WHO Global Action Plan for Physical Activity. GoPA! was created in 2013 as part of this global response to monitor national PA policy, surveillance and research.

Objective: Assess lessons learned after three years of policy monitoring by GoPA!.

Results: In 2016, GoPA! found that 76.3% of its members had policies or plans to address PA: 49,6% with a national NCD plan including PA, and 26.6% with a standalone national PA plan. 85.7% of Sub-Saharan African countries and 66.7% of low income countries had no plan. In 2017 GoPA! developed a global policy audit tool and conducted a pilot with twenty countries. Results varied greatly, however the feasibility of collecting detailed PA policy data was demonstrated.

Conclusion: National PA policy varies substantially by geographic area and country income group. PA policy indicators can enhance understanding of the links between policy and population levels of PA. GoPA! is committed to informing and encouraging adequate policy responses for addressing physical inactivity.

A policy framework approach to promote physical activity and tackle NCDs

Bryony Sinclair, World Cancer Research Fund International

Non-communicable diseases (NCDs) are the leading cause of death globally, accounting for two out of every three deaths, threatening global sustainable development. The prevention of cancer and other NCDs is arguably one of the most significant public health challenges of the 21st century. Governments are off track to meet the 9 voluntary global targets set out in the WHO’s Global NCD Action Plan 2013-2020, including a 10% reduction in physical inactivity. Public policy is critical to create environments conducive to healthy and active ways of living.

WCRF/AICR’s anticipated Third Expert Report, Diet, Nutrition, Physical Activity and Cancer: a Global Perspective brings together the latest research from the Continuous Update Project’s review of the accumulated evidence on cancer prevention and survival related to diet, nutrition and physical activity (launched 24th May 2018). Key findings of the report include strong evidence that physical activity protects against several cancers and that greater body fatness is a cause of many. Building on this report and our unique NOURISHING policy framework to promote healthy diets, we present a new policy framework that can be used as a tool to identify policy action to promote physical activity, healthy diets and breastfeeding and reduce alcohol consumption. The new framework demonstrates how common policy levers can be applied across these risk factors to make progress in achieving the global NCD targets and support the forthcoming WHO Global Action Plan to promote physical activity. Case studies of implemented physical activity policy actions from around the world will be presented.

Exploring the use of systems mapping in the development and dissemination of the draft WHO Global Action Plan to promote physical activity

Nick Cavill¹, Harry Rutter², Fiona Bull³

¹Cavill Associates Ltd, ²London School of Hygiene and Tropical Medicine, ³World Health Organizarion

Introduction: The World Health Organization’s draft global action plan on physical activity (GAPPA) proposes a set of specific policy actions to guide Member States’ efforts to promote physical activity. It emphasises the need for a ‘whole-of society paradigm shift’ to support and to value all people being regularly active, according to ability.

There is an increasing interest in the use of ‘whole systems approaches’ to complex problems such as physical inactivity. These aim to explore and understand the multiple and interacting influences on behaviours, and set them within the context of a complex adaptive system, rather than a set of separate and disconnected issues.

Activities: We set out to explore the extent to which systems thinking could help in the development and dissemination of the GAPPA. We developed a number of draft causal loop diagrams (CLDs) for physical activity. These set out the multiple and interacting influences on physical activity, including environmental; psychological and social influences. These draft CLDs were then discussed with key experts and stakeholders and used to ‘audit’ the actions in the draft GAPPA and to explore potential gaps or areas for future priority.

Results and Conclusions: The mapping process provided extremely interesting insights into the draft GAPPA, showed the extent to which it was taking a global whole systems approach, and identified gaps to be filled. It also proved to be a useful communication tool to develop understanding of the physical activity system and the system response necessary to create the required ‘whole-of-society paradigm shift’.

Session: Developments in wearable devices and analysis

Validation of the Sedentary Sphere in children: Does wrist or accelerometer brand matter?

Liezel Hurter¹, Alex Rowlands², Stuart Fairclough³, Zoe Knowles¹, Anna Cooper-Ryan⁴, Lorna Porcellato¹, Lynne Boddy¹

¹Liverpool John Moores University, ²University of Leicester, ³Edge Hill University, ⁴Salford University

Introduction: Posture classification is vital to sedentary behaviour measurement and central to its definition, though assessing posture using wrist-worn accelerometers is challenging. The Sedentary Sphere allows classification of posture based on arm elevation and has been validated in adults. This study aimed to further validate the Sedentary Sphere method of classifying posture from accelerometers worn on either wrist in children.

Methods: Twenty-seven 9-to-10 year old children wore ActiGraph GT9X and GENEActiv accelerometers on both wrists, and an activPAL on the thigh while completing five sedentary activities, standing with phone, walking (criterion: observation) and ten minutes free-living play (criterion: activPAL). Percent accuracy for posture estimates from both wrists and accelerometer brands were calculated. Pairwise 95% equivalence tests (±10%) and intra-class correlation coefficients (ICC) were used to evaluate agreement of posture estimates between wrists and between accelerometer brands.

Results: Mean percent accuracy was similar, irrespective of accelerometer brand, at 77% for the non-dominant wrist and 79% for the dominant wrist. Posture estimates could be considered equivalent between wrists within brand (±6%, ICC>0.81, lower 95% CI>0.75), between brands worn on the same wrist (±5%, ICC>0.77, lower 95% CI>0.72) and between brands worn on opposing wrists (±6%, ICC>0.78, lower 95%CI>0.72).

Conclusion: This study validates the Sedentary Sphere method to classify posture from wrist-worn ActiGraph and GENEActiv accelerometers in children. The method is equally valid with data from either wrist and either brand of device and removes the requirement for multiple devices to assess both physical activity and sedentary behaviour in children.

Identifying active standing versus sitting using the “zero cadence” step metric

Aston K. McCullough, Elroy J. Aguiar, Scott W. Ducharme, Christopher C. Moore, Catrine Tudor-Locke, University of Massachusetts Amherst

Recent studies have used triaxial accelerometer activity counts to distinguish standing time from sitting time. Further research is needed on methods for classifying standing versus sitting using step-based metrics. Sparsely detected steps peppered into strings of 0 steps/min (i.e., zero cadence) may accurately identify such behaviors.

Purpose: To discriminate between active standing and sitting using steps/min data detected from wrist- and hip-worn ActiGraph GT9X accelerometers.

Methods: Participants [N = 20, women: 50%(10); mean age: 30(4.5) years; mean BMI: 24.6(4.3) kg/m²] engaged in three simulated tasks of daily living [i.e., seated rest (SITR), seated/typing at a computer (SITC), and standing/folding laundry (STND)] for 5-min bouts. Step counts detected in each scenario were analyzed in MATLAB R2017b. For each 5-min bout, cadence signals were deconstructed in both the time and frequency domains. Signal features from the time and frequency domains were modeled as predictors of each respective task using a Decision Tree algorithm (CART) within a one-versus-all classification paradigm. To determine classification performance, the Receiver Operating Characteristic Area Under the Curve (AUC) and its bootstrapped 95% confidence interval (C.I.) were evaluated for each task and device location.

Results: For the wrist-worn location, the AUC(95% C.I.) were—SITR: 0.99(0.96-1.00), SITC: 0.95(0.88-0.97), and STND: 1.00(1.00-1.00). At the hip, values were—SITR: 0.50(0.50-0.50), SITC: 0.75(0.70-0.81), and STND: 0.98(0.90-1.00).

Conclusions: This preliminary evaluation of sparse step count episodes reveals that the “zero cadence” step metric can effectively distinguish between active standing time and sitting when devices are worn at the wrist or hip.

External funding details: Supported by NIH/NIA Grant 5R01AG049024—CADENCE-Adults.

Innovations in the use of raw accelerometry in epidemiology: A basis for harmonisation of physical activity outcomes across international datasets

Alex Rowlands¹, Charlotte Edwardson², Tatiana Plekhanova², Evgeny Mirkes³, Melanie Davies², Kamlesh Khunti², Tom Yates²

¹Univesity of Leicester, ²Leicester Diabetes Centre, ³University of Leicester

Background: To capitalise on the increasing availability of accelerometry data for epidemiological research it is desirable to pool data from multiple surveys worldwide. This study aimed to establish which physical activity outcomes can be considered equivalent between three research-grade accelerometer brands worn on the dominant and non-dominant wrist.

Methods: Eleven adult participants wore a GENEActiv, Axivity and ActiGraph on both wrists for up to 7-days. Accelerometer data were processed using open-source software (GGIR) to generate mean daily activity outcomes (including average dynamic acceleration (ACC), intensity gradient, time inactive (≤50 mg) and time active (≥100 mg)). Agreement was assessed using pairwise 95% equivalence tests (±10% equivalence zone) and intra-class correlation coefficients (ICC, 95% confidence interval (CI)).

Results: ACC and time active were higher (p < 0.01) when measured at the dominant wrist (31.9 vs 28.8 mg and 124 vs 114 min, respectively). ACC could be considered equivalent between monitors worn on the non-dominant wrist (ICC ≥ 0.88, lower 95%CI ≥ 0.61). The intensity gradient (ICC ≥ 0.88, lower 95%CI ≥ 0.55), time inactive (ICC ≥ 0.69, lower 95%CI ≥ −0.06) and the number of valid days (ICC ≥ 0.95, lower 95%CI ≥ 0.81), could be considered equivalent between all monitor/wrist pairings.

Conclusion: Free-living measures of average dynamic acceleration, and outputs that depend on acceleration magnitude, are higher at the dominant relative to the non-dominant wrist. Outputs that take into account the distribution of data, e.g. the intensity gradient and wear-time, are more consistent across wrist and monitor brand. These results will provide an evidence base for researchers wishing to harmonise data from surveys using different protocols and/or monitor brands.

Cadence (step/min) as an indicator of absolute and relative intensity in middle-aged adults

Catrine Tudor-Locke¹, Christopher Moor¹, Elroy Aguiar¹, Scott Ducharme¹, John Schuna², Tiago Barreira³, Stuart Chipkin¹, John Staudenmayer¹

¹University of Massachusetts Amherst, ²Oregon State University, ³Syracuse University

Introduction: Cadence (steps/min) thresholds may be associated with various indicators of absolute and relative intensity, including: metabolic equivalents (METs), percent of age-predicted maximum heart rate (%HRmax), percent of heart rate reserve (%HRR), and Borg Rating of Perceived Exertion (RPE).

Methods: Eighty adults (10 men and 10 women) from each 5-year age-group between 41-60 years (mean age = 50.2 ± 5.9 years; BMI = 26.0 ± 4.0 kg/m2) performed a series of 5-min treadmill bouts, starting at 0.22 m/s, and increasing in 0.22 m/s increments until participants: 1) chose to run, 2) achieved 75% HRmax, or 3) reported RPE >13. Cadence was directly observed. Oxygen consumption (VO2) was measured using indirect calorimetry, with METs calculated from the final 2 min of each stage (VO2*(3.5 mL/kg/min)-1). Absolute intensity was defined as moderate (3 METs) and vigorous (6 METs). Relative moderate and vigorous intensity was defined by the 2011 ACSM Position Stand. Receiver Operating Characteristic (ROC) models were used to identify optimal cadence thresholds.

Results: Cadence thresholds for the various indicators that corresponded to moderate and vigorous intensity were, respectively: METs – 98.5 and 121.9 steps/min; %HRmax – 112.9 and 122.1 steps/min; %HRR – 112.3 and 116.3 steps/min; RPE – 105.5 and 126.2 steps/min, respectively. All area under the curve values were >0.8, and all sensitivity and specificity values were >0.75 (87.5% were >0.8).

Conclusion: The cadence threshold for absolutely-defined moderate intensity was ∼7-15 steps/min lower than those for indicators of relative intensity. Cadence thresholds for absolute and relative vigorous intensity agreed within of ± 5 steps/min.

External funding details: Supported by NIH/NIA Grant 5R01AG049024 - CADENCE-Adults.

Be aware of the consequences of cutting your cut-point when analysing sedentary behaviour and physical activity in youth.

Teatske Altenburg¹, Xinhui Wang¹, Evi van Ekris¹, Lars-Bo Andersen², Heidi Klakk³, Niels Christian Młller³, Niels Wedderkopp³, Mai Chin A Paw¹

¹VU University Medical Center, Amsterdam Public Health Research Institute, ²Norwegian School of Sport Sciences, ³University of Southern Denmark

Purpose: To examine the influence of cutting cut-points to 15- and 60-second epochs on (1) laboratory-controlled and (2) free-living sedentary behaviour (SB) and moderate-to-vigorous (MVPA) activity in youth.

Methods: For the first objective, data from a controlled laboratory study in children was used (n = 80). Children performed eight sedentary and one physical activity for 10 minutes. For the second objective, data from the CHAMPS-study was used (n = 902). Children wore an accelerometer at their right hip. We calculated mean differences in total time and time accumulated in bouts of SB, LPA and MVPA based on 15- and 60-second epochs.

Results: In the laboratory study, classification accuracy for SB was 88-99% and 97-100% for the 15- and 60-second epoch, respectively. Applying the 15-second epoch, 20-33% of dancing time was accurately classified as MVPA versus 0% for the 60-second epoch. Applying the 15-second epoch on free-living data resulted in 156 minutes more SB and 54 minutes more MVPA than the 60-second epoch. Time accumulated in SB bouts ≥10 minutes was lower when applying the 15-second than the 60-second epoch. No differences were found for MVPA bouts ≥10 minutes.

Conclusions: We recommend using a 15-second epoch when analysing both SB and MVPA as (1) misclassification was lower for assessing SB in 15-second epochs than MVPA in 60-second epochs, and (2) mean differences between applying 15- and 60-second epochs in free-living accelerometer data were relatively smaller for SB than MVPA. We recommend future controlled studies to examine the accuracy of classifying SB, light PA and MVPA.

NHANES and NNYFS wrist accelerometer data: Processing 7TB of data for public access

Rick Troiano¹, Stephen Intille², Dinesh John³, Binod Thapa Chhetry², Qu Tang⁴

¹National Cancer Institute, National Institutes of Health, ²College of Computer and Information Science and Bouvé College of Health Sciences, Northeastern University, ³Bouvé College of Health Sciences, Northeastern University, ⁴College of Engineering, Northeastern University

Purpose: The U.S. National Health and Nutrition Examination Survey (NHANES) 2011-2014 and the 2012 NHANES National Youth Fitness Survey (NNYFS) collected 80 Hz triaxial accelerometer data at the non-dominant wrist for up to 1 week on more than 15,000 participants ages 3 years and older. The data are being prepared for public release. This presentation will describe how the NHANES accelerometer data are being processed and how they will be made available.

Methods: Data are being processed on a protected cloud account provided by Amazon Web Services. Gt3x files were converted to an open source, flexible format for processing. A system for running data summarization algorithms in parallel using Python, Java, or R code was developed and tested with pilot data from approximately 700 participants and then scaled up. Data quality assessment was performed by examining distributions of selected signal features and summary data.

Results: NHANES accelerometer data will be processed to provide summary data (wear vs. non-wear vs. sleep estimates, activity volume) at the day and minute levels; high-resolution data will also be provided, including selected frequency and time domain features of the high-resolution signals. Daily and minute-level data will be provided for download from NCHS, while higher resolution data may require processing within a cloud environment.

Conclusions: Researchers will have facilitated access to high frequency and selected feature data from NHANES 2011-2014 and NNYFS for algorithm development, testing and application, as well as summary data for use in epidemiological and other analyses with NHANES data.

Physical activity levels in women and men measured by accelerometer. The Tromsø 7 Study 2015-16

Edvard Sagelv¹, Sigurd Pedersen¹, Alexander Horsch¹, Laila Arnesdatter Hopstock¹, Sameline Grimsgaard¹, Anna Norström², Séren Brage³, Ulf Ekelund⁴, Bente Morseth¹

¹UiT the Arctic University of Norway, ²Umeå University, ³MRC Epidemiology Unit, University of Cambridge, ⁴Norwegian School of Sport Sciences

Introduction: The health benefits of physical activity (PA) is undisputable. However, surveillance data of population PA patterns assessed objectively is rare. The objective of this study was to describe the PA patterns measured by accelerometer in a large Norwegian general population, and describe the prevalence of sufficiently active individuals according to the World Health Organizaiton’s recommendation for PA (150 min of moderate -or 75 min of vigorous PA or a combination of both in 10 min bouts).

Methods: A total of 21083 women and men aged 40-99 participated in Tromsø 7 Study in 2015-16. 6289 wore an accelerometer (ActiGraph wGT3X-BT) for eight consecutive days of which 6141 provided valid data. The counts per minute (CPM) cut-points for different PA intensities were as follows; Sedentary; <100 CPM, light PA; 100-1951 CPM; moderate PA; 1952-5724 CPM; vigorous PA; >5725 CPM.

Results: 1132 (18.4%) accumulated at least 150 min in moderate or 75 min in vigorous PA or a combination of both in 10 min bouts. Time spent in moderate and vigorous PA averaged 16.9 ± 16.4 min/day per day. The participants spent most of their time in sedentary and light PA; 11.6 ± 1.7 (67.3 ± 7.5%) and 5.2 ± 1.3 (29.8 ± 6.8%) hours per day, respectively.

Conclusion: The vast majority of Norwegian adults (>80%) do not fulfill the current recommendations for health enhancing physical activity.

Session: The impact of places and spaces on physical activity

Built environment change and neighbourhood socioeconomic disadvantage: are neighbourhood differences widening over time, and what are the implications for inequalities in physical activity and health?

Gavin Turrell¹, Jerome Rachele², Aislinn Healy³, Billie Giles-Corti⁴

¹Deakin University, ²The University of Melbourne, ³Australian Catholic University, ⁴RMIT University

Introduction: Reducing health inequality is a goal of many governments and international health authorities. As cities change and grow, a key question is whether changes in their built environments lead to a widening of inequalities in physical activity (leisure and transport-related) and health. This longitudinal study tracks built environment change over time (2007 – 2016) in a fast-growing high-income city (Brisbane, Australia) and examines whether change differs by neighbourhood disadvantage and the implications for inequalities in physical activity and health.

Methods: Data come from the HABITAT study. Built environment change is tracked for every neighbourhood in Brisbane (n = 1,680) across five time-points: 2007, 2009, 2011, 2013, and 2016. The built environment is measured using residential density, land-use mix, street connectivity, street lights, bike paths, and parks. Neighbourhood disadvantage is measured using a Census-based index. Analyses are conducted using ANOVA and random coefficient models.

Results: Built environment increases were observed for 3- and 4-way intersections, residential density, street lights, and bike paths, whereas land-use mix decreased. Disadvantaged neighbourhoods had a higher number of 4-way intersections and street lights, they were more residentially dense, had more metres of bike path, and had a more diverse land-use mix. Advantaged neighbourhoods had more 3-way intersections and greater park coverage. The rate of built environment change differed by neighbourhood disadvantage for most of the measures.

Conclusion: The magnitude and direction of built environment change showed a complex pattern which suggested that at a minimum, inequalities in physical activity and health will be sustained in the future.

Built environmental correlates of utilitarian walking among older adults: Does the type of activity places matter?

Camille Perchoux¹, Ruben Brondeel², Rania Wasfi², Olivier Klein³, Geoffrey Caruso⁴, Julie Vallée⁵, Sylvain Klein³, Benoit Thierry⁶, Basile Chaix⁷, Yan Kestens⁸, Philippe Gerber⁹

¹Luxembourg Institute of Socio-Economic Research, ²Centre de Recherche de l’université de Montréal, Université de Montréal, ³Luxembourg Institute of socio-economic research, ⁴Luxembourg Institute of socio-economic research, Université du Luxembourg, ⁵UMR Géographie-cités - CNRS, Université Paris 1, Université Paris 7, ⁶Centre de Recherche de l’université de Montréal, ⁷INSERM, Sorbonne Université, Institut Pierre Louis d’épidémiologie et de Santé Publique, IPLESP UMR-S1136, ⁸Centre de Recherche de l’Université de Montréal, Université de Montréal, ⁹Luxembourg institue of socio-economic research

Introduction: Evidence on environmental determinants of utilitarian walking stresses the necessity to distinguish between commuting and errand. However, this work/non-work dichotomy is an over-simplification of “how travel behavior is influenced by urban form” (Krizek, 2003). Both the location and the type of activity are critical to understand travel modes. This study examines the influence of the type of activity conducted at a given location on walking, and the interaction effect with the built environment and distance to the place of residence.

Method: This study is based on a cohort of 470 elders (≥65 y) from the international CURHA project (Kestens et al. 2016). Information related to demographics, health status and regular activity locations were collected using standard questionnaires and the VERITAS survey. Associations between type of activity (personal, shop, free time, visit, meal, appointment), environmental characteristics (density of amenities, diversity, connectivity, public transport frequency), distance, and walking were analysed by generalized estimating equations models with logit link accounting for demographics, neighborhood self-selection, and physical health.

Results: The type of activity is a strong correlate of walking among elders. While density and diversity of amenities were associated with walking, evidence of interactions with the type of activity is less clear. The barrier effect of distance on walking strongly differ by type of activity.

Conclusion: While increasing interest is dedicated to “when” and “where” travel behavior is realized, this study stresses the importance of “contextualized data” by looking at the type of activity conducted at a specific location.

External funding details: Fond National Recherche Luxemboug

How does the university environment influence students’ physical activity patterns?

Joseph Murphy¹, Ciaran MacDonncha¹, Marie H Murphy², Niamh Murphy³, Catherine B Woods¹

¹University of Limerick, ²Ulster University, ³Waterford Institute of Technology

Introduction: Attending university often involves moving from a family home environment to a more independent living and is accompanied by unhealthy behaviour changes such as decreasing physical activity (PA). The influence of the university campus on students’ PA behaviours is understudied and unclear. Thus, the purpose of this study was to investigate the influence that the university environment and characteristics have on student PA behaviour.

Methods: An environmental audit tool was completed by the relevant personnel in each university (n = 31). Students (n = 8,122; 50.9% male; 21.51 ± 5.65 years) enrolled in these universities completed a supervised online survey gathering information about their PA behaviours. Two-step cluster analysis identified any PA behavioural patterns, while binary logistic regressions examined the influence of the university environment on these patterns. Age, sex, household income, and travel time to university were all controlled for in the analysis.

Results: Five clusters were identified from the analysis and were given names based on key behaviours: Not Active, Active Commuter, Active in University, Active outside University, and Active Everywhere. Increasing the number of organisational structures (OR = 2.331-9.375,p < 0.01), the indoor facilities offered (OR = 1.189-6.297,p < 0.05), the number of sports clubs offered (OR = 2.031-2.490,p < 0.05), and the current investment available (OR = 0.390-2.297,p < 0.01) for PA altered the odds of a student having a behavioural pattern inclusive of PA versus no activity at all.

Conclusion: Increasing our knowledge of interactions between PA and the environment can aid with the development or adaption of university campuses to create optimum conditions for increasing PA and overall health of students.

Walkability index, land-use-mix, street connectivity, residential density and walking for transportation in Sao Paulo city, Brazil

Alex Florindo, Joao Paulo dos Anjos de Souza Barboza, Ligia Vizeu Barrozo

University of São Paulo

Aim: To create walkability index based in residential density, street connectivity, land-use-mix; and to verify the relationship of these variables with walking for transportation in adults who live in Sao Paulo city, Brazil.

Methods: We used Sao Paulo Health Survey/2015 (n = 3,145 adults) that was conducted in five health administration areas and in 150 census tract. Walking for transportation was evaluated by IPAQ questionnaire. Walkability index was elaborated based on residential density, land-use-mix and street connectivity that were obtained on census tract level where people live. We used Kruskal-Wallis and Poisson regression for statistical analysis.

Results: Walkability index was high in North area (p < 0.001), residential density was high in East (p < 0.001), land-use-mix was high in Southeast (p < 0.001), and street connectivity was high in Mid-west (p < 0.001). Areas with high family income had high street connectivity (p = 0.001) and land-use-mix (p < 0.001), however, areas with low family income had a high residential density (p < 0.001). Only land-use-mix was associated with walking for transportation. People who live in places with high quartiles of land-use-mix had more prevalence ratio to walking for transportation independent of the area of the city, sex, age, education and time living in the same residence (p trend = 0.020).

Conclusion: Only land-use-mix was associated with walking for transportation in adults who live in Sao Paulo. It is important to discuss variables that compose the walkability index in megacities. Increasing land-use-mix in other areas of the city favors walking for transportation with benefits for population health. The study was supported by FAPESP (2014-12682-1) and CNPq (306635-2016-0).

Investigating the impact of urban regeneration on public health: A real world natural experiment

Deepti Adlakha, Mark Tully, Ruth Hunter, Margaret Cupples, Frank Kee

Queen’s University Belfast

Introduction: There is a dearth of evidence on the effectiveness of large-scale environmental interventions to help sustain changes in physical activity (PA) behaviours. The Connswater Community Greenway (CCG) is an example of a natural experiment, providing an opportunity to evaluate the public health impact of a major urban regeneration project in Belfast, UK. The CCG aims to regenerate and physically reconnect communities by creating a 9 km linear park offering opportunities for PA and recreation through built environment improvements including the construction of bicycle paths and walkways.

Methods: A representative random sample of 1,209 adults from 62 neighbourhoods in Belfast was recruited prior to the CCG regeneration (Feb 2010 – Jan 2011).

Results: At baseline, participants (N = 1209, female = 60%) completed questions on neighbourhood walkability, socio-economic characteristics and PA levels. Multinomial regression models showed adjusted odds of transport-related PA increased with access to public transport (aOR = 2.4, 95% CI = 1.2, 4.8), walking paths (aOR = 1.9, 95% CI = 1.4, 2.8), shops/stores (aOR = 1.9, 95% CI = 1.1, 3.5), and green space (aOR = 1.5, 95% CI = 1.0, 2.2). Presence of walking routes was significantly associated with levels of leisure related PA (aOR = 1.5, 95% CI = 1.0, 2.2). As part of a broader mixed evaluation, household surveys are being repeated after completion of the CCG in 2018 and pre-post assessment of the effects of the CCG on physical activity and health will be conducted.

Conclusion: By evaluating a ‘real world’ natural experiment, this study adds to the evidence-base about impacts of urban regeneration on public health as well as has implications for the development of natural experiment methodology.

The economic merit of walkable neighbourhoods: A case study in Melbourne, Australia

Belen Zapata Diomedi¹, Lucy Gunn², Claire Boulange², Billie Giles-Corti², Lennert Veerman¹

¹Griffith University, ²RMIT University

Introduction: In Australia, health and economic outcomes of urban developments have not been formally quantified. We address this using a method that could be applied to planned urban developments.

Methods: Health and economic outcomes were compared between three urban developments in Melbourne, Australia by combining a model estimating the probability of transport walking with a proportional multi-state multi-cohort life table model. Urban developments included a greenfield development, infill development, and a composite of highly walkable areas in Melbourne. Built environment features for each development and data on 16,890 adults from the Victorian Integrated Survey of Transport and Activity were used to simulate transport walking probabilities, which were then used in the proportional multi-state multi-cohort life table model to quantify health and economic outcomes between pairs of urban developments.

Results: If an adult population living in a greenfield development was instead exposed to an infill development then health benefits of 30 health-adjusted life years (HALYs), economic benefits of A$3 million and healthcare costs savings of A$0.1 million could be accrued. The benefits would be approximately 40% greater if they were exposed to highly walkable urban development. 36 HALYs gained, A$4 million of economic benefits, and A$0.3 health care costs savings were predicted if infill development residents were instead exposed to a highly walkable urban development.

Conclusions: Quantifying health and economic outcomes for different urban developments provides important information of the unassessed consequences of city design. This research demonstrates that more walkable neighbourhoods could significantly contribute to population health and the economy.

What are the preliminary findings on the impact of city-wide 20mph/30kph legislation in Edinburgh and Belfast?

Paul Kelly¹, Glenna Nightingale¹, Andrew Williams², Ruth Hunter³, Ruth Jepson¹, Nicole Porter¹, Jillian Manner¹

¹University of Edinburgh, ²University of Exeter, ³Queens University Belfast

Implementation of 20 mph speed limits has recently taken place in Edinburgh and Belfast. This presentation will explore the preliminary analyses in terms of: driver perceptions; public support; perceptions of safety; road speeds; number and type of road casualties; and attitudes and levels of walking and cycling.

Data sources for analyses will include routinely collected data (e.g. national surveys), naturally occurring data (e.g. automatic cycle and pedestrian counters) and purposefully collected data by external organisations (e.g. SUSTRANS Route User Intercept Surveys). We also implemented our own Driver and Resident Perceptions survey pre and post implementation in 3 (of 6) implementation zones in Edinburgh.

Data were collected at varying time points and with varying data collection points. As a result, we will use a number of designs and models to analyse the effects including pre-post, time-series and controlled before-and-after designs.

Preliminary data analyses are planned for April 2018. For each of the research questions we will also explore (where and when possible and using appropriate techniques) how the effects differ between areas and population groups (age, gender, and socioeconomic status) and the timeframe for different effects.

Findings will be used to test, refine and modify the Programme Theory and Logic Model. Our overarching objective is to assess the impacts and outcomes of introducing a city-wide 20 mph speed limit in Edinburgh and a city centre speed limit in Belfast.

External funding details: This research was funded by a grant from NIHR grant number 15/82/12

Session: Physical activity and older adults

Choose to Move: Evaluation of a physical activity intervention for older adults delivered at scale across BC, Canada

Heather McKay¹, Lindsay Nettlefold¹, Christa Hoy¹, Adrian Bauman², Joanie Sims-Gould¹

¹University of British Columbia, ²University of Sydney

Introduction: With BC Ministry of Health funding we engaged two community-based organizations to deliver a scalable, evidence-based PA intervention for low active (<150 min/week) older adults (≥60 y). We evaluated intervention effectiveness at both organizations.

Method: Choose to Move (CTM) is a 6-month choice-based PA intervention being scaled up across BC, Canada. Using implementation and scale up frameworks we collaborated with organizations to adapt CTM delivery to their organizational context. We gathered socio-demographic characteristics at baseline and assessed our primary (PA) and secondary (mobility and social connectedness) outcomes at baseline, 3 and 6 months via questionnaire. We explored the role of delivery organization in participant level outcomes via mixed effects models.

Results: On average, PA, and mobility increased, and loneliness decreased from 0 to 3 and 6 months. Social exclusion was decreased at 3, but not 6 months. Most socio-demographic characteristics differed between the two organizations (% female, ethnicity, educational attainment, number of chronic conditions, mobility limitations, self-rated health). Despite this, change over time for PA, loneliness and social exclusion was similar between organizations. However, at 6 months, increased mobility was only apparent at one organization.

Conclusion: The two delivery organizations appear to serve different populations which is valuable for extending reach. Despite differences at baseline, the response to the intervention was similar for many key outcomes among participants at each delivery organization.

External funding details: This work was supported by a Grant-in-Aid from the Ministry of Health, British Columbia and a project grant from the Canadian Institutes of Health Research (CIHR; PJT-153248).

The effects of a 12-week comprehensive golf training program on functional fitness in older adults

Andrea Du Bois¹, Nicole Marcione¹, Steven Castle², George Salem¹

¹University of Southern California, ²VA Greater Los Angeles Healthcare System

Introduction: Aging is associated with declines in muscular performance, cardiovascular endurance, and balance that can impair the ability to perform activities of daily living. Multimodal physical activity interventions are effective in attenuating these declines. Golf is a popular recreational activity that contains multiple components which include walking the golf course, bending over to pick up a golf ball, and high-velocity golf swings. Therefore, the purpose of this study was to investigate the effects of a comprehensive golf training program on the functional fitness of older adults.

Methods: Eight, non-golfing older adults (Age: 70.8 ± 3.5 y) completed a two days per week, twelve-week comprehensive golf training program. Training consisted of complimentary exercises, swing training, and a gradual introduction to golf play. Pre- and post-training, participants completed a six-minute walk (6MWT), 30-second chair stand (CHAIR), 8-foot up and go (UPGO), and grip strength (GRIP) test.

Results: Following the golf-training program 6MWT (Δ = 66.4 ± 55.2 yd), CHAIR (Δ = 1.6 ± 1.6 repetitions), and UPGO (Δ = −1.1 ± 0.3 s) significantly improved (p ≤ 0.024). There were no significant changes in GRIP (Δ = 0.68 ± 3.48 kg; p = 0.622).

Conclusion: Cardiorespiratory endurance, lower body muscular strength/power and balance/agility all improved following participation in the golf training program. These improvements can be attributed to the multimodal nature of golf play. However, grip strength did not improve following the golf training program, likely due to the low-load, high-velocity movement pattern of the golf swing. Overall, these results support a comprehensive golf training program as a plausible activity intervention to improve function in older adults.

The impact of physical activity and sitting time on mobility disability-free life expectancy

Paul Gardiner, Wendy Brown, The University of Queensland

Introduction: Low physical activity (PA) and high sitting time (ST) are risk factors for development of mobility disability. However, their impact on mobility disability-free life expectancy has not been estimated.

Method: Six waves of data were collected over 15 years from 6,289 participants in the 1921-26 cohort of the Australian Longitudinal Study on Women’s Health. Self-report data were collected on mobility disability (limited ability to climb several flights of stairs and walk 500 metres), PA (low = 0-599, high = 600+ MET minutes/week) and ST (low = 0-7.99, high = 8+ hours/week). Mortality was determined by linkage to the National Death Index. Total life expectancy and mobility disability-free life years were estimated using continuous-time multi-state survival models.

Results: Life expectancy was higher in high PA women (8.6 [95% CI: 7.9, 9.1] and 9.9 [9.5, 10.3] years for high and low ST respectively) than low PA women (8.1 [7.7, 8.5] years and 9.5 [9.1, 9.8] years for high and low ST respectively), and 1.3 and 1.4 years higher in the low ST groups within each PA category. The proportion of remaining years that were mobility disability-free was higher in high PA women (54.7 [53.0, 56.5]% for high ST and 58.6 [56.3, 60.8]% for low ST), than in low PA women (40.7 [38.7, 41.5]% for high ST and 48.5 [47.6, 49.3]% for low ST).

Conclusion: ST had a greater impact on total life expectancy than PA, whereas PA had a greater impact on years lived without mobility disability. Targeting both behaviours will ensure longer and healthier lives for older women.

Device-measured and self-reported sedentary behaviour and quality of life: a prospective study of community-dwelling older men.

Barbara J. Jefferis¹, Daniel Aggio¹, Lucy Lennon¹, Sarah Ash¹, Olia Papacosta¹, Goya Wannamethee¹, Peter Whincup²

¹University College London, ²St George’s, University of London

Background: In older adults, structured exercise is associated with better quality of life (QoL), but associations with sedentary behaviours (SB) are less clear. We investigate how SB (total and types) are prospectively related to QoL, and whether SES or presence of mobility limitations modify associations.

Methods: Cohort of men recruited in UK primary care practices. In 2010-12 1566/3137 men (aged 71-91 years) wore a GT3x Actigraph and self-reported types of SB, occupation, education and functional limitations. In 2014 Older People’s QoL scale was completed. Regression models investigated associations between SB and QoL in 844 men with sufficient data. Interactions with SES and functional limitations were tested.

Results: Men spent 71% of their day sedentary (<100 counts/minute). Total SB (accelerometer-measured or self-reported) did not vary by education or occupation, but men with less education and manual occupation reported more TV and car-based SB, and less computer and reading SB. Men with mobility limitations had higher total accelerometer and self-report SB and TV SB than men without. Mean QoL was 55.8 (SD6.5). Each additional hour of total accelerometer-measured, self-reported and TV SB were associated with poorer QoL; -0.89(95%CI -1.30. -0.48), -0.13(95%CI -0.17, -0-09) and -0.08(95%CI -0.11, -0.05). Associations between SB and QoL were not modified by SES or mobility limitations, except that accelerometer-measured SB was only associated with lower QoL in mobility-limited men.

Conclusion: In highly sedentary older men, higher total accelerometer and self-report SB and TV SB time were prospectively associated with lower QoL, mostly regardless of mobility limitations and SES.

External funding details: The British Regional Heart study is supported by British Heart Foundation grants (RG/08/013/25942, RG/13/16/30528). The British Heart Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Why do older adults start and continue to walk with organised walking groups?: A qualitative systematic review

Nicky Laing¹, Ailsa Niven¹, Samantha Fawkner¹, Anne Martin², Paul Kelly¹

¹University of Edinburgh, ²University of Glasgow

Introduction: Older adults are one of the least active groups within the UK, and the Government recommends walking for older adults to meet PA guidelines (Department of Health, 2011). Group walking also provides shared experiences and social opportunities (Killingback, 2017). Understanding why older adults start and continue to walk in groups will help promote walking. The purpose of this qualitative systematic review was to identify why older adults start and continue walking in organised groups. Factors relating to starting, continuing will be determined, including overlap.

Method: Eleven databases were searched with keywords: walking/PA; older adult terms; and walking program(mmes) terms. Inclusion criteria comprised walkers aged 60 plus, attendance at walking groups up to 6 months (initiation phase) and 6 months plus (continuing phase). PRISMA guidelines, including PROSPERO registration, were followed. Thematic synthesis methodology was undertaken.

Results: Analysis is underway, with findings complete for ISPAH. Fourteen worldwide studies were identified for the qualitative review from 73 quantitative/qualitative combined eligible studies (9645 records identified, 9365 irrelevant and 280 full text screened). Seven studies reported initiation and continuing findings, the other seven initiation only. Preliminary findings align with the social/ecological model: individual (e.g history of walking); social (e.g companionship) and environmental (e.g walker safety). Many reasons for starting/continuing are the same but there are key differences.

Conclusion: Older adult group walkers worldwide report similar reasons for starting and continuing to walk with groups. Specific factors relating to health status, preferred environment, and older age, may assist with adherence.

External funding details: Paths for All SCO25535

A wearable technology-based intervention for breast cancer survivors: the ACTIVATE Trial

Brigid Lynch¹, Nga Nguyen¹, Marina Reeves², Melissa Moore³, Dori Rosenberg⁴, Terry Boyle⁵, Jeff Vallance⁶, Christine Friedenreich⁷, Dallas English⁸

¹Cancer Council Victoria, ²The University of Queensland, ³St Vincent’s Hosptial, ⁴Kaiser Permanente Washington Health Research Institute, ⁵University of South Australia, ⁶Athabasca University, ⁷Alberta Health Services, ⁸The University of Melbourne

Introduction: The benefits of physical activity after breast cancer are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial evaluated a 12-week intervention (Garmin Vivofit2^®; a behavioural feedback and goal-setting session; five telephone-delivered health coaching sessions) designed to increase moderate-vigorous physical activity (MVPA) and reduce sedentary behaviour in this population.

Methods: We recruited and randomised 83 inactive, postmenopausal women (who had finished primary treatment for stage I-III breast cancer) to an intervention or control group. MVPA and sedentary behaviour were measured at baseline (T1) and end-of-intervention (T2), using the Actigraph^® GT3X+ (MVPA) and the ActivPAL^™ (sedentary behaviour). Actigraph^® 60 second epoch data were summarised using the triaxial cutpoint for MVPA (2691 counts per minute). Intention-to-treat linear mixed models were used to examine between-group differences post-intervention.

Results: Retention in the trial was high, with 80 (96%) participants completing T2 data collection. At T2, there was a significant between-group difference in MVPA of 68.7 min/week (95% CI: 21.7, 115.6). The trial resulted in a significant decrease in both total sedentary time and sedentary time accrued in prolonged bouts (≥20 mins), with between-group differences of 36.6 min/day (95% CI: -71.7, -1.6) and 42.1 min/day (95% CI: -82.7; -1.6), respectively.

Conclusion: Results of the ACTIVATE Trial suggest that wearable technology presents an inexpensive, scalable opportunity to facilitate a more active lifestyle for cancer survivors. Whether such wearable technology-based interventions can create sustainable behavioural change should be assessed in future research.

External funding details: WCRF International Regular Grant Program 2015/1397

Physical activity and the older adult: A pragmatic, multi-perspective view of driving behaviour change in an ageing population: The REtirement in ACTion (REACT) study. A large-scale, multi-centre, pragmatic randomised control trial to prevent mobility-related disability in older adults. Successful recruitment strategies and findings from the baseline data

Janet Withall¹, Colin Greaves², Janice Thompson², Max Western³, Jolanthe de Koning¹, Jessica Bollen⁴, Sarah Moorlock², Vasiliki Zisi⁵, Afroditi Stathi¹

¹University of Bath, ²University of Birmingham, ³University of Southampton, ⁴University of Exeter, ⁵University of Thessaly

During old age, there is a population-wide transition towards frailty and increased demand for health and social care services. The US-based LIFE Study showed that improving fitness and leg muscle strength can prevent this transition to mobility-related disability in moderately frail older people. However, the LIFE intervention was highly intensive, so cost-effective “real-world” versions are urgently needed.

Aims: To adapt the LIFE intervention to a large, pragmatic UK-based multi-site trial to prevent progression to mobility-related disability in moderately frail older adults.

Methods: Using behaviour change theory and consultation with service users, service providers and experts in the field, we developed a logic model, identified targets for change and behaviour change strategies.

Results: REACT successfully recruited 777 participants at high risk for mobility-related disability. Recruitment strategies and challenges and participant baseline profiles will be presented. Twenty-seven REACT intervention groups are receiving twice-weekly aerobic, muscle-strengthening, flexibility and balance group exercise sessions (for 12 weeks), followed by weekly sessions for 9 months. Participants also attend a social/education programme to support sustainable lifestyle changes. REACT is delivered by qualified exercise professionals in voluntary sector and local authority settings.

Conclusions: This first international presentation of REACT baseline findings describes a complex, evidence-based intervention that has successfully engaged a hard to recruit group through targeted approaches that could be applied to other community-based physical activity programmes. The central role of local partners in REACT delivery has embedded skills in communities and built in future sustainability.

External funding details: REACT is funded by the English National Institute of Health Research

Session: Physical activity interventions for youths

Acute improvements in mathematics performance following randomisation to the Daily Mile (versus sedentary controls) in primary school children

Jade Morris, Andy Daly-Smith, Jim McKenna, Victoria Achrbold, Leeds Beckett University

Introduction: Despite its intuitive appeal, evidence regarding the impact of The Daily MileTM (TDM) on academic performance (AP) is limited. School based interventions assessing the acute impact of physical activity (PA) on AP and cognition suggest variable effects. This study explored the immediate effects of TDM on AP (mathematics fluency).

Method: In a randomised control trial, children from six schools (n = 212, age = 9.03 ± 0.56, 59% girls), already participating in TDM, were individually allocated to either TDM (approximately 15-minutes aerobic exercise, n = 112) or control (normal academic lessons, excluding mathematics, n = 100). Pupils completed the Mathematics Addition and Subtraction, Speed and Accuracy Test (MASSAT) three times; familiarisation one-week prior, immediately before, and 5-minutes after both conditions. An ANCOVA (controlling for age, BMI and pre-test score) assessed changes in MASSAT total score (TS: total correct answers – total incorrect answers) and differences between control and TDM minutes in Moderate-to-Vigorous Physical Activity (MVPA) assessed by GT9 Link waist worn accelerometers using Evenson cutpoints.

Results: Baseline age, height, weight, BMI percentiles and MASSAT TS did not differ between conditions (p > .05). Greater post-test MASSAT TS’s were observed for TDM participants (M = 29.38 ± 0.69) vs controls (M = 28.0 ± 0.73; p = 0.038, 95% CI [0.219, 7.54], η2p = 0.021). TDM participants accumulated significantly more minutes of MVPA (M = 10.47 ± 2.94) compared to controls (M = 0.48 ± 0.92; p = 0.000, 95% CI [9.38, 10.61], η2p = 0.833).

Conclusion: TDM accumulated an average 9.99 minutes/day additional MVPA, leading to significant improvements in mathematics fluency performance versus control. Subsequently, TDM may be used strategically prior to mathematics sessions to enhance performance. Longer-term studies are required to assess outcome and implementation.

“It’s a battle . . . You want to do it, but how will you get it done?”: Teachers’ and principals’ perceptions of implementing additional physical activity in school for academic performance

Vera van den Berg¹, Rosanne Salimi¹, Renate De Groot², Jelle Jolles³, Mai Chinapaw¹, Amika Singh¹

¹VU University Medical Center, ²Open University Heerlen, ³VU University

Purpose: School is an ideal setting to promote and increase physical activity (PA) in children. However, implementation of school-based PA programmes seems difficult, in particular due to schools’ focus on academic performance and a lack of involvement of school staff in program development. The potential cognitive and academic benefits of PA might increase chances of successful implementation. Therefore, the aim of this qualitative study was: (1) to explore the perceptions of teachers and principals with regard to implementation of additional PA aimed at improving cognitive and academic performance, and (2) to identify characteristics of PA programmes that according to them are feasible in daily school practice.

Methods: Twenty-six face-to-face semi-structured interviews were conducted with primary school teachers (grades 5 and 6) and principals in The Netherlands, and analysed using inductive content analysis.

Results/Conclusion: Teachers and principals expressed their willingness to implement additional PA if it benefits learning. Time constraints appeared to be a major barrier, and strongly influenced participants’ perceptions of feasible PA programmes. Teachers and principals emphasised that additional PA needs to be short, executed in the classroom, and provided in “ready-to-use” materials, i.e., that require no or little preparation time (e.g., a movie clip). Future research is needed to strengthen the evidence on the effects of PA for academic purposes, and should examine the forms of PA that are both effective as well as feasible in the school setting.

External funding details: The Netherlands Organisation for Scientific Research (NWO)

Did executive function, behavioral self-regulation, and school related well-being mediate the effect of school-based physical activity on academic performance in numeracy in ten-year-old children? The Active Smarter Kids (ASK) study

Katrine Nyvoll Aadland¹, Eivind Aadland², John Roger Andersen¹, Arne Lervåg³, Vegard Fusche Moe¹, Geir Kåre Resaland¹, Yngvar Ommundsen⁴

¹Western Norway University of Applied Sciences, ²Wester Norway University of Applied Sciences, ³University of Oslo, ⁴Norwegian School of Sports Sciences

Inconsistent findings exist for the effect of school-based physical activity interventions on academic performance. The Active Smarter Kids (ASK) study revealed a favorable intervention effect of school-based physical activity on academic performance in numeracy in a subsample of 10-year-old elementary schoolchildren performing poorer at baseline in numeracy. Aiming to explain this finding, we investigated the mediating effects of executive function, behavioral self-regulation, and school related well-being in the relation between the physical activity intervention and child’s performance in numeracy. An ANCOVA model with latent variable structural equation modeling was estimated using data from 360 children (the lower third in academic performance in numeracy at baseline). The model consisted of the three latent factors as mediators; executive function, behavioral self-regulation, and school related well-being. We found no mediating effects of executive function, behavioral self-regulation or school related well-being in the relationship between the ASK intervention and academic performance in numeracy (p ≥ .256). Our results suggest that the effect of the intervention on performance in numeracy in the present sample is not explained by change in executive function, behavioral self-regulation, or school related well-being. We suggest this finding mainly could be explained by the lack of effect of the intervention on the mediators, which might be due to an insufficient dose of physical activity.

Clinicaltrials.gov: NCT02132494.

External funding details: This work was supported by the Research Council of Norway under grant number 221047/F40, and the Gjensidige Foundation under grant number 1042294.

Reviewing peer-to-peer physical activity interventions with youth: interventions, rationales and effects

Julie Hellesøe Christensen¹, Peter Elsborg², Charlotte Demant Klinker², Glen Nielsen¹, Peter Bentsen²

¹University of Copenhagen, ²Steno Diabetes Center Copenhagen

Introduction: Peer-to-peer approaches have shown positive effects within different areas and settings for the promotion of health and well-being. Such approaches may be particularly relevant in interventions targeting youth, since young people are especially amenable to peer influences. Previous reviews have established effects of peer-to-peer interventions with youth related to e.g. tobacco, alcohol, sexual health, and nutrition. However, peer-led interventions with youth have not previously been reviewed with a primary focus on physical activity interventions.

Methods: A systematic search was conducted in five databases (Embase, Pubmed, Scopus, SPORTDiscus, and Web of Science) to explore peer-to-peer physical activity interventions with youth (age 10-25) in a peer-leader role. Two reviewers screened 1577 abstracts. Forty-five studies were selected for in-depth analysis.

Results: The review characterises and analyses the diverse range of physical activity-related peer interventions involving youth peer leaders. The study synthesises and discusses intervention characteristics; theoretical approaches; the education, role and influence of peer leaders; and health-related effects on peer leaders and participants. School- and community-based intervention studies from Africa, Asia, Australia, Europe, and North America have been included in the review.

Conclusion: The synthesis and analysis provides a knowledge base of rationales, theoretical approaches and types of physical activity interventions, as well as health-related effects on peer leaders and participants. These understandings should be of use for researchers and practitioners working with peer-to-peer approaches in this field.

External funding details: The research is funded by the Novo Nordisk Foundation (NNF17SH0026986) and Innovation Fund Denmark (7038-00204B).

The acceptability and feasibility of a novel peer-led school-based physical activity intervention for adolescent girls: The girls’ peer activity (G-PACT) project

Michael Owen¹, Charlotte Kerner², Lisa Newson³, Robert Noonan¹, Whitney Curry⁴, Maria-Christina Kosteli¹, Stuart Fairclough¹

¹Edge Hill University, ²Brunel University, ³Liverpool John Moores University, ⁴Cornwall Council

Introduction: This study assessed the feasibility and acceptability of a novel peer-led physical activity (PA) intervention for adolescent girls aged 13-14 years.

Methods: The intervention employed a three-tier peer-led model underpinned by Social Cognitive Theory (SCT) and Self-Determination Theory (SDT). The 8-week intervention was delivered in three schools and involved 233 participants. Each school recruited 12-16 girls to become PA-leaders, who received leadership training delivered by undergraduate PA students, who subsequently acted as their intervention mentors and role models. The PA-leaders were encouraged to support their school peers to engage in more PA. Two of the schools provided organised after-school PA opportunities which the PA-leaders actively promoted. The acceptability, practicality, engagement, and perceived success of the intervention was investigated using focus groups and interviews. Qualitative analysis adopted deductive and inductive methods, using SCT and SDT as thematic frameworks, and then exploring additional emergent themes.

Results: The intervention was perceived as feasible and acceptable between mentors (n = 6) and leaders (n = 47). However, the relationship between leaders and their peers (n = 196) suggested uncertainty in delivery and engagement Disparity was reported from the peers in how much and what information was conveyed to them by their PA-leaders.

Conclusions: This intervention was reported to be feasible and acceptable among mentors and PA-leaders. Teachers were supportive of the intervention and the intervention demonstrates innovation incorporating undergraduate students as mentors and role models to adolescent girls. Further research is needed to clarify the roles and responsibilities for the PA-leaders.

External funding details: This research was funded by Edge Hill University.

Results of a systematic and theoretical approach to scaling-up an efficacious school-based physical activity intervention for adolescents: ‘Physical Activity for Everyone’

Matthew Mclaughlin¹, Tom McKenzie², Rachel Sutherland², Libby Campbell², Nicole Nathan², Karen Gilham², Chris Rissel³, Nicola Kerr⁴, Ross Morrison⁵, David Lubans⁶, Philip Morgan⁶, Luke Wolfenden², John Wiggers²

¹University of Newcastle, Hunter New England Population Health, ²Hunter New England Population Health, ³NSW Office of Preventive Health, ⁴Mid North Coast Local Health District, ⁵Department of Education, ⁶PRC for Physical Activity & Nutrition, University of Newcastle

Introduction: Comprehensive school-based physical activity (PA) interventions exist which are efficacious when tested under research conditions, however they often require adaptation for implementation at scale. We report the results of scaling-up Physical Activity 4 Everyone (PA4E1), an efficacious PA intervention conducted in Australian secondary schools.

Method: In the original cluster RCT, the PA4E1 intervention was delivered in five Australian secondary schools. Through the utilisation of implementation and scale-up frameworks and in co-production with researchers and end-users, including principals, teachers, and students, PA4E1 was subsequently scaled for delivery in 38 schools, using a four-stage iterative process which included; 1) collection of data on barriers and enablers of the intervention; 2) addressing identified barriers by developing implementation strategies using the Theoretical Domains Framework; 3) consultation with key stakeholders to prioritise these implementation strategies, and 4) an expert advisory group review of the scaled intervention.

Results: The implementation trial retains the original efficacy intervention’s focus on achieving seven school PA practices, however has made modifications to the implementation support strategies by replacing: 1) face-to-face teacher professional learning with primarily online delivery methods; 2) project specific learning with accredited education sector courses; 3) verbal prompts and manually generated feedback reports with automated prompts and feedback via an online portal; 4) the external change agent with both an internal (School Champion) and an external (Support Officer) change agent; and 5) paper resources with an online portal. Conclusion: Five main modifications were made to scale the intervention, in line with implementation and scale-up frameworks.

Evidence into Practise to increase children’s physical activity through schools settings: An exploration of pupils’ experiences of participating in a school based running programme: Marathon Kids

Anna Chalkley¹, Ash Routen², Jo Harris², Lorraine Cale², Trish Gorely³, Lauren Sherar²

¹National Centre for Sport and Exercise Medicine, Loughborough University, ²1.National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, ³Department of Nursing, University of the Highlands and Islands

Introduction: There is a growing interest in school-based interventions providing additional physical activity outside of physical education. Subsequently, many school based running programmes are being implemented across the UK in a grass roots style movement. However, research on the implementation of these programmes is relatively underdeveloped. Therefore, the aim of this study was to qualitatively explore pupils’ experiences of participating and identify barriers and facilitations to their participation.

Methods: Nine semi-structured focus groups were conducted with a purposeful sample of 55 pupils (27 girls and 28 boys) aged between five and ten years. Pupils were recruited from five schools in England who had implemented the programme for a minimum of one academic year. Transcripts were analysed using an inductive thematic approach.

Results: Pupils identified a range of organisational, interpersonal and intrapersonal barriers and facilitators to participation. Perceived facilitators included enjoyment, motivation to achieve a ‘personal best’ and peer support and acceptance. Other important facilitators included the use of rewards and incentives, time spent outdoors, and having a structured/formal opportunity to participate in activity during lunchtime. Cheating, inclement weather and the school’s weather policy, and lack of playground space were all identified as barriers.

Conclusions: Pupils’ needs and preferences for participating in a physical activity programme should be taken into consideration prior to implementation in school. Furthermore, schools should evaluate the delivery of the programme, and what impact it is having on pupils, to allow adaptation and tailoring.

External funding details: This study was funded by London Marathon Events Ltd and Kids Run Free

Session: Promoting physical activity: From mechanisms to systems

Development of an agent-based model to explore population patterns and trends of leisure-time physical activity

Leandro Garcia¹, Ana Diez Roux², André Martins³, Yong Yang⁴, Alex Florindo³

¹University of Cambridge, ²Drexel University, ³University of Sao Paulo, ⁴University of Memphis

Introduction: Most of the actions aiming to promote leisure-time physical activity (LTPA) at population level showed small or null effects. Approaching the problem from a systems science perspective may shed light on the reasons for these results. We developed an agent-based model to explore how the interaction between psychological attributes and built and social environments leads to the formation and evolution of LTPA patterns in adult populations.

Method: The modeling process consisted of four stages: (1) conceptual model development, (2) model implementation, (3) parametrization, and (4) consistency and sensitivity analyses. The model represents a stylized community containing two types of agents: people and LTPA sites. People interact with each other (proximal network and perceived community) and with the built environment (LTPA sites) over time. Decision-making is based on the person’s intention to practice LTPA, conditioned to the perceived environment. Each iteration is equivalent to one week and we assessed a period of 10 years.

Results: The model was able to reproduce population temporal trends of intention and LTPA reported in literature. Sensitivity analyses indicated that population patterns and trends of intention and LTPA were highly affected by the relationship between person’s behavior in the preceding week and his current intention, the person’s access to built and social environment, and the proportion of LTPA sites.

Conclusions: The proposed agent-based model is suitable to explore the formation and evolution of LTPA patterns among adults, considering the dynamic interaction between individuals’ psychological attributes and the built and social environments in which they live.

External funding details: LG has worked under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence, which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust. LG was also supported by scholarships from the Brazilian Coordination for the Improvement of Higher Education Personnel. AA receives a fellowship from the Brazilian National Council for Scientific and Technological Development (CNPq) (grant 306635/2016-0).

Putting physical activity and sedentary behaviours into context: a systems science perspective for measuring the interplay of multiple lifestyle health behaviours in daily living

Tapio Paljarvi, Nichola Gale, Shantini Paranjothy, Cardiff University

Introduction: Interventions targeting multiple health behaviours may be more effective than interventions targeting only one health behaviour. The purpose of this study is to establish the multidirectional relationships between seven modifiable lifestyle risk factors (alcohol use, diet, sleep, stress, physical activity (PA), sedentary behaviours (SB), and tobacco use) by using a systems science perspective.

Methods: This study is part of a larger prospective two-site (UK and US) pilot study on lifestyle cancer risk behaviours. We aim to recruit a convenience sample of up to 60 healthy community-living adults aged 18-65 who live in the study catchment areas in Wales, UK (50%), and Ohio, US (50%). The study consists of two research laboratory visits and a 14-day data collection period between the visits, during which participants will complete daily diaries on their health behaviours, and they will wear a research-grade accelerometer (Actigraph GT9X Link) on their wrist to objectively measure PA, SB, and sleep.

Results: The results will be analysed to identify the key components of PA and SB systems, to determine how the components are related, what feedback loops operate in the system, what are potential barriers and sources of resistance to change, and to identify potential behavioural outcome delays.

Conclusion: Using a novel systems science perspective on multiple interrelated health behaviours, this study will improve our understanding on how lifestyle health behaviours are interrelated, and how to manage interdependence and potential non-linearity across multiple health behaviours in behavioural change interventions.

External funding details: Funding: Cancer Research UK International Innovation

The influence of social network structure on adolescents’ level of physical activity

Tracie Barnett¹, Henderson Melanie²

¹Institut Armand Frappier- INRS, ²Université de Montréal

We examined the relationship between the structure and composition of adolescents’ person social networks, and their levels of physical activity, using pilot data collected in the QUALITY study, an ongoing investigation on the natural history of obesity. Participating adolescents (egos) nominated up to 10 significant others (alters). Egos reported alter behaviours (e.g. frequency of being physical active: never to very often) and characteristics (e.g. frequency of interactions; proximity of residence) as well as ties between alters (whether or not friends knew each other and how well). Sedentary time was measured with accelerometers worn for 7 days (minimum 4 days, 10 hours per day). Relationships were examined with Spearman rank correlations.

Social network analysis was performed in 46 adolescents (mean age 16.3 yrs). On average each ego nominated 6.6 alters, and 51% lived outside ego’s neighbourhood. Across networks, the average proportion of frequently physically active alters was 30%. Average degree centrality (an indicator of greater ties between alters) was 0.46, i.e. on average each alter was connected to 46% network members.

Overall, sedentary time was positively correlated with network size (r = 0.3) and with the proportion of friends living outside the neighbourhood (r = 0.4); it was negatively correlated with normalized average degree centrality (r = −.3) (i.e. the most sedentary adolescents had fewer friends who knew each other).

Findings suggest that fewer opportunities for face to face interactions may be contributing to increased sedentary time. The findings help identify key social and environmental targets to enhance interventions to reduce sedentary behaviour.

To what extent gender plays a role in physical activity parenting practices

Louise C Mâsse¹, Nicole S Carbert¹, Teresia M O’Connor², Tom Baranowski², Mark R Beauchamp¹, Sheryl O Hughes²

¹University of British Columbia, ²Baylor College of Medicine

Purpose: Parents play a critical role in socializing children’s physical activity (PA) but the extent to which mothers and fathers differ in their PA parenting practices remains understudied. This study examined differences in mothers’ and fathers’ activity-related parenting practices while considering the moderating effect of child’s gender.

Method: Canadian parents (n = 602) of 5- to 12-year old children were recruited from a web-based panel [Mean age = 42; 51% mothers; 51% white; 44% income below median]. PA parenting practices were measured using an item bank composed of 3 domains measuring 12 constructs: control – pressure; autonomy support: outdoor-encouragement, general-encouragement, guided choice, involvement/praise, and rewards; c) structure: co-participation, expectations, facilitation, modeling, and outdoor-restriction, and indoor-restriction. The scales were validated using confirmatory factor analysis and Rasch analysis (α ranged from .76 to .92 and properties invariant by gender of parents). Multivariate analyses of covariance, which controlled for household income, were computed in Stata software 15.0.

Results: Mothers reported using fewer pressuring PA practices than fathers (p < .05). Parents reported fewer pressure- and expectation-related PA practices for girls relative to boys (p < .05). Additionally, there was evidence of a moderating association of child gender as fathers reported less outdoor-restrictions for boys relative to girls than mothers (p < .05).

Conclusion: Gender differences in PA exist, with boys typically more active than girls. The extent to which parenting practices reinforce this socialization process needs to be further investigated in light of the study findings. Furthermore, the findings underscore the importance of de-emphasizing socialization processes that may undermine girls’ participation in PA.

What physical activity parenting practices relate to children’s sense of autonomy, competence, relatedness, and motivation to be physically active?

Louise C Mâsse¹, Nicole S Carbert¹, Teresia M O’Connor², Yingyi Lin¹, Tom Baranowski², Mark R Beauchamp¹, Sheryl O Hughes²

¹University of British Columbia, ²Baylor College of Medicine

Purpose: This study examined whether physical activity (PA) parenting practices are associated with children’s motivation to be active and whether this association is mediated by children’s sense of autonomy, competence and relatedness.

Method: Participants were 124 parents (Mean age = 44; 52% mothers; 56% white; 37% income below median) and their children aged 10 to 13 (52% boys). PA parenting practices were measured using an expert-developed item bank composed of 3 main domains of parenting practices: control, autonomy support and structure. A questionnaire administered to children assessed PA motivation and three self-determination constructs (autonomy, competence, and relatedness). Stata version 15.0 was used to conduct the path analyses, which adjusted for child’s age, gender and household income.

Results: Controlling and autonomy supportive parenting practices were significantly (p < .05) associated with children’s motivation to be physically active (β = −.44 and .46, respectively) as well as being significantly (p < .05) associated with children’s autonomy (β = −.38 and .58, respectively), competence β = −.22 and.47, respectively) and relatedness (β = −.25 and .43, respectively). The associations between controlling parenting practices and children’s motivation weakened when children’s autonomy, competence and relatedness were entered as mediators but remained significant (β = −.31, p = .002). In contrast, the association between autonomy supportive parenting practices was fully mediated when children’s autonomy, competence and relatedness were accounted for (β = .16, p = 0.11).

Conclusion: Our findings highlight how controlling and autonomy supportive PA parenting practices may be associated with children’s motivation to be physically active and the potential importance of addressing these aspects in lifestyle behaviour modification interventions.

Play as a context for motor development in preschool children: a compositional analysis

Dr Lawrence Foweather¹, Matteo Crotti¹, Till Utesch², Jonathan Foulkes³, Mareesa O’Dwyer⁴, Nicola Ridgers⁵, Zoe Knowles¹, Stuart Fairclouh³, Gareth Stratton⁶

¹Liverpool John Moores University, ²University of Münster, ³Edge Hill University, ⁴Government of Ireland, ⁵Deakin University, ⁶Swansea University

Introduction: Play is suggested as an important context for physical development in preschoolers. However, empirical studies examining associations between fundamental movement skills (FMS) and play behaviors are lacking. This study aimed to examine associations between play behaviours during recess and FMS in typically developing preschool children.

Method: One hundred and thirty-three children (55% male; age mean 4.7 ± 0.5 yrs) from twelve preschools completed assessments of six locomotor and six object-control skills, which were video recorded for later analysis (Champs Motor Skill Protocol). A modified version of the System for Observing Children’s Activity and Relationships during Play (SOCARP) was used to record preschool children’s play behaviors (including activity level, activity type, group size and social interaction). A compositional data analysis was undertaken to examine associations between these play behaviours and FMS.

Results: For activity level, total skills score was negatively associated with very active only (β = −1.3080, p = 0.0249). For activity type, total skills score was positively associated with time spent in play without equipment (β = 1.1772, p = 0.0021), but negatively associated with locomotion activities (β = −1.1527, p = 0.0202). No associations were found between total skills score and group size or social interaction.

Conclusion: The findings suggest that play behaviors during recess may not be associated with FMS development. Preschool children may need more structured play or a richer playground environment to foster the development of FMS (including a wider variety of fixed and mobile play equipment). However, future studies should consider more detailed systematic observation tools to assess play behaviors and observe children for a longer duration.

Physical activity and DNA methylation in peripheral blood: results from the Melbourne Collaborative Cohort Study

Eline H. van Roekel¹, Pierre-Antoine Dugué², Dallas R. English², JiHoon E. Joo³, Ee Ming Wong³, Enes Makalic⁴, Melissa C. Southey³, Graham G. Giles², Roger L. Milne², Brigid M. Lynch²

¹Maastricht University, ²Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, ³Genetic Epidemiology Laboratory, Department of Clinical Pathology, The University of Melbourne, ⁴Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health

Introduction: Emerging evidence suggests that physical activity may exert beneficial effects on health via DNA methylation. We performed an epigenome-wide association study of physical activity and DNA methylation in peripheral blood.

Methods: DNA methylation was measured using the Illumina Infinium HumanMethylation450K BeadChip array in peripheral blood samples collected from participants (N = 1,249) in the Melbourne Collaborative Cohort study (MCCS). The International Physical Activity Questionnaire (IPAQ) was used to assess metabolic equivalent (MET)-hours/week of total and leisure-time physical activity. Linear mixed modelling was performed to assess cross-sectional associations between the physical activity measures and DNA methylation at 484,826 individual CpG sites, with adjustment for potential confounders and batch effects.

Results: Participants (67.5% male, mean age: 69.1 years) reported a median of 17.3 (interquartile range: 6.9, 34.7) and 0.0 (0.0, 12.0) MET-hours/week in total and leisure-time physical activity, respectively. Significant associations (P-values < 10⁻⁷) were found for total MET-hours/week of physical activity with methylation at 2 CpG sites. Suggestive associations (P-values < 10⁻⁵) were observed for 13 additional CpG sites with total MET-hours/week and for 7 CpG sites with leisure-time MET-hours/week. Some of these CpG sites are annotated to genes involved in inflammation (SAA2, SNIP1, CYSTM1), brain function (BSN), energy metabolism (AKD1) and cancer development (SNIP1, KFL6).

Conclusion: Physical activity may be associated with DNA methylation in peripheral blood at specific genes potentially related to disease development. Further research using objective activity data and larger sample sizes is warranted.

External funding details: This work was supported by the Australian National Health and Medical Research Council (NHMRC) (grant 1088405). MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057 and 396414 and by infrastructure provided by Cancer Council Victoria. Cases were ascertained through the Victorian Cancer Registry (VCR) and the Australian Cancer Database (Australian Institute of Health and Welfare). The nested case-control methylation studies were supported by the NHMRC grants 1011618, 1026892, 1027505, 1050198, 1043616 and 1074383. MCS is an NHMRC Senior Research Fellow (1061177). EHvR was supported by an Endeavour Research Fellowship from the Department of Education and Training of the Australian Government (6059-2017).

Monday, 16:00–17:00

Session: Interventions to promote physical activity in schools

Implementation and maintenance of a school-based multicomponent physical activity intervention

Søren Smedegaard¹, Kristine Luise Lindhardt Clausen², Thomas Skovgaard³, Lars Breum Christiansen³

¹FIIBL/SDU, ²University of Southern Denmark, ³University of southern Denmark

Introduction: School-based physical activity interventions have to a large extent shown no or small effects, which could be caused by incomplete implementation. Current research in the field focuses mainly on measuring effects, whereas factors related to implementation and maintenance has been explored and reported much less. The purpose of this study is to explore essential implementation and maintenance factors of a school-based intervention through the teachers’ perspective.

Method: The study is based on the multicomponent intervention project ‘Move for Well-being in Schools’. A collective case study is used and 18 teachers from the five best implementing schools participated in focus group interviews 20 months after intervention start-up. Durlak and Dupre’s implementation categories constituted the analytical frame, and results are related to characteristics of the teachers, the intervention and the school system.

Results: The interviews revealed differences in implementation and maintenance across components and between schools. Eight factors were consistent for higher implementation and maintenance: development of teacher competence and self-efficacy; shared decision-making and agreement to participate; school management prioritising, planning and structuring; long-term perspective; all-teachers-participation; preparation time; on-going support from the expert team; and compatibility between the intervention and school structure and capacity.

Conclusion: This study points the attention to eight practical factors, which future school-based interventions should attend to. Most importantly precautions should be taken to secure that interventions are compatible with the schools and teachers and that the intervention can be adapted without losing effect.

External funding details: The study is funded by a donation from the non-profit foundation TrygFonden, Denmark.

Translation and scale-up of interventions to reduce sedentary behaviour and increase physical activity in schools and workplaces. Scaling up the Transform-Us! program to get Australian children moving more and sitting less

Jo Salmon¹, Harriet Koorts², Adrian Bauman³, David Lubans⁴, Chris Lonsdale⁵, Amanda Telford⁶, Nicola Ridgers², Karen Lamb², Lisa Barnett², Lauren Arundell², Helen Brown², Jacqui Della Gatta², Anna Timperio²

¹Deakin University, ²Institute for Physical Activity and Nutrition, Deakin University, ³Charles Perkins Centre, University of Sydney, ⁴Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, ⁵Institute for Positive Psychology and Education, Australian Catholic University, ⁶School of Education, RMIT

Introduction: The implementation of efficacious strategies to increase children’s activity and reduce prolonged sitting at scale is a major challenge in public health research, policy and practice. The Transform-Us! program incorporated novel pedagogical and environmental strategies to successfully target these health behaviours and children’s health. Transform-Us! is currently being disseminated state-wide as a ‘real-world’ program embedded into education and health practice and policy. Key learnings and challenges faced in each phase of the Transform-Us! evolution will be presented.

Methods: Transform-Us! implementation involves teacher professional development to deliver active lessons and active breaks throughout the school day, as well as active homework. Changes to the school environment include standing easels/desks, timers, access to novel sport/circus equipment in the classroom, and playground line markings. Adaptations to the training and material delivery have been made based on extensive piloting. Real-world implementation and effectiveness of the Transform-Us! program ‘at scale’ in partnership with key stakeholders commenced in 2017 and will continue to 2021. All Victorian primary schools (n = 1,786) will have access to the program.

Results: Considerations in translating the efficacious Transform-Us! program into a scalable program include: training delivery, material accessibility, equipment costs, program fidelity, adherence etc. Evaluation is occurring at the Partner/State, school and individual levels to determine the program’s reach, effectiveness, adoption, implementation and maintenance.

Conclusion: Learnings from this implementation trial will provide valuable information regarding the challenges and successes of research to practice translation. The generalisability of this school-based approach is also being tested in the UK.

External funding details: NHMRC Partnership Project grant

Exploring Canadian elementary school teachers’ self-efficacy to instruct physical education

Stephanie Truelove¹, Andrew Johnson², Shauna Burke², Trish Tucker²

¹University of Western Ontario, ²Western University

Introduction: Physical education (PE) provides students with an opportunity to be physically active, and a chance to learn, practice, and execute new motor skills. The quality of PE varies across Canada, however, as generalist teachers (i.e., teachers not specifically trained in PE) are typically responsible for instructing PE class at the elementary school level.

Objectives: This study explored the self-efficacy of generalist and specialist teachers (i.e., those specifically trained in PE) to instruct PE.

Methods: Elementary school teachers across Canada were invited via social media to take part in an online survey to examine their self-efficacy to teach PE. The Teacher Efficacy Scale for Physical Education, a valid and reliable tool, assesses four domains of teacher self-efficacy: motivation, analysis of skill, preparation, and communication. Data collection is ongoing and will cease in Spring 2018. Data will be analyzed using independent sample t-tests to compare generalist and specialist teachers’ self-efficacy for instructing PE.

Results: Mean self-efficacy scores for both generalist and specialist PE teachers for the 4 self-efficacy domains will be presented, along with any differences that may be found between groups.

Future Directions: A preliminary and detailed description of the PE instruction self-efficacy of elementary teachers in Canada will provide an important foundation upon which future research in this area can be conducted. Potential implications for school-based curriculum will also be discussed.

External funding details: This project was supported by the Mitacs Accelerate Program and the GoodLife Kids Foundation.

A school-based gamification strategy to reduce obesity: results from a pilot study

Sebastián Peña¹, Macarena Carranza², Paula Espinoza², Valeska Müller², Ricardo Cerda³, Pedro Zitko⁴, Andrea Cortinez⁵, Nicolas Loira⁶, Cristobal Cuadrado³

¹National Institute for Health and Welfare, ²Municipality of Santiago, ³University of Chile, ⁴King’s College, London, ⁵Pontifical University of Chile, ⁶Independent adviser

Background: School-based interventions have shown mixed results. Most studies have lacked enough statistical power and have been carried out in North America and Europe. We report the results of the gamification strategy and effectiveness of a pilot study in Santiago de Chile.

Methods: The Juntos Santiago cluster-randomized trial uses a gamification strategy (i.e. elements of a game, points, levels and rewards) with a strong community participation component. Participants of the pilot study were 381 children in 5th and 6th grade of three schools selected by convenience. Children voted their enrolment and collectively chose the activity reward they were playing for. The intervention consisted of a healthy snacks and steps challenge. The primary outcome was change in BMI zscore and waist circumference.

Results: Of enrolled students, 88% was examined at baseline and follow-up. Unhealthy snacks brought from home reduced by 6.5 percentage points. Data from steps challenge was not available due to encryption of activity trackers. We observed statistically significant reductions in zBMI (-0.09) and waist circumference (-0.79 cms). No difference was observed for BMI. Systolic blood pressure reduced on average 5.19 mmHg and diastolic blood pressure increased by 1.48 mmHg. The latter changes are likely due to equipment change. Results of the 2018 trial in 4000 participants will also be presented.

Conclusions: Despite the short duration of the pilot, results are promising. The gamification strategy appears to foster community engagement. Attention should be given to data extraction and quality assurance prior the beginning of the trial in 2018.

External funding details: Bloomberg Philanthropies

Using the classroom and a mix of participatory methods to engage lower education secondary school adolescents in mapping their assets to stimulate active lifestyles: the SALVO project in the Netherlands.

Gwendolijn Boonekamp¹, John Dierx²

¹HAN University of Applied Sciences, ²AVANS University of Applied Sciences

Adolescents in pre vocational education schools in the Netherlands exercise less and are less often member of organized sports organisations compared to their peers from other educational levels. Projects that have been developed and performed in stimulating physical activity in these adolescents do not seem to be effective. One of the reasons may be that many of these projects are dominated by professionals and do not take the adolescents’ perspective into account.

The SALVO project in the Netherlands introduced a different approach engaging adolescents in an earlier stage of the project: as a class they were given a voice and a role in mapping their assets and prioritizing what do with them in terms of organizing interventions within the school setting. In this way we reached all children; not only the ones interested in physical activity. Two participatory methods were used: the “structured interview matrix” and “photovoice”.

In this presentation we introduce the combined methods we used to map assets with adolescents in the secondary school settings and present the asset maps that were the result of both an inductive and deductive analysis, based on the results of the sessions in two classes in the Netherlands.

External funding details: This work was funded by the Netherlands Organisation for Health Research and Development (ZONmw) under the research programme “Sport” and co-funded by the HAN University of Applied Sciences, Institute of Sports and Exercise and the University of Applied Science of Amsterdam (HvA).

NAP SACC UK: feasibility cluster randomised controlled trial and process evaluation of an environmental intervention in nurseries and a web-based home intervention to increase physical activity, oral health and healthy eating in children aged 2–4 years

Ruth Kipping¹, Rebecca Langford¹, Rowan Brockman¹, Sian Wells¹, Chris Metcalfe¹, Angeliki Papadaki¹, James White², William Hollingworth¹, Laurence Moore³, Dianne Ward⁴, Rona Campbell¹, Bryar Kadir¹, Laura Tinner¹, Vanessa Er¹, Jane Collingwood¹, Alex Nicholson¹, Russell Jago¹

¹University of Bristol, ²Cardiff University, ³University of Glasgow, ⁴University of North Carolina at Chapel Hill

Background: The nutrition and physical activity self-assessment for childcare (NAP SACC) has shown evidence of effectiveness in the US but not the UK.

Methods: Feasibility cluster RCT including process and economic evaluations in nurseries in southwest England. Focus groups and interviews with staff and parents informed adaptation. Intervention comprised: two staff workshops; Health Visitor support to nurseries; web-based home component. Feasibility and acceptability of the intervention and methods assessed through observation and interviews. Feasibility of outcomes measures assessed at baseline and post-intervention: zBMI, accelerometer-measured physical activity and sedentary time, screen time, diet, child quality-of-life, health care usage, parental and nursery staff mediators and quality of nursery environment.

Results: Formative work resulted in: adding oral health; compliance with UK guidance; workshops led by local experts; and development of home component. 31.6% (12/38) of nurseries and 35.3% (168/476) of children recruited; no nurseries withdrew. Loss-to-follow-up was 14.2%. Interviews with four Health Visitors, 17 nursery staff and 20 parents. Feasibility and acceptability criteria were met; the intervention, trial design and methods were highly acceptable except for the home component (used by 14% of parents. There was suggestion of promise in intervention compared to control nurseries post-intervention for: accelerometer-measured total and moderate-to-vigorous PA; snacks; screen-time; proportion overweight/obese. Many parental and nursery knowledge and motivation mediators improved. Average cost of intervention: £1,184/nursery.

Conclusions: NAP SACC UK is feasible and acceptable, except for the home component, and effectiveness should be tested through a full-scale RCT.

External funding details: NIHR; North Somerset and Gloucestershire Councils; DECIPHer; Elizabeth Blackwell Institute.

Gerlev Playship – A successful national implementation strategy promoting physical activity in cities through political and school kids innovative processes

Finn Berggren¹, Rasmus Casper²

¹Gerlev Physical Education and Sports Academy, ²The Playship - Gerlev Center for Play and Movement

After years of traditional implementation programs in the Danish cities the Gerlev P.E & Sports Academy and Lauritzen Foundation launched in May 2015 the Gerlev Playship. The project is now finished after 4 seasons of sailing visiting more than 100 harbors introducing physical activities and games in the harbor environment. This project is the first of its kind in the world.

Methods: The Gerlev Playship – a former school ship - is the “Messenger for enjoyable Physical Activity” which creates high awareness when the sailship arrive the harbors in Denmark. The project is focusing on:

1.Policy discussions with local politicians and key-persons related to development of the harbor area during Team-building visionary sailing trips
2.Programs introducing active citizenships creating and designing local play and activity innovation by school kids
3.Activity programs for invited kindergartens, school classes and local residents

Results: All local governments/politicians in the different harbors have taken this possibility to create a new approach to discuss harbor and activity development however the most impressive results have been educational programs for school kids to develop innovative active environments in their local community. The project has been evaluated by the University of Southern Denmark (CISC) and the evaluation and the different off spin from the project will be introduced.

Discussion: The different ways of collecting documentation will be discussed as well as future implementation programs based on the experience from Gerlev Playship

External funding details: The Gerlev Playship project has been fully economically funded by the Danish Lauritzen Foundation

Session: Physical activity and mental health

The development of an evidence-informed exercise toolkit for Canadian adults with depression

Guy Faulkner¹, Krista Glowacki²

¹University of British Columiba, ²University of British Columbia

Canadian clinical guidelines now recommend exercise as a treatment for depression. However, it is likely that most mental health professionals have not received any training in exercise prescription while similarly many exercise professionals may not have been exposed to training regarding mental health. This presentation will describe the systematic process undertaken in developing an evidence-informed toolkit for use by Canadian practitioners and patients. Using the AGREE II protocol to formulate content its development occurred over four phases. Phase 1: formative research. Interviews were conducted with patients with depression and clinicians treating patients with depression to identify their needs and preferences for support material. Phase 2: review of evidence base. A systematic review approach was used to gather the evidence to inform the recommendations. Based on this review, barriers and coping strategies were identified and communicated in the toolkit along with information on exercise prescription. Phase 3: development of evidence-informed content and format recommendations. A multidisciplinary panel of 12 leading researchers and providers in the area of exercise delivery, and depression treatment was formed to appraise the evidence from phase 2 and generate content and format recommendations for the toolkit. Phase 4: toolkit creation. The toolkit was created which is now being evaluated in practice. This project has lead to the development of the first evidence informed toolkit that can inform clinical practice by facilitating discussion of exercise with, and exercise prescription for, individuals with depression.

External funding details: Funding for this project was provided by the Canadian Institutes of Health Research (CIHR).

‘Walk This Way’: a pilot randomised controlled trial of a health coaching intervention to reduce sedentary behaviour in people with serious mental illness across UK community mental health teams

Brendon Stubbs¹, Julie Williams², Cathy Flower³, Lucy Barr-Hamilton³, Barbara Grey³, Kathryn Hubbard², Gilda Spaducci², Fiona Gaughran², Tom Craig²

¹KIng’s College London, ²King’s College London, ³South London and Maudsley NHS Foundation Trust

Cardiovascular disease ((CVD) is the leading cause of premature death among people with severe mental illness (SMI). Sedentary behaviour (SB) is an independent risk factor for CVD and mortality and recent research has demonstrated this population spend almost 13 hours a day being sedentary. We developed a health coaching intervention (‘Walk this Way’) aiming to reducing sedentary behaviour (SB) and increasing physical activity (PA) in people with SMI. We conducted a pilot randomised controlled trial over 17 weeks and recruited 40 people with SMI across three UK community mental health teams, who were randomised into the WTW intervention or treatment as usual. The WTW intervention consisted of an initial education session, fortnightly coaching, provision of mHealth devices and access to a weekly walking group. Objective SB and physical activity (PA) were captured with accelerometers. We recruited 40 people to the study and followed up 32 (80%). In total 65% completed the intervention. We noted positive changes in SB and PA in the intervention group compared to the control group at immediate follow up and after 6 months after the intervention. A process evaluation found that participants found the intervention feasible and acceptable and reported that this increased their confidence and reduced social isolation. Our preliminary results suggest that the intervention is feasible and acceptable to people with SMI using community mental health services in the UK. A larger study is needed to assess the effectiveness of the intervention and to assess the implementation challenges into routine NHS care.

An exercise psychology theory-based approach to addressing the treatment gap in the integration of physical activity within Australia’s Mental Health Care System

Amanda Rebar¹, Simon Rosenbaum², Benjamin Gardner³, Corneel Vandelanotte¹

¹Central Queensland University, ²University of New South Wales, ³King’s College London

Mental illness accounts for at least 13% of the total burden of disease in Australia, with 10% of the population living with long-term mental or behavioural problems. An alarming 75% of Australians with poor mental health are inactive. Although advancements have been made to integrate physical activity into the mental health care system, there remain major limitations in the national approach to prescribing physical activity for people with poor mental health. System-level barriers such as lack of referral pathways, in combination with person-level condition-specific barriers to physical activity result in major gaps in physical activity treatment. We will outline the current referral process for people with poor mental health to gain access to exercise professionals, and how this process, which is largely independent of the patients’ involvement, may be hindering an already diminished sense of perceived behavioural control. Additionally, we will present evidence from a large Queensland-based survey (N = 1244, 50% female; age: M = 55 years, SD = 15), of which the findings suggest that people with poor mental health had weaker physical activity habit than people with good mental health (β = −0.06, p < .01). We will discuss how this line of evidence may help to inform a revamping of the current lifestyle counselling approaches being provided by exercise professionals in Australia. This presentation will highlight the treatment gaps in the integration of physical activity within the Australian mental health care system and to take an exercise psychology theory-based approach to provide solutions to these limitations.

It’s all about the bouts: Rethinking physical activity guidelines with mental health in mind

Justin Richards¹, Barnes Michelle², Janette Brocklesby², Anna Kean³, Kris Mayo³, Glen McCarty², Hamish McEwen², Megan Walker³

¹Sport New Zealand, ²Sport NZ, ³Nielsen Research

Introduction: The association between physical activity and mental well-being is well established. However, current global physical activity recommendations are based on epidemiological evidence of its relationship with cardiovascular and metabolic health outcomes. We aim to use existing data to explore the relevance of these recommendations to mental well-being outcomes in adults.

Methods: We examined the nationally representative 2016 Active NZ survey data (n = 18,052). This comprised survey items for health-enhancing recreational physical activity (frequency, duration) and mental well-being (WHO-5). We used logistic regressions to examine the association of meeting physical activity recommendations (150 minutes/week) with mental well-being (dichotomised: “at-risk” threshold) adjusted for age, education and ethnicity. We repeated this analysis for incremental increases in physical activity frequency independent of duration.

Results: There was a positive dose-response association between meeting current physical activity recommendations and mental well-being (OR = 1.58 (95%CI:1.45-1.73). For physical activity frequency, there was only an association with mental well-being when participating at least three days/week (OR = 1.34 (95%CI:1.20-1.49). There was an incremental increase for each additional day to four days (OR = 1.16 (95%CI:1.02-1.33) and five days (OR = 1.17 (95%CI:1.01-1.35), but no additional increase for six days (OR = 0.88 (95%CI:0.73-1.06) or seven days (OR = 1.02 (95%CI:0.84-1.25).

Conclusion: Current global physical activity recommendations may not be appropriate for mental well-being outcomes. Our results suggest that physical activity must be spread over at least three days/week to benefit mental well-being with no additional gains from activity on more than five days/week. Further research is indicated to establish causation and the relative importance of physical activity duration for mental well-being.

Determinants of physical activity for people with serious mental illness - a qualitative study

Wolfgang Schebesch-Ruf¹, Arno Heimgartner², Sylvia Titze³

¹University of Graz, ²University of Graz, Department of Educational Science, ³University of Graz, Institute of Sport Science

Introduction: According to scientific studies, physical activity has a positive impact on symptoms of mental illness. However, there is a lack of theory-based programs how to effectively support people with mental illness to adopt regular physical activity behaviour. The aim of the presentation is to identify determinants of physical activity by analysing the individual perspective of people with mental illness.

Methods: Individuals were eligible if they had a diagnosed mental illness and attended a physical activity program run by a mental health NGO at least once a month since 2013. Semi-structured interviews were undertaken with 15 people (2 women) with a mean age of 36.7 (SD = 11.8). Interview data were analysed using the “documentary method”.

Results: Three physical activity types were generated in the context of individual’s physical activity experience and family background. The first “rehabilitation-orientated” type described physical activity as a supportive measure to re-enter the labour market and develop a daily routine. For the second “social-orientated” type, the social well-being in the group was the primary motive for participating in the physical activity program. The third “trust-orientated” type described the trustful environment of the program as the main reason for participation.

Conclusion: Based on the different type-specific motives of attending a sports programme different settings (mental health care centers or sports clubs) might be needed to regularly attract people with mental illness. Furthermore, coaches with mental health literacy at sport clubs should be considered in the future.

Relatedness is a social mechanism underpinning the association between physical activity and mental health among adolescents

Isabelle Doré¹, Catherine Sabiston¹, Marie-Pierre Sylvestre², Mathieu Bélanger³

¹University of Toronto, ²University of Montreal, ³University of Sherbrooke

Introduction: Physical activity (PA) can improve mental health but underpinning mechanisms remain unclear. This study examine the associations between PA and mental health among adolescents and investigate whether relatedness in PA mediates this association.

Methods: Participants (n = 756, mean age = 10.3, SD = 0.6 at study inception) reported the number of days per week they were physically active for a total of at least 60 minutes (0-7 days) every 4 months for 5 years. Mental health was measured using the Mental Health Continuum and PA relatedness was assessed using the Relatedness in Physical Activity Scale. To account for temporality, measures of PA, relatedness and mental health where taken at cycle 14, 15, and 16, respectively. Multivariate linear regression was used to model the associations between PA and mental health controlling for sex, age, puberty status and neighborhood income. Mediation analyses used causal inference methods to estimate the controlled direct effect (CDE), natural direct and indirect effect (NDE, NIE) of PA relatedness.

Results: A significant positive association was observed for PA and mental health ((95%CI) = 2.33 (1.17, 3.48) suggesting increased benefits on mental health for higher level of PA. A significant NIE was observed for PA relatedness (1.85 (0,87, 2.89)), suggesting that the positive association between PA and mental health is mediated by PA relatedness.

Conclusion: These results suggest that relatedness specific to the PA context represents a social mechanism through which PA impacts mental health positively. Interventions aiming at promoting mental health through PA among adolescents should encourage the development of PA relatedness.

What is it about football? The experiences of football and behaviour change among people with mental health problems

Jackie Hargreaves, Andy Pringle, Leeds Beckett University

Introduction: Physical activity is known to enhance mental health, physical health and recovery in people with mental health problems. However engagement and maintenance in physical activity is low. Football, provided by professional football teams has been found to be beneficial for people – especially men, with mental health problems. However, what happens during the football experience which engages individuals requires further exploration. The aim of this study was to explore the experiences of football provided by a professional club for people with mental health problems. A secondary aim was to explore, how people initially engage in football and how they maintain their engagement in football.

Method: Individual interviews were conducted with twelve men who played football. This football was provided by a professional football team. A hermeneutic phenomenological approach was undertaken for the thematic analysis.

Results: The analysis followed a journey from the initial engagement in football to exploring what happens to maintain engagement in football. Support and football being meaningful was essential for the initial engagement. Maintenance in football was facilitated by experiences of flow and enjoyment, through providing an optimum physical and social environment. The professional football club brought feelings of belonging and responsibility, as well as providing knowledge and skills.

Conclusion: Provision of football by a professional team was central to engaging men in the football sessions. Furthermore, to maintain engagement in football, the experiences should be enjoyable and enable experiences of flow. Outcomes could inform future football led mental health improvement programmes.

Session: Physical activity across the life course

Distinct trajectories of physical activity during life course in the general population: A systematic review

Irinja Lounassalo¹, Kasper Salin¹, Anna Kankaanpää², Mirja Hirvensalo¹, Sanna Palomäki¹, Asko Tolvanen¹, Xiaolin Yang², Tuija Tammelin²

¹University of Jyväskylä, ²LIKES Research Centre for Physical Activity and Health

Introduction: Researchers have started to use trajectory approach for identifying homogeneous subgroups of physical activity (PA) from heterogeneous populations. This study systematically reviewed the data concerning longitudinal PA trajectory classes from general population at different phases of life.

Methods: The included studies used finite mixture models for identifying trajectory classes of PA, exercise or sport participation. The four electronic databases searched were Medline Ovid, PubMed, Web of Science, and CINAHL from their launch up to August 15, 2016.

Results: Seventeen articles were included and organized into age groups: youngest (eight articles), middle (four articles), and oldest (five articles). These studies identified multiple PA trajectory classes, the most common number of classes being four, with some people being persistently active or inactive, and others changing their PA level. Several trajectory classes describing a decline in PA were identified especially among children and adolescents, while trajectory classes of increasers were observed among adults and older adults. The proportion of persistently active individuals was highest in the youngest group and lowest in the oldest group. The proportion of persistently inactive individuals was relatively high at all ages.

Conclusions: The reviewed articles identified distinct PA subgroups indicating that trajectory approach can provide novel information about the complexity of PA behavior compared to studying only population mean PA level. More variability was observed in the trajectory classes among youth than among older adults, suggesting that PA behavior stabilizes with age. The recognition of these subgroups could lead to more precise ways for targeting PA promotion.

Trajectories of physical activity types and their predictors during the transition to old age: a 20-year cohort study of British men

Daniel Aggio, Efstathios Papachristou, Olia Papacosta, Lucy Lennon, Sarah Ash, Peter Whincup, Goya Wannamethee, Barbara Jefferis, University College London

Introduction: Correlates of physical activity (PA) vary according to type. However, predictors of long-term patterns of PA types into old age are unknown. This study aimed to identify 20-year trajectories of PA types into old age and their predictors.

Methods: 7735 men (aged 40-59 years) recruited from UK towns in 1978–80 were followed up after 12, 16 and 20 years. Men reported participation in sport/exercise, recreational activity and walking, health status, lifestyle behaviours and socio-demographic characteristics. Group-based trajectory modelling (GBTM) identified the trajectories of PA types and associations with time-stable and time-varying covariates.

Results: Men with ≥3 measures of sport/exercise (n = 5116), recreational activity (n = 5085) and walking (n = 5106) were included in respective analyses. Three trajectory groups were identified for sport/exercise, four for recreational activity and three for walking. Poor health, obesity and smoking were associated with reduced odds of following a more favourable trajectory for all PA types. A range of socioeconomic, regional and lifestyle inequalities were also associated with PA trajectories but the magnitude and direction of these inequalities were specific to PA type. For example, men with manual occupations were less likely to follow a favourable sport/exercise trajectory but more likely to follow an increasing walking trajectory compared to men with non-manual occupations. Retirement was associated with increased PA but this was largely due to increased sport/exercise participation.

Conclusion: PA trajectories from middle to old age vary by activity type. Most predictors of these trajectories were specific to the type of activity.

External funding details: BHF grants FS/15/70/32044, PG/13/86/30546 and RG/13/16/30528

The combined effects of time spent sleeping, sitting, standing and stepping on markers of cardio-metabolic health: a 24 hour behavioural paradigm using compositional analysis

Greg Biddle¹, Charlotte Edwardson², Joe Henson², Sebastien Chastin³, Melanie Davies², Kamlesh Khunti⁴, Stuart Biddle⁵, Alex Rowlands², Tom Yates²

¹University of Leicester, NIHR Leicester Biomedical Research Centre, ²NIHR Leicester Biomedical Research Centre; University of Leicester, ³Glasgow Caledonian University; Ghent University, ⁴University of Leicester; NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands, ⁵University of Southern Queensland

Introduction: Given each day is bounded by 24 hours, time spent in one physical behaviour is co-dependent on time spent in another. The aim was to examine the association of time spent in different physical behaviours (sleep, sitting, standing and stepping) with adiposity and cardio-metabolic biomarkers, and to estimate change in these health markers when time is reallocated from one behaviour to another using a compositional analysis paradigm.

Methods: Adults at high risk of type 2 diabetes were recruited (n = 1644, age = 59 ± 5.72). Time spent sleeping, sitting, standing and stepping were measured using activPAL. These data were then combined to create a composition (24 hours). Adiposity, cholesterol (HDL, LDL) and triglycerides were measured. Data were analysed using multiple linear regression modelling with time variables transformed into isometric log ratios.

Results: Proportion of time spent sleeping, sitting, standing and stepping was associated with all markers of health (triglycerides only when adjusted for sex, age and ethnicity). Sitting and stepping (negatively and positively) were the most strongly associated behaviours within the composition. Replacing 30 minutes of sitting with stepping predicted decreases in BMI (by 5%), body fat percentage (3%) and waist circumference (1%). However, this relationship is asymmetrical, as replacing 30 minutes of stepping with sitting predicted increases in BMI (7%), body fat percentage (4%) and waist circumference (2%).

Conclusion: The composition of behaviours throughout the day are associated with markers of disease risk. Targeting both sitting time and time spent stepping are important aims of prevention programmes.

External funding details: NIHR Leicester Biomedical Research Centre

Change and stability in health and social factors in mid-adulthood and corresponding changes in leisure-time physical inactivity in a prospective cohort

Snehal Pinto Pereira, Chris Power, University College London

Background: To identify whether changes in adult health and social factors are associated with simultaneous changes in inactivity.

Methods: Health, social factors and leisure-time inactivity (activity frequency < 1/week) were self-reported at 33y and 50y in the 1958 British birth cohort (N = 12,271). Baseline (33y) health and social factors and also change and stability in factors 33y-to-50y were related to inactivity patterns 33y-to-50y (never inactive, persistently inactive, deteriorating, or improving) using multinomial logistic regression.

Results: Approximately 31% were inactive at 33y and 50y; 35% changed status 33y-to-50y (17% deteriorating, 18% improving). Baseline poor health and obesity were associated with subsequent (33y-to-50y) inactivity; e.g. for poor health, relative risk ratios (RRRs) for deterioration (vs never inactive) and improvement (vs persistently inactive) were 1.38(1.16,1.64)and 0.77(0.63,0.94) respectively. Adverse changes in health and weight were associated with simultaneous adverse inactivity patterns; e.g. worsening health (vs always good/excellent) was associated with higher risk of deterioration (RRR:2.20(1.85,2.62)) and lower risk of improvement (RRR:0.61(0.49,0.77)). However, improving health and weight loss were not associated with inactivity improvement. Worsening self-efficacy 33y-to-50y was associated with lower risk of inactivity improvement; there was no association between improving self-efficacy and inactivity change. Downward social mobility was not associated with inactivity deterioration or improvement. Change in depression, marriage/co-habitation and parenthood 33y-to-50y was not associated with inactivity change. No associations were observed for employment.

Conclusions: Associated changes in mid-life health factors with deleterious inactivity changes, highlight the importance of maintaining health, weight and self-efficacy across adulthood to deter inactivity.

External funding details: This work was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium (PHRC) and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. SPP is funded by a UK Medical Research Council Career Development Award (ref: MR/P020372/1). The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. Information about the wider programme of the PHRC is available from http://phrc.lshtm.ac.uk. The funders had no input into study design; data collection, analysis, and interpretation; in the writing of the report; and in the decision to submit the article for publication. Researchers were independent of influence from study funders.

Social interaction and physical activity in 6,401 older women: concurrent and 9-year prospective associations

Jannique van Uffelen¹, Kristiann C Heesch², Yolanda R van Gellecum³, Nicola W Burton⁴, Nancy A Pachana⁵, Wendy J Brown³

¹KU Leuven, ²Queensland University of Technology, Institute of Health & Biomedical Innovation and the School of Public Health and Social Work, Brisbane, QLD, Australia, ³The University of Queensland, School of Human Movement and Nutrition Sciences, and Centre for Research on Exercise, Physical Activity and Health, Brisbane, QLD, Australia, ⁴Griffith University School of Applied Psychology, Brisbane QLD, Australia, ⁵The University of Queensland, School of Psychology, Brisbane, QLD, Australia

Introduction: Although social support, including social interaction, and physical activity (PA) are important determinants of healthy ageing, the association between social interaction and PA in older women is unclear.

Method: Data were from 6,401 community-dwelling women, aged 73-78 years in 1999, who completed mail surveys in 1999, 2002, 2005 and 2008. The association between social interaction (Duke Scale; range 4-12 points; higher score indicates more interaction) and PA (Active Australia questionnaire; categorised as none, some, meeting guidelines) was assessed using random intercept multivariable mixed models. Fully-adjusted concurrent and prospective models were run with PA as the outcome. Bidirectional associations were tested in prospective models with social support as the outcome.

Results: Concurrently, for every 1-point increase in social interaction score there was a 27% (95%CI: 23%-32%) increased likelihood of being in a higher PA category (p < 0.001). Prospectively, there was a 17% (12%-22%) increased likelihood (p < 0.001). The prospective association of PA with social interaction was small but significant: older women who did any PA scored 0.10 (0.04-0.16) points higher on future social interaction than those who did none (p < 0.001).

Conclusion: Social interaction is positively associated with current and future PA levels in older community-dwelling women. A small part of this can be explained by a bidirectional association. These findings emphasize the importance of strategies for increasing social interaction in older women and the inclusion of these strategies in interventions aimed at increasing PA.

External funding details: Data are from the Australian Longitudinal Study on Women’s Health, funded by the Australian Government Department of Health.

Relationship of objectively measured physical activity and physical function of community-dwelling very old in Kawasaki, Japan: baseline assessment of Kawasaki well-being prospective cohort study

Yuko Oguma¹, Takayuki Tajima¹, Yoshinobu Saito¹, Shogo Fukui¹, Yayoi Kibayashi¹, Natsuko Yoshida¹, Hiroyuki Ishida¹, Takumi Hirata², Yukiko Abe¹, Yasumichi Arai¹

¹Keio University, ²Keio University

Introduction: The very old population (≥85 year-old) is increasing, comprising 15% of those aged ≥65 years in Japan. Little is known about their physical activity (PA), though PA is known to tremendously benefit their health. Therefore, we investigated their PA using the accelerometer and its relationship with physical function (PF).

Methods: Participants were 366 community-dwelling elderly aged 85-89 years (86.7 ± 1.4 years, BMI: 23.1 ± 3.0 kg/m², 53.3% female). We assessed PA with moderate-to-vigorous intensity (MVPA), light-intensity (LPA), and sedentary behavior (SB) objectively through the 7-day, waking hour tri-axial accelerometer monitoring. We performed PF assessments (hand grip strength, 5-m walk, open-eye standing, and time up-and-go), and three linear regression models: single-activity, partition, and isotemporal substitution (IS) models to assess the associations of SB, LPA, and MVPA with each measure of PF. The effects of substituting time in activity categories with equivalent time in another category on PF were examined using IS.

Results: The mean durations of MVPA, LPA, and SB were 20 ± 15, 288 ± 94, and 555 ± 116 min/day, respectively. There were significant positive associations of PF with LPA and MVPA in the single-activity, and only MVPA in the partition model. In IS models, replacing SB or LPA with MVPA showed significant favorable associations with all PF measures. Regarding grip strength, replacing SB with LPA showed a significantly positive association.

Conclusion: Replacing small amounts of SB and LPA with MVPA, even SB with LPA regarding grip strength, may contribute to improving PF in the very old men and women.

External funding details: This study was partly supported by JSPS KAKENHI Grant Number JP17H06151, and Keio Gijuku Academic Development Funds.

One Million Days of Mortality

Duncan McGregor¹, Sebastien Chastin², Philippa Dall¹, Javier Palarea-Albaladejo³

¹Glasgow Caledonian University, ²Glasgow Caledonian University, ³Biomathematics and Statistics Scotland (BioSS)

The “One Million Days of Mortality” study is an Open Science project organised by OpenCoDa.net to investigate the association between physical activity and mortality utilising techniques from compositional data analysis in conjunction with the more familiar Cox’s proportional hazards model. Multiple research teams will analyse their own datasets using harmonised methods (implemented in easy-to-use software provided by OpenCoDa.net) that we hope will form the basis for the largest study of its kind. Our ambition is to collect over one million person-days of mortality risk exposure.

Each team will publish their own results, but at the end of this study we will publish (with our collaborators) a harmonised meta-analysis based on the results across all of the teams, that will give us a fuller understanding of how mortality rates are associated with the allocation of time between different physical behaviours across the day.

The study will run between 1 April 2018 and 1 April 2019, and already includes well-characterised datasets such as “NHANES 2005-06”, “Health Survey for England 2008,” and “UK Biobank” but the project remains open to new teams interested in applying our software to new datasets.

The presentation will outline the current scope of the project, an update on progress to date, and the process for teams interested in participating.

External funding details: J. Palarea-Albaladejo has been supported by the Scottish Government’s Rural and Environment Science and Analytical Services Division (RESAS).

Session: Physical activity epidemiology

Increasing physical activity protects against cardiovascular, cancer and premature mortality independent of changes in diet, adiposity, comorbidities, blood pressure and lipids

Alexander Mok, Kay-Tee Khaw, Robert Luben, Nick Wareham, Soren Brage

University of Cambridge

Background: Physical activity (PA) assessed at baseline is protective against premature mortality. However, relating mortality risks to baseline PA may not account for within-person variation over the long-term. We studied the association between 10-year changes in PA and mortality from all-causes, cardiovascular disease (CVD) and cancer.

Methods: Prospective investigation of 14,443 men and women (40–79 years), with repeated lifestyle assessments in the EPIC-Norfolk study. Physical Activity Energy Expenditure (PAEE) was derived from self-report calibrated to objective data. Survival analysis (Cox-regression) with time-updated adjustments for age, sex, socio-demographics, comorbidities, overall diet quality, body mass index (BMI), blood pressure and lipids.

Results: During 169,420 person-years of follow-up, 3,121 deaths occurred. Physical activity was inversely associated with mortality. The fully-adjusted hazard ratios HR (95% CI), for each 1-kJ/kg/day per year increase in PAEE over 10-yrs were: 0.77 (0.71 – 0.83) for all-cause mortality; 0.73 (0.64 – 0.84) for cardiovascular mortality and 0.89 (0.79 – 1.00) for cancer mortality. The strength of associations persisted even after adjusting for time-updated changes in diet, BMI, comorbidities, blood pressure and lipids. Joint analyses with baseline PA indicate that increases in activity irrespective of low, moderate or high baseline PA improved longevity; fully-adjusted HRs of: 0.76 (0.65 – 0.89); 0.62 (0.53 – 0.74); and 0.48 (0.34 – 0.69), respectively.

Conclusions: In middle-aged and even older-adults, small increases in PA (irrespective of past levels) can improve longevity, independent of intermediary changes in diet, comorbidities, BMI, blood pressure and lipids. Further longevity benefits are also possible by increasing PA in already-active adults.

Burden of mortality and years of life lost by breast cancer attributable to physical inactivity in Brazilian female population

Diego Augusto Santos Silva¹, Mark Tremblay², Maria de Fatima Marinho de Souza³, Maximiliano Ribeiro Guerra⁴, Meghan Mooney⁵, Mohsen Naghavi⁵, Deborah Carvalho Malta⁶

¹Federal University of Santa Catarina, ²Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada, ³Ministry of Health, Department of Surveillance of Noncommunicable Diseases, and Injuries, and Health Promotion, ⁴Federal University of Juiz de Fora, ⁵Institute for Health Metrics and Evaluation, ⁶Federal University of Minas Gerais

Introduction: The aim of this study was to estimate the mortality and years of life lost, investigated by disability-adjusted life-years (DALYs), due to breast cancer attributable to physical inactivity in Brazilian women; to compare the estimates of mortality and DALYs due to breast cancer attributable to physical inactivity and attributable to other modifiable risk factors; and to analyze the temporal evolution of these estimates within Brazilian states over 25 years (1990-2015) compared with global estimates.

Method: Databases from the Global Burden of Disease Study for Brazil, Brazilian states, and global information were used. It was estimated the total number and the age-standardized rates of deaths and DALYs in the years 1990 and 2015.

Results: Physical inactivity has contributed to a substantial number of deaths (1990: 875; 2015: 2,075) and DALYs (1990: 28,089; 2015: 60,585) due to breast cancer in Brazil. Physical inactivity was responsible for more deaths and DALYs (∼12.0%) by breast cancer than other modifiable risk factors (∼5.0%). From 1990 to 2015, mortality from breast cancer attributable to physical inactivity increased in Brazil (0.77%) and decreased (-2.84%) around the world. The Brazilian states with better socioeconomic indicators had higher age-standardized rates of mortality and morbidity from breast cancer due to physical inactivity.

Conclusion: These findings support the promotion of physical activity in the Brazilian female population to prevent and manage breast cancer.

External funding details: The study was supported by grants from Bill & Melinda Gates Foundation (GBD Global) and Ministry of Health from Brazil (GBD 2015 Brazil-states; Process No. 25000192049/2014-14).

The contribution of physical inactivity to cardiovascular disease, type 2 diabetes, and all-cause mortality in the Caribbean

Christina Howitt¹, Ian R Hambleton¹, Selvi Jeyaseelan², Curtis Gittens¹, Catherine Brown¹, Nigel Unwin³

¹University of the West Indies, ²Resources for Research, ³University of Cambridge

Introduction: As a major risk factor for non-communicable disease, physical inactivity contributes to morbidity and mortality. Questionnaires are commonly used to estimate inactivity, but tend to underestimate its prevalence. Objective measures such as accelerometry are a gold-standard, but are costly and technically challenging to implement. After identifying national inactivity estimates in the Caribbean, we use objectively-derived estimates to reduce the bias associated with questionnaire-based inactivity assessment. These adjusted estimates provide a more realistic assessment of the public health impact of inactivity than currently exists.

Methods: We systematically identified studies reporting national estimates of inactivity prevalence between 2006 and 2016. One country measured inactivity using objective and questionnaire-based methods, from which we derived an adjustment factor to apply to all self-reported estimates. Using these adjusted prevalences, we calculated population attributable fractions for the amount of disease and mortality that could be averted by reducing or eliminating inactivity.

Results: We identified national estimates of inactivity prevalence for 14 countries. Adjusting self-reported inactivity measures increased the median national prevalence from 34% to 54%. We estimated that 11% of cardiovascular disease (CVD), 17% of type 2 diabetes, and 15% of all-cause mortality was attributable to physical inactivity, after confounder adjustment. Using self-reported inactivity, the estimated contribution of inactivity was: 7% for CVD, 11% for diabetes; and 9% for mortality.

Conclusions: In the Caribbean, around 1/10 CVD cases, 1/5 diabetes cases, and 1/6 premature deaths are potentially avoidable with sufficient physical activity. This burden would have been underestimated if uncorrected self-reported estimates were used.

Do the associations of sitting time with mortality from cardiovascular disease and cancer differ by different levels of physical activity?

Ulf Ekelund¹, Wendy Brown², Jostein Steene-Johannessen³, Morten Fagerland¹, Neville Owen⁴, Kenneth Powell⁵, Adrian Bauman⁶, I-Min Lee⁷

¹Norwegian School of Sport Sciences, ²Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, Australia, ³Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway, ⁴Baker Heart & Diabetes Institute, ⁵Atlanta, ⁶School of Public Health, Sydney University, Australia, ⁷Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Introduction: We recently reported that the associations between sitting and mortality differed depending on how much physical activity was carried out. We here examine whether the associations between sitting time with mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity.

Methods: Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sitting time and into quartiles of physical activity (MET-h per week) and analysed within each individual study, and reported effect estimates for CVD or cancer mortality. We estimated summary HRs with 95% CIs across studies in separate meta-analyses for each outcome with a fixed-effect inverse variance method.

Results: Nine studies (N = 850,060; Deaths = 25,730) and eight studies (N = 777,696; Deaths = 30,851) provided data on sitting time and CVD and cancer mortality, respectively. A dose-response association between sitting time (9% to 32% higher risk; P for trend < 0.001) with CVD mortality was observed in the ‘inactive’, lowest quartile of PA. There was no increased risk for CVD mortality with increasing sitting-time in the most active quartile. Associations between sitting-time and cancer mortality were generally weaker; 6% to 21% higher risk with longer sitting time observed only in the lowest quartile of PA.

Conclusion: PA modifies the association between sitting time with CVD and cancer mortality. Moderate intensity PA commensurate with meeting or exceeding current physical activity guidelines for public health ameliorate or even eliminate the risk of sitting with CVD and cancer mortality.

Non-occupational physical activity and risk of cardiovascular disease, cancer, and mortality: a dose-response meta-analysis of prospective studies

Soren Brage¹, Ali Abbas¹, Alexander Mok¹, Leandro Garcia¹, Eoin McNamara², Alessio Crippa³, Thiago Sá⁴, Andrea Smith⁵, Dani Kim⁶, Justin Im⁷, Oluwaseyi Olayinka⁸, Rajna Golubic⁹, Matthew Pearce¹, Marko Tainio¹, Katrien Wijndaele¹, Phillip Edwards¹⁰, James Woodcock¹

¹University of Cambridge, ²Economic and Social Research Institute, ³Karolinska Institutet, ⁴University of Sao Paulo, ⁵University College London, ⁶Imperial College London, ⁷International Vaccine Institute, ⁸Old Dominion University, ⁹Addenbrooke’s Hospital, ¹⁰London School of Hygiene & Tropical Medicine

Introduction: Physical activity (PA) has been associated with reduced risk of all-cause mortality, cardiovascular diseases, and several cancers. However, dose-response relationships remain unclear. Our objective was to estimate dose-response relationships for non-occupational PA and chronic disease incidence and mortality.

Method: We systematically searched for prospective cohort studies with adults without pre-existing conditions, >10,000 participants, and results for all-cause mortality, cardiovascular disease, stroke, coronary heart disease, total cancer, colon, lung, endometrial, or breast cancer. PA exposure was harmonised to PA energy expenditure in marginal MET-hours per week (MMET.h/week). We performed a restricted cubic splines random-effects meta-analysis and calculated potential impact fractions for all outcomes.

Results: 104 papers were included, covering 74 cohorts. The evidence base was largest for all-cause mortality (24 associations; 2,116,548 individuals), cardiovascular mortality (21 associations; 2,001,351 individuals), and total cancer mortality (15 associations; 1,208,839 individuals). In general, inverse non-linear relationships were observed, steeper up to 8.75 MMET.h/week (current PA recommendations) with smaller gains above this point to 17.5 MMET.h/week, beyond which additional benefits were uncertain. Benefits were larger for all-cause and cardiovascular mortality than for cancer mortality. Risk reductions were observed for incidence outcomes but weaker than for mortality. If all insufficiently active individuals in the cohorts met the recommended level, 11.9% (95%CI: 8.6 to 15.1%) of all premature deaths could be averted.

Conclusion: Our findings support the current PA recommendations, with inverse non-linear dose-response relationships indicating that most of the benefit is accrued by small increases from inactive lifestyles.

Is volume of physical activity more important than pattern of accumulation for onset of cardiovascular disease? A prospective study of objectively measured physical activity intensities and sedentary behaviour in older men

Barbara J. Jefferis¹, Tessa Parsons¹, Claudio Sartini¹, Sarah Ash¹, Lucy Lennon¹, Olia Papacosta¹, Goya Wannamethee¹, I-Min Lee², Peter Whincup

¹University College London, ²Harvard University, ³St George’s University of London

Objectives: To understand how device-measured sedentary behaviour and physical activity are related to cardiovascular disease (CVD) events in older men, an age-group with high levels of inactivity and sedentary behaviour. Total amount and pattern of each activity intensity are investigated.

Methods: Prospective population-based cohort study of men recruited from 24 UK General Practices in 1978-80. In 2010-12, 3137 surviving men were invited to wear an Actigraph GT3x accelerometer for 7 days; 1566 (50%) returned accelerometer data. Men were followed up for CHD and stroke morbidity and mortality up to 1st June 2016.

Results: After median 4.6 years follow-up, 82 CVD events occurred in 1,181 men without pre-existing CVD. For each additional 30 minutes in sedentary behaviour, light PA,10 minutes in MVPA, or 1000 steps/day, hazard ratios (HRs) for CVD mortality were 1.08(95%CI 0.98, 1.18), 0.96(95%CI 0.85, 1.08), 0.89(95%CI 0.81, 0.98) and 0.86(95%CI 0.77 to 0.96) respectively. Adjustments for confounders little changed the estimates. The HR for accumulating 150 minutes MVPA/week irrespective of bout length (achieved by 66% of men) was 0.54 (95% CI, 0.34 to 0.87) and 0.49 (95% CI, 0.21 to 1.13) for accumulating 150 minutes MVPA/week in bouts lasting ≥10 minutes (achieved by 16% of men). Sedentary breaks were not associated with CVD events.

Conclusions: In older men, higher number of steps per day or accumulating more MVPA, irrespective of bouts lasting ≥10 minutes reduced CVD risk. Light PA and sedentary behaviour were not associated with CVD risk. Findings can inform physical activity guidelines for older adults.

External funding details: This work was supported by the British Heart Foundation (PG/13/86/30546 and RG/13/16/30528). The funders had no role in the design and conduct of the study; collection, management, analysis, interpretation of the data; preparation, review, approval of or decision to publish the manuscript.

Moderate-to-vigorous intensity physical activity and all-cause mortality: Do bouts matter?

Pedro Saint-Maurice¹, Richard P. Troiano¹, Charles E. Matthews¹, William E. Kraus²

¹National Cancer Institute, ²Duke University

Introduction: The 2008 Physical Activity Guidelines for Americans recommends that adults accumulate moderate-to-vigorous intensity physical activity (MVPA) in bouts ≥10-minutes for substantial health benefits. To what extent the same amount of MVPA accumulated in bouts vs. sporadically reduces mortality risk remains unclear.

Methods and Results: We analyzed data from the 2003-06 National Health and Nutrition Examination Survey (NHANES) and death records available through 2011 (follow-up period of ∼6.6 yrs; 700 deaths) to examine the associations between objectively measured physical activity accumulated with and without a bout criteria and all-cause mortality in a representative sample of U.S. adults ≥40 yrs (n = 4,840). Physical activity data were processed to generate minutes/day of total and bouted MVPA. Bouted MVPA was defined as MVPA accumulated in bouts of a minimum duration of either 5 or 10 minutes allowing for 1-2 minute interruptions. Hazard ratios for all-cause mortality associated with total and bouted MVPA were similar and ranged from 0.24 for the third quartile of total to 0.44 for the second quartile of 10-minute bouts. The examination of jointly classified quartiles of total MVPA and tertiles of proportion of bouted activity revealed that greater amounts of bouted MVPA did not result in additional risk reductions for mortality.

Conclusion: These results provide evidence that mortality risk reductions associated with MVPA are independent of how activity is accumulated and can impact the development of physical activity guidelines and inform clinical practice.

Session: Physical activity evidence, guidelines and messaging

Digital behaviour change interventions to address sedentarism. Technology within a national integrated social marketing approach to address inactivity: Active 10

Michael Brannan, Justin Varney, Anand Amlani, Public Health England

Introduction: Insufficient physical activity is amongst the top ten causes of the health burden in the UK and addressing inactivity is prioritise in national guidelines, plans and strategies. As part of a broader programme to improve the health of low income, middle-age adults, a national social marketing programme was developed to get inactive, low income 40-60 year olds to move out of inactivity towards recommended physical activity levels.

Methods: Based on ethnographic research and published literature a national social marketing programme was produced based on what works to move inactive adults out of inactivity with a focus on 10 minute daily bursts of walking. Active 10 is an integrated programme involving national and local media and advertising campaigns, cross-sector partnerships and an innovative mobile phone app. The app is a central focus of the campaign and its behaviour change approach, as it supports users to understand periodicity, intensity and accumulation of physical activity over time; the app also generates geographic and demographic profile data for use by local public health and physical activity planners.

Results: An evaluation is underway (due 2018), but early evidence is positive. Over 600 pieces of coverage were achieved with #Active10 trending top five on Twitter. The app has been downloaded 480,000 times and was ranked number one Health and Fitness download.

Conclusion: Technology can play a role within integrated marketing and behaviour change campaigns to drive penetration and improve effectiveness of programmes.

Summary of evidence to include Light activity in physical activity promotion messages.

Sebastian Chastin¹, Marieke De Craemer², Katrien De Cocker³, Lauren Powell⁴, Jelle Van Cauwenberg³, Philippa Dall¹, Mark Hamer⁵, Emmanuel Stamatakis⁴

¹Glasgow Caledonian University, ²Ghent University, ³Ghent University, ⁴Sydney University, ⁵Loughborough University

Introduction: Recently there has been more interest in understanding the role played by light activity (LIPA) in health and it is starting to be explicitly included in guidelines. The aim of this study was to summarise the evidence on the relationship between LIPA and cardiometabolic health.

Method: Systematic review and meta-analysis. Medline, Embase, PsycInfo, CINAHL were searched complemented by three rounds of hand searches for experimental (including acute mechanistic studies and physical activity intervention programme) and observational studies (excluding case and case control studies) conducted in adults(aged ≥18 yrs) published in English before February 2017 and reporting on the relationship between light physical activity (< 3 METs) and cardiometabolic health outcomes or all-cause mortality.

Results: 21 experimental studies and 37 observational studies were eligible. Acute mechanistic experimental studies showed that short but frequent bouts of light intensity activity throughout the day significantly reduced post-prandial glucose (-18.37% CI [-28.47, -8.27]) and insulin (-27.12% [-35.77, -18.48]) levels compared to continuous sitting, but there was very limited evidence for other cardiometabolic markers. Three physical activity programme intervention studies (n ranging from 12 to 58) showed reduced adiposity, improved blood pressure and lipidaemia for light intensity activity programmes of at least 150 min/week lasting for at least 12 weeks. Five prospective observational showed beneficial associations between more time spent in daily light activity and reduced risk of all-cause mortality (HR 0.70 CI [0.61 0.79]).

Conclusions: Light intensity physical activity may potentially play a role in improving adult cardiometabolic health and reducing mortality risk.

Development and testing of the new Flemish physical activity model versus the traditional physical activity pyramid

Ragnar Van Acker, Luc Lipkens, Femke De Meester, Flemish Institute for Healthy Living

Introduction: Very few physical activity (PA) models have been systematically tested in the general public. This new PA model aims to make people aware of its main health messages, and motivate them to be more physically active and to limit sedentary behaviour (SB).

Method: (1) A literature review on national PA models, recommendations, and communication; (2) a panel of independent experts in PA, SB, behavioural change and communication; (3) a focus group protocol with 237 physically inactive and active participants from priority target groups (low SES). Drafts of the new model were also compared with the PA pyramid; (4) collaboration with stakeholders.

Results: After 3 rounds of focus groups and improvements, the prefinal new PA model was evaluated positively by the majority of participants. Its main health messages were perceived well, except for the differentiation in the recommended variety of light, moderate and vigorous intensity PA. Final improvements resolved this issue. For the inactive group, the new PA model outperformed the PA pyramid: the new model was more realistic and implementable with achievable goals. The active groups considered the PA pyramid more comprehensive at first glance, yet found it to be rather illogical (sequence of layers) and less flexible (too directive and structured) after a more thorough reflection.

Conclusion: The new Flemish PA model is a feasible instrument for the general public. For inactive groups it outperforms the golden standard of the PA pyramid. The model is now being disseminated, supported by tools and partners.

External funding details: Funded by the Flemish Government.

Health Promotion across the 24 Hour: New Messages and Strategies for Sleep, Sedentary and more Active Behaviors

Matthew Buman, Arizona State University

Sleep, sedentary, and more active behaviors (i.e., physical activity) disproportionately make up our 24 hours (24 h); however, these behaviors are often viewed in isolation in their relationship to health and health behavior change. By virtue of a fixed 24 h, increasing one behavior inevitably means decreasing another, and the broader impact of any single behavior change (e.g., reducing sedentary time) on other behaviors (e.g., sleep, physical activity) is not fully understood. This presentation will focus on understanding the dynamic interplay of behaviors across the 24 h, the potential for synergy among these behaviors for maximal health behavior change, and their single and combined impact on cardiometabolic and quality of life (QOL) related parameters. A summary of results from three randomized controlled lifestyle interventions will be presented, with a particular focus on novel messages and strategies used to leverage potential synergies for behavior change across the 24 h. Also, the use of smartphone and wearable technologies will be introduced as novel medium for delivery of 24 h interventions, given their ubiquity and ability to track behaviors and provide timely feedback. Collectively this work demonstrates: (a) feasible approaches for intervening on behaviors across the 24 h; (b) physiological and behavioral synergies among behaviors such that impact on one behavior can improve other 24 h behaviors; and (c) enhanced cardiometabolic and QOL benefit when addressing the full 24 h spectrum of behaviors relative to focusing behavior change approaches on any single behavior.

External funding details: Virginia G. Piper Charitable Trust; National Institutes of Health (R01CA198971; R21NR016046; R18DK109516)

Sitting less and moving more: convergent evidence for informing programmes and policy - Public health messaging on sedentary behaviour and health: what should we say and to whom?

Katrien Wijndaele¹, Stuart J.H. Biddle²

¹MRC Epidemiology Unit; University of Cambridge, ²University of Southern Queensland

With sedentary behaviour catching the eye of researchers from the early 2000s, and policy makers some 5-10 years later, it is important to appraise the state of evidence that should underpin appropriate messages in this field. It is now recognised that there is a ‘movement’ continuum that includes sleep, sedentary behaviour, light physical activity and moderate-to-vigorous activity. It makes no sense pitting one of these against others as they all exist in interdependent ways and are important in their own right. However, the field is guilty of interpreting evidence in an inconsistent way–the glass half full vs. glass half empty argument. This will be illustrated by discussing findings on sedentary behaviour and adiposity in young people and mortality in adults. In both cases, alternative and apparently contradictory messages are possible and plausible. This may reflect the ‘decline effect’ where improved measurement and methods, and more nuanced research, provide a better understanding after initial, possibly simplistic and uncritical, messages have been made. Our analysis of campaigns suggested that certain simplistic assumptions were being made about substituting sitting for physical activity, and that sitting was ‘demonised’. Yet there are good examples of media messaging showing an appropriate balance between less sitting and more movement. Finally, it is argued that reductions in sitting can achieve multiple perceived benefits beyond physical health, and that small changes from sitting to light physical activity may be an important starting point for promotion of active lifestyles. ‘Sit less, move more’ may well still be the best message.

Citizen science to communicate about public health messages: the reach of a playful online survey on sitting time and physical activity

Katrien De Cocker¹, Sebastian Chastin², Ilse De Bourdeaudhuij¹, Jeroen Stragier¹, Greet Cardon¹

¹Ghent University, ²Glasgow Caledonian University

There is a lack of research on how to communicate public health guidelines. Citizen science has been an effective way to involve the public in research. This study analyses the reach of a well-established citizen science experiment, launched during an annual national science event, to understand if it could be used as communication strategy for public health issues.

A short playful online survey contained tailored health-related messages associated to an ‘animal totem’ profile, based on the combination of sitting time and physical activity levels (koala: high sitting, low activity; gorilla: high sitting, high activity; zebra: low sitting, low activity; bee: low sitting, high activity). Tweets, radio interviews, radio and online advertisements, press articles and a press conference were used to promote the citizen science experiment. Google Analytics and Facebook graph Application Programming Interface were used to report on the use and spread.

Descriptive statistics were used to describe the adults completing the experiment. 6,246 adults completed the experiment, with a peak of views (n = 5,103) and completions (n = 1,209) a couple of days before the event. Completers were mostly female (65.8%), on average 37.5 years old and had a healthy BMI (23.8 kg/m²). 46.4% had the most beneficial profile (‘bee’), 26.5% the least healthy profile (‘koala’).

Citizen science as part of a national science event is a good platform for health communication as 1 in 1,000 Flemish adults could be reached. However, those completing the experiment were not representative of the general Flemish adult population and reported to be more active.

An exploration of how the UK physical activity and sedentary behaviour guidelines for the early years may be improved for parents: A qualitative study

Georgina Bentley, Katrina Turner, Russ Jago, University of Bristol

Background: Research suggests that many mothers believe their preschool child achieves the UK physical activity (PA) guideline targets (three hours of PA per day) but have also reported difficulties in assessing what counts as PA. Mothers have reported that the UK PA guidelines for the early years were not relatable or constructive. This study explored how these guidelines could be better presented and disseminated to be more useable for parents of pre-schoolers.

Methods: Six focus groups were held with parents of pre-schoolers from areas of varying socio-economic status within Bristol, UK. Alternative wording to describe PA intensities (sedentary, low, and moderate to vigorous), examples of play activities to illustrate these intensities, and how best to disseminate PA guideline information were explored.

Results: Alternative terms for PA intensities included: ‘Still’ for sedentary; ‘Pottering’ for low-intensity; ‘Huff & Puff’ for moderate to vigorous-intensity. Parents found thinking of pre-schoolers play in intensity categories problematic and it was more helpful to think of intensity on a spectrum. They felt that moderate and vigorous intensities should not be combined because they involved different forms of play. Parents suggested that guideline information should be provided from an early age (e.g. anti-natal classes and health-visitor check-ups). Many parents said they would prefer information online or through an app rather than having a printed leaflet.

Conclusion: PA and SB guideline information should provide an explanation of what counts as PA, alongside clear descriptions of levels of PA intensity and examples of play activities to illustrate these levels.

Session: Using technology in interventions and research

Harnessing gamification for population level changes in physical activity: Findings from 18 UK interventions.

Marc Harris, William Bird, Intelligent Health

A recent systematic review concluded insufficient evidence for current population physical activity (PA) interventions, citing scalability as a major contributory factor.

Beat the Street aims to address this key implementation issue by turning a town/city into a game where players register their walking and cycling journeys by tapping a smartcard on RFID readers called ‘Beat Boxes’ placed on lampposts around the town or city. Players monitor their progress via a website where they can see their own and their team’s progress, and the overall city/town target. During registration, participants complete a questionnaire which includes a validated PA measure³. Follow up surveys take place at the end of the game and 6 months later.

In 2016, 18 community-wide interventions were delivered throughout the UK. N = 300,053 people played the game, N = 64,512 registered online, N = 6,767 completed a follow-up survey immediately following the game period and N = 3,103 people completed a follow-up survey 6 months post-intervention. Pre-test/post-test analyses revealed a 9% increase in the proportion of people meeting the WHO PA guidelines and a 5% decrease in the proportion of people reporting being inactive (p < .05). Further analysis revealed a 8% increase in the proportion of people meeting the CMO PA guidelines and a 4% decrease in the proportion of people reporting being inactive, six-months post-intervention (p < .05).

The findings from 18 Beat the Street interventions delivered across the UK in 2016 suggests that gamification is a promising approach to changing population levels of PA.

Calibration of the UK Youth Activity Profile

Danielle Christian¹, Pedro F. Saint-Maurice², Paul Hibbing³, Robert J. Noonan¹, Lynne M. Boddy⁴, Greg J. Welk⁵, Stuart J. Fairclough¹

¹Edge Hill University, ²National Cancer Institute, ³University of Tennessee, ⁴Liverpool John Moores University, ⁵Iowa State University

Introduction: Physical activity self-report methods are cost-effective and straightforward to use with large samples, but their ability to accurately estimate levels of physical activity is limited. This study describes the development of algorithms to calibrate self-reported physical activity from the online UK Youth Activity Profile (UKYAP) survey into estimates of moderate-to-vigorous physical activity (MVPA) and sedentary time (ST).

Method: Four primary schools and five secondary schools were selected to participate, with participants across Year 5 (n = 133, 53% boys), Year 8 (n = 132, 44% boys) and Year 10 (n = 137, 60% boys). Participants wore a multi-sensor Sensewear Armband Mini (SWA) for eight days and completed the 15-item UKYAP online survey on the eighth day. UKYAP scores were temporally matched to SWA MVPA and ST data. Quantile regression generated gender and age group-specific algorithms to estimate in-school, out-of-school, and weekend MVPA, and out-of-school ST.

Results: The in-school algorithm performed well, and predicted 49.6 minutes of MVPA per day (UKYAP) compared to the objectively measured 53.1 minutes MVPA per day (SWA). An underestimation of 11.8 minutes/day was reported for out-of-school MVPA, and 26.4 minutes/day for weekend MVPA. Conversely, out-of-school ST algorithms overestimated by 36.6 minutes/day.

Conclusion: For in-school, out-of-school and weekend segments, the calibration algorithms predicted estimates that were comparable to objectively measured MVPA and ST in both primary and secondary school aged children. Prediction accuracy was higher at the group level than individual.

External funding details: This study was funded by the Youth Sport Trust and Edge Hill University.

Beyond cut-points: Introducing a novel accelerometer metric that captures the physical activity intensity distribution

Alex Rowlands¹, Charlotte Edwards², Melanie Davies², Kamlesh Khunti², Deirdre Harrington², Tom Yates²

¹University of Leicester, ²Leicester Diabetes Centre

Overall activity level, defined as average acceleration over a 24 h period, is directly measured and comparable across studies. However, it tells us little about the intensity distribution. It is important to capture both overall activity and the intensity distribution as, for some health markers, it appears the volume of activity is more important than the intensity, but for others the converse appears to be true.

Herein we introduce a new metric, the intensity gradient, that: captures the entire intensity distribution; does not rely on calibration protocols (that, by nature, are population- and protocol-specific); and is independent of overall activity level, thus can be used alongside average acceleration.

The intensity gradient is taken from the log-log regression line of the negative curvilinear relationship between intensity and time accumulated at that intensity. To demonstrate its potential we applied it to two datasets: 1669 adolescent girls, and 295 adults with type 2 diabetes. The intensity gradient was negatively associated with body fatness in the girls and positively associated with physical function in the adults; associations were independent of average acceleration and co-variates. In contrast, moderate-to-vigorous physical activity was not independently associated with body fatness or physical function.

In summary, collectively the average acceleration and the intensity gradient provide a complementary description of a person’s entire activity profile, facilitating investigation of the relative importance of intensity and volume of activity for a given outcome. Crucially, the metrics are not subject to the error and population-specificity associated with converting acceleration into physical activity outcomes.

Characterizing the activity-friendly built environment using space syntax: The role of urban design in the decision to commute by bicycle: An application using space syntax

Greg Rybarczyk, University of Michigan-Flint

Introduction: Many previous works attempting to forecast the potential for bicycling have included urban design factors in their approaches; however, only a scant amount of work has assessed these at a micro-scale using space syntax. The purpose of the current study was to investigate the effects of several urban design metrics derived from Space Syntax on the probability of bicycle mode-share use for commuting.

Methods: The National Household Travel Survey (NHTS) was used contained a slew of personal travel related variables. Several neighbourhood scale demographic, socioeconomic, and environmental factors were considered control variables during the modelling stage of the analysis. These factors, along with space syntax measures, were examined near each person’s residence (i.e, trip origin) using Geographic Information Systems and a binomial logit discrete choice model.

Results: The urban morphology metrics from space syntax elevated the discrete choice model’s overall robustness by approximately 4%, when compared to models including, personal, household, and environmental factors. The statistically significant space syntax explanatory factors included: integration (OR = 12.7, p < 0.10), entropy (OR = .001, p < 0.05), and clustering coefficient (OR = 0.00, p < 0.001). These measurands displayed reasonable influences and directionality towards bicycle mode choice while controlling for personal, household, and environmental variables.

Conclusions: In this study, we estimated the importance of individual, household, environmental, and urban morphological variables in the decision to commute via bicycle. The research confirms the hypothesis that visibility and perception, as governed by urban form, affect the probability of utilitarian bicycling.

Using location technology to explore physical activity in indoor environments

Clover Maitland¹, Gareth Stratton², Sarah Foster³, Michael Rosenberg⁴

¹University of Western Australia, ²Applied Sports Technology Exercise Medicine Research Centre, College of Engineering, Swansea University, ³Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, ⁴School of Human Sciences, University of Western Australia

Introduction: GPS location data has been vital for understanding built environmental influences and informing policy interventions to increase physical activity (PA). However, investigation of how the structure of indoor built environments may promote or hinder movement is limited, with no gold-standard technology for determining indoor location based activity. This study validated a portable location and PA monitoring system for use with children in homes.

Methods: The RFID location system was deployed in a simulated home environment. Twenty-five children wearing sensor tags and Actigraph GTX3+ accelerometers moved around seven locations at specified time intervals under a range of sedentary and activity conditions (e.g., watching TV, playing, talking). Accuracy to detect room-level location was validated against direct observation. Customised software matched and analysed data to determine time and PA levels in each location.

Results: The system showed 85%, 94% and 97% specificity for detecting location inside monitored rooms in two, five and ten minute trials. Time spent in PA levels was accurate compared to Actilife (ICCs ≥ 0.98). Children spent 82% of time indoors sedentary and 3% in MVPA. Time in the computer room was most sedentary (92%) whereas time outdoors was most active (54%).

Conclusions: The system uses technology novel to the PA and public health field to provide accurate information on PA and sedentariness at indoor room-level. The methodology and resulting data can help to better understand the environmental context of PA and sedentariness in homes and other indoor environments where people spend the majority of their time.

External funding details: Healthway (#21357)

The development and co-design of the PATHway intervention: A theory-driven eHealth platform for the self-management of cardiovascular disease

Catherine Woods¹, Lauri McDermott², Deirdre Walsh², Veronique Cornelissen³, Roselien Buys³, Jomme Claes³, Paolo Zampognaro⁴, Fabio Melillo⁴, Nicos Maglaveras⁵, Ioanna Chouvarda⁵, Andreas Triantafyllidis⁶, Dimitris Filos⁶, Kieran Moran²

¹University of Limerick, ²Dublin City University, ³KU Leuven, ⁴Engineering Ingegneria Informatica, ⁵Aristotle University of Thessaloniki, ⁶Centre for Research and Technology, Institute of Applied Biosciences

Background: Cardiovascular diseases (CVD) are a leading cause of premature death and disability and an economic burden worldwide. International guidelines recommend routine availability and delivery of all phases of cardiac rehabilitation (CR). Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based CR programmes is low, with community-based CR rates and individual long-term exercise maintenance even lower. Home-based CR programs have been shown to be equally effective in clinical and health-related quality of life outcomes, and yet are not readily available. The aim of the current study was to develop the PATHway intervention (Physical Activity Towards Health) for the self-management of cardiovascular disease.

Methods: The PATHway intervention was theoretically informed by the Behaviour Change Wheel (BCW) and Social Cognitive Theory (SCT). All relevant intervention functions, behaviour change techniques (BCTs) and policy categories were identified and translated into intervention content. Furthermore, a person-centred approach was adopted involving an iterative co-design process and extensive user-testing.

Results: Education, enablement, modelling, persuasion, training and social restructuring were selected as appropriate intervention functions. Twenty-two BCTs, linked to the 6 intervention functions and 3 policy categories were identified for inclusion and translated into PATHway intervention content.

Conclusions: The BCW and SCT was used within a person-centred framework to develop an eHealth intervention for the self-management of CVD. The systematic and transparent development of the PATHway intervention will facilitate the evaluation of intervention effectiveness and future replication.

External funding details: This project has received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation Action.

Benefits and risks associated with children and adolescents’ interactions with electronic screens: A synthesis of 474 systematic reviews

Chris Lonsdale¹, Stuart Biddle², Phil Parker¹, Jo Salmon³, Kylie Hesketh³, George Thomas², Nicole Weeks¹, Taren Sanders¹

¹Australian Catholic University, ²University of Southern Queensland, ³Deakin University

Introduction: Systematic reviews have provided evidence for guideline development regarding children and adolescents’ screen time; however, no review has synthesised the evidence across the many relevant outcomes, including physical and psychosocial health, behaviour, and education.

Method: We searched for systematic reviews in 12 databases in September 2017 (no date restrictions). Inclusion criteria were: (1) Sample age < 19 yrs; (2) Measured exposure to any type of electronic media during typical daily living (e.g., school, home); (3) Measured relationship between screen time and a variable that is a plausible outcome of this exposure; (4) Systematic review or meta-analysis/meta-regression of quantitative evidence. Two reviewers independently screened titles and abstracts and then reviewed full-text articles.

Results: We retrieved 14,153 records and reviewed 1,351 full-text articles, with 474 review articles (K) meeting our inclusion criteria. Reviews focused on physical health (K = 118), psychology/behaviour (K = 120), education (K = 97), and health behaviours (e.g., sleep, nutrition) (K = 139). The majority of evidence has been collected using subjective measures and most analyses have only considered linear relationships. Moderator variables have been explored in-depth in a limited number of areas (e.g., violent television content).

Conclusion: There are potential benefits and risks to youth when interacting with electronic media, depending on the content and context of the exposure and the outcome of interest. Future guidelines should reflect these nuances and scalable interventions need to be developed to enable stakeholders, especially parents and teachers, to promote beneficial interactions with screens for children and adolescent

Parallel Oral Sessions: Tuesday 16 October

Tuesday, 13:30–14:40

Session: Developments in wearable devices and analysis

Individualizing cutpoints for moderate-to-vigorous physical activity: a new approach for analysing accelerometry data

Alice Bellicha¹, Cécile Ciangura², Célina Roda³, Jean-Luc Bouillot⁴, Adriana Torcivia⁵, Karine Clément⁶, Christine Poitou⁶, Jean-Michel Oppert²

¹Pitie-Salpêtrière Hospital, ²Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière hospital, Department of Nutrition; Sorbonne University, Faculty of Medicine, Institute of Cardiometabolism and Nutrition (ICAN); Paris, France, ³Barcelona Institute for Global Health; Barcelona, Spain, ⁴Assistance Publique-Hôpitaux de Paris (AP-HP), Ambroise Paré hospital, Department of Visceral Surgery; University Versailles-Saint-Quentin; Boulogne, France, ⁵Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery; Sorbonne University, Faculty of Medicine; Paris, France, ⁶Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière hospital, Department of Nutrition; Sorbonne University, Faculty of Medicine, Institute of Cardiometabolism and Nutrition (ICAN); INSERM, UMRS NutriOmics Team; Paris, France

Introduction: Moderate and vigorous-intensity physical activity (PA) can be defined in absolute (e.g. 3-6 MET) or relative (e.g. 50-70% VO_2max) terms. We aimed to compare habitual PA level of women with obesity when using either absolute-intensity or relative-intensity accelerometer cutpoints.

Methods: Habitual PA was measured during 7 days with Actigraph GT3x accelerometers in 67 obese women candidates to bariatric surgery. Cardiorespiratory fitness, measured by indirect calorimetry during a maximal exercise test, was expressed in MET (MET_max = VO_2max [mL/kg/min]/3.5). Freedson cutpoints were used as absolute-intensity cutpoints. Relative-intensity cutpoints were calculated as corresponding to 52% and 68% MET_max. Time spent in moderate or vigorous-intensity PA obtained with relative and absolute cutpoints were compared using Wilcoxon test.

Results: Mean [SD] age was 43 [10] years, BMI 44.0 [6.0] kg/m² and MET_max 5.2 [1.2]. Relative cutpoints for moderate and vigorous intensity (1,675 [745] and 2,747 [975] counts/min, respectively) were lower than Freedson cutpoints (P < 0.001). Using absolute cutpoints, patients accumulated 28 [18] min/d of moderate-intensity PA and 0 [1] min/d of vigorous PA. Using relative cutpoints, moderate-intensity PA was not modified whereas vigorous PA increased significantly (19 [25] min/d, P < 0.001). Using absolute cutpoints, 92% patients were found inactive. Using relative cutpoints, 23% inactive patients were reclassified as active.

Conclusion: Taking into account individual fitness to define accelerometer cutpoints resulted in a higher estimation of habitual PA in obese subjects. This may have implications to refine our interpretation of accelerometry data in such subjects and, more broadly, in subjects with low cardiorespiratory fitness.

From total volume to patterns: sophisticated accelerometer data analysis taking into account how SB and PA bouts are accumulated and alternated throughout the day

Mai Chin A Paw, Xinhui Wang, Teatske Altenburg, VU University Medical Center

Purpose: To date, epidemiological studies have focused on the potential health effects of total volume of physical activity (PA) or sedentary behaviour (SB). However, two persons may have the same volume of PA or SB but accumulated in a completely different sequence. The pattern of accumulating PA and SB may be far more important for health effects than the total volume. We therefore aimed to develop a sophisticated algorithm translating accelerometer data into detailed sequence maps considering how PA and SB are accumulated throughout the day.

Methods: A novel algorithm to convert accelerometer counts into a sequence map based on behaviour states defined by a combination of intensity (SB, light, moderate, and vigorous intensity PA) and duration (sporadic accumulation or in bouts of different duration) was developed. Additionally, hierarchical cluster analysis was applied to identify clusters of children with similar sequence maps.

Results: Clustering resulted in seven groups of children with similar PA and SB sequence maps: 3 larger clusters (2, 1 and 4) with 33%, 31% and 26% of the children respectively, and four very small clusters (3, 5, 6 and 7) with 7% of the children or less. Clusters 3, 4, and 7 consisted of relatively more girls (68-83%), clusters 6 and 7 relatively more overweight children (33%). Clusters 5 and 6 and 7 stood out with relatively few high fit children (0-33%).

Conclusion: This novel algorithm is a next step in more sophisticated analyses of accelerometer data considering how PA and SB are accumulated throughout the day.

Predicting sleep, sedentary behaviour, and physical activity from commercially available wearable devices using Rotation Forest models

Daniel Fuller, Faramarz Dorani, Hui Luan, Javad Rahimipour Anaraki, Majid Beheshti Mohtasham, Memorial University

Background: Our objective was to predict sleep, sedentary behaviour, and physical activity using commercially available wearable devices.

Methods: We collected five days of data on seven participants using GENEActiv, Apple Watch, and FitBit. The sample included four men and three women ranging in age from 22 to 42 years. Apple Watch and GENEActiv were worn on the non-dominant wrist, and FitBit on the dominant wrist. We used existing methods to label sleep, sedentary behaviour, and physical activity from GENEActiv data. We collected minute level heart rate, steps, floors climbed, energy expenditure, and distance from Apple Watch and Fitbit. We aggregated the GENEActiv data to the minute and used a Rotation Forest classifier. The data were split into training (70% of data) and test sets (30% of data).

Results: We were able to correctly classify 71% and 56% of the data for Apple Watch and FitBit, respectively. The confusion matrix for Apple Watch showed that classification accuracy ranged from 72% (sedentary) to 18% (light activity). FitBit classification accuracy ranged from 59% (sleep) to 0% (light activity). The majority of data were sleep and sedentary behavior making classification of less common light, moderate, and vigorous activity a challenge with our small dataset.

Conclusions: Findings suggest that considerable work is required to correctly classify sleep, sedentary, and physical activity behaviours using data from commercial wearable devices. However, with large samples of high quality data and advances in machine learning methods, we believe highly accurate classification is possible.

External funding details: Health Behaviour Data Challenge

Backward compatibility of sedentary time estimates derived from wrist worn GENEActiv accelerometers

Lynne Boddy¹, Robert Noonan², Alex Rowlands³, Liezel Hurter⁴, Zoe Knowles⁴, Stuart Fairclough⁵

¹Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, ²Edge Hill University, ³Diabetes Research Centre, Unviersity of Leicester, NIHR Leicester Biomedical Research Centre, ARENA University of South Australia, ⁴The Physical Activity Exchange, Liverpool John Moores University, ⁵Edge Hill University

Introduction: This secondary data analysis examined the backward compatibility of wrist-worn accelerometer estimates of sedentary time (ST) with ActiGraph 100 count·min⁻¹ waist ST estimates using a range of raw data thresholds.

Methods: One hundred and eight 10-11 year old children (65 girls) wore an ActiGraph GT3x accelerometer (AG) on their right hip and a GENEActiv accelerometer (GA) on their non-dominant wrist for seven days. GA data were processed using the GGIR R package and signal vector magnitude was calculated using the ENMO approach. GA ST data were classified using published thresholds: 23 mg, 36 mg, 52 mg and 56 mg and arbitrary thresholds: 30 mg, 40 mg and 45 mg. The resultant ST estimates were compared to AG ST data classified using 100 count·min⁻¹. Cronbach’s alpha, intraclass correlation coefficients (ICC), limits of agreement (LOA) and percent agreement were calculated.

Results: Percent agreement ranged from 68-69.9%. Cronbach’s alpha values were all ≥.88. ICCs ranged from .594 (23 mg threshold) to .861 (36 mg). Mean ST was significantly different between AG and all GA thresholds (p < 0.001), with the exception of the 36 mg threshold (p = 0.09). LOA were wide for AG - GA comparisons, with the narrowest observed for the AG v 36 mg comparison (-230.47 - 194.81 minutes).

Conclusions: Despite observing high ICC and Cronbach’s alpha values, the results suggest that wrist mounted, raw acceleration derived ST estimates should not be directly compared at the individual level with those derived from the 100 count·min⁻¹ waist mounted AG threshold. The 36 mg threshold may provide comparable ST estimates at the group level.

How well do smartphones measure steps in free-living conditions?

Shiho Amagasa¹, Masamitsu Kamada², Hiroyuki Sasai³, Noritoshi Fukushima¹, Hiroyuki Kikuchi¹, I-Min Lee⁴, Shigeru Inoue¹

¹Tokyo Medical University, ²Harvard T.H. Chan School of Public Health, The University of Tokyo, ³The University of Tokyo, ⁴Harvard T.H. Chan School of Public Health, Harvard Medical School

Introduction: Despite a great potential for monitoring physical activity (PA) by smartphones in public health and clinical settings, little evidence on their accuracy in free-living conditions in their ordinary usage currently exists. The aim of this study was to assess the accuracy of step counts measured by iPhone in free-living conditions.

Method: We recruited 54 adults (31 ± 10 years) who owned an iPhone. Step count was measured using both a validated pedometer (Kenz Lifecorder) and the iPhone simultaneously. Participants were asked to use their own iPhones as usual and wear a pedometer on their waist for 7 consecutive days during waking hours. A recorded day was deemed valid if the pedometer was worn for ≥10 hours a day on at least 3 days. To assess the agreement between the two measurements, we calculated Spearman’s correlation coefficients and created a Bland-Altman plot.

Results: Mean (SD) step count of iPhone was 9,253 (3,787) steps/day and it was significantly lower than that of the pedometer, 10,530 (3,490) steps/day, by 12% (P < 0.001). The Spearman correlation coefficient between devices was 0.78 (p < 0.001). Compared between groups, the largest underestimation of steps by iPhone against a pedometer was observed among those who seldom carry their iPhones [seldom: -3,036 (2,990) steps/day, sometimes: -1,424 (2,619) steps/day, and almost always: -929 (1,443) steps/day; P for linear trend = 0.081].

Conclusion: Smartphone may be of practical use to individuals, clinicians, and researchers for monitoring PA and for health promotion. However, caution should be paid in their underestimated outputs and non-carrying time.

External funding details: This study was supported by a Grant-in-Aid for Scientific Research (16H03249) from the Japan Ministry of Education, Culture, Sports, Science and Technology, and the Uehara Memorial Foundation.

ActiGraph and Fitbit cadence (steps/min) thresholds for moderate intensity walking in 21-60 year olds: The CADENCE-Adults study

Elroy Aguiar¹, Scott Ducharme¹, Christopher Moore¹, John Schuna Jr², Tiago Barreira³, Stuart Chipkin¹, Catrine Tudor-Locke¹

¹University of Massachusetts Amherst, ²Oregon State University, ³Syracuse University

Introduction: A directly observed walking cadence of ∼100 steps/min has been established as a heuristic (evidence-based, practical, rounded) threshold associated with absolutely-defined moderate intensity (3 metabolic equivalents; METs). It is unclear whether this same threshold can be applied to commonly used research- and consumer-grade wearable devices.

Method: 156 participants (50% women, mean age = 40.6 ± 11.5 years; height = 1.7 ± 0.1 m, BMI = 25.4 ± 3.7 kg/m²) completed a treadmill walking protocol comprised of 5-min bouts at incrementally faster speeds (0.5-5.5 mph) while wearing an ActiGraph GT9X and Fitbit One on a waistband. Fitbit cadence was calculated as displayed steps per bout divided by 5-min. ActiGraph cadence (downloaded after testing) and metabolic intensity (METs; indirect calorimetry) were averaged over the final 2-min of each bout. Receiver Operating Characteristic (ROC) analysis was used to determine optimal cadence thresholds associated with 3 METs.

Results: Cadence ROC models for predicting 3 METs demonstrated excellent fit for both devices (all areas under the curve >0.94). Optimal cadence thresholds (95% CI) were 96 (94-100) steps/min for the ActiGraph and 97 (94-102) steps/min for the Fibit. Sensitivity and specificity values for these thresholds were all ≥85%, indicating high classification accuracy.

Conclusion: A cadence of ∼100 steps/min appears to be a reasonable heuristic threshold representative of absolutely-defined moderate intensity walking when assessed using the ActiGraph GT9X or the Fitbit One. This finding suggests that walking thresholds are translatable across observed and technology-detected cadences. Future studies should determine whether this heuristic threshold can be consistently applied to other popular research- and consumer-grade wearable devices.

External funding details: NIH/NIA Grant 5R01AG049024

Development and feasibility of a wearable infant wrist band for the objective measurement of physical activity using accelerometer

Alessandra Prioreschi¹, Thomas Nappey², Kate Westgate³, Patrick Olivier², Soren Brage³, Lisa Micklesfield¹

¹University of the Witwatersrand, ²Open Lab, ³University of Cambridge

Background: This study aimed to describe the development of an infant wearable wrist-worn band for the measurement of physical activity; to determine the feasibility of the device data for observational measurement of physical activity; and to determine the caregiver reported acceptability of the infant wearable wrist band.

Methods: A wearable band was designed to fit an Axivity AX3 monitor. Mother and infant/toddler (aged 3-24 months) pairs (n = 152) were recruited, and mothers were asked for their child to wear the band with enclosed monitor at all times for one week (minimum 3 days). Feasibility was assessed by determining technical reliability of the data, as well as wear time and compliance according to requirements for observational measurement. Acceptability was assessed via questionnaire.

Results: Technical reliability of the Axivity AX3 monitors in this age group was good. After excluding days that did not have at least 15 hours of wear time, 94% of participants were compliant, thus providing enough valid data for observational measurement. The majority (60%) of mothers reported being “very happy” with the safety of the device, while only 8% were “a little worried”. Most (80%) of participants rated the comfort of the band as “comfortable”, and 10% rated it as “very comfortable”.

Conclusions: The infant wearable band proved to be feasible and acceptable according to the criteria tested, and compliance wearing the band was good. We have therefore provided a replicable, comfortable, and acceptable wearable band for the measurement of infant and toddler physical activity.

Session: National policy approaches from around the world

The Australian Approach

Lindsey Reece, University of Sydney / Office of Sport NSW Government

In Australia, the national physical activity guidelines are consistent with the World Health Organisations recommendations, however much of the population are not sufficiently active to maintain overall good health. Whilst information on physical activity for health is captured through annual health surveys, participation in sport and active recreation is the primary indicator of success in Australia, measured through AUSPLAY. A national policy review identified that different approaches and metrics for success have been adopted across the different states and territories to increase the amount of physical activity and sport the population engages in. No single strategy will be effective to increase participation - a comprehensive, multifaceted, multi-sector approach is required. In response, the Australian Government in May 2017 announced the development of the National Sport Plan which will be delivered through four, interrelated pillars of participation, performance, preventive health through physical activity, and integrity. The development of the National Sports Plan envisions an Australia where everyone can be a part of sport and can be engaged in healthy living. At a state level, the NSW government has invested in a new research partnership with University of Sydney, SPRINTER, that uniquely positions academia alongside policy makers to inform policy, enhance practice to drive population changes in sport and physical activity participation whilst aligning with national priorities. Reflections on the newly announced national sports plan along with critical insights from the SPRINTER partnership will be presented.

External funding details: Office of Sport NSW government financially supports the SPRINTER partnership.

Everybody Active, Every Day, the England experience

Lindsey Reece¹, Dr Justin Varney²

¹University of Sydney / Office of Sport NSW Government, ²Public Health England

In 2014 Public Health England led the co-production of a national evidence-based framework for action to reduce inactivity and increase health promoting physical activity. Everybody Active, Every Day (EAED) was developed through evidence reviews and co-production with over 1,000 stakeholders. It built on the Legacy established by the 2012 Olympics, the UK Chief Medical Officers guidelines on Physical Activity and the evolving narrative and evidence base within the sport and fitness sector led by Sport England. The UK Government accepted the recommendations for action made in EAED at a national level. Since its publication Sport England and Public Health England have worked in synergy with the Department of Health and Department of Digital, Culture, Media and Sport to implement the framework. EAED has been referenced and its recommendations integrated into government policy on sport, welfare reform, transport investment and across a broad range of health related policies. In 2017/18 PHE commissioned an external review of the impact of the framework in two of the four domains of action: creating an active society and creating active environments. This presentation will share the findings of this review as well as reflect on the journey over the last four years and the opportunities moving forward to accelerate change.

Building bridges among policy, practice, research, and communication: Finland’s most successful government programme: Finnish Schools on the Move

Antti Blom¹, Kaarlo Laine², Annaleena Aira², Eino Havas², Tuija Tammelin²

¹Finnish National Agency for Education, ²LIKES Research Centre for Physical Activity and Health

Finnish Schools on the Move (FSM) is a national action programme to establish a physically active operating culture in schools. Schools and municipalities participating in the programme implement their own plans to enhance PA during the school day, mostly during recess and academic lessons. The programme supports the dissemination of the ideas and practises developed by schools through organising seminars and producing and distributing educational materials. FSM operates in close interaction with the central government and has been implemented from the bottom-up and top-down simultaneously. FSM is funded by the Ministry of Education and Culture and organised by the National Board of Education, regional state administrative agencies and various other organisations. In 2010 programme began with 45 comprehensive schools, and at the begin of 2018 total of 2,053 schools (84% of all comprehensive schools) were registered to the programme. Recently FSM has become a priority government programme regarding know-how and education with the financial support of 21 million euros from the Ministry of Education and Culture for 2016–2018 to FSM to operate in municipalities. The objective of the Government is to expand the Schools on the Move programme across the country. The successes and challenges related to the coordination and administration of the progamme will be discussed.

External funding details: Ministry of Education and Culture, Finland

Fostering partnership to advance global and national physical activity agenda: Lesson Learned from Thailand

Niramon Rasri¹, Orana Chandrasiri², Sigit Arifwidodo³

¹Thai Health Promotion Foundation, ²International Health Policy Programme, ³Kasetsart University

Although evidence has shown health benefits of increased physical activity (PA), many people in the world remain physically inactive and sedentary. In Thailand, less than one third of Thai population exercises on a regular basis. In recognition to the slow progress of implementation of interventions to promote physical activity at the global and national levels, Thailand see the importance of hosting the 6th International Congress on Physical Activity and Public Health (ISPAH2016) as a stepping stone to advance the national PA agenda. The congress opens new window opportunity to be more actively involved in the global PA movement. Thai Health Promotion Foundation (ThaiHealth) as one of the major actor in PA promotion then collaborates with national and international partners such as Ministry of Public Health, Ministry of Foreign Affairs, Ministry of Tourism and Sports, International Society for Physical Activity and Health, and World Health Organization. This partnership started with arranging the 69^th World Health Assembly (WHA) side event as a scene-setting. It has resulted in two important milestones: the 69^th South-East Asia Regional Committee Resolution and proposal to establish Global Action Plan on Physical Activity (GAPPA) during the 141^st WHO executive board meeting. This document serves as an important policy guidance to renew global commitment in the form of World Health Assembly resolution which is expected to be endorsed in this May 2018. Thailand’s involvement in global PA movement triggers the high-level actors to start to see the importance of advancing national PA agenda.

Applying a global promotion plan to a European country: What does the WHO Global Action Plan for Physical Activity (GAPPA) mean for Austria?

Randy Rzewnicki, ECF - European Cyclists’ Federation

Introduction: The World Health Organization decided in early 2017 to launch a Global Action Plan for Physical Activity (GAPPA), which was adopted in May 2018. What do such plans mean for public health, active transport planning, and people who are or want to be walking and cycling in a well-developed member-state of Europe like Austria?

GAPPA contains several key proposals and approaches to convince politicians and decision makers to take action and commit resources for the promotion of physical activity. They include:

1.Existence of a decidedly sufficient evidence base to justify taking action (“we know enough to act and how to deliver results”);
2.An absolute prerequisite is the multi-sectoral approach incorporating transport, health, environment, urban planning, economics, finance and education.
3.Valuing cycling (economic contributions including jobs, monetization of health benefits, and harm reduction)

How do these and other recommendations compare with the Austrian experience? This study explores the utility and degree of potential benefit to public health of applying a framework promotion scheme like the GAPPA to Austria.

Conclusions: While GAPPA is not limited to cycling promotion, the argument can be made that global promotion of active transport can make the greatest contribution to increasing levels of physical activity. The results of this study can serve as a basis for the application of GAPPA recommendations in Austria and other EU member states.

Application and evaluation of the ‘Urban Health Check’: an evidence-based planning support system to assist a State Government department with the design and creation of health-promoting communities

Paula Hooper¹, Sarah Foster²

¹The University of Western Australia, ²RMIT

Introduction: Despite a growing acceptance of the need for planning interventions that are health enhancing, planning professionals lack easy access to quantifiable evidence-based information about how their decisions impact community health. This study presents an overview of the application and evaluation of an interactive, empirically-driven, evidence-based health impact planning support system (the ‘Urban Health Check’) developed in partnership with the Western Australian State Government’s Land Development Agency (LandCorp) to embed the consideration of health outcomes across its organisational structures, work practices and into the built environments they are designing and constructing.

Methods: The Urban Health Check was applied to real world development projects to ‘health check’ design concepts, run facilitated design review sessions and assist with communicating the outcomes and health benefits with planning consultants, local governments, elected members and the wider community. Evaluation, through surveys and focus groups, examined the capability of the Urban Health Check to support the planning tasks and activities of professionals, the experiences of using the tool, and the impact or added value of the Urban Health Check on supporting ‘healthier’ planning practices.

Results: Preliminary results indicate that the provision of health focused guidance through the Urban Health Check has assisted LandCorp embed community wellbeing outcomes in its projects and improved staff understanding of the planning and design decisions that impact negative and positive health outcomes.

Conclusion: The ongoing application of the Urban Health Check will help to stimulate strategic decisions and prioritisation of design solutions that are tailored to optimising the community health outcomes.

Session: Physical activity interventions for youths

Testing a social network vlog intervention to promote physical activity among adolescents: A randomized controlled trial

Thabo Van Woudenberg, Kirsten Bevelander, William Burk, Crystal Smit, Laura Buijs, Moniek Buijzen, Behavioral Science Institute, Radboud University

Introduction: The current study will examine the effectiveness of a short video (i.e. vlog) intervention to promote physical activity among adolescents. In addition, this study will test whether a social network vlog interventions is more effective than a mass media vlog intervention. A specific subset of adolescents (i.e. influence agents) will be asked to create six vlogs in which they promote physical activity, based on the behavior change mechanisms proposed by the Fogg’s behavior model.

Method: Thirty classes (N = 1250) will be allocated via cluster randomization to one of the three conditions. Participants will receive a research smartphones to watch the vlogs, fill out the sociometric nominations and measure the covariates. An accelerometer (Fitbit Flex) is used to measure daily physical activity. At baseline, peers will nominate each other on sociometric questions (e.g. friendship) and the most central adolescents will be approached, on the last day of the baseline measures, to become an influence agents. During the intervention week, participants receive a vlog per day of the influence agents in their class (social network condition), from influence agents of another school (mass media condition) or no vlogs (control condition). Follow-up measurement will be five weeks after the intervention.

Results: Mixed models will be used to test the effectiveness of the interventions, controlling for clustering of the data within classes, participants and days.

Conclusion: This study is the first social network intervention that uses vlogs to promote physical activity in adolescents and compare this to a mass media campaign and control condition.

Evidence into practise to increase children’s physical activity through schools settings: Does the Daily Mile improve the physical activity and physiological health of primary school children?

Colin Moran¹, Ross Chesham¹, Josie Booth², Emma Sweeney³, Gemma Ryde¹, Trish Gorely⁴, Naomi Brooks¹

¹University of Stirling, ²University of Edinburgh, ³Northumbria University, ⁴University of the Highlands and Islands

Introduction: The Daily Mile is a physical activity programme made popular by a primary school in Stirling, Scotland. The aim is that each day, during class time, pupils run/walk outside for 15 minutes (∼1 mile) at a self-selected pace. It is anecdotally reported to have a number of physiological benefits. However, no study yet has investigated these reports.

Method: We conducted a quasi-experimental repeated measures study in two primary schools in the Stirling Council area: one school with, and one without, intention to introduce the Daily Mile. Pupils at the control school followed their usual curriculum. Of the 504 children attending the schools, 391 children in primary 1-7 (age 4-12 years) at baseline assessment took part. Follow-up assessment was the same academic year. Outcomes were accelerometer assessed average daily moderate to vigorous intensity physical activity (MVPA) and average daily sedentary behaviour, 20 metre shuttle run fitness test performance and adiposity assessed by sum of four skinfolds sites.

Results: After correction for age and gender, significant improvements were observed in the intervention school relative to the control school. MVPA, 9.1 min/day increase (95%CI 5.1-13.2 mins, SMD = 0.407, p = 0.027); sedentary time, 18.2 min/day decrease (10.7-25.7 mins, SMD = 0.437, p = 0.017); shuttle run, 39.1 m increase (21.9-56.3, SMD = 0.236, p = 0.037); and, skinfolds, 1.4 mm decrease (0.8-2.0 mm, SMD = 0.246, p = 0.036).

Conclusion: In primary school children the Daily Mile intervention seems effective at increasing levels of MVPA, reducing sedentary time, increasing physical fitness and improving body composition. These findings have relevance for education and health policy.

“4PC”: An integrated model to promote Active School in Thailand

Panya Choolers, Narakorn Wongsingha, Piyawat Katewongsa

Institute for Population and Social Research, Mahidol University

Introduction: Recent data from the survey on physical activity of Thai children and youth indicated that only 23.2% of Thai population aged 6 to 17 years met the PA guidelines of 60 min MVPA daily. This study aims to develop a school-based prototype for physical activity promotion in Thailand by considering the context, culture, curriculum and teaching personnel in Thailand.

Method: It was school-based research using a quasi-experimental approach implemented in 15 schools; seven schools classified as experimental group and eight schools as control group. A total of 526 students aged between 9-10 years was drawn from the population in a probability random manners to be enrolled in a three years study.

Results: The prototype development process of active school was based on participatory action research method consisting of educational policy makers, school administrators, teachers, students and research teams. For “4PC” model comprised of 5 essential elements: 1) active Policy 2) active Program 3) active Place 4) active People and 5) active Classroom. During the first year, the participants in the experimental group had an increased in overall physical activity level approximately of 6% (from 55.4% to 61.6%). Furthermore, comparing to control group, it is found that students in the experimental group have reported 9% of higher happiness and school engagement (77.9% and 69.0%).

Conclusion: The findings suggest that 4PC model positively influences the physical activity, emotional quotient, and school engagement of students.

External funding details: This project has been supported by Thai Health Promotion Foundation, Thailand

Evaluation of the Girls Active school-based physical activity programme: Implications for resourcing and delivery

Deirdre Harrington¹, Melanie Davies¹, Joanna Charles², Trish Gorely³, Kamlesh Khunti¹, Alex Rowlands¹, Lauren Sherar⁴, Rhiannon Tudor Edwards², Thomas Yates¹, Charlotte Edwardson¹

¹University of Leicester, ²Bangor University, ³University of the Highlands and Islands, ⁴Loughborough University

Introduction: Evidence from well-designed, adequately powered evaluations of programmes tackling low physical activity (PA) in UK adolescents are emerging. In light of the results of, and experiences from, the randomised controlled trial of the “Girls Active” school-based PA programme, the aim is to discuss the implications for putting this research evidence into practice.

Methods: Named investigators independently evaluated the Youth Sport Trust (YST) Girls Active programme. Twenty UK schools (10 intervention, 10 control) and 1,752 adolescent females were recruited. Effectiveness, economic analysis and process evaluations were undertaken.

Results: Evidence produced can impact the design and resourcing of similar programmes: programme effectiveness on PA and related outcomes; human resource and financial costs of programme implementation; qualitative information on how well Girls Active was received and valued by teachers and pupils and school-level constraints to implementation; and identification of commitments dictated by the national educational landscape that impeded implementation. The level and amount of on-going support offered by the YST was well-received and has merits for replication. Practical challenges encountered highlight the complexities of delivering school-based PA programmes effectively and should be addressed in future programmes.

Conclusions: Schools continue to be a key location for PA programming. Evidence suggests that unless schools are adequately resourced and the policy environment (the wider context) challenged to sustainable delivery of school-based PA programming there are limitations to the success of PA programmes.

External funding details: Girls Active is funded by the Youth Sport Trust. The evaluation was funded by the NIHR Public Health Research Programme.

Move well, move often: Understanding motor competence in children and young people: New horizons in movement skill assessment: sensors

Cain Clark¹, Claire Barnes², Paul Rees², Huw Summers², Gareth Stratton²

¹Coventry University; Swansea University, ²Swansea University

Introduction: Accelerometers are widely used to study physical activity and have been shown to be informative of motion mechanics. Whilst Process-oriented assessment is an important tool in the development of children’s fundamental movement skills, current methods of assessment are cumbersome and subjective. We present a novel analysis framework for activity assessment that uses accelerometry to create sophisticated motion maps and demonstrate their utility in profiling and categorising movement mechanics, objectively, in a diverse range of fundamental movements.

Methods: Acceleration data were collected from ankle and wrist mounted sensors. Children aged 9 - 12 years were assessed in a multi-stage fitness test and a fundamental movement skill (FMS) challenge. Acceleration and magnetometer data were used to construct spectrograms, phase maps of motion and a performance sphere. Specific activity components were analysed through pattern recognition using machine learning, and dynamic time-warping.

Results: Novel analyses of FMS displayed patterns clearly linked to specific activities such as throwing, jumping and body roll. These were sufficient to classify performance into activity categories using pattern recognition and a training set from expert observer scores.

Discussion: Novel analyses of children’s mechanical motion patterns can be achieved for FMS using lightweight, low cost wearable sensors. These motion maps can be predictive of performance based on limited sampling allowing population profiling of FMS. Further, the use of computerised pattern recognition and classification gives an objective scoring of complex motion, normally requiring subjective assessment by expert human observers.

24-Hour Movement Guidelines for the Early Years: A collaborative approach to adopting/adapting guidelines. The Australian 24-Hour Movement Guidelines for the Early Years (Birth to 5 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

Anthony Okely¹, Davina Ghersi², Kylie Hesketh³, Rute Santos¹, Sarah Loughran¹, Dylan Cliff¹, Trevor Shilton⁴, David Grant⁵, Rachel Jones¹, Rebecca Stanley¹, Julie Sherring¹, Trina Hinkley², Stewart Trost⁶, Clare McHugh⁷, Simon Eckermann¹, Karen Thorpe⁸, Karen Waters⁹, Tim Olds¹⁰, Tracy Mackey¹¹, Rhonda Livingstone¹², Hayley Christian¹³

¹University of Wollongong, ²National Health and Medical Research Council, ³Deakin University, ⁴National Heart Foundation, ⁵Department of Health, Government of Australia, ⁶Queensland University of Technology, ⁷Early Childhood Australia, ⁸The University of Queensland, ⁹Children’s Hospital Westmead and University of Sydney, ¹⁰University of South Australia, ¹¹New South Wales Department of Education, ¹²Australian Children’s Education & Care Quality Authority (ACECQA), ¹³The University of Western Australia

Introduction: The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework.

Methods: A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-hr integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the information from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour and made a decision to adopt or adapt the Canadian recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines.

Results: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording, keep the wording of the guidelines, preamble and title of the Canadian Guidelines.

Conclusion: Following this approach allowed the Australian Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Children’s active transportation: The interplay of individual, parental and social factors

Richard Larouche¹, Sébastien Blanchette², Guy Faulkner³, GeneviŁve Leduc⁴, Negin Riazi³, François Trudeau², Mark Tremblay⁵

¹University of Lethbridge, ²Université du Québec à Trois-Rivières, ³University of British Columbia, ⁴Fillactive, ⁵Children’s Hospital of Eastern Ontario

Introduction: Active transportation (AT) is an important source of moderate- to vigorous-intensity physical activity (MVPA) among children, but most previous studies have focused only on the trip to/from school. We investigated the correlates of AT to/from a broader range of destinations including school, parks, shops, sport venues, etc.

Methods: 1,892 children in grades 4-6 were recruited in 37 schools from 3 diverse regions of Canada: Ottawa, Trois-Rivières, and Vancouver. Children completed a questionnaire on AT and independent mobility and wore a SC-StepRX pedometer (capable of measuring time spent in MVPA) for 7 consecutive days. One of their parents completed a questionnaire that included items on their child’s behaviours, perceptions of the environment and socio-demographic characteristics. We used generalized linear mixed models with a negative binomial distribution to investigate the correlates of the number of active trips reported by children while adjusting for gender, school, school-area income, and urbanization.

Results: Children who were granted more independent mobility (exp(b) = 1.06 for each additional mobility license), whose parents reported higher social cohesion (p_trend = 0.025), or owned fewer cars (p_trend < 0.001) reported more active trips. Conversely, children who accumulated an average of <60 min/day of MVPA (exp(b) = 0.88), did not go home for lunch (exp(b) = 0.64), spent less time outside (p_trend < 0.001), did not attend the closest school (exp(b) = 0.74), or spoke a language other than English or French at home (exp(b) = 0.76) reported fewer active trips.

Discussion: Children’s AT is associated with multiple characteristics of the child, the parents, and the social environment. AT interventions should target multiple levels of influence.

Session: Physical activity for people with disabilities: Evidence, interventions and evaluation

Trajectories of health-related quality of life after rehabilitation: results from the longitudinal cohort study ReSpAct

Bregje Seves¹, Femke Hoekstra², Florentina Hettinga³, Rienk Dekker⁴, Lucas van der Woude¹, Trynke Hoekstra⁵

¹University of Groningen, ²The University of British Columbia, ³University of Essex, ⁴University Medical Center Groningen, ⁵VU University Amsterdam

Purpose: To identify trajectories of health-related quality of life (HR-QoL) among people with physical disabilities or chronic diseases after rehabilitation, and to determine which factors are associated with trajectory membership.

Method: Patients(N = 1719) with physical disabilities or chronic diseases were followed at baseline(T0: 3-6 weeks before discharge) and 14(T1), 33(T2) and 52(T3) weeks after discharge from rehabilitation in the longitudinal cohort study Rehabilitation, Sports and Active lifestyle (ReSpAct). Latent class growth mixture modelling was used to determine trajectories of HR-QoL, a data-driven approach, based on self-reported data of the RAND-12. Descriptive statistics were used to determine personal and lifestyle related factors associated with trajectory membership.

Results: Four trajectories of HR-QoL were identified, whereof two small and dynamic trajectories (‘fluctuating’(N = 25) and ‘recovery’(N = 13)). Two large and stable trajectories were distinguished and used for further analysis: ‘high HR-QoL’ (N = 489) and ‘low HR-QoL’ (N = 656). Patients with ‘high HR-QoL’ reported higher levels of physical activity than patients with ‘low HR-QoL’ on each measurement occasion (1617 ± 1305 versus 1121 ± 1170 minutes/week on T3). Patients with ‘high HR-QoL’ were more often male (56.0% versus 44.0%), older (52.6 ± 13.4 versus 49.8 ± 13.3), had a lower Body Mass Index (26.5 ± 5.1 versus 27.8 ± 6.0), smoked less (13.9% versus 20.4%), consumed more alcohol (48.4% versus 36.6%), and had fewer comorbidities (62.9% versus 50.1% with one comorbidity).

Conclusion: This study identified four trajectories of HR-QoL: ‘fluctuating’, ‘recovery’, ‘high’ and ‘low’. The associated personal and lifestyle related factors will help healthcare professionals to identify vulnerable patients and provide them with tailored advice regarding a physically active and healthy lifestyle.

Richmond Group’s physical activity programme movement for al: A realist evaluation of Get Set to Go: A multi-site, community based, peer-led physical activity intervention for people with mental health problems.

Dr Florence Emilie Kinnafick¹, Hayley Jarvis², Lorna Tweed¹, Emma Adams¹, Musgrove Madeline², Jacob Diggle²

¹Loughborough University, ²Mind

Introduction: Limited research has explored the complex relationship between physical activity (PA) and mental health (MH) in community based interventions. Get Set to Go (GStG), a 3 year PA programme funded by Sport England and National Lottery, and delivered by Mind, a UK based MH charity, used online support and face-to-face group based, peer-led PA taster sessions across eight local Mind services in England. We aimed to answer the question, how might we best deliver interventions to capitalise on associations between PA and MH.

Method: Using a Realist evaluation approach (i.e., to understand what works for whom, in what contexts, and how, in complex social phenomena) our methods included nine focus groups with peer-volunteers (4: n = 28), Sport-Coordinators (1: n = 8), and participants (4: n = 35). Using an inductive thematic approach data was analysed first by sample group, then across sample groups to develop meaningful themes.

Results: Analysis highlighted context specific areas for feasible and successful methods of engaging adults with poor MH to support behaviour change; lived experience of MH problems for a supportive socio-contextual environment within group sessions; personalised text messages for participants to facilitate feelings of value and care; a support structure for peer-volunteers; clear line of communication to create stability for participants and peer-volunteers; positive relationships with sports facilities and staff to reduce perceived stigma of poor MH.

Conclusion: Group based, peer-led community programmes can successfully engage those with MH problems, via conducive change mechanisms, by facilitating a supportive socio-contextual environment encompassing the lived experience of MH problems.

A participant-led physical activity programme for disabled people who are ready to become physically active

Eva Jaarsma, Brett Smith, University of Birmingham

Background: Despite physical and psychosocial benefits of participating in physical activity, disabled people are amongst the most inactive people in the community. To successfully increase physical activity participation in disabled people it is crucial that people have the intention to become physically active. Therefore intenders are the ideal target for physical activity promotion interventions.

Objective: Objective of this study was to evaluate a 30 week participant-led physical activity programme for disabled intenders. Second objective was to explore positive and negative experiences of disabled people during the process of becoming physically active.

Methods: A mixed method design using thematic analysis to analyse data from focus groups as well as Friedman tests to determine differences in physical activity, sitting time and self-efficacy in week 1, 12 and 30. Post hoc tests were performed using Wilcoxon tests.

Results: 15 participants completed a 30 week physical activity programme, showing short term improvements (week 1 vs week 12) with increases in vigorous activity (p = 0.068) and self-efficacy (p = 0.017) and a decrease in sitting time (p = 0.026). Participants expressed that being physically active improved their self-confidence and that action plans helped to include physical activities in their daily routine. Long term differences (week 1 vs week 30) will also be determined.

Conclusion: Physical activity programmes for inactive disabled people should start with reducing sitting time before improving physical activity and focus more on ‘every active minute helps’. Finally action plans were useful tools to become physically active.

External funding details: This study was funded by the English Federation of Disability Sport.

The impact of sport and physical activity as a rehabilitation tool upon Invictus Games Competitors

Ian Brittain¹, Jason Bocarro², Michael Edwards²

¹Coventry University, ²NC State University

Introduction: There is a growing body of research highlighting the positive impacts of sport and physical activity upon the physical and mental well-being of traumatically injured military personnel. This study carried out at the 2015 Invictus Games in Orlando, Florida, aimed at better understanding the role of sport-based physical activity in the rehabilitation process of military personnel who have undergone traumatic injury or chronic illness.

Methods: Data were derived from the following: (1) Five in depth focus groups consisting of 19 competitors from 4 countries; (2) Semi-structured interviews were conducted with ten team managers; (3) 153 Competitors (23 female, 130 male) completed open ended questions as part of a survey. The average length of time since the onset of injury for all respondents was just under eight years.

Results: Six main themes around how sport had helped in their rehabilitation process were discernible from the data. These were: sense of camaraderie and achievement, sport providing participants with increased sense of purpose, motivation and confidence, sport providing a safe channel for aggression, sport participation had led to improved physical and psychological wellbeing, and that sport kept their mind off what had happened to them.

Conclusion: Findings appear to indicate that the use of sport and physical activity as an effective rehabilitation tool. Tactics such as goal setting and team mentality, often critical components of both sport and fundamental parts of military training, is helpful in allowing these competitors to reconnect with their military identity, without the negative implications of self-comparison.

External funding details: The authors would like to acknowledge the assistance of the Invictus Games Foundation in providing access to the competitors, friends and family and spectators at the 2016 Invictus Games in Orlando, Florida, which made this research possible. This research was supported by a Marie Curie International Research Staff Exchange Scheme Fellowship within the 7th European Community Framework Programme.

Enabling access for people with mental impairments

Roger Mackett, University College London

Travel provides access to everyday activities including those providing physical activity. Disabled people have greater barriers to travel than other people despite equality legislation in many countries. Arguably, fewer adjustments are made to transport supply for people with mental impairments such as dementia, autism and mental health conditions than for people with physical impairments.

The purpose of this presentation is to identify the factors that deter people with mental impairments from travelling and interventions that can help to overcome these barriers. The research in the paper is based on the analysis of data from the UK Life Opportunities Survey, the National Rail and Bus Passenger Surveys, interviews with stakeholders and examination of the literature, particularly the grey literature.

The main factors that deter people with mental impairments from travelling are anxiety and lack of confidence which stem from two concerns: finding the way (and not getting lost) and interacting with other people. Wayfinding involves the process of decision-making based on the integration of information from two sources: memory recall and perception of the local environment including sources carried by the traveller. All these processes can be challenging for people with mental impairments, as can be communication with travel staff and fellow travellers. There may also be concerns about behaviour, both that of fellow travellers and how one’s own behaviour is perceived.

A number of interventions which can increase confidence and reduce anxiety are examined, including travel training, clear travel planning information, legible local environments, safe places and mobile phone apps.

Benefits or being fit: benefits and disabled people’s fear of being seen to be active

Elliott Johnson, Activity Alliance (formerly English Federation of Disability Sport)

Introduction: Anecdotal evidence from EFDS’ partners has identified a fear among disabled people of losing benefits as a result of being seen to be active. Disabled people are twice as likely as non-disabled people to be inactive but at least seven in 10 would like to do more.

EFDS, on behalf of Dwarf Sports Association UK (DSAuk), undertook a study to examine this fear, with a particular emphasis on experiences of the main disability benefits (PIP, DLA and ESA).

Method: EFDS commissioned Flex^MR who employed a mixed-methods approach. An online quantitative survey of 206 disabled people was designed to measure activity levels and particular experiences of benefits as well as recruit for a second stage. Twenty-six of those with physical impairments took part in this qualitative stage and discussed their experiences in depth in an online private ‘diary’ and a question board shared with all participants.

Results:

•65% rely on benefits to be active
•47% are fearful of losing their benefits if they are more active
•34% have had, or know someone who has had, benefits removed as a result of being active
•55% are likely to be more active if benefits couldn’t be taken away

Conclusion: The fear among disabled people that being active could lead to losing benefits and, therefore, their independence, is a real and quantifiable issue in increasing activity levels. It is essential that broader social considerations are addressed by those responsible for promoting physical activity and policy makers more generally.

External funding details: DSAuk and Sport England

Accessibility and usability of parks by older adults with disability

Meredith Perry¹, Hemakumar Devan¹, John Sullivan¹, Christina Ergler¹, Pauline Boland²

¹University of Otago, ²University of Limerick

Background: Over 2/3rds of older adults (>65 years) report having a disability. Persons with disability are less likely to be physically active yet are at greater risk of poorer physical, psychological and social wellbeing. Urban parks are free and are associated with better health outcomes. However, the accessibility and usability of urban parks by older adults with disability is unknown.

Methods: This mixed-methods study randomly surveyed 1,000 older adults. Questionnaires included the Perceived Access to Urban Parks, and the EQ-5D-5L. Interviews were conducted post survey with older adults who identified as having a disability.

Results: Over 450 older adults with a mean(SD) age of 74(7) years, including 150 with self-reported disability, completed the survey. Significantly more older adults with disability never visited an urban park in the last year compared to older adults (p < 0.01). Private vehicle ownership significantly increase the odds of visiting urban parks (p < 0.01), OR 3.99 (1.48, 10.8) in older adults. Mobility in the park significantly increased the odds of visiting (p < 0.01), OR 9.55 (1.95, 46.8) in older adults with disability. Older adults with disability reported that the natural environment, amenities, community interactions and finding a place to ‘be’ influenced their decision to visit urban parks.

Conclusions: Older adults with disabilities are less likely to visit and report accessibility issues. Given the ageing population and the health benefits from urban park use inclusive, accessible and intergenerational urban parks requires serious consideration.

External funding details: This research was funded by a University of Otago Research Grant.

Session: Physical activity, physical fitness and disease risk

The longitudinal associations between physical fitness, fundamental movement skills and academic achievement

Heidi Syvoja¹, Anna Kankaanpää¹, Laura Joensuu², Jouni Kallio¹, Harto Hakonen¹, Charles H. Hillman³, Tuija Tammelin¹

¹LIKES Research Centre for Physical Activity and Health, ²LIKES Research Centre for Physical Activity and Health/ Faculty of Sport and Health Sciences, University of Jyväskylä, ³Department of Psychology and Department of Health Sciences, Northeastern University

Introduction: This study examined the longitudinal associations of physical fitness (PF) and fundamental movement skills (FMS) with academic achievement.

Methods: 970 adolescents (9–15 y, 52% girls) from 9 schools throughout Finland participated in a two-year follow-up study. Academic achievement scores (grade point average [GPA]), PF and FMS were assessed in the spring of 2013-2015. Aerobic fitness was measured with a maximal 20-m shuttle run test, muscular fitness with curl-up and push-up tests, locomotor skills with a 5-leaps test and manipulative skills with a throwing-catching combination test. Structural equation modelling was applied to examine the longitudinal associations adjusting for age, gender, mother’s education and children’s learning difficulties.

Results: Changes in aerobic and muscular fitness were positively associated with change in GPA (B = 0.244, p = 0.002; B = 0.328, p < 0.001, respectively). Changes in locomotor or manipulative skills were not associated with change in GPA (B = 0.175, p = 0.073; B = 0.188, p = 0.138, respectively), but these skills in 2014 predicted GPA in 2015 (B = 0.048, p = 0.002; B = 0.033, p = 0.011). GPA in 2013 predicted aerobic fitness and manipulative skills in 2014 (B = 0.074, p = 0.001; B = 0.089, p = 0.004, respectively). However, neither GPA nor PF/FMS predicted one another systematically.

Conclusion: In this study, change in PF was positively associated with change in academic achievement, while FMS, although not systematically, predicted academic achievement, and vice versa. Developmental changes in adolescence may induce parallel and simultaneous changes in academic achievement, PF and FMS.

External funding details: This study was funded by the Academy of Finland (grant 273971) and the Finnish Ministry of Education and Culture (OKM/92/626/2013).

German percentile curves of physical fitness from childhood to early adulthood- the MoMo-Study

Claudia Albrecht¹, Doris Oriwol¹, Anke Hanssen-Doose², Alexander Woll¹, Annette Worth²

¹Karlsruhe Institute for Technology, ²University of Education Karlsruhe

Introduction: The aim of this analyses is to report sex- and age-specific physical fitness (PF) percentile curves from childhood to early adulthood in a nationwide sample in Germany. Already in childhood PF is considered as one of the most important health markers. From a developmental and preventive perspective, PF levels are relatively stable from childhood to early adulthood, thus, it is important to monitor population PF levels being able to intervene at early stages.

Methods: Data stem from the nationwide representative MoMo-Study in Germany (data collection wave 1: 2009–2012; age: 4-23 y.; n = 3.770; 50,2% female). PF was assessed by means of the MoMo-test-profile covering four dimensions of PF (strength, endurance, coordination, flexibility). Percentile curves were fitted using the LMS transformation method of Cole and Green (1992).

Results: Data on 3.770 individual with a mean age 12.5 ± 4,8 years, were submitted for analyses. Standardized age- and sex-specific PF percentiles were calculated for eight items covering health-related (endurance, strength endurance, maximal strength, flexibility) and skill-related fitness dimensions (balance, coordination). Percentile-curve-shapes differ between sexes. PF improvements with age are linear (e.g. max. strength) or curvilinear (e.g. coordination) depending on PF dimension.

Discussion: Our results provide for the first time sex- and age-specific PF percentile curves for Germany from childhood to early adulthood. Differences in curve-shapes indicating a timed and capacity-specific PF development. Nationwide German PF percentiles can be useful in comparing populations (e.g. cross-country) and assessing initiatives that aim to improve childhood PF.

External funding details: Federal Ministry of Education and Research 01ER1503

Identifying correlates and determinants of cardiorespiratory fitness: a systematic review

Johannes Zeiher¹, Katherine J. Ombrellaro², Gert B. M. Mensink², Finger Jonas D.²

¹Robert Koch Institute, ²Robert Koch Institute

Introduction: Cardiorespiratory fitness (CRF) is an established predictor of adverse health outcomes. Therefore, it is important to understand why some people are more fit than others, in order to develop and improve public health interventions.

Method: This systematic review of studies, from databases including MEDLINE, EMBASE and Cochrane Library (no time or language restrictions) investigates the relationship between CRF (measured by treadmill or cycle ergometer test) and individual or interpersonal influencing factors among the general, non-symptomatic, non-institutionalized adult population. Risk of bias is evaluated using a customized quality assessment tool. To date, study selection is complete. Final results, including strength and direction of the association between CRF and identified factors, will be presented.

Results: 3.005 studies were identified in the literature, 86 met the inclusion criteria. Studies were heterogeneous with respect to sample size, country of origin and CRF measurement. Included studies were observational, mostly cross-sectional. Ongoing extraction indicates that, aside from sociodemographic factors such as age and sex, biomarkers and anthropometric measures are the most frequently investigated correlates and determinants. Studies included in the review also analyze the association between CRF and behavioral or socioeconomic factors. Commonly adjusted confounding variables include sex, age, physical activity level, anthropometric measures, vital parameters and smoking status.

Conclusion: In synthesizing the current research on correlates and determinants of CRF among adults, this systematic review could identify gaps in the current understanding of factors influencing CRF and aid public health measures promoting the fitness of risk-groups and the general population.

Genetic risk, physical fitness and incident coronary heart disease.

Youngwon Kim¹, Luca Lotta², Stephen Sharp², Katrien Wijndaele², Felix Day², John Perry², Nick Wareham², Soren Brage²

¹University of Utah, ²University of Cambridge School of Clinical Medicine

Introduction: The purpose was to examine the associations of grip strength (GS) and cardiorespiratory fitness (CRF) with incident coronary heart disease (CHD) across different levels of genetic susceptibility to CHD.

Method: UK Biobank is a prospective cohort of >0.5 million adults: baseline (2006-2010) and repeat-assessment (2012-2013). Participants’ polygenic risk scores (PRS) were calculated to represent each individual’s genetic risk for CHD. GS and CRF were measured through hand dynamometers and sub-maximal bike tests, respectively. Incident CHD was defined as the first occurrence of non-fatal/fatal CHD (accrued until 2015). Analyses were performed on 306,530 individuals (9,201 CHD cases) with no cardiovascular disease at baseline and no covariates missing.

Results: Over 6.9-year follow-up, each standard deviation increase in GS was associated with lower incident CHD hazards in women (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.78-0.84) and men (HR: 0.86; 95% CI: 0.84-0.88), independently of PRS and other confounders. In the sub-sample of 43,286 with CRF measures, each standard deviation increase in CRF was associated with lower CHD hazards (HR: 0.89; 95%CI: 0.83-0.95), independently of confounders including PRS. The lowest GS level showed higher CHD hazards compared with the highest across all genetic risk levels in women (p-for-interaction:0.159) and men (p-for-interaction:0.008). The lowest CRF level had higher CHD rates compared with the highest at each genetic risk (p-for-interaction:0.228).

Conclusions: Higher physical fitness was associated with lower CHD risk at high as well as low genetic risk. Similarly, CHD risk was higher at low genetic risk if physical fitness was lower.

Muscle-strengthening exercise participation patterns among 397,423 American adults and associations with health-related outcomes

Jason Bennie¹, Asaduzzaman Khan², Dc Lee³, Glen Wienser⁴, Adrian Bauman⁵, Emmanuel Stamatakis⁵, Stuart Biddle¹

¹University of Southern Queensland, ²The University of Queensland., ³Iowa State University, ⁴Victoria University, ⁵University of Sydney

Introduction: There is limited research on muscle-strengthening exercise (MSE) participation patterns and its independent associations with health-related outcomes among American adults.

Methods: Data were drawn from the American 2015 Behavioral Risk Factor Surveillance System. During telephone surveys, respondents reported how many times during the past week they engaged in MSE. Weighted weekly MSE frequencies were calculated for the total sample and across sociodemographic and lifestyle characteristics. Multivariate logistic regression models assessed the odds of reporting ‘poor’ self-rated health and being classified ‘obese’ (BMI ≥ 30 kg/m²) according to weekly MSE frequency, adjusting for covariates.

Results: Data were available on 397,423 adults (18-80 years). Overall, 30.2 (95% CI: 29.9%-30.5%) met the MSE recommendations (≥2 times/week) and 57.8% (95% CI: 57.5%-58.2%) reported no MSE. Older age, insufficient aerobic activity, lower education, poor self-rated health, female sex and being overweight/obese were independently associated with lower odds of meeting the MSE recommendations. There were U-shaped association for frequency of MSE and poor self-rated health, and a reverse J-shaped association for obesity. When compared to those who did none, those reporting MSE 1-6 times/week were less likely to be classified ‘obese’ or report ‘poor’ self-rated health. However, there was relative increase in odds for these outcomes among those reporting MSE ≥7 times/week.

Conclusions: Almost 60% of American adults do not engage in any MSE. Future public health strategies should focus on getting greater proportions of the population going from doing ‘no’ MSE, to doing ‘some’ to ‘moderate’ amounts of this activity.

The effect of age on the association between muscular strength and mortality in overweight or obese men

Angelique Brellenthin¹, Angelique Brellenthin¹, Xuemei Sui², Steven Blair²

¹Iowa State University, ²University of South Carolina

Introduction: To determine the effect of age on the associations of muscular strength (MS) with cardiovascular disease (CVD) and all-cause mortality in overweight or obese men.

Method: Participants were 5,071 men aged 18-100 years (mean age 43) with a medical examination during 1980-1990 in the Aerobics Center Longitudinal Study. They had body mass indexes (BMI) of ≥25 kg/m² without CVD or cancer at baseline. We measured MS by one repetition maximum of bench and leg press and used tertiles of the age-specific total MS scores from both tests. Mortality was ascertained using the National Death Index. Cox regression models included baseline age, examination year, BMI, smoking, alcohol intake, parental CVD, medical conditions, physical activity, and cardiorespiratory fitness from a maximal treadmill test.

Results: During 19 years of follow-up, 114 CVD and 356 all-cause deaths occurred. We found a significant interaction by age on the associations of MS with CVD and all-cause mortality (both p < 0.01). In men ≥50 years old, the hazard ratios (95% confidence intervals) for CVD and all-cause mortality were 0.65 (0.36-1.16) and 0.67 (0.47-0.95), respectively, in the middle MS tertile, and 0.41 (0.20-0.84) and 0.61 (0.42-0.90), respectively, in the upper MS tertile, compared with the lower MS tertile. However, the associations of MS with CVD or all-cause mortality were not significant in younger men <50 years old.

Conclusion: Higher muscular strength was associated with lower CVD and all-cause mortality risk in older men who were overweight or obesity.

External funding details: Supported by NIH Grants AG06945, HL62508, DK088195, and HL133069.

Muscular strength and association with cluster of cardiovascular risk factors in adults

Tiago Lima¹, David González-Chica², Diego Santos Silva¹

¹FEDERAL UNIVERSITY OF SANTA CATARINA, ²The University of Adelaide

Introduction: Muscle strength is inversely associated with cardiovascular risk. The aim of this study was to investigate the relationship between muscle strength and clusters of metabolic syndrome components (MetS) in adults.

Methods: Cross-sectional population-based study including 533 adults (45.3 ± 11.1 years, 42.2% men) of Florianópolis, Southern Brazil. Muscle strength [calculated as absolute strength (kg) / body mass (kg)] was measured by manual dynamometry. Data on blood pressure (BP), waist circumference (WC), lipids and glycemia were used to identify the components of MetS, which were analyzed as individual factors and clusters (number of positive components or combinations of components). Multiple linear regression adjusted for age, sex, family income, educational level, smoking, alcohol consumption, saturated fat consumption, sugar consumption, calories from alcohol, food fiber consumption, sodium intake an physical activity level was used.

Results: The mean of muscle strength was 0.87 kg (± 0.26). When analyzed as clusters, the number of positive risk factors in the same individual (1, 2, 3 and 4 factors, β of at least -0.05 kg) or the different combinations (clusters of 2, 3 and 4 components; β of at least -0,09 kg) were inversely associated with muscle strength. In addition, the individual presence of Mets components was inversely associated with muscle strength (β of at least -0.08 kg).

Conclusion: Interventions aimed at coping with risk factors for cardiovascular diseases should consider the maintenance of muscle strength levels.

Session: Social dimensions of physical activity and health

How can social practice theories help us understand the physical activity culture of a school?

Gareth Wiltshire¹, Fiona Spotswood², Sara Spear², Liza Liew²

¹University of Bath, ²University of the West of England

Introduction: Underpinned by the understanding that behaviour change requires a conceptualisation of both individual and social determinants, there is a growing interest in exploring social practice theory to address a range of harmful behaviours. As social practice theory is yet to be developed in physical activity (PA) research, the purpose of this study was to investigate how it could be utilised in the context of understanding children’s PA in primary schools. The three-elements model consisting of materials, competences and meanings was used to frame our approach.

Methods Focus group, survey, observation, and interview data were collected with pupils, staff, and parents at one primary school setting in England. Analysis involved identifying physically active practices which comprise the school PA culture and thematically coding those practices using the three-elements model.

Findings Analysis revealed how seven clusters of physically active practices throughout the school day were sustained by and interrupted by the configurations of (1) physical resources (e.g. playground space and equipment), (2) practical know-how (e.g. a skilled understanding of performing the activity), and (3) the socio-cultural significance of those practices (e.g. the values and meanings of the activity). Findings also illuminate how physically active practices are contingent on whether conflicting or complementary social practices exist. In this way, practices such as walking to school were sustained by the complimentary practices involved with ‘doing’ parenthood.

Conclusion: Social practice theory offers new ways of conceptualising PA in schools and may help identify opportunities and frameworks for simultaneous policy, school and individual level interventions.

Safe HABITATS: Does the association between crime and walking differ by area disadvantage?

Sarah Foster¹, Paula Hooper², Nicola Burton³, Wendy Brown⁴, Billie Giles-Corti¹, Jerome Rachele⁵, Gavin Turrell¹

¹RMIT University, ²University of Western Australia, ³Griffith University, ⁴University of Queensland, ⁵University of Melbourne

Introduction: Residents in socio-economically disadvantaged areas are typically exposed to more crime and tend to be more fearful about crime than those in advantaged areas – but often walk in spite of these heightened exposures. This study examines whether crime is a barrier to walking, and tests whether associations differ by area disadvantage.

Methods: HABITAT participants (n = 6680) lived in 200 neighbourhoods that spanned the most and least disadvantaged areas in Brisbane, Australia. They completed questions on their perceived crime and walking behaviours, and objective crime and walkability measures were generated for the 1000 m euclidean distance around participants’ homes. Multi-level models examined associations between perceived and objectively measured ‘crime’ and recreational and transport walking, with progressive adjustment for area-level socio-economic disadvantage and walkability components (density, land-use mix, street connectivity). Interactions tested whether patterns differed by area-level disadvantage.

Results: Higher actual and perceived crime were associated with reduced odds of recreational walking (albeit non-significant). In contrast, actual crime and perceived crime were significantly associated with transport walking, but patterns differed. High perceived crime was associated with reduced odds of transport walking (OR = 0.65, 95% CI = 0.54-0.77), whereas high objective crime was associated with increased odds of transport walking (OR = 1.65, 95% CI = 1.23-2.17). Patterns did not differ by area-level disadvantage.

Conclusion: The counter-intuitive positive association between objective crime and transport walking was partly explained by the correlation between crime and more walkable environments. Inter-relationships between crime, the built environment and area disadvantage may help explain the inconsistencies in the crime and walking evidence base.

External funding details: DE160100140

A longitudinal study of friends’ and parents’ social norms on physical activity

Kirsten Bevelander, Thabo van Woudenberg, William Burk, Laura Buijs, Crystal Smit, Moniek Buijzen, Radboud University

Introduction: This is the first study that investigates whether misperceived peer norms can predict youth’s personal physical activity. In addition, the study examines the long-term effect of friends’ and parents’ role modeling (‘descriptive norms’) and social approval (‘injunctive norms’) on youth’s physical activity.

Method: The study is part of the MyMovez research project that consists of a large-scale cross-sequential cohort study (N = 953; 8-12 and 12-15 y/o). The study uses three data collection waves conducted in February/March 2016, 2017 and 2018. Daily physical activity was measured by means of an accelerometer and self-reported survey data was assessed via a smartphone with the MyMovez research application.

Results: Preliminary findings suggest that youth often underestimate how often their peers reach the norm for being physically active. Cross-lagged structural equation models are used to investigate the influence of friends’ and parents’ descriptive and injunctive norms on objectively measured as well as self-reported physical activity.

Conclusion: Determining the role of (mis)perceived social norms and social expectations deserves more attention in research. Social norms may contribute to youth being less physically active. Strategies may be required to correct misperceived social norms contributing to healthier behavior change.

External funding details: The MyMovez project is funded by the European Research Council (ERC).

A longitudinal study exploring the social and built environmental influences on children’s physical activity during the transition from primary to secondary school.

Peter Collins¹, Matthew Hobbs², Stephen Zwolinsky¹

¹Leeds Beckett University, ²Leeds Trinity University

Background: Children’s physical activity (PA) levels significantly decline during the transition from primary to secondary school. However, little is known about how the change in the social and physical environment may contribute to this decline. PURPOSE: To investigate whether changes in the physical and social environment during the transition from primary to secondary school influences children’s PA levels.

Methods: 181 children (M = 85; F = 96) participated. In 2 schools, 74 students in year 6 primary school transitioned to a different secondary school in year 7, whilst in 2 middle schools 107 students remained in the same school environment from year 6 to year 7. Children wore ActiGraph accelerometers and Garmin GPS devices for 5 consecutive days on four occasions (year 6 winter and summer; year 7 winter and summer). Self-report surveys and focus groups captured children’s perceptions of their social and physical environment.

Results: Significant declines in average daily moderate to vigorous PA (p < 0.05) were observed in children when transitioning from primary to secondary school (-83 mins) and in children remaining in middle school (-62 mins). For transitioning children and those in middle schools, significant declines in MVPA were evident in school lessons and recess, as well as free-time after school (all p < 0.05). Social and environmental factors became less positive towards PA as children aged, although this was consistent between children changing and not-changing schools.

Conclusion: Changes in the social and physical environment during the transition from Primary to Secondary school do not appear to be primary determinants of the decline in children’s PA.

An assessment of physical environment characteristics related to older adult walking behaviours using an audit tool (MAPS Senior): Findings from urban cities in Brazil and the UK

Ruth Hunter¹, Sara Ferguson¹, Hermes Koller de Paiva², Adalberto Lopes², Adriano Akira Ferreira Hino², Ruth Hunter¹, Claire Cleland¹, Rodrigo Siqueira Reis³, Geraint Ellis¹

¹Queen’s University Belfast, ²Pontifical Catholic University of Parana, ³Washington University in St Louis

Introduction: The influence of environments upon older adult physical activity (PA) is becoming increasingly widely documented. However, whilst our understanding of ‘macroscale’ influences (e.g. walkability) advances, there remains limited understanding on the influence of ‘microscale’ features, i.e. those characteristically found along streetscapes older adults may encounter as part of typical walking routines. Combined with walking data, environmental audit tools could provide an effective means of assessing the potential importance of these streetscape environments for promoting older adult PA.

Methods: To ensure the audit tool had a specific relevance to older adult populations, findings from a systematic review and focus groups were used to make adaptations to MAPS Global (Microscale Audit of Pedestrian Streetscapes). This present study examines associations between microscale attributes and (i) self-reported and (ii) objectively measured PA behaviours of older adults (≥60 years) (n = c.600) living in neighbourhoods of varying walkability and income. Using virtual methods, the audit tool will capture land uses, streetscape and sidewalk qualities and amenities, and aesthetic and social elements of; routes, segments and crossings encountered by older adults in Curitiba (Brazil) and Belfast (UK). The tool is to be implemented along the first 400 m of GPS-captured walking routes taken from participant residences. Mixed linear regression analyses adjusted for macro-level walkability will be conducted to assess relationships.

Discussion: Considering microscale environment changes may be easier and more feasible to implement than those at the macroscale, advancing the understanding of this topic may be central to the creation of both activity- and age-friendly environments.

The impact of improvements in urban green space on older adults’ physical activity and wellbeing: a natural experimental study

Jack Benton, Jamie Anderson, Sarah Cotterill, Matthew Dennis, Sarah Lindley, David French, University of Manchester

Introduction: Creating or improving urban green space has the potential to be an effective and sustainable intervention that has reach in increasing physical activity and improving wellbeing. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on older adults’ physical activity and wellbeing. This natural experimental study measures the effect of four urban street greening interventions in Manchester on older adults’ physical activity and wellbeing over a one-year period.

Methods: Four sites where improvements were planned were matched to eight comparison sites based on a systematic matching process using objective and subjective environmental correlates of older adults’ physical activity. The outcome measures are physical activity and two other indicators of wellbeing (connecting with others and taking notice of the environment), collected using a newly developed observation tool, at baseline, 6 and 12 months. Eight hours of observation were conducted for each site; counterbalanced over four days across two weeks.

Results: Baseline data collection occurred in September 2017 before the interventions were installed in November 2017. Eighty-eight hours of data were collected at baseline and 176 hours of data are planned at follow-ups. There was high inter-rater reliability between observers at baseline (ICCs > 0.9). Results will be presented.

Conclusion: This study contributes to improving natural experiment methodology in this field by addressing methodological weaknesses causing high risk of bias in previous natural experimental studies; key improvements include rigorous matching of multiple comparison sites and appropriate statistical control of key confounders.

External funding details: This work is carried out as part of the Green infrastructure and the Health and wellbeing Influences on an Ageing population (GHIA) project Funders: Natural Environment Research Council, the Arts and Humanities Research Council and the Economic and Social Research Council under the Valuing Nature Programme. NE/N013530/1

Pooling and synthesising qualitative datasets to develop a new social science approach to promote active living

Emily Haynes¹, Ruth Garside², Judith Green³, Micheal. P Kelly⁴, David Ogilvie⁵, James Thomas⁶, Cornelia Guell²

¹University of Exeter, ²European Centre for Environment and Human Health (ECEHH), University of Exeter, ³Department of Global Health and Social Medicine, Kings College London, ⁴Primary Care Unit, Institute of Public Health, University of Cambridge, ⁵MRC Epidemiology Unit, University of Cambridge, ⁶UCL Institute of Education, University College London

Innovative approaches are required to better address physical inactivity. To move beyond individual approaches to behaviour change, and develop more appropriate insights for the persistent and complex challenge of increasing population levels of activity, recent research has drawn on social practice theory. This describes the recursive and relational character of active living and related social practices. However, to date these investigations are limited to small-scale, inherently context-specific qualitative research studies. To uncover conditions for change across these data sets, we explored the value of novel approaches to qualitative data synthesis. This study pools and compares qualitative accounts of one important component of physical activity, ‘active travel’, across different contexts, drawn from five studies conducted in the UK, which included data from Belfast, London, Glasgow, Cambridge and Gwynedd. Two key approaches were applied: a meta-ethnography to synthesise cross-study themes from a conceptual, theoretical perspective; and one text mining strategy, an unsupervised machine learning approach to identify unanticipated patterns within text. We report these findings in the context of method feasibility, comparability, strengths and limitations, and application to other research areas where qualitative data are abundant. This study contributes new insights into the application of machine learning to qualitative social science research, and towards a social science approach to behaviour change. The findings have implications for future research and policy decisions about social environments for promoting social practices which increase physical activity.

External funding details: Research funded by an Academy of Medical Sciences and Wellcome Trust grant: Springboard - Health of the Public 2040 (HOP001\1051).

Tuesday, 14:40–15:40

Session: Physical activity and mental health

An innovative approach to integrating physical activity (PA) into the management of mild-to-moderate depression (MMD)

Katarzyna Machaczek¹, Melanie Gee¹, Peter Allmark², Scott Weich², Elizabeth Goyder², Mark Shea³

¹Sheffield Hallam University, ²University of Sheffield, ³Improved Access to Psychological Therapies, Sheffield

Introduction: Physical activity (PA) has been shown to be as effective as medication or psychological therapies in reducing mild-to-moderate depression (MMD). Despite this, support for increasing PA is not routinely included in the management options offered to MMD patients. We therefore undertook a preliminary study to investigate the potential for the integration of PA into MMD management delivered within the Improving Access to Psychological Therapies (IAPT) service. The study explored: the acceptability of integrating PA into MMD management amongst IAPT staff; the extent to which IAPT already integrates PA into MMD management; infrastructure and training needs of IAPT staff related to promoting PA engagement; and, patients’ experiences of barriers and enablers to PA initiation.

Methods: In-depth interviews were conducted with eight IAPT staff (Psychological Wellbeing Practitioners and Cognitive Behavioural Therapists) and twelve individuals with MMD. Transcripts were analysed using [inductive/thematic] approach.

Results: The integration of PA into MMD management were seen as enhancing treatment options and having the potential to improve recovery. For IAPT practitioners barriers included uncertainty about negative consequences; lack of time; limited links to local PA providers. For individuals, many personal, social, and cultural factors affected their ability to initiate PA; including the nature of the condition, but also the wider determinants of health such as socioeconomic status, physical and social environments.

Conclusion: Whilst integration of PA in MMD management is seen as appropriate and feasible by both patients and practitioners, there are many wider and condition-related factors that will influence successful implementation.

External funding details: RCB - SHSC Foundation Trust

Social relationships mediate the relationship between physical activity and mental well-being

Ben J Smith¹, Tilahun Haregu¹, Adrian Bauman²

¹School of Public Health and Preventive Medicine, Monash University, ²School of Public Health, University of Sydney

Introduction: Regular physical activity (PA) is known to improve vitality and mental well-being. It has been reported that social connectedness is an underlying driver of this relationship, with those who have stronger relationships being more active and experiencing greater well-being. This study aimed to examine the pathways between PA, social relationships and mental well-being in a population cohort.

Methods: We used data collected from 1,320 inactive adults who were enrolled in the MOVE Frankston study, conducted in Melbourne Australia. PA, social connectedness and mental well-being were measured at baseline, 12 and 24 months, using validated instruments. Generalized Structured Equation modelling was used to examine the direct and indirect relationships between the variables, with stratified analysis undertaken to identify factors that moderated the mediation pathways.

Results: We found that social connectedness fully mediated the relationship between PA and mental well-being. Personal friendships mediated 73% of the association between total minutes of PA and mental well-being, and 59% of the association between attaining 150 mins/wk of PA and well-being. On the other hand, community connectedness mediated 11% of the relationship between total PA minutes and mental well-being, and 6% of the relationship between achieving 150 mins/wk and this outcome. Household income and presence of chronic conditions moderated these mediation relationships.

Conclusion: Social relationships, particularly personal friendships, play an important role in achieving the mental health benefits that can be derived from PA. Promoting PA in social contexts is not only helpful for behaviour change, but for achieving well-being outcomes.

External funding details: Australian Research Council

Safe, Fit & Well - protecting and improving young people’s mental health through sport

Paul Jarvis-Beesley¹, Louise Mansfield PhD², Alistair John³, Prescott Amy⁴

¹StreetGames, ²Institute for Environment, Health and Societies, Brunel University, ³Division of Sport, Health & Exercise Sciences, Brunel University, ⁴Brunel University

Following a scoping review, carried out in 2016 into the connections between community sport and young people’s mental health and wellbeing in disadvantaged areas, StreetGames commissioned researchers at Brunel University London to conduct primary research on the ‘Safe, Fit and Well’ pilot project between February 2017 and March 2018. The overall aim of the research was to develop understanding of the type of sport offer that can effect change and support the mental health and wellbeing of young people (14-24 years) living in areas of high, socio-economic deprivation.

This presentation presents the preliminary findings from a mixed-method qualitative case study approach including: telephone interviews with the Streetgames core team, the national pilot project leads, and doorstep delivery staff, participatory observations of safe, fit and well delivery activities, and observations and face-to-face interviews with young people taking part in a residential training programme for peer mentors.

The discussion explores both the common and diverse ways that decision makers, delivery experts and participants conceptualise and experience wellbeing in the ‘Safe, Fit & Well’ projects. Pathways for wellbeing are identified, including peer support and workforce development approaches. The potentials and challenges for planning, delivering and evaluating future sport programmes to promote wellbeing are discussed.

A Theory of Change is presented, for further testing in the field, suggesting causal links between the activities and components of a purpose-designed sports programme and the desired outcomes of increased resilience and protected mental wellbeing amongst disadvantaged adolescents.

External funding details: Sport England, Souter Charitable Trust, Garfield Weston Foundation

Physical activity, mental health and academic achievement among pupils in lower secondary schools in Norway

Ingeborg Barth Vedøy¹, Sigmund Alfred Anderssen², Hege Eikeland Tjomsland¹, Knut Ragnvald Skulberg¹, Miranda Thurston¹

¹Inland Norway University of Applied Sciences, ²The Norwegian school of Sport Sciences, Norway

Background: The proportion of youth in Norway stating that they experience mental health problems has increased. For example, 30% report stress-related problems and pressure related to academic achievement (AA) has been identified as a specific stressor. Physical activity (PA) may influence various dimensions of mental health (MH) and research findings suggest that PA and MH may also influence AA. Nevertheless, knowledge about how these factors are associated among pupils at lower secondary schools in Norway is lacking. The aim of this study is to investigate such associations in this pupil group.

Method: This study is an ongoing prospective cohort study involving 11 strategically selected schools in Norway. Annual data collection is conducted from 2016-2018. The 2016 participation rate was 60% (599 participants, 54.4% girls). PA is measured objectively using ActiGraph GT3X+/BT. Data on MH are collected using validated questionnaires (SDQ, SPPA-R and WEMWBS). AA is measured using pupils’ grade point average (GPA). Height, weight and waist circumference are measured objectively.

Results: Based on 2016-data: Higher levels of PA were associated with higher levels of mental well-being (p = 0.001). Higher levels of PA were also associated with a higher GPA in practical subjects (p = 0.001). Self-perception of scholastic competence was associated with a higher GPA (p < 0.001), whereas higher levels of mental health complaints were associated with a lower GPA (p < 0.001).

Conclusion: Physical activity is associated with some dimensions of mental health, and positive mental health is associated with higher academic achievement.

External funding details: This project is funded by the Norwegian Research Council

Feasibility and acceptability of a home-based physical activity program for postnatal women with depressive symptoms: A pilot study

Megan Teychenne¹, Paige van der Pligt¹, Gavin Abbott¹, Leah Brennan², Ellinor Olander³

¹Deakin University, ²Australian Catholic University, ³City University

Background: New mothers, particularly those with heightened depressive symptoms, experience several challenges to being active such as lack of time and childcare, and therefore home-based programs using hired exercise equipment may help overcome these barriers. This study tested the feasibility and acceptability of a home-based treadmill intervention among postpartum women with heightened depressive symptoms.

Methods: Participants were 11 insufficiently active women (3-9 months postpartum) experiencing heightened depressive symptoms (using the Edinburgh Postnatal Depression Scale). Women received a 12-week physical activity (PA) support program, which included free treadmill hire and access to a purposely-designed smartphone web-app. Following participation in the program, one-on-one semi-structured interviews were conducted. Depressive symptoms were assessed at weeks 4 and 8. Thematic analyses were used to identify key themes in qualitative data. Change in depressive symptoms was analysed using repeated-measures analysis of variance (ANOVA).

Results: Overall, postpartum women perceived the program to be convenient, flexible and acceptable. Women suggested the program was useful in overcoming key barriers to PA (e.g. lack of motivation, being housebound), and perceived that the program increased their PA and improved their mental health. There was a significant change over time (i.e., reduction) for depressive symptoms (F₂,₂₀ = 29.928, P < 0.0005).

Conclusion: A home-based PA program involving cost-free exercise equipment hire was feasible and well accepted by postpartum women. Although confirmation of findings using controlled trials is required, pilot data suggests that the program could potentially be used to treat postnatal depressive symptoms.

Healthy on the way (HOTway): Perceived stress of different modes of commuting

Matteo Sattler, Gottfried Köberl, Tanja Färber, Katharina Traußnig, Johannes Jaunig, Pavel Dietz, Mireille van Poppel, University of Graz

Introduction: A large portion of the employed population have high levels of psychological distress combined with low physical activity levels. However, to improve and maintain one’s health, recovering activities such as leisure time physical activity or active transport are important. Current evidence suggests that using active modes of transport for commuting can play an important role in reducing chronic stress levels. However, whether mode of transport also affects acute stress has not been investigated so far. In the HOTway pilot study, we investigated whether different modes of commuting (i.e. active [walking, cycling], passive) are associated with different perceived stress levels.

Methods: Of 227 participants invited, 201 (M_age = 27.8 ± 9.9, 98 female) reported on commute-specific characteristics (e.g. duration, length, route, construction zones, traffic density), and completed a perceived stress questionnaire on three working days, respectively in the morning (i.e. before commuting) and immediately after arriving at work.

Results: Compared to passive commuters, active commuters showed a significant reduction in perceived stress (d = −0.52, 95% CI [-0.81,-0.24], p < 0.01) from before to after travelling to work. This effect was influenced by duration of commuting, revealing increasing differences between the two groups with longer durations. In particular, longer durations were associated with increased perceived stress of passive commuters.

Conclusion: Active commuting may be beneficial for acute and chronic stress levels as well as maintaining and improving health. Further studies with objective measures of physical activity and stress are needed to strengthen the observed relationship.

Bristol Active Life Project (BALP), provision of physical activity in the community for people with Severe and Enduring Mental Illness (SMI)

Margot Hodgson, Avon and Wiltshire Mental Health Partnership NHS Trust

Purpose: BALP provides sport and physical activity for people with SMI and opportunities for achieving sports qualifications as a pathway to employment.

Relevance:

•Mental health is a priority for health improvement, requiring new approaches of physical healthcare to improve health for people with SMI (Department of Health, 2010:2004: 2006).
•Reduction of health inequalities (www.nice.org.uk.2008, Social Exclusion Unit, 2004, CSIP/NIMHE, 2006).

Description: BALP facilitates healthy lifestyles through regular participation in physical activity. It is a partnership between Avon and Wiltshire Mental Health Partnership NHS Trust (AWP), Local Authority, Service Users, Leisure providers and Voluntary Sector.

Evaluation: Evaluation (University of Bristol 2012) identified BALP as a model of good practice for sport and physical activity in mental health, addressing barriers to participation for people with SMI and breaking down barriers of stigma and discrimination.

Conclusions: BALP models good practice in mental health through promoting positive health, wellbeing and social inclusion through physical activity. Further research is needed to develop service delivery and target resources more effectively to provide increased sport and physical activity opportunities for SMI.

Implications: This successful model has the potential to be replicated in other areas of the NHS. It demonstrates that partnership working between Mental Health Services and Local Authorities combines the knowledge, skills and facilities necessary to enable those with SMI to increase their participation in regular physical activity.

External funding details: The Football Foundation awarded BALP £80,000 (2005 – 2008) and £138,000 (2009 – 2012)

Session: Physical activity epidemiology among children

Associations between self-reported physical activity and sedentary behaviour with cardiometabolic risk factors in adolescents: findings from 1993 Pelotas (Brazil) Birth Cohort Study

Gregore Mielke¹, Wendy Brown², Fernando Wehrmeister³, Helen Gonçalves³, Isabel Oliveira³, Ana Menezes³, Pedro Hallal³

¹Federal University of Pelotas / The University of Queensland, ²The University of Queensland, ³Federal University of Pelotas

Purpose: This study aimed to examine the combined association of screen time (ST) and physical activity (PA) at ages 11, 15 and 18 on cardio-metabolic risk factors at 18 years among Brazilian adolescents.

Methods: Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analysed (N = 3,613). Self-reported physical activity and screen time were collected at 11, 15 and 18 years. Cardio-metabolic risk factors (fat mass index, waist circumference, triglycerides, blood glucose, non-HDL cholesterol and resting diastolic blood pressure) were examined at age 18. Multivariate linear regression was used to examine the association between four mutually exclusive PA/ST groups: 1) active (≥1 h/day PA) and low ST (<5 h/day screen time); 2) active (≥1 h/day PA) and high ST (≥5 h/day screen time); 3) inactive (<1 h/day PA) and low ST (<5 h/day screen time); 4) inactive (<1 h/day PA) and high ST (≥5 h/day screen time) at each age and outcomes at age 18.

Results: There were no significant association between PA/ST at ages 11 and 15 with outcomes at 18 years. In the cross-sectional analyses, adolescents in the most active group had significantly better levels of all the outcomes, regardless of ST. Inactive participants with high ST had the highest levels of glucose and non-HDL-C. For diastolic blood pressure, values were higher among inactive participants.

Conclusion: Overall, higher levels of physical activity appeared to be more important than low levels of screen time for cardio-metabolic health in adolescents.

Physical activity and obesity in the Eastern Mediterranean Region: Results from the Global School Health Survey, 2007-2012

Tom Loney¹, Marilia Silva Paulo², Faisal Aziz²

¹Mohammed Bin Rashid University of Medicine and Health Sciences, ²Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University

Background: Our study estimated (i) the prevalence of physical activity (PA) and obesity across 17 Eastern Mediterranean Region (EMR) countries; and (ii) the association between these variables and the individual country Human Development Index (HDI).

Methods: Data from the Global School-Based Health Survey conducted in 17 EMR countries (N = 42,139; aged 13-17 years) between 2007 and 2012 was used to determine the prevalence of physical activity and obesity by country. Physical activity variables were aligned with the indicators used in the Global Matrix 2.0 on Physical Activity for Children and Youth.

Results: Lebanon had the highest proportion (24.5%) of children achieving the daily physical activity recommendations, Tunisia had the highest prevalence (70.5%) of children walking or riding a bike to school at least once a week, and Oman had the highest proportion (47.8%) of children participating in at least 150 minutes of physical education per week. Pakistan had the highest proportion (91.9%) of children sitting less than two hours per day and Kuwait had the highest prevalence of obese children. There was an inverse trend between sitting time (<2 h/d) and individual country HDI and a positive trend between HDI and both the proportion of children participating in ≥150 minutes of PE per week and the prevalence of obesity.

Conclusions: Physical inactivity and obesity are major public health issues in all 17 EMR countries. Culturally-appropriate community- and school-based physical activity interventions are required to improve the overall physical levels of school children in EMR countries.

Are active boys and girls at increased risk of hospital attendance or admission for injury? A longitudinal study in Wales and Scotland using linked cohort and health service records

Lucy Griffiths¹, Mario Cortina-Borja², Karen Tingay¹, Amrita Bandyopadhyay¹, Ashley Akbari¹, Bianca DeStavola², Helen Bedford², Sinead Brophy¹, Ronan Lyons¹, Carol Dezateux³

¹Swansea University, ²UCL Great Ormond Street Institute of Child Health, ³Queen Mary University London

Introduction: The association between objectively measured physical activity (PA) in childhood and hospital attendances or admissions for injuries is unclear. We hypothesised that higher intensity PA at age seven years corresponds to higher rates of subsequent injury-related health service utilisation.

Method: We analysed accelerometer-based estimates of moderate and vigorous (MVPA) and vigorous PA (VPA) from 1585 (777 [46w%] boys) seven-year-old Millennium Cohort Study members, living in Wales or Scotland, whose parents consented to linkage of cohort to routine health records. We fitted negative binomial regression models to estimate the effects of average daily minutes of MVPA and VPA on the number of hospital in-patient admissions and emergency department attendances for injuries from seven to 13.9 years.

Results: Children spent respectively a median of 59.5 (IQR 46.4, 75.2) and 18.1 (12.5, 25.3) minutes in MVPA and VPA/day, with boys on average more active than girls. Overall, 38% of children experienced at least one injury-related admission/attendance. Associations of each 10 minute increment in MVPA and VPA with number of admissions/attendances were significant in boys: confounder-adjusted rate ratio [RR] (95% CI): 1.11 (1.02, 1.20) and 1.19 (1.01, 1.39), respectively; but not in girls: 0.94 (0.85, 1.04) and 0.83 (0.65, 1.06), respectively.

Conclusion: Seven-year-old boys who engaged in more intense physical activity had higher injury-related admission/attendance rates in the next 7 years than less active boys. Significant associations were not found in girls. This may reflect gender differences in choice of active pursuits and will be the subject of future analyses.

External funding details: Wellcome Trust (087389/B/08/Z)

24 hour movement behaviours of school children: associations with academic performance

Erin Howie¹, Courtenay Harris², John Joosten³, Leon Straker²

¹University of Arkansas, ²Curtin University, ³John XXIII College

Introduction: Physical activity, sedentary behaviours and sleep are known to have important influences on health throughout life. Schools are an important context to promote positive movement behaviours by children, but these behaviours are often seen as only of secondary importance compared to academic performance – by both parents and schools. Some evidence suggests that promoting good movement behaviours would also promote better academic performance. Thus, the purpose of this study was to examine physical activity, sedentary behaviour and sleep associations with academic performance.

Methods: Children attending a school with a high social resources score and well-developed health policies completed an online survey. Physical activity, sedentary behaviours and sleep were self-reported. Maths and English subject scores were collated from school records and weighted by class.

Results: In total 924 children (50% girls, mean age 14.7 (SD 2.7) years) from school grades 5 to 11 participated. There were no associations of days meeting physical activity guidelines nor sport participation with academic performance. Reported hours spent in sedentary activities was negatively associated with Maths (β -0.28 [95%CI: -0.43, -0.14], p < .001) and English scores (-0.13 [-0.22, -0.05], p = .002). Later weekend bedtimes were also associated with poorer academic performance in Maths (-1.07 [-1.63, -0.51], p < .001) and English (-0.54 [-0.86, -0.23], p = .001). Hours of sleep on weekends were positively associated with English scores (0.6 [0.1, 1.0], p = .019).

Conclusion: Higher self-reported sedentary time, later weekend bedtimes and less weekend sleep were associated with decreased academic performance. To promote student success, school policies should address multiple activity behaviours.

The relationship between meeting the Australian 24-Hour Movement Guidelines for the Early Years and Pre-schooler Obesity and Social-Emotional Development #

Hayley Christian¹, Stewart Trost², Michael Rosenberg³, Leanne Lester³, Jasper Schipperijn⁴, Gina Trapp⁵, Pulan Bai³

¹The University of Western Australia, ²Queensland University of Technology, ³Ther University of Western Australia, ⁴University of Southern Denmark, ⁵Telethon Kids Institute

Introduction: New Australian 24-hour movement guidelines for the early years provide recommendations on daily physical activity (PA), sedentary screen time (SED), and sleep (SP) for children 2-5 years. This study uses a large representative sample to examine the association between meeting 24-hour movement guidelines, obesity and social-emotional development in young children.

Methods: PLAYCE study data was collected for 1490 children 2-5 years from 122 long daycare centres in metropolitan Perth, Australia. Centres were recruited based on size and SES. PA was assessed using 7 day accelerometry. Parent reported SED and SP was determined using established items. Height and weight were objectively measured and WHO weight status classifications applied. The Strengths and Difficulties Questionnaire was used to measure social-emotional development.

Results: Overall, 30% of children met the 24-hour movement guidelines for PA, 31% for SED and 83% for SP. Only 6.9% of children met guidelines for all three movement behaviours. Children meeting guidelines for two movement behaviours was 8% for PA and SB, 26% for PA and SP and 26% for SED and SP. Children meeting both SED and SP guidelines had 40% decreased odds of being overweight/obese(OR = 0.58; 95% CI: 0.35-0.96). Meeting PA and SED guidelines was associated with decreased odds of being at risk of conduct problems(OR = 0.48; p < 0.1).

Conclusion: Less than 7% of young Australian children meet the 24-hour movement guidelines. Meeting movement guidelines is associated with healthier weight status and social-emotional development. Findings suggest that effective scalable integrated interventions targeting multiple movement behaviours in preschool-aged children are needed.

External funding details: Healthway#24219

Trajectories of physical activity and sedentary behaviours in children and adolescents: The UP & DOWN Study

Kate Parker¹, Anna Timperio¹, Jo Salmon¹, Karen Villanueva², Helen Brown¹, Irene Esteban-Cornejo³, Veronica Cabanas⁴, José Castro-Piñero⁵, David Sánchez-Oliva⁵, Óscar Luis Veiga Núñez⁴

¹Deakin University, ²RMIT University, ³Northeastern University, ⁴Autonomous University of Madrid, ⁵University of Cádiz

Introduction: Physical activity declines and sedentary behaviour increases across childhood and adolescence. It is unknown, however, whether all youth follow the same physical activity and sedentary behaviour trajectories, or whether they differ among those with different activity-related profiles. This study compared longitudinal physical activity and sedentary behaviour trajectories between groups of children and adolescents with different baseline typologies (combinations) of activity-related behaviour.

Methods: Longitudinal study of Spanish children (n = 600, mean age = 9.15 ± 0.44 years, 50.3% girls) and adolescents (n = 1037, mean age = 13.57 ± 1.67, 48.4% girls). Latent class analyses identified activity-related behaviour typologies based on self-reported screen-based, educational, social and relaxing sedentary time, active travel, muscle strengthening and sport at baseline. Within each typology, linear growth models of accelerometer-derived physical activity and sedentary behaviour explored longitudinal trajectories.

Results: Three typologies were identified for children (‘sedentary’, 12.8%, ‘exercisers’, 61.5%, ‘inactives’, 25.7%) and adolescents (‘active screenies’, 43.5%, ‘active academics’, 35%, ‘inactives’, 21.5%) at baseline. Sedentary behaviour followed a positive trajectory among all typologies. Among children, for each typology, physical activity followed negative trajectories. In adolescents, a negative physical activity trajectory was found only among the ‘active academic’ typology. Physical activity remained stable among ‘active screenies’ and ‘inactives’.

Conclusions: The results support the need to intervene at all ages to promote physical activity and prevent increases in sedentary behaviour. Furthermore, adolescents characterised as ‘active academics’ may require specific interventions to maintain their physical activity over time.

External funding details: UP&DOWN Study: DEP 2010-21662-C04-00 grant from the National Plan for Research, Development and Innovation (R + D + i) MICINN.

Born to move? Prenatal and birth predictors of physical activity and sedentary time in three population representative birth cohorts in Pelotas, Brazil

Ding (Melody) Ding¹, Gregore Mielke², Inacio Silva², Pedro Hallal², Ulf Ekelund³

¹University of Sydney, ²Universidade Federal de Pelotas, ³Norwegian School of Sport Sciences

Introduction: According to the Developmental Origins of Health and Disease theory, health outcomes appear partly “programmed” in utero and during early life. While animal studies suggest biologically plausible programming effects of physical activity (PA) and sedentary behaviour, evidence from humans is limited. This study examines the association between prenatal/birth predictors and objectively measured PA/sedentary time (ST) in childhood, adolescence and young adulthood.

Methods: Data were from the 1982, 1993, and 2004 Pelotas Birth Cohorts, which represent >98% of all live births in respective years in Pelotas, Brazil. Infants were measured, and their mothers interviewed within 24 hours of delivery. Predictors were of biological (sex, birth weight, gestational age, birth order, mode of delivery and pre-pregnancy body mass index) and socioeconomic nature (maternal education and family income). Objectively measured overall and moderate-to-vigorous PA and ST were collected using GENEActiv accelerometers following standard protocols in 2010-13. Linear regression models with multiple imputation were used, analysis was further stratified by socioeconomic status (SES).

Results: Across all cohorts and outcomes, males and those with lower maternal education and family income were consistently more active and less sedentary. Less consistently, those with lower birth weight (<2500 g) and higher birth order (4+) were more active and less sedentary, particularly in medium and high SES strata.

Conclusion: In Brazil, SES at birth is the strongest predictor of PA and ST later in life, persisting from childhood to adulthood. Some population subgroups that are at risk of an inactive lifestyle may be identified at birth.

External funding details: Wellcome Trust (WT086974MA)

Session: Physical activity interventions for adults

“SitLess@Work” – developing an evidence-based framework to support the development, implementation and evaluation of interventions to reduce workplace sitting

Kelly Mackenzie¹, Elizabeth Goyder², Paul Norman³, Elizabeth Such²

¹University of Sheffield, ²School of Health and Related Research, University of Sheffield, ³Department of Psychology, University of Sheffield

Introduction: Prolonged sitting is associated with increased risks of chronic disease and premature mortality. Given workplaces contribute to a large proportion of daily sitting time, interventions to reduce workplace sitting are important public health initiatives. Previous systematic reviews suggest such interventions can be effective, but there is a need to explore the factors that might explain variation in effectiveness of workplace sitting interventions in more detail.

Methods: A qualitative systematic review was conducted. Four health and social science databases were searched for studies set in the workplace with desk-based employees and the primary aim of reducing workplace sitting. Extracted data were primarily from author descriptions of intervention implementation. Thematic synthesis was undertaken.

Results: Forty studies met the inclusion criteria. Ten descriptive themes were identified from which emerged three higher-order themes: the development, implementation and evaluation of workplace sitting interventions. Key findings included: balancing top-down and bottom-up approaches; grounding interventions in theory; and conducting comprehensive process and outcome evaluations. Contextual information related to implementation was generally underreported.

Conclusions: These findings provided the basis for a framework to support workplace sitting intervention development, implementation and evaluation which incorporates all ten descriptive themes, and the detailed reporting of contextual information. After formal testing, the framework will be used to develop a practical toolkit to be used by a range of organisations to develop, implement and evaluate their own interventions to reduce workplace sitting time.

External funding details: KM’s Doctoral Research Fellowship is funded by the National Institute for Health Research (DRF-2016-09-023).

Effects of reducing sitting time on adiposity measures in adults: A meta-analysis of intervention studies

Nyssa Hadgraft¹, Elisabeth Winkler², Rachel Climie³, Megan Grace⁴, Lorena Romero⁵, David Dunstan⁴, Neville Owen⁴, Genevieve Healy², Paddy Dempsey⁴

¹Swinburne University of Technology, ²The University of Queensland, ³Paris Centre de Recherche Cardiovasculaire, ⁴Baker Heart and Diabetes Institute, ⁵The Alfred

Introduction: High levels of sedentary behaviour are associated with cardio-metabolic risk. A systematic review and meta-analysis was conducted to assess whether interventions to reduce sitting can positively impact on measures of adiposity—an important indication of cardio-metabolic risk.

Methods: A systematic database search identified 14 peer-reviewed studies (n = 1796 participants) detailing the impact of adult sedentary behaviour interventions (≥ 1 week, with control group, not receiving other interventions e.g., diet) on adiposity outcomes: body mass; BMI; waist circumference; or, fat mass (percentage and total). Meta-analyses using fixed-effects models, or random-effects models (DerSimonian-Laird) for heterogeneous outcomes, were used to summarise pooled effects of the interventions relative to control.

Results: Body mass was reported in 12 studies, waist circumference in 11, BMI in 8, percent fat mass in 7 and fat mass (kg) in 5. Most (93%) intervened for 6 months or less and were workplace-based (57%). Meta-analyses revealed significant (p < 0.05), beneficial, pooled intervention effects: for body mass (-0.67 kg [95% CI: -1.30, -0.05]); BMI (-0.26 kg/m2 [-0.51, -0.02]); and percent fat mass (-0.61% [-0.95, -0.27]). Effects for fat mass (-0.29 kg [-0.61, 0.04], p = 0.08) and waist circumference (-0.47 cm [-1.13, 0.18], p = 0.16) were modest and non-significant. Effects were often heterogeneous.

Conclusions: Interventions targeting sedentary behaviour reductions can lead to statistically significant, albeit modest and variable improvements in some adiposity markers. The short intervention timeframes and healthy study populations may underestimate potential health benefits. Future research should examine long-term interventions and explore reasons for the variable success (for example, what activity replaces sitting).

Dose-response between frequency of breaks in sedentary time and glucose control in Type 2 Diabetes

Aye Paing¹, Kathryn McMillan², Alison Kirk², Andrew Collier³, Allan Hewitt², Sebastien Chastin³

¹Glasgow Caledonian University, ²Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, ³School of Health and Life Sciences, Glasgow Caledonian University, Glasgow

Objective: To investigate dose-response between frequency of light-intensity walking breaks (LIWB) in sedentary time and glucose control in type 2 diabetes.

Method: Twelve adults with type 2 diabetes participated in a randomised two-period balanced incomplete block trial consisting of three conditions: sitting with 3-min of LIWB every (1) 60 minutes; (2) 30 minutes; and (3) 15 minutes. FreeStyle Libre glucose monitoring system and activPAL3 were used to assess glucose and physical activity/sedentary behaviour. Standardised meals were provided. Incremental area under curves (iAUCs) for postprandial glucose and 21-h glucose were calculated.

Results: Breakfast and 21-h glucose iAUCs were lower in LIWB every 15 min (4.0 ± 0.3 mmol · L⁻¹ · 3.5 h⁻¹, P < 0.03) (8.1 ± 1.2 mmol · L⁻¹ · 21 h⁻¹, P < 0.04) compared with LIWB every 60 min (7.2 ± 1.2 mmol · L⁻¹·3.5 h⁻¹) (15.5 ± 3.9 mmol · L⁻¹ · 21 h⁻¹). There was attenuation of lunch and dinner glucose iAUCs in LIWB every 15 min (1.6 ± 0.9 mmol · L⁻¹ · 3.5 h⁻¹, P < 0.04) (0.9 ± 0.8 mmol · L⁻¹ · 3.5 h⁻¹, P < 0.04) and LIWB every 30 min (1.6 ± 0.3 mmol · L⁻¹ · 3.5 h⁻¹, P < 0.03) (1.3 ± 0.7, mmol · L⁻¹ · 3.5 h⁻¹, P < 0.03) relative to LIWB every 60 min (4.1 ± 1.1 mmol · L⁻¹ · 3.5 h⁻¹) (3.4 ± 0.7 mmol · L⁻¹ · 3.5 h⁻¹).

Conclusions: Frequency of LIWB in sedentary time has dose-response effect on glucose, and this might be a simple therapeutic tool.

External funding details: This work is supported by PAL technologies Ltd (Glasgow, UK) and School of Health and Life-Sciences, Glasgow Caledonian University. The authors thank Prof. Joanne Booth (Glasgow Caledonian University) who provided financial support for participants’ meals. The authors also thank the participants who volunteered and devoted their time to the study.

Low dose physical exercise training improves physical literacy in physically inactive adults

Peter Holler¹, Johannes Jaunig², Silvia Tutter¹, Othmar Moser³, Mireille van Poppel², Frank-Michael Amort¹

¹FH JOANNEUM, ²University of Graz, ³Swansea University

Introduction: Physical literacy (PL), as a holistic construct, is considered a person’s capacity and commitment to a physically active lifestyle. Considering that lack of time is the most common exercise barrier, we investigated the effect of a low dose physical exercise training on PL among physically inactive adults.

Methods: A non-randomised controlled trial was conducted. Twenty-three physically inactive adults allocated to the intervention group (IG; 91% female; 53 ± 10 years) participated in a supervised physical exercise intervention (one session of 50–100 min/week for 14 weeks, moderate intensity). A matched, non-exercising control group (CG) consisted of twenty-two physically inactive adults (96% female, 50 ± 11 years). PL, VO_2max, compliance and sociodemographic parameters were measured. PL was evaluated by a questionnaire, covering five domains: physical activity behaviour, attitude towards a physically active lifestyle, exercise motivation, knowledge and self-confidence/self-efficacy. Data was analysed by ANOVA and ANCOVA models, using age, gender, BMI and baseline values as covariates.

Results: Mean compliance was 65%. PL increased significantly in the IG (p < 0.01), while CG showed no changes. Similar improvements were observed for the domains physical activity behaviour (p < 0.01), attitude towards a physically active lifestyle (p < 0.01), exercise knowledge (p < 0.05) and self-confidence/self-efficacy (p < 0.05) in the IG at post-training intervention. No changes in the domain exercise motivation were found in IG. CG remained unchanged for all domains.

Conclusion: Low dose physical exercise training is a safe and feasible intervention to improve PL among physically inactive adults

External funding details: Gesundheitsfonds Steiermark

High Intensity Interval Training (HIIT) for smoking cessation in women

Toby Pavey¹, Coral Gartner², Wendy Brown²

¹Queensland University of Technology, ²University of Queensland

Introduction: Evidence for the efficacy of physical activity as a quit smoking aid is mixed, with insufficient exercise intensity a potential limitation. This study aimed to assess the effects of high-intensity-interval-training (HIIT) and lifestyle physical activity on smoking cessation in female smokers.

Methods: Forty-three women (18-55 y), who smoked ≥5 cigarettes/day, were randomised. Group-1 completed two gym-based supervised HIIT sessions/week over 12-weeks. Group-2 received a resource pack and pedometer, with the aim to increase steps to 10,000 steps/day over 12-weeks. Data on smoking and health outcomes were collected at baseline, post-intervention and follow-up. Data were analysed using Chi-squared test and factorial ANOVA.

Results: For those women who completed (n = 12 HIIT, 10 step-group), there was no significant group difference in quit rates (p > 0.05). However, quit rates at post intervention were 42% (HIIT) and 35% (step-group). There was a time effect for number of cigarettes smoked, with a significant reduction from 10.4 (SD4.8) at baseline, to 5.6 (SD5.6; p < 0.01) post-intervention, and 6.5 (SD6.7; p < 0.001) at follow-up. There was a significant interaction for fitness (VO2_max; f_2,40 = 4.3, p = 0.020). Women in the HIIT group significantly increased their VO2_max post-intervention (40.1, SD8.5) compared to the step group (33.4, SD7.8; p > 0.001).

Conclusion: The quit rate of completers was high, suggesting that physical activity can be used as an aid to help quit smoking. Importantly the HIIT group improved their cardiovascular fitness. Coupled with the quit rates, HIIT can potentially address two major contributors to cardiovascular disease (smoking and fitness) in one intervention.

External funding details: Funding: Heart Foundation Vanguard Grant

Success, struggle and defeat; narrative typologies of exercise referral experience

Coral Hanson¹, Emily Oliver², Caroline Dodd-Reynolds², Linda Allin³

¹Edinburgh Napier University, ²Durham University, ³Northumbria University

Objectives: Exercise referral schemes are an internationally widespread physical activity intervention. This study examined narratives of those referred by health professionals to a scheme recognised as emerging best practice to understand whom this service served well, or poorly, and why.

Design: The study employed a qualitative longitudinal approach.

Method: Participants were 11 individuals referred to a northeast England exercise referral scheme, with a range of long-term conditions including cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems. Participants took part in two interviews, prior to commencing the scheme and 12-20 weeks later. A holistic-form-based mode of analysis focused on the plot of participant narratives and understanding personal constructions of referral experience.

Results: Three narrative typologies emerged. First, success, with engaged participants focused on health outcomes and able to access social support. Second, struggle, short-term success but with concerns regarding continued engagement due to scheme dependency or cyclical needs. Participants focused on regaining structure and control following life events causing a breakdown in their social order. Finally, defeat, where illness, impaired social circumstances, restrictive interpersonal relationships, and/or poor participation experience made engagement difficult.

Conclusion: Participants drew on different narratives to explain engagement/non-engagement with the scheme, providing insight regarding for whom it worked or did not work. Collectively the narrative typologies highlight the complexity within such schemes, and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for those who find engagement difficult, to help them move towards an alternative narrative.

Exercise therapy for acute non-specific low back pain

Teddy Oosterhuis¹, Helma Ijzelenberg¹, Sidney Rubinstein¹, Jill Hayden², Bart Koes³, Maurits van Tulder¹

¹VU University Amsterdam, ²Department of Community Health & Epidemiology, Dalhousie University, Halifax, ³ErasmusMC

Background: Exercise therapy is a worldwide, extensively practiced intervention for the treatment of low back pain (LBP). We updated a Cochrane review that was last published in 2005.

Aim: To assess the effectiveness of exercise therapy compared to no treatment, and other conservative treatments for the outcomes pain, functional status, perceived recovery, return to work and general health in adults with acute non-specific LBP.

Methods: An updated search was conducted for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, CINAHL, PEDro, PsycINFO, SportDiscus. We included RCTs that examined the effectiveness of exercise therapy for adults with acute non-specific LBP with a mean duration of less than or equal to six weeks. Two authors independently conducted study selection and risk of bias assessments. GRADE was used to assess overall evidence quality.

Results: We included 19 studies that involved a total of 2455 participants in this update. We found low quality evidence indicating no difference for pain and function when exercise therapy was compared with no treatment at short-term or intermediate follow-up. There was moderate quality evidence of no difference at the short-term, at intermediate and long-term follow-up for pain and functional status when exercise therapy was compared with other conservative therapies.

Conclusion: Exercise therapy is no better for short-, intermediate or long-term pain relief or improvement in functional status than no treatment, other conservative therapies or sham treatment. There was no strong evidence that any particular form of exercise therapy was better than another.

Session: Promoting physical activity in communities and workplaces

A cluster randomised controlled trial to investigate the effectiveness of a Structured Health Intervention for Truckers (SHIFT)

Stacy Clemes¹, Veronica Varela-Mato¹, Yu-Ling Chen¹, Fehmidah Munir¹, Mark Hamer¹, Thomas Yates², Charlotte Edwardson², Laura Gray², Gerry Richardson³, Jacqui Troughton⁴, James King¹

¹Loughborough University, ²University of Leicester, ³University of York, ⁴University Hospitals of Leicester NHS Trust

Introduction: Heavy goods vehicle (HGV) drivers’ exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and have a reduced life expectancy compared to other occupational groups. Their working environments are not conducive to a healthy lifestyle, yet they are underserved in terms of health promotion efforts. The SHIFT programme is a multicomponent, theory-driven intervention targeting drivers’ physical activity (PA), sedentary behaviour and diet. This presentation will describe the SHIFT programme evaluation protocol.

Methods/analyses: 336 HGV drivers will be recruited from our partner company. Following baseline measurements, depots (clusters) will be randomised to either the SHIFT intervention or usual-care control arm (12 clusters/arm). An internal pilot will be conducted on the first 6 clusters, findings will be presented. The 6-month SHIFT intervention includes a group-based interactive 6-hour education session, worksite champion support, and equipment provision (Fitbit and resistance bands/balls to facilitate a ‘cab-workout’). Total daily PA (steps/day) will be the primary outcome. Secondary outcomes include: time spent sitting, time in light PA and MVPA, sleep quality, markers of physiological, metabolic and psychosocial health. Outcome measures will be taken at baseline, 6 and 12-months and analysed using an intention-to-treat principle.

Discussion: To our knowledge, this is the first RCT to examine the impact of a multicomponent intervention targeting individual and environmental barriers faced by HGV drivers to lead a healthy lifestyle. If effective, the SHIFT programme could be scalable as a Continued Professional Competence resource for drivers. This could have a long-term impact on professional drivers’ health and well-being.

Effectiveness and cost-effectiveness of a Physical Activity Loyalty Scheme to maintain behaviour change: a cluster randomised controlled trial

Ruth Hunter¹, Aisling Gough¹, Jennifer Murray¹, Jianjun Tang¹, Christopher Patterson¹, Mark Tully¹, Alberto Longo¹, George Hutchinson¹, Lindsay Prior¹, David French², Jean Adams³, Emma McIntosh⁴, Frank Kee¹

¹Queen’s University Belfast, ²University of Manchester, ³University of Cambridge, ⁴University of Glasgow

Background: The consequences of physical inactivity are estimated to cost the NHS over £1bn annually. As a large proportion of the UK workforce is employed in inactive occupations, workplace interventions have the potential to contribute significantly to the health of the population. The aim of the study was to investigate the effectiveness and cost-effectiveness of a complex intervention incorporating financial incentives to encourage physical activity and maintained behaviour change.

Methods: Desk-based employees were recruited from public sector organisations and randomised to Intervention or Control (waiting-list) groups. Intervention Group participants were encouraged to be active through provision of retailer vouchers during a 6 month intervention. The primary outcome was mean steps/day (validated Yamax Digi-Walker pedometers). Secondary outcomes included health and wellbeing, and work absenteeism/presenteeism. Data was collected at baseline, 6 and 12 months. Outcomes were compared between groups using ANCOVA adjusting for baseline values, randomisation stratum and season, with standard errors corrected for clustering.

Results: 853 participants (mean age 43.56 (SD 9.60) years; 71% female) were randomised (37 clusters) into two groups. At six months, mean steps/day were 6990 (SD 3078) for the intervention group and 7576 (SD 3345) for the control group (p = 0.02). There was a significant difference between groups in favour of the intervention group for mental wellbeing (WEMWBS) and work absenteeism (p = <0.01).

Conclusion: Although the study did not show a significant intervention effect for physical activity, it did show significant improvements for mental wellbeing, absenteeism and presenteeism. Such improvements may lead to economic benefits for the employer.

External funding details: Funded via the National Institute for Health Research Public Health Research Programme; Award no: 12/211/82. The funding body had no role in the design of the study or collection, analysis, and interpretation of data or in writing the manuscript. The study team would also like to acknowledge funding from the Public Health Agency and South Eastern Health and Social Care Trust. RH is supported by a NIHR Career Development Fellowship and acknowledges funding support from the HSC Research and Development Division. JM is funded by a PhD studentship from the Department for the Economy Northern Ireland. The work was undertaken under the auspices of the UKCRC Centre of Excellence for Public Health Research Northern Ireland and Centre for Diet and Activity Research (CEDAR), UKCRC Public Health Research Centres of Excellence which are funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, MRC, NIHR, and Wellcome Trust.

Activating employees in Liverpool workplaces

Danny Woodworth¹, Nicky Yates², Gina Perigo³, Jean Stephens⁴

¹Merseyside Sport, ²Liverpool City Council, ³NHS Liverpool Clinical Commissioning Group, ⁴Merseyside Sport Partnership

Liverpool has a very high rate of inactive and fairly active employees (46%), coupled with high levels of sedentary behaviour and an inactive workplace culture.

To combat this, Merseyside Sport Partnership (MSP) was commissioned by Liverpool City Council, in partnership with NHS Liverpool Clinical Commissioning Group (LCCG) and strategic stakeholders, to develop and deliver the Liverpool Active Workplace Programme.

MSP worked collaboratively with LCC, LCCG, stakeholders and the business community to launch a package of support for employers to improve staff physical activity levels, synergising with existing services and public health campaigns. A case for change agenda was promoted, citing research that absenteeism levels could be cut by up to 20% by investing in workplace physical activity. With 82 businesses registering for the programme, a mass participation step challenge was delivered and 21 small grants projects were funded. A legacy for the programme was ensured through development of a Workplace Toolkit, plus building organisational capacity by training and empowering 107 Workplace Champions, who organised activities and motivated their peers with behaviour change principles.

The programme evaluation found that the programme motivated 3,700+ employees to increase their activity levels, achieved a reduction in absenteeism in 45% of participating organisations and generated a £14.64 social return on investment for every £1 spent.

Liverpool Active Workplaces was pioneering in being the first practice-based (i.e. non-policy) workplace initiative to be commissioned in the city, which has helped to kick start a movement in the business community.

A HTA analysis of the Swedish Physical activity on prescription model

Mats Börjesson, Sahlgrenska Akademin

We will present data from the first systematic review, evaluating the Swedish PAP (Physical activity on prescription) model. The effects of various other exercise referral schemes have been evaluated in systematic reviews (Pavey et al. 2011, Campbell et al. 2015), with varying results. Important differences between the models for promoting physical activity is that exercise referral schemes, typically are focused on referring patients to a program performed outside the healthcare system lasting around 10-12 weeks, whereas Swedish PAP focuses on incorporating physical activity into the lifestyle of the patient on a long term and continues to be followed-up within the healthcare setting.

The effect of PAP on level of physical activity was based on data reported from five RCTs and one cohort study (eight papers), using the GRADE-system for review. Study participants represented several of the major patient groups suitable for receiving PAP, which increases the external validity of the results. The systematic review and the fact that our assessment was restricted to the Swedish PAP model further increases the applicability of the results.

The results from this systematic review, regarding the effect of Swedish PAP on the level of physical activity compared to no PAP, in adult individuals who have been deemed to be in need of increased physical activity by healthcare, will be presented. As lifestyle behavioural change is universally recommended for a multitude of diseases, the results may affect the use of PA in routine treatment, in healthcare.

The WELL Building Standard^™ (WELL): The intersection of physical activity and the built environment

Vienna McLeod, International WELL Building Institute

Background: Buildings and communities have a profound impact on health. This presents a unique opportunity to utilize the design, construction and operation of built spaces to promote health and address some of today’s most pervasive public health challenges, such as insufficient physical activity (PA).

Description: The WELL Building Standard^™ (WELL) is a performance-based rating system for measuring, certifying and monitoring features of buildings and communities that impact health and wellbeing. Founded in health, science and design research, the program includes over 100 features across ten concepts (Air, Materials, Water, Nourishment, Light, Fitness, Sound, Thermal Comfort, Mind and Community) that leverage design strategies, performance testing and operational policies to establish conditions that foster health.

Components: At the building scale, WELL promotes active design strategies, including accessible and aesthetically designed staircases, active and ergonomic workstations, dedicated PA spaces, on-site equipment and amenities for active commuters. In addition, WELL includes features that encourage tenants to provide meaningful fitness incentive programs and structured PA opportunities. At the community scale, WELL addresses neighborhood-level factors that aim to improve opportunities for active living, including mixed-use development, pedestrian and cyclist friendly streets, and community PA spaces and programming.

Conclusion: Since the program launched in 2014, over 700 projects spanning 32 countries across a variety of building sectors have committed to the healthy building movement and are in pursuit of WELL Certification. Of those, 72 have achieved certification. To date, 26 projects are located in the United Kingdom and four of these have achieved WELL Certification.

A longitudinal study of physical activity in different office types

Viktoria Wahlström¹, Frida Bergman², Fredrik Ohberg³, Therese Eskilsson⁴, Tommy Olsson², Lisbeth Slunga Jarvholm²

¹Umeå University, ²Department of Public Health and Clinical Medicine, Umeå University, ³CEDAR, Center for Demographic and Aging Research, Umeå University, ⁴Department of Community Medicine and Rehabilitation, Umeå University

Introduction: Sedentary behavior is a risk factor for lifestyle diseases. Office workers spend many hours at work sitting. We need strategies to reduce sitting time among office workers. Flex offices have no fixed work stations and employees are presumed to move between different working areas. The flex office may provide opportunities for increased physical activity (PA) at work.

Aim: Investigate the effects on PA when moving from a cell to a flex office.

Methods: A longitudinal study was performed on approximately 400 officials in a Swedish municipality, who initially all worked in cell offices. Half of them moved to a new flex office and half to a new cell office. A multicomponent intervention to increase PA was implemented at both offices. A substudy was performed on 84 officials who were recruited to measure sedentary time and PA with ActivPAL from 6 months before up to 18 months after relocation.

Results: Participants in the cell versus flex office group spent at baseline 51 and 53% of the working hours sitting, 40 and 39% standing, and 9 and 8% walking. After relocation the flex office group increased walking time and total steps. Time spent in moderate to vigorous physical activity (MVPA) at work increased in both groups. There were no changes in sitting or standing time or anthropometry between the groups.

Conclusions: The flex office design might increase walking time at work. A multicomponent intervention could increase time in MVPA at work, regardless of office type.

External funding details: Funded by Afa Insurance Foundation, Sweden.

Investing in inclusive built environment for physical activity and health: Design intervention assessment of urban public park in Bangkok, Thailand

Sigit Arifwidodo¹, Orana Chandrasiri²

¹Kasetsart University, ²International Health Policy Programme

Public Park is considered as one of the important settings for physical activity, especially in urban area. Parks support physical activity through their accessibility; their provision to facilitate active pursuits; their capacity to provide opportunities to a wide range of users; and their semi-permanent nature. The paper explores the design intervention assessment of Benchakitti Park, which serves as the pilot project for active park and showcase during the past ISPAH 2016 conference. The objective of the paper is to understand the health and well-being benefits of urban park in increasing PA levels of urban population and promoting healthy and active lifestyle. System for Observing Play and Recreation in Communities (SOPARC) is used to examine the change of activity patterns of users in the park and their level of PA. A survey questionnaire is used to understand how the new design in the park are perceived by users and how it can improve PA levels. It is found that the design changes the composition of users and pattern of PA. There are increasing number of children and elderly visitors (21% and 34%) and 4.1% and 17.6% increase of biking and running in the park. It is also found that park visitation is significantly associated with the increase of 5 minutes of PA per week. The project shows that even small intervention in built environment can change the people’s attitude and behavior towards physical activity and healthy lifestyle.

Session: The impact of places and spaces on physical activity

Association between urbanicity and physical activity in Mexican adolescents: The use of a composite urbanicity measure

Maria Hermosillo-Gallardo, Simon J. Sebire, Russ Jago, University of Bristol

Introduction: In Mexico, 39.5% of adolescents do not meet the World Health Organisation’s physical activity guidelines. Urbanicity is a potential correlate of physical activity. The aim of this study is to examine the associations between different aspects of urbanicity and adolescents’ physical activity.

Methods: Participants were 4,079 Mexican adolescents aged 15-18 from Mexico City and Oaxaca, Mexico. Data was collected between February and June 2016. Multiple imputation of missing data was implemented after confirming values were missing at random. Multivariable regression models examined associations between five domains of self-reported physical activity: 1) moderate-to-vigorous physical activity, 2) sports activities, 3) leisure time activities, 4) Physical Education class at school, 5) active commuting to school; and a composite measure of urbanicity and its six sub-scores: 1) demographic, 2) economic activity, 3) built environment, 4) communication, 5) education, 6) health services. Multivariable regression models were adjusted for parents’ education and participants’ age.

Results: Urbanicity was positively associated with activity spent in Physical Education class. The association between urbanicity and sport activities depended on state context. Communication-based urbanicity was negatively associated with leisure physical activity and active commuting. Population density was positively associated with active commuting.

Conclusion: Urbanicity is associated with adolescents’ physical activity in Mexico. Findings were largely consistent between Mexico City and Oaxaca and highlight the value of examining urbanicity as a multidimensional construct.

Funding source: The first author (MHG) is funded by The National Council of Science and Technology of Mexico (CONACyT).

Capturing the value of walkable neighbourhoods using hedonic pricing models

Lucy Gunn, Billie Giles-Corti, RMIT University

Background: Many features of the built environment are public goods where differences in provision, quality and location, can be estimated using house prices. House prices can therefore provide a way of measuring the value of walkability which can be used to promote healthy neighborhood and urban design.

Methods: Spatially measured built environment data was collated for participants from the 2007-2009 Victorian Integrated Survey of Travel Activity which was linked to house price data in each area derived from the Australian Property Monitors. Spatial hedonic pricing models were used to estimate the value of walkability measured using several built environment variables including street connectivity, density and land use mix among others in metropolitan Melbourne, Australia.

Results: This research will demonstrate an empirical method for estimating the value of walkability for each of the built environment variables examined. Understanding the value of the built environment provides both an economic and financial impetus for good urban design which is often missing from public health research and planning processes. Good urban design is necessary for supporting healthy behaviours and sustainable environments. Results will be presented for this analysis.

Conclusions: Estimating the value of walkability can provide support for designing healthy neighbourhoods. Such estimates can be used to understand the relative value of different features of the built environment, and as a means of estimating value capture, which is becoming an important tool for funding major infrastructure projects.

External funding details: Research supported by the Centre of Research Excellence in Healthy, Liveable, Communities (NHMRC grant #1061404).

Contribution of parks and green space to physical activity across the life course -ParkIndex: A Standardized GIS-based Park Access Tool

Jasper Schipperijn¹, Andrew T. Kaczynski², J. Aaron Hipp³, Ellen W. Stowe², S. Morgan Hughey⁴, Marilyn E. Wende², Elizabeth L. Oliphant³

¹University of Southern Denmark, ²University of South Carolina, ³North Carolina State University, ⁴College of Charleston

Access to parks and green space is associated with numerous psychological, physiological, social, economic, and environmental benefits for individuals and communities. However, not all parks or neighborhoods are created equal and researchers and planners have employed a wide array of measures for assessing park access and environments. To reduce the problems related to the multitude of measures, ParkIndex, a standardized park access measure incorporating park availability, features, and quality was developed. To inform the development of a ParkIndex, key informant interviews were conducted in Fall 2016 with twelve academics, public health, and parks and recreation professionals representing local and national organizations. These in-depth qualitative data were used to inform the next phase in which data were being collected in four cities across the U.S. In each community, 32 census block groups were selected representing high/low park availability and high/low income and recruitment postcards were mailed to 100 randomly-selected households per block group (n=12,800 total). Using a map-based survey platform (www.maptionnaire.com), respondents indicate parks in their neighborhood used in the past 30 days and answer detailed questions about perceptions and use. Concurrently, all parks within the study area were mapped using GIS and audited for their features and quality using the Community Park Audit Tool. The data were analyzed using multi-level spatial regression techniques to develop a park use probability algorithm, the ParkIndex. ParkIndex can be used as a standardized measure of park access by various users: park planners, citizens, researchers and public health professionals.

External funding details: U.S. National Institutes of Health, 1R21CA202693-01A1

Perceived safety from traffic and cycling: Making more sense of the data through video anchoring vignettes?

Klaus Gebel¹, Melanie Crane², Dafna Merom³, Ding (Melody) Ding²

¹Australian Catholic University, ²University of Sydney, ³Western Sydney University

Background: Perceived safety from traffic is the most important factor affecting cycling, however, its measurement might be subject to scale perception bias. To adjust for this, we used anchoring vignettes (AVs-hypothetical scenarios allowing calibrating responses), a method mostly used in social sciences.

Methods: Staff and students (n = 3,550) of an Australian university completed an online survey about commuting, including three short videos with varying levels of safety from traffic as vignettes. Ratings of traffic safety on the way to university, other destinations and for leisure were recoded depending on vignette ratings. Differences in ratings of the videos by sociodemographic attributes and cycling behaviour were examined. Adjusted and unadjusted perceived safety from traffic and differences in associations with cycling outcomes will be examined.

Results: Preliminary analyses found that 10.8% of the participants cycled to university, 23.3% for transport to other destinations and 40% for leisure. 92% of the participants rank ordered the video vignettes correctly as AV1 ≥ AV2 ≥ AV3. Women rated the safety in the vignettes significantly lower than men (p < .001). There were significant differences in scale interpretations by frequency of cycling, and between unadjusted and corrected safety scores. Additional analyses will examine differences in associations between unadjusted and adjusted safety and different cycling outcomes.

Conclusions: Validity and interpersonal comparability of the measurement of environmental perceptions are important for modelling and for evidence-based policy and planning in health, urban design and transportation. Anchoring vignettes might be a powerful tool for improving the validity of a wide range of Likert-scale items in public health research.

Parental perception of the built environment and children’s active travel to school by deprivation level

Angela Hands¹, Michael Duncan¹, Stefanie Williams¹, Gemma Pearce¹, Lou Atkinson²

¹Coventry University, ²Aston University

Introduction: Active travel to school (ATS) has the potential to increase children’s physical activity. The built environment (BE) can influence ATS. This study examined the association between parental perception of the BE and ATS and whether it is modified by deprivation.

Methods: A cross-sectional study was conducted with 113 parents of children aged 9-11 attending school in different areas of deprivation across Coventry, UK. Parents provided demographic data and completed the ‘Assessing Levels of Physical Activity and Fitness’ (ALPHA) questionnaire to produce a score indicating perceptions of various BE themes. Deprivation was assessed by the English Index of Multiple Deprivation (IMD). Summary theme scores were associated with active travel using logistic regression stratified by deprivation.

Results: Children of parents with positive perceptions of road safety were statistically significantly less likely to travel actively than those with negative perceptions (odds ratio (OR for every point increase in theme score) = 0.77, 95% confidence interval (CI) = 0.64-0.92). Parents from more affluent areas were more likely to perceive traffic safety, crime safety and neighbourhood environment positively, yet their children were less likely to walk or cycle. However, in more deprived areas there was no association between parental perceptions of any BE themes and ATS.

Conclusion: In more affluent areas, parental perception of traffic and crime safety, and neighbourhood environment may be related to children’s active travel to school. Children of parents living in more deprived areas were more likely to travel to school actively, but ATS was not associated with parental perception of built environment themes.

Effectiveness and mechanisms of environmental interventions to promote walking and cycling: what works and how?

Jenna Panter¹, Cornelia Guell², David Humphreys³, David Ogilvie¹

¹University of Cambridge, ²University of Exeter, ³University of Oxford

Practitioners often find it difficult to generalise evidence about the effectiveness of interventions from one location to another. To understand the relationships between context and effectiveness, we reviewed environmental interventions to promote walking and cycling, and why these may or may not be effective. We searched for systematic reviews in seven databases, mined these reviews for evaluative studies and searched for related sources including quantitative or qualitative studies, policy documents or reports. We extracted information about how the interventions worked (e.g contexts, mechanisms, and outcomes) and assessed credibility. 13 studies of interventions were included, most of which were new routes or facilities for walking and cycling, and 49 related sources were used. Most evaluations met 3/5 credibility criteria for effectiveness. Only two provided ‘rich’ evidence of mechanisms, with the remainder providing ‘thin’ or ‘thick’ evidence. The most effective interventions targeted accessibility and safety in both supportive and unsupportive conditions. For example, in physical contexts supportive for cycling such as well-connected streets, cycling might have become even more practical. Equally in car-dominated environments or poor conditions for walking, new infrastructure could encourage people to walk or cycle as it became more convenient to do so. In some situations, unsupportive contexts led to mechanisms not being triggered and no impacts. In others, the same context could trigger different mechanisms. Although evidence was sparse, we were able to understand the role of context in the success of interventions and distil the implications for practitioners through a new approach to evidence synthesis.

External funding details: MRC/NIHR

Modelling personal exposure to poor air quality through transport, and what we can do to mitigate

Andy Cope, Sustrans

Poor air quality is acknowledged as a major health issue. One of the main contributors to poor air quality is transport. Traditional UK approaches to valuing polluting emissions from transport apply a ‘cost per unit emission’ approach. This disregards issues around degrees of personal exposure, and in particular the extent to which the travel choices of individuals affect levels of exposure. This considerably understates the impact of AQ on public health.

Sustrans has undertaken research that has produced a model that addresses the personal exposure component of AQ. This model uses micro-environment concentration, respiratory rates, relative risk factors, mode choice, and many other factors to assess personal exposure. Focusing particularly on active travel, this helps us to understand how we can adjust delivery to improve the health of individuals, and how this scales up across communities. Different forms of outputs are generated for use with different types of audiences (e.g. economic, QALY, reduced hospital admissions).

The model is used in conjunction with the ‘cost per unit emission’ approach to present a more comprehensive overview of the likely extent of impact. I will describe the model, illustrate it’s application, and discuss the ways we have used the insight and the policy implications of the research. This is in the context of Low Emission Zones and Clean Air Plans in the UK, but is internationally transferable. We also consider briefly the AQ implications of ‘transport futures’ (e.g. fleet electrification, autonomy, traffic demand management, etc).

External funding details: Model development funded by Transport Scotland, Scottish Government

Session: Understanding inequalities in physical activity and health

Urban indicators for monitoring progress towards healthy, active cities

Billie Giles-Corti¹, Melanie Lowe², Jim Sallis³, Deborah Salvo⁴, Jonathan Arundel¹, Ester Cerin³, Mark Stevenson⁵, Marc Adams⁶, Erica Hinckson⁷

¹Healthy Liveable Cities Group - RMIT, ²Australian Catholic University, ³Institute for Health and Ageing - Australian Catholic University, ⁴University of Texas Health Science Center at Houston (UTHealth), ⁵Transport, Health and Urban Design Research Hub - University of Melbourne, ⁶School of Nutrition and Health Promotion - Arizona State University, ⁷AUT University

Introduction: Walking and cycling-friendly cities promote good health, and are vital for achieving the UN Sustainable Development Goals. Policies on transport, employment, urban design, housing, open space, and social infrastructure help to shape city planning, which then determines transport mode choices, and ultimately physical activity levels and health outcomes. To measure progress towards creating healthy, active cities, a recent Lancet series proposed a set of urban policy and built environment indicators.

Methods: This is a progress report on a collaborative process to measure those indicators in a range of cities worldwide. The selected cities are part of the International Physical Activity and Environment Network (IPEN) studies. Using GIS methods, IPEN data is used to quantify and map the distribution of built environment attributes. Policy in each city will be assessed for the extent to which they support creation of healthy cities.

Results: Preliminary work in Australia has found significant inequities within and between cities in delivery of transport and urban design that supports active living. Work is underway to scale-up this research in cities globally. Policy and legislative capacity to create active cities is likely to vary considerably between countries; and the ability to create spatial indicators will be determined by GIS data quality.

Conclusions: To assist in addressing global health challenges, there’s a need for evidence-based urban policy targets and consistent city-level built environment data collection. This project is exploring whether common spatial indicators can be used internationally to benchmark cities and address inequities in opportunities for active lifestyles.

The contribution of physical activity to neighbourhood socioeconomic inequalities in the incidence of cardiovascular disease: findings from the HABITAT multilevel longitudinal study in Brisbane, Australia.

Aislinn Healy¹, Jerome Rachele², Lucy Busija¹, Gavin Turrell³

¹Australian Catholic University, ²University of Melbourne, ³Queensland University of Technology

Introduction: Neighbourhood socioeconomic inequalities have been found in the incidence of cardiovascular disease. Understanding the contribution of physical activity will inform strategies to reduce these inequalities. This longitudinal study examines the contribution of physical activity to the incidence of cardiovascular disease by level of neighbourhood socioeconomic disadvantage in Brisbane, Australia.

Methods: Data comes from the HABITAT project, a multilevel longitudinal investigation of health in Brisbane. Data included 11,035 residents in 200 neighbourhoods in 2007, with follow-up completed in 2009, 2011 and 2013. Neighbourhood socioeconomic disadvantage was derived using a Census-based index and divided into quintiles, and cardiovascular disease and physical activity were self-reported. Hazard ratios were estimated using Cox’s proportional hazards regression model, adjusting for age, sex, education, occupation, and household income. Analyses were restricted to 10,385 people without cardiovascular disease in 2007.

Results: There were 408 reported incidences of cardiovascular disease over 28,510 person-waves of observation. Residents of more disadvantaged neighbourhoods (Q1: most disadvantaged HR 2.05, 95%CI 1.47-2.88, Q3: 1.89, 1.42-2.52 and Q4: 1.54, 1.14-2.07) reported significantly higher rates of cardiovascular disease over the follow up. Adjusting for physical activity reduced the hazard ratios by between 7-22%, with the greatest reduction observed in Q2.

Conclusion: This study identified physical activity as a meaningful contributor to neighbourhood socioeconomic inequalities in the incidence of cardiovascular disease. Future research should investigate which neighbourhood-level features are likely to influence physical activity, with a focus on how these features differ between advantaged and disadvantaged neighbourhoods. Such investigations would inform strategies to reduce health inequities.

Is there a deprivation and maternal education gradient to child obesity and physical activity in England?

Robert Noonan, Stuart Fairclough, Edge Hill University

Introduction: This study examined associations between individual- and area-level measures of socioeconomic status (SES) and different measures of overweight/obesity in 7-year-old English children. A secondary objective was to examine associations between individual- and area-level measures of SES and moderate to vigorous intensity physical activity (MVPA).

Method: Data is from wave four of the Millennium Cohort Study. Children wore an ActiGraph accelerometer for 7 consecutive days and measures of stature, body mass and waist circumference were taken. Overweight/obesity was defined using the International Obesity Taskforce definition. Waist-height-ratio ≥0.5 defined central obesity. Individual-level SES was defined using self-reported maternal education (grouped into four categories) Area-level SES was defined using the 2004 English Indices of Multiple Deprivation (grouped into five categories). Mean daily MVPA and number of children achieving 1 hr daily MVPA was calculated. Associations between maternal education, deprivation and outcome measures were examined by adjusted multinomial logistic and linear regression analyses.

Results: Three-thousand-seventeen children (1890 girls) had complete data. Children from the lowest maternal education group and children living in the most deprived neighbourhoods were at greatest risk of being overweight and centrally obese. MVPA was inversely associated with deprivation, and deprived children were most likely to achieve 1 hr daily MVPA.

Conclusion: Individual- and area-level SES measures were independently related to overweight and central obesity. Higher rates of overweight and central obesity among deprived children are not due to physical inactivity. Further research examining the concurrent effect of dietary intake and MVPA on child weight status by deprivation is warranted.

Exploring the determinants of overweight and obesity in South Asian adolescents in England: A mixed-methods approach using population-level Quantitative data alongside in-depth Qualitative interviews

Gurnam Johal¹, Therese Hesketh², Ruth Bell³

¹Public Health England, ²University College London Institute for Global Health, ³University College London Institute of Health Equity

WHO has stated that childhood obesity is one of the most serious challenges facing public health in the 21st century, with obese children and adolescents facing a plethora of health complications and increased risk of many chronic diseases.

Using a systematic methods literature review, quantitative analysis of the WHO Health Behaviour in School-Aged Children (HBSC) data, and qualitative interviews with South Asian adolescents, this research identifies obesogenic behaviours in South Asian adolescents in England. This evidence has been used to create a set of policy recommendations for the Public Health field to consider.

Pearson’s Chi Squared test alongside Multiple Logistic Regression analysis of HBSC data from 2006, 2010 and 2014 (separately and combined) examined variables such as physical activity, dietary behaviours, and mental health indicators in these South Asian ethnic groups.

Qualitative fieldwork was undertaken with a disaggregated population of South Asian Adolescents (Bangladeshi, Indian, Pakistani) of both genders, aged 11-18 years, from the London and Great London area. This involved 26 in-depth face-to-face interviews.

Key findings were that South Asian adolescents have lower physical activity levels compared with their white peers, have worse dietary behaviours, and identified barriers and opportunities to engaging in healthier lifestyles, compared with their white British counterparts.

These negative lifestyle behaviours will need careful consideration of upstream policy and local health service provision and interventions in South Asian adolescents in England. Taking this evidence into action will be crucial in addressing the obesity epidemic and reducing existing health inequalities.

The partnership process in the design, implementation and evaluation the Men on the Move (MOM) gender sensitised community based programme for adult men in Ireland.

Paula Carroll¹, Michael Harrison¹, Noel Richardson², Aisling Keohane¹, Liam Kelly², Alex Donoghue¹, Steve Robertson³

¹WIT, ²IT Carlow, ³Leeds Beckett University

The excess burden of ill-health, mortality and premature death experienced by many men across the developed world has prompted calls for the development of gender sensitised health related services for men. MOM is a community-based physical activity (PA) programme designed to engage inactive men to improve their overall health and well-being. The programme was gender-sensitised in relation to context (e.g. men only groups,), content (e.g. information presented in a scientific manner) and style of delivery (e.g. use of humour and banter). It was delivered by practitioner partnerships across 13 diverse communities and among diverse groups of men under ‘real world’ conditions to assess a) efficacy when compared to matched controls and b) replicability for scaling-up the programme nationally for population wide impact. Establishing appropriate partnerships is critical when implementing PA interventions to ensure research findings translate into practice, are replicable in practice and can be disseminated at a population level. The purpose of this paper is to detail the partnership that underpinned the design, implementation and evaluation of the MoM programme. Specifically, the role of individual partners and the process of maintaining the partnership will be presented in the context of achieving the outcomes of the partnership. Illuminating the partnership process may support others engaged in translational research to ensure their research translates into meaningful outcomes in practice

External funding details: Health Service Executive; Local Sports Partnerships; Men’s Development Network; Waterford Institute of Technology.

Integral PA programmes for vulnerable citizens: What works best?

Annemarie Wagemakers¹, Annemarie Wagemakers², Kirsten Verkooijen²

¹Wageningen University & Research, ²Wageningen University

Introduction: Integral physical activity (PA) programmes are deemed effective to stimulate PA and to improve health and societal participation. In these programmes, multiple sectors (e.g. sports, health insurers, municipalities) collaborate to connect primary care and PA. An example is the X-Fittt 2.0 programme for low SES overweight people in the Netherlands. X-Fittt 2.0, funded by the municipality and a health insurer, offers 2 sports sessions per week, lifestyle coaching and dietary advice for 3 months, and 6 meetings with a lifestyle coach during 2 years. The aim of this study was to unravel the ‘action elements’ explaining the success of X-Fittt 2.0.

Method: Interviews were conducted with 20 professionals and 30 participants of X-Fittt 2.0.

Results: X-Fittt 2.0 resulted into significant health gains: improved perceived health (6.1 – 7.4) after 3 months, and on average 6.7 kg of weight loss after 3 months and 10 kg during the first year. Participants indicated to feel better and more confident, and to participate more actively in society (e.g. play with their (grand)children, start working again). Social support received from other participants and coaches, especially the lifestyle coach, appeared crucial. Furthermore, the weekly weighing with other participants was important for perseverance and social support.

Conclusion: X-Fittt 2.0 contributes both to participant’s health and societal participation. Social support and joined weight monitoring are programme elements that contribute to its success. Integral PA programmes may wish to adopt these elements to improve vulnerable citizen’s health.

External funding details: Funding by ZonMw (Netherlands Organisations for Health Research and Development) (505311098003).

An evaluation of a physical activity and peer-support intervention for people experiencing homelessness: Street Fit Scotland

Stephen Malden, Ruth Jepson, Yvonne Laird, John McAteer, University of Edinburgh

Background: Homelessness affects an individual’s ability to access healthcare, opportunities for social interaction and recreational activities such as physical activity. This study aimed to explore the impact of a community-based physical activity and peer support intervention (Street Fit Scotland) on the health and wellbeing of homeless participants in Edinburgh, Scotland.

Methods: We conducted 10 semi-structured interviews with homeless adults attending the intervention. Interviews explored perceived impact of participation on the health and wellbeing of participants, in addition to strengths and weaknesses of the intervention. Interviews were audio recorded, transcribed and a thematic analysis conducted. A logic model was developed from the findings.

Results: Seven major themes were identified. Participants reported improvements in health and wellbeing since attending the intervention. This was attributed to increased self-esteem and social interaction, which in turn positively affected mental wellbeing. Participants reported increases in physical activity, and healthier choices concerning other health behaviours. The content and structure of the peer support component was identified as an area for improvement.

Conclusion: Findings suggested a positive impact of participation on health and wellbeing, particularly self-esteem, social interaction and physical activity. The logic model developed from these findings should be considered when expanding the intervention to other settings, or developing similar programmes. More efforts should be made to evaluate small-scale interventions that are reaching the most vulnerable population groups.

External funding details: This study received no external funding. SCPHRP is funded by the Medical Research Council and Chief Scientist Office of Scotland.

Parallel Oral Sessions: Wednesday 17 October

Wednesday, 10:20–11:20

Session: Innovative Interventions to Promote Physical Activity

Translation of the evidence for the Scottish Football Fans In Training (FFIT) weight loss programme into practice in Swindon and evaluation of its long-term effectiveness

Una Geary, Penny Marno, Fiona Dickens, Swindon Borough Council

Introduction: Following publication by the Lancet (2014) of evidence of effectiveness of the Scottish FFIT weight-loss programme, Swindon Borough Council (SBC) and Swindon Town Football Club launched FFIT, aimed at men aged between 35-65, with a BMI of 28 (kg/m²) or higher, in January 2015. To date, six 12-week courses with 30 participants each have been delivered. As the first place in England to deliver FFIT, Swindon now has the longest-term follow-up data to evaluate whether weight-loss achieved by programme completion is sustained.

Methods: Linear regression analysis was used to investigate the relationship between weight at baseline and post-intervention, adjusting for length of follow-up. Measurements were available at baseline, at the 12 week programme completion point and at follow-up intervals ranging from 6 to 18 months post-baseline.

Results: Average weight-loss between baseline and programme completion was 8.01 kg (95% confidence interval (CI) = 7.33-8.68 kg), which was highly statistically significant (n = 170, t(169) = 23.47, p < 0.001).

Linear regression analysis found that, on average, participants maintained a statistically significant reduction of 14.5% of their baseline weight at long-term follow-up (n = 125, mean follow-up = 13.35 months, 95% CI = 0.776-0.933, p < 0.001). Average long time weight loss was 8.22 kg.

Conclusion: The FFIT programme was effective in Swindon in supporting men to lose a clinically important amount of weight. Results were sustained long term. Swindon is contributing to the long-term evaluation by Scottish academics, and also piloting courses for female football fans and non-football fans using the same model.

Active Bucks – Using ‘Stealth’ in green spaces to engage inactive residents

Sarah Preston¹, Tom Burton¹, James Cavalier²

¹Buckinghamshire County Council, ²Active In

Active Bucks provides a population-level, evidence-based approach to increasing activity levels of residents, particularly those that are least active. Community engagement was key to understanding what residents wanted, and activities in green spaces were very popular. The programme explored an innovative approach to engaging inactive residents by developing an offer of physical activity by ‘stealth’ in green spaces where physical activity isn’t the primary reason for engaging.

46 six month programmes of stealth activities were commissioned over 18 months, including bushcraft, quidditch, NERF games, wildlife photography and dog agility, engaging 1112 unique participants. A wide range of ages were engaged from a 6 month old to a 101 year old, with 58% of participants under 16. 51% were male and 12% were from BAME groups.

91% of adults and 94% of children were not achieving CMO guidelines when they started, with 35% of adults and 48% of children being inactive. 58% of the programmes were sustained past the end of the funding period, with an additional 14% of sessions sustained seasonally.

Building a social network through meeting near cafes and creating social media groups were critical to maintaining engagement and sustaining activities. Other wider benefits of engaging residents in these activities have been demonstrated, including improved mental wellbeing, building confidence and developing skills.

Stealth activities that engage residents who would not be interested in traditional activities, and are built on a model with sustainability at its core, are effective at engaging inactive residents in regular activity.

Where to from social sport: A model of participant transition pptions

Kiera Staley¹, Matthew Nicholson¹, Erica Randle¹, Rayoni Nelson², Paul O’Halloran¹, Regina Belski³, Pam Kappelides¹

¹La Trobe University, ²Victorian Health Promotion Foundation (VicHealth), ³Swinburne University of Technology

Introduction: The development or expansion of social sport products has provided the opportunity for sport organisations to engage new non-traditional sport participants, with a focus on those who are inactive or somewhat active (across Victoria, Australia). An ongoing challenge is transitioning participants of social sport programs, which are often a short-term (e.g. 4-6 weeks), into regular PA and/or ongoing sport participation (social or traditional).

Method: The assessment of 105 unique social sport products was undertaken over a two-three year period and consisted of 90 interviews across 35 sport organisations and assessment of their reported instance data (locations, dates, and sessions); 120 interviews with program deliverers; 360 participant interviews; and over 3,600 participant program evaluation surveys.

Results: Participants in short-term social programs were often left thinking ‘what next?’, with deliverers found to be lacking knowledge of options for ongoing PA/sport participation beyond the program. A model was developed based on the five options found to be available to participants:

1.The same social sport product repeated;
2.A different social sport product;
3.The same social sport product but regularly;
4.Traditional sport;
5.Active recreation.

Conclusion: Social sport program design should consider the development of pathways for participants to transition into ongoing participation opportunities as their skills, PA and/or interest increase. This might be achieved by providing information about all five options in the participant model, or by designing a program that actively promotes and connects to one or two of the transition pathways.

External funding details: Victorian Health Promotion Foundation (VicHealth)

The Health Impact Planning Support System. A tool for community engagement in urban renewal decision-making

Claire Boulange¹, Paula Hooper², Sarah Foster¹

¹RMIT, ²University of Western Australia

Increasingly studies show that infill developments especially in larger scale urban renewal projects can recycle many of the features that encourage active and healthy urban living. However, to be successful, these community infill projects must be planned in partnership with the local community. Yet, it is often challenging for community members to envision a redesigned and denser future for their neighbourhoods.

Planning Support Systems (PSSs) are spatial simulation tools designed for simulating impacts arising from urban development. Recent studies have found that PSSs can improve understanding of the relationship between the built environment and health, and foster collaboration between researchers, urban planners and community members in promoting healthy built environments. The Health Impact Planning Support System (HI-PSS) was developed to respond to that need.

The HI-PSS is an interactive computer-based tool that allows residents and urban planners to work together by sketching future urban scenarios on a digital map. With the help of interactive evidence-based health and liveability indicators, they can instantly see the impacts on health and liveability associated with changing the urban layout.

The HI-PSS was trialled in real planning practices in Western Australia in July 2017 and feedback were collected via surveys. Residents who engaged with the redevelopment plans via the HI-PSS indicated that the indicators and interactive tool provided additional benefit in allowing them to visualise and understand the redevelopment plans, how it could benefit the community, people’s health and provided them with an alternative avenue through which to provide feedback on the plans.

External funding details: Landcorp

Unlocking physical activity opportunities in vulnerable communities: Key principles for locally-led interventions

Justin Richards¹, Vanessa Hughey², Laura Menzies², Liz Smith³, Neil Snowling²

¹Sport New Zealand, ²Sport NZ, ³Litmus Research

Introduction: Behaviour change research typically involves investigator-led development of structured interventions. This contradicts established practice in community development, which acknowledges local autonomy in intervention design to create meaningful and sustainable change. We explored this disconnect by identifying key principles in a “locally-led” approach to physical activity intervention development.

Methods: In 2016, Sport New Zealand embraced a “locally-led” approach to intervention development through all 14 Regional Sports Trusts (RSTs). One year later, we used appreciative enquiry to identify common themes from key stakeholders within each RST through semi-structured interviews with senior managers and focus groups with program staff. An evidenced-based community-led development framework used in other sectors formed the basis for discussion about key characteristics of successful “locally-led” initiatives.

Results: Key principles identified were: 1) Focus on strengths in the community rather than needs; 2) Develop the initiative iteratively rather than design a definitive intervention at the outset; 3) Enable leadership of local champions by embracing existing initiatives rather than select new leaders to translate interventions across settings; 4) Understand the community and critical physical spaces for target populations rather than entice people into novel intervention settings; 5) Work in cross-sectoral partnerships recognising the limited relevance of some of their outcomes rather than focus solely on physical activity behaviour.

Conclusion: This represent a genuine shift in intervention design for promoting physical activity. The diversity in initiatives that emerges from applying a “locally-led” approach may require novel approaches to evaluation, which challenges the established evidence hierarchy, when applying best-practice in intervention design.

Study on health benefits spectrum of physical activities in urban parks of Shanghai

Chengzhao Wu, Tongji University

Many studies have shown that the health benefits of activities in the natural environment are better than that of the built environment and indoor environment, but how does the different types of physical activities affect the health of users? Does the specific activity attribute affect health benefit acquisition? How to better promote the health benefits of activities from park design and management? This study take the elders in Pine Crane park and the Huangxing park of Shanghai as a case, the integrated use of GPS, the energy consumption of human movement monitor ActiGraph GT3X + and GIS method, preference for park recreation activities, activity and health benefits of the spatial distribution characteristics are analyzed, and build the park recreation activity sequence of health effects based on three dimensions of the activity type, attribute, characteristic of landscape environment.

The study found that exercise was the best activity in promoting high intensity physical activity and energy expenditure, followed by exercise facilities and group boxing activities. In terms of improving attention level and enhancing positive emotions such as pleasure and vitality, group boxing activities are the best, followed by leisure activities.

The results of correlation analysis of activity attribute showed that activity intensity and duration only had a positive effect on energy consumption and achievement of the park activities.

The impact of the natural environment and the humanistic and social environment on the actual health benefits is complex, and there are overlapping or mutually cancelling effects on the actual health benefits.

A novel community-based approach to increase physical activity in older adults using citizen-science and technology

Anja Frei, Kaba Dalla Lana, Thomas Radtke, Emily Stone, Milo Puhan, University of Zurich

Introduction: Promotion of physical activity (PA) in elderly people remains challenging. The aims of this project were to develop, implement and evaluate a novel community-based PA promotion intervention.

Method: The PA intervention considered of multiple determinants of PA (individual, interpersonal, cultural, environmental factors), used modern devices (smartphone with three apps) and followed a dynamic citizen-science approach. We targeted elderly persons, aged > 60 years, from the community of a typical small Swiss town. The intervention aimed to enable the participants to organise structured walking groups in their neighbourhood. Assessments took place at baseline and after 6 months; subsequently the participants were involved in the transfer of the intervention into a self-sustained state (without further support from the study team).

Results: We developed the intervention with active participation of the target population. In total, 29 elderly adults participated during the intervention phase and 25 conducted 6-months follow-up. The participants had a significant increase in daily moderate-to-vigorous PA (p = 0.046) but not in daily steps (p = 0.331). After the official study end (6 months), key participants took over the whole organisation of the intervention, added new walking group offers and are still successfully recruiting new participants.

Conclusion: The novel approach to promote PA was developed with active participation of the participants. After the official study end, it was successfully implemented in the community and is now self-sustained by the older adults, without further support from the study team.

External funding: Foundation Uniscientia and Foundation Walder

Session: Novel Approaches to Assessing Physical Activity Behaviour

The Roanoke Valley Community Healthy Living Index: A grassroots approach to community health surveillance

Elizabeth Ackley, Roanoke College

Community health surveillance (CHS) systems are increasingly relied upon to provide systematic assessments of population-level health outcomes and behaviors. Due to recent mandates imposed on government agencies and health systems, CHS has become commonplace in the USA. In addition to illustrating the magnitude of health inequities, the crux of CHS is generating strategies to improve community health. Given data sensitivity concerns, a common challenge relates to the translation of CHS data to community partners to facilitate health promotion. One possible solution is the development of grassroots systems which prioritize translation and are built to complement mandated CHS.

Objective: To outline the conceptual framework of the Roanoke Valley Community Healthy Living Index (RV-CHLI), a CHS system developed to engender cross-sector strategies to address health inequities in mid-sized communities.

Methods: Conducted annually, the RV-CHLI collates data from citywide FitnessGram assessments with perceptions of access to healthy living resources and health-related beliefs and behaviors. Using spatial technologies, the RV-CHLI informs community partners on the magnitude of health disparities across city neighborhoods in relation to a variety of social and environmental determinants.

Results: Since 2014, the RV-CHLI has led to walkability enhancements; neighborhood revitalization efforts addressing food insecurity; changes in police patrolling to improve neighborhood safety; school garden installations; the inclusion of health as a critical component of the city’s comprehensive master plan; and has leveraged > $650,000 for partner organizations.

Conclusion: The RV-CHLI serves as a model of grassroots CHS with demonstrated success in catalyzing social, environmental, and policy change with potential replicability.

External funding details: Support for this work has been provided by the Robert Wood Johnson Foundation, Virginia Foundation for Healthy Youth, Freedom First Credit Union, and the Brian H. Thornhill endowed professorship.

Harmonising physical activity data using indirect relationships with doubly labelled water method estimates

Matthew Pearce¹, Kate Westgate², Michelle Venables³, Nick Wareham², Soren Brage²

¹Mr, ²MRC Epidemiology Unit, University of Cambridge, ³MRC Elsie Widdowson Laboratory, University of Cambridge

Prediction equations describing direct relationships between estimates from less precise field methods and gold standard approaches are the optimal means to harmonise (calibrate) physical activity data to a common format, a critical step when integrating different sources of information for the same analysis. Such harmonisation efforts are hindered when equations are unavailable for the method or population of interest. This study examined the validity of an indirect approach to harmonisation.

The linear relationship between estimates of Physical Activity Energy Expenditure (PAEE; kJ/kg/day) from Recent Physical Activity Questionnaire (RPAQ) and doubly labelled water method (DLW) was calculated using indirect relationships, first between RPAQ and combined heart rate and motion sensing (ACCHR) in 2664 participants from the Fenland Study; and second between ACCHR and DLW using published data. Errors in the individual method relationships were propagated to the indirect relationship using bootstrapped standard errors. PAEE was estimated from RPAQ using the indirect equation and validated against DLW in 100 independent participants; this was compared against the directly mapped relationship.

The slope of the indirect equation was attenuated compared with the direct relationship. There was statistically significant mean bias for indirectly predicted versus DLW-based PAEE (7.3 kJ/kg/day [15.0%]; 95%CI: 4.0 to 10.6). Root mean square errors for direct (12.8 kJ/kg/day) and indirect (14.2 kJ/kg/day) predictions versus DLW-based PAEE were smaller than for non-calibrated RPAQ-based PAEE estimates (22.1 kJ/kg/day).

Harmonisation using indirect relationships could potentially reduce error in the absence of direct validation data. Further work should examine validity for different methods and populations.

Development and evaluation of a Park Rx Park Audit Tool and Inventory

Courtney Schultz, Jason Bocarro, Aaron Hipp, Myron Floyd, NC State University

Background: Rapidly accumulating evidence suggests public parks hold promise for increasing physical activity (PA). Medical providers are interested in growing PA counseling into a standardized clinical practice. There is a need for an audit tool that assesses parks’ spatial characteristics for PA potential that can help translate open space into dosage-specific PA prescriptions.

Study Purpose: The purpose of this study was to develop a user-friendly tool and integrated inventory of PA behaviors.

Methods and Results: The Park Rx Park Audit Tool (PRxPAT) builds upon existing instruments such as the Community Park Audit Tool and the 2011 Adult Compendium of Physical Activities (ACPA). The PRxPAT contains two sections: Park Information, and Park Activities and Amenities. Inter-rater analysis demonstrated strong reliability for the majority of items in the tool. The ACPA’s 764 PA behaviors were refined to generate a list of 128 behaviors suitable for a sustained PA prescription within parks. These adapted PA categories were then linked to each of the PRxPAT audited areas to create an inventory of spatially-specific PA behaviors that can be selected by medical providers based on patient stated preferences to create tailored PA prescriptions.

Conclusion: Evidence suggests the PRxPAT can enable community and clinical partners to quickly and reliably audit parks for potential PA opportunities, and generate community specific data repositories. By connecting these audited park spaces to specific PA behaviors with metabolic equivalency task (MET) values, medical providers can utilize the data to create tailored PA prescriptions for patients that incorporate intensity, duration, and frequency.

Estimating city-level travel patterns using street imagery: a case study of using Google Street View in Britain

Rahul Goel¹, Leandro Garcia², Anna Goodman³, Rob Johnson², Rachel Aldred⁴, Manoradhan Murugesan⁵, Soren Brage⁶, Kavi Bhalla⁵, James Woodcock²

¹University of Cambridge, ²UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK, ³London School of Hygiene & Tropical Medicine, London, UK, ⁴Department of Planning and Transport, faculty of Architecture and the Built Environment, Westminster University, London, UK, ⁵Department of Public Health Sciences, University of Chicago, Chicago, USA, ⁶MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

Background: Street imagery is a promising big data source providing current and historical images in more than 100 countries. Previous studies used this data to audit built environment features. Here we explore a novel application, using Google Street View (GSV) to predict travel patterns at the city level.

Methods: We sampled 34 cities in Great Britain. In each city, we accessed GSV images from 1000 random locations from years overlapping with the 2011 Census and the 2011-2013 Active People Survey (APS). We manually annotated images into seven categories of road users. We developed regression models with the counts of images of road users as predictors. Outcomes included Census-reported commute shares of four modes (walking plus public transport, cycling, motorcycle, and car), and APS-reported past-month participation in walking and cycling.

Results: In bivariate analyses, we found high correlations between GSV counts of cyclists (‘GSV-cyclists’) and cycle commute mode share (r = 0.92) and past-month cycling (r = 0.90). Likewise, GSV-pedestrians was moderately correlated with past-month walking for transport (r = 0.46), GSV-motorcycles was moderately correlated with commute share of motorcycles (r = 0.44), and GSV-buses was highly correlated with commute share of walking plus public transport (r = 0.81). GSV-car was not correlated with car commute mode share (r = −0.12). However, in multivariable regression models, all mode shares were predicted well. Cross-validation analyses showed good prediction performance for all the outcomes except past-month walking.

Conclusions: Street imagery is a promising new big data source to predict mobility patterns. Further testing across multiple settings is warranted both for cross-sectional and longitudinal assessments.

External funding details: RG, LG, MM, KB, and JW were supported by TIGTHAT, an MRC Global Challenges Project MR/P024408/1. JW and AG were also supported by METAHIT, an MRC Methodology Panel project (MR/ P02663X/1). Contributions from RJ were directly funded by and LG, RG and JW’s work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research (NIHR) and the Wellcome Trust (MR/K023187/1) and (MR/K023187/1). SB was supported by UK Medical Research Council [MC_UU_12015/3]. This work was completed in part with resources provided by the University of Chicago Research Computing Center.

Validating and shortening a park observation measure

James Sallis¹, Carrie Geremia¹, Kelli Cain¹, Terry Conway¹, Brian Saelens²

¹UC San Diego, ²University of Washington

Background: Assessment of park characteristics that may support physical activity (PA) can guide the design of more activity-supportive parks. Direct-observation measures are seldom used due to time and resource restraints.

Methods: We developed shortened versions of the Environmental Assessment of Public Recreation Spaces (EAPRS) tool and tested their construct validity by comparing scores from 40 parks in San Diego, USA to observed park use and PA using SOPARC. EAPRS Original was up to 688 items, Abbreviated was 113 items, and Mini was 38 items.

Results: PA elements were positively associated with park use and park PA across all versions, with the highest correlations for trails (.45 for use and .51 for PA using EAPRS Original; .57 use and .62 PA using Abbreviated and .38 use and .43 PA using Mini). Presence of amenities, using Abbreviated and Mini versions, was correlated with park use (.71, .64) and PA (.67, .59). The overall park quality score using Abbreviated and Mini had similar correlations (adjusted for park size) with park use (.74, .72) and PA (.72, .70) as the EAPRS Full (.71 use and .73 PA).

Conclusion: In all three versions, EAPRS overall park scores were strongly related to observed park use and PA. Shorter versions of EAPRS make it more feasible to use park observations in research and practice.

External funding details: US National Institutes of Health HL109222

If what gets measured gets done: Ensuring population level measurement remains relevant when policy priorities change

Andrew Spiers, Sport England

Introduction: Sport England’s Active People Survey (APS) began collecting data in 2005. Between 2005 and 2016, 10 annual waves of APS data collection were completed before it was replaced by the Active Lives Survey.

During this time, there have been important changes in sport and physical activity policy priorities in England, including:

•London’s selection and hosting of the 2012 Olympics and Paralympics
•An initial shift from regional delivery of Sport England investment to increased investment through National Governing Bodies
•Revised Chief Medical Officer physical activity guidelines
•A recent shift from a ‘sport for sport’s sake’ approach to one more explicitly premised on sport’s contribution to wider government outcomes

Discussion: This presentation will outline some of the challenges shifting policy priorities present to population measurement, including:

•Survey design
•Stakeholder management
•Performance management / metrics
•Communication and reporting

As well as responses to changing policy priorities, it will outline the role population measurement has played in shaping policy in England by providing empirical evidence to illustrate and deepen understanding of emerging trends and / or persistent inequalities in engagement.

Conclusions: The presentation will conclude with reflections on the successes and challenges of the English experience, including:

•Policy priorities will change over time
•Change cannot be perfectly anticipated but flexible design helps ensure population measurement tools remain relevant
•As well as measuring policy effectiveness, sustained population level measurement can shape future policy development

Emphasis will be given to learning relevant / applicable to attendees with similar objectives operating in different national contexts.

Moving Communities: Active leisure trends

Lizzie Broughton¹, Utku Toprakseven², Rachel Lawson¹, Tim Williams¹

¹ukactive, ²DataHub

Background: Leisure centres represent the front-line of preventative care providers and understanding sector trends can offer insight into approaches to improve population health. This work aimed to determine what the UK public sector leisure landscape looks like and how this is changing over time.

Methods: Aggregated data supplied by DataHub from over 300 leisure centres across the UK over the last three years was supplied, covering over 3 million individuals and 150 million visits to leisure facilities. Key factors, including the demographic breakdown of members and peak days and times to visit were examined. Participation in individual sports were examined to find the most popular activities and identify those that were gaining in popularity. Users were segmented by age and sex to examine differences in behaviour between groups.

Results: Visits to leisure centres have increased over the last three years, with females making up over half of the membership base in 2017 (52%). Further, the 65+ age group appear to be under represented within the membership base, making up just 9% of total members. Whilst swimming remains the most popular activity, representing 35% of all visits, the prevalence of this is declining as the popularity of group workouts has grown over the last three years.

The report will be updated with the latest data in Spring 2018 to present up to date analysis and examine how the face of public sector leisure has changed over the last year.

Session: Physical Activity Epidemiology

Differences in physical activity among rural-to-urban migrant and non-migrant: the Bangladesh sibling-pair comparative study

Shirin Jahan Mumu¹, AKM Fazlur Rahman¹, Liaquat Ali¹, Dafna Merom²

¹Bangladesh University of Health Sciences, ²Western Sydney University

Introduction: The detrimental effects of urbanization in developing countries on people’s lifestyles are based on the cross-sectional comparison. This study examined differences in physical activity (PA) between rural-to-urban migrants and their rural siblings in Bangladesh.

Methods: A sib-pair comparative study was designed to compare PA among 164 male migrated from Pirganj rural areas to Dhaka City and their rural siblings (total N = 328). The Global Physical Activity Questionnaire (GPAQ-V2) in the Bengali language was used. We adhered to GPAQ scoring protocol for computation of PA indicators. Generalized linear mixed effect model (GLMM) for the binary outcomes with a pair-specific random effect and SES in the fixed effect was used.

Results: Compared to migrants, rural men had higher mean ± SD age (31.87 ± 7.54 vs 33.35 ± 9.33; p = 0.02), lower proportion of university-level education (17.7% vs 14.6%) and higher proportion of manual worker (53% vs 66%). Rural siblings reported significantly higher total MVPA (median MET-minutes/week: 2340 vs 800, p = 0.04) than did migrants. The median weekly travel moderate PA (710 vs 380, p < 0.001) and leisure time MVPA (260 vs 0, p < 0.001) MET-minutes were higher in rural than migrants. Work-related MVPA did not differ significantly. The prevalence of physical inactivity was 21.30% in rural siblings and 42.70% in migrants. The adjusted odds ratios for low physical activity was 3.26 (1.73; 6.16) for migrants compared to the rural siblings.

Conclusion: Siblings who shared similar rural lifestyle but migrated to megacity were at higher risk of physical inactivity. Interventions targeting rural-to-urban migrants may help to reduce NCDs in Bangladesh.

The effect of moving to East Village (the former London 2012 Olympic Games Athletes Village) on physical activity levels

Claire Nightingale¹, Bina Ram¹, Elizabeth Limb¹, Aparna Shankar¹, Duncan Procter², Ashley Cooper², Angie Page², Christelle Clary³, Daniel Lewis³, Steven Cummins³, Anne Ellaway⁴, Billie Giles-Corti⁵, Peter Whincup¹, Alicja Rudnicka¹, Derek Cook¹, Christopher Owen¹

¹St. George’s, University of London, ²University of Bristol, ³London School of Hygiene and Tropical Medicine, ⁴University of Glasgow, ⁵RMIT University

Introduction: There has been increasing interest in whether the built environment influences health behaviours, but robust longitudinal evidence is limited. We assessed the effect of moving into East Village, a neighbourhood built on active design principles, on levels of physical activity (PA).

Methods: A cohort of 1278 adults seeking to move into social, intermediate (affordable), and market-rent East Village accommodation were recruited in 2013-2015, and followed up after two years. Objective measures of PA using accelerometry (ActiGraph GT3X) were made. We examined change in levels of PA, adjusting for sex, age group, ethnicity, housing sector and household (random effect), comparing those who moved to East Village (intervention group) with those who lived outside East Village (control group). Effects by housing sector and weekdays versus weekends were examined.

Results: 877 adults (69%) were followed-up, half had moved to East Village. Moving to East Village was associated with a small increase in daily steps (187, 95%CI -195, 569), more so in the intermediate sector (418, 95%CI -198, 1033), but effects were not statistically significant. There were no differences in time spent in moderate-to-vigorous PA (MVPA) or any appreciable weekend effects. There was evidence of less time spent in light PA (-6.8 mins/day, 95%CI -12.5, -1.1), largely in the market-rent group (-13.4 mins/day, 95%CI -25.2, -1.7).

Conclusion: At two-year follow-up, moving to East Village, did not have positive, consistent effects on objectively measured physical activity of public health importance.

External funding details: MRC National Prevention Research Initiative (MR/J000345/1) and National Institute for Health Research (12/211/69).

Relationships between outdoor time, physical activity, sedentary behavior and obesity in children: a 12-country study

Richard Larouche¹, Emily Mire², Kevin Belanger³, Tiago Barreira², Jean-Philippe Chaput³, Mikael Fogelholm⁴, Gang Hu², Estelle Lambert⁵, Carol Maher⁶, José Maia⁷, Tim Olds⁶, Vincent Onywera⁸, Olga Sarmiento⁹, Martyn Standage¹⁰, Catrine Tudor-Locke¹¹, Peter Katzmarzyk², Mark Tremblay¹²

¹University of Lethbridge, ²Pennington Biomedical Research Center, ³Children’s Hospital of Eastern Ontario Research Institute, ⁴University of Helsinki, ⁵University of Cape Town, ⁶University of South Australia, ⁷Universidade do Porto, ⁸Kenyatta University, ⁹Universidad de los Andes, ¹⁰University of Bath, ¹¹University of Massachusetts, Amherst, ¹²Children’s Hospital of Eastern Ontario

Introduction: Previous studies have shown that children spending more time outdoors accumulate more physical activity (PA), but this body of evidence is limited to high-income countries. The present study investigated the relationship between outdoor time and PA, sedentary time (SED), and BMI Z-scores among children in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

Methods: 6,478 children (54.4% girls) aged 9-11 years from 12 countries (Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, United Kingdom, and United States) participated between 2011 and 2013. Outdoor time was self-reported, PA and SED were assessed with ActiGraph GT3X+ accelerometers, and height and weight were measured. Data on parental education, neighbourhood collective efficacy, and accessibility to neighborhood recreation facilities were collected from parent questionnaires. Country latitude and climate statistics were collected through national weather data sources. Gender-stratified multilevel models with parental education, climate, and neighborhood variables as covariates were used to examine the relationship between outdoor time, accelerometry measures, and BMI Z-scores.

Results: Each additional hour/day spent outdoors was associated with higher MVPA (boys: +2.8 min/day; girls: +1.4 min/day), higher light-intensity PA (boys: +2.0 min/day; girls: +2.3 min/day) and lower SED (boys: -6.3 min/day; girls: -5.1 min/day). Outdoor time was not associated with BMI Z-scores.

Conclusion: Outdoor time is associated with higher PA and lower SED independent of climate, parental education and neighborhood variables. Future research examining the correlates of outdoor time should be conducted to inform intervention studies aiming to increase time spent outdoors.

“Ecological predictors of sport and exercise participation among Thai adolescents: A multilevel analysis of a cross-sectional population survey”

Areekul Amornsriwatanakul, University of Western Australia

Background: The purpose of this study was to examine predictors of sport/exercise participation (S/EP) across individual, interpersonal, and environmental levels in a nationally representative sample of Thai adolescents.

Methods: Data from 4,617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand. Data on S/EP were collected from individual adolescents using the Student Questionnaire. School environmental data were collected at the school level using a School Built Environment Audit. Multilevel logistic regression taking into account school clustering effects was applied for data analysis.

Results: At the individual level, biological factors, including sex and age, were independently and strongly correlated with S/EP. Adolescents with high preference toward PA (OR = 1.82, p < 0.001) and at least moderate level of self-efficacy (OR = 1.41, p < 0.001) were more likely to have high S/EP. At the interpersonal level, adolescents whose parents joined their sports/exercise at least 1-2 times/week (OR = 1.37, p = 0.002), received ≥3 types of parental support (OR = 1.44, p = 0.004), and received sibling (OR = 1.28, p = 0.005) and friends support (OR = 1.86, p < 0.001) had a greater chance of high S/EP. At the environmental level, adolescents’ S/EP were greater when there were at least 3-4 pieces of home sport/exercise equipment (OR = 2.67, p = 0.004), school grass areas (OR = 1.53, p < 0.001), and at least 1-2 PA facilities in community (OR = 1.38, p < 0.006).

Conclusion: Multiple factors at different levels within an ecological framework influencing Thai adolescents’ S/EP were generally similar to those found in high income countries. The positive predictors should be considered enhancing as they potentially benefits PA promotional efforts among Thai adolescents

External funding details: Thai Health Promotion Foundation

Differential associations of walking and cycling with obesity markers in a sample of 12,776 French adults (the ACTI-Cités project)

Jean-Michel Oppert¹, Mehdi Menai², Helene Charreire³, Chantal Simon⁴, Julie-Anne Nazare⁴, Camille Perchoux⁵, Christophe Enaux⁶, Serge Hercberg², Leopold Fezeu²

¹Sorbonne university, ²University Paris 13, ³University Paris Est, ⁴Lyon University, ⁵Luxembourg Institute of Socio-Economic Research, ⁶Strasbourg University

Introduction: Active transportation has been associated with excess body weight in some populations but the evidence relies mostly on the use of the body mass index (BMI, weight/height²), a useful but crude indicator. We analysed associations of walking and cycling assessed separately with more specific obesity markers such as waist circumference, a marker of abdominal obesity related to cardio-metabolic risk.

Method: A new tool (Sedentary, Transport and Activity questionnaire) was designed, validated vs. accelerometry and doubly labelled water (Mensah BMC Public Health 2016) and then self-administered to 55,694 participants (70% women) of an on-going web-cohort (NutriNet Santé)(Menai IJBNPA 2015). In 12,776 subjects, obesity measures were taken during a clinical visit including percent body fat (bio-impedance) and waist circumference. Associations between walking, cycling and obesity markers were analysed by multivariate regression models accounting for age, gender, socioeconomic status, urban density and diet.

Results: Walking > 2.5 h/week was associated in women only with lower percent body fat (-1.1%) and waist circumference (-1.7 cm) in addition to lower weight (-1.8 kg)(all p < 0.001). Cycling > 1.5 h/week was associated in both men and women with lower percent body fat (-2.5 and -1.9% respectively) and waist circumference (-4.4 and -2.1 cm) in addition to lower weight (-4.3 and -1.4 kg) (all p < 0.001). Results were unaltered with further adjustment on household and leisure physical activity.

Conclusion: Walking and cycling were favourably associated with abdominal fatness. Active transportation needs to be part of public health policies focused on prevention of obesity and promotion of metabolic health.

Cycling but not walking to work or study is associated with physical fitness, body composition and cardiovascular risk factors

Jani P Vaara¹, Tommi Vasankari², Mikael Fogelholm³, Harri Koski⁴, Heikki Kyröläinen⁵

¹National Defence University, ²The UKK Institute for Health Promotion Research, ³University of Helsinki, ⁴Training Division, Defence Command, ⁵University of Jyväskylä

Introduction: Active travel may provide one alternative to be physically active. We studied how active travel components, cycling and walking, are related to physical fitness, body composition and cardiovascular risk factors (CVD).

Methods: 776 young (age 26 ± 7 yrs.) adult men participated in the study. Self-reported transportation mode and distance to work or school, and leisure-time and occupational physical activity were assessed. The participants performed standing long jump, maximal leg and bench press, cardiorespiratory fitness, sit-ups and push-ups tests. Body mass index (BMI) and waist circumference (WC) were measured and CVD risk factors (blood pressure, HDL, LDL, triglycerides, glucose and insulin) were analyzed from blood samples. A continuous clustered cardiovascular risk factor score was formed using all CVD risk factors.

Results: 24% engaged to active travel (10% walkers and 14% cyclists). 96% of walkers reported the distance between school or work and home to be less than 5 km and similarly 96% of cyclists to be less than 10 km. After adjustments for age, smoking, leisure-time and occupational physical activities, cycling but not walking was inversely associated with WC, BMI and maximal strength, while a positive association was observed with aerobic fitness (p < 0.05). Cycling was inversely associated with the clustered CVD risk factor score (β = −0.11, p = 0.044), while walking was not (β = −0.04, p = 0.507).

Conclusion: Cycling to work or study may provide a sufficient training stimulus in young adult men to improve fitness and body composition and CVD risk factors, whereas walking does not.

Session: Physical activity interventions for youths

Moderators of the effect of a school-based intervention on cardiorespiratory fitness in Brazilian students

Giseli Minatto, Edio Luiz Petroski, Juliane Berria, Kelly Samara Silva, Federal University of Santa Catarina

Introduction: School-based interventions had successfully improved cardiorespiratory fitness (CRF) among adolescents. However, it is unclear in which subgroups the actions have been most effective. This study aimed to investigate possible moderators of a school-based intervention effect on CRF in Brazilian students.

Method: A non-randomized controlled design tested 432 students (intervention group [IG]: n = 247), grades 6^th to 9^th from two public schools in Florianópolis, Brazil in 2015. The “MEXA-SE” intervention lasted 13 weeks and included four components: 1) increase of physical activity (PA) in Physical Education classes; 2) active recess; 3) educational sessions and 4) educational materials. The estimated maximum oxygen consumption (VO₂max) obtained by the 20-m shuttle run test, represented the CRF. The moderators analyzed were sex, age group (10-12; 13-14; 15-16), economic level (high and low-middle status), sum of skinfolds triceps and subscapular (low, adequate, and high), and habitual PA (< 420 min/week and ≥ 420 min/week). Comparisons between groups were analyzed by covariance analysis.

Results: The data analysis indicated positive and significative effect of the intervention in VO2max on boys (mean = 1.33; CI95% = 0.26; 2.39; p = 0.015), and for students from 13 to 14 years old (mean = 1.53; CI95% = 0.11; 2.95; p = 0.035) when compared to their peers in the control group. No difference was found for the other moderating variables explored.

Conclusions: The “MEXA-SE” intervention effect on CRF was moderated by sex and age group. The characteristics of these interventions could be used to understand how different subgroups of individuals may benefit from strategies to have greater success for improving CRF. [http://www.ClinicalTrials.gov/: NCT02719704].

Street sports promoting positive youth development: preliminary findings from a peer-to-peer intervention

Julie Hellesøe Christensen¹, Glen Nielsen¹, Charlotte Demant Klinker², Peter Elsborg², Peter Bentsen²

¹University of Copenhagen, ²Steno Diabetes Center Copenhagen

Introduction: This is a qualitative study of a peer-led physical activity intervention with youth in less advantaged neighbourhoods in Denmark. Peer-to-peer strategies seem particularly effective for reaching marginalised groups. Since young people are especially amenable to peer influences, using peer-to-peer approaches in interventions targeting youth seems particularly relevant. The intervention is organised by GAME; a street sports organization that implements activities led by youth peer leaders (“Playmakers” aged 16-25) with the primary aim of fostering positive youth development and secondary aims to increase physical activity and mental wellbeing.

Methods: The study applies the behaviour change wheel as a theoretical framework to understand intervention mechanisms and functions. Data consist of observations of GAME’s peer leader education and during peer-led street sport practices in four less advantaged neighbourhoods. Further, four focus group interviews with youth peer leaders explore their capabilities, opportunities and motivation in relation to intervention implementation.

Results: Preliminary findings will highlight the mechanisms in GAME’s current intervention and explore intervention delivery and ways in which the education is put into practice by peer leaders. The project will increase theoretical understandings of mechanisms in peer-to-peer physical activity interventions for positive youth development in less advantaged neighbourhoods and will inform the further development of GAME’s peer leader education.

Conclusion: The findings should be of interest to practitioners, researchers and policy makers with an interest in peer-to-peer approaches to physical activity involving youth.

External funding details: The research is funded by the Novo Nordisk Foundation (NNF17SH0026986) and Innovation Fund Denmark (7038-00204B).

Factors influencing the implementation and maintenance of a decade-long school-intervention adding three times more physical education in primary schools

Jonas Vestergaard Nielsen, Thomas Viskum Gjelstrup Bredahl, Thomas Skovgaard, University of Southern Denmark

Introduction: School-based physical activity programmes have the potential to improve students’ physical and mental health as well as their academic achievements. However, school-based programmes often face implementation challenges, and the identification of factors influencing this particular programme phase is considered important in order to secure relevant intervention effects. The aim of this study was to identify factors affecting the implementation of the Svendborgproject (SP) - an effective real-world programme tripling the amount of physical education (PE) in primary schools in the municipality of Svendborg, Denmark.

Method: A mixed method design was used. Data consisted of i) documents on programme description and meeting minutes, ii) PE teacher questionnaires, iii) interviews with main programme managers, school heads and PE teachers.

Results: Results show that SP has been implemented with high levels of fidelity. It is now an established part of the municipality and school identity. Schools and programme managers have established solid partnerships, based on long-term collaboration. The provision of added quality to PE lessons has been implemented through teachers attending a professional development course.

Conclusion: The successful implementation of SP has been enabled through the early involvement of schools to meet individual school needs, combined with simple non-negotiable requirements. Finally, the implementation and maintenance of school-based PE is facilitated when programme managers, school heads and teaching personnel has a joint acknowledgement that the initiative is of high value and manageable within an already full curriculum.

External funding details: The study is funded by a donation from the non-profit foundation TrygFonden.

Providing pupils autonomous use of sit-stand desks; behaviour changes and teacher and pupil opinion following an 8 week intervention

Samantha Fawkner¹, Amanda Pitkethly², Josie Booth¹, John Sproule¹, Danielle Hutson²

¹University of Edinburgh, ²Edinburgh Napier University

Introduction: The aim of this pilot study was to examine the impact of providing pupils autonomous use of sit-stand desks in the classroom on sedentary behaviour and on- and off-task behaviour, and explore pupil and teacher opinion of the change to the learning environment.

Methods: One year 7 classroom was provided with nine sit-stand desks for 8 weeks of a single school term, with pupils given autonomy over when they chose to use the desks. Observations of on- and off-task behaviour and objective measurement of time spent sitting, standing and number of sit-to-stand transitions were undertaken at baseline and at the end of the intervention in 10 boys and 11 girls (141 ± 4 months). Teacher interviews (n=3) and two pupil focus groups (n = 8) were conducted.

Results: Compared with baseline, after the intervention the percentage of classroom time spent sitting was marginally less (3.6 ± 13.5%, g = 0.34), standing time marginally more (4.2 ± 11.5%, g = 0.45) and number of sit-to-stand transitions/hour significantly more (3 ± 2, g = 2.03, P = 0.03). Pupils tended to spend more time on task and less time off task during the class observations after the intervention (passive on task P = 0.055, g = 0.62). Both staff and pupils were positive about the intervention, with teachers reporting less disruption, more confidence and autonomy, and pupils indicating an ability to concentrate more.

Conclusion: Providing children autonomous use of sit-stand desks is positively received by teachers and pupils and may help to break up sedentary behaviour and encourage better on- and off-task behaviour.

Effectiveness of a randomized controlled trial to scale up an efficacious school-based intervention to improving children’s MVPA.

Rachel Sutherland¹, Nicole Nathan¹, David Lubans¹, Peter Butler², Nicole McCarthy², Clare Desmet², Lynda Davies², Luke Wolfenden²

¹University of Newcastle, ²Hunter New England Population Health

Introduction: Although comprehensive school-based physical activity interventions are efficacious under research conditions, they often require adaptation for implementation at scale. The primary aim of this paper is to report the effectiveness of an adapted efficacious school-based intervention in improving children’s MVPA.

Methods: An RCT was conducted in primary schools (25 intervention and 22 control schools) located in NSW, Australia. Follow-up measures were taken at 6-months post randomization. The multi-component intervention was based on an efficacious school physical activity program (SCORES program) which was adapted for scalability by a local health service over a 6-month period. The intervention consisted of four PA strategies and seven implementation support strategies. The primary outcome was students mean daily minutes spent in MVPA, objectively measured using accelerometers. School level outcomes included PE lessons quality and school physical activity practices were assessed.

Results: Participants were Grade 3-6 students at follow-up (May-August 2015). At follow-up there were no significant effects favouring the intervention group for overall daily MVPA (adjusted mean difference in daily MVPA between groups (1.96 minutes [CI]: (-3.49,7.41, p = 0.48). However, adjusted difference in mean minutes of overall VPA (2.19,CI 0.06-4.32, p = 0.04), mean minutes of school day MVPA (2.90,CI 0.06-5.85, p = 0.05) were significantly different in favour of the intervention group. PE lesson quality also significantly differed between groups.

Conclusion: The modified intervention was not effective in increasing children’s overall MVPA, when adapted for at-scale. However, did improve daily minutes of VPA and school day MVPA and PE quality.

External funding details: No external funding was recieved.

What we build makes a difference: Mapping activating schoolyard facilities after renewal using GIS, GPS and accelerometers

Henriette Bondo Andersen, Lars Christiansen, Charlotte Pawlowski, Jasper Schipperijn. University of Southern Denmark

Schoolyard renewal can increase physical activity (PA) during recess, but it remains unclear which facilities are most suitable for promoting PA for both genders. This paper aims to investigate PA levels in renewed schoolyards focusing on specific areas. Three Danish schools with large asphalt schoolyards lacking permanent facilities were renewed and received innovative facilities with great variation in design.

At baseline (spring 2014) 353 students (grade 4-8) and following renewal (spring 2016) 300 students (grade 4-8) were asked to wear an accelerometer (ActiGraph GT3X) and GPS (Qstarz BT-Q1000XT) during five school days. Total time and proportions of time spent sedentary, light and moderate-to-vigorous physical activity were calculated per area by gender pre and post renewal. Schoolyards were mapped using ArcGIS and ‘hot-spot analyses’ were used to detect activity-spots.

At two schools, time and PA increased for both genders, but for one school both decreased. The activity was spread out more and new and more activity-spots were identified for both genders, however boys remained more active after renewals. Multi-courts, small soccer-courts, panna-courts, foursquare markings and hills generated activity-spots for both genders, whereas a large screen for dancing activities, an undulating multi-court, a spider-web climbing structure and woodland area only generated activity-spots for girls.

Variation in elements and features is important when building activating schoolyards for both genders. Context, design and function of elements plays a central role in promoting PA behavior in schoolyards.

External funding details: This study was funded by The Danish Cancer Society, Realdania, The Danish Foundation for Culture and Sport

The impact of a childcare intervention on early childhood educators’ physical activity knowledge and self-efficacy

Molly Driediger¹, Leigh M. Vanderloo², Andrew M. Johnson¹, Shauna M. Burke¹, Jennifer D. Irwin¹, Brian W. Timmons³, Anca Gaston⁴, Patricia Tucker¹

¹University of Western Ontario, ²The Hospital for Sick Children, ³McMaster University, ⁴Brant County Health Unit

Introduction: The training Early Childhood Educators (ECEs) receive may influence children’s physical activity (PA) affordances during childcare. This study sought to explore ECEs’ knowledge of Canadian PA guidelines for the early years and their self-efficacy to engage preschoolers in PA before and after receiving training, as part of the multi-component Supporting Physical Activity in the Childcare Environment (SPACE) intervention.

Method: A randomized controlled trial, 11 childcare centres in London, Canada implemented the 8-week intervention, wherein ECEs (n = 49) attended one 4-hour PA workshop. ECEs (n = 34) from 11 additional centres maintained standard care. Educators completed a questionnaire at baseline and post-intervention to assess knowledge of national PA guidelines (1 item) and self-efficacy to engage preschoolers in PA in various circumstances (e.g., when going outside isn’t possible; 6 items). Percentages for accurate identification of the guidelines were tallied, while self-efficacy data were analyzed using a mixed MANOVA in SPSS.

Results: Accurate guideline identification for the intervention group was 8% and 31% at baseline and post-intervention, and 20% and 17% for the control group, respectively. Preliminary results suggest that the training significantly improved ECEs’ self-efficacy to engage preschoolers in PA. Specifically, in regard to their self-efficacy to engage preschoolers in 1) PA in general, 2) for 30 minutes indoors, and 3) when going outside isn’t possible.

Conclusion: This research may provide evidence of the usefulness of PA-related training for ECEs in support of preschoolers’ engagement in PA.

External funding details: Funded by the Canadian Institutes of Health Research (grant # 133559).

Session: Physical activity promotion among specific patient groups

Physical activity and physiotherapy: Moving forwards

Anna Lowe, Sheffield Hallam University/Public Health England

Background: A large proportion of the UK population fail to meet physical activity (PA) guidelines, this impacts on the lives of individuals and has substantial social and economic implications. There are over 55,000 physiotherapists in the UK yet little is known about PA promotion in physiotherapy practice. The overarching aim was to explore PA promotion in physiotherapy practice and to understand the factors that underpin patterns of current practice.

Methods: A systematic scoping review was undertaken to assess the state of the existing global evidence. Following this, a mixed methods study was completed. Phase 1 involved a national, cross-sectional survey of UK physiotherapists and Phase 2 involved a qualitative, explanatory follow-up study.

Findings: Thirty-one studies were included in the scoping review, most were observational, non-UK. Findings from Phase 1 of the mixed methods study indicated that respondents (n = 514) engage in conversations with patients about PA but lack a systematic, evidence-based approach and knowledge of the PA guidelines was poor. These findings were further explained in Phase 2 which showed that participants (n = 12) highlighted a lack of understanding of key concepts and focused on short term restoration of function rather than long term promotion of health.

Conclusion: Physiotherapists have the potential to contribute to tackling inactivity through routine clinical care. However, current approaches appear to be inconsistent and are not systematic. Findings could improve physiotherapy practice such that it reflects current health policy. Furthermore, they could contribute to the bigger goal of orientating health services towards prevention.

Is recreational running associated with earlier delivery and lower birth weight in women who continue to run during pregnancy? An international retrospective cohort study of running habits of 1293 female ‘parkrun’ runners during pregnancy.

Katy Kuhrt, Mark Harmon, Natasha Hezelgrave, Paul Seed, Andre Shennan, Kings College London

Introduction: Women of reproductive age increasingly participate in recreational running, but its impact on pregnancy outcome is unknown. This study investigates whether running affects gestational age at delivery and birthweight as indicators of cervical integrity and placental function respectively, as existing studies are underpowered to determine potential effects.

Methods: Information about running habits and first pregnancy outcome was collected from participants. Women were initially categorized according to whether they continued running in pregnancy or stopped, and further, dependent on average weekly km and trimester they ran into.

1293 female participants were recruited from parkrun, which organises weekly runs across the world, including 691 in the UK. Those under 16 or unable to provide outcome data were excluded from the analysis. Primary outcomes were gestational age at delivery and birthweight centile. Other outcomes included assisted vaginal delivery rates and prematurity at different gestations.

Results: There was no significant difference in gestational age at delivery: 39⁺⁶ weeks’ in both groups (C.I. 39⁺⁴ to 40; p = 0.55) or birthweight centile; 46.9 vs 44.9%, (C.I. 44.5 to 49.4% vs 42.8 to 47.1%; p = 0.22) in women who stopped running and those who continued respectively. Assisted vaginal delivery rate was increased in women who ran; 195/714 (27%) vs 128/579 (22%), (O.R 1.32; C.I. 1.02 to 1.71; p = 0.03).

Conclusion: Running during pregnancy doesn’t influence gestational age at delivery or birthweight centile and appears safe irrespective of intensity. Assisted vaginal delivery rates were higher in women who ran, possibly due to increased pelvic floor muscle tone.

“MOVEdiabetes”: A trial to promote physical activity for adults with Type 2 Diabetes in Oman

Thamra Al Ghafri¹, Saud Alharthi¹, Yahya Al-Farsi², Elaine Bannerman³, Angela M Craigie⁴, Annie S Anderson³

¹Ministry of Health, ²Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Oman., ³Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School., ⁴Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School

Introduction: This study examined the impact of a multi-component intervention (MOVEdiabetes) on physical activity (PA) in inactive adults with type 2 diabetes (T2D) within primary care (PC) in Oman.

Method: A cluster randomized controlled trial of the “MOVEdiabetes” programme (PA consultations delivered by dieticians trained in behaviour change techniques (BCTs), pedometers and monthly telephone WhatsApp messages) versus usual care in eight health centres in Muscat. Sample size was calculated to demonstrate a 50% between group difference in PA (MET-mins/week) over 12 months. The primary outcome was change in PA measured by the Global Physical Activity Questionnaire. Intention to treat analysis was done via SPSS v21.

Results: Of the 232 participants, 59.1% were female, 79.3% married, 6.5% illiterate, >50% employed, and mean age was 44.2 ± 8.1 years. Seventy-five percent completed the 12 month follow-up. At 12 months, mean PA change was +737.9 ± 2224.8 MET-min/week (95%CI 2.9-7.5) in the intervention group compared with +199.3 ± 613.7 MET-min/week (95%CI 1.0-3.1) in the control group. Using a Mann-whitney test, the between group difference in median MET-min/week was 80 MET-min/week (95%CI 0.010-0.014). Overall, 42.6% of the intervention group (vs 28.2% in usual care) achieved WHO PA recommendations (≥600 MET-mins/week) (OR = 1.25, 95%CI 1.1-1.5).

Multilinear regression analysis found greater changes in MET-mins/week at 12 months in males (95%CI 36.5 -851.9), participants with no comorbidities (95%CI 243.5-1199.6) and those with less sitting time (95%CI 311.9-618.4).

Conclusions: PA consultations linked to BCTs, delivered by trained dieticians, can be an effective method to increase levels of PA in primary diabetes care.

Who is at risk for a sedentary and inactive lifestyle? Pooled accelerometer data in patients with cancer.

Maike Sweegers¹, Terry Boyle², Jeff Vallance³, Brigid Lynch⁴, Adrijana D’Silva⁵, Mai Chin A Paw¹, Johannes Brug⁶, Teatske Altenburg¹, Laurien Buffart¹

¹VU University Medical Center, ²University of South Australia, ³Athabasca University, ⁴University of Melbourne, ⁵University of Calgary, ⁶University of Amsterdam

Background: Several reviews and meta-analyses demonstrated beneficial effects of physical activity on physical health and quality of life in patients with cancer. Emerging evidence suggests that sedentary behavior may have detrimental effects on health. Yet little is known about the correlates of these behaviors in patients with cancer. The current study aimed to investigate demographic and clinical correlates of objectively assessed physical activity and sedentary behavior in patients with cancer.

Method: Data from seven studies (n = 1150 cancer survivors) from the Netherlands, Australia and Canada were pooled. We performed multilevel linear regression analyses to examine associations between demographic and clinical variables (age, gender, body mass index (BMI), marital status, education level, smoking status, comorbidities, diagnosis, time since diagnosis, type of treatment and fatigue) and accelerometer-assessed moderate-to-vigorous physical activity (MVPA) and sedentary time, adjusting for confounders which were identified using a directed acyclic graph.

Results: On average, participants spent 538 (standard deviation (SD) = 99) minutes per day sedentary and 25 (SD = 22) minutes per day in MVPA. Older age (β = 1.3, 95% confidence interval (CI) = 0.8;1.7), being male (β = 35.6, 95%CI = 23.6;47.5), higher BMI (β = 1.3, 95%CI = 0.5;2.0) and higher fatigue (β = 8.0, 95%CI = 2.8;13.1) were significantly associated with higher sedentary time. Younger age (β = 0.3, 95%CI = 0.2;0.4), lower BMI (β = 0.3, 95%CI = 0.1;0.5), non-smoking (β = 6.9, 95%CI = 2.1;11.2) and lower fatigue (β = 2.2, 95%CI = 0.9;3.4) were significantly associated with higher levels of MVPA.

Conclusion: Age, gender, BMI, smoking status and fatigue were significantly associated with sedentary behavior and/or MVPA in patients with cancer. This information helps to identify patients who are at risk for a sedentary and inactive lifestyle.

What influences physical activity engagement post-myocardial infarction? A longitudinal qualitative study

Sarah Birtwistle, Rebbecca Murphy, Ian Jones, Ivan Gee, Paula Watson, Liverpool John Moores University

Introduction: Engagement in physical activity (PA) post-myocardial infarction (MI) can reduce risk of reoccurrence and mortality. Yet uptake of PA through cardiac rehabilitation (CR) is poor, and little is known about the long-term PA behaviour of cardiac patients. We aimed to understand factors influencing PA engagement for post-MI patients during the 9-month period following an MI, from the perspective of both patients and family members.

Methods: Six family-dyads (1 patient, 1 family member) engaged in semi-structured interviews at 1, 4 and 9 months post-MI. Interviews explored PA experiences, attitudes, beliefs, behaviours, motivation and family support for PA. Interpretative Phenomenological Analysis involved reading transcripts, identifying emerging themes and comparing themes between cases. Emerging themes were organised into profiles representing common experiences.

Results: In the preliminary analysis, one active profile (5 family-dyads) and one sedentary profile (1 family-dyad) emerged. Patients in the active profile were motivated by interest, enjoyment, knowledge of the benefits of PA and confidence to be physically active, coupled with their desire to return ‘back to normal’. These active patients also reported positive influences from their family and CR team. The sedentary profile was characterised by a lack of interest and negative associations with PA, with family concerns regarding PA (post-MI) acting as a further deterrent.

Conclusions: Although patients’ personal relationship with PA appeared to influence PA engagement, considering the effect of interpersonal interactions on PA engagement may also be worthwhile when designing interventions to enhance PA engagement within a post-MI population.

Effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis

Ulric Abonie, Florentina Hettinga, University of Essex

A tailored approach to activity pacing is recommended to manage fatigue and improve physical activity (PA). However, supporting evidence on tailored activity pacing is limited and conflicting, with no evidence available in persons with multiple sclerosis (MS). The aim of this study was to evaluate the effect of a tailored activity pacing intervention on fatigue and PA in adults with MS.

21 adults with MS (age 59 ± 2 yrs.) were randomly allocated to tailored pacing group (n = 11) or control group (n = 10). Participants wore an accelerometer for 7 days that measured PA behaviours, and self-reported their engagement in pacing and risk of overactivity (Activity Pacing Questionnaire) and fatigue (Fatigue Severity Scale) at baseline and 4-week follow-up. Tailoring involved using data from the accelerometer and questionnaires. PA behaviours were assessed by examining activity level (7-day average activity counts per minute) and activity variability (7-day average highest activity counts each day divided by activity counts on that day). Group differences were examined with one-way ANOVA (p = .05).

Compared to the control group, the tailored group had increased activity level (22.79 ± 44.70 vs. -18.11 ± 36.07; p = .03) and decreased activity variability (-.10 ± .53 vs. .53 ± .80; p = .04). No group difference was found for fatigue (-.10 ± .75 vs. .26 ± .70; p = .27).

Tailoring activity pacing based on attitudes towards pacing, PA and fatigue was effective in improving PA behaviours, without exacerbating fatigue symptoms. This provides the basis to incorporate activity pacing in MS management.

RECREATE: Intervention development to support stroke survivors to reduce and break up sedentary behaviours

Jennifer Hall¹, Sarah Morton², Claire Fitzsimons², David Clarke³, Anne Forster³

¹Bradford Teaching Hospitals NHS Foundation Trust, ²The University of Edinburgh, ³University of Leeds

Introduction: Stroke survivors can spend up to 80% of their day in prolonged sedentary behaviour(s) (SBs), which is more than healthy age-matched controls. Interventions tailored to the needs of stroke survivors to support reducing/breaking up SBs and improve outcomes are needed. To develop appropriate interventions it is necessary to understand current behaviour(s) of stroke survivors and existing practices within stroke care.

Methods: (1) Non-participant observations in two UK (England, Scotland) stroke services, each including a stroke unit and linked community service; (2) Semi-structured interviews with staff, stroke survivors and their caregivers to explore capabilities, opportunities and motivations associated with reducing SBs in stroke survivors. Field note data were thematically analysed. Interview data were analysed using a framework approach to facilitate comparison across and within groups of participants.

Findings: Initial findings indicate that the physical and social environment, perceptions of stroke survivors’ physical and psychological capability to move, and routinized practices enacted by staff, facilitate an expectation to be sedentary in the inpatient setting, which is often carried over when patients leave hospital. There are opportunities to incorporate a reduction in SB within existing routine activities of stroke survivors and staff.

Conclusions: Efforts to reduce SBs in stroke survivors are considered necessary and potentially beneficial for improving long-term recovery. Findings from this study will inform a co-production approach to develop a complex intervention designed to reduce/break up SBs and improve health outcomes in stroke survivors.

External funding details: The abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Development and evaluation of strategies to reduce sedentary behaviour in patients after stroke and improve outcomes, Reference number RP-PG-0615-20019). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Session: Understanding and influencing physical activity behaviour

Evaluating the evidence on sitting, smoking, and health: Is sitting really the new smoking?

Jeff Vallance, Athabasca University

Over the last decade sedentary behavior research has attracted widespread media attention. Sitting has frequently been equated with smoking; some sources go so far as to suggest smoking is safer than sitting. The objective of this presentation is to highlight how sitting and smoking are not comparable. These are distinct behaviours with vastly different levels of risk attributed to them. Meta-analyses of sedentary behaviour and health outcomes report hazard ratios of 1.24 (95% CI: 1.09, 1.41) for all-cause mortality. The relative risk of death from all causes among current smokers, compared to those who have never smoked, is 2.80 (95% CI: 2.72, 2.88) for men and 2.76 for women (95% CI: 2.69, 2.84). The risk is substantially higher for heavy smokers (>40 cigarettes per day, RR = 41.7 [95% CI: 33.18, 52.46] for men, 59.5 [95% CI: 43.62, 81.05] for women). Even light smoking (1-4 cigarettes per day) exceeds the risks associated with very high volumes of sitting. It is not just the magnitude of health risks associated with sitting and smoking that are dissimilar. Other elements of smoking, such as its addictive properties and harm to bystanders, are not comparable to sitting. Conflicting or distorted information about health risks related to behavioural choices and environmental exposures can lead to confusion, and public doubt, with respect to health recommendations. As a scientific community, our public health messages need to be driven by our data and the current body of evidence; there is no room for alternative facts.

Patterns of health behaviour associated with active travel: a compositional data analysis

Louise Foley¹, Dorothea Dumuid², Andrew Atkin³, Timothy Olds², David Ogilvie⁴

¹University of Cambridge, ²School of Health Sciences, University of South Australia, ³School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, ⁴MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge

Introduction: We explored differences in how people doing active travel (walking or cycling for transport) used their time compared to those doing no active travel, incorporating physical activity, sedentary behaviour and sleep.

Methods: We analysed time-use diaries from the cross-sectional 2014/15 United Kingdom Harmonised European Time Use Survey. In participants aged 16+ years, diary activities were categorised into six domains, accounting for a full 24 hours: (1) sleep; (2) leisure moderate to vigorous physical activity (MVPA); (3) leisure sedentary screen time; (4) non-discretionary time (work, study and chores); (5) travel and (6) other. This mixture of activities was defined as a time-use composition. A binary variable was created indicating whether participants reported any active travel on their diary day. Using compositional data analysis, we ran adjusted regression models to test whether time-use composition differed between individuals reporting some active travel and those reporting no active travel.

Results: 6,143 participants (mean age 48 years; 53% female) were included in analysis. There was a statistically significant difference in time-use composition between those reporting some active travel and those reporting no active travel. Compared to those not undertaking active travel, those who did active travel reported 11 minutes more in leisure MVPA and 18 minutes less in screen time per day, and reported lower sleep.

Conclusion: Overall, active travel was associated with a broadly health-promoting composition of time across multiple behavioural domains. From a health perspective, higher MVPA and lower screen time is favourable, but lower sleep could have positive or negative implications.

External funding details: The Centre for Diet and Activity Research (CEDAR) is a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Overview of different physical activity models for the general public in various countries, with pro’s and con’s.

Ragnar Van Acker, Luc Lipkens, Flemish Institute for Healthy Living

Introduction: The objective was to review existing national physical activity (PA) and sedentary behaviour (SB) models, their main features and whether these models are expert-based and tested in the general public.

Methods: (1) A pubmed and google search strategy was conducted using a search strategy with key words in English, Dutch, French and German. (2) For Europe, this was complemented by a search of country-specific models based on an existing systematic overview of national PA recommendations in the European Region of the World Health Organization. Only models or infographs recognized by national agencies or governments were included.

Results: 18 unique PA models or infographs from 12 different countries worldwide were found. Most countries adopted pyramid or triangle shaped models to visualize health recommendations (n = 8), followed by infographics (n = 6) and circle or disc shaped models (n = 6). Most models were reported as expert-based (72%). However, none (0%) were actually tested in the general public during the development phase. The only reported evaluation in the general public was a formative or post-development evaluation (22%). Most models integrated PA and fitness guidelines, but few provided SB guidelines (33%).

Conclusion: No PA or SB models provided reports of evaluation in the general public during their development. There is an urgent need to develop and test models in participation with the general public, in order to communicate feasible public health messages effectively.

External funding details: Funded by the Flemish Government.

A person based approach to developing the ‘Breaks from Sitting’ module within a digital intervention for reducing and preventing cognitive decline in adults aged 60-80.

Rosie Essery¹, Cheryl Hunter², Kirsten Smith¹, Alex Milton³, Fiona Mowbray¹, Stephanie Easton¹, Max Western¹, Sebastien Pollet¹, Anne Ferrey⁴, Bernard Gudgin⁵, Nanette Mutrie⁶, Paul Little¹, Lucy Yardley¹

¹University of Southampton, ²University of East London, ³University of Bristol, ⁴University of Oxford, ⁵PPI Representative, ⁶University of Edinburgh

Background: There is good evidence that optimising older adults’ physical activity behaviours can help to slow or prevent cognitive decline. An important aspect of this includes addressing high levels of sedentary behaviour, more common amongst older adults and an independent risk factor for cardiovascular and cardiometabolic conditions. Such conditions are risk factors for age-related cognitive decline. Breaking up sedentary time with light-intensity activity may also be a manageable first step towards increasing activity - particularly for those with limited mobility, strength or balance issues. In developing the multi-component ‘Active Brains’ digital intervention, we incorporated a module to support individuals to reduce sedentary behaviours.

Methods: In addition to drawing on theoretical and empirical understandings of relevant behaviours, we employed a Person-Based Approach to tailor intervention content and functionality to the needs and preferences of intended users. This involved developing ‘guiding principles’ and conducting over 60 think-aloud and semi-structured qualitative interviews with adults aged 60-80, some with existing cognitive decline. Feedback was systematically coded to determine necessary amendments and to gain a deeper understanding of older adults’ experiences of engaging with the ‘Breaks from Sitting’ intervention module.

Results and Conclusions: We will report on older adults’ experiences of engaging with the ‘Breaks from Sitting’ module and outline changes made to this intervention content, structure and functionality in response to participants’ feedback. Our findings will provide insight into the acceptability and accessibility of a digital intervention to reduce sedentary behaviour amongst older adults with and without cognitive deficits.

External funding details: PGfAR NIHR Programme Grant: RP-PG-0615-20014

Nudging baseball fans to be active: a large-scale, smartphone-based, quasi-experimental study

Masamitsu Kamada¹, Hana Hayashi², Koichiro Shiba³, Masataka Taguri⁴, Naoki Kondo⁵, I-Min Lee⁶, Ichiro Kawachi³

¹The University of Tokyo, ²McCann Global Health, ³Harvard T.H. Chan School of Public Health, ⁴Yokohama City University, ⁵University of Tokyo, ⁶Brigham and Women’s Hospital, Harvard Medical School

Introduction: Sport fandom has the potential to be a powerful draw for habit formation. We investigated the effect of a smartphone application, Pa-League Walk, developed by the Japanese Professional Baseball League (Pacific League), on the daily step counts of fans who used the application.

Method: Quasi-experimental study conducted throughout Japan. Pa-League Walk became freely downloadable on iPhones and Android phones on March 2016. The daily step counter included some gamification features including ranking of friends according to daily step count, and competition between opposing teams’ fans based on daily total steps on game days (e.g., [Eagles fans = 200 M steps] vs [Hawks fans = 300 M steps]). A voluntary survey of 499 users showed that 53% were male and 57% were 30-49 years old. We analyzed the preliminary data of 15,228 iPhone users who downloaded the app in 2016. De-identified data was provided by the Pacific League.

Results: After excluding data with <500 steps/day, we had 606,630 days of data. Fans walked more on “home-game” days (average 7565 steps/day), compared with “visiting-game” (7279, P < 0.001) and “no-game” days (7134, P < 0.001) during the regular season (Apr-Sep). After the introduction of “players photo collection” feature (a reward for 10,000 steps/day achieved) on October 2016, the proportion of days achieving 10,000 steps increased from 24.4% during Apr-Sep to 27.5% during Nov-Dec (P < 0.001), despite the latter being the winter off-season.

Conclusion: This preliminary analysis suggests that the fandom-based app may promote physical activity among baseball fans.

External funding details: Japan Society for the Promotion of Science.

Integrating Fitbit data with the electronic health record (EHR) to promote physical activity in cancer survivors

Lisa Cadmus-Bertram, Amye Tervaarwerk, Mary Sesto, Brittany Van Remortel, Preshita Date, Ronald Gangnon, University of Wisconsin - Madison

Introduction: Breast and colon cancer are highly prevalent, with a combined population of 4 million survivors in the US. Although an active lifestyle provides physical and psychological benefits to cancer survivors, most remain insufficiently active. Although effective interventions have been developed, these have not been integrated with oncology care. The purpose of this pilot trial was to test the feasibility of a technology-based physical activity intervention that imports Fitbit data to the EHR and provides email-based coaching.

Method: Participants were 50 stage I-III breast (N = 45) and colon (N = 5) cancer survivors, each of whom was enrolled alongside a co-survivor (friend/relative/spouse) for peer support. Dyads were randomized to intervention or usual care. Those dyads in the intervention group received Fitbit trackers, with the survivor’s data uploaded to the electronic health record (EHR), and email-based coaching. The primary outcome was physical activity measured at baseline and 12-weeks by the ActiGraph accelerometer.

Results: As of January 2018, 47 dyads have completed the study, two were lost to follow-up, and one is ongoing. Fitbit data were successfully integrated with the EHR for all 26 cancer survivors randomized to the intervention group. Physical activity outcomes are forthcoming.

Conclusion: High retention was observed in a study that combined Fitbit data with the EHR and provided peer support and email coaching. Future studies should examine additional strategies for providing clinical support for physical activity adoption and maintenance.

External funding details: Funding was provided by the University of Wisconsin’s Institute for Clinical and Translational Research (ICTR) and the Carbone Comprehensive Cancer Center.

A reduction in sedentary behaviour in obese women reduces neonatal adiposity: The DALI randomised controlled trial

Mireille van Poppel¹, David Simmons², Gernot Desoye³

¹University of Graz, ²Western Sydney University, ³Medical university Graz

Background: Maternal obesity and gestational weight gain are implicated in the development of childhood obesity, tracking from neonatal adiposity. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity.

Methods: In the Vitamin D And Lifestyle Intervention (DALI) Lifestyle Trial (ISRCTN70595832), 436 women with a body mass index ≥ 29 kg/m² were randomly assigned to counseling on Healthy Eating (HE), Physical Activity (PA), HE&PA, or to usual care (UC). Neonatal outcomes were head, abdominal, arm and leg circumference, skin folds, estimated fat mass, fat percentage, fat free mass, and cord blood leptin. Intervention effects on outcomes were assessed in multilevel analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed.

Results: Outcomes were available from 334 neonates. A reduction in sum of skin folds (-1.8 mm; 95% CI, -3.5 to -0.2; p = 0.03), fat mass (-63 g; 95% CI, -124 to -2; p = 0.04), fat percentage (-1.2%; 95% CI -2.4 to -0.04; p = 0.04), and cord blood leptin (-3.80 µg/l; 95% CI -7.15 to -0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (-5.79 µg/l; 95% CI, -11.43 to -0.14; p = 0.05) compared to UC. Reduced sedentary behavior, but not gestational weight gain, mediated intervention effects on leptin in the HE&PA and PA group.

Conclusion: The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary behavior drove the intervention effect on cord blood leptin. Implications for future adiposity of the offspring need to be elucidated.

External funding details: EU FP7

Wednesday, 13:20- 14:20

Session: Cross Sectoral Approaches to Physical Activity Promotion

Prospective associations between alternatives to the car and cardiovascular disease, cancer and all-cause mortality: Evidence from UK Biobank

Jenna Panter¹, Oliver Mytton¹, Stephen Sharp¹, Séren Brage¹, Steven Cummins², Anthony Laverty³, Katrien Wijndaele¹, David Ogilvie¹

¹University of Cambridge, ²London School of Hygiene and Tropical Medicine, ³Imperial College

Car use may affect health in various ways, including through reduced physical activity. We investigated the associations between using alternatives to the car which are more active and morbidity and mortality. We conducted a prospective study using 358799 adults aged 37-73 from UK Biobank. Commute and non-commute travel were assessed at baseline (2006-2010). We classified participants according to whether they relied exclusively on the car, or used alternative modes of transport at least some of the time. Main outcome measures were incident CVD and cancer, and CVD, cancer and all-cause mortality (up to February 2016). We excluded events in the first two years and conducted analyses separately for those who regularly commuted and those who did not. In maximally-adjusted models, regular commuters with more active patterns of travel on the commute had a lower risk of incident (HR 0.89, 95% CI 0.79 to 1.00) and fatal CVD (HR 0.70, 95% CI 0.51 to 0.95). Those who also had more active patterns of non-commute travel had an even lower risk of fatal CVD (HR 0.57, 95% CI 0.39 to 0.85). Among those who were not regular commuters, more active patterns of travel were associated with a lower risk of all-cause mortality (HR 0.92, 95% CI 0.86 to 0.99). More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality. This is important for individuals choosing how to travel, and for employers and policymakers whose actions influence travel patterns.

External funding details: MRC, BHF and NIHR

Changes of commuting mode to school and fatness measurements in Spanish children and adolescents: Findings from the UP&DOWN longitudinal study

Daniel Camiletti-Moirón¹, Palma Chillón², Alejandro Sánchez-Bey³, Verónica Cabanas-Sánchez⁴, Oscar L. Veiga⁴, Anna Timperio⁵, José Castro-Piñero³

¹University of Cádiz, ²Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain, ³Department of Physical Education, School of Education Sciences, University of Cádiz, ⁴Department of Physical Education, Sports, and Human Movement, Autonomous University of Madrid, ⁵Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences

Introduction: Longitudinal cohort studies show that change in transport mode is linked to reduced body mass index (BMI) in adults. We aimed to examine associations between change in mode of commuting and fatness measurements in children and adolescents over two years.

Methods: This longitudinal study comprised 1226 Spanish children and adolescent (49.6%, girls) aged 8-18 years at baseline, recruited from schools in Cádiz and Madrid, respectively. Mode of commuting to school was self-reported at baseline and 2-year follow-up. Height, weight, waist circumference, triceps and subscapular skinfold thickness were measured. Body Mass Index (BMI, kg/m²) was calculated. Multilevel mixed regression analyses were performed.

Results: Persistent active transport was common (58.7%) and 28.2% were persistent passive commuters. Only 7.0% changed from a passive to active, and 6.1% from an active to passive, mode. There were no sex differences in consistency of travel mode over the two years, but a greater proportion of children were persistent active commuters compared to adolescents (66.8% vs 53.8%, p < 0.001). Among children, girls who changed from a passive to an active mode had lower BMI at follow-up than those who persistently used an active mode (B = −0.7, 95%CI: -1.2,-0.1). No other associations were found.

Conclusions: Travel mode to school remained relatively constant over the 2-year period. The association between the change of travel mode and BMI in younger girls suggest a call to health authorities to promote active transport as a way of incorporating physical activity into everyday life.

External funding details: This study was supported by the DEP 2010-21662-C04-00.

Developing a score to assess the policy environment for cycling and walking promotion in cities: Results of a feasibility study

Sonja Kahlmeier¹, Esther Anaya Boig², Emilia Smeds², Audrey de Nazelle²

¹University of Zurich, ²Imperial College London, Faculty of Natural Sciences, Centre for Environmental Policy

Background: While several scores exist to quantitatively assess cycling and walking environments, hardly any focus on the qualitative aspects of the policy and social environment.

Methods: Information on the social, policy and planning contexts was collected in 7 cities through standardized workshops and semi-structured interviews with stakeholders from health/transport sectors. A purposive scientific and grey literature search revealed the Copenhagenize Index as most suitable guidance.

Results: A subset of the Copenhagenize Index was used to analyse the qualitative information on the social (bicycle/walking culture, social acceptance) and the policy environment (advocacy, politics, urban planning), respectively. Data from a quantitative survey was use to assess perception of safety. Feasibility to derive valid scores was tested using data from 2 cities. A refined approach was applied to the data from the other 5 project cities. 2 experts independently derived a score from 0-4 for walking/cycling for each of the categories, using sequential text interpretation of pre-determined sections from the interview and workshop reports. Explanations on why a particular score was given were recorded. Validation was also explored.

Conclusions: The approach was found to be feasible to derive scores to capture the policy and social context for walking/cycling, respectively, which can be included into quantitative analysis of active transport data. Validity was higher for cycling than for walking, which might be related to more detailed information having been available on the former.

External funding details: EU 7th Framework Programme for research, grant agreement no 602624-2 - PASTA study (Physical Activity through Sustainable Transport Approaches)

Walking towards a brighter future: A participatory research process to advocate for improved walk to school corridors

Anna Greer¹, Alison Martínez Carrasco², Drew Goldsman³, Ann-Uriel Knausenberger¹

¹Sacred Heart University, ²Make the Road Connecticut, ³The Nature Conservancy

Introduction: Bridgeport is the most populous, and one of the poorest, cities in Connecticut. Due to budget limitations, the Bridgeport Board of Education voted to increase the minimum distance requirement for high school busing service from 1 to 2 miles without any improvements to the walk-to-school infrastructure.

Methods: We conducted participatory research to support fifteen youth leaders as they advocate for improvements to their walk-to-school environment. We visited twenty-one classrooms in Bridgeport’s three high schools and used an interactive mapping process with students to identify the most-often used walk-to-school routes (3 routes/school). The youth leaders then examined the quality of these routes using the Microscale Audit of Pedestrian Streetscapes. Youth also collected questionnaires from 187 peers about their school travel experiences. Percentage scores (i.e., percent of total points earned) were calculated for each segment and crossing along the routes assessed. We used chi square tests to examine associations between students’ travel model and negative-travel-related experiences.

Results: Almost all segments (82%) and crossings (91%) examined received a failing grade (<64%). In addition, a greater proportion of students who walk/cycle/skate to school rather than ride in a motor vehicle report feeling unsafe (p = .001), missing first period (p = .006), and lower grades (p.001) due to travel-related challenges.

Conclusions: School districts must create safe walk-to-school environments to ensure all students’ right to travel to school in a safe and timely manner. Other municipalities might benefit from replicating the youth-led, participatory approach used in this study.

External funding details: This project was funded by The Nature Conservancy (#P116393).

Estimated reduction in physical inactivity among inner city adults associated with a rail/trail conversion and park construction: Smart and healthy transportation planning

Gregory Heath¹, Eric Asboe², Mina Sartipi¹

¹University of Tennessee at Chattanooga, ²Chattanooga Department of Transportation

Introduction: Recent studies suggest that urban design at the street-scale level contributes to enhanced transport options for increased physical activity (PA) among residents. Such changes have been linked to the prevention of premature morbidity and mortality from key non-communicable diseases (NCDs). Due to the cost of bike and pedestrian infrastructure planners need to estimate the return on investment of such strategies for increasing PA and decreasing levels of physical inactivity (PI) among persons exposed to such infrastructure.

Methods: Infrastructure costs were accessed by working with a local transportation partner for a rail/trail conversion linking a major transport and recreational corridor with a newly constructed park located within a low-income urban area. Current prevalence of PI and select NCDs among adults 18+ years were available at the census tract level using the Behavioral Risk Factor Surveillance System.

Results: Current PI estimates for the affected census tract was 52.7%. Using a median effect size of 48.2% for street scale interventions targeting increased bicycle and pedestrian activity, derived from the U.S. Community Guide reviews, projected a decrease in physical inactivity of 27.2%. Costs of the infrastructure was set at $2.8M(USD). The potential estimated cost savings over the ensuing four years for NCD’s among this population due to a reduction in PI was $476,000(USD).

Conclusions: Accessing existing data on PI and NCD prevalence, as well as projected costs of specific active transport infrastructure can be an important approach for transportation, urban, and public health planners in prioritizing healthy transportation infrastructure projects in communities.

Evidence and active urban environment: A qualitative study of how stakeholders in three English local authority areas use evidence in decision making for ‘active living’ infrastructure

Anna Le Gouais¹, Cornelia Guell², Louise Foley¹, David Ogilvie¹

¹University of Cambridge, ²University of Exeter

Introduction: Urban design has the potential to influence population levels of physical activity and subsequent health impacts. This qualitative study investigates how decisions are made for ‘active living’ infrastructure (walking and cycling infrastructure and open space), and particularly how evidence is used by different stakeholders.

Method: The research involves three purposively selected local authority areas in England. Qualitative data is collected predominantly through semi-structure interviews, and to a lesser extent ethnographic observations. Participants were chosen using snowball sampling with key stakeholders such as planners, public health, new communities, developers and councillors. 6-10 participants are included for each case study area. Interviews are audio-recorded with consent and transcribed verbatim. Data analysis is supported using qualitative data analysis software NVivo 10.

Results: Decision making may be influenced via multiple ‘windows of opportunity’. Funding opportunities, elected members’ personal opinions, the persuasiveness of pressure groups, willingness to take risks, organisational culture, developers’ attitudes and personal relationships all influence design outcomes. Different types of evidence are used by different stakeholders, ranging from systematic reviews and bespoke research, to population data, transport monitoring and national standards. Economic arguments for ‘active living’ infrastructure receive mixed support from stakeholders – its potential for better design must contend with scepticism and limited mechanisms to influence planning negotiations.

Conclusion: Stakeholders vary in the types of data and evidence used for decision making. Better understanding of decision making processes between stakeholders, as well as clearer health-related evidence and cost effectiveness data could help to enable healthier neighbourhoods.

External funding details: MRC Epidemiology Unit and CEDAR.

Building local capacity for sustainable health-enhancing physical activity promotion: City-wide action on physical activity: how mapping activity using causal loop diagrams can help plan interventions and evaluation

Nick Cavill, Cavill Associates Ltd

Introduction: Local governments are uniquely placed to drive and coordinate cross-sectoral collaboration to plan and implement physical activity programmes across an area. However, the majority of the evidence for the effectiveness of interventions to promote physical activity is focused on single, small, short-term linear interventions and does not tend to take account of the complex dynamic systems that exist within communities.

We set out to develop causal loop diagrams (CLDs) that described the physical activity system in partnership with stakeholders involved in a city-wide physical activity programme in the North of England. We aimed to see if this could help the stakeholders move closer to a ‘whole systems approach’ in both their programme planning and evaluation.

Activities undertaken: We reviewed the activities being planned or implemented in the city-wide approach. At a one-day stakeholder meeting we developed a detailed CLD that described a generic physical activity system, based on the physical activity correlates literature. We discussed the draft CLDs with the stakeholders and refined them, mapping their activities and their evaluaiton data.

Results: In this case study city, this exercise showed that the current plans were far from being a systems approach, and showed some clear gaps in both activites and data collection that could inform the future planning process.

Conclusion: Mapping the physical activity system using CLDs can be a very effective tool to help stakeholder consultation, and to move intervention planning closer to being a whole systems approach.

Session: Physical Activity and Older Adults

Additive effects of acute exercise and breaking up prolonged uninterrupted sitting on fatigue in older adults

Michael Wheeler¹, Daniel Green¹, Kathryn Ellis², Ester Cerin³, Paddy Dempsey⁴, David Dunstan⁵

¹The University of Western Australia, ²The University of Melbourne, ³Australian Catholic University, ⁴Swinburne Univeristy, ⁵Baker Heart and Diabetes Institute

Background: While interrupting prolonged sitting time and an acute moderate-intensity exercise bout can improve fatigue, it is unclear whether combining these approaches amplifies these improvements. We examined the combined effects of acute exercise and breaks in sitting on subjective fatigue in older adults.

Methods: In a randomised crossover trial, inactive adults (n = 38; aged 55-80 years), completed 3 conditions (6 day washout): 1) SIT: uninterrupted sitting (8 hrs, control); 2) EX: sitting (1hr), moderate-intensity walking (30 mins) followed by uninterrupted sitting (6.5 hrs); 3) EX+BR: sitting (1 hr), moderate-intensity walking (30 mins) followed by sitting (6.5 hrs) interrupted every 30 minutes with 3 minutes of light-intensity walking. The Lee Fatigue Scale (consisting of 18 visual analogue scale items scored from 0-100 mm) was administered at five timepoints (every 2 hours) during each condition, with higher scores denoting increased fatigue. Mean fatigue scores [95% CI] were calculated at each timepoint, then averaged over 8 hours, excluding the first (baseline) timepoint.

Results: Compared to SIT, there was a 10% reduction in average fatigue for the EX+BR condition (EX+BR 37 [33-40] vs. SIT 41 [37- 44] p = 0.012), but no significant difference for the EX condition (39 [35-43]).

Conclusion: In the context of prolonged uninterrupted sitting, an acute exercise bout followed by regular brief activity breaks may be a more effective fatigue countermeasure than exercise alone in older adults.

External funding details: This work was supported by funding from the National Health and Medical Research Council of Australia (NHMRC) Grant (1062338) and by the Victorian Government’s Operational Infrastructure Support Program.

‘Mobile Me’: An evaluation of a sport intervention in sheltered housing and care homes

Amanda Burke¹, Ryan Hughes², Andy Jones¹, Shelley Ames²

¹University of East Anglia, ²Active Norfolk

Introduction: Levels of physical activity amongst older adults are low, and this group is at risk of social isolation. ‘Mobile Me’ has bought sports, such as bowling, to older people of all abilities in sheltered housing and care homes. After 10 weeks, the sport coaches leave equipment on site so that the residents can continue playing. Between 2015 and 2018 Mobile Me has reached 52 settings in the county of Norfolk, England.

Methods: Mobile Me is being delivered by ‘Active Norfolk’, the county sports partnership, and evaluated by University of East Anglia. The evaluation compares residents on the programme to those waiting to start; participants are followed-up for one year. Outcomes measurements include the assessment of functional fitness, balance, wellbeing, and sedentary behaviour. A process evaluation will identify best practice and lead to the production of a tool-kit.

Findings: Of the 39 settings receiving Mobile Me to April 2017, 70% are continuing the sport; sessions are mostly being run by residents. One care provider has rolled Mobile Me out to its 35 homes in Norfolk, purchasing equipment and training staff. Interim results suggest a reduction in self-reported sedentary behaviour, along with an improvement in self-reported health scores when using the EQ-5D health questionnaire. Feedback from participants and other stakeholders indicate that Mobile Me is valued for its social aspects, and because it highly inclusive in a group that experiences high levels of ill-health, frailty and disability.

External funding details: Funded through Sport England

Effect of a combined physical activity and fall prevention intervention on older adults’ physical activity levels and mobility-related goals: randomised controlled trial

Juliana Oliveira, Catherine Sherrington, Serene S Paul, Elizabeth Ramsay, Kirkham Catherine, Kathryn Chamberlain, Sandra O’Rourke, Leanne Hasset, Tiedemann Anne, University of Sydney

Introduction: We investigated the impact of a combined physical activity and fall prevention intervention on physical activity and mobility-related goal attainment among people 60+.

Methods: 131 community-dwellers aged 60+ years were randomly assigned to control (n = 67; advice brochure) or intervention groups (n = 64; one physiotherapist visit, 6 months of phone coaching, pedometer, tailored falls prevention advice, brochure). Primary outcomes were objectively measured physical activity (PA) and mobility-related goal attainment at six and 12 months. Secondary outcomes were other PA measures, falls, quality of life, fear of falling, mood, and mobility.

Results: We found no significant between-group difference in physical activity counts at 6 months (mean difference = 12.8 counts per minute (CPM), 95%CI -98.3 to 123.9, p = 0.82) or 12 months (55.6 CPM, 95%CI -13.8 to 125.0, p = 0.12). A greater proportion of people in the intervention compared to control who were not meeting PA guidelines (150 mins/week moderate to vigorous PA) at baseline met guidelines at 6 months (OR 4.0, 95% CI 0.78 to 20.2, p = 0.09) and there was a trend towards greater number of steps/day in intervention group at 6 months (468 steps/day, 95%CI –330 to 1265, p = 0.25); but not at 12 months. The intervention group achieved better mobility goal attainment at 6 months compared to controls (OR 1.97, 95% CI 1.06 to 3.68, p = 0.03). We found no significant between-group differences in the secondary outcomes at six or 12 months.

Conclusion: Our combined physical activity and fall prevention intervention was associated with higher goal attainment and greater physical activity guideline adherence.

Increasing participation in organised physical activity by socially disadvantaged older people

Tracy Nau¹, Genevieve Nolan², Ben J Smith¹

¹School of Public Health & Preventive Medicine, Monash University, ²MOVE Muscle, Bone & Joint Health, Victoria

Introduction: Organised physical activity (PA) conducted in groups and at community facilities provides participation opportunities for older people, and offers social connection as well as disease prevention and functional benefits. Despite this, participation in organised PA is low among older adults in Australia and other nations, especially among those who are socioeconomically disadvantaged, have a disability, or come from culturally and linguistically diverse backgrounds. This study aimed to identify methods of promoting, designing and implementing organised PA programs to improve engagement by socially disadvantaged and underrepresented older people.

Methods: Semi-structured interviews were conducted with 30 community service and PA program providers, and 5 focus groups with 42 older participants in existing PA groups, in Melbourne, Australia. Data were analysed thematically and the PRECEDE-PROCEED framework was used to categorise findings.

Results: Helpful strategies for addressing predisposing factors such as social anxiety and lack of confidence, included user-centred program design and sensitive, informative messaging and promotion. Key enabling strategies were transport assistance and minimising fees. Facilitating gentle entry to groups and fostering inclusion and safety were identified as valuable reinforcing strategies. Providers regarded organisational networks as beneficial for facilitating referral and addressing resource constraints.

Conclusion: A multifactorial approach addressing a range of predisposing, reinforcing and enabling factors is likely to be necessary to enhance engagement in organised PA by socially disadvantaged and underrepresented older people. Key factors relate to creating a positive sociocultural environment, identifying activities of interest, and enhancing ease of access.

External funding details: Victorian Government Department of Health and Human Services

Exercise against dementia: Development, implementation and evaluation of a physical activity intervention for people with dementia

Doris Gebhard, Christina Schmid,, Carinthia University of Applied Sciences

Exercise is a promising tool to counteract the progression of dementia. Nevertheless there are research gaps concerning the ideal design of physical activity interventions for people with dementia, especially in regards to long-term care facilities. Therefore the aim of this study was to develop, realize and evaluate a feasible and health enhancing physical activity intervention for people with dementia living in care homes.

The exercise program was developed on the basis of a method triangulation of three elements: systematic review, interviews with people with dementia and participation workshops with care personnel. The developed multi-component exercise program takes place one hour twice a week with the overall duration of 12 weeks and was piloted in five care homes. In course of a randomized and controlled study design the target parameters mobility, assessed by the Short Physical Performance Battery (SPPB) and the Timed Up and Go Test (TUG), activities of daily living, assessed by Bayer ADL-Scale (B-ADL) and quality of life, assessed by QUALIDEM, were investigated.

In all, 63 individuals with a mean age of 86.21 years participated on the trial. The drop-out rate was 18.87% and the attendance rate was 80.46%. The intervention group shows significant improvements at SPPB (t₀:3.15 vs. t₁:4.50; p = .002), TUG (sec) (t₀:34.12 vs. t₁:31.96; p = .040) and B-ADL (t₀:6.37 vs. t₁:5.02; p = .012). The between groups and time comparison shows significant improvements at SPPB (p = .006).

The participatory approach facilitates the development of an evidence based, feasible and sustainable exercise program that shows health enhancing effects.

External funding details: Fonds Gesundes Österreich

Physical activity levels in adults and older adults 3-4 years after pedometer-based walking interventions:- long-term follow-up of participants from two randomised controlled trials in UK primary care

Tess Harris¹, Sally Kerry², Elizabeth Limb¹, Cheryl Furness¹, Charlotte Wahlich¹, Christina Victor³, Steve Iliffe⁴, Peter Whincup¹, Michael Ussher¹, Ulf Ekelund⁵, Julia Fox-Rushby⁶, Judith Ibison¹, Stephen DeWilde¹, Cathy Mckay¹, Derek Cook¹

¹St George’s University of London, ²Queen Mary’s University of London, ³Brunel, University of London, ⁴University College, London, ⁵Norwegian School of Sports Sciences, ⁶Kings College, University of London

Background: Interventions can increase short-term physical activity (PA), but health benefits require maintenance. Few interventions have evaluated long-term PA objectively. We followed up two pedometer interventions with positive 12-month effects, to examine objective PA levels at 3-4 years.

Methods: Long-term follow-up of 2 trials: PACE-UP (45-75 years) 3-arm (postal, nurse-support, control) at 3 years; PACE-Lift (60-75 years) 2-arm (nurse-support, control) at 4 years post-baseline. Randomly selected patients from 10 UK primary care practices were recruited. Interventions were 12-week walking programmes (pedometer, handbooks, PA diaries) postally (PACE-UP) or with nurse-support (PACE-UP, PACE-Lift). Main outcomes were changes in 7-day accelerometer average daily step-counts and weekly time in moderate-to-vigorous PA (MVPA) in ≥10 minute bouts in intervention versus control groups, between baseline and 3 years (PACE-UP) and 4 years (PACE-Lift).

Results: PACE-UP 3-year follow up was 67% (681/1023), PACE-Lift 4-year was 76% (225/298). PACE-UP 3-year intervention versus control comparisons were: additional steps/day postal +627 (95% CI 198-1056) p = 0.004, nurse +670 (95% CI 237-1102) p = 0.002; total weekly MVPA in bouts (minutes/week) postal +28 (95% CI 7-49) p = 0.009, nurse +24 (95% CI 3-45) p = 0.03. PACE-Lift 4-year comparisons were: +407 (95% CI -177 to 992) p = 0.17 steps/day; and +32 (95% CI 5-60) p=0.02 minutes/week MVPA in bouts. Results were robust to missing data sensitivity analyses.

Conclusion: Previously reported 12-month trial effects on PA levels persisted at 3-4 years. Pedometer interventions, delivered by post or with nurse support, can help address the public health physical inactivity challenge.

External funding details: NIHR(PACE-UP trial HTA Programme, CLAHRC SL, PACE-Lift trial RfPB programme).

Implementing strength and balance exercise programmes for the prevention of falls in older people: Instructors’ experiences of delivering evidence-based exercise.

Helen Hawley-Hague¹, Dawn Skelton², Chris Todd¹

¹University of Manchester, ²Glasgow Caledonian University

Introduction: Encouraging older adults who have experienced a fall to maintain exercise after rehabilitation is difficult. Health authorities claim to provide FaME (evidence-based strength and balance programme), but modification of the programme is common and patients do not receive interventions following the evidence-base in terms of content/length of programme. Exploring instructors’ experiences of delivery gives important information for designing effective exercise programmes.

Methods: 40 instructors were purposively sampled from 247 instructors who responded to a questionnaire on FaME delivery. Semi-structured telephone interviews with 23 instructors.

Results: When asked about delivery of the FaME programme, instructors said that they tried to deliver the programme as trained. They suggested that where the protocol is not adhered to it is due to Trust protocols, lack of adequate staffing or insufficient time/space. Instructors argued that delivering the evidence base gave them confidence, they felt that this then gave participants confidence, improved outcomes and improved adherence rates. Well-developed referral systems were perceived as important to success/maintenance of exercise and communication and good working relationships were essential to this. Opportunity to stay with the same instructor, in the same group was important to adherence because of increased participant confidence and established social bonds.

Conclusions: There are a variety of different models of delivery across the UK, but communication and good relationships are essential to long-term adherence to exercise.

External funding details: Funded through MRC Centenary Award, Faculty of Biology, Medicine and Health, University of Manchester.

Session: Physical Activity Interventions for Adults

‘Touchpoints’ in engaging the less active in a sport program

Erica Randle, Matthew Nicholson, Emma Seal, Kiera Staley, La Trobe University

Introduction: The decline of traditional sport participation in Australia has prompted sport organisations to expand their sport offerings to include modified programs or entry-level opportunities targeted at the less active and/or individuals who are disengaged from sport. This study sought to identify the key ‘touchpoints’ where a less active and/or sport disengaged participant engages or disengages from a program or sport offering. This information could be used to improve program design and deliverer training on how to best engage and retain the less active/disengaged cohort.

Method: Semi-structured interviews (306) were conducted with program facilitators and less active and/or sport disengaged participants across various settings (schools; community sport clubs; modified social offerings; and free public programs) and targeted cohorts (youth; parents; female only; participants retired from sport; and social modified sport participants). Additional focus groups (N = 60) were conducted with 566 secondary schools students who were disengaged from sport.

Results: Touchpoints included ‘marketing messages’; ‘registration’; ‘welcome’; realising others in the group are ‘just like me’; the ‘first mistake’; ‘modifying activities’; the ‘first achievement’, and the ‘invitation back’. The ‘deliverer’ was found to be the key component to engaging the less active and/or sport disengaged into sport and/or physical activity. They were influential in creating the social cohesion of the cohort and the outcome of the key touchpoints identified.

Conclusion: Sport programs and opportunities targeting the less active and/or sport disengaged cohort should consider these touchpoints in their program design and deliverer recruitment and training.

External funding details: VicHealth, Hockey Victoria and the Australian Sports Commission

Gamification and physical activity: What’s the ‘active’ ingredient?

Marc Harris, Intelligent Health

Introduction: In recent years, population level approaches which incorporate gamification components to increase physical activity have grown in popularity. However, little is known about the precise mechanisms essential for successful and unsuccessful implementation, engagement and behaviour change. This study aimed to investigate the motivations to participation in a community-wide gamification-based physical activity intervention called ‘Beat the Street’.

Methods: Beat the Street turns a city into a game where residents register their walking and cycling journeys by tapping a smartcard on RFID readers called ‘Beat Boxes’ placed on lampposts at half-mile intervals throughout the local area. Players compete to see which schools, community groups and individuals can tap the most boxes, or achieve the most points throughout the 6-week game phase. Following Beat the Street in Wolverhampton 2017 which engaged N = 25,790 people, 4 focus groups were conducted with N = 26 players who became active, or more active following the intervention.

Results: Contrary to expectations, the findings of the study indicated that extrinsic motivations (points and prizes) were not a prominent motivation for participation. Key motives for engagement were: purpose seeking, which involved having a break from modern stressors and technology; social influence, taking part in an activity with shared common goals with family, friends and/or colleagues; and exploration, which involved discovering the local area, finding new routes and greenspaces and orienteering to ‘collect’ ‘Beat Boxes’

Conclusion: The findings of the study provide useful insight into the motives which engage typically hard-to-reach individuals into physical activity interventions.

Effectiveness of a text message intervention to improve whole-of-day activity in cancer survivors participating in clinical exercise rehabilitation: a randomised controlled trial

Sjaan Gomersall¹, Tina Skinner², Elisabeth Winkler³, Genevieve Healy³, Elizabeth Eakin³, Brianna Fjeldsoe³

¹The University of Queensland, ²School of Human Movement and Nutrition Sciences, The University of Queensland, ³School of Public Health, The University of Queensland

Introduction: While physical activity intervention is often delivered to cancer survivors via supervised clinical rehabilitation, motivating and maintaining activity changes outside of the clinic setting remains challenging. This study investigated the effect of an individually tailored text-messaging intervention that focused on increasing whole-of-day activity both during and beyond a 4-week, supervised exercise clinic for cancer survivors.

Methods: Participants (n = 36; mean ± SD age 64.8 ± 9.6 years; 44.1 ± 30.8 months since treatment) were randomized 1:1 to receive the standard ‘clinic’ or enhanced ‘clinic+’. Time (min/16-h awake day) spent sitting, standing, and stepping at a light- and moderate-vigorous intensity were assessed using activPAL3. Time use domains were assessed using the Multimedia Activity Recall for Children and Adults (min/day). Clinic days were excluded. Changes and intervention effects were evaluated using linear mixed models, adjusting for baseline values and potential confounders.

Results: Over the first four weeks, no significant (p < 0.05) intervention effects were seen though ‘Physical Activity’ (‘clinic+’) increased and ‘Social Activity’ decreased (‘clinic’) significantly within-groups. By 12 weeks, relative to ‘clinic’ patients, ‘clinic+’ patients sat less (-48 min [95% CI: -90, -6]), did more light-intensity stepping (+7 min [+0, +14]), tended to stand more (+42 min [-4, +88]) and did similar moderate-vigorous stepping (-2 min [-14, 9]). Only Quiet Time (-63 min [-111, -16]) and Screen Time (-62 min [-110, -14]) differed significantly between groups.

Conclusion: Out-of-clinic activity was largely maintained during the supervised clinic period. Afterwards, tailored text messaging resulted in the replacement of sitting with light stepping, predominantly via reducing Quiet Time and Screen Time.

Changes in workplace car parking and commute mode: a natural experimental study

Oliver Mytton, Jenna Panter, David Ogilvie, University of Cambridge

Car use places a considerable burden on public health, increasing physical inactivity and contributing to air pollution and injuries. We used a quasi-experimental design to assess whether changes in workplace car parking policies were associated with changes in travel behaviour. We used cohort data from the Commuting and Health in Cambridge study (2009-2012; n = 910 participants; n = 1,773 transition periods). Commute mode and workplace parking policy at each time point were self-reported. Using generalised estimating equations we examined the associations between changes in parking policy and the proportion of commuting trips that were exclusively made by car, involved any walking or cycling, and involved any public transport. 247% of trips were made exclusively by car, 535% involved any walking or cycling and 114% involved public transport. Shifts to less restrictive workplace parking policies were associated with a decrease in active commuting. Those participants who reported changes from no parking at work to free or paid parking reported higher proportions of trips exclusively by motor vehicle (11·4%, 95% CI: 6.4, 16.3) and lower proportions involving walking or cycling (-13·3%, 95% CI: -20·2, -6·4) and public transport (-5·8%, 95% CI: -10·6, -0·9), compared to those who had no workplace car parking. More restrictive workplace parking policies were associated with small increases in active commuting that were not significant. Parking policies that incentivise car use may exacerbate existing public health problems. Though modest, differences in travel patterns following changes in parking policy, may have a sizeable impact at the population-level.

External funding details: MRC & Wellcome Trust

The new Purple Line light rail within the Washington, D.C. metropolitan area: A protocol for a natural experiment study examining changes in transit behaviors and perception

Jennifer Roberts¹, Ming Hu², Brit Saksvig¹, Micah Brachman³, Casey Durand⁴

¹University of Maryland, School of Public Health, ²University of Maryland, School of Architecture, Planning & Preservation, ³University of Maryland, Center for Geospatial Information Science, ⁴University of Texas Health Sciences Center, School of Public Health

Introduction: Utilizing an expansion of the Washington D.C. area transportation system with a new light rail line, the Purple Line Outcomes on Transportation (PLOT) Study will exam pre- and post-Purple Line public transportation (PT) use, active transportation (AT) behaviors and attitudes and physical activity (PA) among Prince George’s County adults and youth. The PLOT Study will also examine how contextual effects (e.g., neighborhood built environment; sense of community) impact PT, AT and PA.

Methods: PLOT, a quasi-experimental longitudinal pre-post study, will use an exploratory sequential mixed-methodology design. Qualitative phase I focus groups, as well as quantitative phase II questionnaire, accelerometry, and travel diary data will be collected to evaluate PT use, AT behaviors and attitudes and PA from Prince George’s County adults and youth (12-17 years) residing in the forthcoming Purple Line environment. Through focus groups, participants will share their perspectives on the forthcoming Purple Line; their current neighborhood built environment; and their “sense of community”. Overall, the PLOT Study will involve four cycles of data collection ((1) pre-Purple Line baseline; (2) 12 months post-Purple Line; (3) 24 months post-Purple Line; (4) 36 months post-Purple Line).

Discussion: A unique quality of PLOT is the diversity of the Prince George’s County Study population. The study will take advantage of this natural experiment in an area enduring significant racial/ethnic and gender based overweight or obesity and physical inactivity disparities to measure the impact of a transportation infrastructure change on PT use, AT behaviors and attitudes and PA among adults and youth.

To Bergen on a Bike: Using big sport events as a platform for improving public health

Hanne Beate Sundfłr, Aslak Fyhri, Institute of Transport Economics

Introduction: Increasing cycling as a mode of transport is a political goal in Norway, as in many countries, due to the potential for increased overall physical activity and reduced sedentarism. In 2017, Bergen were host city for The UCI Road World Championships. An important aim for the local organizers were to use the event to inspire the general population for increased activity. A gamification-based activity app was developed. The present study assesses the effect of the app on physical activity.

Methods: Through a quasi-experimental design data is collected about the group that downloaded (and used) the app (N = 209) before and after the intervention and compared with data collected from another group (control) in the same period (N = 203). We explore the potential change in amount of physical activity and everyday transport.

Results: The survey results indicate a higher increase in cycling kilometers in the app user group (frequently used), compared to those who downloaded the app, but didn’t use it. However, the change is not significantly different from the control group. Results from the app data will be presented at the conference, exploring the number of active users and distance generated in the app.

Conclusion: The results indicate an increase in cycling activity among the app users, but due to a low number of participants there is not enough data to state that the difference was a result of the intervention. Based on the results we provide suggestions for improvement of the program.

External funding details: The study is funded by Bergen 2017 AS.

Systematic review of the methods used in economic evaluations of individual-level physical activity and sedentary behaviour interventions

Madeleine Cochrane¹, Lee Graves¹, Paula Watson¹, Hannah Timpson¹, Alan Haycox², Brendan Collins², Lisa Jones¹, Antony Martin³

¹Liverpool John Moores University, ²University of Liverpool, ³HCD Economics; University of Liverpool

Introduction: There is an absence of economic evidence in the field of public health to inform decisions in allocating scarce resources.

Methods: A systematic review was conducted to review the methods used in economic evaluations of individual-level physical activity and/or sedentary behaviour interventions.

Results: Ten trial-based and five model-based economic evaluations met the inclusion criteria. All studies assessed the cost-effectiveness of interventions aiming to increase moderate-intensity physical activity; no studies assessed the cost-effectiveness of changing sitting or standing time, or light-intensity physical activity. Overall the quality of the studies was good. Strengths of the studies included the finding that most studies derived their effectiveness estimate from a randomised-controlled trial or meta-analysis, and that all five model studies took a lifetime horizon. Nevertheless, a third of studies did not relate costs and consequences to an appropriate study perspective. Techniques were limited to cost-utility and/or cost-effectiveness analyses; and no studies conducted a cost-benefit analysis. Two model studies conducted a cost-consequence analysis alongside their full economic evaluation. Equity was explored explicitly in one study, while for the remaining studies it was ignored or incorporated implicitly through subgroup analyses.

Conclusions: The findings highlight a lack of development in the methods for incorporating broader costs and consequences, and equity is rarely considered in economic evaluations of individual-level physical activity interventions. Furthermore, the review identified a lack of economic evaluations extrapolating their findings beyond the trial period, and a lack of studies assessing the cost-effectiveness of individual-level sedentary behaviour interventions.

Session: Physical Activity Measurement Among Children

Is after-school sport participation essential for meeting physical activity recommendations in children?

Kerli Mooses, Merike Kull, University of Tartu

The low levels of physical activity (PA) of children is a concern in most developed countries. Participation in organised sport (OS) has been identified as one factor helping the children to meet the PA recommendations – 60 minutes of moderate-to-vigorous physical activity (MVPA) every day.

The PA of children aged 6-13 years was measured with Actigraph GT3x for one week. The inclusion criteria were a minimum of 10 hours of PA data per day with a minimum of five days. The details about sport participation was collected with diary. Evenson cut-point were used to calculate time spent in MVPA.

Out of 492 children measured, 28.0% of all students met the PA recommendations at least on 5 days, while 27.6% met the recommendation on one or none of the days. 52.4% of students participated in OS at least once a week and 33.3% of students not meeting the PA recommendations on any of the day, participated in OS at least once a week. Participation in OS increased 1.65 times (p = 0.019) the odds of meeting the PA recommendations at least on five days when controlled for gender and school stage. Each additional day with sport participation increased the amount of weekly average MVPA by 4.1 minutes (p < 0.000). On average, 23.34 ± 15.3 minutes of MVPA was acquired during trainings, which is 30.3% of training time and 38.9 ± 25.4% of daily recommendation.

Although participation in OS increases the odds of meeting the PA recommendations, PA should be supported also in other day segments.

Lessons from the establishment of routine, low cost and high participatory childhood obesity and risk factor (physical inactivity, sedentary behaviour, poor diet quality, sleep insufficiency) monitoring in regional Victoria, Australia

Claudia Strugnell¹, Nic Crooks¹, Colin Bell¹, Janette Lowe², Craig Chadwick³, Steven Allender⁴

¹Deakin University, ²Southern Grampians Glenelg Primary Care Partnership, ³Goulburn Valley Primary Care Partnership, ⁴Deakin University

Introduction: Collecting routine health data from school children is imperative for examining population trends, identifying at-risk populations, optimizing resource allocation, evaluating interventions and providing evidence for policy. However, few countries have successfully implemented such systems. We present lessons (implementation and ethical considerations, cost of delivery, and results dissemination) from the establishment of two childhood obesity and risk factor monitoring systems in the Great South Coast (GSC) and Goulburn Valley (GV) regions of Victoria, Australia.

Methods: All primary schools in designated local government areas (LGAs) were invited to participate (6 LGAs GSC, 3 LGAs GV) and in each school, Year 2, 4 and 6 students were invited using opt-out (passive) consent. Since 2015, we have collected height and weight data from 6,422 children in 142 Victorian primary schools. Older children also completed self-report behavioural questionnaires and a sub-sample wore accelerometers for 7-days.

Results: We learned quality data can be collected efficiently using a mix of paid researcher time and in-kind capacity from health promotion and council workers. Student response rates were >= 79% and school response rates were >=60% and no complaints regarding the study were raised with the researchers’ or Ethics Committee allaying concerns about opt-out consent. Cost was low but depended on rurality of schools and level of in-kind capacity ($ estimates to be presented). Electronic data collection enabled dissemination of results to schools and community partners within 12-weeks post data-collection.

Conclusion: A low cost childhood obesity monitoring system achieved high participation rates and rapid dissemination.

Boys and more active children are more active during preschool hours than out-of-care, compared to girls and less active children

Ada Kristine Ofrim Nilsen¹, Einar Ylvisaaker¹, Kjersti Johannessen¹, Sigmund Alfred Anderssen², Eivind Aadland¹

¹Western Norway University of Applied Sciences, ²Norwegian School of Sport Sciences

Background: Some studies suggest children accumulate less physical activity (PA) during preschool hours compared to time out-of-care. However, this difference may depend on context and culture, which might also influence how specific groups accrue their PA levels. Therefore, the aim of this study is to investigate in-care and out-of-care PA in a large sample of Norwegian preschool children, and explore differences in PA by sex and PA levels.

Method: In this cross sectional study, 1308 Norwegian preschool children (52% boys) aged 2-6 yrs wore an accelerometer (ActiGraph, GT3X+) for 14 consecutive days during 2015-2016. 1050 children had valid PA across settings (in-care and out-of-care), and were included in the analysis. Levels of MVPA (Evenson cut points:>2296 cpm) were compared between preschool hours and time out-of-care using a linear mixed model including the interactions sex*setting and MVPA quartiles*setting.

Results: Children accumulated 43 and 35 min/day of MVPA during preschool hours and out-of-care, respectively. Both boys and girls accumulated more MVPA during preschool hours compared to time out-of-care (p < 0.001), and boys had higher levels of MVPA compared to girls in both settings (p < 0.001). Girls had relatively less MVPA during preschool hours compared to boys (-3.3 min, p < 0.001), and the less active children had relatively less MVPA during preschool hours than more active children (Q1 vs. Q4: -5.6 min, p < 0.001).

Conclusion: Norwegian preschoolers accumulate more MVPA during preschool hours compared to time out-of-care, but the preschool seem to restrict girls and less active children’s activity levels.

External funding details: Sogn og Fjordane County Council

Do EMG and acceleration responses differ from heart rate responses to standing, ball games, exergames, agility activities and jumping activities in 7-12 year old children?

Arto Pesola¹, Martti Melin², Anssi Vanhala², Ying Gao², Taija Finni²

¹South-Eastern Finland University of Applied Sciences, ²University of Jyväskylä

Introduction: In addition to increasing energy expenditure, physical activity induces also neuromuscular responses, which are not necessarily reflected by measuring energy expenditure. This study compared metabolic and neuromuscular responses to various physical activities in SuperPark activity park.

Methods: The subjects were 16 children who were sitting, standing, walking, jogging, shooting ice hockey, hitting and catching & throwing baseball, playing floorball, playing a football and parkour exergame, performing an agility track, scooting, jumping on a bouncy mattress and a trampoline in a randomized order for 3 min with 2 min breaks. Heart rate above sitting (HR), acceleration counts (ACC; waist-worn sensor) and EMG amplitude (EMG; EMG shorts) were analyzed as the last minute average and normalized to walking. Using HR as a reference method, a distance (d; least squares fit) of ACC (HR-ACC) and EMG (HR-EMG) from a perfect correlation (r = 1, d = 0) were calculated for each individual and activity and compared to those of jogging with paired samples t-test. Direction (+/-) of d from r = 1 was checked visually.

Results: Average d of jogging HR-ACC and jogging HR-EMG from r = 1 were +76,7 ± 89,5 and -65,4 ± 42,7, respectively. Trampoline HR-ACC (+200,7 ± 172,3) differed from jogging HR-ACC (P < 0,01). Standing (-24,2 ± 18,9; P < 0,01) and trampoline (-100,3 ± 72,7; P < 0,05) HR-EMG differed from jogging HR-EMG.

Conclusion: As compared to jogging, ACC responds more to trampoline jumping than HR and EMG responds more to standing and less to trampoline jumping than HR. Different methods can reveal different metabolic and neuromuscular responses to physical activity types.

External funding details: AJP received funding for activity measurements from SuperPark Inc.

Meeting Australian 24-Hour Movement Guidelines for the Early Years: associations with adiposity, fundamental movement skills and health-related quality of life

Katherine Downing, Jill Hnatiuk, Lisa Barnett, David Crawford, Jo Salmon, Kylie Hesketh, Deakin University

Purpose: This study assessed associations between meeting 24-Hour Movement Guidelines at ages 3 mo, 9 mo, 18 mo, 3.5 y and 5 y and adiposity, fundamental movement skills (FMS) and health-related quality of life (HRQoL) at age 5 y.

Methods: Data were from the Melbourne InFANT Program. Physical activity (PA) guideline compliance was determined using parent-reported tummy time at 3 mo and accelerometry at 18 mo, 3.5 y, and 5 y. Sedentary behaviour (SB) and sleep guideline compliance were determined using parent-reported screen time and sleep. At 5 y, body mass index z-scores (zBMI) and FMS (object control and locomotor; Test of Gross Motor Development-2) were assessed; physical and psychosocial HRQoL were parent-reported (Pediatric Quality of Life Inventory). Linear regression models adjusted for clustering, intervention effect, child sex and age.

Results: Compliance with the PA guideline at 3 mo and 5 y was associated with higher physical HRQoL (β = 32.7 [p = 0.013] and β = 56.5 [p = 0.05], respectively). Meeting the SB guideline at 9 mo predicted higher physical HRQoL (β = 29.8 [p = 0.033]) and at 18 mo, 3.5 y and 5 y was associated with lower object control skills (β = −2.3 [p = 0.004], β = −1.7 [p = 0.026], and β = −2.5 [p = 0.006], respectively). Compliance at 3 mo with the sleep guideline predicted higher zBMI (β = 0.3 [p = 0.007]), at 18 mo predicted lower physical and total HRQoL (β = −33.1 [p = 0.005] and β = −72.9 [p = 0.018], respectively), and at 5 y was associated with lower zBMI (β = −0.3 [p = 0.045]).

Conclusion: PA and SB may be important for physical HRQoL; however, FMS appear to need targeted opportunities. Further prospective studies are required to elucidate health outcomes of guideline compliance.

External funding details: Australian National Health and Medical Research Council (425801 & 1008879).

Physical activity data on Australian kids: What’s out there? What’s not?

Verity Booth¹, Natasha Schranz¹, Grant Tomkinson², David Lubans³

¹University of South Australia, ²University of North Dakota, ³University of Newcastle

Introduction: Thousands of studies have collected data on Australian children’s physical activity (PA). However, many of these studies are now left dormant and underutilised. Difficulties also arise when attempting to make comparisons between different groups, geographical areas and time due to the methodological inconsistencies.

Methods: An audit of Australian PA research was conducted on youth aged 0-18 years focusing on overall PA participation, along with the specific domains of active transport, sport, school-based PA, and play, as well as sedentary behaviours. Online databases and grey literature were searched and a set of metadata was developed to assist with data extraction.

Results: The systematic search yielded 22,283 records, of which 1002 articles were screened at full-text. Along with a grey literature search, over 150 datasets were identified consisting of data from over 200,000 children. The coverage of these datasets spans 1971 till today, with the majority collected from 1998 onwards. Twelve was the most common age covered, with a noticeable gap for children aged five and under. A range of objective and subjective methodologies were employed, including hundreds of different questions.

Conclusion: Data on PA participation in Australian children are extensive but disproportionate, and suffer from inconsistencies due to the widely varying survey methods, questions and sampling frames. The ideal question would be comparable with a large volume of historical data, have established reliability and validity, and allow us to assess compliance with guidelines.

Has children’s physical activity declined over the last three decades? Well, that depends

Verity Booth¹, Alex Rowlands², James Dollman¹

¹University of South Australia, ²University of Leicester

Introduction: Only one fifth of Australian children meet the recommended guidelines for daily physical activity (PA), however it is unclear how participation has changed over time and in what PA contexts. This study investigated secular trends in children’s PA over 28 years (1985-2013), separately for active transport (AT), club and school sport, physical education (PE) and school break times.

Method: South Australians aged 10-15 years self-reported PA participation at three cross-sectional time points: 1985 (n = 408), 2004 (n = 446), and 2013 (n = 394). Consistent methodology, based on the 1985 ACHPER Schools Health and Fitness Survey, was used for self-reports of participation within discrete PA contexts. Linear mixed modelling was controlled for socioeconomic status and stratified by sex and age (10-12 y and 13-15 y).

Results: Among younger boys there was a decline in walking to school and lunchtime play, while among older boys declines in cycling for AT, school sport and lunchtime play were observed. Declines in both recess and lunchtime play were observed among younger girls, with no trends in other PA contexts. Among older girls there were declines in every PA context, except for walking to school which increased. Among both boys and girls, older and younger, most observed changes occurred between 2004 and 2013.

Conclusions: There was evidence of relatively recent declines in PA in particular contexts, differentiated by age and sex. Older girls were the subgroup of most concern, with declines in PA participation in almost all contexts.

Session: Research Progress and Future Directions

Road blocks to progress in physical activity research in the last decade

Adrian Bauman¹, Adrian Bauman¹, Wendy Brown², Lars Bo Anderson³

¹Sydney University, ²University of Queensland, ³University of Western Norway

This presentation will consider roadblocks and lack of progress in physical activity in the last decade, focussing on several domains of physical activity. The presentation will begin by demonstrating trends in population levels of physical activity from countries around the world that have used consistent measures over time. These trends appear to indicate limited progress in physical activity behaviour change. Despite increased interest, advocacy efforts and a multitude of research publications, even active travel behaviours have not improved in many countries. The second part of this presentation will critically consider how an over-emphasis on ‘efficacy’ trials and systematic reviews has (1) failed to increase the proportion of interventions that are scaled up to the population level, and (2) resulted in limited policy-relevant information for decision makers on how to increase physical activity in populations.

Occupational physical activity: The evidence

Harold W. Kohl¹, Willem van Mechelen², Wendy Brown³

¹University of Texas Health Science Center at Houston, ²VU Medical Center, ³University of Queensland

The aim of this presentation is to identify large scale shifts in occupational physical activity in recent years and to highlight the challenges of researching this domain of physical activity. The presenter will show that there has been little progress in understanding and demonstrating the health effects of occupational physical activity, and the physiological mechanisms underlying these, probably because there are now so few jobs that require physical work. The potential of occupational physical activity interventions to achieve health benefits has also been limited, as research, practitioner and policy efforts have focussed on the emerging area of sedentary behaviour research, which has become a highly contested area of behavioural epidemiology. As a result, the health effects of different contemporary patterns of occupational physical activity, including part-time flexible work practices and shift work, remain poorly understood.

External funding details: Partially supported by the US National Institutes of Health

Understanding and changing determinants to get people moving more

Wendy J Brown¹, Lars Bo Andersen²

¹University of Queensland, ²Western Norway University of Applied Sciences

The aim of this presentation is to critically examine progress in our understanding of the determinants of physical activity behaviour change, and how we have used this understanding to inform intervention studies in adults. Selected examples of interventions in the health care and community settings will be used to illustrate how commonly used behaviour change models, frameworks and constructs have (or have not) provided insights into critical components of behaviour change. Some of our research with adults suggests that ‘strong’ determinants (such as self-efficacy) actually decline during interventions, while perceived barriers increase once people try to increase their activity levels. Recent research with adults suggests that outcome expectations, social support and access are critical, especially at life stages when competing family commitments appear to override other individual and physical environmental factors, which are often assumed to play a significant role in changing physical activity behaviour. Large scale interventions that positively impact on determinants as well as behaviour are required if we are to counter the trend of declining physical activity in young adults.

Worksite interventions to promote physical activity

Willem van Mechelen, VU University Medical Center

The worksite is a place where we are dealing with a captive audience, potentially providing an ideal venue for physical activity promotion. The aim of this presentation is to briefly outline some of workplace physical activity interventions we have designed, implemented and evaluated (using best practice intervention mapping and behaviour change theory) in the last 20 years. These include interventions with blue- and white-collar employees, as well as managers in various types of companies in the building, service, health care, banking and business sectors. The aim is to show how far we have progressed along the road to health through physical activity, using the workplace as a setting for interventions. Important progress in understanding the cost-effectiveness of worksite health interventions will be illustrated, taking into account the differential role of contextual socio-economic systems on cost-effectiveness outcomes.

The studies that will be presented have received funding from various sources, including Body@Work TNO/VUmc, Delta Lloyd, ZonMW, Dutch Heart Foundation and Stichting Arbouw.

Active travel: moving populations along the road to health

Lars Bo Andersen, Western Norway University of Applied Sciences

The aim of this presentation is to outline progress made in the field of transport-related physical activity in Denmark, using examples of whole community inter-sectoral strategies which have resulted in more active transport. There has been significant progress in research into the behavioural epidemiology of cycling, with studies indicating positive trends in active transport in cities which have invested in improvement in infrastructure for cycling and safety. Recent analyses will be used to show how data can counter common arguments against active transport, with substantially lower mortality rates and lower rates of type 2 diabetes, cancers and cardiovascular disease in cyclists (and to some extent walkers) than in passive travellers. Although many people (including politicians and traffic researchers) perceive cycling to be dangerous, a significant breakthrough in this field is that increased cycling is not followed by increased cycle-related injuries, resulting in a net gain in population health from increased active transport. In Denmark, cycling prevented more than 6000 deaths in 2015, while 26 cyclists were killed in the traffic that year.

Session: Understanding Inequalities in Physical Activity and Health

Building activity-promoting environments that support health across the lifecourse through global citizen science research

Abby King¹, Ann Banchoff¹, Sandra Winter¹, Jenna Hua¹, Olga Lucia Sarmiento Dueáas², Ayelet Dagan³, Nicolas Aguilar-Farias⁴, Afroditi Stathi⁵

¹Stanford University School of Medicine, ²Universidad de Los Andes, ³JDC Israel Eshel, ⁴University de La Frontera, ⁵University of Birmingham

Introduction: Residents represent an under-utilized change agent for promoting activity-friendly local environments, particularly in under-resourced communities and among older populations. We describe both the active aging activities and process evaluation of a global research network, called Our Voice, which systematically engages residents as citizen scientists in enacting local healthy environment changes.

Method: Researchers from 14 countries (6 continents) contributed to the empirically-driven citizen science approach where residents, regardless of circumstances, learn to use a simple, geo-tagged mobile app to identify barriers to physical activity (PA), build consensus around priority issues, and galvanize pragmatic changes with local decision-makers.

Results: Network-based aging adult target areas include converting underutilized public spaces for recreation among low-income seniors (Taiwan); promoting multi-aged resident engagement in evaluations of open streets and park use (Colombia); developing safe walking routes for older adults (Israel); and examining the role of the built environment in facilitating or impeding older adults’ PA (Chile and UK). While, overall, Network member ratings were generally strong for research team readiness for and local stakeholder and resident receptivity to citizen science engagement (means = 9.4, 7.2, and 8.1 out of 10, respectively), Network member self-efficacy (SE) ratings for completing a 1-yr citizen science project were more variable (mean = 5.7 out of 10, range = 1-10). Successful sites were able to identify the reasonably small amount of resources typically needed to support a part-time community-engaged coordinator.

Conclusion: The results support the acceptability and utility of citizen science activities that include aging adults from diverse cultures.

External funding details: Robert Wood Johnson Foundation grant#73344

Spatial patterns of park use by children in low-income and ethnically diverse communities

Claudia Alberico, Oriol Marquet, Elizabeth Mazak, Jing Huang, J. Aaron Hipp, Myron F. Floyd, North Carolina State University

Childhood obesity is a health challenge and those in low-income communities of color are at greatest risk. Physical activity promotion is an effective prevention strategy and parks are key settings for prevention. We aim to determine how children in low-income, ethnically diverse communities are moving within parks and how spaces contribute to MVPA during park visits.

Target population was children (5-10 year olds) in two US cities (Raleigh, NC and New York, NY). Three parks were selected per city according to population density by race/ethnicity (African American, Latino, and Asian). Children were fitted with accelerometer and GPS while in the park (1s epochs), for a minimum of 15 minutes, in spring and summer. Parents were surveyed about their decision to go to the park and facility preferences. Data collection was conducted in New York in 2017 (n = 260) and will be finalized in Raleigh by July 2018 (expected n = 300).

Over 15 hours of monitoring were registered (mean = 25 min/participant). Mean age for children was 7 years old (SD = 1.7), mostly female (49%) and Latino (41%). Over 68% of children made the decision to go to the park (n = 198). Spatial analyses will associate location of participants by type of target area (e.g., courts, playgrounds, water features,) and MVPA.

Spatial patterns in park use and MVPA may be associated with park features as well as individual characteristics of children (e.g., gender). Additionally, a child’s decision to visit a park versus a parent’s decision may also associate with MVPA.

External funding details: Funded by the Robert Wood Johnson Foundation

Barriers and facilitators of physical activity among Black and Minority Ethnic (BME) adults and older adults in the United Kingdom: A meta-ethnographic study

Janet Ige, Paul Pilkington, Selena Gray, Jane Powell, University of the West of England

Introduction: Older adults from BME groups experience a relatively higher burden of physical inactivity and other risk-factors. Despite the increasing number of qualitative studies investigating the barriers and facilitators of physical activity among older adults from BME backgrounds in the UK, there is very limited review level evidence. This review aims to undertake a synthesis using a meta-ethnographic approach, of existing studies that have explored the barriers and opportunities for physical activity among BME adults and older adults in the UK.

Method: Studies conducted between January 2007 and July 2017 were eligible If they met the following criteria: employed any qualitative method; Included participants identified as being BME, aged 50 and above, living within any UK community. In total, 1036 studies were identified from a structured search of six electronic databases combined with hand searching of reference bibliography from identified studies for grey literature. Of these, 10 studies met the inclusion criteria.

Result: Six key themes emerged from the data: awareness of the links between physical activity and health, interaction and engagement with health professionals, cultural expectations and social responsibilities, appropriate environment, religious fatalism and practical challenges. Findings also showed that the barriers and facilitators of physical activity exists at the individual, community and socio-economic, cultural and environmental level. There was a substantial gap in research among Black African groups.

Conclusion: Identifying the barriers and facilitators of physical activity among BME groups and acknowledging and addressing cultural issues is crucial if low levels of physical activity are to be addressed.

Inequalities in participation in community physical activity events: The case of the five Sheffield parkrun

Elizabeth Goyder¹, Daniel Lawrence², Alice Bullas², Callam Edmonds¹, Alec Sabey¹, Matthew Taylor¹, Sarah Potter¹

¹University of Sheffield, ²Sheffield Hallam University

Introduction: Community-based 5k running/walking events run by volunteers (“parkruns”) are a rapidly growing phenomenon with over 1200 people participating each week in Sheffield, over 100 000 across the UK. Individuals living in less affluent areas are known to be less likely to participate, suggesting that better understanding is needed of what makes events accessible to those from poorer neighbourhoods if there is to be a positive impact on inequalities in physical activity and associated wellbeing. This study explored differences in participation and factors that affect participation across the five Sheffield parkrun events.

Methods: We collected information from routine data sources, from the event websites and from social media and conducted structured observations at five events at different locations across the city. The findings were combined to identify similarities and differences between the different events which might explain significant differences in numbers and characteristics of participants across events.

Results: Index of multiple deprivation was a major predictor of attendance, with attendance varying from 584 (most affluent location) to 63 (most deprived location). Men outnumbered women (57% versus 43%) and ethnic diversity was low across all events. Significant differences in participant experience were observed between the larger and smaller events in terms of the competitive ethos, degree of anonymity, sense of community and social engagement.

Conclusion: Current efforts to increase access to opportunities for physical activity in deprived communities need to address ways to attract more participants whilst preserving the perceived benefits of smaller events that promote community ownership and engagement.

Insufficient physical activity and ageing: a longitudinal multilevel study of the influence of neighbourhood disadvantage, individual-level socioeconomic position, and health

Gavin Turrell¹, Nicola Burton², Billie Giles-Corti³, Jerome Rachele⁴, Nancy Pachana⁵, Wendy Brown⁵

¹Deakin University, ²Griffith University, ³RMIT University, ⁴The University of Melbourne, ⁵The University of Queensland

Introduction: Insufficient physical activity (IPA) is a threat to healthy ageing. Cross-sectional studies show that residents of disadvantaged neighbourhoods and individuals from low socioeconomic groups are more likely to be insufficiently active. At present, little is known about change in IPA as people age, or whether any changes are socioeconomically patterned, or moderated by health status: this study investigates these issues.

Methods: Data were collected from 11,035 participants in the HABITAT cohort (Brisbane, Australia) in 2007 (age 40-65), 2009, 2011, and 2013 (age 45-70). IPA was self-reported and defined as <150 minutes/week. Neighbourhood disadvantage was measured using a census-derived index, individual-level socioeconomic position was measured using education, occupation, and household income, and health was self-rated. Data were analysed using mixed-effects logistic regression.

Results: At baseline, 42% of respondents were classified as doing IPA; the probability increased significantly with age, most notably for older persons (60+ in 2007). The odds of IPA were significantly higher for those: with low education; in blue collar work; in low income households; and in disadvantaged neighbourhoods. Rates of age-related increases in IPA were highest for residents of disadvantaged neighbourhoods and those from low income households. Health status explained between 5% and 36% of the socioeconomic differences in the odds of doing IPA.

Conclusions: During mid- and older-age, the likelihood of doing IPA is greatest for low socioeconomic groups, in part due to their poorer health. Policies and interventions that prevent age-related increases in physical inactivity, especially among the socioeconomically disadvantaged, should be a priority.

Mugiment-gipuzkoa: Analysing equity policies in the field of sport at the local level.

Iñaki Iturrioz¹, Unai Asurmendi², Juan Aldaz³, Joseba Zalacain⁴, Arantza Mendieta⁴, Ibai Saavedra

¹Gipuzkoa’s Porvincial Sport Council, ²Gipuzkoa’s Provincial Sport Council, ³University of Basque Country, ⁴SIIS Documentation and Studies Center, ⁵Pasaia’sTown Council

Introduction: Participation in physical activities is linked to socioeconomic factors such as income and educational level, employment, age, gender or belonging to minorities. One of the goals of the Mugiment-Gipuzkoa program is to challenge the equity policies that are being applied in the area of sports by local entities.

Method: A state of the art review has been carried out related to “groups in situation of socioeconomic exclusion” following the definition of WHO, in the field of sports.

A baseline framework has been extracted and served as the basis for a fieldwork through which, by means of a structured interview to the profesionals in charge of the sports area of Gipuzkoa town councils of more than 2,000 inhabitants, a total of 44. The municipalities with fewer than 2,000 inhabitants have been recruited zonally in 4 discussion groups.

Results: The local sports sector has been provided with a framework to deal with main problems of inequity. A descriptive diagnosis has been made concerning equity policies that are being applied by municipalities on school sports, access to services and facilities, physical activity programs and regulations. As a result of collaboration between sectors, physical activity variables have been introduced in the Poverty and Social Inequalities Survey.

Conclusion: The development of a conceptual framework and a diagnosis of the situation on equity policies in the local sports sector helps to highlight inequity and places it on the agendas of policy makers.

The role of KidSport funding in supporting children’s participation in sport and physical activity in Nova Scotia, Canada

John C. Spence¹, Christa Costas-Bradstreet², Nick Holt¹

¹University of Alberta, ²CCB Consulting

Introduction: KidSport is a national not-for-profit organization that provides financial assistance (approx. $350 CDN) for registration fees and equipment to Canadian children aged 18 years and under living in low income so that they can participate in sport. However, little information is available on the effects of this program. The purpose of this study was to evaluate parents’ perspectives on the barriers and opportunities associated with receiving funding from KidSport.

Methods: Using a purposeful sampling strategy, 14 parents of families that had received KidSport funding were recruited in Nova Scotia, Canada. After providing consent, the parents participated in a 60-minute face-to-face semi-structured interview about barriers to participation, their children’s experiences in sport, and their thoughts on KidSport. The interviews were transcribed and subjected to a thematic analysis.

Results: The dominant theme around barriers was related to costs (e.g., programs, transportation).Thus, in the absence of KidSport funding, parents stated their children would not be able to engage in sport. Provision of funding also contributed to a sense of independence and well-being for both the children and parents. Finally, regardless of their own financial situation, parents did not want to receive additional funding if that meant other families would go without.

Discussion: KidSport funding appears to play a critical role in supporting sport participation for children living in low income in Nova Scotia. Furthermore, such funding contributes to family well-being and therefore should be considered as a feature of policies to promote public health more broadly.

External funding details: Funding provided by KidSport Canada

Oral ePosters

Theme: Behaviour Change

Monday 15 October

Bella Mossa: BetterPoints’ use of incentives to encourage active travel and reduce single-occupancy car use in Bologna, Italy

Hannah Bowden, BetterPoints Ltd

Introduction: BetterPoints is an evidence-led health, sustainability and social behaviour change technology company. With local mobility authority SRM we ran a six-month EMPOWER-funded programme in Bologna. Bella Mossa aimed to reduce congestion, improve air quality and encourage healthy activity & wellbeing using a smartphone app and incentives. Bella Mossa was ‘health by stealth’, a transport activity, with the desired outcome of lower car use, bringing significant health benefits.

Method: Participants tracked public transport, cycling, walking and car-sharing journeys using the BetterPoints app, earning BetterPoints for active/sustainable travel. BetterPoints can be converted vouchers or donated to charity. Non-monetary incentives (medals, team challenges and prize-draws) added interest and competition.

Journeys were verified by sophisticated algorithms and OpenStreetMap data. In-app baseline/end of programme surveys allowed comparison of self-reported activity levels and travel habits and demographic data.

Travel behaviour change was assessed in three ways:

•Quantitative – tracked journey data
•Qualitative – self-reported via baseline and end of programme survey
•In-context self-report – responses to in-app question ‘did this journey replace a car journey?’

Results:

•24,428 users tracked 816,139 active/sustainable trips, potentially saving 700+ tonnes CO2
•89% of self-identifying ‘everyday’ car users demonstrated behaviour change with 81% of their active/sustainable journeys replacing car journeys.

Conclusion: We’ll consider conclusions and questions arising around the potential for incentivising travel and health behaviour change using gamification and rewards. We’ll also discuss the health benefits inferred from the results of the programme and look at how gamification features can be further applied to achieve positive behavioural change for specific health outcomes.

Effects of a tailored print communication and SMS text-messaging intervention on physical activity and health Risk: The South African National Educator Wellness Study (SA-NEWS)

Lester Joseph¹, Vicki Lambert², Tracy Kolbe-Alexander³, Catherine Draper², Faith Kumalo⁴, Kirsty Bobrow²

¹Discovery Vitality, ²University of Cape Town, ³University of Southern Queensland, ⁴Department of Basic Education

Introduction: South African educators are at greater risk for non-communicable diseases than the general South African population. Studies show the effectiveness of SMS text message-based interventions for weight loss, physical activity (PA), glycaemic control and hypertension management.

Aim: To compare effectiveness of a single tailored print communication and SMS-text messaging intervention vs standard feedback following a wellness day health risk assessment in South African educators.

Methods: Schools (N = 27) were randomised into intervention (INT, N = 13) or control (N = 14, CTL) conditions, with 571 educators presenting for baseline assessment. The INT group (n = 156) received a single printed tailored letter focused on lifestyle goals and barriers, and 8 tailored, bi-directional SMS messages over 5 months. After 5 months, 59% of educators were re-tested (N = 349). The “as-per-protocol” results are reported.

Results: INT resulted in a significantly greater decrease in BMI and in the proportion educators who were overweight or obese compared to CTL (8.9% vs. 1.1%, P < 0.001). PA increased in both groups, with significantly more educators meeting PA guidelines in the INT group compared to CTL (112.8% vs 58.9%, P < 0.001). The prevalence of hypertension was significantly reduced in INT vs CTL groups (P < 0.001).

Conclusion: A potentially scalable, tailored print communication and SMS text messaging intervention may be more effective for changing physical activity health risk behaviours, than standard feedback following health risk assessment in an “at risk” group such as South African educators.

External funding details: Discovery Vitality Pty (Ltd), National Research Foundation of South Africa, South Africa Department of Basic Education for funding and support

How a nature integration approach involving refugees, migrants and indigenous people in Sweden contributes employment skills but also to physical activity and broader wellbeing

Anna Maria Pálsdttir¹, Azadeh Shahrad², Liz O'Brien³

¹Swedish University of Agricultural Sciences, ²Shahrad, ³Centre for Ecosystems, Society and Biosecurity Forest Research

The integration of migrants into different societies has become an important topic in recent years, particularly due to the influx of refugees and asylum seekers into Europe from Syria and Africa. A partnership between the Swedish Public Employment and Swedish Forestry Agency is using a nature integration approach to bring together refuges and migrants as well as long term Swedish unemployed to participate in a year-long vocational trainee programme. The programme provides training in and nature conservation skills for all the participants and lessons in the Swedish language for the migrants. An evaluation of the programme is exploring whether it has brought about changes in general health, physical activity, self-efficacy and nature connectedness through a survey based approach at baseline and two follow up points in the programme. In-depth case study interviews are exploring the impacts of the programme on wellbeing, changes in behaviour, participant’s attachment to place, and to what extent there has been integration between the Swedes and migrants via their nature conservation activities. Final results from the evaluation will be presented, preliminary results suggest that the Swedes are gaining an understanding of other cultures and the migrants are learning the Swedish language as they work alongside the Swedish unemployed.

External funding details: The study funded by Swedish Public Employment Service and Swedish Forestry Agency.

Improving the synthesis and reporting of behaviour change interventions: The Human Behaviour-Change Project

Emma Norris¹, Marta M. Marques¹, Ailbhe N. Finnerty¹, Alison Wright¹, Marie

Johnston², Robert West¹, James Thomas¹, Michael P. Kelly³, Susan Michie¹

¹University College London, ²University of Aberdeen, ³University of Cambridge

Purpose: Behaviour change interventions are complex, covering a large variety of techniques, delivery, exposures, contexts, behaviours and mechanisms of action. Reporting of such interventions varies greatly in quality. There is a need to synthesise this complex body of evidence to enable large-scale impact on behaviour change.

Aims: The Human Behaviour-Change Project (HBCP) is bringing together behavioural scientists, computer scientists and system architects to synthesise the evidence on behaviour change, including physical activity interventions. This project aims to advance our understanding of what works in behaviour change. Physical activity and tobacco use are the first behaviour types being addressed.

Method: 1) Develop an ‘ontology’ of behaviour change interventions: a structure of organised knowledge using a set of unified terms for entities and the relationships between them. We are using extensive literature reviews, annotations of published papers and expert consensus to generate this. 2) Use this ontology to build an Artificial Intelligence system to scan relevant literature, extract key information and synthesise it. 3) Develop an online, open-access user interface to interrogate this knowledge base.

Results: We have developed the top level of the Behaviour Change Intervention Ontology, containing 21 entities and 24 relationships. We are currently developing all sub-level entities of the Ontology. Tools for annotating, scanning and extracting published literature related to behaviour change are also being developed.

Conclusions: This work will allow researchers, policy-makers and practitioners to answer specific questions about physical activity behaviour change, aiming to inform international intervention and strategy development.

External funding details: Wellcome Trust Collaborative Award (201,524/Z/16/Z).

Learning from cross-sector approaches to increasing walking among adults in the London Borough of Hackney

Damani Goldstein¹, Dominique Humbert¹, Darren English¹, Kristoffer Backer-Rowley¹, Daniel Ward²

¹London Borough of Hackney, ²Public Health England

Hackney Public Health and Transport teams identified walking as a priority; to reduce physical inactivity among adults, and shift short journeys from by car to on foot. A cross council team developed social marketing interventions, complemented by personalised travel planning (PTP).

Walking potential analysis identified areas and groups with the largest numbers of ‘switchable trips’. The campaign promoted brisk walking; encouraging active travel, download of the Active 10 walking app, and participation in walking groups. Campaign promotion was implemented through locally developed out of home posters; a revamp of the Council walking webpage; and digital advertising targeted to mobile devices. These interventions were complemented by PTP advisors engaging with households in target areas.

Results included:

•Campaign posters on billboards around Hackney
•Posters in libraries, job centres, local hospital, GP practices, and pharmacies
•Hackney walking campaign adverts displayed on almost 200,000 mobiles, generating 1,317 clicks to Hackney walking page
•From March-July 2017, unique page views on the Hackney walking webpage more than trebled, compared to previous year
•PTP advisors engaged with 485 households, with 4% increase in walking mode share, and 9% increase in active travel trips to targeted destination
•652 people in Hackney used the PHE Active 10 app during the campaign period, spending 15,703 hours walking, including 3,842 hours brisk walking
•No change in signups to walking groups

Cross sector working between Public Health and Transport enriches approaches to increase physical activity. National campaigns can be tailored and amplified at local level. Further focused work with inactive groups planned.

Qualitative analysis of real-time motivations, facilitators, barriers and strategies for physical activity behaviour during pregnancy

Judith Jelsma, Mireille van Poppel, Frank Snoek, VU University Medical Center

Introduction: Adopting physical activity during pregnancy among overweight women is both a window-of-opportunity but may also be particularly demanding. We aimed to acquire insight into real-time motives, barriers, facilitators and strategies.

Methods: In the European DALI-study pregnant women (BMI ≥ 29 kg/m²) received a behavioural lifestyle intervention addressing healthy eating and/or physical activity. It consisted of five face-to-face sessions with a personal lifestyle coach trained in motivational interviewing. Face-to-face sessions of 26 Dutch participants were audiorecorded and transcribed verbatim (n = 73 sessions). The data was analysed with AtlasTi7 and examined using the Social Ecological Model.

Results: Women were motivated because of benefits for their baby (related to both healthy pregnancy and normal delivery), and to feel good, healthy, fit and energized themselves. Facilitators comprised social support/companionship; fun; available equipment (e.g. pedometer created awareness); work. However, women expressed many pregnancy-related barriers, especially fatigue, physical complaints (e.g. lower back pain, pelvic pain), and anxiousness about risks and dangers for their child. In addition, their growing belly prevented them to be physically active. Lack of time, prioritising other activities above physical activity, weather situation and lack of social support/companionship were mentioned as well. Strategies comprised incorporation of more physical activity in daily life activities (e.g. walking to work, taking the stairs), and alteration to more pregnancy suitable activities (e.g. swimming, walking).

Discussion: Compared to recall interviews this researchmethod comprises a more accurate representation of the actual struggles and solutions women made. The results could stimulate making behavioural changes and inform future health interventions.

External funding details: EU-FP7

Smoking and objectively assessed physical activity among young adults

Melissa Napolitano¹, Meghan Mavredes¹, Samuel Simmens¹, Jessica A Whiteley², Laura L Hayman², Loretta DiPietro¹

¹The George Washington University, ²University of Massachusetts-Boston

Introduction: Tobacco use and physical inactivity are lifestyle behaviors associated with chronic disease. Assessment and intervention for health risk behaviors among young adults (18-35yo) have received comparatively less attention than other life stages.

Method: Young adults at two urban universities (N = 460; %female = 78.5%; %Caucasian = 55.9%; Mage = 23.3 + 4.4; MBMI = 31.3 + 4.4) enrolled in a healthy body weight randomized clinical trial completed baseline assessments including objective physical activity monitoring (ActiGraph) and smoking status. Smoking categories were created: never smoked, experiment, regular (> 5 lifetime packs). Analyses of covariance were conducted to examine the relationship between smoking and two outcomes (MVPA, %time spent in different intensities of activity), controlling for BMI.

Results: The sample averaged 38.3 + 24.7 minutes of MVPA daily; 60% were never smokers, 30.9% were experimenters and 8.10% were regular smokers. The interaction between smoking and sex (p < .001) showed male experimenters being most active (54.0 + 28.2 min) and regular smokers being least active (35.5 + 33.0 min), with no differences for females. However, compared with their male counterparts, female experimenters were significantly less active (38.6 + 24.8 min). Significant effects were found for %time spent in moderate (p < .001) and vigorous activity (p < .01) with experimenters having more time compared with never smokers.

Conclusion: The intersection of smoking experimentation and physical activity behavior is of high public health importance. Given the sex differences in substance use and activity, additional surveillance is critical. Future interventions, including public health messaging and social marketing to educate young adults, are warranted.

External funding details: Supported by: US NIH Grant R01DK100916 (Napolitano-PI)

Using nudges to reduce sedentary behaviour: A pilot intervention

Nicola Eccles, Kiara Lewis, The University of Huddersfield

Traditional interventions which focus on educating or ‘motivating’ individuals to increase activity levels have been largely ineffective. The concept of altering the space in which we live, to enhance health behaviour, has been the focus of recent inactivity research. Point of decision prompts or nudges are a simple, cost effective, immediate aspect of altering the environment. However, we know very little about how or why they work, and how to create effective prompts.

The ‘Environmental Nudges’ project, designed to increase movement and understand more around how individuals interact with prompts, was implemented in three sites across the North of England. The nudges took a two-phased approach, the first classed as ‘subliminal’ and the second as ‘call-to-action’. Pre and post intervention focus group data (N.18) and questionnaires (N.101) underlined the immense pressure respondents perceive they are under. The daily struggle endured by many meant physical activity was considered as stressful and requiring intense motivation, therefore rejected as a leisure activity. Individuals knew they should be active indicating that education is not the issue. The ‘Environmental Nudges’ intervention was considered effective by participants as the prompts allowed autonomy. Individual choice, responsibility and possibility were successful features of the prompts. Further work could refine a two-phased nudge approach as some participants were uncertain about the ‘subliminal’ element. Individuals demonstrated very sedentary daily patterns underlining the pressing need for employers to utilise the working day to increase activity.

This pilot intervention was supported by: Heart Research UK; Kirklees Public Health; The University of Huddersfield.

VAMOS program: Technological innovation for behaviour change in the Brazilian unified health system

Tânia Bertoldo Benedetti¹, Cezar Grontowski Ribeiro², Camila Tomicki², Paula Sandreschi², Sofia Manta², Paulo Souza², Lisandra Konrad²

¹Federal University of Santa Catarina, ²Federal University of Santa Catarina - PPGEF

The use of technologies in health contributes to the expansion of public policies opportunities for an active and healthy lifestyle. The aims to present the new version of the “Vida Ativa Melhorando a Saúde” (VAMOS - Active Life Improving Health) program for establishment in the Brazilian Unified Health System. VAMOS is a program which motivates people to have a healthier lifestyle in regards to physical activity and nutrition. It was developed in 2012 and consists of 12 sections performed over a period of three months. The method of evaluation used focus groups and interviews with participants, multipliers and health managers. In 2017 the structure of the program was re-elaborated and a few changes regarding definition of themes and objectives, development of contents and activities and design and validation by a group of experts were carried out. The new version is available in both presential and online versions with 18 sections to be completed in nine months. The contents are: concepts, benefits, types, obstacles, time management, activity monitoring, social support, obesity, stress, health risks, diseases, good practices, relapses, opportunities, motivation and healthier lifestyle maintenance. Each section includes front page, title, welcoming, summary of the previous section, review of the task, content and activities, tips, summary of the current section and goal setting. The new design is based on the original visual identity of the program. VAMOS is an innovative technology with potential to be used in the Brazilian Health System as a strategy to behavior change to physical activity and nutrition.

Weighing the evidence linking sedentary behaviour to poor health

Katrien Wijndaele¹, Charles Matthews²

¹MRC Epidemiology Unit; University of Cambridge, ²Metabolic Epidemiology Branch; Division of Cancer Epidemiology and Genetics; National Cancer Institute

Research investigating the adverse effects of sedentary behaviour on health in adulthood has accumulated rapidly in the last decade, particularly in relation to mortality outcomes, cardio-metabolic diseases, and more recently cancer. This evidence has come from observational epidemiology, human intervention trials, and studies focused on the biological/molecular mechanisms responsible for these adverse effects. The totality of this diverse set of information forms an evidence-base with the potential to support (or not) broader public health and health policy initiatives designed to reduce sitting time in favour of more physically active pursuits. This presentation will describe common approaches to weighing the evidence and describe selected disease outcomes that have a lot, or only a little, evidence for an adverse effect of prolonged sitting time on health. For example, while much is known about the relationship between sedentary time and mortality, less is known about the range of lower intensity activities that may offset the adverse effects of too much sitting. Furthermore, available evidence linking sedentary behaviour to of less studied health outcomes, such as increased risk of functional limitations or poor quality of life, is more limited. The overarching goal of this presentation is to outline common approaches to weighing the evidence in hopes that future research can be directed to high value targets in the growing evidence-base that may facilitate translation of the research findings into future public health efforts to reduce sitting time, increase physical activity and improve health.

Tuesday 16 October

Are physical activity trajectories from childhood to midlife related to smoking trajectories? The Young Finns Study

Kasper Salin¹, Mirja Hirvensalo¹, Anna Kankaanpää², Irinja Lounassalo¹, Xiaolin Yang², Costan Magnussen³, Nina Hutri-Kähönen⁴, Olli Raitakari⁵, Tuija Tammelin²

¹University of Jyväskylä, ²LIKES Research Centre for Physical Activity and Health, ³University of Tasmania, ⁴University of Tampere, ⁵University of Turku

Despite substantial interest in the development of health behaviors, there is limited research that has examined the longitudinal relationship between physical activity (PA) and smoking trajectories from youth to adulthood. This study aimed to identify trajectories of smoking and PA for males and females, and study the relationship between these trajectories from youth to adulthood.

Latent profile analysis was used to identify trajectories of smoking and PA separately for males and females among 3,355 Finnish adults (52.1% females). Participants’ smoking and PA were assessed five to eight times over a 31-year period (3-18 years old at the baseline, 34-49 years at last follow-up). Latent transition analysis was fitted to the data to study relationship between the trajectories of smoking and PA.

Five smoking trajectories and four PA trajectories were identified for males and females. Of the PA trajectory groups, the persistently active group were least likely to follow the trajectories of regular smoking and the inactive and low active groups were least likely to follow the rare or non-smoking trajectory group. Likewise, inactive (women only) and low active groups were less likely to belong to rare or non-smokers group.

Study suggests that increasing and maintaining PA from youth to adulthood may be in association in preventing and reducing the harmful use of both persistent and increasing smoking.

External funding details: This work was supported by Finnish Cultural Foundation and Ministry of Education and Culture (Major, grant number: 83/626/2014). CGM is supported by a National Heart Foundation of Australia Future Leader Fellowship (100849).

Are spectators at mass participation events inspired to increase their physical activity?

Roshan Gunasekera¹, Elton Chawatama¹, Ted Caplan², Courtney Kipps³

¹University College London, ²Bristol University, ³Institute of Sports Exercise and Health, University College London

Introduction: It has been suggested that Mass Participation Events (MPEs) may inspire individuals to increase their Physical Activity (PA). This study aims to establish whether spectators who are inspired by attending a MPE increase their PA.

Methods: Adult spectators at 7 Half Marathons (HMs) during 2016 were invited to participate in the study. Self-reported PA levels in three domains (work; travel and recreational PA), inspiration and behaviour change, according to the Transtheoretical Model (TTM), were collected using a validated questionnaire. Follow-up questionnaires were emailed to participants at 2 and 12 months.

Results: 190 spectators completed the initial questionnaire. The follow-up rate was 42% and 28% at 2 and 12 months respectively. 63% of participating spectators reported being inspired during the event, however there were no significant changes in PA levels at either follow-up point and there were no significant differences in PA between inspired and uninspired participants. No significant change was seen from individuals evolving out of pre-contemplation stage in the TTM. The most commonly cited barrier to PA was lack of time (N=82), and correspondingly participants valued more free time as the most common potential motivator to increasing PA (N = 40).

Conclusion: Participants in this study reported being inspired by spectating at a MPE however their overall PA levels did not change at 2 and 12 months follow-up. The application of the TTM to the study revealed that attitudes to PA evolved but the follow-up numbers were insufficient to reveal a significant result.

Building smartphone “apps” for lifestyle behavior change in clinical populations

Kristina Hasanaj¹, Nicole Hoffman¹, Meynard L. Toledo¹, Sarah L. Mullane¹, Miranda L. Larouche¹, Kevin Hollingshead¹, Carl Stepnowsky², Dana R. Epstein¹, Peter Reaven³, Lois E. Krahn⁴, Megan E. Petrov¹, Matthew P. Buman¹

¹Arizona State University, ²University of California, San Diego, ³Phoenix Veterans Affairs Health Care System, ⁴Mayo Clinic School of Medicine

Introduction: Lifestyle-based behavior change approaches are difficult to deliver given high cost and complexity in overburdened clinical environments. mHealth approaches may address some challenges by extending care beyond the clinical setting and providing real-time, objective self-monitoring strategies. Our team developed two clinically focused, lifestyle smartphone applications (“apps”). BeWell24, focuses on lifestyle behavior change in at-risk adults. SleepWell24, focuses on increasing positive airway pressure (PAP) therapy adherence through self-management. Both apps incorporated lifestyle change strategies across the 24 hours (i.e., sleep, sedentary time, physical activity, diet).

Methods: The smartphone app development was based on evidence-based strategies, expert opinion, and stakeholder feedback. A community-embedded iterative design framework was used to collect stakeholder feedback from clinical providers (n = 22) and target users (n = 10). This feedback was incorporated during all development phases and incorporated think aloud activities, focus groups, individual interviews, and short-term use studies.

Results: Feedback from providers and target users yielded apps tailored to clinical environments including objective feedback, features to enhance patient-provider communication, and a platform conducive for integration into the electronic medical record. Cloud-based linkages were established with wearable technologies to enhance self-monitoring (e.g., activity monitors, PAP machine). Components were designed to provide knowledge and tools to understand and effectively incorporate healthier habits.

Conclusion: Stakeholder feedback is a necessary component to the development of evidence-based smartphone interventions and should employ iterative design methods to ensure integration into the clinical setting.

External funding details: National Institute of Health: R18DK109516, R21NR016046; Virginia G. Piper Charitable Trust.

Common perceived barriers and facilitators for reducing sedentary behaviour among office-workers

Carla Nooijen¹, Lena Kallings¹, Victoria Blom¹, Örjan Ekblom¹, Yvonne Forsell², Maria Ekblom¹

¹Swedish School of Sport and Health Sciences, ²Karolinska Institutet

Background: Qualitative studies identified barriers and facilitators associated with office work-related sedentary behaviour. The objective of our study was to determine the most common barriers and facilitators among office-workers, to assess subgroup differences and describe time spend sedentary in- and outside the workplace.

Methods: Cross-sectional study among 547 Swedish office-workers (median age: 41 years (IQR = 35-48), 65% women, 66% highly educated). Perceived barriers and facilitators were evaluated using questionnaires, and subgroup differences in age, gender, education and sedentary behaviour assessed with Χ²-tests. Sedentary behaviour was measured for 7 days using inclinometers (n = 311).

Results: The most frequently reported barrier was: sitting is a habit (67%), which was reported more by women than men (Χ² = 5.14, p = 0.03) and by highly sedentary office-workers (Χ² = 14.63, p < 0.01). The two other most reported barriers were that standing is uncomfortable (29%) and tiring (24%). Facilitators with most support were introduction of either standing- or walking meetings (respectively 33% and 29%) and more possibilities or reminders for breaks (31%). The proportion spent sedentary was 64% at the workplace, 61% on working days and 57% on non-working days. The proportion overall standing was 28%

Conclusions: This study provides a detailed understanding of sedentary office-worker’s ideas about sitting and means to reduce sitting. The identified subgroup differences in perceived barriers and facilitators stress the importance of tailored interventions and individualized support in order to reduce sedentary behaviour more effectively. Based on these results we developed an intervention of which we are currently studying the effectiveness in a large longitudinal randomized controlled trial.

Does a confident physical activity facilitator need to be ‘sporty’? A survey of Slimming World behaviour change facilitators

Laura Holloway, Jacquie Lavin, Sarah Bennett, Slimming World

Background: Slimming World (SW) offers a multi-component approach to weight management, encouraging healthy eating and gradual increases in physical activity, alongside support from group behaviour change facilitators (Consultants). All Consultants have experienced being overweight and losing weight themselves, without necessarily increasing physical activity. This research explored whether Consultants’ own interests and abilities in physical activity/sports impacted attitudes and confidence towards supporting SW members in becoming more active.

Methods: SW Consultants were invited to complete a survey investigating attitudes towards physical activity/sports, and supporting members in increasing physical activity.

Results: Presently, 498 Consultants have completed the survey.

Preliminary findings indicate that 77% consider themselves physically active, but 48% of these (58% overall) don’t consider themselves ‘sporty’. 96% feel activity is important for health, 93% feel it improves mood and 64% have made activity habitual.

Of the 58% who aren’t ‘sporty’, most still feel knowledgeable (82%), confident (80%), motivated (75%), proud (75%) and determined (71%) in supporting members with their activity goals. Despite not being ‘sporty’, most aren’t embarrassed (80%) nor worried (72%) about supporting/encouraging physical activity.

15% report being inactive themselves, yet 83% are still confident in offering support.

Conclusion: Findings indicate that many SW Consultants consider themselves physically active, but not sporty, yet are still able to confidently support others in becoming more active. Even those not very active themselves are generally confident in supporting others. A non-sporty approach may be a feasible method of facilitating physical activity increases, particularly for those who find the prospect of physical activity daunting.

Effectiveness of the VAMOS strategy for physical activity and nutrition: a randomized controlled community trial

Tânia Bertoldo Benedetti¹, Simone Meurer², Aline Lopes³, Giovana Mazo⁴, Fabio Almeida⁵

¹Federal University of Santa Catarina, ²Federal Institute of Minas Gerais, ³Federal University of Minas Gerais, ⁴State University of Santa Catarina, ⁵University of Nebraska Medical Center

Introduction: The VAMOS strategy, an educational intervention addressed in the present study, was found to be promising in promoting PA and mental health among elderly Primary Health Care (PHC) users in Florianopolis, Santa Catarina, Brazil.

Purpose: This study aimed to evaluate the effectiveness of the VAMOS strategy (Health-Improving Active Life) in improving physical activity (PA), dietary habits, and anthropometric variables of Primary Health Care (PHC) users in Brazil.

Methods: A randomized controlled community trial was conducted at two units of the Health Academy Program (HAP, a service provided by PHC), which were randomly assigned to the control group (CG) and to the intervention group (IG). The participants in the two groups (CG = 156 and IG = 135) underwent physical exercises provided at the HAP facilities and those in IG also participated in the VAMOS strategy for 12weeks. Physical activity was measured with accelerometers and nutritional status was assessed using dietary habits questionnaires and anthropometric measurements.

Results: Intention-to-treat analysis revealed that participants in IG increased the daily time of moderate-vigorous PA and the frequency of raw vegetable intake, while the intake of ultra-processed foods was reduced. However, no changes in anthropometric variables were observed.

Conclusions: The VAMOS strategy was effective in increasing PA and healthy dietary habits among PHC users. Therefore, VAMOS is suggested as a complement to PHC activities in order to strengthen the autonomy of users regarding their health.

External funding details: PPSUS/FAPESC/2014/TR/2263 and CNPqn.14/2012 A. N. 475075/2012–9

Meta-analysis of broad-reach physical activity interventions for cancer survivors (2013-2017): We still haven’t found what we’re looking for

Jeff Vallance¹, van Harten Wim², Wim Groen²

¹Athabasca University, ²The Netherlands Cancer Institute

Introduction: Physically active cancer survivors have a reduced risk of cancer recurrence and mortality. There is a need to develop and evaluate effective physical activity interventions that employ distance-based, broad-reaching (i.e., non face-to-face) approaches. The primary objective of this study was to conduct a meta-analysis of broad-reach physical activity behavior change interventions (from 2013 to 2017) for cancer survivors.

Methods: PubMed and Embase databases were searched from May 2013 up to October 2017. Studies met the following criteria if: 1) they included post diagnosis adult cancer survivors, 2) the intervention was distance-based with no more than one face-to-face visit or contact, and 3) physical activity was measured pre and post intervention. Review Manager 5 (RevMan 5) software was used to conduct a meta-analysis on all RCTs that presented self-reported moderate-to-vigorous intensity physical activity (MVPA) pre and post intervention means and standard deviations.

Results: Data from 13 RCTs (16 comparisons) were included. Overall, studies were found to be of moderate quality. Excluded studies did not provide MVPA data. The analysis was based on 3,350 patients (1,675 for both intervention and control). These interventions resulted in a small overall effect (standardized mean difference) of 0.19 (95% CI 0.07, 0.30), which was significant (Z = 3.26, p = 0.001). There was significant (p = 0.002) and moderate heterogeneity (I² = 58%) across the included trials.

Conclusions: As changes in physical activity are generally small, relying on the present content of broad-reach programs aiming to facilitate physical activity in cancer survivors may not be prudent.

Systematic review registration: PROSPERO CRD42017080252

Nature-based programmes for health and wellbeing in vulnerable groups: findings from evaluative research

Jo Barton¹, Mike Rogerson¹, Valerie Gladwell¹, Jules Pretty¹, Dominic Higgins²

¹University of Essex, ²Wildlife Trusts

Introduction/Background: We present findings from a number of nature-based health and wellbeing programmes for vulnerable groups, such as individuals experiencing low mental wellbeing (Wildlife Trusts), youth at risk (Wilderness Foundation UK), and older gentlemen experiencing dementia (Future Roots).

Method: Primary focus will be on findings from a study on the participation of 139 individuals in Wildlife Trust projects between February 2016 and February 2017. This study assessed changes in participants’ attitudes, behaviour and mental wellbeing over the course of 12-weeks as a result of taking part in nature conservation volunteering programmes run by five Wildlife Trusts across the North, Midlands and South West of England.

Results: The principle finding was that participants’ mental wellbeing improved to a statistically significant extent over the 12-week period, and that improvements were greatest for individuals who were new to the projects. Proportion of participants reporting low wellbeing (compared to UK norms) fell from 39% at baseline to 19% at 12-weeks. Participants also reported enhanced levels of positivity, health, nature relatedness, pro-environmental behaviour, levels of physical activity, and increased contact with greenspace.

Conclusion: Attending Wildlife Trust volunteering programmes facilitates health and wellbeing improvements particularly for people with low levels of wellbeing. This has important implications for reducing the current NHS burden, by offering complimentary non-medical services to promote health and wellbeing. Evaluative methodological issues are addressed and findings from nature-based health and wellbeing programmes for vulnerable groups are discussed in relation to theory.

Shaping an environment, shapes our minds: The Care About Physical Activity (CAPA) programme, a qualitative piece on promoting movement change in care services for older people

Alex Lucas¹, Matthew Wade¹, Steven Mann², James Steele¹

¹ukactive, ²Places for People Leisure

Background: In 2016 the Care Inspectorate was commissioned by the Scottish Government to deliver the CAPA improvement programme, which aims to promote and increase the movement levels of those in care. This study looks to understand factors that link environmental culture change of care services with the movement behaviour change of older people in care.

Methods: Focus groups were/will be conducted at two time points in October 2017 and April 2018, with a minimum of 11 social care professionals and 15 care residents, across Scotland. Data was combined with anecdotal evidence and was collectively analysed through thematic content analysis.

Results & Discussion: Preliminary results suggest the environmental culture of the care home influences the extent to which movement is prioritised and embedded within the service and how often older people engage in movement. Two overarching themes were found to influence the culture change of care environments; staff/management ‘buy in’ (e.g. staff/management attitudes and perceptions) and environmental economics (e.g. routine and space changes in the care home). Theming indicated that a top-down approach to integrating movement into a care environment is most successful. This involves the active buy in of staff/management to integrate movement into their everyday tasks, priorities and the physical care home environment. Collectively, these cultural changes can influence the extent to which older people change their movement behaviour.

Notes: As an ongoing project results and discussions are likely to develop due to the continuous collection of anecdotal evidence and future planned focus groups.

External funding details: Funded by the Care Inspectorate

The importance and status of global sedentary behaviour surveillance

Katrien Wijndaele¹, Andrew J Atkin²

¹MRC Epidemiology Unit; University of Cambridge, ²School of Heath Sciences, University of East Anglia

Driven by significant and sustained growth in research activity over the last twenty years, sedentary behaviour has risen in prominence as a potential risk factor for chronic disease morbidity and mortality, capturing the attention of policy-makers and mainstream media. Surveillance of sedentary behaviour is required to establish the scale of the burden on public health, to inform priority-setting and public policy, and monitor changes in prevalence over time. In partnership with the Global Observatory for Physical Activity (GoPA), the Sedentary Behaviour Council (SBC) is undertaking a project to collate global data on prevalence, surveillance, research and policy activity as it relates to sedentary behaviour. The GoPA-SBC Sedentary Behaviour Global Monitoring Initiative will be delivered over a number of phases and build upon the GoPA Country Card project methodology. In this presentation, the methods and preliminary results of phase 2 will be presented, which focussed on the collation of sedentary behaviour prevalence/descriptive metrics (Total sitting time, TV viewing) and documentation of surveillance activities across the 6 World Health Organisation regions (Africa, Americas, South-East Asia, Europe, Eastern Mediterranean, Western Pacific). Data will be identified through internet and PubMed keyword searches and by communication with GoPA Country Card contacts in each available country. The protocol for this phase of the project is currently in development, with data collation scheduled to begin in January 2018 and completion due by Autumn 2018. Challenges in data collation and synthesis will be discussed.

Theme: Cross-sector Working

Monday 15 October

A whole systems approach to tackling inactivity across Derby: the contribution of Derby a city on the move

Debra Richardson¹, Mark Faghy¹, Harry Rutter², Nick Cavill³, Chris Bussell¹

¹University of Derby, ²London School of Hygiene and Tropical Medicine, ³Cavill Associates

Introduction: Derby a City on the Move (DaCotM) aims to tackle physical inactivity across Derby, UK and provided impetus and focus to utilising a whole systems approach to tackling inactivity. A consortium of partners work together on the project aiming to develop understanding of the way ‘systems thinking’ can be translated into action, and to inform future planning across Derby City.

Methods: A baseline review focused on the consultation with partners to establish programmes, policies and datasets in place across Derby City. This was translated into a visual image of the current scenario through the use of causal loop diagrams (CLD). A progress review will be conducted later in 2018 with the CLD being revised to reflect changes and adaptations across the system.

Results: The baseline review showed that DaCotM contributes to aspects of a whole systems approach, primarily through inter-personal interventions designed to support behaviour change. It acknowledges the need to look beyond current activity recognising the significance of the built and natural environment in providing opportunities to be active and also recognising the need for further insight into social norms.

Conclusions: Recommendations for the creation of a whole systems approach have been provided specifically in relation to DaCotM and also beyond the life of the project. Derby City Physical Activity and Sport Strategy provides an opportunity to act on these recommendations and work towards a whole systems approach to tackling inactivity across Derby City.

External funding details: This work was funded through Sport England’s ‘Get Healthy, Get Active’ funding stream 2015-2018.

Active school transportation contributes to be physically active during the journey to school

Damian Chandia, Nicolas Aguilar-Farias, Universidad de La Frontera

Introduction: Active School Transportation (AST) constitutes an opportunity for children to increase their daily physical activity (PA). However, little is known about how much AST contributes to PA during specific periods within a school day. The aim of this study was to evaluate the association between AST and PA during three sections of children’s school day.

Methods: School children wore an accelerometer ActiGraph wGT3X-BT during 7 consecutive days. Children completed a question about school transportation habits (active and passive travelers), and weight and height were measured. Multilevel linear regressions were performed to assess the association between AST and total moderate-to-vigorous PA (MVPA) during the journey to school, school-hours and out-school time adjusting for gender, age, nutritional status and accelerometer wear time.

Results: 179 children (47.4% male; aged 10.2 ± 0.9 years; 64.5% overweight/obese) provided valid data. After controlling by covariates, active travelers to school during the journey to school were significantly more physically active than children who travel by car or bus (2.11 ± 0.5 MVPA min/day 95% CI 1.13-3.09; p < 0.001). No differences were found in school-hours (2.80 ± 1.9 MVPA min/day 95% CI -1.08-6.68; p = 0.158) and out-school periods between active and passive travelers (1.27 ± 2.7 MVPA/day 95% CI -4.12- 6.66; p = 0.644).

Conclusions: Although evidence show a substantial association between AST and overall daily PA, in this sample of Chilean children, AST was associated only with higher PA levels of the journey to school period. AST has a positive (but statically negligible) effect during daily PA during school-days and out-school time.

External funding details: Funding: FONDECYT 11160720 – UNETE 14-0008

An examination of the capacity of community bicycle coalitions

Melissa Bopp¹, Dangaia Sims², Emily Hentz-Leister¹, Nicole Vairo¹

¹Pennsylvania State University, ²PSU

Background: Bicycle coalitions serve communities in different ways, including: advocating for physical infrastructure, providing encouragement for biking, safety education and assisting with policy development, though little is known about their functioning, therefore, the purpose of this study was to examine the capacity of these organizations.

Methods: Bicycle coalitions were recruited to participate in an online survey. The survey addressed: information about the coalition, leadership, communication, priorities, and partners. Basic descriptives and frequencies examined trends.

Results: Coalitions (n = 61) from 4 countries completed the survey. The majority of respondents represented a city or county (n = 26, 46.5%), were from larger cities (n = 30, 53.5%) and were located in the USA (n = 51, 91.1%). Coalitions primarily operated as a non-profit (n = 44, 95.7%), 45% (n = 21) had paid staff as leaders; 37% (n = 17) had volunteer leaders. Common leadership skills were fundraising (n = 31, 53.4%) and event planning (n = 31, 53.4%). Education (n = 21, 46.7%), advocacy (48.9%, n = 22) and encouragement (n = 17, 37.8%) were viewed as top priorities. Safety of bicyclists (n = 21, 46.7%) and advocacy for infrastructure/policy (n = 22, 48.9%) the focus of most activities, reflected in participation in Safe Routes to School (n = 31, 53.4%), bike to work events (n = 42, 72.4%) and open streets events (n = 21, 36.2%). All coalitions reported using social media for communication, though most perceived that their communication strategies were not that effective. Common partners were: parks/recreation departments (n = 37, 63.8%), local media (n = 34, 58.6%) and transit organizations (n = 28, 48.3%).

Conclusion: Bike coalitions represent a critical partner in creating activity-friendly environments and understanding their capacity allows for creating skill/capacity building programs and toolkits.

Assessing implementation of HEPA policy at the local level for effective physical activity promotion: Report of local area policy audit tool (L-PAT) study in Japan

Noriko Takeda¹, Yukio Oida², Shigeru Inoue³, Motohiko Miyachi⁴, Fiona Bull⁵

¹Kogakuin University, ²Chukyo University, ³Tokyo Medical University, ⁴National Institute of Health and Nutrition, ⁵The University of Western Australia

Introduction: Increasing levels of health-enhancing physical activity (HEPA) will require a comprehensive policy framework from national to local levels. We tried to assess the policy for physical activity in Japan using the HEPA policy audit tool (PAT). However, we were not able to clarify the actions concerning the implementation of the local policies. Assessing whether national policy is being implemented requires a monitoring system at the local level.

Method: We developed and tested Local PAT (L-PAT) in 47 Prefectures in Japan. It comprises 11 items based on HEPA PAT covering key policy actions including presence of local action plan; implementation of the action plan; cooperation between sectors and evaluation on implementation. L-PAT was sent to local government representatives in key sectors (e.g. health, sports, urban planning and transport) in all 47 prefectures.

Results:The results indicate that the health and sports sectors are the most active sectors in promoting national HEPA policy. There is a national policy for these sectors. We need to monitor and evaluate the progress of these active plans at local level. Although the actions taken by urban planning and transport sectors aren’t covered by the national policy on physical activity, some prefectures reported local actions by those sectors which improved HEPA. Identifying and sharing good practices between local governments is important.

Conclusion: Assessing the progress, capacity and challenges of policy implementation at the local level will provide valuable feedback to the national planning process for the promotion of physical activity.

Developing a national physical activity plan of action in Oman

Huda Alsiyabi¹, Amal Alsiyabi¹, Muhssen Kanaan¹, Ruth Mabry²

¹Ministry of Health, Oman, ³Independent Public Health Researcher

Overview: Oman has experienced widespread societal changes, including rapid urbanization and a decline in physical activity (PA), which has contributed to a high prevalence of overweight and obesity and increasing prevalence of non-communicable diseases (NCDs). Health authorities’ interest in promoting PA was the driving force for developing a multisectoral national plan of action (POA) to promote physical activity. The authors describe the development process and share the lessons learned.

Development Process: A series of steps took place between 2015-2017 to develop the POA. First, a situation analysis of the prevalence of physical inactivity in Oman was conducted. Second, sectoral actions promoting PA were mapped. Third, advocacy visits to key ministries were conducted to obtain commitment and identify experts for a multi-sectoral executive team. Fourth, this team drafted the POA following the guidance of the “seven best investments” to promote PA. Fifth, the draft POA was then reviewed by an international expert. Sixth, a multisectoral taskforce was then formed by the National Committee for NCDs to finalize the POA and oversee the planned activities.

Lessons Learnt: Several lessons have emerged from the Omani experience in developing the POA including: (1) a highly represented national committee creates political commitment and facilitates multisectoral collaboration, (2) sufficient knowledge about the current actions at each sector, cultural characteristics and barriers to PA in the community is critical, (3) available evidence-based approaches and best buys helps guide the planning process and (4) being patient and diplomatic when dealing with partners.

How engaged are health and sport-focused workforces in supporting physical activity promotion for individuals who are overweight or obese?

Emily Oliver, Adam Graver, Molly Owens, Durham University

Introduction and Method: Given its benefits for physical and psychological health, and contribution to weight reduction, physical activity promotion is a core strand of lifestyle-focused interventions for those who are overweight or obese. As policy increasingly seeks to engage both health and sports sectors in targeting obesity, this research examined attitudes and practices of two professional populations involved: ‘Gatekeepers’ (General Practitioners (GPs): n = 87; 80 surgeries) and ‘Deliverers’ (Sport Development Officers (SDOs): n = 6). The former completed questionnaires, and the latter in-depth interviews, examining attitudes towards and professional practices concerning the engagement and delivery of physical activity for obese individuals.

Results: ‘Gatekeepers’ predominantly agreed that activity promotion was part of their job (83%) with more engagement in activity promotion than prescription. GPs desired more relevant training (42%) and would prescribe physical activity more often if financial incentives were present (21%). Conversely, ‘Deliverers’ reported that obesity reduction was not a specific target, but did recognise their remit was changing. They identified a need to improve public health sector links and to better understand new types of client. More positive attitudes and fewer anti-fat stereotypes were reported by those involved with strategy and management as opposed to those coordinating direct delivery.

Conclusion: Collectively, findings suggest both medical and sport-focused professionals are engaged in the physical activity promotion agenda for individuals who are overweight or obese, but that policy and investment is needed in training, facilitating cross-sector links, and developing relevant structures and systems for encouraging, monitoring, and rewarding performance.

How to assess parental barriers towards active commuting to school in children and adolescents: A validity and reliability study of the PABACS questionnaire

Francisco Javier Huertas Delgado¹, Javier Molina-García², Delfien Van Dyck³, Palma Chillon⁴

¹PA-Help “Physical Activity for Health Promotion” research group. Teaching Centre La Inmaculada, University of Granada, Granada, Spain, ²Department of Teaching Music, Visual and Corporal Expression, University of Valencia, Valencia, Spain., ³Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports Sciences. Research Foundation Flanders, Brussels, Belgium, ⁴PROFITH “Promoting FITness and Health through physical activity” research group. Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain

Introduction: Active commuting to school is a daily behaviour related to several health benefits in young people. Parental-perceived barriers are important to determine active commuting to school in children and adolescents. The purpose of this work was to test the validity and the reliability of a questionnaire focusing on parental barriers towards active commuting to school.

Methods: The PArental BArriers towards Active Commuting to School (PABACS) questionnaire is comprised of 23 likert-scale items categorised into 3 scales (general barriers, walking barriers, and cycling barriers). The questionnaire was developed using the Delphi method. Internal consistency, test-retest reliability, and predictive validity of the questionnaire (scales and overall questionnaire) were examined using Cronbach’s alpha, intra-class correlations, and Spearman’s rho correlations. In total, 201 parents of Spanish children and adolescents completed the PABACS on two occasions with a two-week interval.

Results: Good internal consistency and a moderate test-retest reliability was found for the overall questionnaire and for the three scales. The validity to predict active modes of commuting to school was moderate for the overall questionnaire and for the general and walking scales but low for the scale assessing cycling barriers.

Conclusions: This study provides a reliable tool to assess parental barriers towards active commuting to school. The PABACS will be useful for researchers and administrations to identify the most important barriers on which institutions have to focus to increase children’s active commuting to school.

External funding details: This study was supported by a grant from the Spanish Ministry of Education, Culture and Sport [CAST17/00072], and Project PACO was supported by the Spanish Ministry of Economy, Industry and Competitiveness (DEP2016-75598-R, MINECO/FEDER, UE).

Investigating the potential of e-bikes as a means of active transport

Ben Jane, Saul Bloxham, Plymouth Marjon University

Introduction: E-bikes (more specifically, the “pedelec” which only functions if the rider pedals) have been shown to elicit exercise intensities equal to those recommended in health related physical activity guidelines (Berntsen et al, 2017; Peterman et al, 2016) and have been suggested as a means of increasing physical activity in the general population (de Geus and Hendriksen, 2016). While 12% of people currently cycle for any purpose at least once a week (UK Gov, 2018), for many the perceived difficulties of cycling over hilly terrain may be a significant barrier to further increases in cycle commuting rates. E-bikes may present an opportunity to address this perception.This study set out to investigate the barriers and facilitators to e-bike usage in the SouthWest of England by engaging with a variety of potential users and identifying which aspects of behaviour change theories might best inform the future uptake of e-bikes; e.g. theory of planned behaviour, transtheoretical model, or diffusion of innovations.

Method: A combination of online questionnaires and face-to-face focus groups were conducted with the support of a number of local employers.

Results: A range of barriers and facilitators were identified with barriers including technological, social and environmental issues and facilitators being social, environmental, trialability and cost reduction.

Conclusion: E-bikes have been shown to appeal to both existing cycle users and to those who are predominantly car users. This study provides an insight into the barriers and facilitators to increased uptake of e-bikes as a means of transport.

The legally binding roles and responsibilities of Romanian local governments in HEPA promotion

Petru Sandu, Romanian Association for HEPA Promotion – HEPARO

Introduction: The importance of local governments’ involvement in HEPA promotion has been acknowledged and emphasized at European and international level. However, there is little scientific knowledge in regard to this issue. The aim of this study is to explore the legally binding roles and responsibilities of local governments in HEPA (policy) promotion in the Cluj-Napoca municipality.

Methods: Thematic document analysis followed up by stakeholders’ interviews were used. Types of documents explored were legislative acts, statues and operating rules of the local government, organizational charts, strategic documents, legal decisions, any other supporting documents, with legal value (e.g. local government meetings’ minutes).

Results: The local government has a supporting role in HEPA promotion at local level, most of the times allocating financial resources for private organizations involved in health (and HEPA) promotion, or by facilitating the access to publicly owned physical activity infrastructure.

Conclusion: A better understanding of the roles of local governments in HEPA promotion can lead to an increase in debate regarding their actual roles in relation to the international recommendations, and consequently, to an increase in accountability and a change in the legally binding roles assumed by these institutions.

Transport cycling in Chilean adults: Results from 2014 and 2015 national surveys

Kristiann C Heesch¹, Nicolas Aguilar-Farias², Nicolas Salom², Damian Chandia², Andrea Cortinez-O’Ryan³

¹Queensland University of Technology, ²Universidad de la Frontera, ³Universidad de la Frontera & Pontificia Universidad Católica de Chile

Introduction: Active travel surveillance in Latin American is scarce. Surveillance of transport cycling in Chile is critical to document, to serve as a baseline from which to measure future planned strategies to increase transport cycling in Chile. This study aimed to document the prevalence of transport cycling in urban-dwelling Chilean adults and to examine factors associated with transport cycling in this population.

Method: Data were collected from two cross-sectional National Environmental Surveys. The surveys were administered through a computer-assisted telephone interview system to representative samples of adult residents of the 15 regional capital cities in 2014 (n = 5067) and 2015 (n = 5664). Multivariable multi-level logistic regression modeling was used to assess associations between socio-demographic and environmental factors and bicycling as the main transport mode (yes, no).

Results: Cycling for transport was reported by 6.7% of participants in 2014 and 6.6% of participants in 2015. The highest prevalence estimates were found in males (2014: 10%; 2015: 9%), participants aged 18-24 years (both surveys: 12%), participants of low socioeconomic status (both years: 7%), and participants living in cities with warm summers/mild winters (2014: 9%; 2015: 8%. Factors associated with a reduced likelihood of transport cycling were female gender, older age, high socioeconomic status, and living in a city with cool summer temperatures (p < 0.01).

Conclusion: Transport cycling is more prevalent in Chile than in some other Latin American countries and high-income countries (e.g. US, Australia) but low compared to Northern European countries. Correlates of cycling in Chile are similar to those in other low-cycling countries.

Theme: Disability

Tuesday 16 October

Changes over time in levels of fatness and physical fitness of adolescents with Down syndrome. The UP&DOWN longitudinal study

Borja Suarez-Villadat¹, Rocío Izquierdo-Gómez², Oscar Veiga³, Hernan Ariel Villagra³

¹Autonomous University of Madrid, Madrid, Spain, ²Physical Education, Faculty of Education Sciences, University of Cádiz, Puerto Real, Spain, ³Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain

Background: Nowadays, overweight and childhood obesity represent a significant health problem, since it has been associated with suffering cardiovascular disease in adulthood. People with intellectual disabilities, especially Down syndrome (DS), have been associated with high rates of obesity and low levels of physical fitness compared with their peers without DS. The aim of the present study is to examine 2-year longitudinal changes in several markers of fatness and levels of physical fitness in adolescents with DS.

Methods: The study is composed of a sample of 111 adolescents with DS (UP & DOWN longitudinal study). The ALPHA battery was used to assess fatness and physical fitness levels of adolescents at baseline and over 2-years follow-up. Paired sample statistical t-tests segmented for sex and age group were used to analyse the differences between baseline and follow-up fatness and physical fitness data.

Results: The present study shows changes in fatness and physical fitness of adolescents with by sex and age group. All groups increased in all fatness variables, excepted males and older group significantly decrease in percentage of body fat (all P < 0.05). No differences were observed in females and younger group at 2-year change in percentage of body fat. Males and older adolescents improved their levels of handgrip strength and cardiorespiratory fitness, while females improve levels in handgrip strength and motor fitness at 2-year change (P < 0.05).

Conclusions: Adolescents with DS tend to increase levels of fatness and barely change their level of physical fitness by sex and age groups at 2-year follow-ups.

Examining the impact of the Richmond Group’s approach to increasing physical activity

Michelle Roberts, Cherry Russell, Age UK

Introduction: The projects and activities undertaken individually by charities and as part of the collaborative Movement for All programme have helped us to tailor our physical activity ‘offer’ to better meet the specific needs of people who are inactive with long term conditions and disabilities.

Method: The Richmond Group have created a programme of work which encompasses insight projects, delivery of evidence-based physical activity interventions and collaborative development projects. The programme focusses on an holistic, whole system approach to increasing physical activity by working with individuals, their families and support networks and through working with the myriad of different professionals who come into contact with people with long term conditions and disabilities, all of whom have an important role to play in facilitating behaviour change.

Results: As well as increasing physical activity levels of people participating in targeted interventions, the Richmond Group are addressing broader system change to ensure this achievement continues and is sustainable. This has centred on development and dissemination of tailored resources, support, training, and knowledge with the view to improve leisure facilities and physical activity opportunities; improve health care professional signposting and improve the general understanding of physical activity in management of long term conditions.

Conclusion: Working in collaboration to undertake insight, deliver activity and share learning has allowed the Richmond Group and its partners to optimise its offer, ensuring consistency in message, minimising duplication, streamlining approaches and filling gaps in knowledge. The continued cycle of learning ensures ongoing refinement of our approach.

External funding details: Sport England

Inclusive activity: The perceptions of disabled people and their influencers

Elliott Johnson

Activity Alliance (formerly English Federation of Disability Sport)

Introduction: EFDS has undertaken studies into the perceptions of four groups that influence physical activity among disabled people: their supporters, non-disabled peers, activity deliverers and disabled people themselves. We are now able to present a 360° perspective, particularly with reference to inclusive sport (disabled and non-disabled people participating together).

Method: EFDS has commissioned a number of mixed-methods studies, including qualitative depth interviews, focus groups and exposure sessions as well as large-scale quantitative surveys.

Results:

•Disabled people cite psychological barriers–including personal perceptions and those of others–as the greatest challenge to participation, with physical and logistical barriers also apparent
•89% of disabled people’s supporters say they have some influence on disabled people’s activity. 68% think disabled people they support would like to be more active but too many practical and emotional barriers exist
•14% of non-disabled people are aware of having taken part in sport with disabled people. 67% had no prior knowledge of what the term ‘inclusive sport’ means but 73% are open to taking part with disabled people
•77% of activity deliverers have no experience of providing for disabled people, leading to low confidence and interest in such delivery. Many do not understand what the term ‘inclusive activity’ means but fear the concept might negatively impact non-disabled people

Conclusion: A lack of experience of inclusive activity and resulting psychological barriers are prevalent among those with influence on disabled people’s activity levels. An across-the-board approach is essential in increasing participation and improving health and wellbeing.

External funding details: Sport England and SOGB/Mencap

Interim evaluation results from the parkrun PROVE project

Helen Quirk, Steve Haake, Sheffield Hallam University

parkrun provides free-to-enter, weekly 5km running/walking events in community parks and open spaces. The “parkrun: running or volunteering for everyone” (PROVE) project aims to support the positive experience of parkrun by people with LTCs/disabilities by: i) understanding the prevalence of LTCs/disabilities among parkrunners, ii) recruiting ‘Outreach Ambassadors’ for LTC/disability groups, iii) implementing interventions that remove barriers and improve accessibility to parkrun, and iv) working with advocacy groups to promote parkrun to non-parkrunners with LTCs/disabilities. The evaluation will use data from parkrun statistics, surveys, interviews and observations. To date, parkrun has engaged with ten LTC/disability groups including deaf and hard of hearing, diabetes, endometriosis and learning disabilities and has appointed 24 Outreach Ambassadors. Interventions include accessibility guidelines, blog posts, newsletters, new volunteer roles and Facebook support groups. Baseline survey responses from 643 parkrunners across LTC/disability groups suggest that the majority of parkrunners with LTCs/disabilities have had a positive experience of parkrun, feel supported, feel part of a community, and have not experienced any difficulties accessing events. The most common method of being ‘referred’ to parkrun has been by word-of-mouth (55%), with almost no referrals being made via health professionals or charities. Surveys will be repeated every 6 months. Baseline interviews have been conducted (n = 16) with parkrunners and Outreach Ambassadors and will be followed-up up at 12 months. This evaluation will enable lessons to be learnt as the PROVE project develops.

External funding details: The PROVE project is funded by the Department of Health and Sheffield Hallam University have been commissioned to evaluate it.

Physical fitness and falls among rural elderly in Japan: A cross-sectional study

Koji Yamatsu, Saga University

Background: Fallings are common among the elderly population, since ageing is a risk factor of falling. It is important to prevent long-term care as a result of fall. Balance disorders and muscle weakness are associated with increased risk for falling among the elderly, but the relationship with falls is unclear among rural elderly. The aim of this study was to determine whether physical fitness was associated with falls among rural elderly.

Methods: Participants were 636 elderly (mean age: 73.6+/-7.3, male: 10.7%, mean body mass index [BMI]: 23.3+/- 3.5) living rural area in Japan. All participants completed the questionnaires and two types of physical fitness tests (hand grip-strength and usual walking speeds). The physical fitness tests were reported to be valid by previous study (Shinkai et al., 2000). Independent measures were handgrip force and walking speed.

Findings: Of 636 subjects, 21.4% reported falling during the past year. Even after controlling for covariates (age, sex, BMI, healthy eating, sitting time, exercise class adherence and chronic conditions), falls were associated with hand grip (OR = 0.94, 95% CI = 0.90, 0.98) and with walking speed (OR = 0.19, 95% CI = 0.07, 0.53).

Discussions: Hand grip-strength and usual walking ability were significantly associated with falls in Japanese rural elderly.

External funding details: This study was supported in part by JSPS KAKENHI Grant Number JP26282188 and JP15K12723 from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

The carry-over effect of an aquatic-based intervention in children with cerebral palsy

Rowena Naidoo, Samantha Ballington, University of KwaZulu-Natal

Background: Cerebral palsy (CP) is the most common motor disability in childhood. Children with CP are more likely to have decreased physical activity levels than their peers, thus they are at risk for negative health implications. However, there is a belief that aquatic exercise can be used for the improvement of the level of fitness among children with CP.

Objective: To determine the carry-over effect of an aquatic-based programme (postural control and balance) on land (walking, running and jumping) in children with CP pre- and post-intervention.

Methods: The study was a pretest-posttest randomised groups, cross-over design. Children (n = 10) were divided into intervention (n = 5) and control (n = 5) groups. The intervention group participated in two 30 minute sessions a week, while the control group continued with activities as per normal. Pre- and post-intervention testing was conducted using the Gross Motor Function Measure. The ten-point programme of the Halliwick Concept was used.

Results: Results demonstrated that the aquatic therapy had a significant effect on the Gross Motor Function Measure score. The aquatic-based group showed increased growth following the intervention compared to the control group (z = −2.803, p = 0.005). Furthermore, the aquatic-based therapy improved the average score for The Gross Motor Function Measure, post-intervention.

Conclusion: In conclusion, an 8-week aquatic-based intervention produced greater gains in gross motor function in children with cerebral palsy, hence producing a significant carry-over effect on land.

External funding details: University of KwaZulu-Natal College of Health Sciences Scholarship

Theme: Economics

Tuesday 16 October

Do local authorities’ resource allocation decisions have an impact on physical activity among adults: A panel study

Virpi Kuvaja-Köllner¹, Eila Kankaanpää², Johanna Laine², Katja Borodulin³, Tomi Mäki-Opas⁴, Hannu Valtonen²

¹University of Eastern Finland, ²Department of Health and Social Management, University of Eastern Finland, ³National Institute for Health and Welfare, ⁴University of Eastern Finland; National Institute for Health and Welfare

Background: In Finland, local authorities (municipalities) play a major role in providing many services, including sport and physical activity facilities. Most of the decision-making related to physical activity settings takes place at the local level.

Methods: The data on local resources for physical activity (expenditure on physical activity and sport, number of sports associations receiving subsidies from the municipality, kilometres of pedestrian walkways and hectares of parks) in 1999 and 2010 were gathered from national registers. This data were combined with a two-wave national survey data from the Health 2000 Study, conducted in 2000 and 2011. We had individual level data on physical activity in leisure time (N = 3,193) and commuting physical activity (N = 1,408). Due to this hierarchical data structure, i.e., where individuals are nested within municipalities, multi-level analyses are applied.

Results: The resources for physical activity increased and varied between municipalities. Still, these differences and changes did not explain the variation in individuals’ physical activity. Our model shows that mainly individual characteristics like higher education level, better health status and male gender increased leisure time physical activity. Living in an urban area increased physical activity and women practised more commuting physical activity than men.

Conclusions: The decision-makers should know better which facilities or what motivates citizens into being physically active, and then allocate local resources accordingly.

External funding details: This study was funded by Finnish Ministry of Education and Culture (DNRO 50/626/2012) and South Savo Regional fund.

Inequality in socio-economic status and the differences in physical activity pattern

Chutima Yousomboon, Kornkanok Pongpradit, Piyawat Katewongsa

Institute for Population and Social Research, Mahidol University

Introduction: Thailand is one of LMIC with the large inequalities between the rich and the poor in many ways such as incomes, occupation, and education. This created the difference in lifestyle, living standard, quality of life, including physical activity. This paper aims to examine the effects of differences in geographical residence, economic status, education level, or occupation on physical activity pattern among Thai population.

Method: National representative data of 7,602 samples aged 18 to 64 years from Thailand Physical Activity Surveillance System conducted in 2017 by Institute for Population and Social Research, Mahidol University supported by Thai Health Promotion Foundation was employed.

Results: It is found that the overall percentage of sufficiently MVPA among Thai population in 2017 is 72.9%. In the detail, people who lived in rural area (+1%), outside Bangkok (+5%), agricultural sector (+12%), and educated at primary education and lower (+3) would have higher percentage of sufficient MVPA comparing to others. Most of these groups of people are more likely to involve with work-related physical activity than leisure and recreation physical activity (chi-square = 199.334***).

Conclusion: The results confirmed that the differences in SES among Thai population, particularly occupation, continuously creating inequalities in physical activity opportunity.

External funding details: This project has been supported by Thai Health Promotion Foundation, Thailand

What’s a cycling master plan worth? HEAT 4.0 applied to cycling promotion schemes in Austria, Germany, France & the European Union

Randy Rzewnicki, ECF - European Cyclists’ Federation

Introduction: Could better health, less air pollution & CO2 & fewer crashes from cycling for transport really worth 10,000,000,000 € or even 20,000,000,000 €? Using the Health Economic Assessment Tool for walking and for cycling (HEAT), the estimated 134,00,000,000 kilometres cycled annually in the EU prevented 27,860 deaths per year worth 96,554,944,000 € (ECF, 2016).

Since that time, the HEAT has been updated to reflect the health consequences of air pollution, crashes and carbon emissions. The new user guide was published in 2017 and translations in French and German are available on the WHO website. The purpose of this study is to assess the value of cycling with the new tool for the European Union and a selection of member states.

Method: We calculate the value of cycling for transport in Austria, Germany, France and the European Union as a whole. For each population we use the best available data to value current rates of cycling. Likewise we apply the values for cycling projected by each relevant master plan or strategy.

Conclusion: The results of our calculations show that the value of cycling for society, the environment and the economy is higher than previously estimated, in line with research efforts to frame cycling as a form of active mobility with acknowledged multiple benefits. For political decision makers it delivers parameters for sustainable development and transport research policy: Investments in cycling, from planning and budgeting through construction and maintenance, can be realised in sustainable ways.

Theme: Environment

Tuesday 16 October

Barriers and facilitators to the implementation of 20mph speed limit schemes: A qualitative exploration

Kieran Turner¹, Graham Baker¹, Ruth Hunter², Ruth Jepson³

¹The University of Edinburgh, ²Queen’s University Belfast, ³The Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh

Introduction: Process evaluations are important in assessing the fidelity and quality of the implementation of an intervention. They also identify contextual factors associated with variation in outcomes. This presentation aims to understand the barriers and facilitators to the recent implementation of twenty mile per hour (30 kmh) speed limits in Edinburgh and Belfast.

Methods: Seventeen semi-structured interviews were conducted with key stakeholders based on their involvement within four areas of implementation of the schemes in Edinburgh and Belfast: legislation; introduction of signage; awareness-raising and education; and enforcement activities. These included representatives from the local authority, central government, and relevant enforcement agencies.

Purposeful and snowball sampling methods were used. Interviews investigated: what implementation consisted of; barriers/facilitators to implementation; contextual factors influencing implementation; and differences between implementation phases (Edinburgh only). Data were managed in NVivo 11, and key themes were identified using thematic analysis.

Results: Ensuring effective collaborative working between involved parties (i.e. the local authorities, enforcement agency, and schools) was described as facilitating implementation. Additionally, the geographical street layout of Edinburgh was viewed as lending itself to lower traffic speeds. One barrier to implementation identified in Edinburgh related to the lengthy statutory processes associated with introducing a scheme of such scale. Another barrier identified in both sites related to resources available for enforcement.

Conclusions: Authorities should note the substantial processes required before 20mph policies can be implemented and consider the importance of ‘joined-up working’ for effective implementation.

External funding details: This research was funded by a grant from NIHR grant number 15/82/12.

Built environment constructs for defining walking-friendly environments in Mexico and their correlates to physical activity among Mexicans

Celida Isabel Gomez Gamez¹, Eugen Resendiz Bontrud²

¹Universidad Iberoamericana, A. C., ²Instituto Nacional de Salud Publica

Studies investigating the built environment (BE) correlates of physical activity (PA) suggest that their relation may be context-specific. The US Walkability Index is considered a good predictor of PA in high income countries; however, their adequacy to middle income countries such as Mexico must be studied in consideration to more specific BE elements; elements such as aesthetics, proximity of parks, road and public safety are relevant BE features of PA. The purpose of this study is to identify the contextually-relevant BE measures that best define walking-friendly environments in Mexico and assess their correlates to PA among Mexicans.

The study has three phases. a) the identification of contextually-relevant perceived BE constructs for measuring PA in the Mexican context as reported in peer-reviewed literature in urban planning, urban design and architecture. b) the face validation of the constructs of relevance with public health, PA, urban planning and architecture leaders in Mexico. Third, the adaptation of current instruments such as the Abbreviated Neighborhood Environment Walkability Scale (A-NEWS).

Relevant BE constructs for PA among Mexicans were identified: public spaces realms, including parks, streets and plazas, as well as other pedestrian spaces, are relevant measures of BE in relation to PA. Safety from transit and public safety were contextually-appropriate variables. Obstacles for pedestrians (e. g. street vendors, public telephones) emerged as other important BE elements. This study drew on scientific evidence and the expertise of local leaders to identify key BE constructs for defining the characteristics of walking friendly environments in Mexican cities.

Characteristics of the environment and physical activity in midlife: Findings from UK Biobank

Lindsey Smith, Jenna Panter, David Ogilvie, University of Cambridge

Characteristics of the environment influence health and may promote physical activity. We explored associations between neighbourhood environmental characteristics grouped within five facets (spaces for physical activity, walkability, disturbance, natural environment, and the sociodemographic environment) and objective and self-reported physical activity in adults from UK Biobank.

Activity was assessed objectively using wrist-worn accelerometers (2013-2015, N = 65,967) and time spent in moderate-to-vigorous physical activity, walking, and walking for pleasure was self-reported (2006-2010, N = 337,822). We used objective data on 15 environmental characteristics and assessed the associations with five outcomes (recorded mean acceleration and time spent in MVPA, and reported time spent in MVPA, walking, and walking for pleasure) using linear and multinomial logistic regression models.

We found walkability and rural status were positively associated with physical activity. Participants living in areas with higher concentrations of air pollution recorded and reported lower levels of physical activity and those in rural areas and more walkable areas had higher levels of both recorded and reported activity. Some associations varied according to the specificity of the outcome, for example, those living in the most deprived areas were less likely to record higher levels of moderate-to-vigorous physical activity (upper tertile: RRR: 0.80 95% CI: 0.74, 0.86) but were more likely to report higher levels of walking (upper tertile: RRR: 1.09, 95% CI: 1.06, 1.13).

Environmental characteristics have the potential to contribute to different physical activities but interventions which focus on a single environmental attribute or physical activity outcome may not have the greatest benefits for public health.

External funding details: MRC

Cross-sectional associations of environmental perception with leisure-time physical activity and screen time among older adults

Ming-Chun Hsueh, Yung Liao, National Taiwan Normal University

Introduction: This study investigated the associations of perceived environmental factors with leisure-time physical activity (LTPA) and screen time (ST) among older adults.

Method: A cross-sectional study was conducted by administering computer-assisted telephone interviews to 1,028 older Taiwanese adults in November 2016. Data on personal factors, perceived environmental factors, LTPA and ST were included in the study. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the associations between environmental perception with LTPA and ST by using logistic regression analyses.

Results: The results showed that after adjusting for potential confounders, older adults who perceived their neighborhood with good access to shops (AS) and good access to public transportation (AT) were more likely to meet sufficient LTPA (AS: OR = 1.64, 95% CI: 1.16-2.32; AT: OR = 1.43; 95%CI, 1.00-2.03) and less likely to have excessive ST (AS: OR = 0.70; 95%CI: 0.50-0.97; AT: OR = 0.64; 95%CI: 0.46-0.90).

Conclusion: Different perceived environmental factors were also found to be associated with LTPA and ST, respectively. This study highlights environment perception as a crucial factor for LTPA and ST. These findings suggest that policy makers and physical activity intervention designers should develop both common and individual environmental strategies in order to improve and increase awareness of the neighborhood environment to promote LTPA and reduce ST among older adults.

Keywords: the senior citizens; perceived environmental factor; recreational physical activity; screen based sedentary behavior

Development and validation of the school physical activity index

Michalis Stylianou¹, Stewart Trost², James Woodforde¹

¹The University of Queensland, ²Queensland University of Technology

Introduction/Background: Schools have been identified as key physical activity (PA) promotion sites, and multifaceted and coordinated school PA programs have been proposed as a promising strategy to help youth meet the PA guidelines. This study’s purpose was to develop and assess the content validity and reliability of the School PA Index (SPAI), a self-assessment and planning guide for elementary schools that is based on a whole-of-school, multi-component approach to PA promotion.

Methods: This study involved four phases: (a) developing the SPAI based on relevant policies/guidelines, (b) assessing its content validity using expert feedback, (c) conducting cognitive interviews with Physical Education (PE) teachers, and (d) administering the SPAI to a sample of PE teachers two times, two weeks apart (test-retest). Data analyses included descriptive statistics for expert ratings and a review of qualitative feedback from phases (b) and (c). Analytical methods for phase (d) included percentage agreement and weighted Kappa coefficient to examine the reliability of responses to the SPAI items.

Results: In the content validity phase, experts (N = 28, 21 academics, 7 PE teachers/school PA coordinators) rated the relevance and clarity of the SPAI sections and items as high (M range: 5.81 – 6.76, on a 7-point scale). Qualitative feedback from the experts and cognitive interviews with three PE teachers were used to revise the SPAI. Participant (N = 19) responses in the test-retest phase demonstrated moderate to almost perfect agreement for the SPAI items.

Conclusion: The SPAI is a valid and reliable instrument for assessing PA policies and practices in elementary schools.

Development of a theoretical framework of children’s school travel behaviour

Erika Ikeda¹, Erica Hinckson¹, Karen Witten², Melody Smith³

¹Auckland University of Technology, ²Massey University, ³University of Auckland

Introduction: Children’s school travel behaviour is associated with multiple factors across numerous levels including built and social environments, school, household and the individual. The aim of this study was to test a theoretical framework of children’s school travel behaviour using structural equation modelling. The theoretical framework was developed based on Mitra’s Behavioural Model of School Transportation.

Method: A cross-sectional study of children aged 9-12 years across 19 schools was conducted in Auckland, New Zealand. An online softGIS survey was used to measure children’s travel mode and school route, and attitudes towards active school travel. Computer-assisted telephone interview (CATI) with children’s parents or caregivers was conducted to measure household socio-demographics and neighbourhood perceptions. School representatives were interviewed regarding their school policy and active travel programme. Built environment attributes around children’s school route were calculated using Geographic Information Systems (GIS). Descriptive statistics were generated using SPSS Statistics 24. Structural equation modelling was performed using Mplus Version 8.

Results: Overall, 1102 children participated in the study. A new, comprehensive model of children’s school travel behaviour was supported by multiple data sources that accounted for mediating and moderating effects. Car (46.2%) was the most frequently reported travel mode followed by walking (33.9%), public transportation (12.3%), bike (3.9%), scooter (3.2%) and skateboard (0.5%).

Conclusion: The theoretical framework of children’s school travel behaviour provides a comprehensive understanding of children’s school travel behaviour. This framework can contribute to policy making to improve children’s active school travel.

External funding details: Health Research Council of New Zealand

Influence of nature contact on PA in early childhood education and care (ECEC)

Hayley Christian¹, Liz Wenden¹, Pulan Bai¹, Stewart Trost², Clover Maitland¹, Michael Rosenberg¹, Gina Trapp³, Leanne Lester¹, Bryan Boruff¹, Jasper Schipperin⁴

¹The University of Western Australia, ²Queensland University of Technology, ³Telethon Kids Institute, ⁴University of Southern Denmark

Introduction: Natural outdoor experiences are associated with children developing a sense of identity, autonomy, psychological resilience, self-regulation, gross motor skills and healthy behaviours. This study investigated the relationship between nature contact within and surrounding ECEC centres and children’s PA.

Methods: The Play Spaces & Environments for Children’s Physical Activity (PLAYCE) Study collected 7 day accelerometer data from 1762 pre-schoolers attending ECEC (n = 118) in Perth, Australia. Audits collected data on natural environmental features (mature trees, shrubs/bushes, natural/artificial grass, edible gardens, flower beds). Access to green space within 500m of each centre was calculated using the Normalised Difference Vegetation Index (NDVI).

Results: Artificial grass was present in 66% of centres and many had no mature trees (37%), shrubs/bushes (35%), edible gardens (45%) or flower beds (67%). Each additional 10 shrubs/bushes and edible gardens were associated with 2-6 mins less MVPA per day at ECEC. The presence of natural and artificial grass (fake > artificial) and flower beds were associated with more PA per day at ECEC. The NDVI and educator-reported use of nearby green space was not associated with PA whilst at ECEC.

Conclusion: Some natural features in ECEC were not conducive to PA while others were positively associated with PA. The relationship between nature contact and children’s health may be dependent on the context and outcome of interest. Future research should investigate the interplay between natural features, PA and other health and development indicators in children attending ECEC.

External funding details: The PLAYCE Study is supported by the Western Australian Health Promotion Foundation (Healthway; #24219).

Park characteristics preferred for adolescent park visitation and physical activity: a choice-based conjoint analysis using manipulated photographs

Benedicte Deforche¹, Linde Van Hecke¹, Ariane Ghekiere¹, Jenny Veitch², Ilse De Bourdeaudhuij¹, Peter Clarys³, Nico Van de Weghe¹, Delfien Van Dyck¹, Jelle Van Cauwenberg¹

¹Ghent University, ²Deakin University, ³Vrije Universiteit Brussel

Creating environments supportive for physical activity, could be a valuable strategy to increase physical activity at the population level. The purpose of this study was to understand the relative importance of park characteristics for park visitation and park-based physical activity among adolescents, using manipulated photographs of parks. Participants (n = 1197, 54% girls, 13.4 ± 1.3 years) were asked to perform two sets of ten choice tasks. For each choice task, a choice had to be made between two photographs of a park where ten characteristics were manipulated: naturalness, upkeep, walking paths, outdoor fitness equipment/playground, sport field, benches, drinking fountain, peers, mother with children and homeless person. In the first set of choice tasks participants had to select the park most inviting for visitation, in the second, they had to select the park most inviting for physical activity. Hierarchical Bayes Estimations were used to calculate (1) average utilities that represent the desirability of each level within a characteristic and (2) importance scores which reflect the effect each park characteristic had on the choice. The results indicate that among the studied characteristics, park upkeep was the most important characteristic for park visitation and park-based physical activity followed by the presence of playground/outdoor fitness equipment and sport fields. Policymakers could ensure that parks are well maintained, have sport fields and outdoor fitness equipment in order to meet adolescents’ needs. Evaluation of such initiatives can confirm whether these park characteristics will influence actual adolescent park visitation and park-based physical activity.

External funding details: Research Foundation Flanders (FWO, 54488-G0A8514N)

School travel mode among adolescents: The NEArbY Study

Anna Timperio¹, Jenny Veitch², Billie Giles-Corti³, Suzanne Mavoa⁴, Ester Cerin⁵, Hannah Badland³, Kate Parker², Jo Salmon²

¹Deakin University, ²IPAN, Deakin University, ³RMIT, ⁴University of Melbourne, ⁵Australian Catholic University

Introduction: This study examined moderating effects of distance and perceived traffic safety on correlates of habitual school travel modes among adolescents in Melbourne, Australia.

Method: Adolescents (n = 468, 15.4 ± 1.6 y, 59% girls) self-reported usual frequency of 8 travel modes to/from school and agreement with 7 road safety items (summed score) and 19 barriers to walking/riding to school (collapsed into 6 categories). Regular (≥5 times/week) active transport (AT), public transport (PT) and car travel were computed. Objective built environment measures around homes and schools were generated. Mixed effects logistic regression was conducted.

Results: Overall, 46% regularly used AT, 76% PT and 55% regularly travelled by car. Regular AT was associated with personal, planning and safety-related barriers (OR = 0.3-0.6), intersection density around home (OR = 1.1), residential (OR = 1.1) and intersection (OR = 1.2) density around school, and distance from school to PT (OR = 0.2). Regular PT was associated with traffic safety concerns (OR = 1.1), distance (OR = 2.2) and personal, planning, social, infrastructure and safety-related barriers (OR = 1.7-3.2), and car travel with home residential density (OR=0.96). There were several interactions. Home PT options and intersection density were more conducive to AT, and planning-related barriers more prohibitive of car travel, at shorter distances to school. School residential density was positively associated with AT, and home PT options more prohibitive of car travel, with increasing distance. Personal, aesthetic and safety-related barriers were stronger deterrents, and school residential density more conducive, to AT among those with more favourable road safety perceptions.

Conclusion: The results highlight the complexity of influences on mode choice.

External funding details: NIH 1R01HL111378

The influence of neighborhood environment on obesity in Korean adults: Using Bayesian spatial modelling

Eun Young Lee, Sugie Lee, Bo Youl Choi, Jungsoon Choi, Hanyang University

This study aimed to examine the association between the neighborhood environment that provide more opportunities for physical activity (PA) and obesity in Korean adults using Bayesian spatial multilevel model to account spatial association. Data from 78,014 adults living in Gyeonggi province of Korea was drawn from the 2013-2014 Korean Community Health Survey. Korean government databases and Arc GIS software were used to measure neighborhood environment variables from 546 administrative districts of Gyeonggi province. A Bayesian spatial multilevel model was implemented across gender and age group (i.e. 19-39, 40-59, and over 60). Results showed that neighborhood environment that provide more opportunities for PA was negatively related to obesity. The study also found that women aged 19-39 years who lived in community with the farthest distance to public park were more likely to be obese (OR = 1.29, 95% CI = 1.01-1.65). Men aged 40-59 years who lived in community with farther distance to public PA facility were more likely to be obese (OR = 1.13, 95%CI = 1.03-1.23), while men who lived in community with higher population density were less likely to be obese (OR = 0.88, 95% CI = 0.79-0.98.) Overall, the neighborhood environment was more related to obesity in women ages 19-59 years, comparing with in men and women over 60. The findings suggest that neighborhood environments that provide more opportunities for PA may help to prevent the sharp increase of obesity. Creating more PA favorable neighborhood environment considering gender and age could provide a valuable strategy to reduce inequality in population health.

External funding details: This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT) (No. 2015R1C1A2A01054052)

Theme: Epidemiology

Monday 15 October

Applying a quantitative bias analysis to estimate attenuation of association between self-reported physical activity and colorectal cancer risk due to measurement error

Shahid Mahmood¹, Nga Nguyen², Julie Bassett², Robert MacInnis², Amalia Karahalios³, Neville Owen⁴, Roger Milne², Graham Giles², Dallas English³, Brigid Lynch²

¹The University of melbourne, ²Cancer Epidemiology and Intelligence division, Cancer Council Victoria, ³The University of Melbourne, ⁴Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne

Background: Although it is well known that self-reported physical activity is inaccurate, few investigators have attempted to adjust for measurement error when computing relative risks for health outcomes. We performed a calibration study and applied the attenuation factor to hazard ratios for physical activity and colorectal cancer risk from a cohort study.

Methods: A cohort of 235 Australian adults completed a telephone-administered IPAQ-short, and wore an accelerometer for seven days (Actigraph GTX3+, Freedson cutpoints applied). A validity coefficient and an attenuation factor were calculated from a structural equation model adjusted for age, sex, education and body mass index. The attenuation factor was applied to data from the Melbourne Collaborative Cohort Study to compute bias-adjusted hazard ratios and 95% confidence intervals (CI).

Results: Average daily minutes of physical activity reported in the IPAQ-short were significantly higher than the duration from accelerometry (54.5 vs 31.7 minutes, p = 0.003). The validity coefficient (0.32; 95% CI: 0.20-0.43) and attenuation factor (0.20; 95% CI: 0.12-0.28) were low, indicating substantial measurement error in the IPAQ-short. For participants reporting 150 minutes per week vs no physical activity, the hazard ratio for colorectal cancer risk before and after bias adjustment was 0.88 (95% CI: 0.68-1.13) and 0.52 (95% CI: 0.14-1.94), respectively.

Conclusions: Over-estimation of physical activity by the IPAQ-short attenuated the association substantially, suggesting that the protective effect of physical activity has been previously under-estimated. Our attenuation factor may provide other researchers using IPAQ-short the opportunity to undertake a quantitative bias analyses within their own studies and adjust estimates.

Associations of context-specific sitting time with cardio-metabolic risk in Australian adults

Paddy Dempsey¹, Nyssa Hadgraft², Elisabeth Winkler³, Bronwyn Clark³, Paul Gardiner³, David Dunstan⁴, Neville Owen⁴, Brigid Lynch⁵

¹Baker Heart and Diabetes Institute & Swinburne University of Technology, ²Swinburne University of Technology, ³University of Queensland, ⁴Baker Heart and Diabetes Institute, ⁵Cancer Council Victoria

Introduction: Higher volumes of sitting time are associated with adverse cardio-metabolic health outcomes. However, previous studies have predominately used total sitting or TV-viewing time as exposure measures, limiting potential inferences about context-specific sitting. We examined associations of sitting time in four contexts (occupational, transportation, TV/video-viewing, computer use) with clustered cardio-metabolic risk.

Methods: Participants (n = 3,429; mean age 58 years) without clinically diagnosed diabetes or cardiovascular disease were from the 2011-2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regression examined associations of self-reported context-specific sitting time with a clustered cardio-metabolic risk score (calculated from: waist circumference; blood pressure; fasting triglycerides; HDL-cholesterol; and, fasting glucose).

Results: After adjusting for potential confounders (socio-demographics and health behaviours, including physical activity), each hour/day of sitting was associated with significant (p < 0.05) increases in the clustered cardio-metabolic risk score for TV-viewing (0.04, [0.03-0.06]) and for computer use (0.04, [0.02-0.06]). When keeping the total amount of sitting time constant, and comparing each form of sitting to all other forms of sitting combined, TV-viewing (0.03, [0.01-0.05]) and computer use (0.02, [0.00-0.04]) were significantly more deleterious and occupational sitting was significantly less deleterious (-0.02, [-0.03-0.00]) than other forms of sitting.

Conclusions: More sitting time in leisure contexts was associated with higher cardio-metabolic risk scores. Of the ways to accumulate sitting, occupational sitting tended to be comparatively less adverse, while TV-viewing and computer use tended to be comparatively more deleterious. Limitations of our methods notwithstanding, these findings may assist in identifying priorities for sitting reduction initiatives.

Estimating the current and future cancer burden attributable to inadequate leisure-time physical activity among adults in Canada

Christine Friedenreich¹, Darren Brenner², Yibing Ruan¹, Abbey Poirier¹, Xin Grevers¹, Eduardo Franco³, Paul Villeneuve⁴, Stephen Walter⁵, Karena Volesky⁶, on behalf of the ComPARe Study Group⁷

¹Alberta Health Services, ²University of Calgary, ³McGill Univesity, ⁴Carleton University, ⁵McMaster University, ⁶McGill University, ⁷ComPARe

Background: Despite established associations between inadequate physical activity and cancer risk, levels of physical inactivity in Canada remain high. In the Canadian Population Attributable Risk of Cancer (ComPARe) study, we estimated the current and future proportion of cancer incidence attributable to inactivity in Canada.

Methods: We identified 15 cancer sites associated with inadequate physical activity. Age-sex-specific incidence data were combined with self-reported leisure-time physical activity prevalence data. We estimated the cancer burden attributable to moderate inactivity (energy expenditure between 1.5-3.0 kcal/kg per day) and inactivity (< 1.5 kcal/kg per day) and forecast the number of cases that could be avoided between 2012-2042 if the prevalence of physical inactivity was reduced.

Results: Approximately 79% of women and 69% of men in Canada were characterized as moderately inactive or inactive in 2000. Overall, 10.4% (10% for men and 11% for women) of incident cancers in 2012 were attributable to inadequate physical activity (11,048 cases). Encouraging projections demonstrated that if the prevalence of physical inactivity continues on the current trend, the proportion of attributable cases will decrease to 8.6% by 2042. However, if the prevalence of inactivity was reduced by 50%, a cumulative 39,701 cases of cancer could be prevented by 2042.

Conclusion: In Canada in 2012, 10.4% of incident cancers were attributable to inadequate physical activity. These results will help inform and prioritize strategies to increase physical activity, which could reduce future cancer burden in Canada.

External funding details: This research is supported by a Canadian Cancer Society Research Institute Partner Prevention Research Grant (#703106).

Physical inactivity, sedentary and suicidal behaviours of adolescents in Bangladesh

Asad Khan¹, Riaz Uddin¹, Tracy Kolbe-Alexander²

¹The University of Queensland, ²University of Southern Queensland

Introduction: Insufficient physical activity (iPA) and sedentary behaviours (SB) may have deleterious effects on adolescents’ mental health. This study aimed to examine the relationship between iPA and SB, as well as their interactions, with suicidal behaviours of Bangladeshi adolescents.

Methods: Data were from the 2014 Bangladesh Global School-based Student Health Survey (GSHS), a population-based survey of students aged 13-17 years in Bangladesh. Students reported on suicidal and PA behaviours along with socio-demographic characteristics.

Results: Of the participating students (n = 2,989; 35% female), 52% did not meet the recommended PA level (60 min/day), while 15% spent ≥3 hrs/day in SB. The weighted prevalence of suicidal behaviour was 4.9%, 7.4% and 6.3% respectively for suicidal ideation, suicidal plan, and suicidal attempt. Logistic regression analysis found that iPA and SB were independently associated with suicide attempts, after adjusting for age, sex, and weight status (OR = 2.01; 95%CI 1.36-2.96; and OR = 2.14; 95%CI 1.40-3.26, respectively). Further adjusted analyses showed that compared to active+non-sedentary students, students who were inactive+non-sedentary had nearly double the odds of attempting suicide (OR = 1.80; 95%CI 1.15-2.82), while the odds were four times higher for students who were inactive+sedentary (OR = 4.58; 95%CI 2.64-7.97). The odds were significantly higher among students who were inactive+sedentary compared to those who were inactive+non-sedentary or active+sedentary, although no significant difference was found between the two latter groups.

Conclusions: Students who are not sufficiently active and/or sedentary are at an increased risk of attempting suicides. Promoting PA and reducing SB can potentially minimise the burden of suicides in adolescents in Bangladesh.

Prolonged occupational standing: How long is too long for musculoskeletal health?

Leon Straker¹, Sharon Parry¹, Genevieve Healy², David Dunstan³, Pieter Coenen⁴

¹Curtin University, ²The University of Queensland, ³Baker Hearth and Diabetes Institute, ⁴Vrie University Medical Centre

Introduction: Given the increasing evidence of negative health consequences associated with too much sitting, workplaces are establishing initiatives to encourage workers to replace some sitting with standing. However too much standing is also associated with negative health consequences, both acute and chronic. To inform occupational health and safety policies regarding this issue the aim of this study was to systematically review evidence from laboratory studies to determine appropriate limits to avoid acute musculoskeletal discomfort from prolonged standing.

Method: Following PRISMA guidelines, a pre-registered search of databases using terms related to standing and work was conducted. Peer-reviewed journal articles published in English were selected which reported on laboratory studies examining musculoskeletal symptoms associated with standing for periods of longer than 20 minutes. Titles, abstracts and (if needed) full texts were independently screened by two authors and data were extracted from included articles. Dose-response relationships were examined via linear interpolation of pooled data. Sub-group analysis was conducted on participants who developed symptoms.

Results: Of 13,702 unique records, 507 full text articles were reviewed with 26 articles (reporting on 25 studies; n = 591 participants) meeting eligibility criteria. Pooled data indicated that musculoskeletal symptom intensity increased to a clinically meaningful level (>9/100) after 71 minutes of continuous standing for the whole group and after 42 minutes in the sub-group who developed symptoms.

Conclusion: Systematic review evidence from laboratory studies suggests workers should be encouraged to avoid continuous standing for longer than 40 minutes to minimise musculoskeletal discomfort.

Replacing objectively measured sedentary time with physical activity: Cross-sectional associations with cardiometabolic risk factors in Japanese employees

Naruki Kitano¹, Yuko Kai¹, Takashi Jindo¹, Kenji Tsunoda², Yumiko Onodera¹, Satoshi Hanawa¹, Tsutomu Kuchiki³, Ken Uchida⁴, Toshiya Nagamatsu¹

¹Meiji Yasuda Life Foundation of Health and Welfare, ²Yamaguchi Prefectural University, ³Hyogo University, ⁴Meiji Yasuda Shinjuku Medical Center

Introduction: Growing evidence indicates associations between substituting time of sedentary behaviors (SB) with equal time of physical activity (PA) and cardiometabolic risk factors (CmRFs). However, evidence on Japanese subjects who spend long durations in sedentary conditions is limited. We aimed to investigate the effect of reallocating time from SB to low-intensity PA (LPA) or moderate-to-vigorous PA (MVPA) with CmRFs in Japanese employees.

Methods: Study participants were 1,184 Japanese employees (52.1 ± 9.6 years; 72.1% women) from the 2017 Meiji Yasuda Lifestyle study who underwent annual health checkups for measuring CmRFs. Participants were instructed to wear an accelerometer for 10 days. Time spent in SB (≦1.5 METs), LPA (1.6-2.9 METs), and MVPA (≧3.0 METs) were evaluated. Days with ≧10 h of wear time were considered valid; participants with more than two valid weekdays and one weekend were included.

Results: Independent of potential confounders, isotemporal substitution modeling indicated that reallocating 30 min/day of SB into an equal duration of MVPA was associated with significantly more favorable waist circumstance (B = −1.17), HDL-c (B = 2.74), triglycerides (B = −9.84), and fasting glucose (B = −1.21), and was significantly related with lower prevalence of metabolic syndrome (OR = 0.75). In contrast, reallocating 30 min/day of SB into LPA was associated with significantly more detrimental LDL-c (B = 1.66) and triglyceride (B = 2.67).

Conclusion: The interrelationships between SB and PA concerning CmRFs would differ by PA intensity; replacing SB with MVPA seems to be effective in Japanese employees. Future studies using bouted/sporadic LPA are warranted to examine its associations with CmRFs.

The longitudinal relationship between unhealthy lifestyle behaviours and development of psychological distress

Gregory S Kolt, Ian Davidson, Tanya Meade, Emma S George, Western Sydney University

Introduction: A range of unhealthy lifestyle behaviours, including physical inactivity, unhealthy dietary intake, smoking, and alcohol consumption, have been shown individually to impact mental health, and in particular, psychological distress. Given that such unhealthy lifestyle behaviours often occur in combination, it is possible that the clustering of such factors has a more impactful effect on mental health. The aim of this study was to investigate the longitudinal association between unhealthy lifestyle behaviours and psychological distress.

Methods: Data for this study were drawn from the 45 and Up Study, a large-scale longitudinal cohort study of a range of health and social indicators in adults aged 45 years and older from across New South Wales, Australia. Participants were 25,152 adults with complete baseline and 5-year follow-up data for psychological distress (Kessler-10). An index of unhealthy lifestyles was constructed using binary indicators of whether a participant failed to adhere to published guidelines for physical activity, alcohol consumption, consumption of fruit, vegetables and processed meat, and tobacco smoking.

Results: After adjusting for age, gender, marital status, education, income, employment status, and BMI, participants with 4 (OR 1.50; 95%CI 1.06, 2.13), 5 (OR 2.48; 95%CI 1.56, 3.91), or 6 (OR 3.26; 95%CI 1.08, 9.86) unhealthy lifestyle behaviours at baseline had significantly higher odds of reporting high/very high psychological distress (Kessler-10 scores of ≥22/50) at follow-up compared with those with fewer unhealthy lifestyle behaviours at baseline.

Conclusion: A higher number of unhealthy lifestyle behaviours may lead to higher levels of psychological distress.

The socio-demographic correlates and domain-specific patterns of physical inactivity in diverse African populations: An individual pooled data meta-analysis of WHO STEPS survey data

Anna Louise Barr¹, Elizabeth Young², Manjinder Sandhu¹, Ayesha A Motala³

¹University of Cambridge, ²Wellcome Sanger Institute, ³University of KwaZulu-Natal

There is currently a limited understanding of the socio-demographic correlates of physical inactivity, and the domain-specific physical activity patterns, in African populations.

A two-step individual pooled data meta-analysis was conducted using data collected through the WHO STEPS tool in Democratic Republic of Congo (DRC) (n = 1757), Liberia (n = 2565) and South Africa (n=1202). We investigated associations between key socio-demographic measures and physical inactivity, and further examined domain-specific physical activity patterns within countries, and overall.

The age-standardised prevalence of inactivity was significantly different between DRC (26.2%; 95%CI:24.0%-28.4%), Liberia (31.0%; 95%CI:28.5%-33.5%) and South Africa (8.4%; 95%CI:6.8%-10.0%); pooled prevalence: 21.8 (95%CI:7.3%-36.4%; I² = 99.1%). Various socio-demographic factors were associated with increased risk of inactivity in individual populations, with women (RR:1.28; 95%CI:1.11-1.46; I² = 0.0%) and retirees (RR:2.01; 95%CI:1.18-2.84; I² = 0.0%) at a significantly higher risk of inactivity across all countries, after adjustment. Domain-specific physical activity proportions differed between inactive and active individuals and by sociodemographic group, with inactive individuals spending the majority of active time travelling and notably increasing proportions of time spent in recreational activity among increasingly educated individuals.

Consistent with previous work, we observed a high prevalence of physical inactivity across three African countries. Furthermore, we extend this to illustrate important differences in physical activity patterns by socio-demographic sub-groups. Our findings provide critical insight into the design and targeting of effective policies addressing physical inactivity in African populations. Data from seven additional countries are being analysed.

External funding details: This work is funded by the African Partnership for Chronic Disease Research strategic award from UK Medical Research Council (grant number MR/K013491/1).

U.S. Physical Activity Guidelines Advisory Committee 2018: Cancer Prevention & Survival

Anne McTiernan, Fred Hutchinson Cancer Research Center

According to the International Agency for Research on Cancer, there were 14.1 million new cancer cases and 8.2 million cancer deaths in 2012.The 2018 U.S. Physical Activity Guidelines Advisory Committee investigated associations between physical activity and risk for several types of cancer, as well as prognosis among cancer survivors. The Committee considered epidemiologic research conducted through 2016, and primarily relied on systematic reviews, meta-analyses, and pooled analyses of cohort and case-control studies. The Committee found strong evidence that high levels of physical activity reduce risk for bladder, breast, colon, endometrium, esophagus (adenocarcinoma), renal, and gastric cancers, with risk reductions ranging from approximately 10 percent to 20 percent. The Committee’s review of the literature on sedentary behavior and risk of endometrial, colon, and lung cancers found that highest versus lowest levels of sedentary time increased risks of these cancers by a range of 20 percent to 35 percent. The Committee further found inverse association between greater amounts of physical activity and decreased all-cause and cancer-specific mortality in individuals with a diagnosis of breast, colorectal, or prostate cancer, with risk reductions ranging from 38 to 48 percent. The Committee identified several needs for future research, including studies in diverse populations, studies to determine dose-response effects, and randomized controlled trials. This presentation will include the methodology used, the results obtained, and implications for the public and for cancer survivors.

When and how do adolescents sit? ActivPAL measured patterns of daily sitting time, bouts and breaks

Lauren Arundell¹, Jo Salmon², Harriet Koorts², Ana Maria Contardo Ayala², Anna Timperio²

¹Deakin Universtiy, ²Deakin Universtiy, Institute for Physical Activity and Nutrition (IPAN)

Introduction: Understanding how adolescents accumulate their sitting time is important for informing intervention studies. Patterns of adolescents objectively-measured sitting time, sitting bouts, and breaks in sitting during different periods of the day were examined.

Methods: Adolescents (n = 308, 15.4 ± 1.6 years) wore an activPAL^™ for 8 days. Data were extracted during early morning,id-morning, morning break, late morning, lunch, early afternoon, late afternoon and evening on weekdays and weekends, and school time, class time and out-of-school time on weekdays. For each period, the percentage of time spent sitting (%SIT), percentage of each hour in prolonged sitting (bout ≥10 minutes), and number of breaks/hour in sitting were calculated. Differences according to sex and week and weekend days were determined using t-tests.

Results: Participants spent 68% of their day sitting, 29-30% of each hour in prolonged sitting, and performed 3.1 breaks in sitting/hour. The proportion of time sitting was greater in school (70%) and class time (75%) than out-of-school time (65%). Compared to boys, girls had higher %SIT during class (76% vs 72%) and school hours (72% vs 67%), performed more prolonged sitting/hour during school hours (27% vs 23%), and had more sitting breaks/hour during out-of-school time (2.6 vs 2.4), but fewer during class (2.5 vs 3.3) and school hours (2.7 vs 3.3), respectively. %SIT differed between week and weekend days for all periods except for the evening period.

Conclusion: Adolescents spend the majority of their time sitting, with distinct patterns on weekdays and weekend days. Findings provide novel information for intervention development.

Tuesday 16 October

Association between mortality and time-use composition of the 24 hour day

Duncan McGregor¹, Sebastien Chastin², Philippa Dall¹, Javier Palarea-Albaladejo³

¹Glasgow Caledonian Unversity, ²Glasgow Caledonian University, ³Biomathematics and Statistics Scotland (BioSS)

Introduction: Previous studies of the association between mortality and physical activity have used isotemporal substitution. A compositional approach allows for co-dependency between different behaviour types and the relative scale of time-use data.

Methods: A prospective analysis of NHANES 2005-06 on N = 1134 adults (d = 105 deaths) between ages 50-79 was undertaken using Cox Proportional Hazards regression. Daily composition of time spent in sedentary behaviour (SB), light intensity (LIPA) and moderate to vigorous physical activity (MVPA) was determined from waist-mounted accelerometer data (Actigraph 7164) and supplemented with self-reported sleep data to determine the time-use composition of the day. The association of the composition with mortality was assessed both with and without covariates.

Results/findings: The composition of time spent in SB, LIPA, MVPA and sleep was significantly associated with mortality rates in the absence of covariates (p < 0.001), and allowing for age and sex (p = 0.011). This association appears to be driven primarily by the deleterious associations of high SB relative to MVPA and LIPA. No significant association was found after incorporating self-reported health assessment, or lack of mobility. All models considered explained a low proportion of the observed variation (R² < 0.1).

Conclusions: There was some evidence of a weak association between composition of the day and mortality rates, however this could not be distinguished from an individual’s current state of health. More data, or ideally longitudinal data, is needed to better understand the association.

External funding details: J. Palarea-Albaladejo has been supported by the Scottish Government’s Rural and Environment Science and Analytical Services Division.

Associations of physical activity and sedentary time with body composition outcomes in young adults

Bruna Gonçalves C. da Silva, Inácio Crochemore M. da Silva, Shana Ginar da Silva, Natália Peixoto Lima, Bernardo Lessa Horta, Federal University of Pelotas

Introduction: The aims of the present study are to evaluate 1) the association of changes in self-reported leisure-time physical activity (LTPA) from 23 to 30 years of age with body composition at 30 years and 2) the cross-sectional association of objectively measured physical activity and sedentary time with body composition at 30 years of age.

Methods: Analyses with participants from the 1982 Pelotas (Brazil) Birth Cohort were conducted. LTPA was measured using questionnaire when the individuals were 23 and 30 years old, and moderate-to-vigorous physical activity (MVPA) and sedentary time by accelerometer at 30 years. Body mass index, waist circumference, visceral abdominal fat, and fat mass index were evaluated at 30 years. Multiple linear regressions were performed and interaction between MVPA and sedentary time was tested.

Results: 3,206 subjects had information on LTPA at 23 and 30 years of age and at least one of the outcomes. Individuals who were active at 23 and 30 years and individuals who became active at 30 years had lower values of body composition. Individuals who became inactive had similar mean values to individuals who were inactive at both ages. Individuals with higher amount of MVPA had lower values of body composition at 30 years, but a high amount of sedentary time attenuated this benefit.

Conclusion: LTPA was inversely associated with adiposity, but there was no lasting association of previous LTPA on current body composition in young adults. Moreover, spending excessive time in sedentary activities attenuated the benefits of MVPA on body composition.

External funding details: From 2004 to 2013, the Wellcome Trust supported the 1982 birth cohort study. The International Development Research Center, World Health Organization, Overseas Development Administration, European Union, National Support Program for Centers of Excellence (PRONEX), the Brazilian National Research Council (CNPq), and the Brazilian Ministry of Health supported previous phases of the study.

Does reallocation of time from sedentary bouts to physical activity reduce adiposity in children?

Ales Gaba¹, Jan Dygryn¹, Nikola Stefelova¹, Karel Hron¹, Zeljko Pedicis², Dorothea Dumuid³

¹Palacky University Olomouc, ²Victoria university, ³University of South Australia

Substituting sedentary time with physical activity (PA) has several health benefits. However, the effects of reallocating time from different sedentary bouts (SBs) to PA on health outcomes are not well-known. This study investigates the effects of reallocating time spent in different SBs to light-intensity (LIPA) and moderate-to-vigorous PA (MVPA) on adiposity in children. Participants were 425 school-aged children. Total sedentary time (TST) and time spent in different SBs (i.e., 1–9, 10–29 and ≥30 min) and PA were monitored using an ActiGraph accelerometer. Adiposity was expressed as fat mass percentage. To investigate the effects of reallocating TST and time spent in different SBs to PA, the compositional isotemporal substitution model was applied. The composition of movement behaviors was significantly associated with adiposity (R² = 0.07; p < 0.001). Further, the relative contributions of time spent in 10–29 min SB (β_ilr = 0.21; p = 0.036), LIPA (β_ilr = 0.37; p = 0.045) and MVPA (β_ilr = −0.21; p = 0.004) were associated with adiposity. A negligible decrease in adiposity while reallocating TST and time in SBs to LIPA was observed. In contrast, reallocating 1 h/week of TST to MVPA resulted in a decrease of about 0.3 percent points in body fat percentage. The maximum effect on adiposity was observed while time from 10–29 min sedentary bout was reallocated to MVPA. In this case, body fat percentage decreased of about 0.4 percent points with every hour reallocated from 10–29 min SB to MVPA. Replacing sedentary time with MVPA is associated with positive effects on adiposity in children.

Daily walking time and traditional and novel inflammatory biomarkers in the elderly: A subcohort from NISSIN Project

Wenjing Zhao¹, Akiko Tamakoshi¹, Shigekazu Ukawa¹, Jun Morinaga², Motoyoshi Endo², Takashi Kawamura³, Kenji Wakai⁴, Kazuyo Tsushita⁵, Masahiko Ando⁶, Yuichi Oike², Koji Suzuki⁷

¹Faculty of Medicine, Hokkaido University, ²Graduate School of Medical Sciences, Kumamoto University, ³Kyoto University Health Service, ⁴Nagoya University Graduate School of Medicine, ⁵Comprehensive Health Science Center, Aichi Health Promotion Public Interest Foundation, ⁶Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, ⁷Fujita Health University School of Health Sciences

Introduction: There is growing evidence that shows the association between physical activity and inflammatory biomarkers. But it is not yet clear whether daily walking is associated with the traditional and novel inflammatory biomarkers in the elderly.

Method: A subcohort of 715 Japanese community-dwelling residents aged 64/65 years was abstracted from an age-specific prospective cohort study, NISSIN Project (The sampling fraction, about 25%). Daily walking time was evaluated by self-reported questionnaires at baseline and inflammatory biomarkers were measured at baseline and after about 5-year follow-up. Generalized linear model was applied to analyze the cross-sectional and longitudinal association between daily walking time and each protein. The crude and multivariate adjusted model were conducted.

Results: Walking >= 0.5 hour/d was inversely and significantly associated with plasma Angiopoietin-like protein 2 level, and this cross-sectional association did not substantially change after adjustment for gender, work status, tobacco use, alcohol assumption, sleep duration, medical status of hypertension, hyperlipidemia and diabetes mellitus, history of heart disease, cerebrovascular disease and cancer, BMI, dietary behavior and hs-CRP. Walking >= 2 hours/d was positively and significantly associated with plasma adiponectin level before and after full adjustment. But the longitudinal association of daily walking with ANGPTL2 or adiponectin level was not detected. No any significant association between daily walking and hs-CRP was found.

Conclusion: We found the cross-sectional association of daily walking with the novel pro-inflammatory biomarker of ANGPTL2 and the anti-inflammatory biomarker of adiponectin. It provides new evidence of mechanisms between physical activity and health in the elderly.

Individual, social and environmental determinants of physical activity in peri-urban Australia

Jenny Olson¹, Sonja March², Stuart Biddle³, Michael Ireland²

¹University of Southern Queensland, ²Institute for Resilient Regions, University of Southern Queensland, ³Physically Active Lifestyles Group (USQ-PALs), Institute for Resilient Regions, University of Southern Queensland

Peri-urban Australians experience poorer health/wellbeing compared to residents of major cities. Physical activity is critical for health and wellbeing; however, 70% of this population are insufficiently active. Neither benefiting from the range of activity-conducive characteristics of major cities, nor the full consequences of extreme isolation in rural localities, peri-urban communities are unique and warrant specific consideration. This study examines the correlates of physical activity among peri-urban Australians. The design was a quantitative cross-sectional survey of adults living in peri-urban Australia. The outcome was self-reported moderate and vigorous leisure-time physical activity (MVPA) in the previous week. Correlates were based on our prior qualitative work and established theoretical frameworks. These included demographic, health, psycho-social and environmental factors. Preliminary analyses identified self-rated health, BMI, social cohesion, community participation, neighbourhood self-selection, aesthetics, autonomy, intentions, attitudes, norms, perceived behavioural control, action planning and automaticity as significant correlates of MVPA. Psycho-social factors demonstrated the strongest correlations with MVPA (e.g. intentions, r = 0.468). Together, predictors explained a large proportion of variance (28.5%, p = < .001) in MVPA. Individually, only intentions were uniquely associated with MVPA (b = .34, p < .001). This study is the first to systematically examine empirically- and theoretically-derived correlates of physical activity in this vulnerable population. Explaining almost a third of all variability in physical activity, the results can inform the development of policy and interventions designed to support physical activity participation for improved health among peri-urban Australians.

External funding details: JO was supported by an Australian Government Research Training Program Scholarship.

Influence of accelerometer calibration approach on MVPA estimates for adults

Charles Matthews¹, Sarah Keadle², David Berrigan¹, John Staudenmayer³, Pedro Saint-Maurice¹, Richard P. Troiano¹, Patty S. Freedson³

¹U.S. National Cancer Institute, ²California Polytechnic State University, ³University of Massachusetts – Amherst

Purpose: To compare estimates of moderate-vigorous physical activity (MVPA) duration derived from accelerometers calibrated only to walking and running activities to estimates from calibrations based on a broader range of lifestyle and ambulatory activities.

Methods: In a study of 932 older (50-74 yrs) adults we compared MVPA estimates from accelerometer counts based on three ambulatory calibration methods (Freedson 1952 counts/min (cpm); Sasaki 2690 cpm; activPAL 3+ METs) to estimates based on calibrations from lifestyle and ambulatory activities combined (Matthews 760 cpm; Crouter 3+ METs; Sojourn3x 3+ METs). We also examined data from up to 6 previous-day recalls describing the MVPA in this population.

Results: MVPA duration values derived from ambulatory calibration methods were significantly lower than methods designed to capture a broader range of both lifestyle and ambulatory activities (p < 0.05). MVPA (hrs/d) estimates in all participants were: Freedson (median [inter-quartile range] = 0.35 [0.17-0.58]); Sasaki (0.91 [0.59-1.32]); and activPAL (0.97 [0.71-1.26]) compared to Matthews (1.82 [1.37-2.34]); Crouter (2.28 [1.72-2.82]); and Sojourn3x (1.85 [1.42-2.34]). Recall-based estimates in all participants were comparable (1.61 [0.89-2.57]) and indicated participation in a broad range of lifestyle and ambulatory MVPA.

Conclusion: Accelerometer calibration studies that employ only ambulatory activities may produce MVPA duration estimates that are substantially lower than methods calibrated to a broader range of activities. These findings highlight the potential to reduce differences among device-based measures of MVPA due to variation in calibration study design by including a variety of lifestyle and ambulatory activities.

Lipoprotein subclasses and their associations with physical activity and sedentary time in Norwegian schoolchildren: The Active Smarter Kids study

Paul Remy Jones¹, Olav Martin Kvalheim², Geir Kåre Resaland³, Sigmund Alfred Anderssen¹, Ulf Ekelund¹

¹Norwegian School of Sport Sciences, ²University of Bergen, ³Western Norway University of Applied Sciences

Background: Physical activity (PA) is associated with certain lipoproteins, but not consistently across lipoprotein subclasses. We examined cross-sectional associations in children between objectively measured PA and sedentary time (SED) with a number of biomarkers of lipoprotein metabolism.

Methods: We included 1055 healthy fifth-grade (mean age 10.2 yrs) Norwegian schoolchildren (47.4% females). PA intensity (light (LPA); moderate (MPA); vigorous (VPA)), and SED were assessed using accelerometry. We quantified 31 measurements of lipoprotein metabolism using nuclear magnetic resonance spectroscopy. We used linear regression (median regression for skewed data) models adjusted for age, sex, sexual maturity and socioeconomic status. Additional models were adjusted for adiposity. An isotemporal substitution regression model quantified associations of replacing 30 minutes LPA or SED with 30 minutes MVPA. We applied a false discovery rate adjustment to p-values.

Results: Total PA, LPA, MPA, VPA and SED were associated with 10, 0, 16, 19 and 5 of the 31 biomarkers, respectively. The number of significant associations were attenuated after adjusting for adiposity (10, 0, 12, 11, and 0), respectively. Substituting 30 minutes of SED or LPA for MVPA revealed significant associations with 22 and 21 biomarkers, respectively. Following adjustment for adiposity, 10 and 12 associations, respectively, remained statistically significant (p < 0.05).

Conclusion: PA of higher intensity is associated with certain biomarkers of lipoprotein metabolism independent of adiposity. Substituting SED or LPA for MVPA shows favourable associations with these biomarkers. This suggests that increasing PA of at least moderate intensity may favourably affect lipoprotein metabolism in healthy children.

External funding details: Research Council of Norway

Longitudinal relationships of physical activity and aerobic fitness with academic achievement in Japanese adolescents

Akira Kyan, Minoru Takakura, Masaya Miyagi, Minoru Kobayashi, University of the Ryukyus

Background: Physical activity (PA) and aerobic fitness (AF) do not only play an important role in improving health outcomes but also the level of academic achievement (AA) of adolescents. However, its causal relationship remains debatable. The purpose of this study was to explore the impact of PA and AF on the academic achievement of junior high school students over a three-year period.

Methods: In 2015, baseline data were collected from a total of 608 grade seven students (326 boys) at five public junior high schools in Okinawa, Japan. Of these, 570 students (304 boys) were eligible at the end of the two years. AF was assessed through the 20-meter shuttle run test. To gain information about students’ PA, the 2-item assessment instrument (PACE+) was administered. Academic achievement was evaluated using the overall grade point average (GPA). To determine the predictive value of AF and PA at baseline for AA at follow-up assessment 2 years later, multiple linear regression analyses were conducted. All analyses were adjusted for BMI, family structure, parental education level, achievement motive, and baseline values of AA.

Results: After adjustment for the confounding factors, high AF was associated with higher subsequent GPA in boys. In girls, neither PA nor AF at baseline was associated with the overall GPA at follow-up.

Conclusions: We found a significant positive effect of AF on AA after adjusting for parental socioeconomic status and weight status, and psychological characteristics in boys.

External funding details: This study was supported by JSPS KAKENHI Grant Number JP15K12725.

Maintaining a high fitness physical activity pattern reduces cardiometabolic risk in Malaysian adolescents

Zoi Toumpakari¹, Russell Jago¹, Angeliki Papadaki¹, Yazid Jalaludin², Maznah Dahlui², Shooka Mohammadi², Nahar Mohamed², Tin Su², Hazreen Majid², Laura Johnson¹

¹University of Bristol, ²University of Malaya

Introduction: Limited evidence exists on physical activity (PA) patterns and cardiometabolic risk in Malaysia. A novel high-fitness PA pattern score, characterised by high frequencies of football, cycling, and activity in the evening, after school and at the weekend, was investigated for cardioprotective associations during adolescence

Methods: Participants (N = 1,828) were from the Malaysian Health and Adolescent Longitudinal Research Team study (MyHeARTs). Adolescents self-reported PA. Body Mass Index (BMI), fitness, waist circumference, % body fat, systolic and diastolic blood pressure (BP), fasting plasma glucose, LDL cholesterol and triglycerides were measured. Reduced Rank Regression derived a pattern incorporating the type/timing of physical activity from 13-17y, explaining 13% variation in cardiorespiratory fitness. Linear multilevel models estimated PA pattern trajectories by age. Standardised regression coefficients measured associations of PA trajectories with cardiometabolic risk at 17y adjusting for demographics, lifestyle, puberty and baseline cardiometabolic factors (in n = 508 with complete data).

Results: PA pattern score was mean -0.07 (SD 1.2) at 13y and declined by mean -0.0001 (SD 0.04) per year. A higher baseline PA pattern score was associated with a decrease in systolic BP (B = −0.07, p = 0.02) at 17y, and a faster decline in the pattern score was associated with an increase in later waist circumference (B = 0.11, p = 0.02) and BMI (B = 0.11, p = 0.01). There was no evidence of associations with other risk factors.

Conclusion: Targeting behaviours characteristic of a high-fitness PA pattern in early adolescence and preventing their decline, may help to reduce cardiometabolic risk later on.

External funding details: Funded by Medical Research Council grant MR/P013821/1.

Objectively assessed moderate-to-vigorous physical activity is strongly associated with cardiovascular disease after 15 years

Ing-Mari Dohrn, Maria Hagströmer, Karolinska Institutet

Introduction: We investigated associations of objectively assessed physical activity (PA) and sedentary time with morbidity in a nationally representative sample with 15-years follow-up.

Methods: Data from 1221 women and men, 18-75 years, from the population-based Sweden Attitude Behaviour and Change study were included. Exposure variables were tertiles of daily time spent sedentary, in light intensity PA and in moderate-to-vigorous PA (MVPA), and total counts from an Actigraph 7164 accelerometer. Data on diagnosed cardiovascular disease (CVD), cancer, type-2 diabetes, obesity, depression, dementia, and stroke were obtained from the National Patient Register, which includes all in-patient and out-patient care in Swedish hospitals. Kaplan-Meier survival curves and Cox proportional hazards models estimating hazard ratios (HR) with 95% confidence intervals were used for analyses.

Results: Over 14.2 years follow-up, 425 persons were diagnosed with at least one of the diseases. Kaplan-Meier analyses showed lower morbidity for CVD, cancer, obesity, dementia, and total morbidity for those in the highest tertile of MVPA compared with the lowest tertile; and lower morbidity for CVD, cancer, type-2 diabetes, and obesity in the highest tertile of total counts compared with the lowest tertile (p < 0.05). Those in the highest MVPA tertile had a HR = 0.51 (0.32, 0.82) for CVD, HR = 0.88 (0.58, 1.33) for cancer, and HR=0.63 (0.48, 0.82) for total morbidity compared with those in the lowest tertile. A similar pattern was found for total counts. No associations were found between morbidity and light intensity PA or sedentary time.

Conclusion: This study confirms the importance of MVPA for preventing chronic disease.

External funding details: The original ABC study was funded by Stockholm County Council, Swedish National Centre for Research in Sports, and the project ALPHA, European Union Public Health Programme (agreement 2006120). This study was funded by Folksam Insurance, Sweden.

Physical activity and risk of myocardial infarction: An analysis of lifestyle behaviours in a large population-based cohort

Jason Lacombe¹, Miranda Armstrong², Charlie Foster², Lucy Wright¹

¹University of Oxford, ²University of Bristol

Myocardial infarction (MI) is responsible for 200,000 hospital admissions per year in the United Kingdom (UK). Physical inactivity, an unhealthy diet, smoking, and alcohol consumption are major modifiable lifestyle risk factors for MI. Here we examined the independent associations of these four lifestyle behaviours with incident MI and all-cause mortality in UK adults. We followed a total of 349,337 participants from the prospective UK Biobank Study (recruitment 2006-11). To assess physical activity (PA), questions on the baseline touchscreen questionnaire about walking, moderate PA and vigorous PA, which are similar those found in the International Physical Activity Questionnaire, were used to estimate metabolic equivalent (MET) minutes/week of PA. Cox regression models were used to calculate the associations between PA, smoking, alcohol consumption, or fruit and vegetable intake with incident MI or all-cause mortality. During an average of 7 years follow-up, 3955 participants had experienced a first MI event, and 7230 had died. The greatest reduction in MI risk occurred in those who met PA guidelines (600-999 MET-minutes/week) when compared to inactive participants (<120 MET-minutes/week (RR = 0.75, 95% FCI 0.69-0.81). No additional benefit was observed for higher levels of PA. Those who were most active (≥8000 MET-minutes/week) saw the greatest reductions in risk of death (RR = 0.74, 95% FCI 0.67-0.83). Healthier levels of all four lifestyle behaviours led to reduced risk of death (ptrend <0.001). Overall, healthier behaviours reduced the risk of incident MI and all-cause mortality.

External funding details: Jason Lacombe is supported by the British Heart Foundation as part of a non-clinical studentship.

Physical activity correlates in the Thai population: A systematic review

Nucharapon Liangruenrom¹, Melinda Craike¹, Stuart Biddle², Zeljko Pedisic¹

¹Victoria University, ²University of Southern Queensland

Introduction: Understanding determinants and correlates of physical activity (PA) is crucial for the development of effective PA promotion strategies. No previous studies have systematically reviewed evidence on correlates of PA in the Thai population. This review, therefore, summarises available evidence on individual, social, environmental, and policy-related correlates of PA in the Thai population.

Method: A systematic literature search was conducted through ten bibliographic databases with additional articles identified through secondary searches including reference lists, relevant websites of Thai health organisations, Google, and Google Scholar. Study selection was conducted independently by two authors.

Results: A total of 73 included studies investigated associations of PA with its 32 potential correlates among children and adolescents, 61 potential correlates among adults, and 75 among older adults. For nearly half of the explored variables the studies reported predominantly significant associations with PA (49.4%). However, consistent evidence from multiple studies was only found for the associations of higher PA levels with: male gender and lower age among children/adolescents; male gender and lower education level among adults; and higher income, better self-rated general health, better mental health, lower perceived barriers of exercise/PA, and better neighbourhood environment and facilities among older adults.

Conclusion: A number of correlates of PA in the Thai population have been explored in individual studies. However, strong evidence from multiple studies is lacking for most PA correlates. More studies on correlates in the Thai population are needed, particularly on social, environmental, and policy-related factors that are potentially related to PA.

Physical activity, sedentary behaviour and obesity in elderly women: A compositional analysis

Jana Pelclova, Nikola Štefelová, Jan Dygrýn, Jana Hodonská, Palacký University Olomouc

Purpose: The aim of the study was to investigate the combined effect of time spent in SB, light-intensity PA (LIPA), moderate PA (MPA) and vigorous PA (VPA) on the risk of obesity within a robust compositional data analysis framework in elderly women. Compositional character of the data was considered when conducting the analysis.

Methods: Accelerometer and body composition data of 314 elderly women (aged 66.6 ± 6.5 years, BMI 27.1 ± 4.4 kg/m², percent of body fat (FM%) 36.1 ± 7.1) were included into analysis. At least 7 valid days of monitoring with 10 h of accelerometer wear per day were required. According BMI values, the sample was divided into non-obese (111 women) and obese (203 women) group.

Results: According to compositional mean barplot, SB and VPA were the key drivers of the difference between non-obese and obese women. In obese women, the proportion of time spent in SB was higher by 11.7% and the proportion of time spent in VPA was reduced by 12.5% to the overall mean composition. In non-obese women, the proportion of time spent in SB was reduced by 20.5% and the proportion of time spent in VPA was higher by 24.2% to the overall mean composition. Results from compositional MM-regression implied that both BMI and FM% were positively associated with relative dominance of SB (β 1.83, 3.87, respectively, p < 0.001) and negatively associated with relative dominance of MPA and VPA (β ranging from -2.9 to -0.59, p < 0.001).

Conclusions: Re-allocating time from SB to MPA and VPA can prevent obesity in elderly women.

Risk of lung cancer and physical activity by smoking status and body mass index, the Norwegian Women and Cancer Study

Kristin Benjaminsen Borch¹, Elisabete Weiderpass², Tonje Braaten³, Merethe Selnes Hansen³, Idlir Licaj³

¹UiT, The Arctic University of Norway, ²3.Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway, ³Department of Community Medicine

Introduction: We aimed to investigate physical activity (PA) and risk of different histological subtypes of lung cancer according to smoking status and BMI and to take advantage of repeated measurements in a large cohort of women in Norway.

Methods: The study sample for the baseline data analysis consisted of 80,802 women. Repeated measurements of PA level, smoking, weight, and height were available for 54,691 women (63.2%), who were included in repeated measurement analyses combined with multiple imputation to address attrition. Cox proportional hazard regression models were used to calculate hazard ratios with 95% confidence intervals.

Results: During a median follow-up of 12.9 years, 782 cases of primary lung cancer were identified. We found an inverse dose-response association between PA and lung cancer overall. The results were consistent when using baseline data and repeated measurements of PA and possible confounders. We observed a similar trend for adenocarcinoma, but not for squamous cell or small cell carcinomas.

Conclusion: Our findings suggest a more pronounced association between lung cancer and PA levels in current and former smokers and in normal-weight and overweight participants with increasing PA levels.

External funding details: This project received financial support from the Norwegian Extra Foundation for Health and Rehabilitation through EXTRA funds, grant number 2012/2/0048 - 1220048001.

The role of exercise partner in sustained exercise participation among community-dwelling older adults: A 3-year longitudinal study

Yuya Fujii¹, Keisuke Fujii², Jaehoon Seol³, Naruki Kitano⁴, Tomohiro Okura³

¹Graduate School of Comprehensive Human Sciences, ²Ibaraki Prefectural University of Health Sciences, ³University of Tsukuba, ⁴Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare

Purpose: This study aimed to investigate whether the ratio of exercise participation at 3-year follow-up differs according to the presence of exercise partner and identify more favorable types of exercise partners among older adults.

Methods: A 3-year longitudinal study was conducted through a mail survey in Japan. Subjects were 688 older adults (mean age: 72.8 ± 5.6 years; men: 45.2%) who had the habit of exercising (at least once a week) at baseline. We asked them about the presence of an exercise partner, with the following options (multiple answers allowed): by oneself, with spouse, with same-gender friends, with opposite-gender friends, and with exercise experts. At the 3-year follow-up period, subjects were asked about their exercise habits again. To investigate the relationship between the presence of exercise partner at baseline and exercise participation at follow-up, a logistic regression analysis adjusted for potential confounders was conducted.

Results: People who exercise with others showed a higher ratio of exercise participation at follow-up than those exercising by themselves (OR: 1.70, 95%CI: 1.13-2.58). Among people who exercise with others, exercise with same-gender friends (OR: 2.05, 95%CI: 1.07-3.90), opposite-gender friends (OR: 2.50, 95%CI: 1.06-5.95), and exercise experts (OR: 3.62, 95%CI: 1.37-9.57) were favorably associated with the ratio of exercise participation. Exercise with a spouse was not associated with future exercise participation.

Conclusion: The presence of exercise partner may contribute to sustained exercise participation among older adults. Especially, friends and exercise experts might be favorable types of exercise partners.

Weekend catch-up sleep, physical activity and childhood obesity

Wendy Yajun Huang¹, Stephen H. Wong²

¹Hong Kong Baptist University, ²The Chinese University of Hong Kong

Introduction: This study aimed to measure the weekend catch-up patterns of sleep and physical activity over a 2-year period, and to examine the prospective associations between these weekend patterns and obesity in Chinese children.

Methods: Prospective data from 599 Chinese children (54% boys) in the Understand Children’s Activity and Nutrition (UCAN) cohort study were analyzed. Weekly patterns of obesogenic behaviors (physical activity and sleep duration) were assessed annually over a 2-year period. Moderate-to-vigorous physical activity (MVPA) and sedentary time were determined by ActiGraph accelerometry. Data on sleep durations and sociodemographic factors were obtained from parental-reports in response to questionnaires. Weekend catch-up sleep and MVPA patterns were calculated and examined in relation to childhood obesity after controlling for sociodemographic variables and sedentary time.

Results: Every additional hour of average weekly sleep duration was associated with a 16% decrease in the odds of obesity (OR: 0.841, 95%CI: 0.709-0.999). After adjustment of average sleep duration, weekend sleep catch-up categories showed no association with obesity risk. Over a 2-year period, approximately half of the children demonstrated weekend catch-up MVPA. Weekend catch-up MVPA for less than 20 minutes (OR: 0.473, 95%CI: 0.258-0.867) or more than 20 minutes (OR: 0.505, 95%CI: 0.257-0.993) were both related to lower risk of obesity.

Conclusions: Weekend catch-up sleep did not ameliorate the risk of childhood obesity, whereas weekend catch-up MVPA did reduce that risk. More research is needed to explore the factors contributing to these obesogenic behavior patterns.

External funding details: General Research Fund from the Research Grants Council, Hong Kong, China (GRF#451308).

Theme: Inequalities

Monday 15 October

An app that maps communities’ physical activity assets and barriers

Christine Hancock, Phil Veasey, Elisabeth Morgans, C3 Collaborating for Health

Background: Addressing the risk factor of physical inactivity can help curb the non-communicable disease (NCD) epidemic. CHESS^™ (Community Health Engagement Survey Solutions) is an innovative process to shift decision-making to local communities, while also reducing inequalities in the broader determinants of health. Emerging from research in India, China, Mexico and the United States, CHESS has been implemented in eight London boroughs and two United Kingdom communities.

Methods: CHESS engages communities in a data-driven investigation about health and the built environment. Using the CHESS application, community members collect and interpret quantitative data on local assets and barriers that are conducive to physical activity (or not!). Personal stories provide vital context about social, economic and health inequalities. These quantitative and qualitative results inform evidence-based recommendations, guided by public health expertise, for interventions that make it easier to be healthy. The community presents their recommendations to local decision-makers in a compelling argument for change. CHESS leverages social capital and mobile technology to address physical inactivity and equity issues, to make the healthy option the easy option for all.

Results: Thanks to evidence collected by CHESS, communities have been awarded over £2 million to improve physical activity opportunities in their neighbourhoods. An East London project led to two new playgrounds co-designed with local parents. And, outcomes from a recently completed project in Scotland and England (which engaged over 5,000 people) included improving access to physical activity options through sport sessions, dance sessions, community clean-ups of multi-use game areas, and indoor and outdoor activity sessions.

Girls Active

Chris Wright, Ali Goodall, Youth Sport Trust

Girls Active tackles declining physical activity in adolescent girls. It’s a partnership between teachers and girls working together to enable girls to fully engage in physical activity through leadership and marketing to develop, sell and deliver inspiring and relevant opportunities for all girls.

Girls Active starts with professional development for teachers, enabling them to reﬂect on practice and provision within school ensuring that girls are integral to designing, marketing and delivering opportunities to their peers.

Approaches include:

•Working with girls to revise the curriculum
•Using fundraising events as a basis for being active
•Profiling females as role models across the school
•Improving engagement in physical activity
•Creating a club for a targeted group of girls
•Raising adolescent health issues using physical activity e.g. breast cancer

Impact:

•Girls who look forward to PE (38% to 65.7%).
•62% improved their view physical activity
•50% more see activity as being feminine.
•Girls who look forward to sport (35.5% to 65.7%).
•73.3% ‘like the way they feel’ after physical activity
•50% increase in desire to be active
•Positive feelings about school (24% to 78%).
•50% increase in girls who enjoy coming to school
•Number of days each week taking part in physical activity outside of school increased by +14%
•Number of days each week taking part in 60 minutes or more of physical activity increased by +17%
•Minutes a day spent doing physical activity each week increased by +14% (from 72 minutes to 82)

External funding details: YST TOP Foundation, Sport England Lottery, NIHR Research Fund

Is physical activity in middle-income countries driven by necessity or choice? Exploring the roles of motor-vehicle ownership and socioeconomic status on transport-based physical activity in Cuernavaca, Mexico and Chennai, India

Deborah Salvo¹, Deepti Adlakha², Aaron Hipp³, Ross Brownson⁴, Michael Pratt⁵

¹The University of Texas School of Public Health, ²Queens University Belfast, ³North Carolina State University, ⁴Washington University in St. Louis, ⁵University of California, San Diego

Introduction: Findings from middle-income countries (MIC) support that necessity (vs. choice) drives physical activity (PA). This study examined the role of socioeconomic status (SES) and motor vehicle ownership (MVO) on transport-based PA in Cuernavaca, Mexico (MEX), and Chennai, India (IND).

Methods: Cross-sectional analysis of 674 and 367 adults (≥18 years) from MEX (2011), and IND (2015), respectively. Data were collected using standardized procedures of the International Physical Activity Environment Network study. Outcomes (yes/no) were: public transit use; active travel, ≥150 minutes/week of transport-based PA (TPA). Three logistic regression models were run per outcome: SES (income) as single-independent variable, MVO as single-independent variable, and SES plus MVO as mutually-adjusted independent variables. Models were adjusted for age, sex, marital status, and neighborhood cluster.

Results: In both sites, SES was inversely associated with public transit use, active travel, and TPA. After adjusting for MVO, the relation between SES and public transit use was no longer significant. In both sites, SES (IND: OR = 0.1, 95%CI = 0.1-0.4; MEX: OR = 0.7, 95%CI = 0.5,1.0) and MVO (IND: OR = 0.2, 95%CI = 0.0,0.6; MEX: OR = 0.2, 95%CI = 0.2,0.4) remained independently and inversely associated with active travel, and with TPA only in IND ([SES]OR = 0.1, 95%CI = 0.1,0.2, [MOV]OR = 0.3, 95%CI = 0.1,0.8). In MEX, only MOV remained significantly associated with TPA (OR = 0.7, 95%CI = 0.5,1.0).

Conclusion: Findings suggest that drivers of transport-based PA in MICs may be both necessity- and choice-driven. The independent effect of MVO on active travel implies that necessity is an important contributor. Sociocultural norms such as status, social stigma, and cultural beliefs also appear to influence transport-based PA in MICs.

External funding details: This work was supported by an NCD Prevention Training Grant from the CDC Foundation (Mexico site), and by an International Dissertation Award from the Brown School of Washington University in St. Louis (India site).

Older Canadian adults living in public housing’s perceptions of access to physical activity in their residential environment: a study using walk-along interviews

Kadia Saint-Onge, Paquito Bernard, Célia Kingsbury, Janie Houle, Université du Québec à Montréal

Introduction: Older adults and low-income individuals have been described as “hard to reach” through physical activity promotion. Worldwide, health inequalities have been observed between older adults having a low-income compared to the general population. In Quebec, Canada, the gap is even greater between low-income individuals living in public housing and those living in private dwellings. Improved access to physical activity in their residential environment (apartment, building and close neighbourhood) could possibly improve older adults living in public housing’s activity levels and thus their well-being.

Method: Individual walk-along interviews were conducted with 27 older adults living in three public housing sites in Montreal, Canada. Thematic analysis served to survey perceptions of opportunities, facilitators and barriers to everyday all-level physical activity. Two raters coded transcripts guided by the Environmental human-friendliness model (EHF). It identifies four residential environment structures considered to foster well-being: 1) physical (built environment), 2) functional (available services), 3) participative (community participation) and 4) sociocultural (interpersonal interactions).

Results: Notable factors emerged from the participative, functional and sociocultural structures, but not the physical structure. Facilitators include an active tenants’ association as well as knowledge and availability of low-cost opportunities, accompanied by information on which are appropriate according to specific health conditions. Conversely, interpersonal relations and low perception of control on their environment could hinder tenants’ physical activity.

Conclusion: The EHF model allowed to reveal factors that may specifically help or hinder older adults living in public housing’s physical activity. Potential courses of action will be discussed.

External funding details: Funded by the FRQ-SC.

Outdoor sports participation of women in urban areas of southern Europe: Motives and barriers

Vicky Dellas, Agnes Elling-Machartzki, Mulier Instituut

There are numerous advocacy and communication initiatives to enhance girls’ and women’s sport participation In European countries. However, less attention has been paid to design women friendly urban environments for recreational physical activity (RPA)/sports. Research showed that girls and women continue to experience more barriers, compared to boys and men regarding participation in outdoor PRA/sports. This may be especially the case in countries with lower gender equality in sports and larger society like many southern and eastern European countries.

The aim of this study is to identify barriers and motives of adolescent girls and women in southern Europe to participate in outdoor RPA/sports. The research is part of the larger Erasmus+ project Sport for women in Urban Places (SW-UP). A questionnaire will be distributed in March 2018 among adolescent (young) women, aged 15 to 65, in six southern European cities in five countries, with an aimed response of 200 per city. The questionnaire contains items about sociodemographic positions, sport participation, attitudes and about, possibly gender specific, motives and barriers (e.g. physical competence, self-consciousness, social support (partner/peers), experienced safety and inclusiveness to women of public sports places.

The results will be analyzed according to different structural and psychosocial perceived motives and barriers among specific groups of women (age, country of residence, education, household). The results will provide input to guidelines about how to further stimulate outdoor RPA/sports among different groups of women and how to design women friendly urban environments for outdoor RPA/sports.

Outdoor walking groups insufficiently address inequalities: Findings from a scoping review

Benjamin Rigby, Emily Oliver, Caroline Dodd-Reynolds, Durham University

Introduction: Outdoor walking groups are purportedly accessible physical activity interventions which may therefore address health inequalities. Critiquing this position, this paper presents findings from an equity-focused scoping review of published outdoor walking group literatures.

Methods: Arksey and O’Malley’s protocol was followed to develop a comprehensive search strategy and identify relevant academic and grey literatures, which were screened using pre-defined inclusion and exclusion criteria. An extraction form was developed to chart data and collate article characteristics. Data were organised by Cochrane PROGRESS-Plus equity characteristics and thematically analysed across: (1) equity integration strategies; (2) intervention reach; (3) effectiveness; (4) potential social determinants of engagement.

Results: Sixty-two articles were included. Key findings in each theme were: (1) Intervention trials were commonly targeted. Delivered programmes demonstrated principles of proportionate universalism by tailoring national schemes to regional activity and health needs. However, participant demographics seldom informed analyses. (2) Participation was more likely among white, middle-class, middle-to-older aged, female and able-bodied adults. (3) Positive physical and psychological outcomes did not extend along social gradients. (4) Interventions primarily addressed intermediary determinants (e.g. psychosocial barriers; material resource). Social capital (e.g. friend-making) was identified as potentially important for addressing physical activity inequities.

Conclusions: Outdoor walking groups insufficiently address inequalities as advantaged subpopulations are typically afforded preferential access. Future research may address inequalities through multi-paradigmatic approaches, which focus on social determinants, rather than individualistic ecological perspectives.

External funding details: ESRC/Wolfson Research Institute (Durham, UK).

Prevalence and correlates of objectively measured sedentary time among pregnant women in the UK

Janelle Wagnild, Helen Ball, Tessa Pollard, Durham University

Introduction: While sedentary behaviour has been increasingly examined among the general population, the prevalence and correlates of sedentary behaviour during pregnancy are poorly understood.

Methods: Pregnant women recruited from two hospitals in the North East of England wore activPAL accelerometers continuously for seven days during the 20th week of pregnancy (second trimester). Those who provided at least four valid days of measurement (n = 192) were included in analyses.

Results: On average, participants spent 9.57 hours (SD = 1.62) per day sedentary, which accounted for 65.2% of waking hours. Univariate analyses indicated that BMI (b = −2.65, p = 0.04) and index of multiple deprivation (IMD) tertile (p < 0.01 for trend) were significant predictors of sedentary time (minutes). However, in a multivariate model adjusting for age, BMI, and other factors, IMD tertile was the only significant predictor of sedentary time such that residing in a neighbourhood corresponding with the middle tertile was associated with significantly higher sedentary time (b = 49.6, SE = 19.2, p = 0.01) compared to the most deprived tertile. While the least deprived tertile followed a similar pattern, this did not reach significance (b = 30.4, SE = 19.5, p = 0.12).

Conclusion: In this sample of pregnant women, sedentary time accounted for the majority of waking hours, and living in less-deprived areas was associated with higher sedentary time than residing in the most deprived IMD tertile. These findings are among the very first to describe an association between socioeconomic position and objectively measured sedentary time during pregnancy.

Socioeconomic inequalities in participation and the amount of moderate-to-vigorous physical activity: analysis using the Health Survey for England 2008 and 2012

Shaun Scholes, Jennifer Mindell, Epidemiology & Public Health, University College London

Introduction: It is unknown whether describing socioeconomic inequalities using the average amount of time spent in moderate-to-vigorous physical activity (MVPA) masks differences in the proportion of persons that are active or differences in the amount of activity performed by those who are active.

Methods: Hurdle models are increasingly used in physical activity research to accommodate outcomes with a stack of zeros (non-participation) and a continuous positively-skewed part (amount amongst those active). Using the Health Survey for England (HSE 2008; 2012), we applied hurdle models to estimate inequalities in these two separate parts of MVPA data, and assess changes over time. Analyses were sex-specific and adjusted for potential confounders.

Results: Differences in the proportions of persons active per week were largest for overall MVPA (difference in percentage active for highest- versus lowest-income tertiles: 14.9 percentage points (pp) men; 12.7pp women); walking (20.5 pp; 15.8 pp); and sports (22.7 pp; 25.0 pp). Amongst those who were active, differences in the average hours-per-week (hpw) spent active between the highest- and lowest-income tertiles were most pronounced in overall MVPA [men: 3.8 hpw (95%CI: 2.6-4.9); women: 3.4 hpw (2.5-4.2)]. Amongst both sexes, time spent in sports/exercise was 1.3 hpw higher in the highest-income group. Time spent walking showed the opposite pattern amongst men [-1.9 hpw (-2.8 to -1.0)], but showed no difference amongst women. Patterns were similar in 2008 and 2012.

Conclusions: Inequalities were more pronounced for participation than for the amount of activity, highlighting the importance of tackling inactivity. Our results will be updated when HSE 2016 data are available (spring 2018).

Sports-based active recreation for children and young people living in marginalized neighbourhoods: a life course and settings-based approach for reducing inequality in health

Peter Elsborg¹, Glen Nielsen², Charlotte D. Klinker³, Julie H. Christensen³, Paulina S. Melby³, Peter Bentsen³

¹Steno Diabetes Center Copenhagen, ²Department of Nutrition, Exercise and Sports, University of Copenhagen, ³Health Promotion Research, Steno Diabetes Center Copenhagen

The rising global burden of non-communicable diseases (NCDs) amongst the lowest social classes in society has heightened the awareness of the necessity for primary risk prevention programs in marginalized neighborhoods.

Viewing this problem through a life course perspective and taking a risk population approach points to the solution of making sustainable changes with children and young people that belong to marginalized groups in society. This is proposed to be achieved through programs that facilitate long-term behavior changes in children and adolescents living in marginalized neighborhoods with the aim of reducing NCD risk factors and disease onset in later-life. Ample empirical evidence supports that extrinsic motives for participating in physical activities, such as increasing health, are insufficient when long term participation is the goal.

In this debate paper, we argue that interventions with the aim of reducing the social gradient in health should adopt a settings-perspective and include activities which hold both broad health and sustainable participation potentials. Here, we advocate that basing such interventions on sports-based active recreation hold several advantages. To argue these advantages a comprehensive argument model is presented demonstrating why interventions that provide sport-based active recreation activities are an especially beneficial direction for future interventions and intervention-based research.

External funding details: The research is funded by the Novo Nordisk Foundation (NNF17SH0026986).

Theme: Interventions—Adults

Monday 15 October

A rapid review to identify physical activity accrued whilst playing golf

Jack Luscombe¹, Andrew Murray², Evan Jenkins¹, Daryll Archibald³

¹University of Edinburgh, ²Physical Activity for Health Research Centre, University of Edinburgh, ³School of Psychology and Public Health, La Trobe University

Objective: To identify physical activity accrued whilst playing golf, and modifiers of physical activity accrued.

Design: A rapid review of primary research studies. Quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for cohort and cross-sectional studies.

Methods and outcomes: The following databases were searched from 1900 to March 2017: SPORTDiscus, Web of Science, PsycINFO, MEDLINE, Google Scholar, Google Advanced Search, ProQuest, World Health Organisation International Clinical Trials Registry Platform. All primary research investigating golf or golfers with any of the following outcomes was included: metabolic equivalent of task, oxygen uptake, energy expenditure, heart rate, step count, distance covered, strength, flexibility, balance, sedentary behaviour.

Results: Phase one searching identified 4944 citations and phase two searching identified 170 citations. In total 19 articles met inclusion criteria. Golf is primarily a moderate intensity physical activity, but may be low intensity depending upon the playing population and various modifiers. Less physical activity is accrued by those who ride a golf cart compared to those walking the course.

Conclusions: Golf can be encouraged in order to attain physical activity (PA) recommendations. Further research is required into the relationship between golf and strength and flexibility physical activity recommendations, and how modifiers affect physical activity accrued.

Systematic review registration: PROSPERO 2017:CRD42017058237

External funding details: Dr Andrew Murray works in a clinical capacity for the European Golf Tour, and has received research funding (although not for this project) from the World Golf Foundation.

Ageing well with physical activity in the over 75’s

Jessica Jeffreys¹, Karen Tocque²

¹Brio Leisure CIC, ²University of Chester

Introduction: Brio Leisure trialled a novel Public Health intervention, with a view to making a measurable difference to the quality of life and wellbeing of older people living in Cheshire West and Chester.

Method: A free membership to all 75+ year old residents was rolled out in 2015 to support improved health and wellbeing in a rapidly increasing aging population. All attendances for these members was extracted from Brio’s membership activity database and analysed with regard to the type of activity.

Results: During 2016/17, there were 1,450 75+ concession members (4.6% reach). In reality, only two thirds of these (960) actually attended one of Brio Leisure facilities; 33% did not actually attend. In total, these 960 individuals had over 40,000 attendances (an average of 42 attendances per person) over a 14 month period, equating to 3 times per month. The main activities were swimming (19 times) and gym (13 times) but they also made use of the sauna (5 times), fitness programmes (2.5 times) and aquafit (2 times). Prior to this scheme, only 203 (14%) of free 75 concessions were previous members.

Conclusion: Whilst these elderly individuals may already be the more active residents of the borough, evaluating the impact of this programme has led to a revised scheme and a review of targeted support for hard to reach cohorts which is financially sustainable.

External funding details: £54k (4.8%) per annum of a £1.18 PH Integrated Wellbeing service awarded to Brio Leisure was allocated to provide the free memberships to residents aged 75+.

Community-based, citizen-led approach to jogging participation- examples from jogscotland and parkrun UK

Godze Ozakinci, University of St Andrews

Purpose: A variety of programmes exist aiming to increase physical activity with differing levels of success. Approaches involving volunteers and physical activity taking place outside gym environments are popular. The purpose of the studies was to understand the facilitators and barriers of continued participation and participant characteristics when it comes to two popular community-based approaches.

Methods: Two studies will be presented. Study 1: Interviews were conducted from three ‘jogscotland’ groups (Scotland’s recreational running network for runners of all abilities) (N = 20; 11 women; Age: 29-77). Self-determination theory guided the study and thematic analysis was used. Study 2: A cross-sectional online/paper survey of parkrunners with open-ended items (N = 655;322 women; Age:16-79) was conducted in 4 UK parkrun sites using participatory action research.

Results: jogscotland data indicated several themes: inclusivity of the groups facilitating participation; social-contextual factors fostering feelings of ‘competence’ enhancing intrinsic motivation; and a combination of intrinsic and integrated regulation factors sustaining the activity.

parkrun data showed that the sense of belonging to parkrun in a familial sense; sense of achievement and challenge; health/wellbeing benefits; and the event format were key factors for participation.

Both groups emphasised the importance of structure and the volunteer-led nature of these activities for its success.

Conclusions: These complementary data show that volunteer-led, community-based approaches to physical activity offer potential for sustainable behaviour change. Increasing access to these approaches need to be considered in policy development to increase public health benefit.

External funding details: The parkrun work was funded by Cancer Research Cancer Prevention BUPA Foundation Fund

Efficacy of a multi-component intervention to reduce workplace sitting time in office workers: A cluster randomised controlled trial

Daniel Bailey¹, Benjamin Maylor¹, Charlotte Edwardson², Julia Zakrzewski-Fruer¹, Rachael Champion¹

¹University of Bedfordshire, ²University of Leicester

Introduction: High levels of sedentary behaviour are associated with poor metabolic health and increased risk of cardiometabolic disease and mortality. Office workers are an important population to target reduction in sedentary behaviour due to prolonged periods of sitting in the workplace. The aim of this study was to investigate the efficacy of a work-based multicomponent intervention to reduce office workers’ sitting time.

Methods: Offices (n = 12; 89 workers) were randomised into an 8-week intervention (n = 48) incorporating organisational (education and brainstorming session, step challenge), individual (health report feedback, software prompts, telephone support), and environmental elements (changes to workspace) or control arm. Sitting time and physical activity (activPAL) and cardiometabolic health were measured at baseline and at the end of intervention.

Results: Linear mixed modelling revealed no significant change in workplace sitting time but changes in workplace prolonged sitting time (-39 min/shift), sit-upright transitions (7.8 per shift) and stepping time (12 min/shift) at follow-up were observed, in favour of the intervention group (p < 0.01). There were also significant changes in the number of sit-upright transitions (4 [0.8, 7.2] transitions/day) and total steps (550 [276, 825] steps/day) across the whole day, in favour of the intervention group. Results for cardiometabolic health markers were mixed.

Conclusion: This short multicomponent workplace intervention was unsuccessful at reducing total sitting time but successful at reducing prolonged sitting time and increasing physical activity in the workplace. The potential for incorporating such interventions into common workplace practice now requires investigation.

Evaluation of the implementation of a national workplace sport and physical activity intervention

Emma Adams, Loughborough University

Introduction: Understanding how to effectively implement interventions at scale is important for increasing population physical activity levels. This study aimed to identify the factors which influenced the implementation of the Workplace Challenge, a national sport and physical activity intervention in England.

Methods: Interviews/focus groups were conducted using a semi-structured protocol with delivery partners (n = 7 interviews), workplace representatives (n = 6 interviews), workplace champions (n = 10 interviews) and programme participants (n = 9 focus groups). Data were coded in NVIVO 10 and analysed thematically to identify factors influencing implementation.

Results: Four overarching themes emerged: 1) delivery model (national leadership with local delivery, ability to adapt national programme to suit local needs, comprehensive intervention package, local partnership development, support from National Governing Bodies, responsive to feedback); 2) workplace engagement (no joining cost, inclusiveness, flexibility in using the intervention to complement existing workplace health programmes, positive influence on workplace culture for physical activity and health promotion); 3) engagement of the target group (tailored information, low level taster sessions/alternative activities, emphasis on fun, enjoyable and social activities, awareness raising and prompting intention formation, use of incentives, role of workplace champions); and 4) employee participation (individual registration, flexible participation, competition element, benefits for working relationships and morale).

Conclusions: A number of factors were identified which influenced the successful implementation of a national scaled-up workplace physical activity intervention. These factors should be taken into consideration in developing future workplace physical activity interventions to facilitate successful scale-up.

External funding details: Workplace Challenge was funded through Sport England’s Lottery Funded Get Healthy Get Active portfolio.

HIIT@work: Acute circulatory, metabolic, thermal, cognitive and perceptual responses to prolonged sitting interrupted by a six-minute session of high-intensity interval exercise

Birgit Sperlich¹, Ine De Clerck², Billy Sperlich¹

¹Julius-Maximilian University Würzburg, ²Artevelde University College Ghent

Introduction: Experimental studies indicate that interrupting prolonged sitting with light physical activity reduces harmful cardio-metabolic health risks for physically inactive individuals. However, such short-term improvement in the metabolic profile could not be observed in physically active. The aim of this study was to examine health aspects while sitting following a brief session of high-intensity interval exercise (HIIT).

Methods: Twelve students (5 men; age, 22 ± 2 yrs) performed two trials involving either simply sitting for 180 min (SIT) or sitting for this same period with a 6-min session of HIIT after 60 min sitting (SIT+HIIT). At T₀ (after 30 min of resting), T₁ (after a 20-min breakfast), T₂ (after sitting for 1 h), T₃ (immediately after the HIIT), T₄, T₅, T₆ and T₇ (30, 60, 90 and 120 min after the HIIT), circulatory, metabolic, thermoregulatory, cognitive, and perceptual responses were assessed.

Results: The blood lactate concentration (at T₃-T₅), heart rate (at T₃-T₆), oxygen uptake (at T₃-T₇), respiratory exchange ratio, and sensations of heat (T₃-T₅), sweating (T₃, T₄) and odor (T₃), as well as perception of vigor (T₃-T₆), were higher and the respiratory exchange ratio (T₄-T₇) and mean body and skin temperatures (T₃) lower in the HIIT trial compared to only SIT-trial. Levels of blood glucose, feelings of anxiety/depression, fatigue or hostility, as well as the variables of cognitive function did not differ between HIIT and SIT+HIIT.

Conclusion: Interruption of prolonged sitting with a 6-min session of HIIT induced more pronounced circulatory and metabolic responses and improved certain aspects of perception.

The effects of exercise interventions on sedentary behaviour in women - intermittent versus continuous walking: Effects on physiological and psychological variables in sedentary employees during a 10-week intervention

Mynor Rodriquez-Hernandez¹, Danielle Wadsworth²

¹University of Costa Rica, ²Auburn University

Introduction: This study evaluated the effects of two different walking programs on psychological (self-regulation and self-efficacy) and physiological (Body composition, HbA1c, VO2, MVPA, sedentary behavior) outcomes.

Methods: Fifty-one female sedentary employees were randomly assigned to one of three groups: intermittent walking (Age = 46 ± 9 years, BMI = 30.33 ± 5.79 kg/m²), continuous walking (Age = 48 ± 9 years, BMI = 30.53 ± 6.17 kg/m²) or control group (Age = 42 ± 10 years, BMI = 27.66 ± 5.11 kg/m²). Experimental groups were time and intensity matched and walking behavior was completed independently. Self-regulation and self-efficacy questionnaires, MVPA, sedentary behavior, and VO₂ were obtained at baseline, week 6, and week 11. HbA1c and body composition were obtained at baseline and week 11. Daily walking was measured via a wrist worn accelerometer.

Results: The continuous group significantly improved in self-regulation from pre-test to week 6 and week 11 (p < 0.05); increased MVPA from pre-test to week 6 (p = 0.009); increased daily steps from pre-test to week 6 (p = 0.033), had a significant higher percentage of change in MVPA compared to the control group (p < 0.05) and significantly reduced HbA1c (p < 0.05). Intermittent walking group increased lean mass significantly (p < 0.001). Fat mass, body weight, and fat percentage decreased significantly for all three groups (p < 0.05). No changes in VO₂ or sedentary behavior (p > 0.05) were observed. Self-efficacy decreased significantly from pre-test to week 6 (p = 0.047) and to week 11 (p = 0.008) for all groups.

Conclusions: Continuous walking activity seems to be a better approach to improve self-regulatory skills, physical activity and HbA1c and may provide a more feasible approach to prescribe exercise in sedentary office employees.

The Park Prescription Trial: Prescribing physical activity and park use to promote health and well-being of adults in Singapore

Falk Müller-Riemenschneider¹, Jiali Yao¹, Anne H Y Chu¹, Angelia Sia², Anbumalar Ramiah³, Michael Wong³, Han Jane³, Bee Choo Tai¹, Léonie Uijtdewilligen¹

¹National University of Singapore, ²National Parks Board, ³Khoo Teck Puat Hospital

Purpose: This trial investigates the effectiveness of a carefully developed park prescription intervention to improve physical activity (PA), PA in parks, physical and mental well-being among community-dwelling adults.

Methods: Participants aged 40 to 65 years were recruited through Population Health Screenings in Singapore if they were physically inactive, passed the PA Readiness Questionnaire and had blood pressure and blood glucose values within healthy ranges. They were randomly assigned to the Park Prescription Intervention or control. Participants completed baseline, 3- and 6-months follow-up assessments, including self-report questionnaires, accelerometer assessment, and health screening. T-test was used to compare outcomes between groups. A p-value <0.05 was considered statistically significant.

Results: Eighty participants were allocated to each group with comparable characteristics at baseline. Participants were predominantly female (79.4%), of Chinese ethnicity (81.3%) and married (78.8%). At the 6-month follow-up, 90.6% of the participants provided outcome data. Mean time (minutes/month) spent in parks (Intervention: 333.9 ± 506.2; control: 186.4 ± 358.4; p-value: 0.047) and PA in parks (Intervention: 333.0 ± 499.3; control: 140.5 ± 270.7; p-value: 0.005) was significantly greater in the intervention group. Objectively measured PA, physical health and mental well-being outcomes will additionally be reported.

Conclusion: Park Prescription has the potential to be applied in community screenings in Singapore. Findings suggest that the intervention effectively increased park use and PA in parks. Outcomes on objectively measured PA, physical and mental well-being will provide further insights into the effectiveness of the intervention.

External funding details: National Parks Board Singapore and the National University of Singapore.

Sit less or exercise more? Differential effects on endothelial and metabolic risk markers

Bernard Duvivier¹, Johanne Bolijn¹, Annemarie Koster¹, Casper Schalkwijk², Hans H.C.M. Savelberg¹, Nicolaas C. Schaper²

¹Maastricht University, ²Maastricht University Medical Centre +

Introduction/Background: Recent studies suggest that substituting sitting with light physical activity has beneficial metabolic effects, but if this is associated with parallel changes in endothelial function is unclear.

Method: Data from three randomised cross-over studies, in which 61 subjects (normal weight; overweight; type 2 diabetes) followed different activity regimens (Sit, SitLess and/or Exercise) of four days each, were analysed. Subjects were instructed to sit 14 h/day (‘Sit’), to substitute 1 h/day of sitting with moderate-to-vigorous cycling (‘Exercise’) or to substitute 5-6 h/day sitting with light-intensity walking and standing (‘SitLess’). The Exercise and SitLess regimens were designed to have comparable energy expenditure. Physical activity was assessed 24 h/day by accelerometry (ActivPAL) and diet was standardised. Fasted circulating biomarkers of endothelial dysfunction, lipids and insulin sensitivity (HOMA2-IR) were assessed the morning after each activity regimen. The endothelial dysfunction score (ED-score) was computed by averaging the Z-scores of the circulating biomarkers of endothelial dysfunction (sVCAM1, sICAM and sE-selectin).

Results: Compared to Sit, Exercise resulted in a lower ED-score (p=0.003), while no change was observed after SitLess and the ED-score after Exercise was lower compared to SitLess (p = 0.001). In contrast, compared to Sit, insulin sensitivity and plasma lipids (HDL-cholesterol, non-HDL-cholesterol, total cholesterol and Apo B) were improved after SitLess (p < 0.017) but did not change after Exercise.

Conclusions: Light physical activity and moderate-to-vigorous physical activity had a differential effect on risk markers of cardio-metabolic health and suggest the need of both performing structured exercise as well as reducing sitting time on a daily basis.

What they talk about when they talk about running- implications for behaviour change of beginner runners’ un/helpful beliefs about running

Katy Kennedy, University of Surrey, UK

Introduction: Beginner running groups are a popular way to start to run, providing an opportunity for examining trajectories of behaviour change and factors associated with success. The purpose of the Running Commentary study was to investigate participants’ experiences in beginner running groups, following up to examine physical activity behaviour change.

Methods: This was a longitudinal, mixed methods field study, using mobile audio recordings and follow-up online questionnaires with 70 participants from 13 UK beginner running groups. Audio recordings were transcribed and analysed thematically using an inductive interpretative approach, combined with questionnaire data on running success at six months. A major theme identified and linked to dis/continuing running was how participants talked about ‘what running is’.

Findings: Participants’ use of concepts such as ‘running should be hard’, ‘running is natural’ and ‘running is social’ were key to negotiating running success or justifying drop-out. For example, believing ‘running should be hard’ meant participants ran unsustainably fast, with beginners thinking they were ‘doing it wrong’ if they weren’t in discomfort or pain. However, successful participants used contrasting concepts, e.g. ‘running is a challenge’ or ‘running should be enjoyable’ to complement or challenge such beliefs. Implications for policy and practice are identifiable, such as social marketing and training for running group leaders, particularly emphasising older or less physically active demographics.

Conclusions: Participants’ beliefs expressed about running were associated with long-term success rates. Transforming such taken for granted beliefs about running could improve beginner running experiences, with potential for contributing to physical activity behaviour change.

Tuesday 16 October

A gamefully designed intervention to impact motivation for physical activity and physical activity levels

Dominique Gummelt¹, Sebastian Deterding², Ernesto Medina³, Afroditi Stathi⁴

¹Andrews University, ²University of York, ³Loma Linda University, ⁴University of Birmingham

Introduction: Gameful design has been shown to have potential to increase motivation for physical activity (PA). However, well-designed theoretically grounded interventions identifying effective gamefully designed methods to support increased PA are still lacking.

Purpose: To assess whether a gamefully designed, web-based pilot intervention can impact motivation for PA and PA levels in sedentary adults between the ages of 25 – 44.

Methods: Participants (n = 83; mean age = 33.56; SD = 6.4; females = 48) were randomized, to either a six-week participation in a commercial web-/mobile-based gamefully designed PA application (consisting of various features including tracking PA, challenges, group engagement, feedback, earning badges and points) or to a control group. Assessments were conducted at six weeks, three months and six months including objective measurement of MVPA, the Behavioural Regulation of Exercise Questionnaire (BREQ-2) and the Intrinsic Motivation Inventory (IMI). Changes in MVPA and the relationship between intrinsic motivation for PA and MVPA levels were examined.

Results: No statistically significant changes to MVPA were observed (treatment x time interaction p = 0.57). At six weeks the intervention group showed statistically significant increased levels of identified regulation (internalised motivation) for PA (p = 0.04). Overall a significant association (p = 0.03) between intrinsic regulation and MVPA was also observed (adjusting for age, gender, baseline BMI, baseline MVPA, and time).

Conclusion: The small sample size reduced the statistical power to detect changes in MVPA and intrinsic motivation. The results related to internalised motivation merit further evaluation of more complex processes via qualitative assessment.

An m-health workplace-based ‘sit less, move more’ program: Impact on employees´ sedentary and physical activity patterns.

Judit Bort-Roig¹, Emilia Chirveches-Pérez², Maria Giné-Garriga³, Lydia Navarro-Blasco⁴, Roser Bausà-Peris⁴, Pedro Iturrioz-Rosell⁵, Angel M González-suárez⁶, Iván Martínez-Lemos⁷, Emma Puigoriol-Juvanteny⁸, Kieran Dowd⁹, Anna Puig-Ribera¹⁰

¹University of Vic–Central University of Catalonia, Vic, ²Research Group on Methodology, Methods, Models and Health and Social Outcomes (M3O), Faculty of Health Sciences and Welfare, Universitat de Vic–Central University of Catalonia. Clinical Epidemiology Unit, Hospital Consortium Vic, ³Physical Activity and Sport Sciences Department, FPCEE Blanquerna, Universitat Ramon Llull., ⁴Hospital de Santa Creu i Sant Pau, ⁵Osakidetza, Servicio Vasco de Salud, ⁶Departamento de Educación Física y Deportiva, Universidad del País Vasco, ⁷Facultad CC.EE. e do Deporte, Universidad de Vigo, ⁸Tr2lab Tissue Repair & Regeneration, Faculty of Health Sciences and Welfare, Universitat de Vic–Central University of Catalonia. Clinical Epidemiology Unit, Hospital Consortium Vic, ⁹Department of Sports and Health, Athlone Institute of Technology, ¹⁰Research Group on Physical Activity and Sports, Centre for Health and Social Care Research, Department of Physical Activity Science, University of Vic–Central University of Catalonia

Introduction: This study evaluated the short-term impact of a 12-week m-health workplace-based ‘sit less, move more’ intervention (Walk@WorkApp; W@W-App, 2015) on objectively-determined physical activity (PA) and sedentary behaviours in employees.

Method: A site randomised control trial recruited employees at four Spanish hospitals (n = 141; 45 ± 9 years; 82% female). Participants were assigned by hospital to an Intervention (IG; used W@W-App; n = 90) or an active Comparison group (A-CG; monitored occupational activity n = 51). W@W-App, installed on participants´ own smartphones, provided real time feedback for occupational sitting, ambulatory activity and gave access to automated strategies to sit less and move more at work. A mean comparison for repeated measures assessed changes in total sitting time, sedentary bouts, light and moderate-to-vigorous PA (activPAL 3^TM; minutes/day) between baseline and after program completion during weekdays and weekends.

Results: Over the A-CG, the IG reported a higher proportion of sedentary time in shorter bouts from 5 to 10 minutes (p = 0.013) outside work and a higher time spent in total moderate-to-vigorous PA (p = 0.016). Non-significant changes were found for light intensity PA and total sitting time.

Conclusion: W@W-App reduced prolonged periods of sedentary behaviour outside work but not during working hours, providing translational evidence that m-health programmes might have the potential to improve employees´ daily sedentary patterns.

External funding details: The W@W-App Project was supported by the Spanish Ministry of Science and Innovation (DEP2012- 37169).

BariFit: Mobile health intervention to improve physical activity after bariatric surgery

Dori Rosenberg¹, Predrag Klasnja², Jane Anau², Chris Mack², Jing Zhou², Kevin Filocamo², Anirban Gupta¹, David Arterburn²

¹Kaiser Permanente Washington, ²Kaiser Permanente Washington Health Research Institute

Introduction: Physical activity remains low after bariatric surgery. Mobile health holds promise for supporting improvements in physical activity, particularly when embedded in clinical care. We developed and tested the feasibility of the BariFit intervention to increase walking after bariatric surgery.

Methods: Participants were recruited at Kaiser Permanente Washington at their post-operative visit (N = 45 completers; mean age = 45, % female = 84; mean pre-surgery BMI = 42.0). Between 1-2 months post-surgery, participants were given several commercial mHealth tools (Fitbit Charge 2, Fitbit app, and Withings scale), text messages providing daily adaptive step goals and contextually-tailored suggestions for 4 months, and progress reports at surgery follow-up visits. Step counts were assessed using the activPAL worn for 7 days before starting Barifit (baseline) and 4 months later and with Fitbit data from the first and last 2 weeks of the intervention.

Results: Among 27 participants with valid activPAL data, step counts increased by 1371 steps on average (p = .07). Among 43 participants with valid Fitbit data, mean step counts increased by 350 steps/day (p = .27).

Conclusions: Fitbit data was available for a larger number of participants but showed that steps improved only slightly over the course of the intervention; however, the Fitbit data did not have a true baseline level of steps. activPAL data collection was problematic in this population though those with activPAL data (i.e. a true baseline step count) had improvements in steps with a highly scalable and low-burden mHealth intervention warranting further investigation.

Effects of active commuting and leisure time exercise on markers of cardio-metabolic health in individuals with overweight and obesity: A randomised trial

Martin Petersen¹, Mads Rosenkilde¹, Anne Sofie Gram², Marie Tindborg², Anders Nymark Christensen³, Jonas Salling Quist², Bente Merete Stallknecht²

¹University of Copenhagen, ²University of Copehagen, ³Technical University of Denmark

Objectives: To evaluate cardio-metabolic health effects of active commuting and leisure-time exercise of moderate and vigorous intensity.

Trial design: Single centre randomized controlled trial with repeated measures.

Primary outcome: Peripheral insulin sensitivity

Methods: Physically inactive, healthy, Caucasian women and men (20–45 years) with overweight or class 1 obesity (BMI: 25–35 kg/m²) were randomized in a 1∶2∶2∶2 ratio to 6 months of no intervention (CON), active commuting (BIKE), or moderate (MOD, 50% VO₂peak) or vigorous intensity (VIG, 70% VO₂peak) leisure-time exercise. Exercise frequency was 5 days/week with a weekly exercise energy expenditure of 1600 kcal for women and 2100 kcal for men. Neither participants nor researchers were blinded to group allocation. Clinicaltrials.gov identifier: NCT01962259

Results: The study was completed in June 2016. 188 participants were recruited; of these 130 were randomized and 100 (CON n = 16, BIKE n = 20, MOD n = 33, VIG n = 31) completed follow-up testing. Peripheral insulin sensitivity was 24% (CI95% 6 to 46, P = 0.01) higher in VIG compared with CON after 3 months and tended to be higher in VIG compared with BIKE (P = 0.06). After 6 months, peripheral insulin sensitivity was increased by 20% in BIKE (CI95% 1 to 43, P = 0.04) and 25% in VIG (CI95% 7 to 47, P < 0.01) compared with CON and a strong tendency for an increase was seen in MOD (17%, CI95% -0.2 to 37, P = 0.053).

Conclusions: Active commuting conveys long-term cardio-metabolic health benefits on par with leisure-time exercise. Leisure-time exercise of vigorous intensity confers effects on peripheral insulin sensitivity at an earlier time point.

External funding details: The work is carried out as a part of the research program ‘Governing Obesity’ funded by the University of Copenhagen’s Excellence Programme for Interdisciplinary Research (http://go.ku.dk/). Additional funding was provided by the Faculty of Health and Medical Sciences, University of Copenhagen, TrygFonden and Gerda and Aage Haensch’s Fond.

Effects of active commuting and leisure-time exercise on total and non-exercise energy expenditure in individuals with overweight and obesity

Jonas Salling Quist¹, Mads Rosenkilde¹, Martin Bák Blond¹, Anne Sofie Gram¹, Kevin Hall², Peter Walter², Bente Stallknecht¹

¹University of Copenhagen, ²National Institute of Diabetes and Digestive and Kidney Diseases

Background: Controversy exist whether physical exercise affects total energy expenditure (TEE) and non-exercise energy expenditure (NonExEE) in individuals with overweight and obesity.

Objective: To examine effects of active commuting and leisure-time exercise on TEE and NonExEE in individuals with overweight and obesity.

Methods: In a sub-study of a randomized controlled trial in younger, physically inactive women and men with overweight and obesity (BMI: 25–35 kg/m²), 32 participants completed 6 months of habitual lifestyle (CON, n = 6), active commuting (BIKE, n = 7), or leisure-time exercise of moderate (MOD, 50% VO₂peak-reserve, n = 13) or vigorous intensity (VIG, 70% VO₂peak-reserve, n = 8). TEE was measured by doubly labeled water at baseline, 3, and 6 months. Exercise energy expenditure (ExEE) was calculated based on heart rate monitoring. Here we present preliminary results.

Results: ExEE did not differ between groups (p ≥ 0.16) as intended by study design. TEE did not change in any of the exercise groups after 3 months (p ≥ 0.82 vs. CON). At 6 months, TEE (kcal/day) increased in VIG compared to the other groups (CON: 440 [91; 787]; BIKE: 361 [26; 696]; MOD: 352 [51; 654], all p ≤ 0.04), but did not change in BIKE and MOD (p ≥ 0.56 vs. CON). NonExEE (kcal/day) did not change at 3 or 6 months (p ≥ 0.16 vs. CON) but increased in VIG compared with MOD at 6 months (399 [44; 754], p = 0.03).

Conclusion: Our preliminary findings suggest that TEE and NonExEE are unaltered after 3 months of active commuting and leisure-time exercise but that TEE is increased after 6 months of vigorous intensity exercise.

External funding details: The study was funded by the University of Copenhagen Excellence Programme for Interdisciplinary Research (www.go.ku.dk), TrygFonden and Gerda and Aage Haensch’s Fund. Jonas Salling Quist was supported by a PhD scholarship from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark

Exploring effective physical activity interventions in women with previous gestational diabetes

Audrey Buelo¹, Ruth Jepson², Alison Kirk³

¹Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, ²University of Edinburgh, ³University of Strathclyde

Introduction: Women with previous gestational diabetes are at seven times the risk of Type 2 diabetes later in life. Physical activity can reduce this risk, but most women with recent gestational diabetes are not active. We are systematically reviewing the literature to understand what factors in the lives of women with previous gestational diabetes influence the effectiveness of physical activity interventions.

Methods: A mixed-methods systematic review is currently underway in which a quantitative review of physical activity intervention effectiveness and a qualitative review exploring barriers and facilitators to physical activity in women with previous gestational diabetes are combined, to explore why different interventions are effective or ineffective. Following Cochrane methodology, we have systematically searched seven databases and grey literature, including forward and backward citation searches and no date/language restrictions. Two reviewers are independently selecting studies for inclusion, assessing methodological quality, and dividing records into quantitative and qualitative reviews to extract data. Using cross-study synthesis methodology, we will explore to what extent the interventions (results of quantitative review) address the factors (results of qualitative review) that influence physical activity in women with previous gestational diabetes.

Results: Results from this mixed-methods review will be completed by May 2018 and will show the ‘how and why’ of effective and ineffective physical activity interventions in women with previous gestational diabetes.

Conclusion: Combining the results of qualitative and quantitative studies can provide a nuanced understanding of the effectiveness of physical activity interventions.

External funding details: Diabetes UK

Prototyping in public health practice: Demonstrating a streamlined implementation process with a community-based weight management programme (Momenta)

Caroline Dodd-Reynolds¹, Lisa Nevens², Emily Oliver¹, Tracy Finch³, Coral Hanson⁴

¹Durham University, ²Northumbria Healthcare Foundation Trust, ³Northumbria University, ⁴Edinburgh Napier University

Background: While stakeholder co-production may reduce the ‘implementation gap’ in design of public health programmes, it can be time-consuming and costly. Prototyping offers a potential solution; we tested its value using a 3-month weight-management programme ‘Momenta’, in a deprived area with poor health indices, in Northumberland.

Evaluation Framework: Following pragmatic stakeholder consultation, a mixed methods evaluation framework was developed. Three referral groups (BMI ≥ 25 kg/m²) were compared: Momenta (M, n = 59), Momenta and fitness membership (MF, n = 58), fitness membership (F, n = 65). Effectiveness was examined at 3 and 12 months. Implementation and prototyping was evaluated through interviews with referring professionals (n = 5), programme participant focus groups (n = 13), and researcher reflection.

Results: Uptake and 12-week adherence respectively, were higher for M (84.7%, 45.8%) and MF (93.1%, 60.3%) versus F (75.4%, 24.6%). 12-week weight loss [median, (IQR)] was M -2.9 (-5.0 to -2.0) and MF -2.9 (-5.1 to -1.6) p < 0.001, compared to F 0.0 (-3.2 to 1.0) p = 0.379. BMI and waist circumference showed similar trends. 12-month follow-up data suggested persistence of weight loss for MF. 3-month change was positive for mental wellbeing, depression and anxiety in M and MF, remaining at 12 months (p < 0.05). Prototyping did not detrimentally impact on participants’ reported experiences. Refinements included broadening inclusion criteria, with implementation gaps apparent around referral process and practitioner knowledge.

Conclusions: Momenta was effective for weight loss, particularly with fitness facility access. Prototyping aided implementation and we recommend this providing: a strong theoretical and empirical underpinning of the intervention, and co-production methods shape iterative refinement of implementation.

Running the gauntlet: Examining the occurrence of runner harassment

David Hindley, Department of Sport Science, Nottingham Trent University

Introduction: Personal accounts of recreational runners being subjected to intrusive practices when exercising in public spaces feature conspicuously in running blogs, discussion forums, and mainstream running literature. In contrast, academic investigation of this phenomenon remains scant. The aims of the research are a) to characterise runner harassment, b) to determine the prevalence of runner harassment, and c) to analyse typical strategies employed by publicly harassed runners.

Methods: This study employed a mixed methods approach, namely an online questionnaire (N = 430) then a series of semi-structured interviews (N = 10) to explore recreational runner’s experiences of harassment. Thematic analysis of the transcribed interviews and open-ended survey data was undertaken to code the qualitative data to identify patterns.

Findings: The survey results indicated the prevalence of runner harassment (81.4%). Verbal abuse (67.1%) and car/vehicle horns (67.4%) were the most common. Physical assault or its threat was rare, whilst there were a few instances of runners who had objects thrown at them or who had been spat at. Some respondents recalled that their way had been intentionally obstructed or that attempts had been made to pursue them either on foot or in a vehicle.

Conclusions: From this study, runner harassment acts to perpetuate a number of hierarchies. There is a patriarchal social order, where there are significant differences for women and men. The accounts of harassment also speak to the notion of a mobile social order in which recreational runners are deemed to be in minority, sharing public spaces where pedestrians represent the ‘normal’ majority.

Systematic review of interventions outside the workplace for reducing sedentary behaviour in adults under 60 years

Elaine Murtagh¹, Charles Foster², Karen Milton³, Nia Roberts⁴, Clodagh O’Gorman⁵, Marie Murphy⁶

¹Mary Immaculate College, University of Limerick, ²University of Bristol, ³University of East Anglia, ⁴University of Oxford, ⁵University of Limerick, ⁶University of Ulster

Introduction: Excessive sedentary time is associated with increased risk of morbidity and mortality. As adults spend approximately 70% of their non-work time being sedentary there is great scope for changing behaviour to improve population health. This systematic review aims to evaluate the effectiveness of interventions for reducing sedentary behaviour in non-occupational settings.

Methods: The following databases were searched: CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus. Randomised Controlled Trials (RCT) and Cluster RCTs that aimed to change sedentary behaviour in community-dwelling adults aged 18 – 59 years and free from pre-existing medical conditions that may limit participation in the intervention, were eligible for inclusion. Results will be reported as mean treatment effects and 95% confidence intervals using a random effects model. Subgroup analysis will be conducted to examine evidence of differential responses to the interventions. Sensitivity analysis will explore the impact of risk of bias on study findings.

Results: Searches yielded 7653 hits. 18 publications representing 9 studies were included. Results of the meta-analysis and narrative synthesis will be presented. This will include assessment of heterogeneity, reporting biases, subgroup and sensitivity analysis.

Conclusion: At present there is some evidence that interventions targeted in the home and leisure environment may reduce sedentary time in the short term. The present study augments the existing evidence base by synthesising available research and will therefore aid evidence-based decision making by policy-makers and practitioners working to address sedentary behaviour.

External funding details: EM is supported by a Cochrane Fellowship from the Health Research Board (Ireland).

Theme: Interventions—Children and Young People

Monday 15 October

A mixed method systematic review of primary school based interventions to promote physical activity and/or reduce sedentary behaviour

Michelle Jones¹, Emmanuel Defever¹, Kelly Mackintosh², Ayland Letsinger³

¹Southampton Solent University, ²Swansea University, ³Texas A&M University

Introduction: Evidence confirms few children engage in the recommended 60 minutes of daily moderate-to-vigorous physical activity and highlights a decline in participation from around 5 to 7 years. Children spend approximately 40% of their waking hours at school and form early health behaviours in childhood; primary schools are therefore an important setting to promote physical activity. This systematic review was conducted to ascertain the effectiveness of school based physical activity interventions in 5–11 year old children.

Methods: Adhering to the PRISMA guidelines, five databases were searched using predefined terms; additional records were identified through bibliographic searching. After removing duplicates, 444 records were screened by abstract, using inclusion criteria agreed a priori. Two independent reviewers used the mixed-methods appraisal tool (MMAT) to assess the methodological quality of 81 full text articles. Further methodological details can be found in the Prospero record (CRD42017082184).

Results and Discussion: The interventions were summarised using the TIDierR checklist and the volume, intensity and type of physical activity were considered. The articles were of variable methodological approach and quality. Research findings were analysed in relation to the theory of expanded (e.g., before/after school clubs, class breaks, and physically active learning), extended (e.g., increased physical education or play/break times) or enhanced (e.g., increasing physical activity within PE, play/break times) opportunities. A number of multi-component interventions were also identified. Future research should not only ascertain the effectiveness of school-based interventions across a population, but rather for who it works, how and why.

A qualitative investigation of factors that influence children’s enjoyment of physical education

Matthew Domville¹, Paula Watson¹, David Richardson², Lee Graves¹

¹Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, ²Research Institute for Sport and Exercise Sciences, Liverpool John Moores University

Introduction: Physical education (PE) is a key setting to engage children in health-enhancing physical activity. Little is known however about factors children perceive important to PE enjoyment, and how the current PE delivery framework in UK primary schools impacts motivational experiences. Self-determination theory (SDT) suggests enjoyment of activities is an intrinsic motivator for sustained engagement. Therefore, to better support PE instructors to promote physical activity within and beyond PE, this study investigated children’s perceptions of factors influencing PE enjoyment.

Method: Eight mixed-gender focus groups with 47 children (24 girls, 7–11 years) from four schools within a socio-economically deprived area in North-West England asked children about their perceptions of PE, their feelings towards PE instructors, and, factors influencing their PE enjoyment. Transcripts were transcribed verbatim with data analysed thematically using NVivo10.

Results: Factors influencing children’s PE enjoyment included 1) individual preferences, 2) peer and coach interactions, 3) instructor support and involvement. Findings interpreted in relation to SDT generated recommendations to help instructors and schools create a PE environment that enhances children’s enjoyment and autonomous motivation for PE.

Conclusions: Instructors and peers are important in creating a PE environment that supports children’s psychological needs for autonomy, competence and relatedness, which influence enjoyment. To consistently provide children with enjoyable PE lessons, schools should support the ongoing development of generalist teachers, and facilitate better working relationships between generalist teachers and specialist coaches. SDT can be used by instructors to guide practice that enhances children’s enjoyment and autonomous motivation for PE.

External funding details: Match-funded by SOKKA Ltd.

Active Schools Skelmersdale: A multi-component intervention to promote primary school physical activity in a low socio-economic status community

Sarah Taylor¹, Robert J. Noonan¹, Zoe R. Knowles², Bronagh McGrane³, Whitney Curry¹, Stuart J. Fairclough¹

¹Edge Hill University, ²John Moores University, ³Dublin City University Institute of Education

Introduction: Whole-school approaches to physical activity (PA) participation, using a variety of strategies across different settings are advocated as a means of engineering a range of PA opportunities for children. This study evaluated the effectiveness of the Active Schools: Skelmersdale (AS:Sk) school-based multi-component intervention.

Methods: Year 5 classes (age 9–10 years) in four schools implemented an eight component PA intervention for eight weeks, three schools acted as controls. Schools were situated in an area of high deprivation. Informed consent was obtained for 232 children (n = 117 intervention, n = 115 control). The eight intervention components included: running/walking club (daily mile or 100 mile club three times weekly), daily active classroom breaks for five minutes, ‘bounce at the bell’ three times daily, ‘Born To Move’ exercise videos twice per week, playground activity cards, PA homework challenges, physical education teacher development, and health newsletters. Children wore wrist-mounted ActiGraph GT9X accelerometers for seven days pre and post intervention.

Results: Mean baseline school day MVPA was 39.2 and 31.2 minutes in the control and intervention schools, respectively. At follow up, school day MVPA in the control schools decreased by 10.0 minutes and increased by 5.9 minutes in intervention schools. Differences in school day MVPA at follow up between control and intervention schools were significantly different when controlling for baseline MVPA (p = .001).

Conclusion: The AS:Sk multi-component intervention was effective in increasing MVPA levels of children attending the intervention schools.

External funding details: This project was funded by West Lancashire Sport Partnership, West Lancashire Leisure Trust, and Edge Hill University.

Addressing the decline in sport participation and physical activity in secondary school students

Erica Randle¹, Matthew Nicholson¹, Paul O’Halloran¹, Arthur Stukas¹, Emma Sherry¹, Kane Bradford², Greg Wood²

¹La Trobe University, ²Australian Sports Commission

Introduction: Sport programs were piloted at one-hundred secondary schools targeted at students who had disengaged from sport. The aims of the study were to identify what causes youth to disengage from sport and the key influences, barriers and enablers to increasing sport engagement and delivery in the secondary school environment.

Method: A mixed method approach was taken and data collected from the following stakeholders:

•Surveys (students) (N = 6,713);
•Surveys (teachers) (N = 282);
•Surveys (parents/guardians) (N = 1,345);
•Focus groups (N = 60) (students N = 566);
•Semi-structured interviews (PE teachers)(N = 200);
•Semi-structured interviews (sport deliverers) (N = 92).

Standard qualitative and quantitative analysis procedures were conducted.

Results: The secondary school environment is a complex and pressurised setting in which to deliver sport. We found that sport participation and delivery becomes more ‘stressful’ for all stakeholders, and the focus on competition in sport intensifies, shifting away from the social and ‘fun’ elements. There was a perception from students that sport has failed to modify its offerings (both those inside the school environment and those in the community) to address their motivations, needs and barriers.

Conclusion: Secondary school sport programs should not be fully prescribed by a National Sport Organisation, but the deliverer given the flexibility to build a relationship with the PE teacher and the program modified to address each school’s context and student cohort. Further, deliverers should be skilled at building a positive group dynamic during the program, and contribute to building a positive sport culture with the wider school community.

External funding details: Australian Sports Commission

An insight into parent Involvement in Scottish Primary School Health Education activities

Samantha Donnelly¹, Duncan Buchan¹, Ann-Marie Gibson², Rosie Arthur¹

¹The University of the West of Scotland, ²University of Strathclyde

Introduction: Childhood overweight and obesity is prevalent worldwide with Scottish children amongst the least active in the world. School-based physical activity interventions involving parents have found success, however limited research exists regarding the best methods to involve parents in these interventions. Socioeconomic status has been found to mediate parent involvement. Therefore, the aim of this study was to interview parents from a low socioeconomic status (SES) to gains insights into their involvement in school-based health activities.

Methods: Parents (n = 132) were recruited from five schools. Parents (n = 24) were identified based on the following criteria; being the mother of the child, from a Scottish Index of Multiple Deprivation decile 1 or 2 and scoring low on the Family Involvement Questionnaire- Elementary. Parents (n = 16) agreed to be interviewed. An inductive approach to hierarchical analysis was employed.

Results: From the transcripts, 130 first-, 16 second-, and 6 third-order themes emerged. Whilst the influence of children and family can encourage parents to be involved in school-based activities, there are several barriers which result in them being less-involved. The importance of home-school relationships, and the efforts parents and schools play in encouraging parent involvement was evident.

Discussion: It is clear that parents of low SES are less-involved in school-based activities. Barriers to their involvement include lack of confidence and additional responsibilities. Our findings indicate that many of these barriers can be overcome based on the recommendations within this study which can help inform future school-based interventions.

Changes in cycling-related knowledge, Self-efficacy and behaviour following cycle skills training in children and adolescents

Enrique Garcia Bengoechea¹, Charlotte Flaherty², Tessa Pocock², Kek Chiew Ching², Christina Ergler³, Palma Chillon⁴, Sandra Mandic²

¹University of Limerick, ²Active Living Laboratory, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, ³Department of Geography, University of Otago, Dunedin, ⁴Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada

Introduction: Promoting cycling to school among children and adolescents is considered a promising strategy to increase physical activity in this group. This study examined the short- and medium-term effects of CST (1–10 weeks) with or without on-road training on cycling-related knowledge, self-efficacy and behaviour in children (both genders) and adolescent girls.

Method: Children (n = 429; 11.0–0.9 years; 52.1% boys; 3 schools) and adolescent girls (n = 117; 13.9–0.7 years; 2 schools) participated in either playground-based CST (Traffic-Free CST; n = 207) or playground-based plus on-road CST (Traffic-Free + OnRoad CST; n = 339) in Dunedin, New Zealand in 2015–2016. Participants completed pre-training, post-training, and follow-up (6–9 months after CST) self-report assessments of cycling-related knowledge, self-efficacy, and behaviour and practical skills assessment. Data were analysed using linear mixed models and generalized linear mixed models.

Results: Knowledge increased initially and, subsequently, the observed increase decelerated post-intervention, both in children and adolescent girls. Self-efficacy levels increased linearly from pre-test to follow-up, but no significant changes in cycling behaviour (frequency of riding a bicycle) were still apparent in either age group over the 6–9 month follow-up period. In children, initial gender differences in self-efficacy and cycling frequency favouring boys tended to disappear at follow-up. Similarly, initial differences in self-efficacy and cycling frequency in favour of children who participated in CST with on-road training disappeared at follow-up.

Conclusions: Sustained increases in self-efficacy were not matched with changes in frequency of cycling during the period considered, particularly in adolescent girls. Therefore, additional supports may be necessary to encourage cycling to school among children and adolescents.

External funding details: Cycle skills training program in Dunedin, New Zealand, was supported by Dunedin City Council, New Zealand Transport Agency, Sport New Zealand, Otago Community Trust and Kiwisport. Evaluation of the program was supported by Dunedin City Council and Sport New Zealand.

Effect of a school-based intervention on screen time behavior and family support: the “MOVIMENTE” program

Priscila Santos, Alexsandra Bandeira, Valter Barbosa Filho, Kelly Silva, Federal University of Santa Catarina

Evidence on effective strategies in school-based interventions to reducing screen time (ST) and psychosocial factors are unclear, mainly in vulnerable areas. This study aimed to verify the effect of a school-based intervention on ST and family support for ST among Brazilian students.

This cluster-randomized controlled study (3 intervention and 3 control schools) included 948 Brazilian adolescents from 7^th to 9^th grades. Intervention strategies were focused on environmental changes, teacher training and educational actions. Baseline (March/April 2017) and post-intervention (November/December 2017) evaluations included the self-reported ST (TV and computer/games) during the week days (<2 hours/day or >2 hours/day). Adolescents reported the agreement that their parents encouraged, commented on and controlled them in reducing ST. McNemar test was performed to assess statistical significance (p ≤ 0.05) of follow-up changes.

At baseline, 81.3% and 77.6% of adolescents spent >2 hours/day on ST in the control and intervention groups, respectively. After the follow-up, there was a significant reduction of this prevalence in the intervention group (-6.6%, CI95%:-10.3;-2.8); no change occurred in control students (-5.1%, CI95%:-10.4;0.1). In the intervention group, there was a reduction in the prevalence of adolescents who agreed that the parents commented that excessive ST is harmful to health (-6.0%, CI95%:-10.3;-1.7), but no difference was found for encouragement to decrease ST (-2.4%, CI95%:-7.7;2.8) and controlling excessive ST (-2.8%,CI95%:-7.7;2.1). No change was found in control group.

The results suggest that the intervention was effective in reducing ST. However, other strategies to increase family support in reducing ST need to be assessed.

Effects of a technology-based and teacher-directed physical activity intervention in preschoolers: Findings from a pilot study

Wonwoo Byun¹, Erica Y. Lau², Timothy A. Brusseau¹

¹University of Utah, ²University of British Columbia

Introduction: This pilot study evaluated the effects of an intervention employing a physical activity (PA) monitoring system and teachers’ self-directed modifications in instructional strategies to promote PA in preschoolers.

Method: Five childcare centers were recruited (N = 93 children, 53% girls, 4.7–0.6 years), and randomly assigned into Control (CON, N = 45) and Intervention (INT, N = 48) groups. The current intervention is based on the social ecological model. It consisted of a real-time PA monitoring system that provided teachers with instant feedback on children’s PA levels. Based on the feedback and their classroom contexts, teachers made self-directed modifications to their instructional strategies to provide more active opportunities. Time spent in sedentary behavior (SED) and total PA (TPA) were measured as primary outcomes using ActiGraph GT3X+ accelerometer over a 5-day period while children were attending childcare centers.

Result: Overall, children in the INT showed significantly lower level of SED (31.6 vs. 33.6 min/hr), and higher level of TPA (28.4 vs. 26.4 min/hr) than children in the CON, after adjusting for age, sex, race, parent education level, parent perception of child’s PA, BMI, and childcare centers. The percentage of hours meeting the PA recommendation (≥15 min/hr of TPA) was slightly higher the INT than the CON (47.3% vs. 43.2%).

Conclusion: This technology-based, teachers’ self-directed intervention showed promising effects on promoting preschoolers’ PA at childcare centers. Subsequent studies at larger-scale are needed to fully determine the effectiveness of the intervention strategies used in this study.

Evidence into practice to increase children’s physical activity through schools settings: Development of a framework for increasing physical activity in schools and colleges

Loretta Sollars, Claire Robson, Tatiana de Berg, Public Health England

Introduction: Schools and Colleges are recognised as settings with easy access to increasing the physical activity levels of children. Many organisations offer schools products or approaches to do this, but teachers do not know which are the most effective. Public Health England developed a resource to help schools to adopt an evidence based approach to this challenge.

Method: An evidence review was conducted. The key messages concerning effective practice and the links between physical activity and educational attainment were identified and distilled into a framework of eight principles. A consultation process that included practitioners, stakeholder organisations and school pupils refined the framework.

The Framework: The eight principles of the framework apply to all aspects of school life including curriculum provision, extra curricular activities and the physical environment.

Public Health Impact: The principles were published alongside practice examples and national policies in 2016.It has subsequently been used by policy makers, school programme developers and schools to develop and deliver programmes that embed physical activity throughout the school day. The document has also informed policy development at a national level. It was updated in 2018 which demonstrates its continued value as a resource in an environment where there is significant policy development.

External funding details: Public Health England funded and commissioned the Association of Colleges Sport and Youth Sport Trust to carry out the evidence review, framework design and consultation activity. Public Health England published the document “What Works in Schools and Colleges to Increase Physical Activity”.

Factors and strategies to prevent dropout in youth sport: results of a rapid review and expert opinions

Joseph Murphy¹, Catherine B Woods¹, Dorien Dijk², Jan Seghers³

¹University of Limerick, ²Knowledge Centre of Sport Netherlands, ³Department of Movement Sciences, KU Lueven

Introduction: Physical activity of young people in Europe is decreasing and dropout from sports participation is identified as a key problem between the ages of 12 and 19 years. The Erasmus+ collaborative partnership project “Keep Youngsters Involved” aims to find answers to the question: ‘How do we keep youngsters involved and connected with sport and physical activity?’

Methods: To collect relevant research information about dropout from sports participation in youngsters, a rapid review of the published literature was conducted using a selection of search syntaxes entered into relevant databases. Appropriate grey literature and strategies for preventing youth sports dropout were gathered from the partner countries in a systematic manner. Project meetings (n = 4) and conferences helped gain expert opinions and generate a list of factors and strategies related to youth sports dropout.

Results: Of the 440 papers found in the rapid review, three review studies were identified as being relevant. Ten pieces of grey literature were added to the published literature findings. Factors (n = 14) were identified as preventing sports dropout and were used to develop good practice statements. One hundred and fifty-nine strategies that aimed to influence one or more of the 14 factors for preventing youth sports dropout were identified. These strategies were organised as being useful for coaches, parents, or clubs.

Conclusion: The findings from this rapid review and the information generated from project meetings will be used to develop a manual and online toolkit for use at grassroots level to aid with the prevention of youth sports dropout.

Gaelic4Girls for increased physical activity participation - a multi-component, pilot intervention: Study design and protocol

Orlagh Farmer, Dr. Wesley O’ Brien, University College Cork

Introduction: Multi-component sports-based interventions have the potential to increase childhood physical activity (PA) levels, motor skills, and psychosocial well-being. Few interventions, however, have been conducted for young girls in community sports-based environments, specifically in Ireland. This study aims to report the theory-based design protocol, and assess the effectiveness of a multi-component, community sports-based intervention for increasing girls PA levels, fundamental movement skill (FMS) proficiency, and psychosocial well-being.

Methods: A sample of 241 female participants, aged 8 to 12 years old, from five sub-urban and rural primary schools in County Cork were recruited. The Gaelic4Girls intervention was delivered once a week, for 60 minutes, over a 10 week period (March to May 2017) in a rural community sports club setting, as guided by the Social Ecological, and Self-Determination theoretical frameworks. Each session comprised of: 1) participatory child component (a 6 × 10 minute rotatory station-based structure emphasizing mastery of movement), 2) a coach volunteer component (providing continuous professional development) and 3) a parent component (knowledge-based PA support structures). The study outcomes were assessed at pre- and post- intervention, using reliable self-report PA questionnaires, and the Test of Gross Motor Development-2 (TGMD-2) for FMS. Three focus group interviews were also conducted with the child participants, parents and coaches to explore perceptions of the intervention. Data analysis is currently ongoing.

Discussion: This pilot study will provide evidence regarding the effectiveness of a multi-component, community-sports based intervention, and may help inform the development of theory-based interventions targeting PA promotion for pre-adolescent girls in Ireland.

Is it what it looks like? Physical activity opportunities in Southampton primary schools

Emmanuel Defever, Solent University

Background: The primary school setting has been promoted for physical activity intervention as it has the assets to educate and provide physical activity at population level. Despite growing evidence on poor physical activity levels within children, the health consequences and interventions there has been limited documentation of what opportunities commonly exist within primary school settings.

Aim: The purpose of the study was to conduct a city-wide analysis of Southampton primary and junior schools on physical activity opportunities for 7–11 year old children.

Methods: Southampton is a unitary authority of approx. ½ million population and the 2017 health profile suggests higher proportion of low income families, deprivation, and overweight Year 6 children compared to national average. All 44 state primary and junior schools in Southampton were included and sources of information were a) a survey consisting of short answer questions, b) PE and Sport Premium Impact report and c) Ofsted report. Data was qualitatively analysed to explore the extent of current opportunities.

Findings: The main findings include: 1) a typical school day offering limited specific opportunities for physical activity promotion, 2) reliance of ad hoc internal and external events focusing on sporting activities as opposed to sustainable and balanced opportunities, 3) generally low quality and lacking in standardisation on reporting of the funding impact, and 4) implementation barriers including insufficient resource, staff training and pressures of academic attainment.

Conclusion: Collectively, schools provide a range of physical activity opportunities; however, the variability is wide-ranging and inconsistent throughout the city.

Moving Well-Being Well: An intervention aimed at increasing fundamental movement skills, while also increasing teacher confidence in delivering physical activity based lessons

Stephen Behan, Cameron Peers, Sarahjane Belton, Johann Issartel, Dublin City University

Physical Activity (PA) has long been positively linked with health benefits. Recent research shows that 67% of adolescents are not getting the recommended one hour of moderate to vigorous activity (MVPA) per day. In addition, 99.5% of the same sample did not achieve the level of Fundamental Movement Skill (FMS) proficiency expected of their age. In young children FMS proficiency is hypothesised to correlate with increased PA in later life, and these skills are best developed throughout the early school going years. To address these alarming statistics, phase one of the Moving Well-Being Well project has assessed a nationwide sample (n = 2148) of primary school children (5–13 years) in Ireland. The range of assessments covered all aspects of the currently accepted physical literacy model: competence, motivation, confidence, and knowledge and understanding.

The results show that 77.5% of primary school children were classed as ‘very poor’ or ‘below average’ in FMS proficiency (n = 2098, Male 53%). The findings also show significantly higher (p < 0.001) FMS proficiency for children who achieve high levels of MVPA, over those who are less active. Confidence and motivation both saw significant increases (p < 0.05) for those categorised as highly active, compared to those in the low activity group. There was significant difference between these groups for knowledge and understanding, and 54.8% did not know the minimum recommended MVPA guidelines. These findings have been used to develop the intervention aiming at addressing these deficiencies. The intervention targets increasing teacher confidence in delivering FMS programmes through an innovative school’s in-service training program.

Optimising childhood movement in Ireland: The fundamental ‘building blocks’

Wesley O’ Brien¹, Diarmuid Lester¹, Orlagh Farmer¹, Sarahjane Belton², Johann Issartel², Bronagh McGrane²

¹University College Cork, ²Dublin City University

Introduction/Background: The prominence of ‘motor competency’ is now considered to be a critically important correlate of regular childhood physical activity participation and health-related ﬁtness. Yet, most recent research has shown that the majority of Irish children and youth are insufficiently active and fail to reach a level of proficiency across basic movement skills. This lecture will present the performance of selected fundamental movement skills amongst 5- to 16- year olds (N = 995) over a six-year timeline.

Method: Baseline data for fundamental movement skills were collected between 2010 and 2017, specifically as part of selected larger longitudinal childhood physical activity and movement-oriented intervention studies in Ireland. The following sample range of fundamental movement skills were assessed, with the use of reliable instrument protocol; run, skip, horizontal jump, vertical jump, leap, gallop, slide, hop, kick, catch, overhand throw, strike, underarm roll, stationary dribble and balance. To ensure participant consistency in both primary and post-primary school settings, no feedback from any of the trained field staff were given during individual skill performances.

Results and Conclusion: Overall, preliminary results across this large sample suggest that participants within Irish primary and post-primary schools are performing fundamental movement skills at a low level, in light of their expected age-related equivalence for movement proficiency. The lecture will use this example data to present key next steps for enhancing movement in European children.

Overweight and obese children’s and families’ experiences of physical activity and the opportunities offered as part of a community based weight management intervention

Vicki Coulton¹, Lindsey Reece², Robert Copeland¹, Helen Crank¹, David Broom¹

¹Sheffield Hallam University, ²Sheffield Hallam University and University of Sydney

Introduction: Childhood obesity is a global epidemic and effective multicomponent weight management interventions (WMI) are recommended to tackle it. This study explored children and families’ experiences of a 12-week community-based WMI that comprised diet, physical activity and behaviour change approaches.

Method: Semi-structured interviews were conducted with children aged 8–12 years with a BMI ³91^st centile and their families; pre (n = 23), post (n = 13), 6 months (n = 5), 12 months (n = 7) and 24 months (n = 4) post intervention. Interviews were transcribed verbatim and analysed in NVIVO using the framework method.

Results: Prior to the intervention, families reported spending limited time together being physically active. Their home environments encouraged sedentary behaviour where screen time use was prominent. Parents concerns about their child’s weight spanned breathlessness whilst being active, bullying, low self-esteem and not fitting in clothes for their age. Post intervention and at follow up, it was clear that the physical activity sessions were consistently reported as enjoyable whereas the didactic learning sessions were less so from the child’s perspective. Only a few families reported sustained physical activity as a direct result of the WMI, and they generally cited activity as important for achieving energy balance. Parents frequently cited the child’s responsibility for making healthy choices as a concern, particularly as they get older and have more autonomy.

Conclusion: Practitioners need to consider how to integrate the families’ home environment into WMI to enable sustained behaviour change once intervention support is withdrawn.

Popular road running events as physical activity promotion vectors for school-going children

Bengt Kayser, University of Lausanne

Background: In the realm of the largest Swiss popular city running event (Escalade race, Geneva, >44’000 finishers in 2017) we developed a health promotion program for children aged 6–12 yrs. Launched in 2004 in a few municipalities, in collaboration with the state education department the program was extended to schools in 2005, enrolling teachers and parents to run the program. It consists of 2 months of weekly running training preceding the race, combined with teaching of basic dietary concepts.

Methods: Comparison of the number of participating schools and children to official state statistics. Questionnaires before the race, just after and 6 months later.

Results: Participation increased from 145 children in 2006, to 4460 in 2017 and from three schools in 2006 to 84 in 2017. In 2017 about 40% of the Geneva state population between 6–12 yrs participated. Knowledge about good dietary habits increased significantly and was retained up to 6 months. Children liked to participate and teachers/parents value the program.

Conclusion: The increase in participation of children and the retention of knowledge of healthy eating habits suggest an adequate design of the program. The implementation in schools with support from the government was decisive. Whether these changes are accompanied by actual changes in behavior remains unknown but statistics of the State Juvenile Health Services indicate a trend for a decline in obesity prevalence in this age group.

External funding details: The sant”e”scalade project is made possible with financial help from the State of Geneva and the Gourgas Foundation.

Post primary school pupils’ views on strategies employed by school based physical activity interventions: The Healthy Ireland Demonstration Project

Fiona McHale¹, Kwok Ng¹, Donal O’Shea², Catherine Norton¹, Gemma Barrett¹, Joanna Clifford¹, Pierce Murphy¹, Catherine Woods¹

¹University of Limerick, ²St Vincent’s University Hospital

Introduction: Few post-primary school pupils meet the minimum physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity (MVPA) daily, yet pupils who meet these recommendations have the best health profile of all. A vast range of physical activity (PA) programmes are being implemented worldwide, however the most effective formula for behaviour change in this age group is unknown. This formative research will be used to design an intervention.

Method: Pupils (aged 13–16 years) from three schools were recruited for nine focus groups. These were audio recorded, transcribed, and then a qualitative content analysis of the data was performed. Open-ended questions were used to determine the pupils’ opinions regarding current PA promotion strategies employed internationally for this target group. Questions also asked pupils what they liked about PE and what they what change.

Results: Pupils (N = 41; 20% males) would like more information on PA for good health. Providing choice and a greater variety of activities to pupils for the PE programme throughout the year was suggested. Other ideas included one off sports days and PE trips. The element of fun was imperative.

Conclusion: Opportunities for involvement by pupils in the PE plan for the academic year could enhance intrinsic motivation for improved participation and provide greater enjoyment. The wide variety of activities available on the PE curriculum should allow for more autonomy of choice for pupils’ preferences.

External funding details: Department of Health, Ireland, Department of Education, Ireland

The CHARMING study: Development and pilot of a school-based active role model program for pre-adolescent girls

Kelly Morgan¹, Jordan Godwin², Kirsty Darwent³, Alison Fildes⁴

¹Cardiff University, ²Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, ³Faculty of Health Sciences and Sport, Stirling University, ⁴University of Leeds

Introduction: Many preadolescent girls do not meet current physical activity (PA) guidelines. Role models are one suggested mechanism to inspire young girls to become active. The Charming study aimed to develop and pilot a school-based, multi-component, role-model programme for girls aged 9–11 years.

Methods: Two primary schools from low-socioeconomic areas were recruited and all Year 5 and 6 girls (aged 9–11 years) invited to participate (n = 66). Pilot measures included a pre- and post-intervention survey, attendance and session enjoyment data and post-intervention school staff surveys (n = 4).

Results: Girls were provided with an after-school 60 min taster session for 6 weeks. Each session covered a different activity identified by the girls (including sports, dance and unconventional activities). Role models were sourced through sports governing bodies and community clubs. The number of girls attending each session ranged from 34 to 49 (45% of girls attended every session). Mean attendance was 3.8 sessions with session enjoyment between 69.6 to 93%. Follow-up data (91% completed) revealed that 36% of girls had since joined a new community club and 57% reported that they would like to. Main reasons for non-attendance included no free time (50%) and religious practice commitments (47%). Teacher evaluations concerned parental involvement and the duration and range of activities.

Conclusion: Findings suggest it is possible to recruit 9–11 year olds to participate in an after-school role model intervention, with role models sourced from local communities. The potential to positively influence girls PA levels using this approach requires future testing.

External funding details: Cancer Research UK

The implementation and effectiveness of Project FLAME: A multi-component, school-based, movement intervention in Ireland

Diarmuid Lester, Wesley O’ Brien, University College Cork

Introduction/Background: Results from most recent Irish data found that adolescents are failing to reach a basic level of fundamental and functional movement proficiency while physical activity (PA) participation levels also decline dramatically during this period. Schools and the engagement of stakeholders, particularly qualified Physical Education (PE) specialist teachers, are key vehicles for the promotion and provision of movement-based opportunities in youth. The current research examines the effectiveness of a movement intervention for post-primary Irish youth, entitled Project FLAME (Fundamental and Functional Literacy for Activity and Movement Efficiency).

Methods/Design: Using a non-randomized controlled trial, a target sample of 326 participants (mean age: 14.02 + 0.89 years) were recruited in October 2017 from three mixed-gender sub-urban schools (two intervention; one control) in Cork, for pre-test data collection, followed by a 13-week consecutive Project FLAME intervention roll out, and post-test data collection in March 2018. This whole-school weekly delivered multi-component approach involves the following pillars: 1) student component, 2) specialist PE teacher component, 3) non-specialist PE teacher kinaesthetic classroom component, and 4) digital literacy component. Primary outcome measures assessing the intervention effectiveness include the assessment of fundamental movement skills (FMS), the functional movement screen (FMS^™) and anthropometric characteristics (height and mass). Data analysis is currently ongoing.

Discussion: This Project FLAME intervention is the first of its kind in Ireland targeting fundamental and functional movement improvements for adolescents. The study will provide future evidence regarding the effectiveness of school-based, movement interventions, which specifically includes the concurrent involvement of specialist PE teachers, and non-specialist PE teachers.

Understanding youth personalities to help young people get active

Jayne Molyneux, Carol Fraser, Sport England

A high proportion of young people take part in sport and physical activity but many are not active enough. Sport England’s 2014 qualitative research unearthed some significant emotional baggage attached to sport and found that sport and physical activity opportunities for young people tended to attract and cater for the more the active and engaged. There was a need to identify what could be done to tailor delivery to different groups of young people.

In 2015, Sport England carried out a survey of nearly 2,000 young people aged 14 to 25 to segment this age group based on their attitudes and behaviours in relation to physical activity. Six ‘

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7th International Society for Physical Activity and Health Congress

7th ISPAH Congress Committees

Organising Committee

Scientific Advisory Committee

Symposia: Monday 15 October

Session: Acting locally to promote activity-friendly environments globally: Leveraging citizen science to foster health equity

Session: Adapted, adaptive and adapting physical activity

Session: Are all METs the same? The role of posture, intensity, time-pattern, domain and measurement of physical activity for health

Session: Evidence on effectiveness and feasibility of physical activity in the school setting: Bridging the gap between evidence and practice

Session: Physical activity promotion in health care settings: Recent developments in Europe

Session: Physical activity research in vulnerable populations using Ecological Momentary Assessment (EMA)

Symposia: Tuesday 16 October

Session: Air pollution and physical activity

Session: Increasing physical activity in overweight football fans: From developing and evaluating intervention programs to wider implementation in practice

Session: Integrating health effects into transport planning: Achievements, pitfalls and lessons learned from 10 years of the WHO Health Economic Assessment Tool (HEAT) for walking and cycling

Session: Physical activity and social inequality: Using ethnography to make disadvantaged voices heard and inform interventions

Session: Tackling inactivity: improving the evidence base for the effectiveness of sport and physical activity in improving health and wellbeing

Session: Walking and health: How much and how fast is enough?

Parallel Oral Sessions: Monday 15 October

Session: Advocacy, policy and monitoring frameworks

Session: Developments in wearable devices and analysis

Session: The impact of places and spaces on physical activity

Session: Physical activity and older adults

Session: Physical activity interventions for youths

Session: Promoting physical activity: From mechanisms to systems

Monday, 16:00–17:00

Session: Interventions to promote physical activity in schools

Session: Physical activity and mental health

Session: Physical activity across the life course

Session: Physical activity epidemiology

Session: Physical activity evidence, guidelines and messaging

Session: Using technology in interventions and research

Parallel Oral Sessions: Tuesday 16 October

Session: Developments in wearable devices and analysis

Session: National policy approaches from around the world

Session: Physical activity interventions for youths

Session: Physical activity for people with disabilities: Evidence, interventions and evaluation

Session: Physical activity, physical fitness and disease risk

Session: Social dimensions of physical activity and health

Tuesday, 14:40–15:40

Session: Physical activity and mental health

Session: Physical activity epidemiology among children

Session: Physical activity interventions for adults

Session: Promoting physical activity in communities and workplaces

Session: The impact of places and spaces on physical activity

Session: Understanding inequalities in physical activity and health

Parallel Oral Sessions: Wednesday 17 October

Session: Innovative Interventions to Promote Physical Activity

Session: Novel Approaches to Assessing Physical Activity Behaviour

Session: Physical Activity Epidemiology

Session: Physical activity interventions for youths

Session: Physical activity promotion among specific patient groups

Session: Understanding and influencing physical activity behaviour

Session: Cross Sectoral Approaches to Physical Activity Promotion

Session: Physical Activity and Older Adults

Session: Physical Activity Interventions for Adults

Session: Physical Activity Measurement Among Children

Session: Research Progress and Future Directions

Session: Understanding Inequalities in Physical Activity and Health

Oral ePosters

Theme: Behaviour Change

Theme: Cross-sector Working

Theme: Disability

Theme: Economics

Theme: Environment

Theme: Epidemiology

Theme: Inequalities

Theme: Interventions—Adults

Theme: Interventions—Children and Young People

7^th ISPAH Congress Committees