• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-16
Anthony D. Okely; Rebecca M. Stanley; Rachel A. Jones; Dylan P. Cliff; Stewart G. Trost; Donna Berthelsen; Jo Salmon; Marijka Batterham; Simon Eckermann; John J. Reilly; Ngiare Brown; Karen J. Mickle; Steven J. Howard; Trina Hinkley; Xanne Janssen; Paul Chandler; Penny Cross; Fay Gowers

Participation in adequate levels of physical activity during the early years is important for health and development. We report the 6-month effects of an 18-month multicomponent intervention on physical activity in early childhood education and care (ECEC) settings in low-income communities. A cluster randomised controlled trial was conducted in 43 ECEC settings in disadvantaged areas of New South Wales, Australia. Three-year-old children were recruited and assessed in the first half of 2015 with follow-up 6 months later. The intervention was guided by Social Cognitive Theory and included five components. The primary outcome was minutes per hour in total physical activity during ECEC hours measured using Actigraph accelerometers. Intention-to-treat analysis of the primary outcome was conducted using a generalized linear mixed model. A total of 658 children were assessed at baseline. Of these, 558 (85%) had valid accelerometer data (mean age 3.38y, 52% boys) and 508 (77%) had valid accelerometry data at 6-month follow-up. Implementation of the intervention components ranged from 38 to 72%. There were no significant intervention effects on mins/hr. spent in physical activity (adjusted difference = − 0.17 mins/hr., 95% CI (− 1.30 to 0.97), p = 0.78). A priori sub-group analyses showed a greater effect among overweight/obese children in the control group compared with the intervention group for mins/hr. of physical activity (2.35mins/hr., [0.28 to 4.43], p = 0.036). After six-months the Jump Start intervention had no effect on physical activity levels during ECEC. This was largely due to low levels of implementation. Increasing fidelity may result in higher levels of physical activity when outcomes are assessed at 18-months. Australian New Zealand Clinical Trials Registry ACTRN12614000597695.

更新日期：2020-01-17
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-16
Harriet Koorts; Patti-Jean Naylor; Rachel Laws; Penelope Love; Jaimie-Lee Maple; Femke van Nassau

Ineffective research-practice translation is a major challenge to population health improvement. This paper presents an international perspective on the barriers and facilitators associated with the uptake of and engagement in Dissemination and Implementation (D&I) research in the fields of physical activity and nutrition. A mixed methods study involving participants from the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) network. Participants completed an online survey (May–July 2018) and/or participated in a focus group during the annual ISBNPA conference (June 2018). Descriptive statistics were generated for quantitative online and pre-focus group survey data. Fisher’s exact tests investigated associations of (i) length of time in academia, (ii) career stage and (iii) country of work, and agreement with ‘perceptions of D&I’. Qualitative data were analysed thematically. In total, 141 participants responded to the survey (76% female, 21% aged 35–39 years, 14 countries represented) and 25 participated in focus groups (n = 3). Participants self-identified as having knowledge (48%), skills (53%) and experience supporting others (40%) to conduct D&I research. The majority (96%) perceived D&I was important, with 66% having organizational support for D&I, yet only 52% reported prioritizing D&I research. Perceptions of D&I differed by length of time in academia, career stage and country of work. Barriers included: (i) lack of D&I expertise; (ii) lack of organisational support/value for D&I; (iii) embedded scientific beliefs/culture; (iv) methodological challenges with D&I research; (v) funding/publishing priorities and; (vi) academic performance structures. Facilitators included: (i) increased presence/value of D&I; (ii) collective advocacy; (iii) organisational support for D&I; (iv) recruitment of D&I scientists and; (v) restructure of academic performance models, funding/publishing criteria. Individual, organisational and system-wide factors hindered academics’ engagement with and support for D&I research, which was perceived to reduce opportunities for research-practice translation. Factors were mostly consistent across countries and individual career stages/time spent in academia. Embedding D&I early within academic training, and system-wide reorientation of academic performance and funding structures to promote and facilitate D&I research, are some of the necessary actions to reduce the research-practice gap. Consistent with public health more broadly, these changes are long overdue in the fields of physical activity and nutrition.

更新日期：2020-01-17
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-17
Nicolette R. den Braver; Julia G. Kok; Joreintje D. Mackenbach; Harry Rutter; Jean-Michel Oppert; Sofie Compernolle; Jos W. R. Twisk; Johannes Brug; Joline W. J. Beulens; Jeroen Lakerveld

Car driving is a form of passive transportation associated with higher sedentary behaviour, which is associated with morbidity. The decision to drive a car is likely to be influenced by the ‘drivability’ of the built environment, but there is lack of scientific evidence regarding the relative contribution of environmental characteristics of car driving in Europe, compared to individual characteristics. This study aimed to determine which neighbourhood- and individual-level characteristics were associated with car driving in adults of five urban areas across Europe. Second, the study aimed to determine the percentage of variance in car driving explained by individual- and neighbourhood-level characteristics. Neighbourhood environment characteristics potentially related to car use were identified from the literature. These characteristics were subsequently assessed using a Google Street View audit and available GIS databases, in 59 administrative residential neighbourhoods in five European urban areas. Car driving (min/week) and individual level characteristics were self-reported by study participants (analytic sample n = 4258). We used linear multilevel regression analyses to assess cross-sectional associations of individual and neighbourhood-level characteristics with weekly minutes of car driving, and assessed explained variance at each level and for the total model. Higher residential density (β:-2.61, 95%CI: − 4.99; -0.22) and higher land-use mix (β:-3.73, 95%CI: − 5.61; -1.86) were significantly associated with fewer weekly minutes of car driving. At the individual level, higher age (β: 1.47, 95%CI: 0.60; 2.33), male sex (β: 43.2, 95%CI:24.7; 61.7), being employed (β:80.1, 95%CI: 53.6; 106.5) and ≥ 3 person household composition (β: 47.4, 95%CI: 20.6; 74.2) were associated with higher weekly minutes of car driving. Individual and neighbourhood characteristics contributed about equally to explained variance in minutes of weekly car driving, with 2 and 3% respectively, but total explained variance remained low. Residential density and land-use mix were neighbourhood characteristics consistently associated with minutes of weekly car driving, besides age, sex, employment and household composition. Although total explained variance was low, both individual- and neighbourhood-level characteristics were similarly important in their associations with car use in five European urban areas. This study suggests that more, higher quality, and longitudinal data are needed to increase our understanding of car use and its effects on determinants of health.

更新日期：2020-01-17
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-14
Kylie Ball; David Crawford

Changing academic landscapes, including the increasing focus on performance rankings and metrics, are impacting universities globally, contributing to high-pressure environments and anxious academic staff. However, evidence and experience shows that fostering a high performing academic team need not be incompatible with staff happiness and wellbeing.

更新日期：2020-01-15
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-14
Byron J. Kemp; Anne-Maree Parrish; Dylan P. Cliff

Physical activity (PA) tends to decline during late childhood and adolescence. In Australia, this decline has been shown to occur particularly in non-organized PA (e.g. active play and informal sport). Using a social marketing approach, segments of youth may be identified and targeted based on their profile of alternative activities that compete with non-organized PA during the transition to adolescence. The objectives of this study were to identify and describe segments of youth whose participation in non-organized PA declined between 11 and 13 years, based on changes in other potential competing activities during this period. Data were sourced from Waves 4 and 5 of the Longitudinal Study of Australian Children. Participation in non-organized PA and thirteen alternative activities (e.g. video games, homework, sleep) were measured using 24-h time-use diaries. Analyses were limited to participants whose non-organized PA had declined between 11 and 13 years (n = 1043). Two-stage cluster analysis was conducted and segments were described using chi-square and t-tests. Among the analytic sample, average non-organized PA participation declined by 87 min/day between 11y and 13y (p < 0.001). Two segments were identified (κ = 0.66). The ‘Social Screens’ segment (n = 143) had large increases in texting, emailing and social media use (+ 56 min/day, p < 0.001) and other internet use (+ 32 min/day, p < 0.001). Conversely, ‘the Mainstream’ segment (n = 900) had smaller increases in a wider range of activities, including other PA (organized PA, active transport, active chores/work) (+ 16.0 min/day, p < 0.001), homework/study (+ 9.5 min/day, p < 0.001) and electronic gaming (+ 6.7 min/day, p < 0.05). ‘Social Screens’ were more likely to attend public school, live in urban areas and have more advanced pubertal development (girls only). ‘The Mainstream’ were more likely to participate in PA and out-of-school activities. The ‘Social Screens’ segment had a much larger increase in texting, emailing, social media and other internet use, and lower participation in overall PA and out-of-school activities, compared with ‘the Mainstream’. Future research may trial PA promotion strategies to replace benefits that this segment may seek in competing activities (e.g. social PA apps).

更新日期：2020-01-15
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-03
Hazel Wolstenholme; Colette Kelly; Marita Hennessy; Caroline Heary

Fussy/picky eating behaviours are common across childhood. Recent reviews of the fussy eating literature focus on quantitative research and do not adequately account for families’ subjective experiences, perceptions and practices. This review aims to synthesise the increasing volume of qualitative work on fussy eating. A systematic search of relevant databases was carried out. Studies were included if they were qualitative, published since 2008, with a primary focus on families’ experiences, perceptions and practices regarding fussy eating, food neophobia, or food refusal in children (aged one to young adult). Studies with clinical samples, or relating to children under one year were excluded. Ten studies were eligible for this review and were synthesised using meta-ethnography (developed by Noblit and Hare). This review provides a comprehensive description and definition of fussy eating behaviours. A conceptual model of the family experience of fussy eating was developed, illustrating relationships between child characteristics (including fussy eating behaviours), parent feeding beliefs, parent feeding practices, mealtime emotions and parent awareness of food preference development. Our synthesis identified two ways in which fussy eating relates to mealtime emotions (directly and via parent feeding practices) and three distinct categories of parent beliefs that relate to fussy eating (self-efficacy, attributions and beliefs about hunger regulation). The model proposes pathways which could be explored further in future qualitative and quantitative studies, and suggests that parent beliefs, emotions, and awareness should be targeted alongside parent feeding practices to increase effectiveness of interventions. The majority of studies included in this review focus on pre-school children and all report the parent perspective. Further research is required to understand the child’s perspective, and experiences of fussy eating in later childhood. PROSPERO Registration: CRD42017055943

更新日期：2020-01-04
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2020-01-02

The direction of the longitudinal relationship between physical activity (PA) and fundamental motor skills (FMS) remains unclear. We evaluated the bi-directional, prospective relationships between intensity-specific physical activity (PA) and domain-specific fundamental motor skills (FMS) over 2 years in children attending preschool at baseline. A sample of 230 children (mean age at baseline 4.7 yr, 52% boys) from the 'Sogn og Fjordane Preschool Physical Activity Study' was measured 2 years apart. PA was assessed using ActiGraph accelerometers (GT3X+). FMS were evaluated by a test battery guided by the 'Test of Gross Motor Development 3' and the 'Preschooler Gross Motor Quality Scale'. PA outcomes were total PA (TPA [counts per minute]) and intensity specific PA and sedentary behaviour (SED) (min/day). FMS outcomes were locomotor, object control, and balance skills. Linear mixed model adjusting for potential co-variates was used to evaluate the bi-directional prospective associations between these variables, including the moderating effect of sex and age. Baseline total PA, moderate-to-vigorous PA (MVPA), and vigorous PA predicted higher locomotor, object control, and balance skills at follow-up (standardized regression coefficient (β): 0.17 to 0.26, p = 0.002–0.017). Baseline SED predicted lower locomotor skills at follow-up (β: − 0.27, p = 0.012). Baseline light PA did not predict FMS at follow-up. Baseline FMS were not associated with PA or SED at follow-up. MVPA was positively associated with development of FMS in young children. In contrast, FMS were not related to future PA levels. Our results suggest promotion of MVPA is important for FMS development in young children.

更新日期：2020-01-02
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-27
Jadwiga Konieczna; Dora Romaguera; Veronica Pereira; Miguel Fiol; Cristina Razquin; Ramón Estruch; Eva M. Asensio; Nancy Babio; Montserrat Fitó; Enrique Gómez-Gracia; Emilio Ros; José Lapetra; Fernando Arós; Lluís Serra-Majem; Xavier Pintó; Estefanía Toledo; José V. Sorlí; Monica Bulló; Helmut Schröder; Miguel A. Martínez-González

Consumption of certain foods is associated with long-term weight gains and abdominal fat accumulation in healthy, middle-aged and young, non-obese participants. Whether the same foods might be associated with changes in adiposity in elderly population at high cardiovascular risk is less known. Using yearly repeated measurements of both food habits and adiposity parameters, we aimed to investigate how changes in the consumption of specific foods were associated with concurrent changes in weight or waist circumference (WC) in the PREDIMED trial. We followed-up 7009 participants aged 55–70 years at high cardiovascular risk for a median time of 4.8 years. A validated 137-item semi-quantitative Food Frequency Questionnaire was used for dietary assessment with yearly repeated measurements. We longitudinally assessed associations between yearly changes in food consumption (serving/d) and concurrent changes in weight (kg) or WC (cm). Yearly increments in weight were observed with increased consumption (kg per each additional increase in 1 serving/d) for refined grains (0.32 kg/serving/d), red meat (0.24), potatoes (0.23), alcoholic beverages (0.18), processed meat (0.15), white bread (0.07) and sweets (0.04); whereas inverse associations were detected for increased consumption of low-fat yogurt (− 0.18), and low-fat milk (− 0.06). Annual WC gain (cm per each additional increase in 1 serving/d) occurred with increased consumption of snacks, fast-foods and pre-prepared dishes (0.28), processed meat (0.18), alcoholic beverages (0.13), and sweets (0.08); whereas increased consumption of vegetables (− 0.23), and nuts (− 0.17), were associated with reductions in WC. In this assessment conducted in high-risk subjects using yearly repeated measurements of food habits and adiposity, some ultra-processed foods, refined carbohydrates (including white bread), potatoes, red meats and alcohol were associated with higher weight and WC gain, whereas increases in consumption of low-fat dairy products and plant foods were associated with less gain in weight and WC. This study was registered at controlled-trials.com with International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.

更新日期：2019-12-30
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-27
Nishat Bhuiyan; Pritika Singh; Samantha M. Harden; Scherezade K. Mama

Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S. populations. Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8). A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance. We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities. The review protocol was registered with PROSPERO: CRD42019116308.

更新日期：2019-12-30
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-30
David Bann; Shaun Scholes; Meg Fluharty; Nikki Shure

Despite global concerns regarding physical inactivity, limited cross-national evidence exists to compare adolescents’ physical activity participation. We analysed data from 52 high- and low-middle income countries, with activity undertaken inside and outside of school in 2015. We investigated gender and socioeconomic disparities, and additionally examined correlations with country-level indices of physical education (PE) curriculum time allocation, wealth, and income inequality. We compared adolescents’ reported activity levels inside and outside of school using nationally representative cross-sectional data from 52 high- and low-middle income countries (N = 347,935)—the Programme for International Student Assessment (PISA) in 2015. Students reported average attendance (days/week) in PE classes, and the days/week engaged in moderate activity (MPA) and vigorous activity (VPA) outside of school. We also compared gender and socioeconomic disparities, and additionally examined correlations with purported determinants—country-level estimates of PE curriculum time allocation, wealth, and income inequality. Average activity levels differed substantially both between and within regions, with potentially important differences in distributions identified—such as a bimodal distribution in the U.S. and Canada in PE. Males were more active than females, as were those from households with higher rather than lower household wealth; these disparities were modest for PE, but higher for moderate and vigorous activity outside school—there was strong evidence for heterogeneity in the magnitude of these disparities (e.g., I2 > 95% for gender differences across all countries). PE class attendance was positively correlated with PE curriculum time allocation (rho = 0.36); activity outcomes were inconsistently associated with country-level wealth and income inequality. Our findings reveal extensive cross-country differences in adolescents’ physical activity; in turn, these highlight policy areas that could ultimately improve global adolescent health, such as the incorporation of minimum country-level PE classes, and the targeting of gender and socioeconomic disparities in activity conducted outside of school. Our findings also highlight the utility of educational databases such as PISA for use in global population health research.

更新日期：2019-12-30
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-26
Sarah Louise Bell; Suzanne Audrey; David Gunnell; Ashley Cooper; Rona Campbell

Mental illness is a worldwide public health concern. In the UK, there is a high prevalence of mental illness and poor mental wellbeing among young people. The aim of this study was to investigate whether physical activity is associated with better mental wellbeing and reduced symptoms of mental health disorder in adolescents. A cohort of 928 12–13 year olds (Year 8) from six secondary schools in England, who had participated in the AHEAD trial, ‘Activity and Healthy Eating in Adolescence’, were followed up three years later (when 15–16 years old, Year 11). At baseline, physical activity was measured using accelerometers. At follow-up, mental wellbeing was measured using the ‘Warwick Edinburgh Mental Wellbeing Scale’ (WEMWBS) and symptoms of mental health disorder using the ‘Strengths and Difficulties Questionnaire’ (SDQ). Multivariable linear regression analyses were used to investigate associations between physical activity and both mental wellbeing and symptoms of mental health disorder. 794 (86%) of the eligible 928 young people provided valid accelerometer data at baseline. 668 (72%) provided complete mental wellbeing data and 673 (73%) provided complete symptoms of mental health disorder data at follow-up. The multivariable analyses showed no evidence of an association between physical activity volume (counts per minute (cpm)) or intensity (Moderate to Vigorous Physical Activity (MVPA)) and mental wellbeing (WEMWBS overall score) or overall symptoms of mental health disorder (SDQ Total Difficulties Score). However, higher levels of physical activity volume at age 12–13 years were associated with lower scores on the emotional problems subscale of the SDQ at age 15–16 years. This cohort study found no strong evidence that physical activity is associated with better mental wellbeing or reduced symptoms of mental health disorder in adolescents. However, a protective association between physical activity and the emotional problems subscale of the SDQ was found. This suggests that physical activity has the potential to reduce symptoms of depression and anxiety in adolescents. Future cohort study designs should allow for repeated measures to fully explore the temporal nature of any relationship.

更新日期：2019-12-27
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-23
Tsung-Jen Hsieh; Shin-Chang Su; Chun-Wei Chen; Yaw-Wen Kang; Ming-Hsia Hu; Li-Lin Hsu; Szu-Yun Wu; Likwang Chen; Hsing-Yi Chang; Shao-Yuan Chuang; Wen-Harn Pan; Chih-Cheng Hsu

Following publication of the original article [1], the author reported that an abbreviation was incorrect in the original article;

更新日期：2019-12-23
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-23
Aina M. Galmes-Panades; Veronica Varela-Mato; Jadwiga Konieczna; Julia Wärnberg; Miguel Ángel Martínez-González; Jordi Salas-Salvadó; Dolores Corella; Helmut Schröder; Jesús Vioque; Ángel M. Alonso-Gómez; J. Alfredo Martínez; Luís Serra-Majem; Ramon Estruch; Francisco J. Tinahones; José Lapetra; Xavier Pintó; Josep A. Tur; Antonio Garcia-Rios; Blanca Riquelme-Gallego; José Juan Gaforio; Pilar Matía-Martín; Lidia Daimiel; Rafael Manuel Micó Pérez; Josep Vidal; Clotilde Vázquez; Emilio Ros; Ana Garcia-Arellano; Andrés Díaz-López; Eva M. Asensio; Olga Castañer; Francisca Fiol; Luis Alfredo Mira-Castejón; Anai Moreno Rodríguez; Juan Carlos Benavente- Marín; Itziar Abete; Laura Tomaino; Rosa Casas; F. Javier Barón López; José Carlos Fernández-García; José Manuel Santos-Lozano; Ana Galera; Catalina M. Mascaró; Cristina Razquin; Christopher Papandreou; Olga Portoles; Karla Alejandra Pérez-Vega; Miguel Fiol; Laura Compañ-Gabucio; Jessica Vaquero-Luna; Miguel Ruiz-Canela; Nerea Becerra-Tomás; Montserrat Fitó; Dora Romaguera

This study explored the association between inactive time and measures of adiposity, clinical parameters, obesity, type 2 diabetes and metabolic syndrome components. It further examined the impact of reallocating inactive time to time in bed, light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on cardio-metabolic risk factors, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. This is a cross-sectional analysis of baseline data from 2189 Caucasian men and women (age 55–75 years, BMI 27–40 Kg/m2) from the PREDIMED-Plus study (http://www.predimedplus.com/). All participants had ≥3 components of the metabolic syndrome. Inactive time, physical activity and time in bed were objectively determined using triaxial accelerometers GENEActiv during 7 days (ActivInsights Ltd., Kimbolton, United Kingdom). Multiple adjusted linear and logistic regression models were used. Isotemporal substitution regression modelling was performed to assess the relationship of replacing the amount of time spent in one activity for another, on each outcome, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. Inactive time was associated with indicators of obesity and the metabolic syndrome. Reallocating 30 min per day of inactive time to 30 min per day of time in bed was associated with lower BMI, waist circumference and glycated hemoglobin (HbA1c) (all p-values < 0.05). Reallocating 30 min per day of inactive time with 30 min per day of LPA or MVPA was associated with lower BMI, waist circumference, total fat, visceral adipose tissue, HbA1c, glucose, triglycerides, and higher body muscle mass and HDL cholesterol (all p-values < 0.05). Inactive time was associated with a poor cardio-metabolic profile. Isotemporal substitution of inactive time with MVPA and LPA or time in bed could have beneficial impact on cardio-metabolic health. The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.

更新日期：2019-12-23
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-21
Emily Haynes; Judith Green; Ruth Garside; Michael P. Kelly; Cornelia Guell

Innovative approaches are required to move beyond individual approaches to behaviour change and develop more appropriate insights for the complex challenge of increasing population levels of activity. Recent research has drawn on social practice theory to describe the recursive and relational character of active living but to date most evidence is limited to small-scale qualitative research studies. To ‘upscale’ insights from individual contexts, we pooled data from five qualitative studies and used machine learning software to explore gendered patterns in the context of active travel. We drew on 280 transcripts from five research projects conducted in the UK, including studies of a range of populations, travel modes and settings, to conduct unsupervised ‘topic modelling analysis’. Text analytics software, Leximancer, was used in the first phase of the analysis to produce inter-topic distance maps to illustrate inter-related ‘concepts’. The outputs from this first phase guided a second researcher-led interpretive analysis of text excerpts to infer meaning from the computer-generated outputs. Guided by social practice theory, we identified ‘interrelated’ and ‘relating’ practices across the pooled datasets. For this study we particularly focused on respondents’ commutes, travelling to and from work, and on differentiated experiences by gender. Women largely described their commute as multifunctional journeys that included the school run or shopping, whereas men described relatively linear journeys from A to B but highlighted ‘relating’ practices resulting from or due to their choice of commute mode or journey such as showering or relaxing. Secondly, we identify a difference in discourses about practices across the included datasets. Women spoke more about ‘subjective’, internal feelings of safety (‘I feel unsafe’), whereas men spoke more about external conditions (‘it is a dangerous road’). This rare application of machine learning to qualitative social science research has helped to identify potentially important differences in co-occurrence of practices and discourses about practice between men’s and women’s accounts of travel across diverse contexts. These findings can inform future research and policy decisions for promoting travel-related social practices associated with increased physical activity that are appropriate across genders.

更新日期：2019-12-21
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-19
Rubina Mulchandani; Ambalam M. Chandrasekaran; Roopa Shivashankar; Dimple Kondal; Anurag Agrawal; Jeemon Panniyammakal; Nikhil Tandon; Dorairaj Prabhakaran; Meenakshi Sharma; Shifalika Goenka

Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults. All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome. A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: − 2.61 kg, 95% CI: − 3.89 to − 1.33) BMI (19 studies, mean diff: − 0.42 kg/m2, 95% CI: − 0.69 to − 0.15) and waist circumference (13 studies; mean diff: − 1.92 cm, 95% CI: − 3.25 to − 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant. Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research. Prospero registration number: CRD42018094436.

更新日期：2019-12-20
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-19
R. G. Prins; C. B. M. Kamphuis; F. J. Van Lenthe

Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods. Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates. Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking. Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults.

更新日期：2019-12-19
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-18
Venurs H. Y. Loh; Jenny Veitch; Jo Salmon; Ester Cerin; Lukar Thornton; Suzanne Mavoa; Karen Villanueva; Anna Timperio

Increasing emphasis has been placed on improving physical activity levels through multilevel interventions. This study aims to examine moderating effects of neighborhood safety (crime and traffic) and social support (from parent and sibling/peer) for physical activity in the relationship between the built environment and moderate-to-vigorous physical activity (MVPA) outside school hours among adolescents in Melbourne. Data were from the NEighbourhood Activity in Youth study conducted among adolescents in Melbourne, Australia (n = 358, 15.3 (SD = 1.5) years). MVPA outside school hours was assessed by accelerometer. Built environment features within 1 km and 2 km residential buffers including recreation facilities, park area, and walkability and its components were assessed using Geographic Information Systems. Neighborhood safety, social support for physical activity and sociodemographic information were self-reported by adolescents. Multilevel linear regression models were used to estimate associations. Support for physical activity from sibling/peer positively moderated the relationship between recreation facilities (1 km), residential density (2 km) and MVPA. Recreation facility (count within 2 km), walkability (1 km and 2 km) and residential density (1 km) had significant positive associations with MVPA outside school hours. The built environment appeared to have stronger facilitating effects on MVPA among adolescents who had favourable support for physical activity from their sibling or peer. Multilevel interventions that target the built environment and social factors are needed to promote MVPA outside school hours among adolescents.

更新日期：2019-12-19
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-16
Luiza Isnardi Cardoso Ricardo; Inácio Crochemore M. da Silva; Otávio Amaral de Andrade Leão; Marlos Rodrigues Domingues; Fernando C. Wehrmeister

The aim of this study is to describe objectively measured physical activity (PA) and its correlates in one-year-old children. The current study includes participants from the 2015 Pelotas (Brazil) birth cohort. At age one, PA was assessed in a 24-h protocol during 4 days with a wrist-attached accelerometer (ActiGraph, wGT3X-BT), from which two complete days of data were analyzed, with 5-s epochs. A total of 2974 individuals provided valid accelerometry data. Infants able to walk independently spent on average 19 h per day below 50 mg of acceleration (including sleep time), and those who could not walk spent on average 21 h in this intensity category. Girls spent approximately 10 min more than boys below 50 mg daily in both walking status categories, and less activity than boys on higher intensity categories. Boys and infants whose mothers were more physically active during pregnancy presented more acceleration, regardless of walking status. Among infants who could walk by themselves, those with mothers with one to eight schooling years; adequate length-for-age (z-score); not attending daycare; and more physically active fathers also showed higher levels of acceleration. Our findings demonstrate higher levels of PA among boys and those children with higher maternal PA during pregnancy, regardless of walking status. Also, among infants able to independently walk, 1–8 years of maternal schooling, adequate length-for-age (z-score), no daycare attendance and higher paternal PA are positive correlates of objectively measured PA early in life.

更新日期：2019-12-17
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-12
Manou Anselma; Teatske M. Altenburg; Helga Emke; Femke van Nassau; Merlin Jurg; Robert A. C. Ruiter; Janine M. Jurkowski; Mai J. M. Chinapaw

Youth-led Participatory Action Research (YPAR) involves children throughout the process of developing and implementing interventions. Combining YPAR with a structural approach for designing and planning interventions, such as Intervention Mapping (IM), may further improve implementation and effectiveness of interventions. This paper describes how YPAR and IM were combined in the Kids in Action study. The Kids in Action study aims to improve health behaviors of 9–12-year old children living in a low socioeconomic neighborhood in Amsterdam, by co-designing interventions with these children. At each of four schools 6–8 children (N = 18–24 total per year) and two academic researchers formed participatory groups that met weekly or every fortnight during two school years. An IM expert panel advised the participatory groups on the application of IM. Following the IM protocol, we conducted a participatory needs assessment with children, parents and professionals, in IM-step 1. In IM-step 2, the IM expert panel constructed matrices of program objectives, and the children provided feedback. In collaboration with children programs were designed and produced using an iterative process during IM-steps 3–4. In IM-step 5, the participatory groups and professional community partners designed the implementation plan. Finally, in IM-step 6, the protocol of the process and effect evaluation – executed by academic researchers with input from children – was developed. By combining YPAR and IM, several interventions have been developed and implemented, varying from a school water policy to extracurricular sports activities. Sharing responsibility with children was challenging when combining IM with YPAR. In YPAR children are given as much autonomy as possible, while traditional IM development work is primarily done by academic researchers. Strengths in combining IM and YPAR include the involvement of the end-users - children - throughout the process while at the same time developing interventions based on existing evidence. Time-management, a multidisciplinary team, and flexibility are important conditions when combining IM with YPAR. A strong community project group, with professionals who were willing to help children develop and execute their ideas, was an important success factor. This study can serve as an example to other YPAR studies developing interventions using the IM protocol.

更新日期：2019-12-13
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-11
Christoph Buck; Gabriele Eiben; Fabio Lauria; Kenn Konstabel; Angie Page; Wolfgang Ahrens; Iris Pigeot

Physical activity (PA) is one of the major protective behaviours to prevent non-communicable diseases. Positive effects of the built environment on PA are well investigated, although evidence of this association is mostly based on cross-sectional studies. The present study aims to investigate the longitudinal effects of built environment characteristics in terms of a moveability index on PA of children in their transition phase to adolescence using data of the IDEFICS/I.Family cohort. We used data on 3394 accelerometer measurements of 2488 children and adolescents aged 3 to 15 years old from survey centres of three countries, Germany, Italy, and Sweden, who participated in up to three surveys over 6 years. In network-dependent home neighbourhoods, a moveability index was calculated based on residential density, land use mix, street connectivity, availability of public transport and public open spaces such as green spaces and public playgrounds in order to quantify opportunities for PA of children and adolescents. Linear trajectories of light PA (LPA) and moderate-to-vigorous PA (MVPA) were estimated using linear mixed models accounting for repeated measurements nested within individuals. Least squares means were estimated to quantify differences in trajectories over age. LPA and MVPA declined annually with age by approximately 20 min/day and 2 min/day respectively. In girls, the moveability index showed a consistent significantly positive effect on MVPA ($$\hat{\beta}$$ = 2.14, 95% CI: (0.11; 4.16)) for all ages, while in boys the index significantly lessened the decline in LPA with age for each year. ($$\hat{\beta}$$ = 2.68, 95% CI: (0.46; 4.90)). Availability of public open spaces was more relevant for MVPA in girls and LPA in boys during childhood, whereas in adolescence, residential density and intersection density became more important. Built environment characteristics are important determinants of PA and were found to have a supportive effect that ameliorates the decline in PA during the transition phase from childhood to adolescence. In childhood environmental support for leisure time PA through public open spaces was found to be the most protective factor whereas in adolescence the positive influence of street connectivity and residential density was most supportive of physical activity.

更新日期：2019-12-11
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-11
Lisa M. Barnett; Jill A. Hnatiuk; Jo Salmon; Kylie D. Hesketh

Fundamental motor skills (FMS) are important for physical activity and healthy weight status in children, yet it is unclear which early childhood factors facilitate subsequent motor skill. The aim of this prospective study was to investigate which modifiable family and home environment factors in the early years predict children’s FMS at age five. Mothers from the Melbourne InFANT program (registered with the International Standard Randomised Controlled Trial Number Register (ISRCTN81847050)) completed questionnaires when child was aged 4, 9, 19 months old, and 3.5 years old on factors hypothesised to predict motor skills. Some factors were grouped in tertiles (high, medium, low) due to the nature of the distribution. At 5 years old children were assessed on 6 locomotor and 6 object control skills (Test of Gross Motor Development-2). Eight regression models examined the association between factors at each time-point and children’s skills (object control and locomotor) at 5 years old. The sample varied by time-point (178 to 259 children). Maternal physical activity optimism (4 months; β = 2.43), home physical activity equipment (9 months; β = 0.82), time outdoors – middle (9 months; β = 2.50) and highest tertile (9 months; β = 2.86), time free to move about - highest tertile (19 months; β = 2.41), time with older children - middle (19 months; β = 3.15) and highest tertile (3.5 years; β = 3.00) were predictive of better locomotor scores. Mothers’ own physical activity (9 months; β = − 0.01) and time active with mum – highest tertile (3.5 years; β = − 3.73) were negatively associated with locomotor skill. Time with older children - highest (4 months; β = 2.27) and middle tertile (19 months; β = 2.97), time free to move about – middle (19 months; β = 2.55) and highest tertile (19 months; β = 2.47), and more home equipment (9 months; β = 0.83); (3.5 years; β = 0.17) were predictive of better object control skills. Maternal physical activity knowledge (3.5 years; β = − 3.05) was negatively associated with object control skill. Providing a supportive environment with older children and equipment, and allowing toddlers’ freedom to move, appears important. Opportunities exist to educate parents on their important role in developing children’s motor skills. Clinicians could advise parents that the home environment can make a difference to their child’s FMS starting from infancy.

更新日期：2019-12-11
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-09
Ing-Mari Dohrn; Anna-Karin Welmer; Maria Hagströmer

Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking. To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days. In total, 1220 women and men, 18–75 years, from the population-based Sweden Attitude Behaviour and Change study 2000–2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay. Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48–0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33–0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37–0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20–4.74). This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message “sit less and move more”.

更新日期：2019-12-11
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-09
Tim Lindsay; Kate Westgate; Katrien Wijndaele; Stefanie Hollidge; Nicola Kerrison; Nita Forouhi; Simon Griffin; Nick Wareham; Søren Brage

Physical activity (PA) plays a role in the prevention of a range of diseases including obesity and cardiometabolic disorders. Large population-based descriptive studies of PA, incorporating precise measurement, are needed to understand the relative burden of insufficient PA levels and to inform the tailoring of interventions. Combined heart and movement sensing enables the study of physical activity energy expenditure (PAEE) and intensity distribution. We aimed to describe the sociodemographic correlates of PAEE and moderate-to-vigorous physical activity (MVPA) in UK adults. The Fenland study is a population-based cohort study of 12,435 adults aged 29–64 years-old in Cambridgeshire, UK. Following individual calibration (treadmill), participants wore a combined heart rate and movement sensor continuously for 6 days in free-living, from which we derived PAEE (kJ•day− 1•kg− 1) and time in MVPA (> 3 & > 4 METs) in bouts greater than 1 min and 10 min. Socio-demographic information was self-reported. Stratum-specific summary statistics and multivariable analyses were performed. Women accumulated a mean (sd) 50(20) kJ•day− 1•kg− 1 of PAEE, and 83(67) and 33(39) minutes•day− 1 of 1-min bouted and 10-min bouted MVPA respectively. By contrast, men recorded 59(23) kJ•day− 1•kg− 1, 124(84) and 60(58) minutes•day− 1. Age and BMI were also important correlates of PA. Association with age was inverse in both sexes, more strongly so for PAEE than MVPA. Obese individuals accumulated less PA than their normal-weight counterparts, whether considering PAEE or allometrically-scaled PAEE (− 10 kJ•day− 1•kg− 1 or − 15 kJ•day− 1•kg-2/3 in men). Higher income and manual work were associated with higher PA; manual workers recorded 13–16 kJ•kg− 1•day− 1 more PAEE than sedentary counterparts. Overall, 86% of women and 96% of men accumulated a daily average of MVPA (> 3 METs) corresponding to 150 min per week. These values were 49 and 74% if only considering bouts > 10 min (15 and 31% for > 4 METs). PA varied by age, sex and BMI, and was higher in manual workers and those with higher incomes. Light physical activity was the main driver of PAEE; a component of PA that is currently not quantified as a target in UK guidelines.

更新日期：2019-12-11
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-09
Matthew Keeble; Jean Adams; Martin White; Carolyn Summerbell; Steven Cummins; Thomas Burgoine

Greater neighbourhood takeaway food outlet access has been associated with increased takeaway food consumption and higher body weight. National planning guidelines in England suggest that urban planning could promote healthier food environments through takeaway food outlet regulation, for example by restricting the proliferation of outlets near schools. It is unknown how geographically widespread this approach is, or local characteristics associated with its use. We aimed to address these knowledge gaps. We used data from a complete review of planning policy documents adopted by local government areas in England (n = 325), which contained policies for the purpose of takeaway food outlet regulation. This review classified local government area planning policies as having a health (diet or obesity) or non-health focus. We explored geographical clustering of similar planning policies using spatial statistics. We used multinomial logistic regression models to investigate whether the odds of planning policy adoption varied according to local characteristics, for example the proportion of children with excess weight or the current number of takeaway food outlets. We observed clusters of local government areas with similar adopted planning policies in the North East, North West, and Greater London regions of England. In unadjusted logistic regression models, compared to local government areas with the lowest, those with highest proportion of 10–11 year olds with excess weight (OR: 25.31; 95% CI: 6.74, 94.96), and takeaway food outlet number (OR: 54.00; 95% CI: 6.17, 472.41), were more likely to have a health-focused planning policy, than none. In models adjusted for deprivation, relationships for excess weight metrics were attenuated. Compared to local government areas with the lowest, those with the highest takeaway food outlet number remained more likely to have a health-focused planning policy, than none (OR: 16.98; 95% CI: 1.44, 199.04). When local government areas were under Labour political control, predominantly urban, and when they had more geographically proximal and statistically similar areas in the same planning policy status category, they were also more likely to have health-focused planning policies. Planning policies for the purpose of takeaway food outlet regulation with a health focus were more likely in areas with greater numbers of takeaway food outlets and higher proportions of children with excess weight. Other characteristics including Labour political control, greater deprivation and urbanisation, were associated with planning policy adoption, as were the actions of similar and nearby local government areas. Further research should engage with local policymakers to explore the drivers underpinning use of this approach.

更新日期：2019-12-11
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-09
Maura M. Kepper; Candice A. Myers; Kara D. Denstel; Ruth F. Hunter; Win Guan; Stephanie T. Broyles

Investigating the association of the neighborhood social environment on physical activity is complex. A systematic scoping review was performed to (1) provide an inventory of studies assessing the influence of the neighborhood social environment on physical activity since 2006; (2) describe methodologies employed; and (3) formulate recommendations for the field. Two databases were searched using terms related to ‘physical activity,’ ‘neighborhood,’ and ‘social environment’ in January 2017. Eligibility criteria included: 1) physical activity as an outcome; 2) neighborhood social environment as a predictor; 3) healthy population (without diagnosed clinical condition or special population); 4) observational or experimental design. Of 1352 studies identified, 181 were included. Textual data relevant to the social environment measurement and analysis were extracted from each article into qualitative software (MAXQDA) and coded to identify social environmental constructs, measurement methods, level of measurement (individual vs. aggregated to neighborhood), and whether authors explicitly recognized the construct as the social environment. The following measures were generated for each construct: number of unique measurements; % of times measured at an aggregate level; % of times authors referred to the construct as the social environment. Social environmental constructs were then grouped into larger descriptive dimensions. Fifty-nine social environmental constructs were identified and grouped into 9 dimensions: Crime & Safety (n = 133 studies; included in 73% of studies); Economic & Social Disadvantage (n = 55, 33%); Social Cohesion & Capital (n = 47, 26%); Social Relationships (n = 22, 12%); Social Environment (n = 16, 9%); Disorder & Incivilities (n = 15, 8%); Sense of Place/Belonging (n = 8, 4%); Discrimination/Segregation (n = 3, 2%); Civic Participation & Engagement (n = 2, 1%). Across all articles, the social environment was measured using 176 different methods, was measured at an aggregate-level 38% of the time, and referred to as the social environment 23% of the time. Inconsistent terminology, definitions, and measurement of the social environment and the lack of explicit language identifying constructs as the social environment make it challenging to compare results across studies and draw conclusions. Improvements are needed to increase our understanding of social environmental correlates and/or determinants of physical activity and facilitate cross-disciplinary conversations necessary to effectively intervene to promote physical activity. PROSPERO CRD42017059580.

更新日期：2019-12-09
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-05
Amy L. Wilson; Cathy Nguyen; Svetlana Bogomolova; Byron Sharp; Timothy Olds

Despite the ongoing promotion of physical activity, the rates of physical inactivity remain high. Drawing on established methods of analysing consumer behaviour, this study seeks to understand how physical activity competes for finite time in a day – how Exercise and Sport compete with other everyday behaviours, and how engagement in physical activity is shared across Exercise and Sport activities. As targeted efforts are common in physical activity intervention and promotion, the existence of segmentation is also explored. Time-use recall data (n = 2307 adults) is analysed using the Duplication of Behaviour Law, and tested against expected values, to document what proportion of the population that engage in one activity, also engage in another competing activity. Additionally, a Mean Absolute Deviation approach is used to test for segmentation. The Duplication of Behaviour Law is evident for everyday activities, and Exercise and Sport activities – all activities ‘compete’ with each other, and the prevalence of the competing activity determines the extent of competition. However, some activities compete more or less than expected, suggesting the combinations of activities that should be used or avoided in promotion efforts. Competition between everyday activities is predictable, and there are no specific activities that are sacrificed to engage in Exercise and Sport. How people share their physical activity across different Exercise and Sport activities is less predictable – Males and younger people (under 20 years) are more likely to engage in Exercise and Sport, and those who engage in Exercise and Sport are slightly more likely to Work and Study. High competition between Team Sports and Non-Team Sports suggests strong preferences for sports of different varieties. Finally, gender and age-based segmentation does not exist for Exercise and Sport relative to other everyday activities; however, segmentation does exist for Team Sports, Games, Active Play and Dance. The Duplication of Behaviour Law demonstrates that population-level patterns of behaviour can yield insight into the competition between different activities, and how engagement in physical activity is shared across different Exercise and Sport activities. Such insights can be used to describe and predict physical activity behaviour and may be used to inform and evaluate promotion and intervention.

更新日期：2019-12-05
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-02
Tsung-Jen Hsieh; Shin-Chang Su; Chun-Wei Chen; Yaw-Wen Kang; Ming-Hsia Hu; Li-Lin Hsu; Szu-Yun Wu; Likwang Chen; Hsing-Yi Chang; Shao-Yuan Chuang; Wen-Harn Pan; Chih-Cheng Hsu

Frail older adults are predisposed to multiple comorbidities and adverse events. Recent interventional studies have shown that frailty can be improved and managed. In this study, effective individualized home-based exercise and nutrition interventions were developed for reducing frailty in older adults. This study was a four-arm, single-blind, randomized controlled trial conducted between October 2015 and June 2017 at Miaoli General Hospital in Taiwan. Overall, 319 pre-frail or frail older adults were randomly assigned into one of the four study groups (control, exercise, nutrition, and exercise plus nutrition [combination]) and followed up during a 3-month intervention period and 3-month self-maintenance period. Improvement in frailty scores was the primary outcome. Secondary outcomes included improvements in physical performance and mental health. The measurements were performed at baseline, 1 month, 3 months, and 6 months. At the 6-month measurement, the exercise (difference in frailty score change from baseline: − 0.23; 95% confidence interval [CI]: − 0.41, − 0.05; p = 0.012), nutrition (− 0.28; 95% CI: − 0.46, − 0.11; p = 0.002), and combination (− 0.34; 95% CI: − 0.52, − 0.16; p < 0.001) groups exhibited significantly greater improvements in the frailty scores than the control group. Significant improvements were also observed in several physical performance parameters in the exercise, nutrition, and combination groups, as well as in the 12-Item Short Form Health Survey mental component summary score for the nutrition group. The designated home-based exercise and nutrition interventions can help pre-frail or frail older adults to improve their frailty score and physical performance. Retrospectively registered at ClinicalTrials.gov (identifier: NCT03477097); registration date: March 26, 2018.

更新日期：2019-12-02
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-12-02
Samuel Cassar; Jo Salmon; Anna Timperio; Patti-Jean Naylor; Femke van Nassau; Ana María Contardo Ayala; Harriet Koorts

Globally, many children fail to meet the World Health Organization’s physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings. The review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents; (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results; and (iv) interventions delivered under real-world conditions. Exclusion criteria: (i) efficacy trials; (ii) studies applying or testing school-based physical activity policies, and; (iii) studies targeting special schools or pre-school and/or kindergarten aged children. 27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers’ Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results (n = 9), for planning evaluation and interpreting results (n = 8), for planning evaluation (n = 6), for intervention design (n = 4), or for a combination of designing the intervention and interpreting results (n = 3). We identified 269 factors related to barriers (n = 93) and facilitators (n = 176) for the adoption (n = 7 studies), implementation (n = 14 studies) and sustainability (n = 7 studies) of interventions. Implementation model use was predominately centered on the interpretation of results and analyses, with few examples of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale. PROSPERO (CRD42018099836).

更新日期：2019-12-02
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-11-29
Ester Cerin; Andrea Nathan; Wing Ka Choi; Winsfred Ngan; Shiyuan Yin; Lukar Thornton; Anthony Barnett

Neighbourhood environments influence older adults’ health and health-enhancing behaviours, such as physical activity, eating a healthy diet and socialising. However, little is known about the effects of the neighbourhood environment on the health of older immigrants, the number of which is rapidly increasing in developed countries. Using Nominal Group Technique (NGT) sessions, this study of older Chinese immigrants to urban Melbourne, Australia, examined built and social environmental facilitators of and barriers to regular engagement in physical activity, eating a healthy diet and regular contact with other people. Participants were recruited from four types of neighbourhoods stratified by walkability and proportion of Chinese dwellers. Twelve NGTs, four specific to each of physical activity, healthy diet and social contacts were conducted in Mandarin or Cantonese (91 participants). NGT responses from groups addressing the same questions were aggregated, similar items were combined, and scores combined across groups. Inductive thematic analysis was used to categorise answers into higher-order themes of factors associated with each behaviour. For physical activity, 29 facilitators and 28 barriers were generated with the highest ranked facilitator and barrier being “proximity to destinations” and “poor/inadequate public transport”, respectively. For healthy diet, 25 facilitators and 25 barriers were generated, the highest ranked facilitator and barrier were “high food safety standards/regulations” and “lack of family/household members’ social support for a healthy diet”. The social contacts NGTs generated 23 facilitators and 22 barriers, with the highest ranked facilitator and barrier being “proximity to destinations and activities” and “poor public transport”, respectively. Independent living arrangements and the accessibility of destinations of daily living (e.g., bilingual health services, libraries, places of worship and grocery stores / supermarkets), recreational facilities, affordable public transport, and community centres and activities for Chinese people are key elements for promoting regular engagement in physical activity, healthy eating and socialising in older Chinese immigrants. Governments should plan for the provision of this basic infrastructure of community facilities for older immigrants.

更新日期：2019-11-30
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-11-29
Taren Sanders; Philip D. Parker; Borja del Pozo-Cruz; Michael Noetel; Chris Lonsdale

Excessive engagement with digital screens is harmful to children’s health. However, new evidence suggests that exposure at moderate levels may not be harmful and may even provide benefit. Therefore, our objective was to determine if there are curvilinear relationships between different types of screen time and a diverse set of outcomes, including health and education. We address our objective using a repeated measures design. Children (N = 4013), initially aged 10–11 were assessed every 2 years between 2010 and 2014. Children’s screen time behavior was measured using time-use diaries, and categorized into five types: social, passive, interactive, educational, or other. We used measures of children’s physical health, health-related quality of life, socio-emotional outcomes, and school achievement. The analysis plan was pre-registered. Models were adjusted for gender, socio-economic status, ethnicity, number of siblings, and housing factors. There were linear associations between total screen time and all outcomes, such that more screen time was associated with worse outcomes. However, there was variability when examined by screen time type. Passive screen time (e.g., TV) was associated with worse outcomes, educational screen time (e.g., computer for homework) was associated with positive educational outcomes and had no negative relations with other outcomes. Interactive screen time (e.g., video games) had positive associations with educational outcomes but negative associations with other outcomes. In all instances, these significant associations were small or very small, with standardised effects < 0.07. We found little evidence of curvilinear relationships. The small effects of screen time on children’s outcomes appear to be moderated by the type of screen time. Policy makers, educators, and parents should consider the type of screen time when considering the benefits and harms of use.

更新日期：2019-11-30
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-11-29
Seth LaJeunesse; Sam Thompson; Nancy Pullen-Seufert; Mary Bea Kolbe; Stephen Heiny; Cathy Thomas; Edward R. Johnson

Schools located in rural parts of the United States and North Carolina have benefited proportionally less from the federal Safe Routes to School (SRTS) program than their more urban counterparts. We investigated whether and how diverse elementary and middle school communities throughout North Carolina have engaged in a SRTS-inspired, multi-sectoral initiative called the Active Routes to School (ARTS) project over the course of 5 years (2013 through 2017). Analyses included a study sample of 2602 elementary and middle schools in North Carolina, 853 that participated in the ARTS project over the five-year study period and 1749 that had not. Statistical models controlling for county- and school-level confounders predicted schools’ involvement in walking and bicycling-promotive events, programs, and policies over time. Schools’ engagement with ARTS Project programming increased significantly over the study period, with 33% of eligible schools participating with the project by the end of 2017. Participation was most common in promotional events. Such event participation predicted engagement with regularly recurring programming and school- and district-level establishment of biking- and walking-facilitative policies. Lower income schools were more likely to establish recurring bike and walk programs than wealthier schools, whereas rural schools were less likely than city schools to participate in promotional events, yet equally as likely as other schools to participate in recurring bike and walk programs. Schools’ engagement with the North Carolina ARTS Project diffused despite many schools’ rural geographies and lower socioeconomic status. Further, participation in one-time promotional events can portend schools’ establishment of recurring walking and biking programs and supportive policies.

更新日期：2019-11-30
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-16
Patrick Crowley; Jørgen Skotte; Emmanuel Stamatakis; Mark Hamer; Mette Aadahl; Matthew L. Stevens; Vegar Rangul; Paul J. Mork; Andreas Holtermann

Pooling data from thigh-worn accelerometers across multiple studies has great potential to advance evidence on the health benefits of physical activity. This requires harmonization of information on body postures, physical activity types, volumes and time patterns across different brands of devices. The aim of this study is to compare the physical behavior estimates provided by three different brands of thigh-worn accelerometers. Twenty participants volunteered for a 7-day free-living measurement. Three accelerometers - ActiGraph GT3X+, Axivity AX3 and ActivPAL Micro4 - were randomly placed in a vertical line on the midsection of the right thigh. Raw data from each accelerometer was processed and classified into 8 physical activities and postures using the Acti4 software. Absolute differences between estimates and the respective coefficient of variation (CV) were calculated. We observed very minor differences between physical behavior estimates from three different accelerometer brands. When averaged over 24 h (1,440 min), the absolute difference (CV) between accelerometers were: 1.2 mins (0.001) for lying/sitting, 3.4 mins (0.02) for standing, 3.5 mins (0.06) for moving, 1.9 mins (0.03) for walking, 0.1 mins (0.19) for running, 1.2 mins (0.19) for stair climbing, 1.9 mins (0.07) for cycling. Moreover, there was an average absolute difference of 282 steps (0.03) per 24 h. Physical behaviors were classified with negligible difference between the accelerometer brands. These results support harmonization of data from different thigh-worn accelerometers across multiple cohorts when analyzed in an identical manner.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-19
Emily Truman; Charlene Elliott

Teenagers are aggressively targeted by food marketing messages (primarily for unhealthy foods) and susceptible to this messaging due to developmental vulnerabilities and peer-group influence. Yet limited research exists on the exposure and power of food marketing specifically to teenage populations. Research studies often collapse “teenagers” under the umbrella of children or do not recognize the uniqueness of teen-targeted appeals. Child- and teen-targeted marketing strategies are not the same, and this study aims to advance understanding of teen-targeted food marketing by identifying the teen-specific promotion platforms, techniques and indicators detailed in existing literature. A systematic scoping review collected all available literature on food marketing/advertising with the term “teenager” or “adolescent” from nine databases, as well as Google Scholar for grey literature, and a hand search of relevant institutional websites. Included were all peer-reviewed journal articles, book chapters, and grey literature in which food marketing to youth was the central topic of the article, of any study type (i.e., original research, reviews, commentaries and reports), and including any part of the 12–17 age range. The 122 articles reviewed define the scope of existing literature on food marketing to young people age 17 and under, identifying leading trends in countries studied (United States, 52%), populations identified (children and teens studied concurrently, 36%), outcomes measured (advertising exposure, 54%), study type (cross-sectional, 58%) and methods used (content analysis, 46%). The promotion platforms and techniques used by food marketers to appeal to young people (as reported in the literature) are also identified and classified. Few studies (7%) use indicators to identify teen-targeted food marketing. Unique treatments of teen populations are limited in food marketing literature, as is the application of clear indicators to identify and differentiate teen-targeted food marketing from child- or adult-targeted content. Given the need to better measure the presence and power of teen food marketing, this is a significant oversight in existing literature. The indicators identified will help researchers to develop more accurate strategies for researching and monitoring teen-targeted food promotion.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-20
André O. Werneck; Se-Sergio Baldew; J. Jaime Miranda; Oscar Díaz Arnesto; Brendon Stubbs; Danilo R. Silva

Physical inactivity and sedentary behavior are major concerns for public health. Although global initiatives have been successful in monitoring physical activity (PA) worldwide, there is no systematic action for the monitoring of correlates of these behaviors, especially in low- and middle-income countries. Here we describe the prevalence and distribution of PA domains and sitting time in population sub-groups of six south American countries. Data from the South American Physical Activity and Sedentary Behavior Network (SAPASEN) were used, which includes representative data from Argentina (n = 26,932), Brazil (n = 52,490), Chile (n = 3719), Ecuador (n = 19,851), Peru (n = 8820), and Suriname (n = 5170). Self-reported leisure time (≥150 min/week), (≥150 min/week), transport (≥10 min/week), and occupational PA total (≥10 min/week), as well as sitting time (≥4 h/day) were captured in each national survey. Sex, age, income, and educational status were exposures. Descriptive statistics and harmonized random effect meta-analyses were conducted. The prevalence of PA during leisure (Argentina: 29.2% to Peru: 8.6%), transport (Peru: 69.7% to Ecuador: 8.8%), and occupation (Chile: 60.4 to Brazil 18.3%), and ≥4 h/day of sitting time (Peru: 78.8% to Brazil: 14.8%) differed widely between countries. Moreover, total PA ranged between 60.4% (Brazil) and 82.9% (Chile) among men, and between 49.4% (Ecuador) and 74.9% (Chile) among women. Women (low leisure and occupational PA) and those with a higher educational level (low transportation and occupational PA as well as high sitting time) were less active. Concerning total PA, men, young and middle-aged adults of high educational status (college or more) were, respectively, 47% [OR = 0.53 (95% CI = 0.36–0.78), I2 = 76.6%], 25% [OR = 0.75 (95% CI = 0.61-0.93), I2 = 30.4%] and 32% [OR = 0.68 (95% CI = 0.47-1.00), I2 = 80.3%] less likely to be active. PA and sitting time present great ranges and tend to vary across sex and educational status in South American countries. Country-specific exploration of trends and population-specific interventions may be warranted.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-22
Suzanne Harte; Maryanne Theobald; Stewart G. Trost

Establishing healthy eating behaviours in early life has implications for health over the life course. As the majority of Australian children aged five and under regularly attend early childhood education and care (ECEC) services, mealtimes at ECEC settings present opportunities to promote healthy eating behaviors. The purpose of this study was to explore children’s eating behaviours and interactions between peers and educators during mealtimes in ECEC settings, with the aim of constructing a grounded theory of children’s mealtimes in ECEC. In-depth qualitative case studies were undertaken at two ECEC centres. Each centre had been assessed as meeting national quality standards and were located in a lower socioeconomic status area. Data collection consisted of direct observation, video recording, written memos, and daily field notes. The analysis included open coding of video recorded mealtimes and field notes resulting in the allocation of initial codes and focused codes. Codes were grouped to form thematic categories and emergent themes. Theoretical sampling was used to identify mealtime interactions exemplifying thematic categories. Data from 47 mealtimes was available. A grounded theory of children’s mealtimes was developed to demonstrate children’s outcomes at mealtimes. Outcomes were represented by five thematic categories: rituals, learning moments, food preference development, socialisation and child agency. Mealtimes offered opportunities for children to construct a community of peers with their educators by sharing information, stories and occasionally their food. Each centre established its own unique culture within mealtimes observed as the children were involved in routines and rituals. Mealtimes in ECEC settings are a unique cultural phenomenon co-constructed by the ECEC community of children and educators. The findings highlight the importance of mealtimes as a time for learning and socialization. The routine and rituals of mealtimes provide an opportunity for educators to support the development of healthy food preferences.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-22
Bozhi Chen; Jonathan Y. Bernard; Natarajan Padmapriya; Jiali Yao; Claire Goh; Kok Hian Tan; Fabian Yap; Yap-Seng Chong; Lynette Shek; Keith M. Godfrey; Shiao-Yng Chan; Johan G. Eriksson; Falk Müller-Riemenschneider

Integrated 24-Hour Movement Guidelines provide specific recommendations on screen viewing (SV), moderate-to-vigorous physical activity (MVPA) and sleep to improve health of children and youth. However, few studies have examined whether these guidelines are met in young children, particularly in Asia. We evaluated adherence to integrated and individual guidelines and its predictors in 5.5-year-old Singaporean children. Growing Up in Singapore towards Healthy Outcomes (GUSTO) is a mother-offspring birth cohort study. At age 5.5 years, child SV was reported by parents. Movement behaviours (MBs) were measured continuously using wrist-worn accelerometers over 7 consecutive days and nights. For accelerometer data including ≥3 days with ≥16 h/day we estimated mean (±SD) daily MVPA, SV and nighttime sleep duration across the week. Adherence to integrated (Canadian/Australian) guidelines was defined as meeting all individual guidelines: ≥60 min of MVPA/day, ≤2 h of screen time/day, and 9–11 h of sleep/night. Socio-demographic and maternal predictors collected at pregnancy enrolment and at 26–28 weeks’ gestation were examined by multivariable logistic regression. Of 864 children followed up age 5.5 years, 547 (63.3%) had both valid ActiGraph and questionnaire data (51.7% boys and 58.3% Chinese ethnicity). Children averaged 101.9 (± 88.7) min/day SV, 67.3 (± 23.7) min/day MVPA and 480.6 (± 57.2) min/night sleep. Few children met integrated guidelines. Specifically, the proportions of children who met none, SV, MVPA, sleep and integrated guidelines were 11.2, 70.2, 59.6, 13.7 and 5.5%, respectively. Multivariable analysis showed that maternal activity and television (TV) viewing were associated with meeting integrated guidelines (insufficiently vs. highly active (OR [95% CI]): 0.11 [0.01, 0.95]; 2–3 vs. ≥ 3 h TV: 3.52 [1.02, 12.22]). Examining higher adherence to individual guidelines, Chinese ethnicity, younger maternal age and lower maternal TV and sleep time were associated with greater SV; male sex, Malay ethnicity, higher birth order and higher maternal activity level were associated with greater MVPA; and older maternal age was associated with adherence to sleep guideline. Beyond individual behaviours, consideration of the full spectrum of MBs may be important to improve children’s health. However, few Singaporean children adhere to integrated 24-h movement guidelines. Maternal behaviours as early as during pregnancy could be important targets for future interventions aiming to promote these MBs in children.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-22
Amanda L. Rebar; Ryan E. Rhodes; Benjamin Gardner

Studies of the physical activity intention-behavior gap, and factors that may moderate the gap (e.g., habit, perceived behavioral control), can inform physical activity promotion efforts. Yet, these studies typically apply linear modeling procedures, and so conclusions rely on linearity and homoscedasticity assumptions, which may not hold. We modelled and plotted physical activity intention-behavior associations and the moderation effects of habit using simulated data based on (a) normal distributions with no shared variance, (b) correlated parameters with normal distribution, and (c) realistically correlated and non-normally distributed parameters. In the uncorrelated and correlated normal distribution datasets, no violations were unmet, and the moderation effects applied across the entire data range. However, because in the realistic dataset, few people who engaged in physical activity behavior had low intention scores, the intention-behavior association was non-linear, resulting in inflated linear moderation estimations of habit. This finding was replicated when tested with intention-behavior moderation of perceived behavioral control. Comparisons of the three scenarios illustrated how an identical correlation coefficient may mask different types of intention-behavior association and moderation effects. These findings highlight the risk of misinterpreting tests of the intention-behavior gap and its moderators for physical activity due to unfounded statistical assumptions. The previously well-documented moderating effects of habit, whereby the impact of intention on behavior weakens as habit strength increases, may be based on statistical byproducts of unmet model assumptions.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-22
Ruth Salway; Lydia Emm-Collison; Simon J. Sebire; Janice L. Thompson; Deborah A. Lawlor; Russell Jago

Physical activity is associated with improved physical and mental health among children, but many children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to investigate participation in active after-school clubs and active travel to and from school at age 11 and estimate the average daily minutes of MVPA associated with active club attendance and active travel. Accelerometer data were collected on three weekdays for 1296 11-year-old children in a cross-sectional study. Children reported attendance at active after-school clubs and how they travelled to and from school for each day of the week. To account for repeat days within child and clustering within schools we used multilevel models with random effects at the school and child level, and fixed effects for all covariates. We calculated odds ratios for participation in active after-school clubs and active travel for gender, measures of socio-economic position and BMI category. We also explored the association between active club attendance, active travel and daily average MVPA. Boys and girls were equally likely to attend active after-school clubs. Boys were more likely to travel to school using active modes. Attendance at active after-school clubs and active travel home were not associated with each other. Attending an active after-school club was associated with an additional 7.6 min (95% CI: 5.0 to 10.3) average MVPA on that day among both boys and girls. Active travel was associated with an additional 4.7 min (95% CI: 2.9 to 6.5) average MVPA per journey for boys and 2.4 min (95% CI: 1.0 to 3.7) for girls. Both active after-school clubs and active travel are associated with greater physical activity on the day that children participate in these, and we saw no evidence that those attending active clubs do so at the expense of active travel home afterwards. While the increased daily MVPA is small to moderate, active after-school clubs and active travel on multiple days of the week could make important contributions as part of complex interventions aimed at increasing population levels of physical activity in children.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-27
Eivind Aadland; Olav Martin Kvalheim; Sigmund Alfred Anderssen; Geir Kåre Resaland; Lars Bo Andersen

The analysis of associations between accelerometer-derived physical activity (PA) intensities and cardiometabolic health is a major challenge due to multicollinearity between the explanatory variables. This challenge has facilitated the application of different analytic approaches within the field. The aim of the present study was to compare association patterns of PA intensities with cardiometabolic health in children obtained from multiple linear regression, compositional data analysis, and multivariate pattern analysis. A sample of 841 children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) provided valid accelerometry and cardiometabolic health data. Accelerometry (ActiGraph GT3X+) data were characterized into traditional (four PA intensity variables) and more detailed categories (23 PA intensity variables covering the intensity spectrum; 0–99 to ≥10,000 counts per minute). Several indices of cardiometabolic health were used to create a composite cardiometabolic health score. Multiple linear regression and multivariate pattern analyses were used to analyze both raw and compositional data. Besides a consistent negative (favorable) association between vigorous PA and the cardiometabolic health measure using the traditional description of PA data, associations between PA intensities and cardiometabolic health differed substantially depending on the analytic approaches used. Multiple linear regression lead to instable and spurious associations, while compositional data analysis showed distorted association patterns. Multivariate pattern analysis appeared to handle the raw PA data correctly, leading to more plausible interpretations of the associations between PA intensities and cardiometabolic health. Future studies should consider multivariate pattern analysis without any transformation of PA data when examining relationships between PA intensity patterns and health outcomes. The study was registered in Clinicaltrials.gov 7th of April 2014 with identification number NCT02132494 .

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-28

The potential effects of dishware size on energy intake are unclear, as many previous studies have been of low methodological quality. A newly published paper by Kosīte et al. (IJBNPA 10.1186/s12966-019-0826-1, 2019) reports findings from a rigorous, pre-registered investigation of the effects of manipulating plate size on total energy intake within a single eating occasion. This Editorial considers the implications of these new findings in light of previous evidence pertaining to the efficacy of behavioral nudges in particular, and in relation to contextual drivers of food consumption more generally. We conclude that the potential impact of behavioral nudges may have been exaggerated in the past, and call for future high-quality randomized controlled trials to establish whether reducing dishware size and other behavioral nudges might offer an effective complement to more comprehensive, multi-level interventions to reduce overconsumption of foods and beverages at a population-level.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-08-28
Daina Kosīte; Laura M. König; Katie De-loyde; Ilse Lee; Emily Pechey; Natasha Clarke; Olivia Maynard; Richard W. Morris; Marcus R. Munafò; Theresa M. Marteau; Paul C. Fletcher; Gareth J. Hollands

There is considerable uncertainty regarding the impact of tableware size on food consumption. Most existing studies have used small and unrepresentative samples and have not followed recommended procedures for randomised controlled trials, leading to increased risk of bias. In the first pre-registered study to date, we examined the impact on consumption of using larger versus smaller plates for self-served food. We also assessed impact on the underlying meal micro-structure, such as number of servings and eating rate, which has not previously been studied. The setting was a purpose-built naturalistic eating behaviour laboratory. A general population sample of 134 adult participants (aged 18–61 years) was randomly allocated to one of two groups varying in the size of plate used for self-serving lunch: large or small. The primary outcome was amount of food energy (kcal) consumed during a meal. Additionally, we assessed impact on meal micro-structure, and examined potential modifying effects of executive function, socio-economic position, and sensitivity to perceptual cues. There was no clear evidence of a difference in consumption between the two groups: Cohen’s d = 0.07 (95% CI [− 0.27, 0.41]), with participants in the large plate group consuming on average 19.2 (95% CI [− 76.5, 115.0]) more calories (3%) compared to the small plate group (large: mean (SD) = 644.1 (265.0) kcal, versus small: 624.9 (292.3) kcal). The difference between the groups was not modified by individual characteristics. There was no evidence of impact on meal micro-structure, with the exception of more food being left on the plate when larger plates were used. This study suggests that previous meta-analyses of a low-quality body of evidence may have considerably overestimated the effects of plate size on consumption. However, the possibility of a clinically significant effect – in either direction – cannot be excluded. Well-conducted trials of tableware size in real-world field settings are now needed to determine whether changing the size of tableware has potential to contribute to efforts to reduce consumption at population-level. The study protocol ( https://osf.io/e3dfh/ ) and data analysis plan ( https://osf.io/sh5u7/ ) were pre-registered on the Open Science Framework.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-03
Pernilla Sandvik; Anna Ek; Karin Eli; Maria Somaraki; Matteo Bottai; Paulina Nowicka

Research on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used. This study examines the role of picky eating in a randomized controlled obesity intervention for preschoolers using subscales from two instruments: The Child Eating Behavior Questionnaire (CEBQ) and the Lifestyle Behavior Checklist (LBC). The study includes 130 children (mean age 5.2 years (SD 0.7), 54% girls, mean Body Mass Index (BMI) z-score 2.9 (SD 0.6)) and their parents (nearly 60% of non-Swedish background, 40% with university degree). Families were randomized to a parent-group treatment focusing on evidence-based parenting practices or to standard treatment focusing on lifestyle changes. The children’s heights and weights (BMI z-score) were measured at baseline, and at 3, 6 and 12 months post baseline. At these time-points, picky eating was reported by parents using the CEBQ (Food Fussiness scale, 6 items) and 5 items from the LBC. Child food intake was reported with a Food Frequency Questionnaire (FFQ). Pearson correlation was used to study associations between baseline picky eating and baseline BMI z-scores and food intake. Mixed effects models were used to study associations between the two measurements of picky eating and changes in picky eating, to assess the effects of changes in picky eating on BMI z-scores, and to evaluate baseline picky eating as a predictor of changes in BMI z-scores. Neither the standard treatment nor the parent-group treatment reduced the degree of picky eating (measured with CEBQ or LBC). Baseline picky eating measured with the CEBQ was associated with a lower BMI z-score and lower intake of vegetables. Children with a higher degree of picky eating at baseline (measured with the CEBQ) displayed a lower degree of weight loss. When degree of picky eating was examined, for 25% of the children, the CEBQ and the LBC yielded diverging results. Baseline picky eating may weaken the effectiveness of obesity treatment, and assessments should be conducted before treatment to adjust the treatment approach. Different measurements of picky eating may lead to different results. The CEBQ seems more robust than the LBC in measuring picky eating. Clinicaltrials.gov , NCT01792531. Registered 15 February 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01792531

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-03
S. Forberger; L. Reisch; T. Kampfmann; H. Zeeb

Nudges are used to alter lifestyles and thus curb the rise of non-communicable diseases. Physical activity is a core prevention strategy to reduce the burden of non-communicable diseases. This paper aims to (1) give an overview of the scope of interventions using choice architecture techniques to promote physical activity at the population levels and (2) identify research gaps by analysing the different approaches in terms of class and type of intervention used. A systematic electronic database search was combined with snowball citation sampling of a starter set of publications to search for studies published through October 2018 reporting interventions to promote physical activity at the population level using choice architecture techniques. The methodology of the Joanna Briggs Institute for Scoping Reviews was applied. In all, 35 publications were included. Most of the interventions used point-of-choice prompts tested at railway stations, shopping malls and airports (N = 27). Eight studies were online studies. While all studies were aimed at the general population, details, if reported at all, were vague and basic. All studies focused on individual-level lifestyle behaviour. None of the studies attempted to alter population-based lifestyle behaviour. Online and “real-world” approaches were rarely combined. Neither, interventions targeting meso- and macro-level structures nor combinations of individual-level and specific meso- or macro-level interventions were found. Nudging is in principle an effective approach to promote physical activity within the general population. However, there are large gaps in research. Available opportunities have not yet been exhausted. Further research is needed that is explicitly based on behavioural insights and covering the full range of nudging approaches, particularly focussing on theoretical developments, practical feasibility tests and scale-up activities.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-04
Michelle Eykelenboom; Maartje M. van Stralen; Margreet R. Olthof; Linda J. Schoonmade; Ingrid H. M. Steenhuis; Carry M. Renders

Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax. Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions. Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38–0.47) supports an SSBs tax, 39% (0.29–0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60–0.72) supports an SSBs tax if revenue is used for health initiatives. Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-05
Elizabeth L. Adams; Michele E. Marini; Timothy R. Brick; Ian M. Paul; Leann L. Birch; Jennifer S. Savage

Use of food to soothe infant distress has been linked to greater weight in observational studies. We used ecological momentary assessment to capture detailed patterns of food to soothe and evaluate if a responsive parenting intervention reduced parents’ use of food to soothe. Primiparous mother-newborn dyads were randomized to a responsive parenting intervention designed for obesity prevention or a safety control group. Responsive parenting curriculum included guidance on using alternative soothing strategies (e.g., swaddling), rather than feeding, as the first response to infant fussiness. After the initial intervention visit 3 weeks after delivery, mothers (n = 157) were surveyed for two 5–8 day bursts at infant ages 3 and 8 weeks. Surveys were sent via text message every 4 h between 10:00 AM-10:00 PM, with 2 surveys sent at 8:00 AM asking about nighttime hours. Infant fusses and feeds were reported for each 4-h interval. Food to soothe was defined as “Fed First” and “Not Fed First” in response to a fussy event. Use of food to soothe was modeled using random-intercept logistic regression. The control group had greater odds of having Fed First, compared to the responsive parenting group at ages 3 and 8 weeks (3 weeks: OR = 1.9; 95% CI = 1.4–2.7; p < 0.01; 8 weeks: OR = 1.4; 95% CI = 1.0–2.1; p = 0.053). More responsive parenting mothers reported using a responsive parenting intervention strategy first, before feeding, than controls at ages 3 and 8 weeks (3 weeks: 58.1% vs. 41.9%; 8 weeks: 57.1% vs. 42.9%, respectively; p < 0.01 for both). At both ages combined, fewer fusses from responsive parenting infants were soothed best by feeding compared to controls (49.5% vs. 61.0%, respectively; p < 0.01). For both study groups combined, parents had greater odds of having Fed First during the nighttime compared to the daytime at both ages (3 weeks: OR = 1.6, 95% CI = 1.4–1.8; p < 0.01; 8 weeks: OR = 2.1; 95% CI = 1.7–2.6; p < 0.01). INSIGHT’s responsive parenting intervention reduced use of food to soothe and increased use of alternative soothing strategies in response to infant fussiness. Education on responsive parenting behaviors around fussing and feeding during early infancy has the potential to improve later self-regulation and weight gain trajectory. NCT01167270 . Registered July 21, 2010.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-05
Scott Duncan; Tom Stewart; Julia McPhee; Robert Borotkanics; Kate Prendergast; Caryn Zinn; Kim Meredith-Jones; Rachael Taylor; Claire McLachlan; Grant Schofield

Most physical activity interventions in children focus on the school setting; however, children typically engage in more sedentary activities and spend more time eating when at home. The primary aim of this cluster randomised controlled trial was to investigate the effects of a compulsory, health-related homework programme on physical activity, dietary patterns, and body size in primary school-aged children. A total of 675 children aged 7–10 years from 16 New Zealand primary schools participated in the Healthy Homework study. Schools were randomised into intervention and control groups (1:1 allocation). Intervention schools implemented an 8-week applied homework and in-class teaching module designed to increase physical activity and improve dietary patterns. Physical activity was the primary outcome measure, and was assessed using two sealed pedometers that monitored school- and home-based activity separately. Secondary outcome measures included screen-based sedentary time and selected dietary patterns assessed via parental proxy questionnaire. In addition, height, weight, and waist circumference were measured to obtain body mass index (BMI) and waist-to-height ratio (WHtR). All measurements were taken at baseline (T0), immediately post-intervention (T1), and 6-months post-intervention (T2). Changes in outcome measures over time were estimated using generalised linear mixed models (GLMMs) that adjusted for fixed (group, age, sex, group x time) and random (subjects nested within schools) effects. Intervention effects were also quantified using GLMMs adjusted for baseline values. Significant intervention effects were observed for weekday physical activity at home (T1 [P < 0.001] and T2 [P = 0.019]), weekend physical activity (T1 [P < 0.001] and T2 [P < 0.001]), BMI (T2 only [P = 0.020]) and fruit consumption (T1 only [P = 0.036]). Additional analyses revealed that the greatest improvements in physical activity occurred in children from the most socioeconomically deprived schools. No consistent effects on sedentary time, WHtR, or other dietary patterns were observed. A compulsory health-related homework programme resulted in substantial and consistent increases in children’s physical activity – particularly outside of school and on weekends – with limited effects on body size and fruit consumption. Overall, our findings support the integration of compulsory home-focused strategies for improving health behaviours into primary education curricula. Australian New Zealand Clinical Trials Registry, ACTRN12618000590268 . Registered 17 April 2018.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-06
Chloe Clifford Astbury; Tarra L. Penney; Jean Adams

Evidence suggests eating home-prepared food (HPF) is associated with increased dietary quality, while dietary quality varies across socio-demographic factors. Although it has been hypothesised that variation in HPF consumption between population sub-groups may contribute to variation in dietary quality, evidence is inconclusive. This study takes a novel approach to quantifying home-prepared food (HPF) consumption, and describes HPF consumption in a population-representative sample, determining variation between socio-demographic groups. It tests the association between HPF consumption and dietary quality, determining whether socio-demographic characteristics moderate this association. Cross-sectional analysis of UK survey data (N = 6364, aged≥19; collected 2008–16, analysed 2018). High dietary quality was defined as ‘DASH accordance’: the quintile most accordant with the Dietary Approaches to Stopping Hypertension (DASH) diet. HPF consumption was estimated from 4-day food diaries. Linear regressions were used to determine the association between HPF consumption and socio-demographic variables (household income, education, occupation, age, gender, ethnicity and children in the household). Logistic regression was used to determine the association between HPF consumption and DASH accordance. Interaction terms were introduced, testing for moderation of the association between HPF consumption and DASH accordance by socio-demographic variables. HPF consumption was relatively low across the sample (Mean (SD) % of energy consumption = 26.5%(12.1%)), and lower among white participants (25.9% v 37.8 and 34.4% for black and Asian participants respectively, p < 0.01). It did not vary substantially by age, gender, education, income or occupation. Higher consumption of HPF was associated with greater odds of being in the most DASH accordant quintile (OR = 1.2 per 10% increase in % energy from HPF, 95% CI 1.1–1.3). Ethnicity was the only significant moderator of the association between HPF consumption and DASH accordance, but this should be interpreted with caution due to high proportion of white participants. While an association exists between HPF consumption and higher dietary quality, consumption of HPF or HPF’s association with dietary quality does not vary substantially between socio-demographic groups. While HPF may be a part of the puzzle, it appears other factors drive socio-demographic variation in dietary quality.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-12
Wataru Nagatomo; Junko Saito; Naoki Kondo

In light of recent theories in behavioural economics, an intervention program with monetary incentives could be effective for helping patrons order healthy food, even if the incentive is small and less than one’s perceived marginal value. In this single-arm cluster crossover trial at 26 local restaurants, a 1-week campaign offered a 50-yen (approximately 0.5 US dollars) cash-back payment to customers ordering vegetable-rich meals, while no pre-order incentives were offered during the control period. In total, 511 respondents out of 7537 customers (6.8%), and 704 respondents out of 7826 customers (9.0%), ordered vegetable-rich meals during the control and intervention periods, respectively. During the intervention period, the covariate-adjusted proportion of vegetable-rich meal orders was 1.50 times higher (95% confidence interval [CI]: 1.29 to 1.75), which increased daily sales by 1.77 times (95% CI: 1.11 to 2.83), even when subtracting the cost of cash-back payments. Respondents who reported spending the least amount of money on eating out (used as a proxy measure for income) were the least likely to order vegetable-rich meals during the control period. However, these individuals increased their proportion of purchasing such meals during the intervention period (a 3.8 percentage point increase (95% CI: 2.82 to 4.76) among those spending the least vs a 2.1 percentage point increase (95% CI: 1.66 to 2.62) among those spending the most; P for interaction = 0.001). Similarly, irregular employees exhibited a larger increase (+ 5.2 percentage points, 95% CI: 4.54 to 5.76) than did regular workers (− 1.4, 95% CI: − 1.66 to − 1.05, P for interaction = 0.001). A program with an immediate low-value monetary incentive could be a public health measure for reducing inequalities in making healthy food choices. UMIN Clinical Trials Registry, UMIN000022396 . Registered 21 May 2016.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-09-18
Melissa N. Laska; Caitlin E. Caspi; Kathleen Lenk; Stacey G. Moe; Jennifer E. Pelletier; Lisa J. Harnack; Darin J. Erickson

Many lower-income and racially diverse communities in the U.S. have limited access to healthy foods, with few supermarkets and many small convenience stores, which tend to stock limited quantities and varieties of healthy foods. To address food access, in 2015 the Minneapolis Staple Foods Ordinance became the first policy requiring food stores to stock minimum quantities and varieties of 10 categories of healthy foods/beverages, including fruits, vegetables, whole grains and other staples, through licensing. This study examined whether: (a) stores complied, (b) overall healthfulness of store environments improved, (c) healthy customer purchases increased, and (d) healthfulness of home food environments improved among frequent small store shoppers. Data for this natural (or quasi) experiment were collected at four times: pre-policy (2014), implementation only (no enforcement, 2015), enforcement initiation (2016) and continued monitoring (2017). In-person store assessments were conducted to evaluate food availability, price, quality, marketing and placement in randomly sampled food retailers in Minneapolis (n = 84) and compared to those in a nearby control city, St. Paul, Minnesota (n = 71). Stores were excluded that were: supermarkets, authorized through WIC (Special Supplemental Nutrition Program for Women, Infants, and Children), and specialty stores (e.g., spice shops). Customer intercept interviews were conducted with 3,039 customers exiting stores. Home visits, including administration of home food inventories, were conducted with a sub-sample of frequent shoppers (n = 88). Overall, findings indicated significant improvements in healthy food offerings by retailers over time in both Minneapolis and St. Paul, with no significant differences in change between the two cities. Compliance was low; in 2017 only 10% of Minneapolis retailers in the sample were fully compliant, and 51% of participating Minneapolis retailers met at least 8 of the 10 required standards. Few changes were observed in the healthfulness of customer purchases or the healthfulness of home food environments among frequent shoppers, and changes were not different between cities. This study is the first evaluation a local staple foods ordinance in the U.S. and reflects the challenges and time required for implementing such policies. NCT02774330 .

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-07
Basile Chaix; Tarik Benmarhnia; Yan Kestens; Ruben Brondeel; Camille Perchoux; Philippe Gerber; Dustin T. Duncan

Policymakers need accurate data to develop efficient interventions to promote transport physical activity. Given the imprecise assessment of physical activity in trips, our aim was to illustrate novel advances in the measurement of walking in trips, including in trips incorporating non-walking modes. We used data of 285 participants (RECORD MultiSensor Study, 2013–2015, Paris region) who carried GPS receivers and accelerometers over 7 days and underwent a phone-administered web mobility survey on the basis of algorithm-processed GPS data. With this mobility survey, we decomposed trips into unimodal trip stages with their start/end times, validated information on travel modes, and manually complemented and cleaned GPS tracks. This strategy enabled to quantify walking in trips with different modes with two alternative metrics: distance walked and accelerometry-derived number of steps taken. Compared with GPS-based mobility survey data, algorithm-only processed GPS data indicated that the median distance covered by participants per day was 25.3 km (rather than 23.4 km); correctly identified transport time vs. time at visited places in 72.7% of time; and correctly identified the transport mode in 67% of time (and only in 55% of time for public transport). The 285 participants provided data for 8983 trips (21,163 segments of observation). Participants spent a median of 7.0% of their total time in trips. The median distance walked per trip was 0.40 km for entirely walked trips and 0.85 km for public transport trips (the median number of accelerometer steps were 425 and 1352 in the corresponding trips). Overall, 33.8% of the total distance walked in trips and 37.3% of the accelerometer steps in trips were accumulated during public transport trips. Residents of the far suburbs cumulated a 1.7 times lower distance walked per day and a 1.6 times lower number of steps during trips per 8 h of wear time than residents of the Paris core city. Our approach complementing GPS and accelerometer tracking with a GPS-based mobility survey substantially improved transport mode detection. Our findings suggest that promoting public transport use should be one of the cornerstones of policies to promote physical activity.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-12
Benjamin Gardner; Stuart Flint; Amanda L. Rebar; Stephen Dewitt; Sahana K. Quail; Helen Whall; Lee Smith

Growing evidence suggests that prolonged uninterrupted sitting can be detrimental to health. Much sedentary behaviour research is reliant on self-reports of sitting time, and sitting-reduction interventions often focus on reducing motivation to sit. These approaches assume that people are consciously aware of their sitting time. Drawing on Action Identification Theory, this paper argues that people rarely identify the act of sitting as ‘sitting’ per se, and instead view it as an incidental component of more meaningful and purposeful typically-seated activities. Studies 1 and 2 explored whether people mentioned sitting in written descriptions of actions. Studies 3–5 compared preferences for labelling a typically desk-based activity as ‘sitting’ versus alternative action identities. Studies 6 and 7 used card-sort tasks to indirectly assess the prioritisation of ‘sitting’ relative to other action descriptions when identifying similar actions. Participants rarely spontaneously mentioned sitting when describing actions (Studies 1–2), and when assigning action labels to a seated activity, tended to offer descriptions based on higher-order goals and consequences of action, rather than sitting or other procedural elements (Studies 3–5). Participants primarily identified similarities in actions based not on sitting, but on activities performed while seated (e.g. reading; Studies 6–7). ‘Sitting’ is a less accessible cognitive representation of seated activities than are representations based on the purpose and implications of seated action. Findings suggest that self-report measures should focus on time spent in seated activities, rather than attempting to measure sitting time via direct recall. From an intervention perspective, findings speak to the importance of targeting behaviours that entail sitting, and of raising awareness of sitting as a potential precursor to attempting to reduce sitting time.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-15
Manoj Chandrabose; Ester Cerin; Suzanne Mavoa; David Dunstan; Alison Carver; Gavin Turrell; Neville Owen; Billie Giles-Corti; Takemi Sugiyama

Living in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers. The Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999–2000, 2004–05, and 2011–12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants’ homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation. There was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P < 0.001), and high-density lipoprotein cholesterol (P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590). Our mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-17
Claudia Nieto; Alejandra Jáuregui; Alejandra Contreras-Manzano; Edna Arillo-Santillan; Simón Barquera; Christine M. White; David Hammond; James F. Thrasher

Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world. Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding (“easy”/“very easy to understand” vs “difficult”/“very difficult to understand”), and, for NFTs and GDAs, frequency of use (“sometimes”/“often” vs “never”). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors. Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4–5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31–0.37) and the MTL (OR = 0.56, 95% CI = 0.52–0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41–0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07–0.14). Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-21
Mikko Kärmeniemi; Tiina Lankila; Tiina Ikäheimo; Soile Puhakka; Maisa Niemelä; Timo Jämsä; Heli Koivumaa-Honkanen; Raija Korpelainen

Given the high global prevalence of physical inactivity, there is a need to design cities that support active modes of transportation. High density diverse neighborhoods with good access networks have been associated with enhanced walking and cycling, but there is a lack of large-scale longitudinal studies utilizing a life course perspective to model residential relocation trajectories. The objectives of the present longitudinal study were to model and visualize residential relocation trajectories between 31 and 46 years of age based on neighborhood density, mixed land use and access networks (DMA), and to assess neighborhood DMA as a predictor of self-reported regular walking and cycling and objectively measured physical activity. Based on data from the Northern Finland Birth Cohort 1966 (N = 5947), we used self-reported regular walking and cycling and objectively measured physical activity as outcome variables and objectively assessed neighborhood DMA as the main explanatory variable. We conducted sequence analysis to model residential relocation trajectories, and generalized linear mixed models and Fisher’s exact test were used to explore longitudinal associations between neighborhood DMA and physical activity. Over 80% of the participants lived in a neighborhood with the same level of neighborhood DMA during the follow-up. Relocation occurred more often from higher to lower DMA neighborhoods than reverse. Increased neighborhood DMA was associated with increased regular walking (OR 1.03; 95% CI: 1.00, 1.05; p = 0.023) and cycling (OR 1.17; 95% CI: 1.12, 1.23; p < 0.001). Residential relocation trajectory from lower to highest neighborhood DMA increased the odds of starting regular walking (OR 3.15; 95% CI: 1.50, 7.14; p = 0.001) and cycling (OR 2.63; 95% CI: 1.23, 5.79; p = 0.009) as compared to higher to lower neighborhood DMA trajectory. The results strongly support the hypothesis that increasing urban DMA can enhance regular walking and cycling at population level and so improve public health. The findings have implications for zoning and transportation policies, favoring the creation of dense and diverse neighborhoods with good access networks to support regular walking and cycling.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-22
Vicki Brown; Alison Barr; Jan Scheurer; Anne Magnus; Belen Zapata-Diomedi; Rebecca Bentley

Physical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia. Baseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20–74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements. Multi-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse). Based on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-22
Sander Hermsen; Monica Mars; Suzanne Higgs; Jeana H. Frost; Roel C. J. Hermans

Eating rate is a basic determinant of appetite regulation: people who eat more slowly feel sated earlier and eat less. A high eating rate contributes to overeating and potentially to weight gain. Previous studies showed that an augmented fork that delivers real-time feedback on eating rate is a potentially effective intervention to decrease eating rate in naturalistic settings. This study assessed the impact of using the augmented fork during a 15-week period on eating rate and body weight. In a parallel randomized controlled trial, 141 participants with overweight (age: 49.2 ± 12.3 y; BMI: 31.5 ± 4.48 kg/m2) were randomized to intervention groups (VFC, n = 51 or VFC+, n = 44) or control group (NFC, n = 46). First, we measured bite rate and success ratio on five consecutive days with the augmented fork without feedback (T1). The intervention groups (VFC, VFC+) then used the same fork, but now received vibrotactile feedback when they ate more than one bite per 10 s. Participants in VFC+ had additional access to a web portal with visual feedback. In the control group (NFC), participants ate with the fork without either feedback. The intervention period lasted four weeks, followed by a week of measurements only (T2) and another measurement week after eight weeks (T3). Body weight was assessed at T1, T2, and T3. Participants in VFC and VFC+ had a lower bite rate (p < .01) and higher success ratio (p < .0001) than those in NFC at T2. This effect persisted at T3. In both intervention groups participants lost more weight than those in the control group at T2 (p < .02), with no rebound at T3. The findings of this study indicate that an augmented fork with vibrotactile feedback is a viable tool to reduce eating rate in naturalistic settings. Further investigation may confirm that the augmented fork could support long-term weight loss strategies. The research reported in this manuscript was registered on 4 November 2015 in the Netherlands Trial Register with number NL5432 ( https://www.trialregister.nl/trial/5432 ).

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-25
Sara C. Folta; Lynn Paul; Miriam E. Nelson; David Strogatz; Meredith Graham; Galen D. Eldridge; Michael Higgins; David Wing; Rebecca A. Seguin-Fowler

Women living in rural areas face unique challenges in achieving a heart-healthy lifestyle that are related to multiple levels of the social-ecological framework. The purpose of this study was to evaluate changes in diet and physical activity, which are secondary outcomes of a community-based, multilevel cardiovascular disease risk reduction intervention designed for women in rural communities. Strong Hearts, Healthy Communities was a six-month, community-randomized trial conducted in 16 rural towns in Montana and New York, USA. Sedentary women aged 40 and older with overweight and obesity were recruited. Intervention participants (eight towns) attended twice weekly exercise and nutrition classes for 24 weeks (48 total). Individual-level components included aerobic exercise, progressive strength training, and healthy eating practices; a civic engagement component was designed to address social and built environment factors to support healthy lifestyles. The control group (eight towns) attended didactic healthy lifestyle classes monthly (six total). Dietary and physical activity data were collected at baseline and post-intervention. Dietary data were collected using automated self-administered 24-h dietary recalls, and physical activity data were collected by accelerometry and self-report. Data were analyzed using multilevel linear regression models with town as a random effect. At baseline, both groups fell short of meeting many recommendations for cardiovascular health. Compared to the control group, the intervention group realized significant improvements in intake of fruit and vegetables combined (difference: 0.6 cup equivalents per day, 95% CI 0.1 to 1.1, p = .026) and in vegetables alone (difference: 0.3 cup equivalents per day, 95% CI 0.1 to 0.6, p = .016). For physical activity, there were no statistically significant between-group differences based on accelerometry. By self-report, the intervention group experienced a greater increase in walking MET minutes per week (difference: 113.5 MET-minutes per week, 95% CI 12.8 to 214.2, p = .027). Between-group differences in dietary and physical activity behaviors measured in this study were minimal. Future studies should consider how to bolster behavioral outcomes in rural settings and may also continue to explore the value of components designed to enact social and environmental change. clinicaltrials.gov Identifier: NCT02499731. Registered 16 July 2015.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-25
Lana Vanderlee; Christine M. White; David Hammond

A significant proportion of the Canadian diet comes from foods purchased in restaurant settings. In an effort to promote healthy eating, the province of British Columbia (BC) implemented the Informed Dining Program (IDP), a voluntary, industry supported information program in 2012, while the province of Ontario implemented mandatory calorie labelling on menus in 2017. The study examined differences in awareness and the self-reported influence of nutrition information on food choices in restaurants with voluntary nutrition information, calorie labelling on menus, and no nutrition information program. Exit surveys were conducted outside of nine chain restaurants in Toronto, Ontario and Vancouver, British Columbia (Canada) in 2012, 2015, and 2017 with varying nutrition information programs implemented. Logistic regression analyses compared self-reported noticing and influence of nutrition information in restaurants with: 1) the IDP which provided nutrition information upon request, 2) calorie labelling on menus, and 3) control restaurants with no specific nutrition information program in place, adjusted for year, city and socio-demographic characteristics. Awareness and knowledge of the IDP were also examined. There were no significant differences in noticing and self-reported influence of nutrition information on food choices between restaurants with the IDP and restaurants with no program. Participants were more likely to notice nutrition information in restaurants when calorie information was provided on menus (57%) compared to in restaurants with the IDP (22%, AOR = 6.20, 95%CI 3.51–10.94, p < 0.001) or restaurants with no nutrition information program (20%, AOR = 7.44, 95%CI 4.21–13.13, p < 0.001). Participants in restaurants with menu labelling were also more likely to report that nutrition information influenced their food purchase (38%) compared to restaurants with the IDP (12%, AOR = 4.43, 95%CI 2.36–8.30, p < 0.001) and restaurants with no nutrition information program (12%, AOR = 5.29, 95%CI 2.81–9.95, p < 0.001). Fewer than 1 in 5 participants who visited an IDP restaurant had heard of the IDP across all data collection years in both cities. There was no evidence that voluntary programs which provide nutrition information upon request were effective. Providing calorie information on menus increased the likelihood that consumers noticed and that their food choices were influenced by nutrition information in restaurant settings.

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-26
Famke J. M. Mölenberg; Jenna Panter; Alex Burdorf; Frank J. van Lenthe

Previous reviews have suggested that infrastructural interventions can be effective in promoting cycling. Given inherent methodological complexities in the evaluation of such changes, it is important to understand whether study results obtained depend on the study design and methods used, and to describe the implications of the methods used for causality. The aims of this systematic review were to summarize the effects obtained in studies that used a wide range of study designs to assess the effects of infrastructural interventions on cycling and physical activity, and whether the effects varied by study design, data collection methods, or statistical approaches. Six databases were searched for studies that evaluated infrastructural interventions to promote cycling in adult populations, such as the opening of cycling lanes, or the expansion of a city-wide cycling network. Controlled and uncontrolled studies that presented data before and after the intervention were included. No language or date restrictions were applied. Data was extracted for any outcome presented (e.g. bikes counted on the new infrastructure, making a bike trip, cycling frequency, cycling duration), and for any purpose of cycling (e.g. total cycling, recreational cycling, cycling for commuting). Data for physical activity outcomes and equity effects was extracted, and quality assessment was conducted following previous methodologies and the UK Medical Research Council guidance on natural experiments. The PROGRESS-Plus framework was used to describe the impact on subgroups of the population. Studies were categorized by outcome, i.e. changes in cycling behavior, or usage of the cycling infrastructure. The relative change was calculated to derive a common outcome across various metrics and cycling purposes. The median relative change was presented to evaluate whether effects differed by methodological aspects. The review included 31 studies and all were conducted within urban areas in high-income countries. Most of the evaluations found changes in favor of the intervention, showing that the number of cyclists using the facilities increased (median relative change compared to baseline: 62%; range: 4 to 438%), and to a lesser extent that cycling behavior increased (median relative change compared to baseline: 22%; range: − 21 to 262%). Studies that tested for statistical significance and studies that used subjective measurement methods (such as surveys and direct observations of cyclists) found larger changes than those that did not perform statistical tests, and those that used objective measurement methods (such as GPS and accelerometers, and automatic counting stations). Seven studies provided information on changes of physical activity behaviors, and findings were mixed. Three studies tested for equity effects following the opening of cycling infrastructure. Study findings of natural experiments evaluating infrastructural interventions to promote cycling depended on the methods used and the approach to analysis. Studies measuring cycling behavior were more likely to assess actual behavioral change that is most relevant for population health, as compared to studies that measured the use of cycling infrastructure. Triangulation of methods is warranted to overcome potential issues that one may encounter when evaluating environmental changes within the built environment. The protocol of this study was registered at PROSPERO (CRD42018091079).

更新日期：2019-11-28
• Int. J. Behav. Nutr. Phys. Act. (IF 6.037) Pub Date : 2019-10-28
Taru Manyanga; Joel D. Barnes; Jean-Philippe Chaput; Peter T. Katzmarzyk; Antonio Prista; Mark S. Tremblay

Insufficient physical activity, short sleep duration, and excessive recreational screen time are increasing globally. Currently, there are little to no data describing prevalences and correlates of movement behaviours among children in low-middle-income countries. The few available reports do not include both urban and rural respondents, despite the large proportion of rural populations in low-middle-income countries. We compared the prevalence of meeting 24-h movement guidelines and examined correlates of meeting the guidelines in a sample of urban and rural Mozambican schoolchildren. This is cross-sectional study of 9–11 year-old children (n = 683) recruited from 10 urban and 7 rural schools in Mozambique. Moderate- to vigorous-intensity physical activity (MVPA) and sleep duration were measured by waist-worn Actigraph GT3X+ accelerometers. Accelerometers were worn 24 h/day for up to 8 days. Recreational screen time was self-reported. Potential correlates of meeting 24-h movement guidelines were directly measured or obtained from validated items of context-adapted questionnaires. Multilevel multivariable logit models were used to determine the correlates of movement behaviours. Meeting 24-h movement guidelines was defined as ≥60 min/day of MVPA, ≤2 h/day of recreational screen time, and between 9 and 11 h/night of sleep. More rural (17.7%) than urban (3.6%) children met all three 24-h movement guidelines. Mean MVPA was lower (82.9 ± 29.5 min/day) among urban than rural children (96.7 ± 31.8 min/day). Rural children had longer sleep duration (8.9 ± 0.7 h/night) and shorter recreational screen time (2.7 ± 1.9 h/day) than their urban counterparts (8.7 ± 0.9 h/night and 5.0 ± 2.3 h/day respectively). Parental education (OR: 0.37; CI: 0.16–0.87), school location (OR: 0.21; CI: 0.09–0.52), and outdoor time (OR: 0.67; CI: 0.53–0.85) were significant correlates of meeting all three 24-h movement guidelines. Prevalence and correlates of meeting movement guidelines differed between urban and rural schoolchildren in Mozambique. On average, both groups had higher daily MVPA minutes, shorter sleep duration, and higher recreational screen time than the 24-h movement guidelines recommend. These findings (e.g., higher than recommended mean daily MVPA minutes) differ from those from high-income countries and highlight the need to sample from both urban and rural areas.

更新日期：2019-11-28
Contents have been reproduced by permission of the publishers.

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