Results from Ireland North and South's 2022 report card on physical activity for children and adolescents.

Background: The Ireland North and South Report Card on Physical Activity (PA) for Children and Adolescents aims to monitor progress in PA participation across a range of internationally established indicators. Methods: Data were collated for 11 indicators and graded following the harmonised Active Healthy Kids Global Alliance report card process. Six representative studies (sample size range n = 898 to n = 15,557) were primarily used in the grading, with many indicators supplemented with additional studies and reports. Data collected since the implementation of COVID-19 public health measures in March 2020 were excluded. Results: Grades were awarded as follows: 'Overall physical activity', C-; 'Organised Sport and Physical Activity', C; 'Active Play', INC; 'Sedentary Behaviours', C-; 'Physical Fitness', INC; 'Family and Peers', D+; 'School', C-; 'Physical Education', D; 'Community and Environment', B+ and 'Government', B. Separate grades were awarded for disability as follows; 'Overall physical activity', F; 'Organised Sport and Physical Activity', D; 'Sedentary Behaviours', C-; 'Family and Peers', C; 'School', C- and 'Government', B. 'Active Play', 'Physical Fitness', 'Physical Education' and 'Community and Environment' were all graded INC for disability. Since the last report card in 2016, four grades remained the same, three increased ('Overall physical activity', 'School' and 'Physical Education') and two ('Family and Peers,' and 'Government') were awarded grades for the first time. Conclusion: Grades specific to children and adolescents with disability were generally lower for each indicator. While small improvements have been shown across a few indicators, PA levels remain low across many indicators for children and adolescents.

The Forgotten Age Phase of Healthy Lifestyle Promotion? A Preliminary Study to Examine the Potential Call for Targeted Physical Activity and Nutrition Education for Older Adolescents.

To date, little research on healthy lifestyle promotion has focused on older adolescents (16-18-year-olds), yet this is a key time that habitual healthy lifestyles could be developed. Ninety-three participants (thirty-nine males; fifty-four females) (mean age = 16.9, (SD 0.4) years), from three low socio-economic high schools in England, completed an online questionnaire on their self-reported: (i) daily physical activity (PA), (ii) active transportation, (iii) active leisure time, (iv) food intake and (v) experiences of how healthy lifestyles are promoted specifically to them. Overall, 60% reached the daily PA recommended guidelines. Yet, 92% used a bicycle/walked for a least 10 min continuously as active transport and of these, 86% undertook this at least 5 days per week. Almost half undertook MVPA as active leisure, but 66% still spent ≥ 5 h sedentary. Seventeen percent met recommended nutritional guidelines for health and 90% (n = 80) did not report school as a place that promoted healthy lifestyles. It is recommended as a public health measure and as an educational policy matter that schools implement more targeted PA and healthy eating initiatives for older adolescents that also include the adolescent voice. Further, gaining a deeper insight into male older adolescents' health literacy is needed.

Relationships between physical function, body composition and metabolic health in Pacific Island youth.

The Pacific Islands Families (PIF) study is a birth cohort study designed to increase knowledge about the growth and development of Pacific children living in Auckland, New Zealand. Adolescence is a critical time of growth and development, yet the roles of physical function and body composition in metabolic health at this life stage are not clear. We aimed to investigate associations between measures of physical function (the 6-minute-walk-test (6MWT)), heart rate changes before and after the 6MWT, handgrip strength, body composition including appendicular skeletal muscle mass (ASMM) measured by dual-energy X-ray absorptiometry and biomarkers of metabolic health from a fasting blood sample.A total of 200 youth (98 girls, 102 boys) aged 14-15 years, from the birth-cohort of children in the Pacific Islands families study were measured. In girls, the proportion of ASMM was lower and fat higher than in boys. Controlling for age, a 1% increase in ASMM predicted a longer walk distance (+6.3, 95%CI 2.2, 10.4 m in girls; +7.1, 95%CI 4.4, 9.1 m in boys) and lower heart rate following the 6MWT. ASMM and fat mass were independently predictive of maximal handgrip strength which was increased by 1.4 (1.0,1.8) kg in girls and 1.7 (1.3, 2.0) kg in boys for each kg increase in ASMM and reduced by 0.23 (0.08, 0.38) kg in girls and 0.26 (0.14, 0.37) kg in boys for each kg increase in fat mass. Lower total cholesterol and LDL were associated with an increase in distance walked in boys only. For each year of age, distance walked was reduced by 34 (15, 53) m in girls and 59 (36,84) m in boys. These findings should be explored further in the context of other influences such as food security, opportunities for physical activity and cultural expectations.

The Gender-Specific Relationship between Nutritional Status, Physical Activity and Functional Mobility in Irish Community-Dwelling Older Adults.

Research suggests that both nutrition and physical activity can protect mobility in older adults, but it is yet to be determined whether these relationships are affected by gender. Thus, we investigated the gender-specific relationship between nutritional status, physical activity level and functional mobility in Irish older adults. A cross-sectional study was undertaken in 176 community-dwelling older adults (73.6 ± 6.61 years) living in Cork, Ireland. Nutritional status was measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and physical activity was assessed via the Physical Activity Scale for the Elderly (PASE). Functional mobility was measured using the Timed Up and Go (TUG) test. The gender-stratified relationship between variables was assessed using Pearson's correlations and multiple linear regression. Partial correlations (p < 0.05) were observed for TUG with PASE score in both genders, and with MNA-SF score in females, only. Multiple regression showed that physical activity was a predictor of TUG in both genders (ß = 0.257 for males, ß = 0.209 for females, p < 0.05), while nutritional status was a predictor of TUG in females, only (ß = -0.168, p = 0.030). Our results suggest that physical activity is associated with functional mobility in both genders, while the relationship between nutritional status and mobility may be specific to older females. These findings may be of interest for the design of functional preservation strategies.

The Association of Family, Friends, and Teacher Support With Girls' Sport and Physical Activity on the Island of Ireland.

BACKGROUND: The current study was the largest physical activity (PA) surveillance assessment of youth undertaken in Ireland in recent years. The purpose of this research was to assess the impact of social support, while controlling for age and screen time, on PA and sport participation, across a representative sample of Irish female youth. METHODS: A total of 3503 children (mean age: 13.54 [2.05] y) across the island of Ireland participated. Participants completed a previously validated electronic questionnaire while supervised in a classroom setting, which investigated their (1) levels of PA; (2) screen time; (3) community sport participation; and (4) social support (friend, family, and teacher) to be physically active/partake in sport. RESULTS: There were significant differences, with medium and large effect sizes, for social support from friends and family across types of sports participation. Specifically, girls who participated in the most popular team sports, when compared with the most popular individual sports, reported higher social support scores for friends and family structures. CONCLUSIONS: Findings from this study confirm the contributing influence of friends and family as sport and PA support networks for girls. Interventions should consider the importance of culturally relevant team sports for PA engagement in female youth.

The nutritional status and dietary intake of free-living seniors: A cross-sectional study.

BACKGROUND AND AIMS: Older adults are a population group at risk of inadequate nutrition due to reduced appetite, malabsorption, taste alterations and social factors. Yet, dietary investigations in Irish older adults are scarce. The aim of this study was to analyse the nutritional status and dietary intake of a sample of community-dwelling Irish elderly, in addition to the effect of age and gender on dietary intake in this age group. METHODS: A cross-sectional study was performed in 162 (n = 91 female, n = 71 male, age 73.8 ± 6.8 years) adults aged 65 years and over in a region of Southern Ireland. Nutritional status was measured using the Mini Nutritional Assessment - Short Form (MNA-SF). Dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). RESULTS: 21.0% and 1.2% of the study population were at risk of malnutrition and malnourished, respectively. A high prevalence of dietary insufficiencies was observed. The most common insufficiencies reported were energy (54.9%), fibre (82.7%), calcium (58.6%), magnesium (62.3%), iron (54.9%), folate (66.0%), vitamin D (93.2%) and vitamin E (61.1%). Increasing age did not significantly influence nutrient intakes in males, while vitamin C and vitamin D intakes decreased with age in females, and the incidence of dietary folate insufficiency was higher in the oldest females. Gender differences in dietary intake were evident, with a higher prevalence of dietary inadequacy in male subjects. Excessive intake of sugars, snacks and fats was observed, particularly in males, while dairy recommendations were not being met. Dietary supplement use was rare (27.2%). CONCLUSIONS: The poor dietary quality of this cohort may have significant health implications. Public health strategies to improve the diets of older adults are warranted, with a particular focus on increasing micronutrient intakes.

Children's Perceived and Actual Physical Activity Levels within the Elementary School Setting.

To date, little research has longitudinally examined young children's physical activity (PA) during school hours, nor questioned children's perceptions of their own PA behaviours. This study investigated 20 children's actual physical activity levels (APA) and their perceived physical activity levels (PPA) (10 infants, mean age 6.6 years; 10 juniors, mean age 9.5 years). APA was evaluated using accelerometers across 36 whole school days (371 min per day); 18 days included Physical Education (PE) lessons and 18 did not. A repeated-measures three-factor ANOVA analysed: type of day; age phase; parts of the day and sex. PPA was collected by an interactive handset and an adapted version of the PA Questionnaire for Children (PAQ-C). Participants undertook 10 more minutes of moderate to vigorous PA (MVPA) on PE days (53 ± 19 min) compared to non-PE days (43 ± 15 min) (F = 92.32, p < 0.05) and only junior boys reached daily MVPA recommendations (60 ± 13 min) on PE days. Juniors over-estimated, and infants under-estimated, their APA levels. Educators need more support to teach and embed different PA intensities into the school day to enable children to better understand the health benefits associated with varying the intensity of their PA during school hours.

Associations between Food Group Intake and Physical Frailty in Irish Community-Dwelling Older Adults.

BACKGROUND: Certain nutrients have shown protective effects against frailty, but less is known about the influence of individual food groups. Thus, this study aimed to investigate the relationship between the intake of different food groups and physical frailty in a cohort of community-dwelling older adults in Cork, Ireland. METHODS: One hundred and forty-two (n = 81 females, n = 61 males, age 74.1 ± 6.80 years) Irish community-dwelling volunteers aged ⩾65 years participated in this cross-sectional study. Dietary intake was assessed using a validated food frequency questionnaire (FFQ). Frailty was identified as having 3 or more of the following criteria: weight loss, exhaustion, weakness, slow walking speed and low physical activity. Relationships between intakes of food groups and frailty score were determined using Spearman's rank (and partial rank) correlations and ordinal logistic regression analysis. RESULTS: Negative Spearman's rank correlations were observed between frailty score and fish and fish products, fruit and vegetables and nuts and seeds, while positive correlations were found between frailty score and potatoes, fats and oils and sugars, preserves and snacks (P < .05). After adjustment for confounders, partial rank correlations remained statistically significant (P < .05) for all of the above dietary variables, with the exception of nuts and seeds (P > .05). Following ordinal logistic regression, the odds ratios (ORs) (95%CI) for frailty incidence for those in the lowest tertile of food group intake compared to the highest were; 3.04 (1.09-8.85) for fish and fish products, 4.34 (1.54-13.13) for fruit and vegetables, 1.52 (0.58-4.15) for nuts and seeds, 0.54 (0.19-1.51) for potatoes, 0.58 (0.17-1.95) for fats and oils and 0.49 (0.16-1.47) for sugars, preserves and snacks. CONCLUSION: This study suggests that intakes of selected food groups are independently associated with frailty. These findings may hold significant relevance for the development of future frailty prevention strategies.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Identifying dietary patterns in Irish schoolchildren and their association with nutritional knowledge and markers of health before and after intervention.

The aim of the study was to identify dietary patterns (DP) and examine differences in anthropometric measures, blood pressure (BP), cardiorespiratory fitness and nutritional knowledge of 6- and 10-year-old children at baseline and following a nutrition and physical activity intervention, with respect to DP and treatment group. This is a longitudinal study. Food diary, nutritional knowledge questionnaire and 550-m walk/run test measured dietary intake, nutritional knowledge and cardiorespiratory fitness, respectively. BP, weight, height and waist circumference were also measured and BMI and waist-to-height ratio (WHtR) were derived. All measurements were performed at baseline and following intervention. Two primary schools (one intervention, one control) in Cork, Ireland, were selected. Participants were 6- (n 39, age 5·9 (sd 0·6) years) and 10- (n 49, age 9·8 (sd 0·5) years)-year-olds. Two DP were identified, using k-means cluster analysis, for both 6- (unhealthy and nutrient-dense) and 10-year-olds (processed and Western diet) at baseline. DP derived post-intervention were (1) plant-based and (2) processed foods for 6-year-olds and (1) nutrient-dense and (2) unhealthy for 10-year-olds. There was no statistically significant difference in DP for 6- and 10-year-olds at baseline and post-intervention (P > 0·05). Following the intervention, a multivariate ANOVA showed there were no statistically significant differences in nutritional knowledge, BMI, WHtR, cardiorespiratory fitness and BP based on DP and intervention/control group for both age groups (P > 0·05). Three out of four dietary patterns identified for 6- and 10-year-olds were unfavourable. While no statistically significant evidence of intervention impact was found on DP, a positive trend was emerging among 10-year-olds.

Cardiorespiratory effects of project energize: a whole-of region primary school nutrition and physical activity programme in New Zealand in 2011 and 2015.

BACKGROUND: Since 2004, Sport Waikato has delivered Project Energize, a through-school nutrition and physical activity program to primary schools in the Waikato. As part of the program's continued assessment and quality control, the programme was evaluated in 2011 and 2015. This paper's aim was to compare the cardiorespiratory fitness (time to run 550 m (T550)) levels of children participating in Project Energize in 2011 and 2015. METHODS: In the 2011 evaluation of Project Energize, gender specific- T550-for-age Z scores (T550AZ) were derived from the T550 of 4832 Waikato children (2527 girls; 2305 boys; 36% Maori) aged between 6 and 12 years. In 2015, T550 was measured for 4798 (2361 girls; 2437 boys; 32% Maori) children, representative of age, gender and school socioeconomic status (SES). The T550AZ for every child in the 2015 study and 2011 evaluation were derived and differences in T550 between 2015 and 2011 by gender, SES and age were determined using independent t-tests. Multiple regression analysis predicted T550 Z score and run time, using year of measurement, gender, ethnicity, age and school SES. RESULTS: With and without adjustment, children in 2015 ran 550 m faster than in 2011 (adjusted Z score 0.06, time 11 s). Specifically, girls ran at a similar speed in 2015 as 2011 but boys were faster than in 2011 (Z score comparison P < 0.001, mean difference 0.18 95%CI 0.12, 0.25). Regression analysis showed time taken to run 550 m was 11 s less in 2015 compared with 2011. Boys ran it 13 s faster than girls (Z score 0.07) and for each 1 year age increase, children were 8 s slower (Z score 0.006). For each 10% decrease in SES, children were 3 s slower (Z score 0.004) and Maori children were 5 s slower than Non-Maori children (Z score 0.15). CONCLUSIONS: The findings from this study support the continuation of the delivery of Project Energize in the Waikato region of New Zealand, as cardiorespiratory fitness scores in 2015, compared to 2011, were improved, particularly for lower SES schools and for Maori children. Ethnically diverse populations, schools with higher deprivation and girls, continue to warrant further attention to help achieve equity.

Teachers' Perceptions and Understanding of Children's Fluid Intake.

No public health data exists on elementary teachers' perceptions of both their own fluid intake and of their elementary school aged children's fluid intake. A total of 271 (20 males, 251 females) teachers in developed areas of Australia, Belgium, England, Ireland, United Arab Emirates, and the United States of America completed an online questionnaire (Feb-Mar 2019) on: (i) their fluid intake, (ii) their perception and understanding of children's fluid intake and (iii) barriers in the school day that they felt prevented school children consuming fluids. Overall, the data indicated that teachers consume considerably lower amounts than recommended themselves, but have a good awareness of children's fluid intake and estimate children drink approximately half (1 litre (34% n = 93)) of what is recommended per day. The results were also similar to those reported by children previously. Yet, the data highlighted a lack of active encouragement of drinking water throughout the school day by teachers, with only 11% (n = 29) suggesting they actively encourage children to drink and 45% (n = 123) reporting no active encouragement at all. It is recommended as a public health measure that all school children consume an extra cup of water during lunch times in those schools where water intake was recognized as sub optimal. Furthermore, depending on weather conditions, a cup of water before, during and after Physical Education lessons should be encouraged by teachers. Water coolers or bottles may be used as a supplementary resource, provided that hygiene is maintained. From an educational perspective, more professional development needs to be provided to teachers on the importance of regular water consumption, and more time dedicated across the elementary curriculum to educational understanding of fluid consumption.

The role of nutrition and physical activity in frailty: A review.

Frailty is a clinical syndrome with a worldwide prevalence of 5-27% among those aged over 65 years. Frailty is characterised by loss of muscle strength and impaired physical function, and is associated with increased falls, hospitalisation and death. Nutritional deficiencies and low physical activity are common in this age group due to ill health, disability and reductions in enthusiasm, food intake and therefore, energy availability. Both low physical activity and inadequate dietary intake have a significant role to play in the onset and progression of frailty, primarily through bone and muscle health implications. Frailty is, however, preventable and reversible, and several interventions have been carried out to offset and reverse the condition. This article reports the recent evidence on the role of nutrition and physical activity in the pathogenesis of frailty and provides a critical review of previously implemented interventions focussed on physical activity and nutrition to prevent and reduce frailty among older adults.

Project Spraoi: a two-year longitudinal study on the effectiveness of a school-based nutrition and physical activity intervention on dietary intake, nutritional knowledge and markers of health of Irish schoolchildren.

OBJECTIVE: To assess the effectiveness of a nutrition and physical activity (PA) intervention on dietary intake (DI), nutritional knowledge (NK), blood pressure (BP), anthropometric measures and cardiorespiratory fitness (CRF) of schoolchildren. DESIGN: Longitudinal study. DI, NK, BMI, waist-to-height ratio (WHtR), BP and CRF were all measured/calculated prior to (October 2014) and at the end of (June 2016) intervention delivery. SETTING: Two primary schools (one intervention and one control), Cork, Ireland. PARTICIPANTS: Six-year-olds (n 49; mean age = 6·09 (sd 0·33) years) and 10-year-olds (n 52; mean age = 9·90 (sd 0·37) years). RESULTS: There was a large and a moderate statistically significant difference between the change in systolic (P = 0·005, effect size (ES) = 0·165) and diastolic BP (P = 0·023, ES = 0·116), respectively, for 10-year-olds in the intervention and control groups. There was also a large statistically significant difference between the change in WHtR (P = 0·0005, ES = 0·386) and a moderate statistically significant difference between the change in NK (P = 0·027, ES = 0·107) for 10-year-olds in the intervention and control groups. There was a large statistically significant difference between the change in percentage of energy from protein in 10-year-old females (P = 0·021, ES = 0·276) in the intervention and control groups. CONCLUSIONS: Project Spraoi is Ireland's first ever school-based intervention that has been evaluated and proven effective in improving DI, NK, WHtR and BP in older primary-school children in one intervention school.

The Nutritional Value of Children's Menus in Chain Restaurants in the United Kingdom and Ireland.

OBJECTIVE: Obesity in the United Kingdom and the Republic of Ireland is rising, as is the frequency of eating out in restaurants. The aim of this study was to investigate the nutritional quality of children's menus in restaurants. DESIGN: Cross-sectional review of menus aimed at children from 20 popular chain restaurants in the United Kingdom and Ireland. MAIN OUTCOME MEASURES: Total energy, fat, saturated fat, and salt were collected from every food item on the menu in each restaurant. All potential meal combinations were created. A total of 39,266 meals were analysed. ANALYSIS: Meals were compared with UK nutritional guidelines. Meals from fast food and full-service restaurants and main meals and meal deals were compared. RESULTS: The average meal for younger children (aged 2-5 years) contained 609 ±117 kcal, and for older children (6-12 years) 653 ± 136 kcal compared with guidelines of 364 and 550 kcal, respectively. A total of 68% of younger children's and 55% of older children's meals contained more total fat than recommended and more than 4 times the amount of saturated fat. Fast food restaurant meals contained less energy, fat, and salt than did full-service restaurants, and meal deals were less likely to meet dietary guidelines than were main meals alone. CONCLUSION AND IMPLICATIONS: Eating in chain restaurants, in particular meal deals, does not contribute positively to the diet of children in the United Kingdom and Ireland.

Biological determinants of physical activity across the life course: a "Determinants of Diet and Physical Activity" (DEDIPAC) umbrella systematic literature review.

BACKGROUND: Despite the large number of studies and reviews available, the evidence regarding the biological determinants of physical activity (PA) is inconclusive. In this umbrella review, we summarized the current evidence on the biological determinants of PA across the life course, by pooling the results of the available systematic literature reviews (SLRs) and meta-analyses (MAs). METHODS: We conducted an online search on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases up to January 2018. SLRs and MAs of observational studies that investigated the association between biological determinants of PA and having PA as outcome were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. RESULTS: We identified 19 reviews of which most were of moderate methodological quality. Determinants that were studied most frequently among all ages and demonstrated evidence suggesting a positive association to PA were younger age, being male, higher health status, and higher physical fitness levels. Among adults, normal birth weight was found to be positively associated to PA with convincing strength of evidence, while findings among adolescents were inconsistent and with limited strength of evidence. CONCLUSIONS: Different social or behavioral factors may contribute to the decrease of PA with age and among females versus males, and creating programmes targeted at diverse ages, female population, and adults with abnormal birth weight is recommended. Future studies should use prospective study designs, standardized definitions of PA, and objective measurement methods of PA assessment.

Socio-economic determinants of physical activity across the life course: A "DEterminants of DIet and Physical ACtivity" (DEDIPAC) umbrella literature review.

BACKGROUND: To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course. METHODS: Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus were searched for systematic literature reviews and meta-analyses of observational studies investigating the association between socioeconomic determinants of PA and PA itself (from January 2004 to September 2017). Data extraction evaluated the importance of determinants, strength of evidence, and methodological quality of the selected papers. The full protocol is available from PROSPERO (PROSPERO2014:CRD42015010616). RESULTS: Nineteen reviews were included. Moderate methodological quality emerged. For adults, convincing evidence supports a relationship between PA and socioeconomic status (SES), especially in relation to leisure time (positive relationship) and occupational PA (negative relationship). Conversely, no association between PA and SES or parental SES was found for pre-school, school-aged children and adolescents. CONCLUSIONS: Available evidence on the socioeconomic determinants of PA behaviour across the life course is probable (shows fairly consistent associations) at best. While some evidence is available for adults, less was available for youth. This is mainly due to a limited quantity of primary studies, weak research designs and lack of accuracy in the PA and SES assessment methods employed. Further PA domain specific studies using longitudinal design and clear measures of SES and PA assessment are required.

Policy determinants of physical activity across the life course: a 'DEDIPAC' umbrella systematic literature review.

Background: Despite the large number of studies and reviews available, the evidence regarding the policy determinants of physical activity (PA) is inconclusive. This umbrella systematic literature review (SLR) summarizes the current evidence on the policy determinants of PA across the life course, by pooling the results of the available SLRs and meta-analyses (MAs). Methods: A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus and SPORTDiscus databases up to April 2016. SLRs and MAs of observational studies investigating the association between policy determinants of PA and having PA as outcome were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence and the methodological quality. Results: Fourteen reviews on 27 policy determinants of PA were eligible for this umbrella SLR. The majority of the reviews were of moderate quality. Among children, a clear association between time spent outdoors and PA emerged. Among adults, working hours were negatively associated with PA, though evidence was limited. At the population level, community- and street-scale urban design and land use policies were found to positively support PA levels, but levels of evidences were low. Conclusions: With this umbrella SLR the policy determinants of PA at individual-level and population-level have been summarized and assessed. None of the investigated policy determinants had a convincing level of evidence, and very few had a probable level of evidence. Further research is needed, preferably by using prospective study designs, standardized definitions of PA and objective measurement of PA.