The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities.

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.

Physical Activity Surveillance in the United States for Work and Commuting: Understanding the Impact on Population Health and Well-being.

OBJECTIVE: To summarize and describe the current US surveillance systems that assess physical activity (PA) for work and commuting. METHODS: An expert group conducted an environmental scan, generating a list (n = 18) which was ultimately reduced to 12, based on the inclusion of PA and/or sedentary behavior data. RESULTS: The 12 surveys or surveillance systems summarized provide nationally representative data on occupational-level PA or individual-level PA at work, data on active commuting, some are scorecards that summarize workplace health best practices and allow benchmarking, and one is a comprehensive nationally representative survey of employers assessing programs and practices in different worksites. CONCLUSIONS: The various surveillance systems and surveys/scorecards are disparate and need to be better analyzed and summarized to understand the impact of occupational-level PA and commuting on population health and well-being, life expectancy, and workforce productivity.

Climate Change, Air Pollution, and Physical Inactivity: Is Active Transportation Part of the Solution?

Active transportation is defined as self-propelled, human-powered transportation modes, such as walking and bicycling. In this article, we review the evidence that reliance on gasoline-powered transportation is contributing to global climate change, air pollution, and physical inactivity and that this is harmful to human health. Global climate change poses a major threat to human health and in the future could offset the health gains achieved over the last 100 yr. Based on hundreds of scientific studies, there is strong evidence that human-caused greenhouse gas emissions are contributing to global climate change. Climate change is associated with increased severity of storms, flooding, rising sea levels, hotter climates, and drought, all leading to increased morbidity and mortality. Along with increases in atmospheric CO2, other pollutants such as nitrogen dioxide, ozone, and particulate matter (e.g., PM2.5) are released by combustion engines and industry, which can lead to pulmonary and cardiovascular diseases. Also, as car ownership and vehicle miles traveled have increased, the shift toward motorized transport has contributed to physical inactivity. Each of these global challenges has resulted in, or is projected to result in, millions of premature deaths each year. One of the ways that nations can mitigate the health consequences of climate change, air pollution, and chronic diseases is through the use of active transportation. Research indicates that populations that rely heavily on active transportation enjoy better health and increased longevity. In summary, active transportation has tremendous potential to simultaneously address three global public health challenges of the 21st century.

Effects of Two Warm-up Programs on Balance and Isokinetic Strength in Male High School Soccer Players.

Ghareeb, DM, McLaine, AJ, Wojcik, JR, and Boyd, JM. Effects of two warm-up programs on balance and isokinetic strength in male high school soccer players. J Strength Cond Res 31(2): 372-379, 2017-One of the most common warm-up programs used to prevent injury in soccer, FIFA11+, integrates aerobic, strength, and balance. The purpose of this study was to compare FIFA11+ to a new warm-up program (NWP) on balance and isokinetic strength of the quadriceps and hamstrings at 60, 180, and 300°·s in male high school soccer players. Participants at one school (n = 17) performed the NWP before practice for 6 weeks during one soccer season, whereas participants at another school (n = 17) performed FIFA11+. There were no differences at baseline. At posttest, players in NWP significantly improved (p < 0.01) in Overall Stability Index Balance, Anterior/Posterior Index Balance, and Medial Lateral Index with large effect sizes (ES) > 1.3. No changes were seen in FIFA11+. Isokinetic strength peak torque increased at 60°·s in the quadriceps and hamstrings in dominant and nondominant legs in NWP (p < 0.01, ES, 0.59-1.02) and in hamstrings in FIFA11+ (p ≤ 0.05, ES, 0.32-0.40). At 180°·s, NWP improved peak torque (p < 0.01, ES, 0.74-0.90) except hamstrings in the nondominant leg, whereas FIFA11+ showed improvements across all muscle groups (p < 0.01), but with smaller ES, 0.25-0.84. Both programs improved isokinetic peak torque at 300°·s except hamstrings in the nondominant leg in NWP, although ES were higher in NWP (ES, 0.60-1.03) than FIFA11+ (ES, 0.31-0.42). The NWP seems to be effective for soccer conditioning by improving balance and isokinetic strength.

Sports Nutrition Knowledge among Mid-Major Division I University Student-Athletes.

Competitive athletes have goals to optimize performance and to maintain healthy body composition. Sports nutrition is a component of training programs often overlooked by student-athletes and their coaches. The purpose of this study was to examine student-athletes' sports nutrition knowledge across sex, class level, team, and completion of prior nutrition coursework. Participants included 123 mid-major Division I university student-athletes (47 females and 76 males) from baseball, softball, men's soccer, track and field, and tennis. The student-athletes completed a survey questionnaire to determine adequate sports nutrition knowledge (mean ≥ 75%). The overall mean sports nutrition knowledge score for the student-athletes was 56.9% which was considered inadequate sports nutrition knowledge (mean < 75%). Only 12 student-athletes achieved adequate sports nutrition knowledge score of 75% or higher. There were no differences by sex, class level, team, and completion of prior nutrition coursework. Student-athletes' inadequate sports nutrition knowledge may place them at nutrition risk, lead to impaired performance, and affect their lean body mass and energy levels. Athletics personnel should not assume student-athletes have adequate sports nutrition knowledge. Athletic departments may make available a board certified Sports Dietitian or Registered Dietitian and offer classroom or online courses facilitating student-athletes to optimize nutrition knowledge and behaviors.

Aging and the social cognitive determinants of physical activity behavior and behavior change: evidence from the guide to health trial.

Part one of this study investigated the effect of aging on social-cognitive characteristics related to physical activity (PA) among adults in the baseline phase of a health promotion intervention. Participants' questionnaire responses and activity logs indicated PA levels and self-efficacy declined with age, while social support and the use of self-regulatory behaviors (e.g., goal setting, planning, and keeping track) increased. With age participants were also less likely to expect PA to interfere with their daily routines and social obligations. Part two of the study was among overweight/obese, inactive participants completing the intervention; it examined whether improvements in psychosocial variables might counteract declining PA associated with age. After treatment, participants were more active and decreased body weight regardless of age, and improved self-efficacy, outcome expectations, and self-regulatory behaviors. In a causal model, increases in self-efficacy at 7-months lead to increased PA levels and, albeit marginally, weight loss at 16 months; increased PA was associated with greater weight loss. Aging adults who were more confident exercised more and as a result lost more weight. This longitudinal study suggests interventions that offset the effect of aging on self-efficacy may be more successful in helping older participants become more active and avoid weight gain.

Web-based guide to health: relationship of theoretical variables to change in physical activity, nutrition and weight at 16-months.

BACKGROUND: Evaluation of online health interventions should investigate the function of theoretical mechanisms of behavior change in this new milieu. OBJECTIVES: To expand our understanding of how Web-based interventions influence behavior, we examined how changes at 6 months in participants' psychosocial characteristics contributed to improvements at 16 months in nutrition, physical activity (PA), and weight management as a result of the online, social cognitive theory (SCT)-based Guide to Health intervention (WB-GTH). METHODS: We conducted recruitment, enrollment, and assessments online with 272 of 655 (41.5%) participants enrolling in WB-GTH who also completed 6- and 16-month follow-up assessments. Participants' mean age was 43.68 years, 86% were female, 92% were white, mean education was 17.45 years, median income was US $85,000, 84% were overweight or obese, and 73% were inactive. Participants received one of two equally effective versions of WB-GTH. Structural equation analysis of theoretical models evaluated whether psychosocial constructs targeted by WB-GTH contributed to observed health behavior changes. RESULTS: The longitudinal model provided good fit to the data (root mean square error of approximation <.05). Participants' weight loss at 16 months was predicted by improvements in their PA (beta(total) = -.34, P = .01), consumption of fruits and vegetables (F&V) (beta(total) = -.20, P = .03) and calorie intake (beta(total) = .15, P = .04). Improvements at 6 months in PA self-efficacy (beta(total) = -.10, P = .03), PA self-regulation (beta(total) = -.15, P = .01), nutrition social support (beta(total) = -.08, P = .03), and nutrition outcome expectations (beta(total) = .08, P = .03) also contributed to weight loss. WB-GTH users with increased social support (beta(total) = .26, P = .04), self-efficacy (beta(total) = .30, P = .01), and self-regulation (beta(total) = .45, P = .004) also exhibited improved PA levels. Decreased fat and sugar consumption followed improved social support (beta(total) = -.10, P = .02), outcome expectations (beta(total) = .15, P = .007), and self-regulation (beta(total) = -.14, P = .008). Decreased calorie intake followed increased social support (beta(total) = -.30, P < .001). Increased F&V intake followed improved self-efficacy (beta(total) = .20, P = .01), outcome expectations (beta(total) = -.29, P = .002), and self-regulation (beta(total) = .27, P = .009). Theorized indirect effects within SCT variables were also supported. CONCLUSIONS: The WB-GTH influenced behavior and weight loss in a manner largely consistent with SCT. Improving social support, self-efficacy, outcome expectations, and self-regulation, in varying combinations, led to healthier diet and exercise habits and concomitant weight loss. High initial levels of self-efficacy may be characteristic of Web-health users interested in online interventions and may alter the function of SCT in these programs. Researchers may find that, although increased self-efficacy enhances program outcomes, participants whose self-efficacy is tempered by online interventions may still benefit. TRIAL REGISTRATION: Clinicaltrials.gov NCT00128570; http://clinicaltrials.gov/ct2/show/NCT00128570 (Archived by WebCite at http://www.webcitation.org/5vgcygBII).

Social cognitive determinants of nutrition and physical activity among web-health users enrolling in an online intervention: the influence of social support, self-efficacy, outcome expectations, and self-regulation.

BACKGROUND: The Internet is a trusted source of health information for growing majorities of Web users. The promise of online health interventions will be realized with the development of purely online theory-based programs for Web users that are evaluated for program effectiveness and the application of behavior change theory within the online environment. Little is known, however, about the demographic, behavioral, or psychosocial characteristics of Web-health users who represent potential participants in online health promotion research. Nor do we understand how Web users' psychosocial characteristics relate to their health behavior-information essential to the development of effective, theory-based online behavior change interventions. OBJECTIVE: This study examines the demographic, behavioral, and psychosocial characteristics of Web-health users recruited for an online social cognitive theory (SCT)-based nutrition, physical activity, and weight gain prevention intervention, the Web-based Guide to Health (WB-GTH). METHODS: Directed to the WB-GTH site by advertisements through online social and professional networks and through print and online media, participants were screened, consented, and assessed with demographic, physical activity, psychosocial, and food frequency questionnaires online (taking a total of about 1.25 hours); they also kept a 7-day log of daily steps and minutes walked. RESULTS: From 4700 visits to the site, 963 Web users consented to enroll in the study: 83% (803) were female, participants' mean age was 44.4 years (SD 11.03 years), 91% (873) were white, and 61% (589) were college graduates; participants' median annual household income was approximately US $85,000. Participants' daily step counts were in the low-active range (mean 6485.78, SD 2352.54) and overall dietary levels were poor (total fat g/day, mean 77.79, SD 41.96; percent kcal from fat, mean 36.51, SD 5.92; fiber g/day, mean 17.74, SD 7.35; and fruit and vegetable servings/day, mean 4.03, SD 2.33). The Web-health users had good self-efficacy and outcome expectations for health behavior change; however, they perceived little social support for making these changes and engaged in few self-regulatory behaviors. Consistent with SCT, theoretical models provided good fit to Web-users' data (root mean square error of the approximation [RMSEA] < .05). Perceived social support and use of self-regulatory behaviors were strong predictors of physical activity and nutrition behavior. Web users' self-efficacy was also a good predictor of healthier levels of physical activity and dietary fat but not of fiber, fruits, and vegetables. Social support and self-efficacy indirectly predicted behavior through self-regulation, and social support had indirect effects through self-efficacy. CONCLUSIONS: Results suggest Web-health users visiting and ultimately participating in online health interventions may likely be middle-aged, well-educated, upper middle class women whose detrimental health behaviors put them at risk of obesity, heart disease, some cancers, and diabetes. The success of Internet physical activity and nutrition interventions may depend on the extent to which they lead users to develop self-efficacy for behavior change, but perhaps as important, the extent to which these interventions help them garner social-support for making changes. Success of these interventions may also depend on the extent to which they provide a platform for setting goals, planning, tracking, and providing feedback on targeted behaviors.

Guide to Health: A Randomized Controlled Trial of the Effects of a Completely WEB-Based Intervention on Physical Activity, Fruit and Vegetable Consumption, and Body Weight.

BACKGROUND: Theory-based, efficacious, long-term, completely Internet-based interventions are needed to induce favorable shifts in health behaviors and prevent weight gain. PURPOSE: To assess nutrition, physical activity, and, secondarily, body weight outcomes in the tailored, social cognitive theory Guide to Health (WB-GTH) program with all recruitment, assessment, and intervention performed on the Internet. METHODS: The focus of the efficacy study was engaged participants who completed 3 or more program modules plus baseline, 6-months post and, 16-months follow-up assessments (n = 247). To be eligible, participants needed to be between 18-63 years of age, with a BMI between 23-39, sedentary to low-active but otherwise healthy. Participant had a mean age of 45.5 years (10.3), 86.2% were female, with 8.5% from minority groups, with a mean 17.5 (3.0) years of education, and had a median annual household income of about $85k. Nevertheless, about 83% were overweight or obese and about 75% were sedentary (i.e., <5000 steps/day) or had low levels of activity (i.e., 5,000 - 7499 steps/day). Participants were randomized to the WB-GTH-Basic intervention or WB-GTH-Enhanced intervention. Content, overall target behaviors, program goals and strategies were the same in the two interventions with the difference that Basic included a generic feedback and planning approach and Enhanced included a highly tailored planning and feedback approach. Participants reported at assessments pedometer step counts to assess physical activity, bodyweight from a scale provided, and fruit and vegetable (F&V) servings were assessed from food frequency questionnaires completed online. RESULTS: Participants in both Basic and Enhanced at follow-up increased physical activity by about 1400 steps/day, lost about 3% of bodyweight, and increased F&V by about 1.5 serving/day. There was evidence that the least physically active, those who were obese, and those with poorest nutrition made greater long-term improvements. CONCLUSIONS: Given similar outcomes for Basic and Enhanced, a relatively simple entirely Internet-based program can help people improve health behaviors and prevent weight gain.

Social cognitive mediators of change in a group randomized nutrition and physical activity intervention: social support, self-efficacy, outcome expectations and self-regulation in the guide-to-health trial.

In an evaluation of the theoretical foundations of behavior change, the current study examined whether social cognitive (SCT) variables mediated treatment effects on physical activity and nutrition in the recently reported Guide-to-Health trial (GTH). Adults (N = 661) were assessed at baseline, seven months and 16 months to examine whether treatment-related changes in SCT variables at seven months mediated change in nutrition and physical activity at 16 months. GTH treatment effects were mediated by self-efficacy, self-regulation and social support; self-regulation mediated self-efficacy. Social-cognitive variables explained only part of the treatment effects suggesting future investigations evaluate the environmental-selection and affective processes of behavior change.

Prescribing physical activity: applying the ACSM protocols for exercise type, intensity, and duration across 3 training frequencies.

When physicians advise patients to attain more physical activity, they usually recommend a walking program. However, in a similar way to no exercise, those embarking on a walking program will typically lose 4 to 6 lb of lean weight and reduce their resting metabolic rate 2% to 3% every decade. These effects may be mitigated by the inclusion of resistance exercise. The American College of Sports Medicine (ACSM) minimum exercise guidelines recommend 20 minutes of aerobic activity 3 days per week, and 1 set (8-12 repetitions) of 8 to 10 resistance exercises to train the major muscle groups 2 days per week. However, large-scale testing of these recommendations in a field setting has been minimal. Men and women between 21 and 80 years (N = 1725) [corrected] participated in a 10-week combined strength and aerobic activity program based on the ACSM protocols for exercise intensity and duration across 3 training frequencies (1, 2, or 3 sessions/week). Across all training frequencies, mean changes included a reduction in body fat of 1.97%, a decrease in fat weight of 1.7 kg, an increase in lean weight of 1.35 kg, a reduction in systolic blood pressure of 3.83 mm Hg, and a reduction in diastolic blood pressure of 1.73 mm Hg. More frequent weekly training sessions were associated with greater improvements in body fat percent, fat weight, and lean weight. Participants responded favorably to the ACSM exercise program with a 91% completion rate and a 95% satisfaction rating. This article presents recommendations for prescribing safe, effective, and time-efficient exercise programs.

Small changes in nutrition and physical activity promote weight loss and maintenance: 3-month evidence from the ASPIRE randomized trial.

BACKGROUND: Current obesity interventions use intensive behavior changes to achieve large initial weight loss. However, weight regain after treatment is common, and drop out rates are relatively high. Smaller behavioral changes could produce initial weight loss and be easier to sustain after active treatment. PURPOSE: We examined the efficacy of an intervention that targeted small but cumulative participant-chosen changes in diet and physical activity (ASPIRE) and compared this treatment to standard didactic and wait-list control groups. The primary outcome measures were body weight, waist circumference, and intra-abdominal fat. METHODS: Fifty-nine overweight or obese sedentary adults were randomized to one of three groups: (1) the ASPIRE group (n = 20), (2) a standard educationally-based treatment group (n = 20), or (3) a wait list control group (n = 19) for 4 months. Active treatment groups received identical resistance and aerobic training programs. RESULTS: Intention-to-treat analyses showed that participants in the ASPIRE group lost significantly more weight than the standard and control groups (-4.4 vs. -1.1 and +0.1 kg, respectively), and the greater initial weight loss in the ASPIRE group was sustained 3 months after active treatment (4.1 kg). An alternative analytic strategy (0.3 kg/month weight gain for those lost to follow-up) showed continued weight loss (-0.2 kg after active treatment; -4.6 kg from baseline) at follow-up in the ASPIRE group. Similar patterns were observed for the other adiposity measures. CONCLUSION: More modest behavioral changes are capable of promoting weight loss, decreasing adiposity markers and sustaining these changes over 3 months. Longer-term studies comparing this approach with traditional behavioral weight loss treatments are warranted.

Self-regulation, self-efficacy, outcome expectations, and social support: social cognitive theory and nutrition behavior.

BACKGROUND: Understanding the need for and accessibility to healthier foods have not improved the overall diets of the U.S. population. Social cognitive theory (SCT) may explain how other variables, such as self-regulation and self-efficacy, may be key to integrating healthier nutrition into U.S. lifestyles. PURPOSE: To determine how SCT accounts for the nutritional content of food purchases and consumption among adults in a health promotion study. METHODS: Participants were 712 churchgoers (18% African American, 66% female, 79% overweight or obese) from 14 churches in southwestern Virginia participating in the baseline phase of a larger health promotion study. Data were collected on the nutrition related social support, self-efficacy, outcome expectations, and self-regulation components of SCT, as well as on the fat, fiber, fruit, and vegetable content of food-shopping receipts and food frequency questionnaires. These data were used to test the fit of models ordered as prescribed by SCT and subjected to structural equation analysis. RESULTS: SCT provided a good fit to the data explaining 35%, 52%, and 59% of observed variance in percent calories from fat, fiber g/1000 kcals and fruit and vegetable servings/1000 kcals. Participants' age, gender, socioeconomic status, social support, self-efficacy, negative outcome expectations, and self-regulation made important contributions to their nutrition behavior -- a configuration of influences consistent with SCT. CONCLUSIONS: These results suggest a pivotal role for self-regulatory behavior in the healthier food choices of adults. Interventions effective at garnering family support, increasing nutrition related self-efficacy, and overcoming negative outcome expectations should be more successful at helping adults enact the self-regulatory behaviors essential to buying and eating healthier foods.

Guide to health: nutrition and physical activity outcomes of a group-randomized trial of an Internet-based intervention in churches.

BACKGROUND: Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight. PURPOSE: The aim was to assess nutrition; physical activity; and, secondarily, body weight in the tailored, social cognitive Guide to Health (GTH) Internet intervention delivered in churches. METHODS: Participants (N = 1,071; 33% male, 23% African American, 57% with body mass index > or = 25, 60% sedentary, Mdn age = 53 years) within 14 Baptist or United Methodist churches were randomized to the GTH intervention only (GTH-Only; 5 churches), with church-based supports (GTH-Plus; 5 churches), or to a waitlist (control; 4 churches). Verified pedometer step counts, measured body weight, fat, fiber, and fruit and vegetable (F&V) servings from food frequency and supermarket receipts were collected at pretest, posttest (7 months after pretest), and follow-up (16 months after pretest). RESULTS: Participants in GTH-Only increased F&V at post (approximately 1.50 servings) compared to control (approximately 0.50 servings; p = .005) and at follow-up (approximately 1.20 vs. approximately 0.50 servings; p m = .038) and increased fiber at post (approximately 3.00 g) compared to control (approximately 1.5 g; p = .006) and follow-up (approximately 3.00 g vs. approximately 2.00 g; p = .040). GTH-Plus participants compared to control increased steps at post (approximately 1,500 steps/day vs. approximately 400 steps/day; p = .050) and follow-up (approximately 1,000 steps/day vs. approximately - 50 steps/day; p = .010), increased F&V at post (approximately 1.5 servings; p = .007) and follow-up (approximately 1.3 servings; p = .014), increased fiber at post (approximately 3.00A g; p = .013), and follow-up (approximately 3.00; p = .050) and decreased weight at post (approximately - 0.30 kg vs. approximately + 0.60 kg; p = .030). CONCLUSIONS: Compared to control, both GTH treatments improved nutrition at posttest, but church supports improved physical activity and nutrition at posttest and follow-up, suggesting environmental supports may improve Internet-based interventions.

Social-cognitive determinants of physical activity: the influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study.

A social-cognitive model of physical activity was tested, using structural equation analysis of data from 999 adults (21% African American; 66% female; 38% inactive) recruited from 14 southwestern Virginia churches participating in the baseline phase of a health promotion study. Within the model, age, race, social support, self-efficacy, and self-regulation contributed to participants' physical activity levels, but outcome expectations did not. Of the social-cognitive variables, self-regulation exerted the strongest effect on physical activity. Independent of self-regulation, self-efficacy had little effect. Social support influenced physical activity as a direct precursor to self-efficacy and self-regulation. The model provided a good fit to the data and explained 46% of the variance in physical activity among the diverse group of adults.