Evidence from big data in obesity research: international case studies.

BACKGROUND/OBJECTIVE: Obesity is thought to be the product of over 100 different factors, interacting as a complex system over multiple levels. Understanding the drivers of obesity requires considerable data, which are challenging, costly and time-consuming to collect through traditional means. Use of 'big data' presents a potential solution to this challenge. Big data is defined by Delphi consensus as: always digital, has a large sample size, and a large volume or variety or velocity of variables that require additional computing power (Vogel et al. Int J Obes. 2019). 'Additional computing power' introduces the concept of big data analytics. The aim of this paper is to showcase international research case studies presented during a seminar series held by the Economic and Social Research Council (ESRC) Strategic Network for Obesity in the UK. These are intended to provide an in-depth view of how big data can be used in obesity research, and the specific benefits, limitations and challenges encountered. METHODS AND RESULTS: Three case studies are presented. The first investigated the influence of the built environment on physical activity. It used spatial data on green spaces and exercise facilities alongside individual-level data on physical activity and swipe card entry to leisure centres, collected as part of a local authority exercise class initiative. The second used a variety of linked electronic health datasets to investigate associations between obesity surgery and the risk of developing cancer. The third used data on tax parcel values alongside data from the Seattle Obesity Study to investigate sociodemographic determinants of obesity in Seattle. CONCLUSIONS: The case studies demonstrated how big data could be used to augment traditional data to capture a broader range of variables in the obesity system. They also showed that big data can present improvements over traditional data in relation to size, coverage, temporality, and objectivity of measures. However, the case studies also encountered challenges or limitations; particularly in relation to hidden/unforeseen biases and lack of contextual information. Overall, despite challenges, big data presents a relatively untapped resource that shows promise in helping to understand drivers of obesity.

Professional football clubs' involvement in health promotion in Spain: an audit of current practices.

The implementation of effective community-based health interventions within Spanish football clubs has the potential to positively influence the public health agenda and enable the healthcare system in Spain to be more successful and sustainable. This paper aims to explore the involvement of Spanish football clubs in health promotion activities, their potential for future involvement and what that would require. A mixed methods explanatory sequential design, with a purposive sample of La Liga clubs. Data collection included online questionnaires and phone interviews. Quantitative methods enabled us to describe the number and types of programmes the clubs are currently involved in. Qualitative data was useful to further unpick the processes followed by the clubs in planning and developing health promotion programmes, while identifying any determinants to change. Seventeen clubs completed questionnaires and 11 participated in interviews. Clubs generally support inclusive programmes that target disadvantaged groups. Health-related programmes focus on healthy eating, physical activity and blood donation. Thematic analysis of interviews with 11 representatives of La Liga clubs resulted in three-key themes. These related to: (i) Diversity of programmes; (ii) (Lack of) evidence-based approaches to intervention design and evaluation and (iii) Contrasting views about a club's role in health promotion interventions. Spanish football clubs have potential to reach into communities that are currently underserved. However, there is limited infrastructure and understanding within the clubs to do this. Nevertheless, there is huge opportunity for organizations with public health responsibility in Spain to implement translational approaches within football-based settings.

A Delphi study to build consensus on the definition and use of big data in obesity research.

BACKGROUND: 'Big data' has great potential to help address the global health challenge of obesity. However, lack of clarity with regard to the definition of big data and frameworks for effectively using big data in the context of obesity research may be hindering progress. The aim of this study was to establish agreed approaches for the use of big data in obesity-related research. METHODS: A Delphi method of consensus development was used, comprising three survey rounds. In Round 1, participants were asked to rate agreement/disagreement with 77 statements across seven domains relating to definitions of, and approaches to, using big data in the context of obesity research. Participants were also asked to contribute further ideas in relation to these topics, which were incorporated as new statements (n = 8) in Round 2. In Rounds 2 and 3 participants re-appraised their ratings in view of the group consensus. RESULTS: Ninety-six experts active in obesity-related research were invited to participate. Of these, 36/96 completed Round 1 (37.5% response rate), 29/36 completed Round 2 (80.6% response rate) and 26/29 completed Round 3 (89.7% response rate). Consensus (defined as > 70% agreement) was achieved for 90.6% (n = 77) of statements, with 100% consensus achieved for the Definition of Big Data, Data Governance, and Quality and Inference domains. CONCLUSIONS: Experts agreed that big data was more nuanced than the oft-cited definition of 'volume, variety and velocity', and includes quantitative, qualitative, observational or intervention data from a range of sources that have been collected for research or other purposes. Experts repeatedly called for third party action, for example to develop frameworks for reporting and ethics, to clarify data governance requirements, to support training and skill development and to facilitate sharing of big data. Further advocacy will be required to encourage organisations to adopt these roles.

Designing programmes of physical activity through sport: learning from a widening participation intervention, 'City of Football'.

BACKGROUND: Implementation profoundly influences how well new audiences engage with sport-based physical activity programmes. Recognising that effective implementation relies on concurrently generating supportive contexts, systems and networks for the least engaged 'target' groups; this paper aims to address what underpins children's (non) engagement with football-based physical activity. METHODS: An observational research design, using a non-probability sample of N = 594 primary and secondary schoolchildren assessed outcomes of a three-year 'City of Football' (CoF) programme. Pupils self-reported football participation, personal friendship networks and exposure to six concurrent sources of influence (SoI). A 2-step hierarchical cluster analysis and univariate analyses assessed between-cluster differences. RESULTS: Girls played football least regularly (χ2 [4] = 86.722, p = 0.000). Overall, participation was significantly associated with personal networks engaged in football. Boys' personal networks were more stable and structurally effective. Football participation was also positively and linearly association with SoI scores. Girls and pupils with no personal networks around football reported the lowest SoI scores. Three clusters emerged, dominated by social network influences. The Traditional Market (n = 157, 27.7%) comprised 81.7% boys; they regularly played football, had the most effective network structure and scored highly across all six domains of SoI. The Sporadically Engaging Socialisers (n = 190, 33.5%) comprised 52.9% girls who rarely played football, reported low SoI scores and an inferior network structure. In the Disconnected cluster (n = 220, 38.8%), 59.3% were non-footballing girls who reported the lowest motivation and ability SoI scores; and no personal networks engaged in football. CONCLUSIONS: This study reveals new insights about the primacy of social network effects for engaging children in football-based physical activity programmes. With little or no attention to these social-oriented issues, such interventions will struggle to attract 'target' children, but will readily engage already well-connected, experienced football-playing boys. The challenge for drawing non-footballing children into football-based interventions lies with engaging children - especially girls - whose social networks are not football-focused, while they also find football neither personally motivating nor easy to do.

Reaching older people with PA delivered in football clubs: the reach, adoption and implementation characteristics of the Extra Time Programme.

BACKGROUND: Older adults (OA) represent a core priority group for physical activity and Public Health policy. As a result, significant interest is placed on how to optimise adherence to interventions promoting these approaches. Extra Time (ET) is an example of a national programme of physical activity interventions delivered in professional football clubs for OA aged 55+ years. This paper aims to examine the outcomes from ET, and unpick the processes by which these outcomes were achieved. METHODS: This paper represents a secondary analysis of data collected during the evaluation of ET. From the 985 OA reached by ET, n=486 adopted the programme and completed post-intervention surveys (typically 12 weeks). We also draw on interview data with 18 ET participants, and 7 staff who delivered the programme. Data were subject to thematic analysis to generate overarching and sub themes. RESULTS: Of the 486 participants, the majority 95%, (n= 462) were White British and 59.7% (n=290) were female. Most adopters (65.4%/n=318) had not participated in previous interventions in the host clubs. Social interaction was the most frequently reported benefit of participation (77.2%, n=375). While the reach of the club badge was important in letting people know about the programme, further work enhanced adoption and satisfaction. These factors included (i) listening to participants, (ii) delivering a flexible age-appropriate programme of diverse physical and social activities, (iii) offering activities which satisfy energy drives and needs for learning and (iv) extensive opportunities for social engagement. CONCLUSIONS: Findings emerging from this study indicate that physical activity and health interventions delivered through professional football clubs can be effective for engaging OA.

Health improvement for men and hard-to-engage-men delivered in English Premier League football clubs.

Unhealthy behaviours represent modifiable causes of non-communicable disease. In men, concern focuses on those (i) demonstrating the poorest health, exacerbated by a lack of awareness of the risks that their lifestyles pose and (ii) who neither consult their doctor nor use health services. Classed as 'hard-to-engage', distinctive strategies are needed to reach these men. Impact and process evaluations assessed the effect of a programme of men's health-delivered in/by English Premier League football clubs. Men attended match-day events and/or weekly classes involving physical activity and health education. Validated self-report measures for demographics and lifestyle behaviours were completed pre- and post-intervention. Intention-to-treat analysis was performed on pre-versus-post-intervention differences in lifestyle profiles, whereas interviews (n = 57) provided men's accounts of programme experience. Participants were predominantly white British (70.4%/n = 2669), 18-44 (80.2%/n = 3032) and employed (60.7%/n = 1907). One-third (n = 860) 'never' visited their doctor. Over 85% (n = 1428) presented with combinations of lifestyle risk factors. Intention-to-treat analysis showed improvements (P < 0.001) in lifestyle profiles. Interviews confirmed recruitment of men who were hard-to-engage and unhealthy. Men were attracted through football and/or the clubs, whereas specific design factors impacted on participation. Limitations include use of self-reports, narrow demographics, small effect sizes, lack of follow-up and the absence of non-completers in interviews.

Optimizing lifestyles for men regarded as 'hard-to-reach' through top-flight football/soccer clubs.

This study assessed the effect of a 12-week behavioural intervention delivered in and by English Premier League football/soccer clubs, and its influence on lifestyle behaviours, in men typically regarded as hard-to-reach. One hundred and thirty men aged 18 years or older engaging in the programme self-reported data on optimal lifestyle behaviours (OLBs) (physical activity, diet, smoking and alcohol consumption) at pre- and post-intervention. Logistic regression models were used to predict the likelihood of OLBs post-intervention. Healthy behaviours were uncommon at baseline, yet at 12 weeks, 19% (n = 24) of men displayed positive change in one behaviour and 67% (n = 87) had changed ≥2. A combination of improving diet (odds ratio [OR] = 2.76; 95% confidence interval [CI] = 1.65-4.63) and being employed (OR = 4.90, CI = 1.46-16.5) significantly increased the likelihood of reporting ≥150 min of physical activity per week. Increased physical activity significantly increased the likelihood of self-reporting a healthy diet (OR = 2.32, CI = 1.36-3.95). This study shows that a 12-week behavioural intervention can reach and engage a proportion of at risk men. Further, among such men, the intervention helped to stabilize and improve several of the most important lifestyle behaviours that impact mortality and morbidity.

An Investigation into the Physical Activity Experiences of People Living with and beyond Cancer during the COVID-19 Pandemic.

This study investigated the physical activity experiences of people living with and beyond cancer (PLWBC) during the COVID-19 pandemic. Participants attended the cancer and rehabilitation exercise (CARE) programme delivered by a football community trust. Staff (n = 2) and participants (n = 9) attended semi-structured interviews investigating the PA participation and experiences of attending/delivering different modes of CARE, including exercise classes delivered outdoors and delivered online. Interviews also investigated participant aspirations for returning to CARE sessions delivered in person indoors. The findings show that the COVID-19 pandemic and government restrictions impacted on PA participation, yet exercise sessions provided via CARE offered participants an important opportunity to arrest their inactivity, keep active and maintain their fitness and functionality. Barriers to participation of CARE online included access to IT infrastructure, internet connectivity and IT skills and comfort using IT. Regarding CARE outdoors, the weather, range of equipment, variety of exercises and the lack of toilets and seats were barriers. In the different CARE modes, the skills of delivery staff who were sensitive to the needs of participants, social support, and the need for participants to maintain good mental and social health were important facilitators for engagement and are considerations for programme delivery. CARE helped PLWBC to keep physically active.

A Mixed-Methods Evaluation of CARE (Cancer and Rehabilitation Exercise): A Physical Activity and Health Intervention, Delivered in a Community Football Trust.

With increasing cancer survivorship has come an increased necessity to support people living with cancer (PLWC) to have a good quality of life including being physically active. Using mixed methods, the current study aimed to use the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to determine how the football community trust delivered CARE (Cancer and Rehabilitation Exercise) intervention was able to increase participants' physical activity in order to improve their quality of life and regain physiological and psychological function. Quantitative outcome data were collected at baseline, 3 and 6 months using the Cancer Physical Activity Standard Evaluation Framework questionnaire. Semi-structured focus groups (n = 5) captured participants' (n = 40) lived experience of the reach, effectiveness, adoption, implementation, and maintenance of CARE. Questionnaire data were analysed using repeated measures ANOVAs and qualitative data were thematically analysed. Following diagnosis, CARE was successful in providing participants with a unique and accessible opportunity to become or restart physically activity, by providing a local, socially supportive, and inclusive environment. This resulted in significant increases in physical activity (F(1.58, 23) = 5.98, p = 0.009), quality of life (QoL) (F(2,36) = 13.12, p = 0.000) and significant reductions in fatigue (F(1.57,31) = 11.19, p = 0.000) over 6 months. Participants also reported becoming more active, recovering physical function, regaining independence, and enhanced psychological well-being as a result of attending CARE. Key design features of CARE were also identified across RE-AIM. CARE, a football community trust delivered physical activity intervention was successful in significantly improving participants' QoL and in regaining the physical and psychological functioning of people living with cancer. Results suggest that maintaining engagement in CARE for 6 months and beyond can support people to maintain these changes. Engaging in robust evaluations such as this can help organizations to successfully secure future funding for their programs.

Systematic review of acute physically active learning and classroom movement breaks on children's physical activity, cognition, academic performance and classroom behaviour: understanding critical design features.

OBJECTIVE: To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour. DESIGN: Systematic review. DATA SOURCES: PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias. RESULTS: Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies. CONCLUSION: Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies. PROSPERO REGISTRATION NUMBER: CRD42017070981.

Physical Activity and Sedentary Behavior Clustering: Segmentation to Optimize Active Lifestyles.

BACKGROUND: Increasingly the health impacts of physical inactivity are being distinguished from those of sedentary behavior. Nevertheless, deleterious health prognoses occur when these behaviors combine, making it a Public Health priority to establish the numbers and salient identifying factors of people who live with this injurious combination. METHODS: Using an observational between-subjects design, a nonprobability sample of 22,836 participants provided data on total daily activity. A 2-step hierarchical cluster analysis identified the optimal number of clusters and the subset of distinguishing variables. Univariate analyses assessed significant cluster differences. RESULTS: High levels of sitting clustered with low physical activity. The Ambulatory & Active cluster (n = 6254) sat for 2.5 to 5 h·d(-1) and were highly active. They were significantly younger, included a greater proportion of males and reported low Indices of Multiple Deprivation compared with other clusters. Conversely, the Sedentary & Low Active cluster (n = 6286) achieved ≤60 MET·min·wk(-1) of physical activity and sat for ≥8 h·d(-1). They were the oldest cluster, housed the largest proportion of females and reported moderate Indices of Multiple Deprivation. CONCLUSIONS: Public Health systems may benefit from developing policy and interventions that do more to limit sedentary behavior and encourage light intensity activity in its place.