Family predictors of physical activity change during the COVID-19 lockdown in preschool children in Germany.

The COVID-19 pandemic is associated with crucial changes in children's daily life including their physical activity (PA) and screen time (ST). Among preschool children, the family represents an important factor for sufficient PA levels by being the gatekeeper for PA. Thus, the aim of this study was to investigate the influence of the family environment, specifically SES, parental support, and having siblings on COVID-19-related changes of PA and ST behavior in 317 (170 boys, 147 girls) German preschool children using longitudinal data. Our results indicate a decline in total amount of sports-related PA, an increase in outdoor play, as well as an increase in leisure ST in preschool children. The changes in total amount of PA differed between children with different levels of parental support as well as in dependence on having siblings. Furthermore, levels of outdoor play and ST in preschool children were influenced by environmental factors like having access to their own garden. We conclude that the family environment (parental support as well as physical environment) is highly relevant for PA and ST levels in preschool children. To provide every child with PA opportunities during potential future lockdowns, restriction policies should be adapted and parents need sophisticated information about the importance of their support and thus the PA levels of their children.

How do adolescents experience the decision-making process on travel mode choice?

Active travel can contribute to multiple health benefits in youth. Previous research has identified several factors influencing travel behavior. This study investigates how adolescents process these factors during their decision-making process on travel mode choice. Semi-structured interviews were conducted with 13 adolescents (11-14 years) and analysed using deductive-inductive thematic analysis. Four themes were generated from which the decision-making process on mode choice was conceptualized according to adolescents. The step-by-step process in which travel mode options were gradually reduced, was dependent on the context (Theme 1), the perceived availability of travel mode choice options, which was influenced by factors beyond the individual's perceived control (Theme 2), and on adolescents' pros/cons assessment to identify the most convenient option. Adolescents' habitually used travel mode influenced the decision at several stages throughout the process (Theme 4). To promote healthy travel behaviors, interventions should consider contextual circumstances, balance between enabling autonomous choices and promoting advantages of active travel modes, address individual travel modes and include practices that foster conscious processing of decision-making.

Monitoring of physical activity promotion in children and adolescents in the EU: current status and future perspectives.

BACKGROUND: Policy action is required to address physical inactivity in boys and girls. This action can be supported by international data collection, comparisons and sharing of good practices. Thus, this study aims to present and discuss the ongoing monitoring of physical activity (PA) indicators in children and adolescents in the 28 EU Member States. METHODS: Data on PA recommendations, PA prevalence, physical education (PE) and PA promotion programs for children and adolescents were provided by governments in a joint EU/WHO survey on the implementation status of the EU Council Recommendation on Health-Enhancing Physical Activity (HEPA) across Sectors. RESULTS: In 23 countries, national recommendations on PA are available. Detailed PA prevalence data among children and adolescents was available in 27 countries, in most cases separately for sex/gender and age groups. The total amount of PE lessons in schools differed greatly between countries and lessons were predominantly mandatory. After-school HEPA promotion programs were mostly implemented in EU Member States (78.6%), followed by active school breaks (57.1%), active travel to school (57.1%) and active breaks during school lessons (53.6%). CONCLUSIONS: This study summarizes the monitoring of PA indicators among children and adolescents in all EU Member States by providing a comprehensive overview of the status of PA promotion and monitoring across the region. Based on our findings, it could be concluded that the current EU monitoring system on PA promotion should be adapted to provide evidence that can inform future policy development.

Predictors of physical activity behavior change based on the current stage of change-an analysis of young people from Hawai'i.

This study investigated the corresponding change between psycho-social predictors and physical activity (PA) behavior and if these relationships were dependent on the stages of change from the Transtheoretical Model in Minority American adolescents. We conducted a longitudinal field study with N = 357 students aged 13-18 years (M = 14.24 years, SD = 0.88); predominantly Filipino (61.2%) using a test-retest design assessing psycho-social PA predictors (enjoyment, self-efficacy, family support, friends' support, knowledge, stage of change) and moderate-to-vigorous physical activity (MVPA) at two time points over six months. Hierarchical regression results indicated that a positive change of enjoyment, knowledge about PA and family support predicted a change of MVPA, independently of stage. The time-varying covariation showed the importance of the current stage of change for enjoyment, self-efficacy and support of friends for a change of MVPA. Overall, our findings suggest that an individual's current stage of change should be considered to determine individually appropriate starting points and goals for designing interventions to promote PA among Minority American adolescents.

Trends in active commuting to school from 2003 to 2017 among children and adolescents from Germany: the MoMo Study.

BACKGROUND: Inactivity in children and adolescents is a global issue requiring interventions that target different domains of physical activity, such as active transport. The aim of this study was to assess the prevalence, historical trends and socio-demographic correlates of active commuting to school (ACS) in a nationwide sample of girls and boys from Germany. METHODS: Data of commuting behaviour and socio-demographic factors were collected, covering three measurement points from 2003 to 2017. The MoMo Study derived its data from a representative sample of children and adolescents aged 4-17 years who answered a questionnaire (N = 11 387). Statistically significant differences between Baseline, Wave 1 and Wave 2 were determined via 95% confidence intervals (CIs) for complex samples. RESULTS: Overall, ACS decreased from 84.4% at the first measurement point to 78.3% in the third measurement point. The proportion of cases in which children opted for passive modes of commuting increased predominantly in those aged 4-5 years, in children with a low-to-medium socio-economic status, and in children residing in small- or medium-sized towns. No gender differences were found in active commuting. The results of multinomial logistic regression identified age, migration background and residential area as correlates of walking for boys. For girls, the likelihood of walking, cycling and taking public transport instead of opting for motorized transport increased with age. CONCLUSIONS: Intervention programmes to increase active transport in children and adolescents should target different age groups and also consider parental influence in determining the child's choice of transport mode.

A sex/gender perspective on interventions to promote children's and adolescents' overall physical activity: results from genEffects systematic review.

BACKGROUND: To evaluate the effects of interventions on children's and adolescents' overall physical activity (PA) for boys and girls separately and to appraise the extent to which the studies haven taken sex/gender into account. METHODS: Systematic review and semi-quantitative analysis. Eleven electronic databases were searched to identify all relevant randomized and non-randomized controlled trials. Studies had to report overall PA as the main outcome to be eligible for inclusion in the review. The main outcomes of the studies is a quantified measure of overall PA. Additionally, all studies had to report sex/gender disaggregated overall PA at baseline and/or follow up and/or explain how they dealt with sex/gender during outcome analysis (i.e., sex/gender adjusted analyses) and/or report that there were no differences in the outcome when looking at sex/gender. PRISMA guidelines were followed. Two authors independently screened studies for eligibility and assessed the risk of bias. Semi-quantitative analyses were conducted to evaluate intervention effects, taking into account the extent to which studies have considered sex/gender aspects. To evaluate sex/gender considerations in primary studies, a newly developed sex/gender checklist was used. The study was registered previously (registration number CRD42018109528). RESULTS: In total, 97 articles reporting 94 unique studies with 164 outcomes for overall PA were included in the present review. Average sample size was 829 participants, ranging from five to 9839. Participants' ages ranged from three to 19 years. Our review shows that overall 35% of PA outcomes had significant effects in increasing overall PA of children and adolescents. Not including single sex/gender studies, 105 out of 120 PA outcomes resulted in same intervention effects for boys and girls. The interventions reported to have similar effects on PA outcomes for boys and girls showed higher quality of reporting sex/gender aspects of measurement instruments, participant flow and intervention content and materials than PA outcomes with effects only in boys or only in girls. Overall, consideration of sex/gender aspects in intervention studies is low. CONCLUSIONS: There is still a need to address sufficient consideration of sex/gender aspects in developing and implementing interventions in the context of PA.

Effects of the built environment on physical activity: a systematic review of longitudinal studies taking sex/gender into account.

BACKGROUND: Individual health behavior is related to environmental and social structures. To promote physical activity (PA) effectively, it is necessary to consider structural influences. Previous research has shown the relevance of the built environment. However, sex/gender differences have yet not been considered. The aim of this systematic review was to identify built environmental determinants of PA by taking sex/gender into account. METHODS: A systematic literature search was carried out using six electronic databases (PubMed, CINAHL, SportDiscus, PsycInfo, Scopus, Web of Knowledge) to identify studies analyzing the effect of changes in the built environment on PA, taking sex/gender into account. To be included, studies had to be based on quantitative data and a longitudinal study design. Changes in the built environment had to be objectively assessed. The methodological quality of the studies was examined using the QualSyst tool for examining risk of bias. RESULTS: In total, 36 studies published since 2000 were included in this review. The data synthesis revealed that the majority of reviewed studies found the built environment to be a determinant of PA behavior for both, males and females, in a similar way. Creating a new infrastructure for walking, cycling, and public transportation showed a positive effect on PA behavior. Findings were most consistent for the availability of public transport, which was positively associated with overall PA and walking. The improvement of walking and cycling infrastructure had no effect on the overall level of PA, but it attracted more users and had a positive effect on active transportation. In women, the availability of public transport, safe cycling lanes, housing density, and the distance to daily destinations proved to be more relevant with regard to their PA behavior. In men, street network characteristics and road environment, such as intersection connectivity, local road density, and the presence of dead-end roads, were more important determinants of PA. CONCLUSION: This review sheds light on the relevance of the built environment on PA. By focusing on sex/gender differences, a new aspect was addressed that should be further analyzed in future research and considered by urban planners and other practitioners.

Prevalence and socio-demographic correlates of active commuting to school in a nationwide representative sample of German adolescents.

OBJECTIVE: To assess the prevalence and socio-demographic correlates of walking and cycling to school in a nationwide representative cross-sectional sample of German adolescents. METHODS: A sample of 1828 German adolescents aged 11-17 years were examined between 2003 and 2006. Mode of commuting to school was assessed using a reliable self-report measure. Socioeconomic status, migration background and residential area were assessed as socio-demographic variables using a parent-report questionnaire. RESULTS: Overall, 19.4% of adolescents walked and 22.2% cycled to school. Compared to girls with high socioeconomic status, girls with low socioeconomic status were more likely to walk (OR = 1.89, 95% CI = 1.23-2.89). Migration background increased the chance of walking in girls (OR = 0.47, 95% CI = 0.32-0.70) and decreased the chance of cycling in boys (OR = 2.39, 95% CI = 1.35-4.24). Compared to living in cities, living in rural areas lowered the chance of walking (girls: OR = 0.29, 95% CI = 0.18-0.50; boys: OR = 0.54, 95% CI = 0.32-0.93) and cycling (girls: OR = 0.12, 95% CI = 0.06-0.24; boys: OR = 0.34, 95% CI = 0.21-0.56), and living in medium-sized towns increased the chance of cycling in girls (OR = 1.86, 95% CI = 1.24-2.78) and boys (OR = 1.75, 95% CI = 1.20-2.56), respectively. CONCLUSIONS: In Germany many adolescents use motorised transportation. Socio-demographic variables were associated with mode of commuting.

Systematic review on measurement properties of questionnaires assessing the neighbourhood environment in the context of youth physical activity behaviour.

BACKGROUND: High-quality measurement instruments for assessing the neighbourhood environment are a prerequisite for identifying associations between the neighbourhood environment and a person's physical activity. The aim of this systematic review was to identify reliable and valid questionnaires assessing neighbourhood environmental attributes in the context of physical activity behaviours in children and adolescents. In addition, current gaps and best practice models in instrumentation and their evaluation are discussed. METHODS: We conducted a systematic literature search using six databases (Web of Science, Medline, TRID, SportDISCUS, PsycARTICLES and PsycINFO). Two independent reviewers screened the identified English-language peer-reviewed journal articles. Only studies examining the measurement properties of self- or proxy-report questionnaires on any aspects of the neighbourhood environment in children and adolescents aged 3 to 18 years were included. The methodological quality of the included studies was assessed using the COSMIN checklists. RESULTS: We identified 13 questionnaires on attributes of the neighbourhood environment. Most of these studies were conducted in the United States (n = 7). Eight studies evaluated self-report measures, two studies evaluated parent-report measures and three studies included both administration types. While eight studies had poor methodological quality, we identified three questionnaires with substantial test-retest reliability and two questionnaires with acceptable convergent validity based on sufficient evidential basis. CONCLUSIONS: Based on the results of this review, we recommend that cross-culturally adapted questionnaires should be used and that existing questionnaires should be evaluated especially in diverse samples and in countries other than the United States. Further, high-quality studies on measurement properties should be promoted and measurement models (formative vs. reflexive) should be specified to ensure that appropriate methods for psychometric testing are applied in future studies.

Determination of cut-off points for the Move4 accelerometer in children aged 8-13 years.

BACKGROUND: To assess physical activity (PA) there is a need of objective, valid and reliable measurement methods like accelerometers. Before these devices can be used for research, they need to be calibrated and validated for specific age groups as the locomotion differs between children and adults, for instance. Therefore, the aim of the present study was the calibration and validation of the Move4 accelerometer for children aged 8-13 years. METHODS: 53 normal weighted children (52% boys, 48%girls) aged 8-13 years (mean age = 10.69 ± 1.46, mean BMI = 17.93 kg/m- 2, 60th percentile), wore the Move4 sensor at four different body positions (thigh, hip, wrist and the Move4ecg including heart rate measurement at the chest). They completed nine activities that considered the four activity levels (sedentary behavior (SB), light PA (LPA), moderate PA (MPA) and vigorous PA (VPA)) within a test-retest design. Intensity values were determined using the mean amplitude deviation (MAD) as well as the movement acceleration intensity (MAI) metrics. Determination of activities and energy expenditure was validated using heart rate. After that, cut-off points were determined in Matlab by using the Classification and Regression Trees (CART) method. The agreement for the cut-off points between T1 and T2 was analyzed. RESULTS: MAD and MAI accelerometer values were lowest when children were lying on the floor and highest when running or doing jumping jacks. The mean correlation coefficient between acceleration values and heart rate was 0.595 (p = 0.01) for MAD metric and 0.611 (p = 0.01) for MAI metric, indicating strong correlations. Further, the MAD cut-off points for SB-LPA are 52.9 mg (hip), 62.4 mg (thigh), 86.4 mg (wrist) and 45.9 mg (chest), for LPA-MPA they are 173.3 mg (hip), 260.7 mg (thigh), 194.4 mg (wrist) and 155.7 mg (chest) and for MPA-VPA the cut-off points are 543.6 mg (hip), 674.5 mg (thigh), 623.4 mg (wrist) and 545.5 mg (chest). Test-retest comparison indicated good values (mean differences = 9.8%). CONCLUSION: This is the first study investigating cut-off points for children for four different sensor positions using raw accelerometer metrics (MAD/MAI). Sensitivity and specificity revealed good values for all positions. Nevertheless, depending on the sensor position, metric values differ according to the different involvement of the body in various activities. Thus, the sensor position should be carefully chosen depending on the research question of the study.

Parental perspectives on the decision-making process on transport mode choice in adolescents: a qualitative study with mothers and fathers.

Objective: The present study aims to understand the familial decision-making process on transport mode choice in adolescents with a focus on the parental perspective within this process. Background: Active travel contributes to adolescents' overall physical activity and its positive health effects. Based on the social-learning theory, especially parents are assigned a central role for adolescents' travel behavior. The aim of the present study was to examine how parents are involved in the decision-making process on transport mode choice in adolescents. Method: The study is part of the cross-sectional mixed-methods ARRIVE study which includes semi-structured interviews with mothers (n = 12) and fathers (n = 7) of 11- to 14-year-old German adolescents. The interviews focused on travel behavior in adolescents and the decision-making process on transport mode choice from the parental perspective. All interviews were analyzed inductively using Thematic Analysis. Results: Our study revealed that parents do not primarily decide for or against active travel in adolescents, but are mostly involved in the decision-making process, especially in case of a deviation from the main transport mode. Different forms of parental involvement in the decision-making process were identified. Some parents acted as main decision makers which is the highest form of involvement while others gave their children complete freedom of choose a transport mode for themselves. These parents accepted their child's choice fully which shows a low involvement in the decision-making process. Conclusion: The results provide a deeper understanding of the familial decision-making process on travel behavior in adolescents. The results indicate an occasionally parental involvement in the decision-making process on the mainly used transport mode by adolescents, and that mothers and fathers are always involved when deviating from the main mode. Implications: Further research should investigate changes in travel behavior from childhood to young adulthood to understand long-term travel decisions in families. Due to the findings that parents are often involved in the decision-making process on transport mode choice and that they mainly reported safety concerns as barriers to their children's active travel, further research should focus especially on the social and physical environment of adolescents.

Prevalence and socio-demographic correlates of the compliance with the physical activity guidelines in children and adolescents in Germany.

BACKGROUND: Regular physical activity (PA) is a prerequisite for normal growth and maturation, health, and fitness of children and adolescents. Because of the growing evidence of the health benefits of regular PA, several national and international public health organisations have established PA guidelines. The purpose of this study was to assess the percentage of children and adolescents in Germany who meet the PA guideline of 60 minutes of moderate-to-vigorous PA each day and to evaluate socio-demographic correlates of compliance with the PA guideline. METHODS: The sample consists of 4,529 children and adolescents aged between 4 and 17 years who lived and were registered in the Federal Republic of Germany between 2003 and 2006. The compliance with the PA guideline was assessed using a widely accepted screening measure. Socioeconomic status, immigration background and residential area were assessed using a parent questionnaire. RESULTS: Overall, 13.1% of girls and 17.4% of boys complied with the national guideline of 60 minutes of moderate-to-vigorous PA daily. While compliance was significantly lower in older participants of both gender groups, the steepest decrease in compliance was observed for age groups around the transition time from primary to secondary school. Logistic regression revealed that socioeconomic status and a migration background were significant predictors for compliance in girls and residential area for compliance in boys. CONCLUSIONS: Programs and policy action addressing the problem of decreasing compliance with PA guideline with increasing age are warranted. The transition from primary school to secondary school seems to be a critical stage in life with respect to PA behaviour. Therefore, specific interventions should aim at restructuring and reorganising their daily and physical activities during this transition.

Validity and reliability of a self-report instrument to assess social support and physical environmental correlates of physical activity in adolescents.

BACKGROUND: The purpose of this study was to examine the internal consistency, test-retest reliability, construct validity and predictive validity of a new German self-report instrument to assess the influence of social support and the physical environment on physical activity in adolescents. METHODS: Based on theoretical consideration, the short scales on social support and physical environment were developed and cross-validated in two independent study samples of 9 to 17 year-old girls and boys. The longitudinal sample of Study I (n = 196) was recruited from a German comprehensive school, and subjects in this study completed the questionnaire twice with a between-test interval of seven days. Cronbach's alphas were computed to determine the internal consistency of the factors. Test-retest reliability of the latent factors was assessed using intra-class coefficients. Factorial validity of the scales was assessed using principle components analysis. Construct validity was determined using a cross-validation technique by performing confirmatory factor analysis with the independent nationwide cross-sectional sample of Study II (n = 430). Correlations between factors and three measures of physical activity (objectively measured moderate-to-vigorous physical activity (MVPA), self-reported habitual MVPA and self-reported recent MVPA) were calculated to determine the predictive validity of the instrument. RESULTS: Construct validity of the social support scale (two factors: parental support and peer support) and the physical environment scale (four factors: convenience, public recreation facilities, safety and private sport providers) was shown. Both scales had moderate test-retest reliability. The factors of the social support scale also had good internal consistency and predictive validity. Internal consistency and predictive validity of the physical environment scale were low to acceptable. CONCLUSIONS: The results of this study indicate moderate to good reliability and construct validity of the social support scale and physical environment scale. Predictive validity was only confirmed for the social support scale but not for the physical environment scale. Hence, it remains unclear if a person's physical environment has a direct or an indirect effect on physical activity behavior or a moderation function.

Use of Digital Media for Home-Based Sports Activities during the COVID-19 Pandemic: Results from the German SPOVID Survey.

Health authorities recommend digital tools for home-based sport and exercise routines to stay active and healthy during the COVID-19 pandemic. The study investigates the prevalence, duration, most popular activities, and social selectivity of home-based digital sport and its contribution to overall levels of sporting activity during the pandemic. It is based on cross-sectional survey data (n = 1508), representing the population >14 years living in Germany. Data collection took place in October 2020, using computer-assisted web interviewing. Results show that overall, 23% of respondents used digital media for sports activities at least one time during the COVID-19 pandemic. Numbers increased during the lockdown and decreased afterwards. People engaged in a variety of fitness workouts, most frequently practiced with the help of publicly accessible fitness videos from video-sharing platforms. Digital sports practitioners are younger, better educated, and financially better off. Females are overrepresented. Individuals engaged in digital sports achieved 30 min/week more sports activity during the pandemic compared to individuals solely involved in offline sports. Hence, home-based digital sports activities were a popular means to stay active, particularly in the period of the lockdown. Strong social disparities indicate that the possible health benefits of digital sports only reach out to particular population groups.

Levels of physical activity in four domains and affective wellbeing before and during the Covid-19 pandemic.

BACKGROUND: Latest studies indicated that the general mental health level is low during the pandemic. Probably, this deterioration of the mental health situation is partly due to declines in physical activity. The aim of this study was to investigate differences in and the association between affective wellbeing and levels of different domains of physical activity at three time points before and during the pandemic. METHOD: We used a nationwide online panel with a trend data design encompassing a total sample of N = 3517, representing the German population (> 14 years). Four different activity domains (sport and exercise, light outdoor activity, housework/gardening, active travel) and affective wellbeing (positive and negative affect) were assessed at three time points before and during the Covid-19 pandemic (October 2019, March 2020, October 2020). RESULTS: Multivariate analyses of variance (MANOVA) indicate differences regarding affective wellbeing over the three time points with the lowest values at the second time point. Levels of activity in the four domains differed significantly over time with the strongest decrease for sport and exercise from the first to the second time point. Partial correlations indicated that the relationships between sport and exercise and positive affect were most consistent over time. CONCLUSIONS: Overall, our findings suggest that physical activity plays a particularly important role in the pandemic period as a protective factor against poor mental health. Especially sports and exercise seem to be supportive and should be encouraged, e.g. by providing additional support in finding adequate outdoor, home-based or digital substitutes.

Scaling Up a Community-Based Exercise Program for Women in Difficult Life Situations in Germany-The BIG Project as a Case-Study.

Scaling up community-based participatory research (CBPR) remains challenging. This case-study reports on how, and under which conditions, a CBPR project aiming at promoting exercise among socially disadvantaged women (BIG) scaled up at four project sites. As part of BIG, researchers support city administrations in implementing a participatory project to reach socially disadvantaged women for exercise. The case study was conducted in winter 2020 in southern Germany and is based on a co-creative process involving city administrators and researchers. Following Kohl and Cooley's scaling up dimensions, scaling up BIG was investigated at the four sites using a mixed-method approach. Course registrations and offers were analysed, and qualitative interviews (n = 4) with administrative staff members were conducted and analysed using content analysis. The geographical coverage of exercise classes, the addressed groups, and the utilisation of participatory methods by city administrations are described. All four sites managed to scale-up project activities. Three of the four sites reported that further growth of the project was no longer possible due to limited resources. All sites attempted to reach a larger number of, and more diverse, women. One site managed to scale-up the use of participatory methods within the city administration. The following important facilitators for scaling up CBPR projects were reported: advertisements tailored to the needs of the addressed women, utilising participatory approaches, and equipping project coordinators with sufficient resources.

Locations of Physical Activity: Where Are Children, Adolescents, and Adults Physically Active? A Systematic Review.

The aim of this systematic review was to examine where physical activity (PA) takes place and how much time children, adolescents and adults spend being physically active within the identified locations. A systematic literature search was carried out in five electronic databases (PubMed, CINAHL, SPORTDiscus, PsycInfo, Scopus). For inclusion, primary studies had to identify locations of PA using device-based or self-report tools, whereas minutes of PA had to be examined using device-based tools only. Thirty-two studies were included, methodological quality and sex/gender sensitivity of the studies were assessed. The narrative data synthesis revealed that the highest average amount of daily moderate-to-vigorous PA was found in home and recreational locations, followed by school and neighborhood locations. In adults, highest average amount of daily moderate-to-vigorous PA was found in neighborhood and home locations followed by workplace and recreational locations. The majority of studies had a low risk of bias in four out of six domains; eight studies reported significant sex/gender differences in location-based PA. The results indicate that different locations are used for PA to a varying degree across the lifespan. Future research on the promotion of PA should focus on location-specific design features that encourage children, adolescents and adults to be physically active.

Physical inactivity in healthy, obese, and diabetic adults in Germany: An analysis of related socio-demographic variables.

BACKGROUND: Adults with diabetes or obesity are more likely to be physically inactive than healthy adults. Physical activity is essential in the management of both diseases, necessitating targeted interventions in these groups. This study analysed physical inactivity (defined as not taking part in leisure-time physical activity) in over 100,000 adults in Germany considering their body mass index and the presence of diabetes. Furthermore, the relationship between specific socio-demographic factors with physical inactivity was investigated, particularly focussing diabetic and obese people, to refine the identification of risk-groups for targeted interventions on physical activity promotion. METHODS: Data from 13 population-based health surveys conducted in Germany from 1997 to 2018 were used. The relevant variables extracted from these datasets were merged and employed in the analyses. We included data from 129,886 individuals in the BMI analyses and 58,311 individuals in the diabetes analyses. Logistic regression analyses were performed to identify the importance of six socio-demographic variables (age, sex/gender, education, income, employment, and migration) for the risk of physical inactivity. RESULTS: Obese and diabetic people reported a higher prevalence of physical inactivity than those who were not affected. Logistic regression analyses revealed advanced age, low education level, and low household income as risk factors for physical inactivity in all groups. A two-sided migration background and unemployment also indicated a higher probability of physical inactivity. CONCLUSION: Similar socio-demographic barriers appear to be important determinants of physical inactivity, regardless of BMI status or the presence of diabetes. However, physical activity promoting interventions in obese and diabetic adults should consider the specific disease-related characteristics of these groups. A special need for target group specific physical activity programmes in adults from ethnic minorities or of advanced age was further identified.

Do Intervention Studies to Promote Physical Activity and Reduce Sedentary Behavior in Children and Adolescents Take Sex/Gender Into Account? A Systematic Review.

BACKGROUND: Physical inactivity is often reported in youth and differs among boys and girls. The aim of this study is to assess sex/gender considerations in intervention studies promoting physical activity and reducing sedentary behavior in youth using a sex/gender checklist. METHODS: A systematic search was conducted in August 2018 to identify all relevant controlled trials. Studies screened must have reported a quantified measure of physical activity and/or sedentary behavior, and identified participants by sex/gender at baseline. For evaluation of the sex/gender consideration, the authors used a sex/gender checklist developed by expert consensus. RESULTS: The authors reviewed sex/gender considerations in all aspects of intervention development, implementation, and evaluation in 217 studies. Sex/gender aspects were only rudimentarily taken into account, most frequently during statistical analyses, such as stratification or interaction analysis. CONCLUSIONS: Sex/gender effects are not sufficiently reported. To develop guidelines that are more inclusive of all girls and boys, future interventions need to document sex/gender differences and similarities, and explore whether sex/gender influences different phases of intervention programs. The newly developed sex/gender checklist can hereby be used as a tool and guidance to adequately consider sex/gender in the several steps of intervention planning, implementation, and evaluation.

Transferring a Community-Based Participatory Research Project to Promote Physical Activity Among Socially Disadvantaged Women-Experiences From 15 Years of BIG.

Introduction: Community-based participatory research (CBPR) is an effective approach to health promotion, especially in relation to socially disadvantaged groups. However, the long-term implementation of CPBR-based projects on a broad scale is often challenging, and research regarding the sustainable transfer of participatory research is lacking. This limits the scaling-up and public health impact of CBPR. Therefore, this study examines the mechanisms utilized to transfer and sustain the BIG project, a multifaceted CBPR project aimed at promoting physical activity among women in difficult life situations. Materials and Methods: Borrowing from the RE-AIM framework, we analyzed project documentation and conducted a reflection workshop to investigate methods of transferring BIG to new sites as well as strategies from researchers to support project implementation and the maintenance of program activities at those sites. Moreover, we analyzed the reasons for discontinuing program activities at some former BIG sites and the costs involved in transferring BIG. Results: Since its establishment in 2005, BIG was transferred to and implemented at 17 sites. As of the winter of 2019, the program activities were maintained at eight sites. The average duration of sites that continue to offer program activities was more than 9 years. Discontinued sites maintained project activities for an average of 4 years. According to the study findings, the extent of scientific support, the provision of seed funding, and the local project coordinator, the person managing the project at the site, all have a significant impact on the sustainability of the transfer. A patchwork of funding agencies was needed to finance scientific support and seed funding in BIG. The transfer of BIG projects accrued annual costs of approximately EUR20,000 per site; however, long-term project implementation resulted in a decline in the annual transfer costs of BIG. Discussion and Conclusion: The sustainable transfer of CBPR is challenging but possible, and increased support of research and seed funding can facilitate long-term transfer. Nevertheless, other factors in the implementation setting are beyond scientific control. With scarce financial resources, researchers need to carefully balance the efforts of the sustainability and transfer of CBPR projects. To address this issue, there is a need for further research into the interrelationship of the sustainability and transfer of CBPR projects as well as increased long-term funding.