Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users.

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Transform-Us! cluster RCT: 18-month and 30-month effects on children's physical activity, sedentary time and cardiometabolic risk markers.

OBJECTIVE: To test the efficacy of the Transform-Us! school- and home-based intervention on children's physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles. METHODS: A 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (2010-2012), that used pedagogical and environmental strategies to reduce and break up SB, promote PA or a combined approach, compared with usual practice. Primary outcomes (accelerometry data; n=348) were assessed at baseline, 18 and 30 months. Secondary outcomes included body mass index (BMI) and waist circumference (WC) (n=564), blood pressure (BP) (n=537) and biomarkers (minimum n=206). Generalised linear mixed models estimated the interactive effects of the PA and SB interventions on the outcomes. If there was no interaction, the main effects were assessed. RESULTS: At 18 months, there were intervention effects on children's weekday SB (-27 min, 95% CI: -47.3 to -5.3) for the PA intervention, and on children's average day PA (5.5 min, 95% CI: 0.1 to 10.8) for the SB intervention. At 30 months, there was an intervention effect for children's average day SB (-33.3 min, 95% CI: -50.6 and -16.0) for the SB intervention. Children's BMI (PA and SB groups) and systolic BP (combined group) were lower, and diastolic BP (PA group) was higher. There were positive effects on WC at both time points (SB intervention) and mixed effects on blood parameters. CONCLUSIONS: The Transform-Us! PA and SB interventions show promise as a pragmatic approach for reducing children's SB and adiposity indicators; but achieving substantial increases in PA remains challenging. TRIAL REGISTRATION: ISRCTN83725066; ACTRN12609000715279.

School lunchboxes as an opportunity for health and environmental considerations: a scoping review.

Very little research has focussed on children's school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children's lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes-particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children's health and sustainability behaviour, and mobilizing their pro-environmental agency.

School food environments play a key role in children's health and behaviour development. However, there are environmental implications of school food and this is not often considered in conjunction with schoolchildren's health based on their food consumption patterns. While wider environmental impacts of school food provision models have been studied, the more immediate and child-relevant outcomes (such as food and packaging waste) are also worth considering, especially in the context of school lunchboxes. This scoping review explored the existing literature for studies that focussed on school children's lunchbox contents and considered health attributes along with packaging and waste characteristics. Results from this review of 10 articles, which also describes the five interventions identified, pointed towards the merit of tapping into children's agency of change while also recognizing socio-ecological influences to drive sustainability practices for health co-benefits. The interconnectedness of nutritional quality and sustainability characteristics of school lunchboxes is an understudied phenomenon, but one with promising potential to promote and improve public health and planetary wellbeing.

Intervention effects on children's movement behaviour accumulation as a result of the Transform-Us! school- and home-based cluster randomised controlled trial.

BACKGROUND: It is unknown if and how children's movement behaviour accumulation patterns change as a result of physical activity and/or sedentary behaviour interventions. It is important to establish the effectiveness of interventions targeting changes in such accumulation patterns. This study aimed to investigate the effect of the Transform-Us! school- and home-based intervention program on children's movement behaviour accumulation patterns, focusing on sporadic accumulation versus time in bouts. METHODS: Baseline and post-intervention (18 months) accelerometer data from the Transform-Us! 2 × 2 factorial design cluster randomised controlled trial was used (Melbourne, 2010-2012; analytical sample n = 267; aged 8-9 years). Linear mixed models were fitted to examine effects of three different interventions (targeting increases in physical activity [PA-I], reductions in sedentary time [SB-I], or both [PA + SB-I]) compared to a usual practice (control) group on post-intervention movement behaviour accumulation compositions with eight components, including sporadic time and bouts of sedentary time, and light-, moderate- and vigorous-intensity physical activity. RESULTS: Intervention effects on distribution of time in the post-intervention waking movement behaviour accumulation composition (adjusted for baseline composition) were small and not significant. However, visual inspection of the change in compositions over time revealed that only groups with a sedentary behaviour intervention component (SB-I and PA + SB-I) reduced time in sedentary bouts, compared to the overall sample compositional mean. In addition, the SB-I group was the only group with an increase in vigorous-intensity physical activity. The combined intervention group (PA + SB-I) was characterized by the largest proportional increase in MPA bouts. The usual practice group was characterized by the largest proportional increases in both sporadic and bouts of sedentary time. CONCLUSIONS: This study showed some early evidence to suggest that the "break up your sitting" message may result in greater impact than the "move more" message. Future research, including larger sample sizes, should investigate if this type of messaging is indeed more effective in changing movement behaviours and ultimately child health. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN83725066 ; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279 .

Is level of implementation linked with intervention outcomes? Process evaluation of the TransformUs intervention to increase children's physical activity and reduce sedentary behaviour.

BACKGROUND: TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms. METHODS: At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) 'Low' (< 33% delivered); (ii) 'Moderate' (33-67% delivered); and (iii) 'High' (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children's physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically. RESULTS: Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children's enjoyment, and teachers' awareness of program benefits all facilitated delivery and sustainability. CONCLUSIONS: This study demonstrated that intervention dose and fidelity increased over time, and that children's enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387&isReview=true.

Community gardens and their effects on diet, health, psychosocial and community outcomes: a systematic review.

BACKGROUND: We systematically reviewed the effects of community gardens on physical and psychosocial health, health behaviors and community outcomes. METHODS: Quantitative studies that examined associations of health, psychosocial or community outcomes with community gardens were included in the review. Studies up to December 2020 were captured from searches of Medline, Web of Science, PsycInfo, EBSCOHost and CAB Abstracts. Data were extracted and study quality including risk of bias was examined. RESULTS: There were 53 studies that met the inclusion criteria. Studies examining associations between community gardens and nutrition or food security were most frequently reported (k = 23). Other factors examined for associations with community gardens were health (k = 16), psychosocial (k = 16) and community outcomes (k = 7). Effects appeared positive for fruit and vegetable intake, some psychosocial and community outcomes, but mixed for physical health outcomes. Evidence quality overall was low. CONCLUSIONS: Community gardening was associated with higher fruit and vegetable intake, positive psychosocial and community outcomes, but poor evidence quality suggests the effects of community gardening may be overestimated.

Content analysis of school websites: policies and programs to support healthy eating and the environment.

Preschools and primary schools are important settings for the development of healthy eating habits and awareness of environmentally friendly practices. This study explored South Australian government schools' policies and programs in relation to healthy eating and environmentally friendly aspects of food choice (such as packaging), and whether any schools approached these issues in combination. Websites of 18 government preschools and primary schools in the Greater Adelaide region, stratified by low, medium and high socioeconomic status were reviewed for publicly available policies and other relevant content. A content analysis was undertaken, with policies and programs analysed deductively and thematically. Healthy eating (n = 8) and environment (n = 3) related policies were found on preschool websites only. The main themes observed across the three categories of interest (healthy eating, environmentally friendly practices and low-waste healthy foods) included the presence/absence of formal policy, promotional strategies and implementation. Expectations of children bringing healthy 'nude' foods that were environmentally friendly were mentioned informally on the websites but were not part of policy documents. Policies and programs around healthy eating and environmentally friendly practices (in combination) were lacking. There is scope to address this gap to improve health and sustainable outcomes within the school environment context.

Evidence Regarding Automatic Processing Computerized Tasks Designed For Health Interventions in Real-World Settings Among Adults: Systematic Scoping Review.

BACKGROUND: Dual process theories propose that the brain uses 2 types of thinking to influence behavior: automatic processing and reflective processing. Automatic processing is fast, immediate, nonconscious, and unintentional, whereas reflective processing focuses on logical reasoning, and it is slow, step by step, and intentional. Most digital psychological health interventions tend to solely target the reflective system, although the automatic processing pathway can have strong influences on behavior. Laboratory-based research has highlighted that automatic processing tasks can create behavior change; however, there are substantial gaps in the field on the design, implementation, and delivery of automatic processing tasks in real-world settings. It is important to identify and summarize the existing literature in this area to inform the translation of laboratory-based research to real-world settings. OBJECTIVE: This scoping review aims to explore the effectiveness of automatic training tasks, types of training tasks commonly used, mode of delivery, and impacts of gamification on automatic processing tasks designed for digital psychological health interventions in real-world settings among adults. METHODS: The scoping review methodology proposed by Arskey and O'Malley and Colquhoun was applied. A scoping review was chosen because of the novelty of the digital automatic processing field and to encompass a broad review of the existing evidence base. Electronic databases and gray literature databases were searched with the search terms "automatic processing," "computerised technologies," "health intervention," "real-world," and "adults" and synonyms of these words. The search was up to date until September 2018. A manual search was also completed on the reference lists of the included studies. RESULTS: A total of 14 studies met all inclusion criteria. There was a wide variety of health conditions targeted, with the most prevalent being alcohol abuse followed by social anxiety. Attention bias modification tasks were the most prevalent type of automatic processing task, and the majority of tasks were most commonly delivered over the web via a personal computer. Of the 14 studies included in the review, 8 demonstrated significant changes to automatic processes and 4 demonstrated significant behavioral changes as a result of changed automatic processes. CONCLUSIONS: This is the first review to synthesize the evidence on automatic processing tasks in real-world settings targeting adults. This review has highlighted promising, albeit limited, research demonstrating that automatic processing tasks may be used effectively in a real-world setting to influence behavior change.

Are independent mobility and territorial range associated with park visitation among youth?

BACKGROUND: Parks are important for providing opportunities for physical activity among youth. Apart from engaging in physical activity whilst visiting a park, active transportation (e.g. walking or cycling) to parks is potentially an additional source of physical activity. Previous research has shown that a major barrier to young people visiting parks is their inability to visit parks unaccompanied by an adult. It is not known; however, whether young people who have greater independent mobility and territorial range (ability to move around their neighbourhood alone or with friends, unaccompanied by an adult) are more likely to visit parks. This study examined park visitation and travel mode to parks and whether independent mobility and territorial range were associated with park visitation among youth living in disadvantaged areas of Victoria, Australia. METHODS: In 2010-11, 311 youth aged 8-16 years self-reported their park use, active transport, independent mobility to parks, and territorial range. Logistic regression models determined the odds of park visitation (once per week or more) according to independent mobility and territorial range, adjusting for key covariates. RESULTS: Overall, 75% of participants reported visiting parks, and 37% visited their 'usual' park at least once per week. Of those who reported visiting parks, 87% travelled to the park they usually visited using active transport: 57% walked, 22% cycled, and 8% used a scooter/skateboard. Just 15% and 13% of youth regularly walked or cycled alone to parks/playgrounds respectively, and 25% and 19% regularly walked or cycled with friends or siblings (no adults) respectively. For the 84% who reported having parks/playgrounds within walking distance from home, those who regularly walked alone to parks (OR 3.61; CI=1.67, 7.80), and regularly walked (OR 2.27; CI=1.14, 4.55) or cycled (OR 3.38; CI=1.73, 6.62) with friends to parks, were significantly more likely to visit a park at least once per week, compared to others. CONCLUSIONS: This study showed that active transport is frequently used by this sample of young people to travel to parks. Findings also highlight the potential importance of providing opportunities for youth aged 8-16 years to visit local parks independent of an adult.

A systematic review of intervention effects on potential mediators of children's physical activity.

BACKGROUND: Many interventions aiming to increase children's physical activity have been developed and implemented in a variety of settings, and these interventions have previously been reviewed; however the focus of these reviews tends to be on the intervention effects on physical activity outcomes without consideration of the reasons and pathways leading to intervention success or otherwise.To systematically review the efficacy of physical activity interventions targeting 5-12 year old children on potential mediators and, where possible, to calculate the size of the intervention effect on the potential mediator. METHODS: A systematic search identified intervention studies that reported outcomes on potential mediators of physical activity among 5-12 year old children. Original research articles published between 1985 and April 2012 were reviewed. RESULTS: Eighteen potential mediators were identified from 31 studies. Positive effects on cognitive/psychological potential mediators were reported in 15 out of 31 studies. Positive effects on social environmental potential mediators were reported in three out of seven studies, and no effects on the physical environment were reported. Although no studies were identified that performed a mediating analysis, 33 positive intervention effects were found on targeted potential mediators (with effect sizes ranging from small to large) and 73% of the time a positive effect on the physical activity outcome was reported. CONCLUSIONS: Many studies have reported null intervention effects on potential mediators of children's physical activity; however, it is important that intervention studies statistically examine the mediating effects of interventions so the most effective strategies can be implemented in future programs.

Children's perceptions of the factors helping them to be 'resilient' to sedentary lifestyles.

Despite the increased risk of sedentary lifestyles associated with socioeconomic disadvantage, some children living in disadvantaged areas display 'resilience' to unhealthy behaviours whereby they manage to engage in regular physical activity and avoid high levels of screen time. It is important to understand what is helping these children to do well. This qualitative study explored the perceptions of 'resilient' children regarding factors that assist them to engage in high levels of physical activity and low screen time. In-depth face-to-face interviews were conducted with 38 children (7-13 years) living in disadvantaged neighbourhoods in urban and rural areas of Victoria, Australia. Themes that emerged relating to physical activity included: parental support and encouragement of physical activity, having a supportive physical environment and having friends to be active with. Themes relating to screen time included: individual preferences to be active, knowledge of health risks associated with sedentary behaviour, having a home environment supportive of physical activity and parental rules. The results provide valuable insights regarding factors that may help children living in disadvantaged neighbourhoods to be physically active and reduce their screen time and may inform future studies targeting this important population group.

Standardising the 'after-school' period for children's physical activity and sedentary behaviour.

ISSUE ADDRESSED: Studies examining children's after-school physical activity (PA) and sedentary behaviours (SB) often use arbitrary times to signify the period start and end. A standardised time is required for future research examining this period. The aim of the present study was to compare children's after-school behaviour using three definitions of the after-school period, namely (1) end of school to 6 pm; (2) end of school to dinner time; and (3) end of school to sunset, to determine the extent of variability in PA and SB during the after-school period depending on the definition used. METHODS: Children (n=308; aged 8 years) from the Melbourne Transform-Us! intervention wore an accelerometer and a subsample (n=112) wore an activPAL inclinometer in 2010. The end of school bell time was obtained from the child's school, parents completed a 2-day log reporting their child's dinner time and sunset times were obtained from Geoscience Australia. ActiGraph accelerometers assessed the proportion of time spent sedentary (SED) and that spent in light (LPA), moderate (MPA) and moderate-to-vigorous (MVPA) PA during the three time periods; activPAL inclinometers assessed the proportion of time spent sitting (SIT). RESULTS: Apart from the end of school time (3:30 pm), dinner (range 3:30 pm-8:40 pm) and sunset (range 5:07 pm-7:34 pm) times varied. Despite this, there were no significant differences in estimates of the proportions of time children spent in SED, LPA, MPA, MVPA or SIT between the three after-school periods examined. CONCLUSION: Given the small differences in SED, PA and SIT during the after-school period regardless of the definition (6 pm, sunset or dinner time), it appears that applying a standardised definition of end of school to 6 pm is acceptable for defining children's PA and SB during the after-school period. So what? The use of a standardised after-school definition (end of school to 6 pm), will enable future studies exploring children's after-school PA and SB to be more comparable.

Cross-sectional and longitudinal associations between parenting style and adolescent girls' physical activity.

BACKGROUND: Understanding the influences on physical activity is crucial, particularly among important target groups such as adolescent girls. This study describes cross-sectional and longitudinal associations between parenting style and girls' participation in organized sport, walking/cycling trips and objectively assessed moderate to vigorous physical activity (MVPA). METHODS: Data were collected from adolescent girls (n=222) and their parents in 2004 and again in 2006. Parents self-reported their demographic characteristics and parenting style. Girls self-reported their organized sport participation and weekly walking/cycling trips, while MVPA was assessed using accelerometers. Linear regression and interaction analyses were performed. Interactions between socio-demographic factors and parenting style with organized sport, walking/cycling trips and MVPA are presented. RESULTS: There were cross-sectional associations between authoritative (B=-0.45, p=0.042) and indulgent (B=-0.56, p=0.002) parenting and the number of walking/cycling trips, and authoritarian (B=0.27, p=0.033) parenting and frequency of organized sport. Significant interactions included those between: family status, authoritative parenting and daily (p=0.048) and week day (p=0.013) MVPA; education, indulgent parenting and MVPA on weekend days (p=0.006); and, employment, authoritarian parenting and duration and frequency of organized sport (p=0.004), highlighting the complexity of these relationships. Longitudinal analyses revealed significant decreases in organized sport and MVPA, significant increases in walking/cycling trips and no significant associations between parenting and physical activity. CONCLUSION: Parenting styles appear to influence walking and cycling trips among adolescent girls, though not physical activity within other domains. Socio-demographic characteristics interact with the relationships between parenting and physical activity. While these findings can inform the development of family-based interventions to improve child and adolescent health, the direction of the observed associations and the number of associations approaching significance suggest the need to further explore this area.

Socio-demographic characteristics of children experiencing socioeconomic disadvantage who meet physical activity and screen-time recommendations: the READI study.

OBJECTIVE: To identify socio-demographic characteristics of children from socioeconomically disadvantaged neighbourhoods who meet physical activity and screen recommendations. METHOD: Children aged 5-12 years (n=373; 45% boys) were recruited in 2007 from socioeconomically disadvantaged urban and rural areas of Victoria, Australia. Children's physical activity, height and weight were objectively measured. Mothers reported their highest level of education, and proxy-reported their child's usual screen-time. Odds ratios (OR) and 95% confidence intervals (95% CI) examined odds of meeting physical activity (>60 minutes/day) and screen (≤ 120 minutes/day) recommendations according to socio-demographic characteristics. RESULTS: Approximately 84% of children met physical activity and 43% met screen recommendations. Age was inversely associated with odds of meeting physical activity and screen recommendations, and overweight/obese status was associated with lower odds of meeting screen recommendations (boys: OR=0.39, 95%CI=0.16-0.95; girls: OR=0.47, 95%CI=0.26-0.83). Among boys, living in a rural area was positively associated with meeting screen recommendations (OR=3.08, 95%CI=1.42-6.64). Among girls, high levels of maternal education were positively associated with meeting screen recommendations (OR=2.76, 95%CI=1.33-5.75). CONCLUSION: Specific socio-demographic characteristics were associated with odds of meeting physical activity and screen recommendations. Identifying factors associated with such 'resilience' among this group may provide important learnings to inform future physical activity promotion initiatives.

The Perspectives of Diabetes Educators and Dietitians on Diet and Lifestyle Management for Gestational Diabetes Mellitus: A Qualitative Study.

This study explores the knowledge and practice of diabetes educators and dietitians on diet and lifestyle management in women with gestational diabetes mellitus (GDM). Diabetes educators and dietitians were recruited from three maternity hospitals in Adelaide (Australia), through snowball and purposive sampling. Thirteen semistructured interviews were conducted, audio recorded, transcribed verbatim, and analysed for codes and themes. Four themes emerged: guidelines and resources, dietary intervention, management delivery, and communication. Diabetes educators and dietitians demonstrated consistent knowledge of nutritional management for GDM and uniform delivery methods. However, a lack of culturally diverse resources was highlighted, along with a lack of continuity of care across the multidisciplinary team. Barriers towards uptake of dietary intervention were reflected by diabetes educators and dietitians as women showing signs of guilt and stress and disengaging from the service. Further exploration on the knowledge and practice of diabetes educators and dietitians for GDM to best inform implementation strategies for knowledge translation of nutritional management is needed. The indication of language and cultural barriers and resources highlight an ongoing key priority area to support the care of women of ethnic minorities.

A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: the Transform-Us! study.

BACKGROUND: Physical activity (PA) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior (SB) may be detrimental to children's health independent of PA. The primary aim of the Transform-Us! study is to determine whether an 18-month, behavioral and environmental intervention in the school and family settings results in higher levels of PA and lower rates of SB among 8-9 year old children compared with usual practice (post-intervention and 12-months follow-up). The secondary aims are to determine the independent and combined effects of PA and SB on children's cardio-metabolic health risk factors; identify the factors that mediate the success of the intervention; and determine whether the intervention is cost-effective. METHODS/DESIGN: A four-arm cluster-randomized controlled trial (RCT) with a 2 × 2 factorial design, with schools as the unit of randomization. Twenty schools will be allocated to one of four intervention groups, sedentary behavior (SB-I), physical activity (PA-I), combined SB and PA (SB+PA-I) or current practice control (C), which will be evaluated among approximately 600 children aged 8-9 years in school year 3 living in Melbourne, Australia. All children in year 3 at intervention schools in 2010 (8-9 years) will receive the intervention over an 18-month period with a maintenance 'booster' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessments. To maximize the sample and to capture new students arriving at intervention and control schools, recruitment will be on-going up to the post-intervention time point. Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey. DISCUSSION: To our knowledge, Transform-Us! is the first RCT to examine the effectiveness of intervention strategies for reducing children's overall sedentary time, promoting PA and optimizing health outcomes. The integration of consistent strategies and messages to children from teachers and parents in both school and family settings is a critical component of this study, and if shown to be effective, may have a significant impact on educational policies as well as on pedagogical and parenting practices. TRIAL REGISTRATION: ACTRN12609000715279; Current Controlled Trials ISRCTN83725066.

A translational research intervention to reduce screen behaviours and promote physical activity among children: Switch-2-Activity.

Translational or implementation research that assesses the effectiveness of strategies to promote health behaviours among children that have been previously tested under 'ideal' conditions is rarely reported. Switch-2-Activity aimed to examine the effectiveness of an abbreviated programme delivered by teachers targeting children's television viewing, computer use, physical activity and potential mediators of behaviour change. Fifteen schools from disadvantaged areas in Melbourne, Australia agreed to participate in the study (43% school-level response rate). Out of the 1566 Grades 5 and 6 (9-12 year old) children invited to take part in the study, 1048 (67% response rate) provided informed consent. Schools were randomized to either an intervention or wait-list control condition. Teachers delivered six lessons, which included strategies such as self-monitoring, behavioural contracting and budgeting of screen time. Children completed a self-report survey at baseline and post-intervention examining screen-based behaviours, physical activity, self-efficacy and behavioural capability. Teachers reported implementation of and attitudes to the programme. Seventy-one per cent of teachers delivered at least four of the six lessons. Most teachers reported that the materials were easy to follow and deliver; however, many teachers reported modifying the materials in some way. Among boys, there were favourable small intervention effects on weekend screen time [(coefficient = -0.62, 95% 95% confidence interval: -1.15, -0.10, p = 0.020)]. The intervention also had significant positive effects on children's self-efficacy for reducing television viewing and on behavioural capability (television viewing styles). Future studies that assess the translation of efficacious programmes and that test whether such programmes are equally effective in different settings (e.g. in the family setting) are urgently required.

Cross-Sectional Associations of Total Daily Volume and Activity Patterns across the Activity Spectrum with Cardiometabolic Risk Factors in Children and Adolescents.

Sedentary and physical activity patterns (bouts/breaks) may be important for cardiometabolic health in early life. This study aimed to examine cross-sectional associations of total daily volume and patterns across the activity spectrum with cardiometabolic risk factors in youth aged 7-13 years. Objectively measured accelerometer and cardiometabolic risk factor data were pooled from two studies (n = 1219; 69% valid accelerometry). Total daily volume of sedentary time and light-, moderate-, and vigorous-intensity physical activity was determined. Time in sustained bouts and median bout lengths of all intensities and breaks in sedentary time were also calculated. Outcomes included body mass index, waist circumference, blood pressure, blood lipids, and a cardiometabolic summary score. Regression models revealed beneficial associations between total daily volumes of moderate- and vigorous-intensity physical activity and cardiometabolic risk. Time spent in ≥1 min vigorous-intensity physical activity bouts was beneficially associated with cardiometabolic risk, yet this disappeared after adjusting for total vigorous-intensity physical activity and confounders. Time accumulated in light- (≥1 min; ≥5 min) and moderate-intensity (≥1 min) physical activity bouts was detrimentally associated with cardiometabolic risk. Total daily volume and activity patterns may have implications for cardiometabolic risk early in life. Sporadic physical activity may be more beneficial for health than sustained physical activity.

Activity Accumulation and Cardiometabolic Risk in Youth: A Latent Profile Approach.

INTRODUCTION: This cross-sectional study aimed to i) identify and characterize youth according to distinct physical activity (PA) and sedentary (SED) accumulation patterns, and ii) investigate associations of these derived patterns with cardiometabolic risk factors. METHODS: ActiGraph accelerometer data from 7- to 13-yr-olds from two studies were pooled (n = 1219; 843 (69%) with valid accelerometry included in analysis). Time accumulated in ≥5- and ≥10-min SED bouts, ≥1- and ≥5-min bouts of light, and ≥1-min bouts of moderate and vigorous PA was calculated. Frequency of breaks in SED was also obtained. Latent profile analysis was used to identify groups of participants based on their distinct accumulation patterns. Linear and logistic regression models were used to test associations of group accumulation patterns with cardiometabolic risk factors, including adiposity indicators, blood pressure, and lipids. Total PA and SED time were also compared between groups. RESULTS: Three distinct groups were identified: "prolonged sitters" had the most time in sustained SED bouts and the least time in vigorous PA bouts; "breakers" had the highest frequency of SED breaks and lowest engagement in sustained bouts across most PA intensities; and "prolonged movers" had the least time accumulated in SED bouts and the most in PA bouts across most intensities. Although breakers engaged in less time in PA bouts compared with other groups, they had the healthiest adiposity indicators. No associations with the remaining cardiometabolic risk factors were found. CONCLUSION: Youth accumulate their daily activity in three distinct patterns (prolonged sitters, breakers, and prolonger movers), with those breaking up sitting and least time in prolonged PA bouts across the day having a lower adiposity risk. No relationships with other cardiometabolic risk factors were identified.

Is the perception of time pressure a barrier to healthy eating and physical activity among women?

OBJECTIVES: To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity. DESIGN: A cross-sectional survey of food intake, physical activity and perceived causes of time pressure. SETTING: A randomly selected community sample. SUBJECTS: A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity. RESULTS: Time pressure was reported as a barrier to healthy eating by 41% of the women and as a barrier to physical activity by 73%. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently. CONCLUSIONS: Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women's food and physical activity behaviours.