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.

Physical activity and sedentary behaviours in Greek-Cypriot children and adolescents: a cross-sectional study.

BACKGROUND: There are no data on physical activity and sedentary behaviours of Greek-Cypriot children and adolescents, and no study to date examined the association between these two behaviours in this population. The purpose of this study was to document the prevalence of physical activity and sedentary behaviours among Greek-Cypriot adolescents and examine the association between physical activity and a range of sedentary behaviours. Logistic regression analyses were performed to examine the association between physical activity and sedentary behaviours. METHODS: A cross-sectional study among 1,966 Greek-Cypriot children and adolescents was conducted in 2008/2009. Data were collected by means of a questionnaire across primary, middle, high and technical/vocational schools. RESULTS: Overall 52.3% and 52.4% of the participants met physical activity and television viewing guidelines respectively. Boys and younger children were more likely to meet guidelines. Boys who attended sports clubs for two or more times per week were more likely to be physically active (OR = 3.4), and those who listened to music for one or less than one hour per day were less likely to be physically active (OR = 0.6). Girls who attended sports clubs for two or more times per week and who watched television for two or less than two hours per day were more likely to be physically active, (OR = 3.0 and OR = 1.5 respectively). Girls who reported travelling by car/bus/motorbike for one or less than one hour per day were more likely to actively travel to school (OR = 1.8). CONCLUSIONS: Findings from this study provide limited support for the displacement hypothesis whereby sedentary behaviours displace physically active time. About 50.0% of Greek children and adolescents in Cyprus meet existing physical activity and television viewing guidelines. Encouraging children to attend sports clubs for at least two times per week may markedly improve their physical activity levels.

Social, attitudinal and behavioural correlates of fruit and vegetable consumption among Cypriot adolescents.

OBJECTIVE: To examine the prevalence and correlates of fruit and vegetable (FV) consumption in Cypriot adolescents. DESIGN: A cross-sectional study. SETTING: The Republic of Cyprus. SUBJECTS: A total of 1966 adolescents with a mean age of 14·7 (SD 2·2) years from nine elementary (n 448), six middle (n 657), five high (n 475) and five technical/vocational schools (n 386) in Cyprus. Participants completed a questionnaire assessing FV consumption using a two-item screening measure and a number of social, attitudinal and behavioural correlates of FV consumption. RESULTS: Overall, 19·3% of adolescents reported consuming five or more portions of FV daily, with elementary and middle school students more likely to meet recommendations (23·8% and 24·4%, respectively) compared with high and technical/vocational school students (14·0% and 12·5%, respectively). Consuming five or more portions of FV was associated with preference for FV (OR = 2·2), family eating patterns (OR = 1·5), friends' FV consumption (OR = 1·2) and school support for FV consumption (OR = 0·8). Consuming at least one portion of fruit daily was significantly associated with preference for FV (OR = 2·0) and family eating patterns (OR = 1·7). Consuming at least one portion of vegetables daily was associated with preference for FV (OR = 4·2) and eating while watching television (OR = 0·8). CONCLUSIONS: Targeting individual and family-based components may enhance the effectiveness of intervention programmes to promote FV consumption.

Six-month follow-up and participant use and satisfaction of an electronic mail intervention promoting physical activity and nutrition.

PURPOSE: To evaluate the effects of a 12-week e-mail intervention promoting physical activity and nutrition, and to describe participant use and satisfaction feedback. DESIGN: A longitudinal, randomized trial. SETTING: Five large workplaces in Alberta, Canada. PARTICIPANTS: One thousand forty-three participants completed all three assessments, and 1263 participants in the experimental group provided use and satisfaction feedback after receiving the 12-week intervention. INTERVENTION: Paired physical activity and nutrition messages were e-mailed weekly to the experimental group. The control group received all messages in bulk (i.e., within a single e-mail message) at the conclusion of the intervention. MEASURES: Self-report measures of knowledge, cognitions, and behaviors related to physical activity and nutrition were used. Satisfaction with e-mail messages was assessed at Time 2. ANALYSIS: Planned contrasts compared the experimental group measures at Time 3 with those reported at Time 2 and with control group measures reported at Time 3. Control group measures at Time 3 were also compared with control group measures at Time 2. RESULTS: The small intervention effects previously reported between Time 1 and Time 2 were maintained at Time 3. Providing the e-mail messages in bulk also had a significant positive effect on many of the physical activity and nutrition variables. CONCLUSIONS: E-mail offers a promising medium for promoting health-enhancing knowledge, attitudes, and behaviors. Additional research is needed to determine optimal message dose and content.

Prevalence and correlates of active traveling to school among adolescents in Cyprus.

More data regarding prevalence and correlates of active travel to school are needed from different parts of the world. The purpose of this study was to examine prevalence and correlates of active travel to school among adolescents in Cyprus. A cross-sectional study was conducted among 1966 adolescents attending grade 6, grades 7-9, grades 10-12 and technical/vocational schools in Cyprus. Overall prevalence of active travel to school was 19.4%. Parental perceptions of safe route to school, other children walking to school from the child's neighborhood and school location (urban versus rural) were associated with active travel across different levels of education. Having enough time to walk to school in the moming was the most consistent correlate of active travel. Low prevalence estimates of active traveling to school among adolescents in Cyprus raise the need to promote this source of daily physical activity.

Screen time behaviour in a sample of 11- to 12-year-old Greek-Cypriot children: A cross-sectional study of parental and child reports.

OBJECTIVE: This cross-sectional study examined the association between parental and child-reported correlates and children's screen time. METHODS: Children (N = 154) and their parents completed questionnaires examining correlates of screen time. Children recorded the time they devoted to screen-based and study-related sedentary activities and wore a pedometer for 6 days (four weekdays and two weekend days). Parents also provided information relating to the time their children devoted to screen time. RESULTS: Children reported significantly higher time watching television and playing electronic games as well as higher total screen time during the weekend compared to weekdays. On the contrary, they reported significantly lower time doing homework and recorded significantly lower steps during the weekend compared to weekdays. The scale 'Parent-child Television Viewing' yielded significant associations with both parent and child-reported total screen time and television watching. Associations ranged from r = 0.193, p < 0.05 to r = 0.599, p < 0.001. The scales 'Child Screen Time with Friends' and 'Friends' Norms for Screen Time' demonstrated significant associations with child-reported electronic games and total screen time, and with parent-reported electronic games and computer use. Associations ranged from r = 0.180, p < 0.05 to r = 0.478, p < 0.001. Variance explained for total screen time at the multivariate level ranged from 8% to 37% with the scale 'Parent-child Television Viewing' having significant associations with both parent and child-reported weekday total screen time. CONCLUSIONS: Obtaining data from both parents and children may provide further understanding of screen time behaviour. While parental factors appear to be consistently associated with children's total screen time, studies may consider focusing more on parents to reduce time spent watching television, and more on friends to limit time spent in electronic games.

Promoting physical activity during school break times: piloting a simple, low cost intervention.

OBJECTIVE: The purpose of this pilot study was to examine the effectiveness of two interventions on children's physical activity during the 20-min school break. METHODS: Children from three schools participated in this study. In the first intervention school (n=89) the school's courts were allocated to different children on alternate days of the week, playground markings were painted in the school's yard and jump ropes were provided. In the second intervention school (n=89) the school's courts were just allocated to different children on alternate days of the week. The third school served as the control group (n=69). Physical activity was measured with a pedometer during the 20-min break (09:05-09:25) and during the after school period (13:05 till bed time). Data were collected in Cyprus, between January/April of 2007. RESULTS: A significant time by group interaction indicated a change in break-time activity. Four weeks after the intervention, mean steps in the first (1427+/-499) and second (1331+/-651) intervention schools were significantly higher than steps in the control school (1053+/-447). Non-significant increases were observed in the after-school activity of children in the intervention schools. CONCLUSIONS: Implementing simple, low-cost interventions during break periods could help increase children's activity.

Differences in the correlates of physical activity between urban and rural Canadian youth.

BACKGROUND: Despite the benefits of physical activity (PA), a significant proportion of youth remains inactive. Studies assessing differences in the correlates of PA among urban and rural youth are scarce, and such investigations can help identify subgroups of the population that may need to be targeted for special intervention programs. The purpose of this study was to assess differences in the correlates of PA between Canadian urban and rural youth. METHODS: The sample consisted of 1398 adolescents from 4 urban schools and 1290 adolescents from 4 rural schools. Mean age of the participants was 15.6 +/- 1.3 years. Hierarchical regression analyses were used to examine the association between self-reported PA and a number of demographic, psychological, behavioral, and social correlates. RESULTS: Common correlates between the 2 locations included gender (with girls being less active than boys) perceptions of athletic/physical ability, self-efficacy, interest in organized group activities, use of recreation time, and friends' and siblings' frequency of participation in PA. Active commuting to school and taking a physical education class were unique correlates of PA at the multivariate level in urban and rural students, respectively. Variance explained in PA ranged from 43% for urban school students to 38% for rural school students. CONCLUSIONS: Although more similarities than discrepancies were found in the correlates of PA between the 2 geographical locations, findings from this study strengthen the policies that argue for a coordinated multisector approach to the promotion of PA in youth, which include the family, school, and community.

Associations between Parental and Friend Social Support and Children's Physical Activity and Time Spent outside Playing.

The purpose of this study was to examine the structural validity of a parent and a child questionnaire that assessed parental and friends' influences on children's physical activity and investigate the associations between the derived factors, physical activity, and time spent outside. Children (N = 154, mean age = 11.7) and 144 of their parents completed questionnaires assessing parental and friends' influences on children's physical activity. Children wore a pedometer for six days. Exploratory factor analyses revealed four factors for the parental and five for the child's questionnaire that explained 66.71% and 63.85% of the variance, respectively. Five factors were significantly associated with physical activity and five significantly associated with time spent outside. Higher correlations were revealed between "general friend support," "friends' activity norms," and physical activity (r = 0.343 and 0.333 resp., p < 0.001) and between "general friend support" and time spent outside (r = 0.460, p < 0.001). Obtaining information relating to parental and friends' influences on physical activity from both parents and children may provide a more complete picture of influences. Parents and friends seem to influence children's physical activity behavior and time spent outside, but friends' influences may have a stronger impact on children's behaviors.

Efficacy of an E-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context.

PURPOSE: The purpose of this study was to evaluate a 12-week workplace e-mail intervention designed to promote physical activity and nutrition behavior. DESIGN: A pre- and post-test design was conducted to compare the effects of e-mail messages between intervention and control groups. SETTING: Five large workplaces in Alberta, Canada. SUBJECTS: Employees with access to a personal e-mail address (N = 2121) were randomly assigned to an intervention (n = 1566) or a control group (n = 555). INTERVENTION: Physical activity and nutrition messages were based on social-cognitive theories. The intervention group received one physical activity and one parallel nutrition message per week for 12 weeks. The control group received no weekly messages. MEASURES: Each participant completed self-report measures of physical activity and nutrition related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week after (time 2) the intervention. RESULTS: The intervention group was more efficacious at time 2 on measures of self-efficacy, pros, cons, intentions, and behavior related to physical activity. This group also reported more favorable changes in practicing healthy eating, balancing food intake with activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat foods. Effect sizes for all significant differences were small. CONCLUSION: E-mail is a promising mode of delivery for promoting physical activity and nutrition in the workplace. Further theoretically driven studies are needed.

Physical activity, smoking, and obesity among Canadian school youth. Comparison between urban and rural schools.

BACKGROUND: More information is needed to document the prevalence of health risk factors in youth. The purpose of this study is to compare the prevalence of physical inactivity, smoking and overweight/obesity among youth in urban and rural schools. METHODS: Data were obtained from a Student Physical Activity and Smoking Survey of 2,697 high school students in four urban schools in Ontario and four rural schools in Alberta. Prevalence of physical inactivity was assessed by examining compliance with Canada's Physical Activity Guide to Healthy Active Living, and with daily energy expenditure classification values. Prevalence of smoking was assessed by examining current smoking status. Overweight and obesity prevalences were examined by comparing BMI values to the BMI index for age and sex percentiles set by the Centers for Disease Control and Prevention. RESULTS: Physical activity prevalence was found to be low in our study, with only 57.0% of youth achieving Canada's Physical Activity Guidelines, and with 26.0% classified as sedentary based on the daily energy expenditure classification values. A higher proportion of rural students reported "trying smoking" than urban school students (73.0% versus 64.4%, p<0.001). A significantly higher proportion of rural males were 'overweight' than urban males, and a significantly higher proportion of rural females were 'obese' in comparison to urban females. CONCLUSION: Our findings add further support for an urgent need to promote physical activity among Canadian youth. Additionally, our results suggest that it is especially important to target rural students, particularly girls, for smoking prevention programs. Future studies are required to examine such rural and urban differences within provinces.

Population-based estimates of physical activity for adults with type 2 diabetes: a cautionary tale of potential confounding by weight status.

At a population level, the method used to determine those meeting physical activity guidelines has important implications, as estimating "sufficient" physical activity might be confounded by weight status. The objective of this study was to test the difference between three methods in estimating the prevalence of "sufficient activity" among Canadian adults with type 2 diabetes in a large population sample (N = 1614) while considering the role of weight status as a potential confounder. Our results revealed that estimates of physical activity levels vary by BMI categories, depending on the methods examined. Although physical activity levels were lower in the obese, their energy expenditure estimates were not different from those who were overweight or of a healthy weight. The implications of these findings are that biased estimates of physical activity at a population level may result in inappropriate classification of adults with type 2 diabetes as "sufficiently active" and that the inclusion of body weight in estimating physical activity prevalence should be approached with caution.

School location and gender differences in personal, social, and environmental correlates of physical activity in Cypriot middle school children.

BACKGROUND: A number of studies indicate higher prevalence of overweight and obesity among rural school children. The purpose of this study was to examine the differences in personal, social, and environmental correlates of physical activity between school location (urban versus rural) and gender. METHODS: Middle school children (N = 676) from different districts in Cyprus completed questionnaires assessing physical activity and potential correlates. RESULTS: Children from rural schools reported higher friend support for physical activity and more ease of walk to a bus station from their home. Urban school children reported higher presence of sidewalks in their neighborhood. Boys reported more hours per day playing outside and higher enjoyment and friend support for physical activity than girls, whereas girls reported higher means in the variable 'I see a lot of people walking or being physically active in my neighborhood'. Significant two-way interactions between gender and school location were noted with rural school girls having less favorable scores in a number of correlates of physical activity. CONCLUSIONS: More studies are needed to further understand the higher incidence of overweight and obesity observed among rural youth. Girls from rural areas may be targeted as a priority group for promoting physical activity.

Differences in physical activity by gender, weight status and travel mode to school in Cypriot children.

OBJECTIVE: More information about children's physical activity during different periods of the day is needed. The purpose of this study was to describe children's physical activity during the segmented school day and examine potential differences during different periods of the day across gender, travel mode to school and weight status. METHODS: School children (N=247) wore pedometers for four consecutive school days and recorded their steps during the before school period, the 20-min school break, the whole school period, the after school period and for the whole day. Children also reported how they traveled to school. Data were collected in Cyprus, in January/February of 2007. RESULTS: T-tests indicated that boys took significantly higher steps than girls throughout all the segments of the day (p<0.001) and children who walked to school exhibited higher step counts during the before school period (p<0.001), the after school period (p<0.01), and the whole day (p<0.01) in comparison to children who used motorized transport. A three-way ANOVA revealed significant two-way interactions between weight status and travel mode to school. CONCLUSION: Results suggest that there is a need to promote physical activity among children, especially among girls. Promoting active transport to school may further enhance the effectiveness of intervention programs.

Testing a conceptual model related to weight perceptions, physical activity and smoking in adolescents.

The purpose of this study was to test a conceptual model based on theoretical and empirically supported relationships related to the influences of weight perceptions, weight concerns, desires to change weight, friends, age and location in relation to physical activity (PA) and smoking in adolescents. A total of 1242 males and 1446 females (mean age = 15.6 +/- 1.3) were recruited from rural and urban Canadian schools. Study respondents provided self-reports of PA, 'smoking', 'perceived body weight', 'desire to change weight', 'concern about weight gain' and 'friends' smoking and PA behaviors'. Results revealed an acceptable fitting model chi2 (40) = 155.63, P < 0.05, root mean square error of approximation = 0.047 and comparative fit index = 0.98. Large effect sizes for both genders were observed between friends' and adolescents' smoking behavior, and between perceived body weight and desire to change weight. Further, significant differences were identified between the male and female models [chi2 difference (24) = 65.28, P < 0.05]. Several findings of this study point to the need to design programs to motivate adolescent females to adopt healthy weight-control practices and to target young peoples' social networks to promote health behaviors, especially with regard to smoking.

Correlates of Pedometer-Assessed Physical Activity in Cypriot Elementary School Children.

BACKGROUND: The purpose of this study was to examine the association between pedometer-assessed physical activity and a number of individual, social, and environmental correlates among Cypriot elementary school children. METHODS: School children in grades 5 and 6 (N = 104) and their parents (N = 70) wore pedometers for five consecutive weekdays and completed questionnaires assessing potential correlates of steps/d. RESULTS: A hierarchical regression analysis indicated that gender, weekly frequency of sports club attendance, and hours playing outside accounted for 32% of the variance in steps/d. In addition, children with a body-mass index (BMI) above the 85th percentile (based on age and gender) scored significantly lower steps/d than children with a BMI below the 85th percentile. CONCLUSIONS: This study suggested that correlates of steps/d in children are similar to the findings of other studies using different measures of physical activity behavior.

Differences in physical activity levels between urban and rural school children in Cyprus.

This study attempted to examine differences in physical activity levels between urban and rural primary school children. The sample consisted of 256 Greek-Cypriot children and their parents from two schools representing urban areas and three schools representing rural areas. Children's activity levels were assessed for 4 weekdays in the winter and for 4 weekdays in the summer using a pedometer (DW-200; Yamax, Tokyo, Japan). Daily step counts were used to describe children's activity levels. Parents completed a questionnaire assessing environmental variables in both seasons. Two-way ANOVAs indicated that urban school children were significantly more active in winter than rural school children (means = 13,583 +/- 4,313 versus 12 436 +/- 3610, P < 0.001) and that rural school children were significantly more active in the summer (means = 16,450 +/- 5134 versus 14,531 +/- 4,901, P < 0.001). Parents of children in rural schools reported more space available in the garden and in the neighbourhoods, and safer neighbourhoods than parents of children in urban schools, whereas children in urban schools had more exercise equipment available at home and were transported more frequently to places where they could be physically active. Results of this study suggest that intervention programmes to promote physical activity need to consider seasonal and geographical location differences in physical activity levels.

Age, gender, and urban-rural differences in the correlates of physical activity.

BACKGROUND: The majority of the population is inactive, and strategies to date for promoting regular physical activity have been limited in their effectiveness. Further research is needed to identify correlates of physical activity in different subgroups to design more efficacious interventions. This study sought to identify correlates of physical activity across men and women, urban and rural geographical locations, and four distinct age groups (18-25; 26-45; 46-59; and 60+). METHODS: This study employed data from a large provincial household random sample (N = 20,606) of Canadians. Analyses were utilized to examine the amount of variance explained in self-reported physical activity by a number of demographic and/or biological, psychological, behavioral, social, and environmental variables within each subgroup. RESULTS: Proportion of friends who exercise, injury from past physical activity, educational level, perceived health status, and alcohol consumption were among the strongest correlates across subgroups. CONCLUSIONS: A number of correlates were identified as being significant across all subgroups examined. Most differences in the correlates of physical activity were found within different age groups rather than among urban and rural residents and gender.