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.

Social isolation is associated with higher leisure-time sedentary behavior and lower physical activity practice: A multi-country analysis of data from 79 countries from the Global School-Based Student Health Survey.

AIM: To investigate the association of social isolation with physical activity and leisure-time sedentary behavior among adolescents. METHODS: We used data from the Global School-based Health Survey, including a representative sample of 296,861 adolescents (11-18y) from 79 countries (48.9% girls, 14.5 ± 1.6 years). Social isolation was estimated by combining the self-reported number of friends and loneliness perception. Physical activity and leisure-time sedentary behavior were assessed through questionnaires. Multinomial logistic regression models were created to analyze the associations of social isolation with physical activity and leisure-time sedentary behavior. RESULTS: Compared with those practicing ≥60 min of physical activity during 1-4 days/week, social isolation was associated with a higher prevalence of not practicing physical activity (Prevalence ratio [PR]:1.24; 95%CI:1.19-1.29), and a lower prevalence of practicing during ≥5d/wk. (PR:0.91; 95%CI:0.88-0.94). Compared with <4 h/d of leisure-time sedentary behavior, being socially isolated was also associated with a higher prevalence of 4-7 h/d (PR: 1.08; 95%CI:1.03-1.14) and ≥ 8 h/d (PR: 1.24; 95%CI:1.16-1.33) of leisure-time sedentary behavior. Compared with those participants without elevated leisure-time sedentary behavior and with those practicing adequate physical activity, social isolation was independently associated with a higher prevalence of physical inactivity (PR: 1.20; 95%CI: 1.15-1.26) and elevated leisure-time sedentary behavior (PR: 1.21; 95%CI: 1.14-1.30), as well as with both risk factors simultaneously (PR: 1.36; 95%CI: 1.28-1.45). CONCLUSION: Reducing social isolation could be an important component of future interventions to reduce sedentary behavior and physical inactivity among adolescents.

Physical activity behaviours in adolescence: current evidence and opportunities for intervention.

Young people aged 10-24 years constitute 24% of the world's population; investing in their health could yield a triple benefit-eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10-14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.

Prospective Associations of Leisure-Time Physical Activity With Psychological Distress and Well-Being: A 12-Year Cohort Study.

OBJECTIVE: This study aimed to investigate the associations of leisure-time physical activity with psychological distress and well-being, and potential mediators. METHODS: We used data from the 1970 British Cohort Study (n = 5197; 2688 men), including waves 34y (2004), 42y (2012), and 46y (2016). Participants reported leisure-time physical activity frequency and intensity (exposure) at age 34 years (baseline); cognition (vocabulary test), body mass index, disability, mobility and pain perception (potential mediators) at age 42 years; and psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale) at age 46 years. Baseline confounders included sex, country, education, employment status, alcohol use, tobacco smoking, and psychological distress. Main analyses included logistic regression and mediation models. RESULTS: Higher leisure-time physical activity intensity at baseline was associated with lower psychological distress at 46y (ß = -0.038 [95% confidence interval {CI} =-0.069 to -0.007]), but not leisure-time physical activity frequency. Baseline leisure-time physical activity frequency and intensity were associated with higher psychological well-being at 46y (frequency: ß = 0.089 [95% CI = 0.002 to 0.176]; intensity: ß = 0.262 [95% CI = 0.123 to 0.401]); and total: ß = 0.041 [95% CI = 0.013 to 0.069]). Only body mass index at 42y partially mediated the association between leisure-time physical activity frequency (15.7%) and total leisure-time physical activity (6.2%) at 34y, with psychological well-being at 46y. CONCLUSIONS: Our findings highlight the role of leisure-time physical activity in psychological distress and well-being, with greater effect sizes associated with higher frequency and intensity of leisure-time physical activity. Future interventions should consider examining potential mediators of the association of leisure-time physical activity with psychological well-being, such as body mass index.

Association of public physical activity facilities and participation in community programs with leisure-time physical activity: does the association differ according to educational level and income?

BACKGROUND: Our aim was to analyze the association of the presence of public physical activity (PA) facilities and participation in public PA programs with leisure-time PA, with an emphasis on the moderating role of educational level and income. METHODS: We used data of 88,531 adults (46,869 women), with a mean age of 47.2 ± 17.1y, from the 2019 Brazilian National Health Survey. Leisure-time PA (dichotomized considering 150 min/week), the presence of a public PA facility near the household (yes or no), participation in public PA programs (yes or no), educational level (divided into quintiles) and per capita income (divided into quintiles) were all self-reported through interviews. Adjusted logistic regression models were used for the analyses. RESULTS: The presence of public PA facilities near the household and the participation in public PA programs were associated with higher leisure-time PA among all quintiles of income and educational level. However, multiplicative interactions revealed that participating in PA programs [Quintile (Q)1: OR: 13.99; 95%CI: 6.89-28.38 vs. Q5: OR: 3.48; 95%CI: 2.41-5.01] and the presence of public PA facilities near the household (Q1: OR: 3.07; 95%CI: 2.35-4.01 vs. Q5: OR: 1.38; 95%CI: 1.22-1.55) were more associated with higher odds of being active in the leisure-time among the lowest quintile of educational level. CONCLUSIONS: The presence of public PA facilities and participation in public PA programs are environmental correlates that may be relevant for designing effective public health interventions to reduce social inequalities in leisure-time PA among adults in low-income areas.

Global prevalence of physical activity for children and adolescents; inconsistencies, research gaps, and recommendations: a narrative review.

BACKGROUND: One of the strategic actions identified in the Global Action Plan on Physical Activity (PA) 2018-2030 is the enhancement of data systems and capabilities at national levels to support regular population surveillance of PA. Although national and international standardized surveillance of PA among children and adolescents has increased in recent years, challenges for the global surveillance of PA persist. The aims of this paper were to: (i) review, compare, and discuss the methodological inconsistencies in children and adolescents' physical activity prevalence estimates from intercontinental physical activity surveillance initiatives; (ii) identify methodological limitations, surveillance and research gaps. METHODS: Intercontinental physical activity surveillance initiatives for children and adolescents were identified by experts and through non-systematic literature searches. Prevalence of meeting PA guidelines by country, gender, and age were extracted when available. A tool was created to assess the quality of the included initiatives. Methods and PA prevalence were compared across data/studies and against the methodological/validity/translation differences. RESULTS: Eight intercontinental initiatives were identified as meeting the selection criteria. Methods and PA definition inconsistencies across and within included initiatives were observed, resulting in different estimated national prevalence of PA, and initiatives contradicting each other's cross-country comparisons. Three findings were consistent across all eight initiatives: insufficient level of PA of children and adolescents across the world; lower levels of PA among girls; and attenuation of PA levels with age. Resource-limited countries, younger children, children and adolescents not attending school, with disability or chronic conditions, and from rural areas were generally under/not represented. CONCLUSIONS: There are substantial inconsistencies across/within included initiatives, resulting in varying estimates of the PA situation of children and adolescents at the global, regional and national levels. The development of a new PA measurement instrument that would be globally accepted and harmonized is a global health priority to help improve the accuracy and reliability of global surveillance.

Body mass index trajectories and noncommunicable diseases in women: The role of leisure time physical activity.

OBJECTIVE: To analyze the association between body mass index trajectories and non-communicable diseases (NCDs) in women, and the interaction effects of leisure time physical activity on this relationship. METHODS: Sample was composed by 15 628 women (≥30 years old) who performed objective measurement of body mass, height, and blood pressure in the 2013 Brazilian Health Survey (2013). Information regarding the body mass at 20 years old, current type 2 diabetes (T2DM), dyslipidemia diagnosis, and leisure time physical activity were self-reported by the participants. Socio-demographic and behavioral covariates were considered. Logistic regression models were used for the statistical analysis. RESULTS: Those who were obese in both moments and women who become obese showed similar high risk, however, the prevalence of NCDs among women who were no longer obese was similar to the consistently non-obese. Leisure time physical activity attenuated the general deleterious effect of obesity, especially among the consistently obese women for dyslipidemia (inactive: OR: 2.02 [95%CI: 1.69-2.43] vs active: OR: 1.05 [95%CI: 0.55-1.99]), T2DM (inactive: OR: 3.84 [95%CI: 2.72-5.43] vs active: OR: 4.38 [95%CI: 1.49-12.86]) and high blood pressure (inactive: OR: 2.00 [95%CI: 1.56-2.57] vs active: OR: 1.15 [95%CI: 0.57-2.52]). CONCLUSIONS: Changes in body mass index appear to be sensitive to detecting the risk of NCDs over lifespan. In addition, leisure time physical activity attenuates the negative effects of obesity on NCDs, but this appears more important for the consistently non-obese women.

Physical activity can attenuate, but not eliminate, the negative relationships of high TV viewing with some chronic diseases: findings from a cohort of 60 202 Brazilian adults.

BACKGROUND: This study examined the joint associations of leisure time physical activity and television (TV) viewing time with the prevalence of chronic diseases among Brazilian adults. METHODS: Data from the Brazilian Health Survey, a nationally representative survey conducted in 2013 (n = 60 202; ≥18 years), were used. Time spent in TV viewing and leisure physical activity, physician diagnoses of diabetes, hypertension and heart disease and information on co-variables (chronological age, education, ethnicity, candies/sweets consumption, sodium intake and tobacco smoking) were collected via interview. Descriptive statistics (mean and 95% confidence interval) and logistic regression models were used for etiological analyses. RESULTS: Physical activity attenuated but did not eliminate the risk associated with high TV viewing for at least one chronic disease in the general population [odds ratio [OR]: 1.29 (1.11-1.50)] and among women [OR: 1.31 (1.09-1.60)], adults [OR: 1.24 (1.05-1.46)] and older adults [OR: 1.63 (1.05-2.53)]. On the other hand, physical activity eliminated the risk associated with high TV viewing for at least one chronic disease among men [OR: 1.24 (0.98-1.58)]. CONCLUSIONS: We conclude that physical activity can attenuate but not eliminate the negative effects of high TV viewing on chronic disease among subgroups of Brazilian adults.

Physical activity attenuates metabolic risk of adolescents with overweight or obesity: the ICAD multi-country study.

BACKGROUND: Although the benefits of physical activity (PA) at an early age are well established, there is no robust evidence of the role of PA as well as its intensities in attenuating the association between weight status and metabolic risk among adolescents. In this investigation, we analyzed the association between weight status, intensities of PA, and metabolic risk among adolescents. METHODS: Data from six cross-sectional studies in the International Children's Accelerometry Database were used (N = 5216 adolescents; boys 14.6 ± 2.1 years and girls 14.7 ± 2.0 years). Weight status was assessed and classified according to body mass index. Fasting glucose, triglycerides, inverse high-density lipoprotein cholesterol, and blood pressure composed the metabolic risk indicator (z-score). PA was measured by accelerometers. The estimated age of peak height velocity was used as a covariate for somatic maturation. RESULTS: We observed that increase in weight status showed a strong positive relationship with metabolic risk. However, adolescents with overweight or obesity in the highest tertile of PA (moderate-to-vigorous and vigorous intensity) showed a similar metabolic risk score as the normal weight groups. Moderate intensity PA seemed related to metabolic risk even within some categories of vigorous PA. CONCLUSIONS: We conclude that PA attenuates the metabolic risk of adolescents with overweight or obesity. Although this attenuation is largely explained by vigorous PA, moderate intensity seems also important for better metabolic profile.

Development and validation of the neighborhood environment walkability scale for youth across six continents.

BACKGROUND: The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents' physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability. METHODS: Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status. RESULTS: Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity. CONCLUSIONS: A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Tracking of physical fitness in elementary school children: The role of changes in body fat.

OBJECTIVES: The aim of the present study was to examine the stability of physical fitness, and the interrelationships among intra-individual changes in fitness and fatness among elementary school children. METHODS: A longitudinal study was conducted among 372 adolescents (196 boys) and followed up over 3 years (from childhood to adolescence). Physical fitness was estimated using three indicators: cardiorespiratory fitness (through a 9-minute running test), flexibility (through a sit-and-reach test), and muscle resistance (through maximal abdominals in 1 minute). Body adiposity was obtained through triceps and subscapular skinfolds. Somatic maturation was assessed by the peak of height velocity. Kappa and Lin's tests of concordance as well as logistic regression analyses were conducted with P < 0.05 in STATA 15.1. RESULTS: Tracking of physical fitness from childhood to adolescence was moderate for both sexes [boys: kappa = 0.441 (P < 0.001); LCCC = 0.591 (P < 0.001). Girls: kappa = 0.335 (P < 0.001); LCCC = 0.534 (P < 0.001)]. A larger increment in body fat was associated with a higher likelihood to decrease a tertile in physical fitness among boys [OR: 4.17 (95% CI: 1.31-13.22)] and with a lower likelihood to increase a tertile in physical fitness among both sexes [boys: OR = 0.25 (95% CI: 0.09-0.67); girls: OR: 0.37 (95% CI: 0.15-0.92)]. CONCLUSIONS: Health-related physical fitness has moderate tracking from childhood to adolescence. Increases in body adiposity from childhood to adolescence are associated with a reduction in physical fitness tertile.

Association between physical activity and alcohol consumption: sociodemographic and behavioral patterns in Brazilian adults.

BACKGROUND: Our aim was to investigate the association between physical activity and alcohol consumption, as well as the sociodemographic and behavioral patterns of this association in a representative sample of Brazilian adults. METHODS: Data from the Brazilian Health Survey (PNS), a nationally representative survey conducted in 2013 (n = 60 202; age≥18 years), were used. Time spent in leisure physical activity, alcohol consumption as well as sociodemographic (chronological age, educational status and skin color) and associated behavioral factors (TV viewing and tobacco smoking) were collected via interview. Logistic regression models were used for the main analyses. RESULTS: Prevalence of weekly and almost daily alcohol consumption were 29.5% and 6.7% for men and 12.0% and 1.0% for women respectively. Adults with weekly alcohol consumption were more likely to be classified as physically active [young: men=OR:1.20 (CI 95%:1.02-1.39), women= OR:2.33 (CI 95%:1.92-2.82); middle-aged: men= OR:1.46 (CI 95%: 1.17-1.82), women= OR:1.75 (CI 95%:1.38-2.22); older: men= OR:1.83 (CI 95%:1.27-2.66), women= OR:2.11 (CI 95%: s1.26-3.52)], when compared to adults with no alcohol consumption. Almost daily alcohol consumption was associated with lower physical activity among young and middle-aged adults but with higher physical activity among older adults of both sexes and young women. CONCLUSIONS: Weekly alcohol consumption was associated with a higher level of physical activity among young, middle aged and older adults.

Association(s) Between Objectively Measured Sedentary Behavior Patterns and Obesity Among Brazilian Adolescents.

PURPOSE: To investigate the association between patterns of sedentary behavior and obesity indicators among adolescents. METHODS: This was a cross-sectional study conducted among 389 adolescents (186 boys) aged 10-14 years. Body mass index, body fat (skinfolds), and waist circumference were adopted as outcomes. Sedentary behavior patterns (total time, bouts, and breaks) measured through accelerometry (GT3X and GT3X+; ActiGraph, Pensacola, FL) were adopted as exposures. Peak height velocity, moderate to vigorous physical activity (accelerometer), cardiorespiratory fitness (Léger test), sex, and chronological age were adopted as covariates. Linear regression models adjusted for covariates were used to determine associations between outcome and exposure variables. RESULTS: The mean age of adolescents was 11.8 (0.7) years. Boys were more active than girls (P < .001). Accumulating shorter bouts (1-4 min) of sedentary behavior was negatively associated with body mass index (ß = -0.050; 95% confidence interval [CI], -0.098 to -0.003) and waist circumference (ß = -0.133; 95% CI, -0.237 to -0.028). Similarly, a higher number of breaks in sedentary behavior were negatively associated with body mass index (ß = -0.160; 95% CI, -0.319 to -0.001) and waist circumference (ß = -0.412; 95% CI, -0.761 to -0.064). CONCLUSION: Shorter bouts of sedentary behavior (1-4 min) and a higher number of breaks of sedentary behavior were associated with lower adiposity. Our findings also suggest that breaking up sedentary time to ensure bouts of sedentary behavior are short might contribute to the prevention of obesity in adolescents.

Development and convergent validity of new self-administered questionnaires of active transportation in three African countries: Kenya, Mozambique and Nigeria.

BACKGROUND: There is currently a rapid physical activity transition taking place in developing countries that includes a decrease in active transportation. Building on findings from an earlier systematic review, this paper describes the development and convergent validity of self-administered child and parent questionnaires assessing active transportation of children in three African countries: Kenya, Mozambique and Nigeria. METHODS: A pilot study was conducted to examine the convergent validity of the developed questionnaires by comparing responses between children and their parents (N = 121; n = 43 for Mozambique, n = 24 for Kenya and n = 54 for Nigeria). After modification, the questionnaires were then administered to a larger convenient sample of both children and parents from Kenya (n = 1123), Mozambique (n = 1097) and Nigeria (n = 831) which defined the main study. The questionnaires assessed active transportation to/from 8 categories of destinations including school, friends' and relatives' home/houses, parks and playgrounds among others. Twenty items were used to assess child - and parent-perceived barriers to active transportation, and the parent questionnaire inquired about parent education and availability of cars, motorcycles, and bicycles. Spearman's rho was used to compare children's mode of travel in the pilot study while the prevalence-adjusted bias-adjusted kappa (PABAK) coefficient was used to compare convergent validity between children's and parents responses on active transportation in the main study. RESULTS: Findings of the main study show that convergent validity for active transportation to and from each destination in the combined sample ranged from 0.472 (from school) to 0.998 (to other places). Convergent validity for challenges/barriers to active transportation to school ranged from fair (0.30 - The route does not have good lighting) to substantial (0.77 - My child has a disability). It varied between countries from fair (n = 11-items) to moderate (n = 9-items) agreement in Kenya and from poor (n = 2-items) to fair (n = 16-items) agreement in Nigeria. Data from Mozambique was however missing and therefore could be included. CONCLUSIONS: The questionnaires provided valid information on the number of trips to/from various destinations and show acceptable and modest convergent validity for measuring barriers to active transport in a sample of children from three African countries. These questionnaires may be suitable for future research on active transport among school children in Sub-Saharan African countries.

Relationship between Physical Activity and Health Related Quality of Life among Pregnant Women.

The study aimed to investigate the association between health-related quality of life (HQoL) and physical activity (PA) among pregnant women. Sample of pregnant women (N= 398; mean age=27.86±5.15 years) were surveyed using the Pregnancy Physical Activity and Health Related Quality of Life (SF 12) Questionnaires. Spearman correlation coefficient and logistic regression analyses were used to determine the bivariate relationship and association between HQoL and PA intensities and domain respectively. Overall, sedentary behaviour was positively albeit tenuously related to HQoL (r=0.111, P <0.01) whereas sport/exercise was the only domain of PA tenuously associated with the Physical health of HQoL (r=0.142, p <0.01). Also, pregnant women with sufficient PA were 4 times likely to report good quality of life in physical component not in the mental component of HQoL (OR: 4.33, 95% CI: 1.36-13.80). In conclusion, sports/exercise may be an important domain of PA to target when delivering interventions to improve the physical wellbeing among pregnant women in Maiduguri, Nigeria.

Progress in physical activity over the Olympic quadrennium.

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.

NEWS for Africa: adaptation and reliability of a built environment questionnaire for physical activity in seven African countries.

BACKGROUND: Built environment and policy interventions are effective strategies for controlling the growing worldwide deaths from physical inactivity-related non-communicable diseases. To improve built environment research and develop African specific evidence, it is important to first tailor built environment measures to African contexts and assess their psychometric properties across African countries. This study reports on the adaptation and test-retest reliability of the Neighborhood Environment Walkability Scale in seven sub-Saharan African countries (NEWS-Africa). METHODS: The original NEWS comprising 8 subscales measuring reported physical and social attributes of neighborhood environments was systematically adapted for Africa through extensive input from physical activity and public health researchers, built environment professionals, and residents in seven African countries: Cameroon, Ghana, Kenya, Mozambique, Nigeria, South Africa and Uganda. Cognitive testing of NEWS-Africa was conducted among diverse residents (N = 109, 50 youth [12 - 17 years] and 59 adults [22 - 67 years], 69 % from low socioeconomic status [SES] neighborhoods). NEWS-Africa was translated into local languages and evaluated for 2-week test-retest reliability in adult participants (N = 301; female = 50.2 %; age = 32.3 ± 12.9 years) purposively recruited from neighborhoods varying in walkability (high and low walkable) and SES (high and low income) and from villages in six of seven participating countries. RESULTS: The original 67 NEWS items was expanded to 89 scores (76 individual NEWS items and 13 computed scales). Several modifications were made to individual items, and some new items were added to capture important attributes in the African environment. A new scale on personal safety was created, and the aesthetics scale was enlarged to reflect African specific characteristics. Over 95 % of all NEWS-Africa scores (items plus computed scales) demonstrated evidence of "excellent" (ICCs > .75 %) or "good" (ICCs = 0.60 to 0.74) reliability. Seven (53.8 %) of the 13 computed NEWS scales demonstrated "excellent" agreement and the other six had "good" agreement. No items or scales demonstrated "poor" reliability (ICCs < .40). CONCLUSIONS: The systematic adaptation and initial psychometric evaluation of NEWS-Africa indicates the instrument is feasible and reliable for use with adults of diverse demographic characteristics in Africa. The measure is likely to be useful for research, surveillance of built environment conditions for planning purposes, and to evaluate physical activity and policy interventions in Africa.

Measurement of physical activity in urban and rural South African adults: a comparison of two self-report methods.

BACKGROUND: Due to the large mortality from inactivity-related non-communicable diseases in low- and middle- income countries, accurate assessment of physical activity is important for surveillance, monitoring and understanding of physical (in)activity epidemiology in many of these countries. Research on relative performance of self-report physical activity instruments commonly used for epidemiological research in Africa have rarely been reported. The present study compared estimates of physical activity measured with the International Physical Activity Questionnaire - Short Form (IPAQ-SF) and the Baecke Physical Activity Questionnaire (BPAQ) among urban and rural black South African adults. METHODS: Self-reported physical activity data using the IPAQ-SF and BPAQ were collected from a representative sample of 910 urban and rural black South African adults (age = 59.2 ± 9.5 years, 69.7 % women) participating in the 2015 wave of the Prospective Urban and Rural Epidemiological (PURE) study in the North West Province of South Africa. Between-method relationships (pearson correlations [r] and intraclass correlation coefficients [ICCs]) and agreements (Bland-Altman mean difference with 95 % limits of agreement and Kappa coefficient [k]) of IPAQ-SF and BPAQ variables were estimated. Sensitivity and specificity of the BPAQ relative to the IPAQ-SF to classify individuals according to the international guidelines for sufficient physical activity were calculated using chi-square statistics. RESULTS: Correlations between IPAQ-SF scores and BPAQ indices were small (r = 0.08-0.18; ICCs = 0.09-0.18) for BPAQ leisure and sport indices, moderate-to-large for work index (r = 0.42-0.59; ICCs = 0.40-0.62) and total physical activity index (r = 0.52-0.60; ICCs = 0.36-0.51). Between methods mean difference for total physical activity was large (1.85 unit), and agreement in physical activity classifications was poor to moderate (k = 0.16-0.44). The sensitivity of the BPAQ to identify sufficiently active people from the IPAQ-SF was very good (98 %), but its specificity to correctly classify insufficiently active people was weak (23 %). CONCLUSION: Notable disparities in physical activity estimates between methods suggest that utilization of IPAQ-SF and BPAQ for surveillance and epidemiology studies in Africa should depend on research questions and population to be studied. Future studies with objective measures are needed to confirm the relative validity between the two instruments.

A systematic review of active transportation research in Africa and the psychometric properties of measurement tools for children and youth.

BACKGROUND: Previous systematic reviews indicate that active transportation (AT; the use of non-motorized travel modes such as walking, running and cycling) is an important source of daily physical activity (PA). However, no previous systematic review has examined travel behaviours among African children and youth or the psychometric properties of measurement tools used among children and youth worldwide. METHODS: Studies on AT among African children and youth (aged 5-17 years) were identified through 1) the MEDLINE and Embase databases; 2) manual searches of six African journals that are not indexed in these databases; and 3) the articles included in a previous systematic review on PA among children and youth in Sub-Saharan Africa. Second, literature on the psychometric properties of measurement tools for children and youth was searched using the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, SportDiscus, and Health and Psychosocial Instruments databases. Study quality was assessed with a modified version of the Downs and Black checklist. RESULTS: Twenty studies reported original data on AT among African children and youth. This evidence suggests that rates of AT to/from school are lower in urban areas and in youth attending higher SES schools. Two population-based studies reported rates of AT ranging between 19.8% and 66.6% in multiple countries. Studies conducted in Africa seldom examined non-school travel and only one reported data on the psychometric properties of their measures of travel behaviours. Nineteen studies conducted predominantly in high-income countries provided psychometric data. Child and parent reports were used in 17 studies, and these measures generally showed substantial to almost perfect test-retest reliability and convergent validity for school trips. Limited information was available regarding non-school trips. Objective measures of travel behaviours have been used much less often, and further validity and reliability assessments are warranted. CONCLUSION: These findings emphasize a need for more research examining travel behaviours among African children and youth, particularly for non-school travel. Further research is needed to develop valid and reliable measures of non-school travel and to examine their psychometric properties in the African context. These measures could then be used to evaluate AT promotion interventions.