Ecological momentary assessment of physical activity and sedentary behaviour in shift workers and non-shift workers: Validation study.

This study examined the criterion validity of an ecological momentary assessment (EMA)-reported physical activity and sedentary time compared with accelerometry in shift workers and non-shift workers. Australian workers (n = 102) received prompts through a mobile EMA app and wore the Actigraph accelerometer on the right hip for 7-10 days. Participants received five EMA prompts per day at 3-hour intervals on their mobile phones. EMA prompts sent to shift workers (SW-T) were tailored according to their work schedule. Non-shift workers (NSW-S) received prompts at standardised times. To assess criterion validity, the association of EMA-reported activities and the Actigraph accelerometer activity counts and number of steps were used. Participants were 36 ± 11 years and 58% were female. On occasions where participants reported physical activity, acceleration counts per minute (CPM) and steps were significantly higher (ß = 1184 CPM, CI 95%: 1034, 1334; ß = 20.9 steps, CI 95%: 18.2, 23.6) than each of the other EMA activities. Acceleration counts and steps were lower when sitting was reported than when no sitting was reported by EMA. Our study showed that EMA-reported physical activity and sedentary time was significantly associated with accelerometer-derived data. Therefore, EMA can be considered to assess shift workers' movement-related behaviours with accelerometers to provide rich contextual data.

Physical activity and sedentary behaviour among south Asian immigrants in Australia.

ISSUE ADDRESSED: South Asians make up the second-largest group of immigrants in Australia and experience a higher burden of chronic diseases compared with non-immigrants. Most chronic diseases are associated with insufficient physical activity (PA) and sedentary behaviour (SB); however, studies involving PA and SB in immigrants are limited. This study aimed to explore PA and SB and associated factors among South Asian immigrants in Australia. METHODS: South Asian adult immigrants in Australia were surveyed online (from November 2020 to March 2021) about PA, SB, knowledge and barriers to PA. Logistic regressions were used to examine factors associated with insufficient PA (<150 minutes/week) and a high sitting time (>8 hours/day). RESULTS: A total of 321 participants provided complete data. Approximately 76% of participants reported insufficient PA and 27% reported high sitting time. Only 6% of participants walked or bicycled. The main reported barriers to PA were lack of time, costs, transport facilities, skills, and culturally appropriate resources. Around 52% of participants were not aware of the importance of PA. Participants with self-reported poor health and who used motorized travel were more likely to have inadequate PA. High sitting time was more common among middle-aged, overweight/obese, and middle-income participants. CONCLUSIONS: Most South Asian immigrants are insufficiently active with a lack of socio-economically appropriate PA facilities identified as a major challenge. A stronger collaboration between policymakers and community is required for sustainable solutions. SO WHAT?: Affordable and appropriate PA facilities in neighbourhoods could overcome major barriers. Also, information about PA should incorporate cultural expectations in the general recommendations to encourage participation.

The effects of age on dyspnea and respiratory mechanical and neural responses to exercise in healthy men.

The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga ) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro-transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end-expiration, Pga expiratory tidal swings, and the gastric pressure-time product (PTPga ) at absolute and relative minute ventilation were higher (p < 0.05) for older compared to younger men. There were no differences in EMG responses between older and younger men. Younger men were more likely to report shallow breathing (p = 0.005) than older men. Our findings showed younger and older men had similar respiratory neuromuscular activation patterns and reported different dyspnea descriptors, and that older men had greater expiratory muscle pressure generation during exercise. Greater expiratory muscle pressures in older men may be due to compensatory mechanisms designed to offset increasing airway resistance due to aging. These results may have implications for exercise-induced expiratory muscle fatigue in older men.

An Evaluation of Community Health Workers' Knowledge, Attitude and Personal Lifestyle Behaviour in Non-Communicable Disease Health Promotion and Their Association with Self-Efficacy and NCD-Risk Perception.

Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs' knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs' perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion.

Bullying Experiences of South Asian Immigrants in Australia: a Mixed-Method Study.

Bullying is a pervasive problem faced by immigrants that negatively impacts their health and well-being. Understanding the factors that contribute to bullying and the prevalence of bullying victimisation may help to develop strategies to prevent bullying. Using a mixed-method approach, this study explored the perceptions and prevalence of bullying of South Asian immigrants living in Australia. Five focus group discussions (FGDs) were conducted to explore bullying experiences and to inform an online survey. The online survey included the California Bullying Victimisation Scale-Retrospective (CBVS-R) to measure prevalence, types, and places of bullying victimisation. Data collected from FGDs were thematically analysed while survey data were examined to identify factors associated with bullying. The main contributing factors reported by participants during FGDs were ethnic attire (clothing), religion, accent, workplace achievement, skin colour, and body shape. The online survey collected responses from 313 participants that included females (44%) and males (56%) with a mean age of 41.0 (SD ± 10.3) years. Almost 31% of participants surveyed experienced multiple bullying incidents per month with no differences observed between gender (32% in males, 31% in females). Males were mostly bullied (63%) in their workplaces while females were mostly bullied (56%) at bus or train stations. Country of birth, employment status, educational qualification, and English proficiency significantly associated with bullying experience (p < 0.001). These findings show that bullying affects male and female immigrants in different forms and settings; therefore, a large national assessment is needed to evaluate the magnitude of bullying and its consequences on immigrant health and well-being.

'Cost, culture and circumstances': Barriers and enablers of health behaviours in South Asian immigrants of Australia.

The health behaviours related to chronic diseases experienced by South Asian immigrants are interrelated with their culture and socioeconomic conditions. South Asian immigrants experience a disproportionate burden of chronic disease compared with non-immigrants Australian-born general population. The primary aim of this study was to gain an in-depth understanding of health behaviours and healthcare access in the South Asian immigrant population of Australia. Five focus group discussions (FGDs) were conducted with South Asian immigrants (n = 29; 18 females) aged 27-50 years in Brisbane, Australia. Separate FGDs were conducted for males and females in the English language. Semi-structured guided questions related to the perception, barriers and facilitators of health behaviours. Data were analysed with Nvivo-12 following a thematic analysis. A conceptual model is proposed to provide a summarised understanding of barriers and facilitators of health behaviours in South Asian immigrants. The major reported constraints for participating in physical activity were cultural beliefs, lack of time, work stress and high fees of fitness activities, while parks and peer modelling were mentioned as a strong motivator for walking, cycling and participating in group sports activities. The cultural and religious connections, cost of cigarettes and drink driving penalties were the most mentioned facilitators for a healthy lifestyle. The important factors related to unhealthy eating habits were the traditional cooking methods, social interactions and the high cost of fruits and vegetables. Community perceptions and language barriers were also acknowledged as the main factors for the decrease in accessing health care services. This study illustrates that cultural beliefs, high cost of healthy food and facilities and social circumstances are mainly linked with the health behaviours and healthcare access in South Asian immigrant's lifestyles.

Gender inequalities in physical activity among adolescents from 64 Global South countries.

PURPOSE: The aims of this study were to (a) describe gender inequalities in physical activity (PA) among adolescents from Global South countries, and (b) investigate the relationship between gender inequalities in PA and contextual factors, such as geographic region, human development index, gender inequality index, and unemployment rates. METHODS: We analyzed cross-sectional data from the Global School-Based Student Health Survey conducted in Global South countries between 2010 and 2020 among 13- to 17-year-old adolescents. Country-context variables were retrieved from secondary data sources (World Health Organization, World Bank, and Human Development Reports). PA was assessed by a self-administered questionnaire querying the number of days in the past week in which participants were physically active for a total of at least 60 min. PA absolute gender inequalities were evaluated by the differences in the prevalence between boys and girls, 95% confidence intervals (95%CIs) were estimated using the bootstrap method. Relative inequalities were obtained through Poisson regression. Meta-analyses with random effects were used to calculate pooled estimates of absolute and relative inequalities. RESULTS: Based on 64 Global South countries/surveys, the prevalence of PA was 6.7 percentage points (p.p.) higher in boys than in girls, ranging from 0.5 p.p. in Afghanistan to 15.6 p.p. in Laos (I2= 85.1%). The pooled ratio for all countries showed that boys presented a PA prevalence 1.58 times higher than girls (95%CI: 1.47-1.70) on average. The highest absolute and relative inequalities were observed in high income countries. Countries with higher Human Development Index rankings and lower Gender Inequality Index rankings also presented greater gender differences. CONCLUSION: Given that girls are overall less active than boys across the globe, the findings of this study reinforce that macro- and micro-level changes should be actively sought if we aim to increase population levels of PA in adolescents and promote equity in PA.

A Longitudinal Assessment of Risk Factors and Chronic Diseases among Immigrant and Non-Immigrant Adults in Australia.

This study aimed to investigate the prevalence and trajectories of chronic diseases and risk behaviors in immigrants from high-income countries (HIC), low-middle-income countries (LMIC), to Australian-born people. Data were used from five waves of the HABITAT (2007-2016) study-11,035 adults living in Brisbane, Australia. Chronic diseases included cancer, diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease (COPD). Risk factors assessed were body mass index (BMI), insufficient physical activity, and cigarette smoking. Diabetes mellitus increased in all groups, with the highest increase of 33% in LMIC immigrants. The prevalence of cancers increased 19.6% in the Australian-born, 16.6% in HIC immigrants, and 5.1% in LMIC immigrants. The prevalence of asthma increased in HIC immigrants while decreased in the other two groups. Poisson regression showed that LMIC immigrants had 1.12 times higher rates of insufficient physical activity, 0.75 times lower rates of smoking, and 0.77 times lower rates of being overweight than the Australian-born population. HIC immigrants had 0.96 times lower rates of insufficient physical activity and 0.93 times lower rates of overweight than Australian-born. The findings of this study can inform better strategies to reduce health disparities by targeting high-risk cohorts.

Associations between indicators of energy intake and expenditure with excess weight and obesity among women in sedentary and less-sedentary jobs.

The aim of this study was to compare the associations between indicators of energy intake and expenditure with excess weight and obesity in women who work full-time in sedentary and less sedentary jobs. Data were from 3444 participants the Australian Longitudinal Study on Women's Health, who reported their weight, dietary intake, physical activity and occupation in 2009 (baseline), and weight in 2012 (follow-up). Participants were categorised as being in a 'less sedentary' or 'sedentary' job, based on occupational activity patterns. Odds of excess weight (BMI ≥ 25) at baseline and of being obese (BMI ≥ 30) at follow-up, by indicators of energy intake and expenditure, were compared in the two occupational groups. In multivariate analyses, high non-work sitting time and saturated fat intake were associated with increased odds of obesity at 3-year follow-up in both occupational groups. In the sedentary job group, high physical activity (in leisure and transport) was associated with a 51% reduction in odds of obesity (OR 0.49, 95%CI 0.25-0.97). In the less-sedentary job group, energy intake and high soft drink consumption were associated with markedly increased odds of obesity (OR 1.67 95%CI 1.07-2.61; OR 2.08 95%CI1.42-3.05, respectively). In this cohort of young Australian women, sedentariness at work did not markedly affect the prevalence of excess weight or obesity. Indicators of high energy intake and low energy expenditure were associated with increased odds of both excess weight and obesity, regardless of sedentariness of occupational group.

Associations Between Self-Reported Sleep Duration and Mortality in Employed Individuals: Systematic Review and Meta-Analysis.

OBJECTIVE: Sleeping less or more than the 7-8 h has been associated with mortality in the general population, which encompasses diversity in employment status, age and community settings. Since sleep patterns of employed individuals may differ to those of their unemployed counterparts, the nature of their sleep-mortality relationship may vary. We therefore investigated the association between self-reported sleep duration and all-cause mortality (ACM) or cardiovascular disease mortality (CVDM) in employed individuals. DATA SOURCES: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, searches between January 1990 and May 2020 were conducted in PubMed, Web of Science and Scopus. Inclusion/exclusion criteria: Included were prospective cohort studies of 18-64-year-old disease-free employed persons with sleep duration measured at baseline, and cause of death recorded prospectively as the outcome. Gray literature, case-control or intervention design studies were excluded. DATA EXTRACTION: Characteristics of the studies, participants, and study outcomes were extracted. The quality and risk of bias were assessed using the Newcastle-Ottawa Scale. DATA SYNTHESIS: The pooled relative risks (RR) with 95% confidence intervals (CI) were obtained with a random-effects model and results presented as forest plots. Heterogeneity and sensitivity analysis were assessed. RESULTS: Shorter sleep duration (≤6 h) was associated with a higher risk for (ACM) (RR: 1.16, 95% CI: 1.11 -1.22) and CVDM (RR: 1.26, 95% CI: 1.12 -1.41) compared to 7-8 h of sleep, with no significant heterogeneity. The association between longer sleep (≥8 h) and ACM (RR: 1.18, 95% CI:1.12 -1.23, P < 0.001) needs to be interpreted cautiously owing to high heterogeneity (I2 = 86.0%, P < 0.001). CONCLUSION: Interventions and education programs targeting sleep health in the workplace may be warranted, based on our findings that employed individuals who report shorter sleep appear to have a higher risk for ACM and CVDM.

Assessing the validity and reliability and determining cut-points of the Actiwatch 2 in measuring physical activity.

OBJECTIVE: The Actiwatch 2 (AW2) is a wrist-worn accelerometer typically used to measure sleep. Although it can measure physical activity, there is limited evidence supporting its validity. We assessed the validity and reliability of the AW2 to measure sedentary behavior and physical activity (light, moderate, vigorous intensities), and reported their respective count cut-points. APPROACH: Twenty-eight males and 22 females completed a task battery comprising three sedentary tasks and six randomized physical activity tasks at varying intensities, whilst wearing the AW2, a reference accelerometry device (Actigraph GT3X) and a cardiopulmonary gas analyzer on two separate occasions. Validity was assessed using correlations (AW2 counts versus GT3X counts and metabolic equivalent (MET) values), reliability using Bland-Altman analyses, and cut-points were determined using receiver operating characteristic (ROC) area under the curve (AUC) analyses. MAIN RESULTS: AW2 counts were positively correlated with GT3X counts (rho = 0.902, p < 0.001) and METs (rho = 0.900, p < 0.001). AW2-derived counts were comparable across independent assessment periods. Sedentary (AUC = 0.99, cut-point: 256 cpm) and vigorous activity (AUC = 0.95, cut-point: 720 cpm) were strongly characterized, and moderate activity (AUC = 0.66, cut-point: 418 cpm) was weakly characterized. SIGNIFICANCE: The use of the AW2 in physical activity monitoring looks promising for sedentary behavior, moderate and vigorous activity, however, further validation is needed.

Shift Work and Poor Mental Health: A Meta-Analysis of Longitudinal Studies.

Background. Shift work is characterized by employees working outside the standard hours of 7:00 am to 6:00 pm. Because shift work includes night work, the normal sleep-wake cycle (circadian rhythm) is disrupted, with potential consequences for shift workers' physical and mental health.Objectives. To assess the pooled effects of shift work on mental health and to evaluate whether these differ in men and women.Search Methods. We searched PubMed, Scopus, and Web of Science databases for peer-reviewed or government reports published up to August 2018Selection Criteria. To be included, studies had to be longitudinal or case-control studies of shift work exposure associated with adverse mental health outcomes. For subanalyses, we grouped these outcomes as anxiety symptoms, depressive symptoms, or general poor mental health symptoms.Data Collection and Analysis. We followed the Meta-Analysis of Observational Studies in Epidemiology Group guidelines. We extracted adjusted risk estimates for each study to calculate pooled effect sizes (ESs) using random effect models and metaregression analysis to explore sources of heterogeneity.Main Results. We included 7 longitudinal studies, with 28 431 unique participants. Shift work was associated with increased overall risk of adverse mental health outcomes combined (ES = 1.28; 95% confidence interval [CI] = 1.02, 1.62; I2 = 70.6%) and specifically for depressive symptoms (ES = 1.33; 95% CI = 1.02, 1.74; I2 = 31.5%). Gender differences explained more than 90% of heterogeneity, with female shift workers more likely to experience depressive symptoms than female non-shift workers (odds ratio = 1.73; 95% CI = 1.39, 2.14).Authors' Conclusions. To our knowledge, this is the first meta-analysis to investigate the pooled effects of shift work on the risk of poor mental health, including subanalyses by type of poor mental health and gender. Shift workers, particularly women, are at increased risk for poor mental health, particularly depressive symptoms.Public Health Implications. Depression accounts for 4.3% of the global burden of disease and incidence, with mental disorders worldwide predicted to cost US $16.3 million by 2030. With 1 in 5 people in the United States and Europe doing shift work, and the increased risk of poor mental health among shift workers, shift work industries are a priority context for reducing this burden. Workplace health promotion programs and policies are needed to minimize shift workers' risk of poor mental health.

A hard day's night: time use in shift workers.

BACKGROUND: Differences in how shift workers accumulate physical activity (PA) while at work and in leisure time, on days when they are working at night, during the day, or on non-work days, are largely unexplored. The aim of this study was to improve understanding of physical activity patterns in two groups of shift workers, and to measure variations according to their shift schedules. METHODS: This pragmatic pilot study was conducted in two workplaces. Employees in Workplace 1 (n = 10) were required to drive for most of their shift. Workplace 2 was a manufacturing company where most of the employees' (n = 30) occupational tasks were completed while standing. Use of time was assessed using the adult version of the Multimedia Activity Recall for Children and Adults (MARCA) administered by telephone interview. Three MARCA interviews were conducted with each participant, in order to capture a typical profile of a day-shift day, a night-shift day and a non-work day, using a two-day recall for each interview. Participants were asked to wear the activPAL3™ activity monitor, for 7 consecutive days. Paired and independent t-tests were used to compute significant differences between day-shift, night-shift and non-work days within and between workplaces. RESULTS: The total number of days quantified for the MARCA data was 192 days (64 day-shift, 60 night-shift and 68 non-work days). Workplace 2 participants reported more physical activity and less sedentary behaviour on day-shift and night shift days than on non-work days. Time spent in sedentary behaviour was similar on day-shift, night-shift and non-work days in Workplace 1. Workplace 1 participants were more sedentary (p = 0.003) and engaged in more light intensity PA (p = 0.031) on day-shift and night-shift workdays, than those from Workplace 2. Sleep times were lowest on day-shift days. CONCLUSION: As the occupational tasks for participants in Workplace 2 involved physical activities, the findings do not support the conventional view that shift workers are more sedentary than those who only work during the day. Rather occupational tasks appear to be a more important determinant of physical activity patterns both on work and non-work days than varying shift patterns.

Feasibility for the Use of a Standardized Fitness Testing Protocol Among Australian Fitness Industry Professionals.

PURPOSE: There is currently no standardized testing protocol for assessing clients' fitness/health within the Australian fitness industry. This study examined the perceptions of the feasibility of using a standardized testing protocol among Australian fitness industry professionals. METHOD: In 2014, 1,206 registered fitness industry professionals (aged 17-69 years) completed an online survey. Perceived feasibility for using a standardized testing protocol was assessed based on responses to 6 items. Respondents were classified as having a high level of perceived feasibility if they reported all 6 items to be "definitely feasible." A multivariate logistic regression analysis, adjusting for demographic and fitness industry-related factors (e.g., qualification/years of experience), assessed the likelihood of having a high level of perceived feasibility. RESULTS: Overall, 25.5% (95% CI [23.1%, 28.0%]) of the sample perceived the use of a standardized testing protocol as highly feasible. Items ranked most often as "definitely feasible" were "undertaking training to use the protocol" (55%) and "conducting follow-up testing every 6 to 12 weeks" (52%). After adjustment for the effect of confounding factors, casually employed professionals (OR = 0.63; 95% CI [0.45, 0.90]) and group instructors (OR = 0.58; 95% CI [0.41, 0.82]) were less likely to perceive standardized testing protocols as highly feasible. CONCLUSIONS: Among a large sample of Australian fitness industry professionals, slightly more than a quarter perceived using a standardized testing protocol to be highly feasible. Group instructors and casual employees perceived lower feasibility. Further research should determine the barriers to implementing a standardized testing protocol across the fitness industry.

A systematic review of physical activity-based interventions in shift workers.

Shift workers are at increased risk of a range of chronic diseases and there is evidence to suggest that these risks can be ameliorated by physical activity. Little is known however about the efficacy of physical activity interventions in shift workers. The aim was therefore to critically review the literature to improve understanding of the efficacy of physical activity promotion initiatives for this occupational group. A systematic review of randomized controlled trials of physical activity in shift workers was conducted in 2016-2017 following the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Only seven studies were found. None of the studies measured changes in physical activity behaviour or reported on the timing or setting of the intervention protocols. Instead, most focused on health-related outcomes including body composition, fitness and sleep. Almost all provided physical activity 'prescriptions' with walking or 'aerobic activity' as the primary intervention mode and most reported significant improvements in one of the outcome measures. Although the findings suggest that physical activity may mitigate intermediate risk factors associated with non-communicable diseases (NCD) in shift workers, the studies offer little insight into physical activity behaviour change in this occupational group. Future research should assess actual changes in physical activity behaviour, and its determinants, as well as the reach and uptake of intervention strategies in this challenging population group.

Shifting the Physical Inactivity Curve Worldwide by Closing the Gender Gap.

PURPOSE: The aims of this study were to (i) examine gender differences in physical inactivity in countries with different levels of Human Development Index (HDI); and (ii) assess whether small changes in the prevalence of inactivity in women could achieve the World Health Organization's (WHO) global inactivity target. METHODS: Data on inactivity were extracted for 142 countries for the year 2010 from the WHO Data Repository. Data for HDI were obtained for the year 2010 from the United Nations Development Program. Absolute and relative gender differences were calculated for countries according to four HDI categories. The potential effects of increasing women's activity levels on achievement of the WHO physical inactivity target were computed. RESULTS: Overall inactivity prevalence was higher in women (27%) than in men (20%). Women were more inactive than men in all except eight countries. Absolute gender differences [median 7.5% (range -10.1 to 33.2)] did not vary by HDI category, but there was a small negative correlation between relative gender difference in inactivity and HDI (rho -0.19; p = 0.02), which was mostly influenced by three outlier countries with low HDI. A decrease in inactivity levels of 4.8% points among women across the world would achieve the WHO target of reducing global levels of inactivity by 10%. CONCLUSION: Gender differences in the prevalence of physical inactivity were highly variable, both within and across categories of HDI. Interventions which result in small changes in inactivity prevalence in women would achieve the 2025 WHO global target for inactivity, without any change to the prevalence in men.

Which Women are Highly Active Over a 12-Year Period? A Prospective Analysis of Data from the Australian Longitudinal Study on Women's Health.

INTRODUCTION: Current Australian physical activity (PA) guidelines encourage adults to accumulate 150-300 min of moderate to vigorous PA each week. Some critics assert that 300 min is unachievable. OBJECTIVES: The aims of this study were to identify the proportion of younger and mid-aged women who met the 300-min recommendation over a 12-year period, examine how the "highly active" women achieved this level of activity (in terms of walking, moderate activity, and vigorous activity), and to identify the sociodemographic, biological, lifestyle, and work-related determinants of being "highly active". METHODS: Younger (n = 7843) and mid-aged (n = 8043) participants in the Australian Longitudinal Study on Women's Health completed triennial surveys between 2000 and 2013, when their ages were 24.6-36.3 and 52.5-64.5 years, respectively. Self-reported PA was assessed as time spent in walking, moderate activity, and vigorous activity in the previous week; an index of MET.min/week was derived and dichotomized as <1000 MET.min/week (<300 min; not highly active) or ≥1000 MET.min/week (≥300 min; highly active). Generalized estimating equations were used to examine univariable and multivariable associations between a number of sociodemographic, lifestyle, and health variables with PA status (measured at every survey). RESULTS: In the younger cohort, the proportion who were highly active decreased from 40% in 2000 to 31% in 2012. High levels of activity were achieved through a combination of walking (39.1-45.1% of total activity) and vigorous PA (41.8-47.7%). In the mid-age cohort, the proportion of women who were highly active increased from 32% in 2001 to 47% in 2013; this was achieved predominantly through walking (55.8-59.7%). In multi-variable models, the highest odds for being in the high PA category (odds ratios [ORs] ≥ 1.20; p < 0.001) were for younger women who were single, those who worked long full-time hours, those who drank any quantity of alcohol, and those who sat for less than 8 h/day. In the mid-age cohort, the highest odds for being in the high PA category (ORs ≥1.20; p < 0.001) were for women with post-school education, those who were retired, those who were low-risk drinkers (compared with non-drinkers), those who sat for less than 8 h/day, and those with lower levels of stress. DISCUSSION: Our findings clearly indicate that the upper limit of the Australian PA guidelines is achievable for large numbers of women. Factors associated with being highly active were different for younger and mid-age women, but healthy weight, high education, and paid work (full-time in the younger women, part-time in mid-age) were common characteristics of highly active women in both cohorts.

Sitting Time, Physical Activity and Sleep by Work Type and Pattern-The Australian Longitudinal Study on Women's Health.

Data from the Australian Longitudinal Study on Women's Health were used to examine how work was associated with time spent sleeping, sitting and in physical activity (PA), in working women. Young (31-36 years; 2009) and mid-aged (59-64 years; 2010) women reported sleep (categorised as shorter ≤6 h/day and longer ≥8 h/day) and sitting time (work, transport, television, non-work computer, and other; summed for total sitting time) on the most recent work and non-work day; and moderate and vigorous PA (categorised as meeting/not meeting guidelines) in the previous week. Participants reported occupation (manager/professional; clerical/sales; trades/transport/labourer), work hours (part-time; full-time) and work pattern (shift/night; not shift/night). The odds of shorter sleep on work days was higher in both cohorts for women who worked shift or night hours. Longer sitting time on work days, made up primarily of sitting for work, was found for managers/professionals, clerical/sales and full-time workers. In the young cohort, clerical/sales workers and in the mid-aged cohort, full-time workers were less likely to meet PA guidelines. These results suggest multiple behaviour interventions tailored to work patterns and occupational category may be useful to improve the sleep, sitting and activity of working women.

Construct Validity of the Neighborhood Environment Walkability Scale for Africa.

PURPOSE: The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity-related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries. METHODS: NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18-85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. RESULTS: The overall "walkability" index had a positive relationship with both walking for transportation (η = 0.020, P = 0.005) and recreation (η = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η = 0.020, P = 0.006 and η = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η = 0.016, P = 0.015), road/path connectivity (η = 0.025, P = 0.002), path infrastructure (η = 0.021, P = 0.005), and overall places for walking and cycling (η = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda. CONCLUSIONS: Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.

The economic burden of physical inactivity: a global analysis of major non-communicable diseases.

BACKGROUND: The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide. METHODS: Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality. FINDINGS: Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates. INTERPRETATION: In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases. FUNDING: None.