Muscle-Strengthening Exercise Questionnaire (MSEQ): an assessment of concurrent validity and test-retest reliability.

OBJECTIVES: Muscle-strengthening exercise (MSE) has multiple independent health benefits and is a component of global physical activity guidelines. However, the assessment of MSE in health surveillance is often limited to the constructs of frequency (days/week), with little focus on constructs such as MSE type, muscle groups targeted and intensity. This study describes the test-retest reliability and concurrent validity of the Muscle-Strengthening Exercise Questionnaire (MSEQ), which was developed to assess multiple MSE participation constructs. METHODS: The MSEQ was developed to assess the weekly frequency, session duration and intensity, types of MSE (eg, weight machines, bodyweight exercise) and muscle groups targeted. Two convenience samples of adult participants were recruited. Test-retest reliability was completed online by 85 participants. Concurrent validity was assessed for 54 participants using an online 7-day MSE log. RESULTS: The MSEQ shows high test-retest reliability for frequency, duration and level of intensity for each of the four MSE types (using weight machines, bodyweight exercises, resistance exercises and holistic exercises), and for the four types combined (ρ range 0.76-0.91). For muscle groups targeted, the reliability ranged mostly from moderate-to-substantial for each of the four MSE types (κ range 0.44-0.78) and fair-to-moderate for the four types combined (κ range 0.35-0.51). Concurrent validity for frequency, duration and level of intensity for each of the four MSE types, and the four types combined, was moderate-to-high (ρ range 0.30-0.77). CONCLUSION: The MSEQ shows acceptable reliability and validity for four key MSE constructs. This new MSEQ survey instrument could be used to assess adults' MSE.

Smartphone-Delivered Ecological Momentary Interventions Based on Ecological Momentary Assessments to Promote Health Behaviors: Systematic Review and Adapted Checklist for Reporting Ecological Momentary Assessment and Intervention Studies.

BACKGROUND: Healthy behaviors are crucial for maintaining a person's health and well-being. The effects of health behavior interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can use real-time user reports (ecological momentary assessments [EMAs]) to trigger appropriate support when needed in daily life. OBJECTIVE: This systematic review aims to assess the characteristics of smartphone-delivered EMIs using self-reported EMAs in relation to their effects on health behaviors, user engagement, and user perspectives. METHODS: We searched MEDLINE, Embase, PsycINFO, and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMAs delivered through smartphone apps to promote health behaviors in any health domain. Studies were independently screened. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. We performed a narrative synthesis of intervention effects, user perspectives and engagement, and intervention design and characteristics. Quality appraisal was conducted for all included studies. RESULTS: We included 19 papers describing 17 unique studies and comprising 652 participants. Most studies were quasi-experimental (13/17, 76%), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (8/17, 47%), followed by substance abuse (3/17, 18%), diet, weight loss, physical activity (4/17, 24%), and smoking (2/17, 12%). Of the 17 studies, the 4 (24%) included randomized controlled trials reported nonstatistically significant effects on health behaviors, and 4 (24%) quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<.001) and psychotic symptoms (P=.03), drinking frequency (P<.001), and eating patterns (P=.01). EMA was commonly used to capture subjective experiences as well as behaviors, whereas sensors were rarely used. Generally, users perceived EMIs to be helpful. Common suggestions for improvement included enhancing personalization, multimedia and interactive capabilities (eg, voice recording), and lowering the EMA reporting burden. EMI and EMA components were rarely reported and were not described in a standardized manner across studies, hampering progress in this field. A reporting checklist was developed to facilitate the interpretation and comparison of findings and enhance the transparency and replicability of future studies using EMAs and EMIs. CONCLUSIONS: The use of smartphone-delivered EMIs using self-reported EMAs to promote behavior change is an emerging area of research, with few studies evaluating efficacy. Such interventions could present an opportunity to enhance health but need further assessment in larger participant cohorts and well-designed evaluations following reporting checklists. Future research should explore combining self-reported EMAs of subjective experiences with objective data passively collected via sensors to promote personalization while minimizing user burden, as well as explore different EMA data collection methods (eg, chatbots). TRIAL REGISTRATION: PROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739.

Assessment of muscle-strengthening exercise in public health surveillance for adults: A systematic review.

There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, sit-ups) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (≥2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n = 1140 in full-text) against specific inclusion criteria (adults aged ≥18 years, English, studies containing <1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular 'yes' vs 'no' response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.

The epidemiology of muscle-strengthening exercise in Europe: A 28-country comparison including 280,605 adults.

OBJECTIVE: Muscle-strengthening exercise (use of weight machines, free weights, push-ups, sit-ups), has multiple independent health benefits, and is a component of the Global physical activity guidelines. However, there is currently a lack of multi-country muscle-strengthening exercise prevalence studies. This study describes the prevalence and correlates of muscle-strengthening exercise across multiple European countries. METHODS: Data were drawn from the European Health Interview Survey Wave 2 (2013-14), which included nationally representative samples (n = 3,774-24,016) from 28 European countries. Muscle-strengthening exercise was assessed using the European Health Interview Survey Physical Activity Questionnaire. Population-weighted proportions were calculated for (1) "insufficient" (0-1 days/week) or (2) "sufficient" muscle-strengthening exercise (≥2 days/week). Prevalence ratios were calculated using multivariate Poisson regression for those reporting sufficient muscle-strengthening by country and by sociodemographic/lifestyle characteristics (sex, age, education, income, self-rated health etc.). RESULTS: Data were available for 280,605 European adults aged ≥18 years. Overall, 17.3% (95% CI = 17.1%-17.5%) reported sufficient muscle-strengthening exercise (≥2 days/week). Muscle-strengthening exercise was geographically patterned with the lowest prevalence reported in South-eastern European countries (Romania, Malta and Cyprus: range: 0.7%-7.4%), and the highest prevalence in the Nordic countries (Iceland, Sweden, and Denmark: range: 34.1%-51.6%). Older age, insufficient aerobic activity, poorer self-rated health, lower income/education, being female, and being overweight/obese were significantly associated with lower likelihood of reporting sufficient muscle-strengthening exercise, independently of other characteristics. CONCLUSIONS: Most European adults do not report sufficient muscle-strengthening exercise, and prevalence estimates varied considerably across countries. Low participation in muscle-strengthening exercise is widespread across Europe, and warrants public health attention.

Who Uses Action Planning in a Web-Based Computer-Tailored Intervention to Reduce Workplace Sitting and What do Action Plans Look Like? Analyses of the Start to stand Intervention among Flemish Employees.

BACKGROUND: Action planning plays an important role in many web-based behaviour change interventions. As such, it is important to identify who engages in action planning and what action plans look like. This study examines (1) attributes of users creating an action plan and (2) the content of action plans made during a web-based intervention to reduce workplace sitting. METHODS: Users answered "what" (short standing breaks and/or longer periods of standing), "when" (working hours, work breaks, commuting), "where" (workplace, transport mode), and "how" (frequency, duration, implementation intentions) questions. MANOVA and chi-squared tests were conducted to compare those creating an action plan with those who did not. Descriptive statistics were used to examine the content of the action plans. RESULTS: Those creating an action plan (n = 236/1,701) were significantly older, more sedentary at work, and more aware of health risks related to excessive sitting compared to those not planning (n = 1,465). The majority planned standing breaks (n = 212) every 30 minutes, and periods of standing (n = 173) for 1 to 2 hours. CONCLUSIONS: Future interventions should promote action planning more, especially among younger employees and those with less health-related knowledge about sitting. Action plans were compatible with current sitting messages used in health promotion.

What factors explain socioeconomic inequalities in adults' television-related sitting time?

BACKGROUND: There are considerable socioeconomic inequalities in television-related sitting time, but there is little evidence for the explanatory mechanisms. We used a cohort of Belgian adults (25-60 years) and older adults (≥65 years) to examine the social cognitive, home environmental and health-related factors contributing to socioeconomic differences in television-related sitting. METHODS: We included 301 adults and 258 older adults (total n = 559). Linear regression analyses were used to examine the associations of education and occupational status with television-related sitting time, adjusted for age and gender. We assessed the explanatory power of social cognitive, home environmental and health-related factors using the traditional 'change-in-estimation method'. RESULTS: Those with low and medium education, respectively, engaged in 54 and 28 minutes per day more television-related sitting time than those with high education. We found no association between occupational status and television-related sitting time. Social cognitive factors explained 54% of the difference in television-related sitting time between those with low and high education, while home environmental factors only explained 6%, and health-related variables explained 10% of these differences. CONCLUSION: We found no occupational inequalities in television-related sitting time. Social cognitive variables such as attitude and modelling of the partner explained a large part of the educational inequalities in television-related sitting time. If confirmed by future studies, a focus on social cognition may help reduce sedentary behaviours in low-educated adults and diminish inequalities in sedentary behaviours.

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

BACKGROUND: The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. METHODS: Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. RESULTS: Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. CONCLUSIONS: Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

Cross-Sectional Associations between Home Environmental Factors and Domain-Specific Sedentary Behaviors in Adults: The Moderating Role of Socio-Demographic Variables and BMI.

Despite the negative health effects of too much sitting, the majority of adults are too sedentary. To develop effective interventions, insight is needed into home environmental correlates of adults' sedentary behaviors, and into the susceptibility of population subgroups to these home environmental cues. In total, 559 Flemish adults reported socio-demographics, weight and height, home environmental factors and domain-specific sedentary behaviors. Generalized linear modeling was conducted to examine main associations between home environmental factors and domain-specific sedentary behaviors, and to test the moderating role of socio-demographics and BMI on these associations. In case of significant interactions, stratified analyses were performed. Results showed that, among those who did use a computer/laptop during the last week, a one-unit increase in the number of computers or laptops was associated with 17% (OR = 1.17; 95% CI = 1.02, 1.34) and 24% (OR = 1.24; 95% CI = 1.08, 1.43) more minutes computer time per day, respectively. The proximity of the remote controller (p < 0.001) and the number of televisions (p = 0.03) were positively associated with television time, and the number of motorized vehicles (95% CI = 0.001, 0.12) was positively associated with the odds of participation in transport-related sitting time. The latter two associations were moderated by BMI, with significant positive associations limited to those not overweight. To conclude, home environmental factors were associated with domain-specific sedentary behaviors, especially in healthy weight adults. If confirmed by longitudinal studies, public health professionals should encourage adults to limit the number of indoor entertainment devices and motorized vehicles.

Objectively measured physical environmental neighbourhood factors are not associated with accelerometer-determined total sedentary time in adults.

BACKGROUND: The physical neighbourhood environment may influence adults' sedentary behaviour. Yet, most studies examining the association between the physical neighbourhood environment and sedentary behaviour rely on self-reported data of either the physical neighbourhood environment and/or sedentary behaviour. The aim of this study was to investigate the associations between objectively measured physical environmental neighbourhood factors and accelerometer-determined total sedentary time in adults. METHODS: In total, 219 Dutch and 128 Belgian adults (mean age ± SD: 55.8 ± 15.4 years) were recruited between March and August 2014 as part of the European SPOTLIGHT project. Physical environmental neighbourhood factors, grouped into eight domains, i.e. walking, cycling, public transport, aesthetics, land use mix, grocery stores, food outlets and recreational facilities, were assessed using the SPOTLIGHT Virtual Audit Tool. Sedentary time was collected using ActiGraph GT3X+ accelerometers. General linear mixed models were conducted to examine associations between physical environmental neighbourhood factors and total sedentary time. RESULTS: Participants were sedentary, on average, for 542.9 min/day (SD: 84.3), or 9.1 h/day. None of the examined physical environmental neighbourhood factors were significantly related to total sedentary time. CONCLUSIONS: Our findings do not support associations of objectively measured physical environmental neighbourhood factors with adults' objectively sedentary time in Dutch and Belgian adults. More research on sedentary behaviours in settings such as the home and work setting is needed to examine the influence of more specific physical environmental factors on these context-specific sedentary behaviours.

What are the working mechanisms of a web-based workplace sitting intervention targeting psychosocial factors and action planning?

BACKGROUND: Office workers demonstrate high levels of sitting on workdays. As sitting is positively associated with adverse health risks in adults, a theory-driven web-based computer-tailored intervention to influence workplace sitting, named 'Start to Stand,' was developed. The intervention was found to be effective in reducing self-reported workplace sitting among Flemish employees. The aim of this study was to investigate through which mechanisms the web-based computer-tailored intervention influenced self-reported workplace sitting. METHODS: Employees (n = 155) participated in a clustered randomised controlled trial and reported socio-demographics (age, gender, education), work-related (hours at work, employment duration), health-related (weight and height, workplace sitting and physical activity) and psychosocial (knowledge, attitudes, self-efficacy, social support, intention regarding (changing) sitting behaviours) variables at baseline and 1-month follow-up. The product-of-coefficients test of MacKinnon based on multiple linear regression analyses was conducted to examine the mediating role of five psychosocial factors (knowledge, attitudes, self-efficacy, social support, intention). The influence of one self-regulation skill (action planning) in the association between the intervention and self-reported workplace sitting time was investigated via moderation analyses. RESULTS: The intervention had a positive influence on knowledge (p = 0.040), but none of the psychosocial variables did mediate the intervention effect on self-reported workplace sitting. Action planning was found to be a significant moderator (p < 0.001) as the decrease in self-reported workplace sitting only occurred in the group completing an action plan. CONCLUSIONS: Future interventions aimed at reducing employees' workplace sitting are suggested to focus on self-regulatory skills and promote action planning when using web-based computer-tailored advice. TRIAL REGISTRATION: Clinicaltrials.gov NCT02672215 ; (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02672215 ).

Socio-Ecological Variables Associated with Context-Specific Sitting Time in Belgian Older Adults: A One-Year Follow-Up Study.

INTRODUCTION: Knowledge about variables associated with context-specific sitting time in older adults is limited. Therefore, this study explored cross-sectional and longitudinal associations of socio-demographic, social-cognitive, physical-environmental and health-related variables with sitting during TV viewing, computer use and motorized transport in older adults. METHODS: A sample of Belgian older adults completed structured interviews on context-specific sitting time and associated variables using a longitudinal study design. Objective measurements of grip strength and physical performance were also completed. Complete baseline data were available of 258 participants (73.98±6.16 years) of which 229 participants remained in the study at one year follow-up (retention rate: 91.60%). Cross-sectional correlates (baseline data) and longitudinal predictors (change-scores in relation with change in sitting time) were explored through multiple linear regression analyses. RESULTS: Per context-specific sitting time, most of the cross-sectional correlates differed from the longitudinal predictors. Increases over time in enjoyment of watching TV (+one unit), encouragement of partner to watch less TV (+one unit) and TV time of partner (+30.0 min/day) were associated with respectively 9.1 min/day (p<0.001), 16.0 min/day (p<0.001) and 12.0 min/day (p<0.001) more sitting during TV viewing at follow-up. Increases over time in enjoyment of using a computer (+one unit), the number of smartphones and tablets (+1) and computer use of the partner (+30.0 min/day) were associated with respectively 5.5 min/day (p < .01), 10.4 min/day (p < .05) and 3.0 min/day (p < .05) more sitting during computer use at follow-up. An increase over time in self-efficacy regarding taking a bicycle or walking was associated with 2.9 min/day (p < .05) less sitting during motorized transport at follow-up. CONCLUSIONS: The results stressed the importance of looking at separate contexts of sitting. Further, the results highlighted the importance of longitudinal research in order to reveal which changes in particular variables predicted changes in context-specific sitting time. Variables at the social-cognitive level were most frequently related to context-specific sitting.

Socio-Demographic, Social-Cognitive, Health-Related and Physical Environmental Variables Associated with Context-Specific Sitting Time in Belgian Adolescents: A One-Year Follow-Up Study.

INTRODUCTION: More knowledge is warranted about multilevel ecological variables associated with context-specific sitting time among adolescents. The present study explored cross-sectional and longitudinal associations of ecological domains of sedentary behaviour, including socio-demographic, social-cognitive, health-related and physical-environmental variables with sitting during TV viewing, computer use, electronic gaming and motorized transport among adolescents. METHODS: For this longitudinal study, a sample of Belgian adolescents completed questionnaires at school on context-specific sitting time and associated ecological variables. At baseline, complete data were gathered from 513 adolescents (15.0±1.7 years). At one-year follow-up, complete data of 340 participants were available (retention rate: 66.3%). Multilevel linear regression analyses were conducted to explore cross-sectional correlates (baseline variables) and longitudinal predictors (change scores variables) of context-specific sitting time. RESULTS: Social-cognitive correlates/predictors were most frequently associated with context-specific sitting time. Longitudinal analyses revealed that increases over time in considering it pleasant to watch TV (p < .001), in perceiving TV watching as a way to relax (p < .05), in TV time of parents/care givers (p < .01) and in TV time of siblings (p < .001) were associated with more sitting during TV viewing at follow-up. Increases over time in considering it pleasant to use a computer in leisure time (p < .01) and in the computer time of siblings (p < .001) were associated with more sitting during computer use at follow-up. None of the changes in potential predictors were significantly related to changes in sitting during motorized transport or during electronic gaming. CONCLUSIONS: Future intervention studies aiming to decrease TV viewing and computer use should acknowledge the importance of the behaviour of siblings and the pleasure adolescents experience during these screen-related behaviours. In addition, more time parents or care givers spent sitting may lead to more sitting during TV viewing of the adolescents, so that a family-based approach may be preferable for interventions. Experimental study designs are warranted to confirm the present findings.

Physical Environmental Correlates of Domain-Specific Sedentary Behaviours across Five European Regions (the SPOTLIGHT Project).

BACKGROUND: The relation between neighbourhood environmental factors and domain-specific sedentary behaviours among adults remains unclear. This study firstly aims to examine the association of perceived and objectively measured neighbourhood safety, aesthetics, destinations and functionality with transport-related, work-related and leisure-time sedentary behaviour. Secondly, the study aims to assess whether these associations are moderated by age, gender or educational level. METHODS: In 60 randomly sampled neighbourhoods from 5 urban regions in Europe (Ghent and suburbs, Paris and inner suburbs, Budapest and suburbs, the Randstad, and Greater London), a virtual audit with Google Street View was performed to assess environmental characteristics. A total of 5,205 adult inhabitants of these neighbourhoods reported socio-demographic characteristics, sedentary behaviours, and neighbourhood perceptions in an online survey. Generalized linear mixed models were conducted to examine associations between physical environmental neighbourhood factors and sedentary behaviours. Interaction terms were added to test the moderating role of individual-level socio-demographic variables. RESULTS: Lower levels of leisure-time sedentary behaviour (i.e. all leisure activities except television viewing and computer use) were observed among adults who perceived greater numbers of destinations such as supermarkets, recreational facilities, or restaurants in their neighbourhood, and among adults who lived in a neighbourhood with more objectively measured aesthetic features, such as trees, water areas or public parks. Lower levels of work-related sedentary behaviour were observed among adults who perceived less aesthetic features in their neighbourhood, and among adults who lived in a neighbourhood with less objectively measured destinations. Both age, gender and educational level moderated the associations between neighbourhood environmental factors and sedentary behaviours. CONCLUSION: Preliminary evidence was found for associations between neighbourhood environmental factors and domain-specific sedentary behaviours among adults. However, these associations varied according to objective or subjective environmental measures. More research is needed to confirm and clarify the associations.

Mediating role of energy-balance related behaviors in the association of neighborhood socio-economic status and residential area density with BMI: The SPOTLIGHT study.

OBJECTIVES: This study aimed to examine the mediating effects of energy-balance related behaviors on the association of neighborhood socio-economic status (SES) and neighborhood residential area density (RAD) with body mass index (BMI). METHODS: In total, 6037 adults from four neighborhood types (high SES/high RAD, high SES/low RAD, low SES/high RAD, and low SES/low RAD) in five Mid-European urban regions completed an online survey asking about their energy-balance related behaviors (physical activity [PA], sedentary behavior, and dietary behavior), determinants of these behaviors and their body weight and height. MacKinnon's product-of-coefficients test was used to assess mediating effects. RESULTS: Transport-related PA, leisure-time PA and vegetable intake seemed to mediate the association between neighborhood type and BMI. Residents from low SES/low RAD neighborhoods reported less transport-related PA, less leisure-time PA and less vegetable intake than high SES/high RAD residents, and these behaviors (i.e. transport-related PA, leisure-time PA and vegetable intake) were related to having a higher BMI. CONCLUSION: The association between neighborhood type and BMI can be explained, at least in part, by energy-balance related behaviors.

Do sedentary behaviors mediate associations between socio-demographic characteristics and BMI in women living in socio-economically disadvantaged neighborhoods?

BACKGROUND: Women living in deprived neighborhoods are a risk group for overweight and obesity, particularly during the childbearing years. Several socio-demographic characteristics may compound this risk, but little is known about why this might be the case. Sedentary behaviors are emerging as a socio-demographically patterned risk factor for obesity. The purpose of the present study was to assess socio-demographic differences in sedentary behaviors, and to examine whether these behaviors could explain the relation between socio-demographic variables and BMI (BMI) in this risk group. METHODS: Women aged 18-46 years were recruited from 40 urban and 40 rural deprived neighborhoods in Victoria, Australia. In total, 3879 women reported socio-demographic variables (age, educational level, employment status, marital status, number of children, residential location and country of birth), sedentary behaviors (television time, computer time, total screen time and total sedentary time), physical activity, and height and weight, which were used to calculate BMI. For each socio-demographic variable, four single mediation models were conducted using two-level mixed-models regression analyses. Mediating effects were examined using the MacKinnon product-of-coefficients procedure and the Sobel test. RESULTS: All socio-demographic variables were significantly associated with sedentary behaviors. Single mediation analyses revealed that television time (αß = 0.017, 95% CI = 0.000, 0.030) and total screen time (αß = 0.006, 95% CI = 0.000, 0.012) mediated 14.1% and 4.9% of the relationship between educational level and BMI, respectively. Total screen time mediated 45.1% of the relationship between employment status and BMI (αß = -0.020, 95% CI = -0.033, -0.006), and television time mediated 8.2% of the relationship between country of birth and BMI (αß = -0.008, 95% CI = -0.016, -0.001). CONCLUSION: Sedentary behaviors differed depending on socio-demographic characteristics, and partly explained the relationship between socio-demographic factors and BMI in this sample of women. Both television time and total screen time are potential behaviors to target in future programs aimed at reducing socio-demographic disparities in overweight and obesity.

Acceptability and feasibility of potential intervention strategies for influencing sedentary time at work: focus group interviews in executives and employees.

BACKGROUND: Occupational sitting can be the largest contributor to overall daily sitting time in white-collar workers. With adverse health effects in adults, intervention strategies to influence sedentary time on a working day are needed. Therefore, the present aim was to examine employees' and executives' reflections on occupational sitting and to examine the potential acceptability and feasibility of intervention strategies to reduce and interrupt sedentary time on a working day. METHODS: Seven focus groups (four among employees, n = 34; three among executives, n = 21) were conducted in a convenience sample of three different companies in Flanders (Belgium), using a semi-structured questioning route in five themes [personal sitting patterns; intervention strategies during working hours, (lunch) breaks, commuting; and intervention approach]. The audiotaped interviews were verbatim transcribed, followed by a qualitative inductive content analysis in NVivo 10. RESULTS: The majority of participants recognized they spend their working day mostly sitting and associated this mainly with musculoskeletal health problems. Participants suggested a variety of possible strategies, primarily for working hours (standing during phone calls/meetings, PC reminders, increasing bathroom use by drinking more water, active sitting furniture, standing desks, rearranging the office) and (lunch) breaks (physical activity, movement breaks, standing tables). However, several barriers were reported, including productivity concerns, impracticality, awkwardness of standing, and the habitual nature of sitting. Facilitating factors were raising awareness, providing alternatives for simply standing, making some strategies obligatory and workers taking some personal responsibility. CONCLUSIONS: There are some strategies targeting sedentary time on a working day that are perceived to be realistic and useful. However several barriers emerged, which future trials and practical initiatives should take into account.

Understanding occupational sitting: prevalence, correlates and moderating effects in Australian employees.

OBJECTIVE: To (1) compare occupational sitting between different socio-demographic, health-related, work-related and psychosocial categories, (2) identity socio-demographic, health-related, work-related and psychosocial correlates of occupational sitting, and (3) examine the moderating effect of work-related factors in the relation between correlates and occupational sitting. METHODS: Randomly-selected Australian adults completed a web-based survey assessing socio-demographic (country of birth, gender, age, education, income), health-related (general health, weight, physical activity), work-related (employment status, occupational task, occupational classification) and sedentary-specific psychosocial (social norm, social support, self-efficacy, control, advantages, disadvantage, intention) factors, and occupational sitting-time. t-tests, ANOVAs and multiple linear regression analyses were conducted (in 2013) on a sample of employees (n=993). RESULTS: Respondents sat on average for 3.75 (SD=2.45) h/day during work. Investigated correlates explained 41% of the variance in occupational sitting. More occupational sitting was associated with being male, being younger, higher education and income, part-time and full-time employment, sedentary job tasks, white-collar/professional occupations, higher BMI, and perceiving more advantages of sitting less at work. Employment status and occupational classification moderated the association between control to sit less and occupational sitting. A lack of control to sit less was associated with higher occupational sitting in part-time and full-time workers, but not in casual workers; and in white-collar and professional workers, but not in blue-collar workers. CONCLUSIONS: Most important contributors to occupational sitting were work-related and socio-demographic correlates. More research is needed to confirm present results.

Evaluation of a real world intervention using professional football players to promote a healthy diet and physical activity in children and adolescents from a lower socio-economic background: a controlled pretest-posttest design.

BACKGROUND: The increasing rates of obesity among children and adolescents, especially in those from lower socio-economic backgrounds, emphasise the need for interventions promoting a healthy diet and physical activity. The present study aimed to examine the effectiveness of the 'Health Scores!' program, which combined professional football player role models with a school-based program to promote a healthy diet and physical activity to socially vulnerable children and adolescents. METHODS: The intervention was implemented in two settings: professional football clubs and schools. Socially vulnerable children and adolescents (n = 165 intervention group, n = 440 control group, aged 10-14 year) provided self-reported data on dietary habits and physical activity before and after the four-month intervention. Intervention effects were evaluated using repeated measures analysis of variance. In addition, a process evaluation was conducted. RESULTS: No intervention effects were found for several dietary behaviours, including consumption of breakfast, fruit, soft drinks or sweet and savoury snacks. Positive intervention effects were found for self-efficacy for having a daily breakfast (p < 0.01), positive attitude towards vegetables consumption (p < 0.01) and towards lower soft drink consumption (p < 0.001). A trend towards significance (p < 0.10) was found for self-efficacy for reaching the physical activity guidelines. For sports participation no significant intervention effect was found. In total, 92 pupils completed the process evaluation, the feedback was largely positive. CONCLUSIONS: The 'Health Scores!' intervention was successful in increasing psychosocial correlates of a healthy diet and PA. The use of professional football players as a credible source for health promotion was appealing to socially vulnerable children and adolescents.

Educational inequalities in TV viewing among older adults: a mediation analysis of ecological factors.

BACKGROUND: Television (TV) viewing, a prevalent leisure-time sedentary behaviour independently related to negative health outcomes, appears to be higher in less educated and older adults. In order to tackle the social inequalities, evidence is needed about the underlying mechanisms of the association between education and TV viewing. The present purpose was to examine the potential mediating role of personal, social and physical environmental factors in the relationship between education and TV viewing among Australian 55-65 year-old adults. METHODS: In 2010, self-reported data was collected among 4082 adults (47.6% men) across urban and rural areas of Victoria, for the Wellbeing, Eating and Exercise for a Long Life (WELL) study. The mediating role of personal (body mass index [BMI], quality of life), social (social support from family and friends, social participation at proximal level, and interpersonal trust, social cohesion, personal safety at distal level) and physical environmental (neighbourhood aesthetics, neighbourhood physical activity environment, number of televisions) factors in the association between education and TV viewing time was examined using the product-of-coefficients test of MacKinnon based on multilevel linear regression analyses (conducted in 2012). RESULTS: Multiple mediating analyses showed that BMI (p ≤ 0.01), personal safety (p < 0.001), neighbourhood aesthetics (p ≤ 0.01) and number of televisions (p ≤ 0.01) partly explained the educational inequalities in older adult's TV viewing. No proximal social factors mediated the education-TV viewing association. CONCLUSIONS: Interventions aimed to reduce TV viewing should focus on personal (BMI) and environmental (personal safety, neighbourhood aesthetics, number of televisions) factors, in order to overcome educational inequalities in sedentary behaviour among older adults.

'10 000 Steps Flanders': evaluation of the state-wide dissemination of a physical activity intervention in Flanders.

The aim of the study was to evaluate the impact of the state-wide dissemination of a physical activity (PA) intervention in Flanders. In 2011, a random sample was taken of the entire adult (25-75 years) population of Flanders. Data of the Flemish sample were compared with baseline data of the intervention and control group of '10 000 Steps Ghent' (2005). In total, data of the International Physical Activity Questionnaire were available of 2556 respondents (1675 of the comparison sample and 881 of the Flemish sample). Pedometer data were obtained by 269 respondents of the Flemish sample and by 1236 respondents of the comparison sample. Compared with the comparison sample of 2005, the Flemish sample reported more walking (P < 0.001), moderate (P < 0.001), vigorous (P < 0.001), work-related (P < 0.001), leisure time (P = 0.01) and household PA (P = 0.03). Step count analyses revealed that the Flemish sample took more pedometer-based daily step counts (P < 0.001) than the comparison sample. Furthermore, a higher proportion of respondents reaching the 10 000 steps/day goal (P = 0.005) was found in the Flemish sample. A positive effect of '10 000 Steps Flanders' was found. Results indicate that a state-wide approach based on socio-ecological models is an effective strategy to promote PA in a large population.