Physical activity, screen time and dietary behaviours in New Zealand adolescents prior to and following the onset of the COVID-19 pandemic.

BACKGROUND: Insufficient physical activity, high screen time, and unhealthy dietary patterns among adolescents may have worsened during the pandemic, but data are lacking. This study compared physical activity, screen time and fruit and vegetable intake in adolescents from Dunedin, New Zealand, 5-6 years before (Study 1) and during (Study 2) the COVID-19 pandemic. METHODS: Adolescents completed an online survey as part of the Built Environment and Active Transport to School (BEATS) studies in 2014/2015 (Study 1; n = 1,266; age: 15.3 ± 1.4 years; 54.6% female) and 2021/2022 (Study 2; n = 819; age: 15.2 ± 1.4 years; 47.4% female). The proportion of adolescents meeting guidelines for physical activity (≥ 60 min/day of moderate-to-vigorous physical activity), outside school screen time (≤ 2 h/day) and fruit and vegetable intake (> 1 serving/day for both fruit and vegetables) was calculated. Data were analysed using multivariable linear and logistic regression modelling. RESULTS: Few adolescents met recommended health behaviour guidelines. Compared to Study 1, significantly greater proportions of adolescents at Study 2 met guidelines for physical activity (16.7% vs. 23.1%; p < 0.001) and outside school screen time (13.3% vs. 18.3%; p < 0.001) while fruit and vegetable intake was not different (29.6% vs. 27.0%; p = 0.322). Compared to Study 1, average outside school screen time at Study 2 was lower on both weekdays (5.0 ± 2.9 vs. 4.6 ± 2.9; p < 0.001) and weekend days (6.9 ± 3.5 vs. 6.1 ± 3.6 h/day; p < 0.001). Reported frequency of consuming sweets was higher and soft drinks lower at Study 2 versus Study 1. CONCLUSIONS: Despite observed higher levels of physical activity and lower levels of outside school screen time during the pandemic compared to the pre-pandemic levels, few adolescents met health behaviour guidelines at both time points. Therefore, comprehensive health promotion that aims to improve physical activity levels, screen time and dietary patterns for adolescents is still necessary to prevent chronic health conditions adulthood.

Temporal relationships in the movement behaviour of adolescents: Testing and methodological considerations of the ActivityStat hypothesis.

The study aimed to investigate the ActivityStat hypothesis by examining the presence and the timeframe of the temporal relationships among physical activity (PA) levels and stationary time (ST) in adolescents. A secondary analysis was performed on data involving 356 adolescents in Dunedin, New Zealand. Participants wore a waist-worn accelerometer for several consecutive days to assess PA levels [i.e. light PA (LPA), and moderate-to-vigorous PA (MVPA)] and ST. Bayesian continuous-time structural equation modelling (CT-SEM) was used to examine the relationship between the behaviours over time and the timeframe during which these relationships occur. Increases in LPA, MVPA, and ST were positively associated with their later behaviours until 2.5, 1.7, and 2 days later, respectively. A cross-behavioural reciprocal and negative relationship between LPA and ST was demonstrated 0.4 days later. A positive relationship between ST and MVPA was observed until about 0.4 days later. This is the first study to investigate the ActivityStat hypothesis using Bayesian CT-SEM in adolescents, examining the multivariate relationships among different behaviours and the associated timeframes. To conclude, evidence of activity synergy was suggested for the within-behavioural relationships, while behavioural compensation was noted for ST. Thus, the findings provide some support for the ActivityStat hypothesis in adolescents.

Results from Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth: A call to address inequities in health-promoting activities.

Background: This article reports the methods and findings for Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth indicators, and on inequities within these indicators. Methods: Grades were assigned to indicators using the Active Healthy Kids Global Alliance criteria depending on data availability, and inequities reported based on gender, ethnicity, disability status, area-level socioeconomic deprivation, urbanicity, and school year. Two additional indicators were included in this report card: Sleep, and Physical literacy. Results: Grades were assigned to indicators as follows: Overall physical activity: C+, Organised sport and physical activity: B-, Physical literacy: B, Active transportation: D, Sedentary behaviours: C-, Sleep: B+, Whanau (family) and peers: D, School: C+, Government: A. Inequities across all socio-demographic variables were observed. An 'inconclusive' grade was assigned to the Active play, Physical fitness, and Community and Environment indicators due to insufficient data. Conclusion: It is imperative that targeted, comprehensive, and population-specific approaches are implemented to support health-promoting physical activity behaviours and reduce inequities among children and youth in Aotearoa. There is a need to promote all dimensions of physical activity (overall activity, active play, recreation, organised sport, active transportation) and the reduction of screen time through policy, research, evidence-based social marketing campaigns, and urban design. Regular, nationally representative surveys that enable the consistent and regular measurement of key Report Card indicators are needed.

Active commuting to school among 36,781 Spanish children and adolescents: A temporal trend study.

This study examines trends in the rates of active commuting to school (ACS) in Spanish children (n = 18 343; 8.93 ± 1.68) and adolescents (n = 18 438; 14.11 ± 1.58) aged 6-18 years from 2010 to 2017. Given the study period included the economic crisis in Spain (2008-2013), the second aim of this study was to compare ACS rates during and after the economic crisis. Data were obtained from 28 studies conducted across Spain. The overall trends in ACS were evaluated using multilevel logistic regression analysis. Among Spanish children and adolescents, the rates of ACS to school ranged around 60% between 2010 and 2017. The rates of ACS in Spanish youth did not change significantly during the 2010-2017 period, except a sporadic increase in the rate of ACS in adolescents in 2012-2013. No significant association between the ACS and the economic crisis time period in youth was found. As conclusion, the ACS remains stable in Spain during the last decade, which is a promising result regarding the evidenced decreasing trend in many countries. Further educational and policy strategies are important to continue promoting this behavior in children and adolescents in the long term.

A school-based physical activity promotion intervention in children: rationale and study protocol for the PREVIENE Project.

BACKGROUND: The lack of physical activity and increasing time spent in sedentary behaviours during childhood place importance on developing low cost, easy-toimplement school-based interventions to increase physical activity among children. The PREVIENE Project will evaluate the effectiveness of five innovative, simple, and feasible interventions (active commuting to/from school, active Physical Education lessons, active school recess, sleep health promotion, and an integrated program incorporating all 4 interventions) to improve physical activity, fitness, anthropometry, sleep health, academic achievement, and health-related quality of life in primary school children. METHODS: A total of 300 children (grade 3; 8-9 years of age) from six schools in Granada (Spain) will be enrolled in one of the 8-week interventions (one intervention per school; 50 children per school) or a control group (no intervention school; 50 children). Outcomes will include physical activity (measured by accelerometry), physical fitness (assessed using the ALPHA fitness battery), and anthropometry (height, weight and waist circumference). Furthermore, they will include sleep health (measured by accelerometers, a sleep diary, and sleep health questionnaires), academic achievement (grades from the official school's records), and health-related quality of life (child and parental questionnaires). To assess the effectiveness of the different interventions on objectively measured PA and the other outcomes, the generalized linear model will be used. DISCUSSION: The PREVIENE Project will provide the information about the effectiveness and implementation of different school-based interventions for physical activity promotion in primary school children.

Parental perceptions of barriers to active commuting to school in Spanish children and adolescents.

Background: : Understanding parental barriers is crucial to promote active commuting to school since the parental perceptions influence how young people commute. This study examined parental barriers to active commuting to school among Spanish children and adolescents, and their association with their gender and the usual mode of commuting. Parents of children ( n = 628) and parents of adolescents ( n = 151) from Granada (Spain) completed a paper-based questionnaire about perceived parental barriers to active commuting to school and mode of commuting. Data were analyzed using the Chi-square test. Among Spanish parents, the most common barriers reported by parents of children were traffic volume and dangerous intersections, whereas the most frequent barriers reported by parents of adolescents were distance to school and dangerous intersections. Compared to parents of children, a greater proportion of parents of adolescents reported distance to school and crime and smaller proportion reported traffic volume as barriers to active commuting to school. Among parents of children, crime was a more commonly reported as a barrier by parents of girls. Although some barriers reported by parents of passive commuters were similar for children and adolescents (such as distance to school and absence of a policeman at crosswalks), other barriers were specific to parents of children. The main parental barriers to active commuting in children were traffic volume and dangerous intersections whereas for adolescents were distance and dangerous intersections. Among Spanish parents, parental barriers to active commuting are influenced by children's age, gender and mode of commuting to school.

Examining motivations and barriers for attending maintenance community-based cardiac rehabilitation using the health-belief model.

BACKGROUND: Reasons for low attendance at maintenance cardiac rehabilitation (CR) programs remain largely unknown. Using the Health Belief Model as a theoretical framework, this study compared the motivations and barriers for attending a community-based CR maintenance program in high attenders (HA), low attenders (LA) and non-attenders (NA) with coronary artery disease (CAD). METHODS: Forty-four older adults with CAD (70.5% males; age: 72.7±6.9 years; 11 HA, 16 LA and 17 NA) completed questionnaires examining reasons for attending CR: perceived threat (symptoms of CAD; the Revised Illness Perception Questionnaire), perceived benefits (Multi-dimensional Outcomes Expectations for Exercise Scale), perceived barriers (Cardiac Rehabilitation Barriers Scale) and cues to action questionnaire. RESULTS: Sociodemographic characteristics and perceived threat were not different between the groups. Compared to LA and NA, HA perceived greater social and physical (vs NA only) benefits of participation in maintenance CR and had fewer barriers to attending (all p<0.05). The CR program newsletter, personal health concerns and others having heart problems were stronger cues to action for HA versus NA (all p<0.05). CONCLUSIONS: Participants perceived greater benefits from attending CR, had fewer barriers and perceived stronger cues to action compared to non-attenders. Promoting CR maintenance programs should emphasise physical and social benefits and provide encouragement.

Community-Based Cardiac Rehabilitation Maintenance Programs: Use and Effects.

BACKGROUND: Cardiac rehabilitation (CR) graduates are encouraged to attend maintenance programs to promote long-term physical activity and preserve gains in function. This study describes the characteristics, attendance and physical function of community-based maintenance CR participants, compared to primary prevention participants. METHODS: In this cross-sectional study, participants from two programs in New Zealand completed an interview, anthropometry, functional assessments (walking tests, chair stand test, handgrip strength), a 12-month physical activity recall, and a cardiopulmonary exercise test (subsample only). Attendance was ascertained from club records. RESULTS: Participants (n=101, 55.4% Secondary Prevention) attended 37.4±27.9% of sessions annually. Participants were predominately New Zealand-European (93.5%), retired (80.2%), married (68.3%) elderly individuals, with musculoskeletal problems (60.0%), who lived proximate to the clubs. In Secondary but not Primary Prevention participants, first-year attendance was strongly correlated with attendance in subsequent years (p<0.001). In all participants, greater attendance in the previous 12 months was significantly associated with lower waist circumference, and greater shuttle walk test duration, chair stands and balance (p<.05). Session attendance was positively correlated to peak oxygen consumption (p=0.041) in Secondary Prevention participants only. CONCLUSION: Participation in community-based CR maintenance programs is associated with health benefits but these programs are not accessed by a diversity of patients.

Attitudes to food differ between adolescent dieters and non-dieters from Otago, New Zealand, but overall food intake does not.

OBJECTIVE: There is increasing pressure for adolescents to be thin and this may not always be acted upon in healthy ways; for example, certain foods or food groups may be restricted or meals skipped. As foods are not eaten in isolation it is useful to examine dietary patterns and associated psychosocial factors to better understand eating behaviour. The aim of the present study was to identify correlates of 'dieting' in adolescents from Otago, New Zealand. DESIGN: A web-based survey was conducted in 2009, collecting information on food consumption and factors potentially associated with food consumption. Principal components analysis was used to investigate dietary patterns. Correlates were examined in 1329 students using multiple logistic regression analysis. SETTING: Nineteen secondary schools in the province of Otago, New Zealand. SUBJECTS: Students from school years 9 and 10 (mean age 14.1 (SD 0.7) years). RESULTS: There was no relationship between dieting and dietary patterns. Those not dieting were 17 % (95 % CI 7, 26 %) more likely to eat lunch and 22 % (95 % CI 3, 37 %) more likely to eat an evening meal on one more weekday than those who were dieting. Those who reported dieting were more likely to report healthiness (OR = 2.18, 95 % CI 1.11, 4.26) as an important factor when choosing food and that eating fruit and vegetables makes you better looking. No sex by dieting interaction was found. CONCLUSIONS: In this cohort, while there was no difference in actual food consumption between dieters and non-dieters, there were significant differences in attitudes to food.

Dietary Pattern Indicators among Healthy and Unhealthy Weight Adolescents Residing in Different Contexts across the Otago Region, New Zealand.

Reported obesity rates for adolescents in different urban and rural areas are inconsistent. We examined indicators of healthy and unhealthy dietary patterns among 1863 adolescents aged 13-18 years with a healthy or excess body weight attending 23 secondary schools in four different settlement types across the Otago region, New Zealand. An online survey included demographics and dietary behaviours. Height and weight were measured, and body mass index was calculated. New Zealand defined urban and rural settlement types were used. Home addresses determined a small area-level index of deprivation. Data were analysed using Chi-square tests and ANOVA. A logistic model was fitted to estimate adjusted odds ratios of excess weight. The proportion of adolescents with a healthy weight differed (p < 0.001) between the most (64.9%) and least (76.4%) deprived neighbourhood areas. There was only indicative evidence of differences between settlement types (p = 0.087). Sugar-sweetened beverage and fast-food consumption was more frequent in the most deprived areas (p < 0.001), and in urban versus rural settlements (p < 0.001). The most important associations with excess weight were area-level deprivation and ethnicity, but not settlement type. Prioritising socioeconomic factors irrespective of settlement type is necessary when developing interventions to improve dietary patterns and body weight status among adolescents.

Getting kids active by participating in sport and doing it more often: focusing on what matters.

BACKGROUND: Reduced time dedicated to physical education and free play in recent decades emphasizes the need to promote opportunities for sport participation in adolescents in order to increase physical activity levels. The purpose of this study was to examine the association of sociodemographic and biological characteristics, behavioural patterns, and school-related and sport-specific variables with time spent participating in sport. METHODS: A total of 1837 secondary school students (age: 14.6 ± 1.2 years; 50.9 % boys) from 19 of 23 schools in the Otago Region (New Zealand) completed an online sport survey and Youth Physical Activity Questionnaire in 2009. Using multilevel modeling, we examined the association of individual-, school- and sport-related variables on sport participation and the amount of time spent in sports. RESULTS: Higher rates of sport participation were associated with lower neighbourhood deprivation scores (OR (95%CI): 0.75 (0.49-1.14), 0.57 (0.38-0.86), 0.48 (0.28-0.81)), higher quintiles of physical activity (2.89 (2.10-3.96), 2.81 (1.68-4.70), 3.54 (2.24-5.57), 3.97 (1.99-7.95)), highest quintiles of screen time (1.58 (0.94-2.65), 1.99 (1.42-2.80), 2.17 (1.43-3.30), 1.88 (1.37-2.57)) and boys only school status (2.21 (1.57-3.10)). Greater amount of time spent in sports was associated with male gender (0.56 (0.43-0.74), lower neighbourhood deprivation scores (0.72 (0.59-0.93), 0.78 (0.58-1.04), 0.62 (0.39-1.00)), higher quintiles of physical activity (3.18 (2.29-4.41), 4.25 (2.91-6.20), 8.33 (5.58-12.44), 6.58 (4.07-10.64)), highest quintile of screen time (1.83 (1.31-2.56), greater availability of sports outside school (1.68 (1.22-2.32)), better sport management (2.57 (1.63-4.07)) and provision of sport courts at school (0.57 (0.40-0.81)). Conversely, obesity was associated with less time spent participating in sport (0.50 (0.31-0.80)). CONCLUSION: Results support the use of sport participation as an effective strategy to increase physical activity levels and identify target groups and areas for interventions, program design and policy development. Interventions should focus on improving accessibility to sport programs for all adolescents, providing adequate sport grounds at school, and promoting good sport management practices. Programs and policies encouraging sport participation should address in particular the needs of adolescents living in deprived neighborhoods, those attending coeducational and girls-only schools, and those who are obese.

Resistance versus aerobic exercise training in chronic heart failure.

It is now accepted that exercise training is a safe and effective therapeutic intervention to improve clinical status, functional capacity, and quality of life in people with chronic heart failure (CHF). Nevertheless, this therapeutic modality remains underprescribed and underutilized. Both aerobic and resistance training improve exercise capacity and may partially reverse some of the cardiac, vascular, and skeletal muscle abnormalities in individuals with CHF. Aerobic training has more beneficial effects on aerobic power (peak oxygen consumption) and cardiac structure and function than resistance exercise training, while the latter is more effective for increasing muscle strength and endurance and promoting favorable arterial remodeling. Combined aerobic and resistance training is the preferred exercise intervention to reverse or attenuate the loss of muscle mass and improve exercise and functional capacity, muscle strength, and quality of life in individuals with CHF. The challenge now is to translate these research findings into clinical practice.

More-Than-Human: A Cross-Sectional Study Exploring Children's Perceptions of Health and Health-Promoting Neighbourhoods in Aotearoa New Zealand.

A disconnect between children's ideas and their incorporation into environmental design, in the context of rapid urbanisation and climate crises, compelled us to reflect on children's meaningful participation in positive environmental change. Our research aimed to bring new knowledge to the fore using a participatory, child-centred approach to understanding children's perceptions of health and health-promoting neighbourhoods in Aotearoa New Zealand. The cross-sectional Neighbourhoods and Health study was conducted with 93 primary school-aged children (approximate ages 8 to 10 years) from two schools in Otepoti Dunedin and two schools in Tamaki Makaurau Auckland from June 2020 to August 2021. We present a framework of twelve child-centred topics of importance for health (Healthcare and 'not getting sick', 'How you feel', and Taking care of yourself), health-promoting neighbourhoods (Proximity, safety and feel, Range of 'places to go', 'Friendly streets', and 'No smoking'), and those common to both (Connections with other humans, Healthy food and drink, Exercising and playing sport 'to keep fit', 'Nature' and 'helping the environment', and Recreational activities). The more-than-human theory was used to situate our study findings, and we explored three threads evident in children's thinking: (1) care for humans and non-humans, (2) vital interdependence of human-non-human relations, and (3) understanding complex urban environments through everyday activities. We conclude that the thriving of humans and non-humans in urban environments is important to children in Aotearoa New Zealand. We affirm that children have clear and salient ideas about health and health-promoting neighbourhoods.

Association of active school commuting with physical activity and sedentary behaviour among adolescents: A global perspective from 80 countries.

OBJECTIVES: To examine associations of active school commuting (ASC) with time spent in physical activity (PA) and sedentary behaviour (SB) among adolescents. DESIGN: Cross-sectional study. METHODS: Global School-based Student Health Survey data from 277,833 adolescents aged 11-17 years (48.9% girls), collected during 2007-2016, were analysed. Adolescents were asked how many days per week they walked or bicycled to and from school, were physically active, and how much time they spent sitting on a typical day. ASC was defined as ≥3 days/week, meeting PA recommendations as ≥60min/day, high SB as leisure-time sitting ≥3h/day. Multilevel logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of the association estimates. RESULTS: Adolescents who used ASC≥3 days/week had over double the odds of meeting PA recommendations (OR: 2.06, 95% CI: 2.01-2.12), after adjusting for a set of covariates. Adolescents who reported ASC≥3 days/week had 17% lower odds of reporting high SB (0.83, 0.81-0.85). The estimated OR of ASC and PA was 2.57 (2.31-2.86) in low-income and 1.84 (1.75-1.94) in high-income countries. Adolescents with ASC≥3 days/week had 22% lower odds of reporting high SB in African and Eastern Mediterranean regions (0.78, 0.73-0.84 and 0.75-0.82, respectively). Country-wise estimates of the associations are presented. CONCLUSIONS: ASC is strongly and positively associated with PA recommendations and moderately with lower SB in adolescents. These estimates vary across WHO regions and by country's income. Promoting ASC has the potential to promote active lifestyle among adolescents around the globe.

Taking the bus? Barriers and facilitators for adolescent use of public buses to school.

Transport to school can contribute significantly to adolescents' physical activity but in New Zealand - as in many other countries around the world - many adolescents are driven to school. Public transport offers an opportunity to integrate incidental active transport into school commutes. In this paper, we bring together multiple sources of data into a multi-method study to elucidate the barriers to and facilitators of public transport use by adolescents for school travel in Dunedin, New Zealand, a city with low rates of public transport use. The data include a public bus survey from Otago School Students Lifestyle Survey (OSSLS, 1391 adolescents); the Built Environment Active Transport to School (BEATS) Study parental survey (350 parents), focus groups (54 adolescents, 25 parents, 12 teachers) and semi-structured interviews (12 principals); interviews with three policy-makers from local/regional/national agencies; and analysis of 10 relevant local/regional/national strategies/transport plans. The findings show how distance to school, cost, parental trip chaining, built environment features, the weather, convenience, and safety perceptions are major barriers to using public transport to school. Moreover, current transport planning documents do not favour public health. A number of recommendations that could increase public transport use are made including: raising parking prices to discourage parents driving and trip-chaining; improving bus infrastructure and services; providing subsidies; and changing perceptions of public transport use and users. These actions, however, require collaboration between government authorities across the local, regional and national scale.

Comparison of physical activity patterns across large, medium and small urban areas and rural settings in the Otago Region, New Zealand.

AIM: This study compared accelerometer-measured physical activity (PA) patterns in adolescents living in diverse urban and rural areas of Otago, New Zealand. METHOD: Participants (n=377; age: 14.9±1.4 years; 66.8% female; 23 schools) completed an online school travel survey, anthropometry and seven-day PA accelerometer assessment. Participants resided in large (n=237), medium (n=45) and small (n=44) urban areas or rural settings (n=51). RESULTS: Overall, participants participated in 54.4±21.0 minutes of moderate-to-vigorous physical activity (MVPA) daily and 35.0% met PA guidelines (school day vs weekend day: 40.8% vs 26.0%; p<0.001) with no difference across geographical settings. A greater proportion of males (43.2% vs 31.9%; p=0.016), school sport participants (70.1% vs 54.0%; p=0.005) and active-transport-to-school users (40.2% vs 26.1%) met PA guidelines compared to their counterparts. Compared to rural adolescents, those from large urban areas accumulated more MVPA during the school commute time (before school: 8.3±6.7 vs 5.3±3.8 minutes, p<0.001; after school: 10.1±6.0 vs 7.7±4.3 min, p=0.003), but overall spent more time sedentary (584.9±84.7 vs 527.8±88.2 minutes/day; p<0.001). CONCLUSION: PA in Otago adolescents is low, with significant differences by gender, sport participation, mode of travel to school and geographical setting. Increased PA should be encouraged in both urban and rural adolescents.

Understanding children's perceptions of, and priorities for, healthy neighbourhoods in Aotearoa New Zealand: study protocol for a cross-sectional study.

INTRODUCTION: Neighbourhood environments can have significant and enduring impacts on children's physical, psychological and social health. Environments can impact health through promoting or hindering physical activity, active travel, and healthy eating in addition to opportunities for social interaction, cognitive development, rest and relaxation. There is a paucity of research that has examined neighbourhood and health priorities, strengths and needs from the perspectives of the community, and even less that has focused on the perspectives of children within communities. The aim of this article is to describe the research protocol for a project to gather child-identified needs and strengths-based solutions for promoting child health and well-being in urban neighbourhood environments. METHODS AND ANALYSIS: This participatory research project is designed to partner with children in school settings in Tamaki Makaurau Auckland and Otepoti Dunedin, Aotearoa New Zealand. An abundant communities approach will be used with children to identify needs and strengths related to neighbourhoods and health. Specific methods including collaborative, creative, play-based methods such as concept-mapping activities and co-creation of final dissemination material on the key messages are described. Plans for researcher reflections, data analysis and dissemination are also detailed. ETHICS AND DISSEMINATION: This research has been approved by the University of Auckland Human Participants Ethics Committee. Results will be disseminated through child and researcher co-created output, a technical report and academic journal articles. By using evidence-based child-centred approaches to knowledge generation, we anticipate the research will generate new localised insights about children's preferences and needs for healthy neighbourhoods which will be shared with stakeholders in planning and practice. The detailed session protocol including critical researcher reflections is shared in this manuscript for application, development and refinement in future research.

School Bag-Related Factors and Their Implications for Walking and Cycling to School among New Zealand Adolescents.

Excessive school bag weight may be a modifiable barrier to active transport to school. This study examined correlates of school bag weight and adolescents' perceptions of excessive school bag weight for walking and cycling to school among New Zealand adolescents living in diverse settlement types. Adolescents (n = 1512; 15.0 ± 1.3 years) completed a questionnaire and had their bag weight (n = 1190) and body weight (n = 1038) measured. Adolescents using active transport and rural adolescents had lighter school bags compared to their counterparts. One-third of adolescents reported excessive school bag weight for walking (31.2%) and cycling (37.2%) to school. Positive correlates of relative school bag weight were female gender (regression coefficient (95% CI): 0.53 (0.13, 0.93)), and underweight (2.21 (1.39, 3.02)), whereas negative correlates were Maori ethnicity (-0.87 (-1.41, -0.32)), overweight (-1.84 (-2.35, -1.34)) and obesity (-3.57 (-4.26, -2.87)), and school location in small urban areas (-2.10 (-4.19, -0.01)), and rural settlements (-3.58 (-5.66, -1.49)). Older adolescents, females, those with greater relative school bag weight, and those experiencing school bag-related pain symptoms and/or fatigue were more likely to report excessive school bag weight for both walking and cycling to school. Future initiatives should target reducing excessive school bag weight, particularly in female and urban adolescents.

A School-Based Randomized Controlled Trial to Promote Cycling to School in Adolescents: The PACO Study.

This manuscript describes the rationale and protocol of a school-based randomized controlled trial called "Cycling and Walk to School" (PACO, by its Spanish acronym) that aims to promote cycling to and from school and physical activity (PA) in adolescents. This study will examine the effects of this intervention in cycling and active commuting to and from school (ACS), PA and several ACS-related factors based on self-determination theory (SDT) and a social-ecological model (SEM). A total of 360 adolescents attending six high schools (three experimental and three control) from three Spanish cities will participate in this randomized controlled trial. The intervention (four cycling sessions; 1-2 h per session, one session per week) will be conducted by the research staff; the control group will continue their usual activities. PA levels will be measured by accelerometers, whereas ACS and the other study variables will be self-reported using questionnaires at baseline and post-intervention. The primary outcomes will be: rates of cycling to school, ACS and PA levels. In addition, SDT-related variables and individual, interpersonal, community, and environment variables relevant to ACS will be based on SEM. The findings will provide a comprehensive understanding of the short-term effects of this school-based intervention on cycling to school behaviour, ACS and PA levels in Spanish adolescents.

Characterizing differences in mortality at the low end of the fitness spectrum in individuals with cardiovascular disease.

BACKGROUND: A graded but nonlinear relationship exists between fitness and mortality, with the greatest mortality differences occurring between the least-fit (first, Q1) and the next-least-fit (second, Q2) quintiles of fitness. The purpose of this study was to compare clinical characteristics, exercise test responses, and physical activity (PA) patterns in Q1 versus Q2 in patients with cardiovascular disease (CVD). DESIGN: Observational retrospective study. METHODS: A total of 5101 patients with a history of CVD underwent clinical treadmill testing and were followed up for 9.1+/-5.5 years. Patients were classified into quintiles of exercise capacity measured in metabolic equivalents. Clinical characteristics, treadmill test results, and recreational PA patterns were compared between Q1 (n = 923) and Q2 (n = 929). RESULTS: Q1 had a nearly two-fold increase in age-adjusted relative risk of cardiovascular mortality compared with Q2 (hazard ratio: 3.79 vs. 2.04, P<0.05; reference: fittest quintile). Q1 patients were older, had more extensive use of medications, and were more likely to have a history of typical angina (35 vs. 28%), myocardial infarction (30 vs. 24%), chronic heart failure (25 vs. 14%), claudication (15 vs. 9%) and stroke (9 vs. 6%) compared with Q2 (all comparisons: P<0.05). Recent and lifetime recreational PA was not different between the two groups. CONCLUSION: Greater severity of disease in the least-fit versus the next-least-fit quintile likely contributes to but cannot fully explain marked differences in mortality rates in CVD patients. To achieve potential survival benefits, our results suggest that unfit CVD patients should engage in exercise programs of sufficient volume and intensity to improve fitness.