A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep.

BACKGROUND: In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. METHODS: The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines. RESULTS: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1-2 years) and preschoolers (3-5 years). CONCLUSIONS: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis.

BACKGROUND: Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. METHODS: A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. RESULTS: A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e.g., U.S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA. CONCLUSIONS: Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Perceived neighborhood environment and physical activity in 11 countries: do associations differ by country?

BACKGROUND: Increasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country. METHODS: Population representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported. RESULTS: Significant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries. CONCLUSION: There is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

Neighborhood environments and physical activity among adults in 11 countries.

BACKGROUND: Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the International Physical Activity Questionnaire, allowing analyses with pooled data. METHODS: The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002-2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country. RESULTS: Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity-supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes. CONCLUSIONS: Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.

Why New Zealand must rapidly halve its greenhouse gas emissions.

New Zealand must commit to substantial decreases in its greenhouse gas emissions, to avoid the worst impacts of climate change on human health, both here and internationally. We have the fourth highest per capita greenhouse gas emissions in the developed world. Based on the need to limit warming to 2 degrees C by 2100, our cumulative emissions, and our capability to mitigate, New Zealand should at least halve its greenhouse gas emissions by 2020 (i.e. a target of at least 40% less than 1990 levels). This target has a strong scientific basis, and if anything may be too lenient; reducing the risk of catastrophic climate change may require deeper cuts. Short-term economic costs of mitigation have been widely overstated in public debate. They must also be balanced by the far greater costs caused by inertia and the substantial health and social benefits that can be achieved by a low emissions society. Large emissions reductions are achievable if we mobilise New Zealand society and let technology follow the signal of a responsible target.

The New Zealand Physical Activity Questionnaires: validation by heart-rate monitoring in a multiethnic population.

BACKGROUND: This study validated the short- and long-form New Zealand Physical Activity Questionnaires (NZPAQ-SF and NZPAQ-LF) against heart-rate monitoring (HRM) with individual calibration. METHODS: A multiethnic sample (N = 180), age 19 to 86 y, underwent HRM for 3 consecutive days while simultaneously completing physical activity (PA) logs. RESULTS: Both NZPAQs showed significant (p < .001) correlations to HRM data for brisk walking (r = .27-.43), vigorous-intensity PA (r = .27-.35), and total PA (r = .25; 95% CI, 0.10-0.40), whereas moderate-intensity PA was substantially overreported (mean = 157-199 min). Although the NZPAQ-LF performed better for brisk walking and vigorous-intensity PA, the NZPAQs were strongly correlated (r = .61 and r = .52, respectively, p < .0001). European/Other participants demonstrated the most accurate PA recall of total PA on both NZPAQs (r = .36-.41, p < .01). CONCLUSIONS: The NZPAQs are acceptable instruments for measuring adult PA levels and produce similar results. Substituting culturally specific examples of PAs on the NZPAQs and their accompanying show cards could potentially improve PA recall for Maori and Pacific people.

Metabolic equivalent (MET) intensities of culturally-specific physical activities performed by New Zealanders.

AIMS: This study's purpose was to objectively measure the intensity, expressed as metabolic equivalents (METs), of free-living physical activities (PAs) performed by New Zealanders. METHODS: A sample of 186 European/Other (n=60), Maori (n=61), and Pacific (n=65) males and females (mean age 48.6 plus or minus 16.4 yrs) underwent 3 days of minute-by-minute heart rate monitoring (HRM) with individual calibration on a cycle ergometer. Mean METs were derived from average heart rate readings and compared to published equivalents from the United States (US) Compendium of Physical Activities. RESULTS: Although New Zealand-derived METs were slightly higher, comparison to the US instrument showed strong correlations (R2=0.62). Overall intensities for Maori kapahaka PAs ranged from 4.3 to 7.1 METs, and were generally classified as vigorous- and moderate-intensity for males and females, respectively. In addition to 12 New Zealand Maori and Pacific activities, 5 PAs captured during HRM are not found in the US Compendium, and New Zealand-derived METs for 9 PAs were classified differently from the US instrument. CONCLUSIONS: Availability of New Zealand-specific MET intensities increases the precision of estimating energy expenditure and PA levels when direct measures are not possible. PA surveillance in New Zealand is further enhanced by the ability to substitute culturally-specific examples of intensity when necessary.

Evaluation of the national 'Push Play' campaign in New Zealand--creating population awareness of physical activity.

AIMS: Physical inactivity is considered to be as detrimental to public health as hypertension or tobacco use, but there is limited evidence on the impact of community-wide interventions in this area. This paper describes the impact of an initiative to increase physical activity at a population level in New Zealand. METHODS: A media-led, community-wide intervention campaign was initiated by the Hillary Commission (now SPARC, Sport and Recreation New Zealand). The 'Push Play' campaign recommended 30 minutes of daily, moderate-intensity physical activity as fun, part of community life, and easy to achieve for New Zealand adults. In addition, there were community-level and primary care supporting programmes and events. Annual cross-sectional population surveys (1999-2002) monitored the impact of the campaign on message awareness, recognition of the Push Play logo, intention to be active, and recent activity. RESULTS: There were substantial increases in awareness of the Push Play message (30% in 1999 to 57% in 2002, p <0.001), and of the Push Play logo (14% to 52%, p <0.001). There were significant increases in the numbers of adults who intended to be more active (1.8% in 1999 to 9.4% in 2002). No sustained changes in physical activity levels were seen in these Push Play serial evaluation surveys, with 38.6% of the 1999 sample reporting 5+ days activity per week, increasing to 44.5% in 2000, but declining to 38.0% in 2002. The only significant difference in physical activity levels occurred from 1999 to 2000 (difference 5.8%, 95% CI 0.1%-11.6%). In an unrelated, much larger population survey, a 3% increase in physical activity participation was noted among adults between 1997 and 2001. CONCLUSIONS: The national Push Play campaign resulted in increases in message recognition and in intention to become more active. If sustained, efforts like this may have a long-term impact on adult activity patterns, leading to improved health outcomes and reduced health costs.