Results from the United Arab Emirates 2022 report card on physical activity for children and adolescents.

Objective: The United Arab Emirates (UAE) 2022 Report Card provides a systematic evaluation of the physical activity (PA) levels of children and adolescents in the UAE. Methods: The 2022 Report Card utilized data from 2017 to 2021 to inform 10 core PA indicators that were common to the Global Matrix 4.0. Results: One in five (19%) UAE school children achieved the recommended amount of moderate-to-vigorous PA (i.e. ≥60 min/d; Total Physical Activity Grade F). Less than 1% of school children used active transport to and from school (Active Transportation Grade F). One in four (26%) secondary school children achieved the recreational screen time recommendations (i.e. ≤2 h/d; Sedentary Behaviours Grade D-). A quarter of adults reported achieving the recommended PA level (i.e. ≥150 min of moderate-intensity PA per week, or equivalent) (Family and Peers Grade D-). All school children are taught physical education (PE) by a specialist with at least a bachelor's degree in PE; however, the duration of weekly PE classes varied between schools (School Grade A-). The UAE Government has invested significant funds and resources into developing and implementing strategies and facilities that will increase PA across the entire population (Government Grade B+). Organised Sport and Physical Activity, Active Play, Physical Fitness, and Community and Environment indicators were graded 'Incomplete' (INC) due to a lack of available data. Conclusions: Overall, PA levels remain low and sedentary behaviours remain high amongst UAE children and adolescents. The UAE Government has sustained investment in further developing PA opportunities for all children and adults which should translate to increased PA and health improvements at a population level.

Sense of effort is distorted in people with chronic low back pain.

BACKGROUND: Proprioceptive deficits in people with low back pain (LBP) have traditionally been attributed to altered paraspinal muscle spindle afference and its central processing. Studies conducted in the upper limb demonstrated that sense of effort is also an important source of kinaesthetic information. OBJECTIVES: To better understand proprioceptive deficits in people with chronic LBP (cLBP), this study aimed to test whether sense of effort is affected in people with cLBP. DESIGN: Cross-sectional study. METHOD: Fourteen participants with cLBP and fourteen healthy participants performed a 120 s force matching task with their trunk extensor muscles at a low intensity. RESULTS: When visual feedback of the generated force was provided, both groups performed the task accurately. Removal of visual feedback resulted in an increase in error for both groups (p < 0.0001), but the increase in error was significantly larger for the cLBP group (p = 0.023). This larger error could be attributed to undershooting of the target force (p = 0.020). The control group did not consistently undershoot or overshoot the target force (p = 0.93). Furthermore, the amount of undershooting for the cLBP group increased as the task progressed (p = 0.016), which was not observed for the control group (p = 0.80). CONCLUSIONS: The results of this study revealed that sense of effort is affected in cLBP. People with cLBP overestimated the trunk extension force they generated, and the error increased as the trial progressed. With visual feedback however, people with cLBP were able to compensate and perform the task as accurately as people without cLBP.

Accelerometer measured physical activity patterns of children during segmented school day in Abu Dhabi.

BACKGROUND: The overwhelming majority of United Arab Emirates (UAE) school-aged children do not meet the 60 min per day recommendation of moderate-to-vigorous physical activity (MVPA). Understanding the different school day segments contribution to children reaching this goal is a crucial step toward developing successful strategies to promote school day MVPA levels. This study aimed to objectively measure children's' physical activity levels and to examine the difference in physical activity levels between high active and low active children during the school day in Abu Dhabi. METHODS: A total of 133 school children (56% boys; mean age 10.5 years; grades 4-7) from two elementary schools in Abu Dhabi wore accelerometers (ActiGraph GT9X Link) for up to 5 non-consecutive days during spring 2019. Children's' MVPA was estimated during the following school segments: class time, lunch, recess, physical education (PE), and whole school day. Children were stratified as "high active" meeting the ≥30 min/day MVPA school time guideline or "low active" accumulating < 30 min/day MVPA. RESULTS: On average children accumulated 21.8 ± 22.6 min/day of MVPA on PE days and 22.4 ± 15.9 min/day of MVPA on non-PE days. Only 19% of children met the 30 min or more of school day MVPA recommendation, with higher proportion of boys (27%) meeting such recommendation compared to girls (8%). High active boys, spent the highest percent of time in MVPA during PE (28%), followed closely by lunch (27%). In compression, high active girls spent the highest percent of time in MVPA during lunch (14.2%) followed by recess (9.1%). High active children accumulated 15.06 more minutes of MVPA during PE (p < 0.001), 2 more minutes during recess (p < 0.001), 3 more minutes of MVPA during lunch (p < 0.001) and 5 more minutes of MVPA during class time (p < 0.001). CONCLUSION: The overwhelming majority of school children did not meet the recommended 30 min /day MVPA during school time. Girls substantially accumulated less MVPA and more sedentary minutes across all segments during the school days compared to boys. Further research is needed to investigate school day segments contribution to children MVPA in the UAE.

Health literacy research in the Eastern Mediterranean Region: an integrative review.

OBJECTIVES: This integrative review examines health literacy research in the Eastern Mediterranean Region (EMR) and describes: (1) assessments and screening tools used to measure levels of health literacy, and (2) the focus, methods, and findings of health literacy research in the region. METHODS: A total of 246 records were identified through a systematic search of online databases from 1950 to 2017, to include: ProQuest Middle East and Africa, MEDLINE, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic OneFile, Web of Science, Scopus, and Google Scholar. The final sample included 49 full-text articles. RESULTS: This research described 7 studies which used existing or new health literacy measures. Levels of health literacy in the EMR were similar to those for Europe and the United States. Low health literacy in EMR countries was more prevalent among females than males. The relationships between health literacy and knowledge, behavior and health outcomes varied across countries. CONCLUSIONS: To our knowledge, this study is the first in the EMR. Appropriately designed studies should better define health literacy needs due to variations in socioeconomic status within subregions. Future health literacy measures must consider stronger psychometric properties to guide development and validation.

Process Evaluation of Making HEPA Policy Practice: A Group Randomized Trial.

This study examines the link between implementation of Strategies to Enhance Practice (STEPs) and outcomes. Twenty after-school programs (ASPs) participated in an intervention to increase children's accumulation of 30 minutes/day of moderate to vigorous physical activity (MVPA) and quality of snacks served during program time. Outcomes were measured via accelerometer (MVPA) and direct observation (snacks). STEPs implementation data were collected via document review and direct observation. Based on implementation data, ASPs were divided into high/low implementers. Differences between high/low implementers' change in percentage of boys accumulating 30 minutes/day of MVPA were observed. There was no difference between high/low implementers for girls. Days fruits and/or vegetables and water were served increased in the high/low implementation groups, while desserts and sugar-sweetened beverages decreased. Effect sizes (ES) for the difference in changes between the high and low group ranged from low (ES = 0.16) to high (ES = 0.97). Higher levels of implementation led to increased MVPA for boys, whereas girls MVPA benefited from the intervention regardless of high/low implementation. ESs of the difference between high/low implementers indicate that increased implementation of STEPs increases days healthier snacks are served. Programs in the high-implementation group implemented a variety of STEPs strategies, suggesting local adoption/adaptation is key to implementation.

Physical activity and healthy eating environmental audit tools in youth care settings: A systematic review.

BACKGROUND: There is a growing interest in evaluating the physical activity (PA) and healthy eating (HE) policy and practice environment characteristics in settings frequented by youth (≤18years). OBJECTIVE: This review evaluates the measurement properties of audit tools designed to assess PA and HE policy and practice environment characteristics in settings that care for youth (e.g., childcare, school, afterschool, summer camp). METHOD: Three electronic databases, reference lists, educational department and national health organizations' web pages were searched between January 1980 and February 2014 to identify tools assessing PA and/or HE policy and practice environments in settings that care for youth (≤18years). RESULTS: Sixty-five audit tools were identified of which 53 individual tools met the inclusion criteria. Thirty-three tools assessed both the PA and HE domains, 6 assessed the PA domain and 14 assessed the HE domain solely. The majority of the tools were self-assessment tools (n=40), and were developed to assess the PA and/or HE environment in school settings (n=33), childcare (n=12), and after school programs (n=4). Four tools assessed the community at-large and had sections for assessing preschool, school and/or afterschool settings within the tool. The majority of audit tools lacked validity and/or reliability data (n=42). Inter-rater reliability and construct validity were the most frequently reported reliability (n=7) and validity types (n=5). CONCLUSIONS: Limited attention has been given to establishing the reliability and validity of audit tools for settings that care for youth. Future efforts should be directed towards establishing a strong measurement foundation for these important environmental audit tools.

Association of environment and policy characteristics on children's moderate-to-vigorous physical activity and time spent sedentary in afterschool programs.

BACKGROUND: Afterschool programs are an important setting in which to promote children's physical activity. This study examines the association of environmental and policy characteristics on the moderate-to-vigorous physical activity and sedentary behavior of children attending afterschool programs. METHODS: A total of 1302 children attending 20 afterschool programs across South Carolina wore accelerometers (ActiGraph GT3X+) for up to 4non-consecutive days. Policy-level characteristics were evaluated using the Healthy Afterschool Program Index-Physical Activity scale. Physical activity space was measured using a measuring wheel (indoor, ft(2)) and Geographical Information Systems software (outdoor, acres). The structure (free-play or organized) of activity opportunities was evaluated via direct observation. Time spent in moderate-to-vigorous physical activity and sedentary, both indoors and outdoors, was estimated using accelerometry. RESULTS: For every 5000 ft(2) of utilized indoor activity space an additional 2.4 and 3.3 min/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 min/day and 10.0 min/day, respectively). For every 1 acre of outdoor activity space used, an additional 2.7 min/day of moderate-to-vigorous physical activity was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor moderate-to-vigorous physical activity for boys and girls (4.4 and 3.4 min/day increase, respectively). Policy characteristics were unrelated to moderate-to-vigorous physical activity levels and time spent sedentary. CONCLUSION: Findings indicate that policies and size of activity space had limited influence on moderate-to-vigorous physical activity and sedentary behavior, suggesting that a programmatic structure may be a more effective option to improve moderate-to-vigorous physical activity levels of children attending afterschool programs.

Impact of policy environment characteristics on physical activity and sedentary behaviors of children attending afterschool programs.

State and national organizations recently developed policies focused on increasing physical activity (PA) in afterschool programs (ASPs). These policies emphasize "activity friendly" environment characteristics that, when present, should lead to higher levels of PA and reduce the amount of time children spend sedentary during an ASP. Currently, little is known about the impact of existing PA policies on children's PA and sedentary behaviors in ASPs. A sample of 18 community-based ASPs serving 1,241 children (5-12 years) were audited for environment features outlined in existing PA policies (i.e., presence of a written policy to promote PA, collecting child feedback, staff training to promote PA and the quality of that training, holding parent workshops, use of PA curricula, evaluating PA, allocating time in the schedule for PA opportunities, and providing activities that appeal to both boys and girls). Children's PA and sedentary behavior were measured via accelerometry. Unexpectedly, the presence of a written policy, collecting child feedback, and receiving 1 to 4 hours of staff training for PA was associated with an increase in time spent sedentary and a decrease in PA. Conversely, allocating 50% or more time in an ASP schedule for PA and providing activities that appealed to boys and girls was associated with a decrease of time spent sedentary and an increase in PA. The present state of practice in ASPs suggests that policy environment characteristics are largely unrelated to the amount of PA children accumulate while attending ASPs.

The healthy afterschool activity and nutrition documentation instrument.

BACKGROUND: Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies. PURPOSE: To describe the development of the Healthy Afterschool Activity and Nutrition Documentation (HAAND) instrument, which consists of two subscales: Healthy Afterschool Program Index for Physical Activity (HAPI-PA) and the HAPI-Nutrition (HAPI-N). METHODS: Thirty-nine afterschool programs took part in the HAAND evaluation during fall/spring 2010-2011. Inter-rater reliability data were collected at 20 afterschool programs during a single site visit via direct observation, personal interview, and written document review. Validity of the HAPI-PA was established by comparing HAPI-PA scores to pedometer steps collected in a subsample of 934 children attending 25 of the afterschool programs. Validity of the HAPI-N scores was compared against the mean number of times/week that fruits and vegetables (FV) and whole grains were served in the program. RESULTS: Data were analyzed in June/July 2011. Inter-rater percent agreement was 85%-100% across all items. Increased pedometer steps were associated with the presence of a written policy related to physical activity, amount/quality of staff training, use of a physical activity curriculum, and offering activities that appeal to both genders. Higher servings of FV and whole grains per week were associated with the presence of a written policy regarding the nutritional quality of snacks. CONCLUSIONS: The HAAND instrument is a reliable and valid measurement tool that can be used to assess the physical activity and nutritional environment of afterschool programs.

Usefulness of serum bilirubin and cardiorespiratory fitness as predictors of mortality in men.

Elevated serum bilirubin has been suggested to reduce the risk for mortality. Cardiorespiratory fitness (CRF) has also been reported to have inverse association with all-cause and cardiovascular disease (CVD) mortality. The association between serum bilirubin, all-cause and CVD mortality, and the effect of CRF on the observed association was investigated. A total of 1,279 men aged 30 to 82 years underwent baseline medical examinations from 1974 to 1997 at the Cooper Clinic in Dallas, Texas. During an average of 17 years of follow-up, 698 men died, with 253 deaths due to CVD (36%). Men in the highest bilirubin quartiles had significantly lower risk for all-cause mortality compared to men in the lowest quartiles (p for trend = 0.0043), after adjusting for age and examination year. This inverse association remained significant after further adjustment for known confounders (p for trend = 0.0018). Additional adjustment for treadmill time attenuated the association (p for trend = 0.0090). Similar patterns of association were observed between serum bilirubin quartiles and CVD mortality. CRF was inversely associated with all-cause mortality (p for trend <0.0001) after adjusting for age and examination year. This inverse association also was observed after further adjusting for known confounders (p for trend = 0.0004). After additional adjustment for serum bilirubin, the association between CRF and all-cause mortality remained significant (p for trend = 0.0012). All-cause mortality and CVD mortality were significantly lower in men in the moderate- to high-fitness quartiles in the low- and high-bilirubin groups. In conclusion, serum bilirubin level and CRF level were strongly and independently associated with all-cause and CVD mortality.