Sociodemographic differences in recreational screen time before and during the COVID-19 pandemic in Canada.

Background: Over the last several years, recreational screen time has been increasing. During the COVID-19 pandemic, recreational screen time rose among Canadian youth and adults, and those who increased screen time had poorer self-reported mental health compared with those who decreased or maintained their recreational screen time levels. Data and methods: Using data from the 2017, 2018, and 2021 Canadian Community Health Survey, the prevalence of meeting the recreational screen time recommendation from the Canadian 24-Hour Movement Guidelines was compared before and during the pandemic across sociodemographic groups. Logistic regression was used to identify sociodemographic groups that were more likely to meet the recreational screen time recommendation before and during the pandemic. Results: The amount of time Canadians spent engaging in daily recreational screen time increased from 2018 to 2021, leading to fewer youth and adults meeting the recreational screen time recommendation during the pandemic compared with before. The prevalence of meeting the recommendation was lower during the pandemic compared with before the pandemic among almost all sociodemographic groups. Among youth, living in a rural area was associated with a greater likelihood of meeting the recommendation before and during the pandemic. Among adults, the following characteristics were all associated with a greater likelihood of meeting the recommendation during the pandemic: being female; living in a rural area or a small population centre; identifying as South Asian; being an immigrant to Canada; living in a two-parent household; being married or in a common-law relationship or widowed, separated, or divorced; working full time; and being a health care worker. Interpretation: The prevalence of meeting the recreational screen time recommendation during the pandemic was lower overall compared with before the pandemic. Several sociodemographic groups were more likely to meet the recommendation during the pandemic. Continued surveillance of recreational screen time is necessary to monitor the indirect effects of the pandemic and to identify population subgroups that would benefit from tailored interventions in the pandemic recovery period.

Cardiorespiratory fitness is a strong and consistent predictor of morbidity and mortality among adults: an overview of meta-analyses representing over 20.9 million observations from 199 unique cohort studies.

OBJECTIVE: To examine and summarise evidence from meta-analyses of cohort studies that evaluated the predictive associations between baseline cardiorespiratory fitness (CRF) and health outcomes among adults. DESIGN: Overview of systematic reviews. DATA SOURCE: Five bibliographic databases were searched from January 2002 to March 2024. RESULTS: From the 9062 papers identified, we included 26 systematic reviews. We found eight meta-analyses that described five unique mortality outcomes among general populations. CRF had the largest risk reduction for all-cause mortality when comparing high versus low CRF (HR=0.47; 95% CI 0.39 to 0.56). A dose-response relationship for every 1-metabolic equivalent of task (MET) higher level of CRF was associated with a 11%-17% reduction in all-cause mortality (HR=0.89; 95% CI 0.86 to 0.92, and HR=0.83; 95% CI 0.78 to 0.88). For incident outcomes, nine meta-analyses described 12 unique outcomes. CRF was associated with the largest risk reduction in incident heart failure when comparing high versus low CRF (HR=0.31; 95% CI 0.19 to 0.49). A dose-response relationship for every 1-MET higher level of CRF was associated with a 18% reduction in heart failure (HR=0.82; 95% CI 0.79 to 0.84). Among those living with chronic conditions, nine meta-analyses described four unique outcomes in nine patient groups. CRF was associated with the largest risk reduction for cardiovascular mortality among those living with cardiovascular disease when comparing high versus low CRF (HR=0.27; 95% CI 0.16 to 0.48). The certainty of the evidence across all studies ranged from very low-to-moderate according to Grading of Recommendations, Assessment, Development and Evaluations. CONCLUSION: We found consistent evidence that high CRF is strongly associated with lower risk for a variety of mortality and incident chronic conditions in general and clinical populations.

The Effect of Sedentary Behaviour on Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis.

BACKGROUND: Cardiorespiratory fitness (CRF) is an important indicator of current and future health. While the impact of habitual physical activity on CRF is well established, the role of sedentary behaviour (SB) remains less understood. OBJECTIVE: We aimed to determine the effect of SB on CRF. METHODS: Searches were conducted in MEDLINE, Embase, PsycINFO, CINAHL and SPORTDiscus from inception to August 2022. Randomised controlled trials, quasi-experimental studies and cohort studies that assessed the relationship between SB and CRF were eligible. Narrative syntheses and meta-analyses summarised the evidence, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty was based on evidence from randomised controlled trials. RESULTS: This review included 18 studies that focused on youth (four randomised controlled trials, three quasi-experimental studies, 11 cohort studies) and 24 on adult populations (15 randomised controlled trials, five quasi-experimental studies, four cohort studies). In youth and adults, evidence from randomised controlled trials suggests mixed effects of SB on CRF, but with the potential for interventions to improve CRF. Quasi-experimental and cohort studies also support similar conclusions. Certainty of evidence was very low for both age groups. A meta-analysis of adult randomised controlled trials found that interventions targeting reducing SB, or increasing physical activity and reducing SB, had a significant effect on post-peak oxygen consumption (mean difference = 3.16 mL.kg-1.min-1, 95% confidence interval: 1.76, 4.57). CONCLUSIONS: Evidence from randomised controlled trials indicates mixed associations between SB and CRF, with the potential for SB to influence CRF, as supported by meta-analytical findings. Further well-designed trials are warranted to confirm the relationship between SB and CRF, explore the effects of SB independent from higher intensity activity, and investigate the existence of such relationships in paediatric populations. CLINICAL TRIAL REGISTRATION: PROSPERO CRD42022356218.

Sedentary time at school and work in Canada.

OBJECTIVES: High levels of sedentary time (ST) are associated with poor physical and mental health. Given that Canadians spend a large portion of their days at school and work, they may be important targets for reducing ST. Our objectives are to estimate the daily amount of school and work ST among Canadians, examine differences by subgroups, and determine associations with health. METHODS: Using the 2020 Canadian Community Health Survey Healthy Living Rapid Response module (N = 5242), the amount of time spent sitting while at school and work was estimated among youth (12-17 years) and adults (18-34 and 35-64 years). Differences by sociodemographics and 24-Hour Movement Guideline adherence were assessed with independent t-tests. Associations between school and work ST and health indicators were assessed using adjusted logistic regression. RESULTS: Canadian youth aged 12-17 years and adults aged 18-34 years reported an average of 4.5 and 5.2 h/day of school ST, respectively. Adults 18-34 years and 35-64 years reported an average of 3.9 and 4.0 h/day of work ST, respectively. School and work ST differed within several subgroups. Among adults 18-34 years, higher school ST was associated with a reduced odds of 'excellent/very good' mental health, whereas higher work ST was associated with a greater likelihood of reporting 'excellent/very good' general health. CONCLUSION: Canadian youth and working-age adults report an average of 4-5 h/day sedentary at school or work. This is the first study estimating school and work ST in a representative sample of Canadians and will aid in increasing awareness of setting-specific behaviours to better inform targeted interventions including addressing inequalities in ST.

RéSUMé: OBJECTIFS: Des niveaux élevés de sédentarité sont associés à une mauvaise santé physique et mentale. Étant donné que les Canadiens passent une grande partie de leur journée à l'école et au travail, ils peuvent représenter des cibles privilégiées sur la question de la sédentarité. Nos objectifs sont les suivants : estimer le temps que les Canadiens passent assis par jour à l'école et au travail, c'est-à-dire le temps de sédentarité, examiner les différences qui existent entre les sous-groupes et déterminer les effets sur la santé. MéTHODES: À l'aide du module de réponse rapide concernant un mode de vie sain de l'Enquête sur la santé dans les collectivités canadiennes de 2020 (N = 5 242), nous avons estimé le temps passé assis à l'école et au travail chez les jeunes (12­17 ans) et chez les adultes (18­34 ans et 35­64 ans). Nous avons évalué les différences en fonction des données sociodémographiques et en fonction du respect (ou non) des directives en matière de mouvement sur 24 heures, ce à l'aide de tests indépendants. Grâce à une régression logistique ajustée, nous avons évalué le lien entre la sédentarité à l'école et au travail et les indicateurs de santé. RéSULTATS: Les jeunes Canadiens âgés de 12 à 17 ans et les adultes âgés de 18 à 34 ans ont déclaré un temps moyen de sédentarité par jour à l'école de 4,5 heures et de 5,2 heures respectivement. Les adultes de 18 à 34 ans et de 35 à 64 ans ont déclaré un temps moyen de sédentarité par jour au travail de 3,9 heures et de 4 heures respectivement. Le temps de sédentarité à l'école et au travail varie selon les sous-groupes. Chez les adultes de 18 à 34 ans, un temps de sédentarité plus élevé à l'école réduit la probabilité d'avoir une santé mentale « excellente/très bonne ¼, tandis qu'un temps de sédentarité plus élevé au travail est associé à une plus grande probabilité de déclarer une santé générale « excellente/très bonne ¼. CONCLUSION: Les jeunes Canadiens et les adultes en âge de travailler déclarent un temps de sédentarité moyen de 4 à 5 heures par jour à l'école ou au travail. Il s'agit de la première étude qui estime le temps de sédentarité à l'école et au travail dans un échantillon représentatif de Canadiens. Elle contribuera à mieux faire connaître les comportements spécifiques sur la question, afin de mieux guider les interventions ciblées, notamment la lutte contre les inégalités en matière de sédentarité.

Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users.

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Associations between school-level environment and individual-level factors of walking and cycling to school in Canadian youth.

Identifying individual-level and school-level correlates of walking and cycling to school remains a public health priority as only one in four Canadian youth actively travels to school. This study aimed to estimate the prevalence of Canadian youth in grades 6 to 10 who walk, cycle, or use motorised transport to go to school, and to examine if school neighbourhood walkability, neighbourhood-level and individual-level correlates are associated with mode of transportation to school. Data come from the 2017/2018 Health Behaviour in School-aged Children study. The walkability of the schools' neighbourhood was measured using the Canadian Active Living Environments (Can-ALE) index. We observed that only 22.4% and 4.2% of youth walked and cycled to school, respectively. Most (73.4%) used motorised transport to school, including 53.2% of youth who lived less than 5 minutes from school. Schools located in neighbourhoods with higher Can-ALE classes (i.e., higher walkability) were positively associated with walking to school. No statistically significant association between school walkability and cycling to school was observed. Individual-level socioeconomic status (SES) was associated with walking, but not cycling, to school. Conversely, neighbourhood-level SES was associated with cycling, but not with walking, to school. Correlates of walking to school differed from those for cycling to school, suggesting that different approaches to promoting active transportation are needed.

Identifying the sociodemographic and work-related factors related to workers' daily physical activity using a decision tree approach.

BACKGROUND: The social and behavioural factors related to physical activity among adults are well known. Despite the overlapping nature of these factors, few studies have examined how multiple predictors of physical activity interact. This study aimed to identify the relative importance of multiple interacting sociodemographic and work-related factors associated with the daily physical activity patterns of a population-based sample of workers. METHODS: Sociodemographic, work, screen time, and health variables were obtained from five, repeated cross-sectional cohorts of workers from the Canadian Health Measures Survey (2007 to 2017). Classification and Regression Tree (CART) modelling was used to identify the discriminators associated with six daily physical activity patterns. The performance of the CART approach was compared to a stepwise multinomial logistic regression model. RESULTS: Among the 8,909 workers analysed, the most important CART discriminators of daily physical activity patterns were age, job skill, and physical strength requirements of the job. Other important factors included participants' sex, educational attainment, fruit/vegetable intake, industry, work hours, marital status, having a child living at home, computer time, and household income. The CART tree had moderate classification accuracy and performed marginally better than the stepwise multinomial logistic regression model. CONCLUSION: Age and work-related factors-particularly job skill, and physical strength requirements at work-appeared as the most important factors related to physical activity attainment, and differed based on sex, work hours, and industry. Delineating the hierarchy of factors associated with daily physical activity may assist in targeting preventive strategies aimed at promoting physical activity in workers.

Strength-training and balance activities in Canada: historical trends and current prevalence. / Activités de musculation et d'amélioration de l'équilibre au Canada : historique des tendances et prévalence actuelle.

INTRODUCTION: Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000-2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22 physical activities. In 2020, a healthy living rapid response module (HLV-RR) on the CCHS asked new questions on the frequency of muscle/bonestrengthening and balance activities. The objectives of the study were to (1) estimate and characterize adherence to meeting the muscle/bone-strengthening and balance recommendations; (2) examine associations between muscle/bone-strengthening and balance activities with physical and mental health; and (3) examine trends (2000-2014) in adherence to recommendations. METHODS: Using data from the 2020 CCHS HLV-RR, we estimated age-specific prevalence of meeting recommendations. Multivariate logistic regressions examined associations with physical and mental health. Using data from the 2000-2014 CCHS, sex-specific temporal trends in recommendation adherence were explored using logistic regression. RESULTS: Youth aged 12 to 17 years (56.6%, 95% CI: 52.4-60.8) and adults aged 18 to 64 years (54.9%, 95% CI: 53.1-56.8) had significantly greater adherence to the muscle/ bone-strengthening recommendation than adults aged 65 years and older (41.7%, 95% CI: 38.9-44.5). Only 16% of older adults met the balance recommendation. Meeting the recommendations was associated with better physical and mental health. The proportion of Canadians who met the recommendations increased between 2000 and 2014. CONCLUSION: Approximately half of Canadians met their age-specific muscle/bonestrengthening recommendations. Reporting on the muscle/bone-strengthening and balance recommendations elevates their importance alongside the already recognized aerobic recommendation.

Daily accelerometer-measured physical activity patterns and associations with cardiometabolic health among Canadian working adults.

Background: Previous studies examining the cardiometabolic risks associated with physical activity (PA) in workers have predominantly used self-reported measures. Little is known about workers' distinct daily PA patterns and whether these are linked with cardiometabolic risks. This study examined associations between patterns of workers' accelerometer-measured daily PA and four markers of cardiometabolic health. Data and methods: Working adults (N=8,229; 47% women; average age: 42 years; standard deviation = 0.3) were sampled from the Canadian Health Measures Survey (five cycles: 2007 to 2017). Accelerometer devices measured daily PA, and hierarchical cluster analysis identified distinct activity patterns. Multiple linear regression analyses examined associations between activity patterns and cardiometabolic risk markers (waist circumference, systolic and diastolic blood pressure, and non-high-density lipoprotein [HDL] cholesterol). Results: Workers were classified into six distinct activity patterns. On average, compared with workers classified in the "lowest activity" pattern, workers with the "moderate consistent activity," "fluctuating moderate activity," "high daytime activity" and "highest activity" patterns were associated with lower waist circumferences; workers with the "fluctuating moderate activity" and "highest activity" patterns were associated with lower systolic blood pressure; the "moderate evening activity" pattern was associated with lower diastolic blood pressure; and workers with the "fluctuating moderate activity," "high daytime activity" and "highest activity" patterns were associated with lower non-HDL cholesterol. "High daytime activity" was associated with lower waist circumference in women, compared with men, and the "moderate consistent activity" and "fluctuating moderate activity" patterns were associated with lower diastolic blood pressure in younger workers (40 years or younger). Interpretation: Workers with high daily PA levels tended to have the most optimal cardiometabolic health. Some evidence suggested that there are benefits to moderate levels of PA, particularly for lowering waist circumference and non-HDL cholesterol. Findings may assist in identifying workers for PA initiatives to promote cardiometabolic health benefits.

The association between social media use and physical activity among Canadian adolescents: a Health Behaviour in School-aged Children (HBSC) study.

OBJECTIVE: To determine the association between social media use (SMU) and physical activity (PA) among Canadian adolescents. METHODS: We used data from 12,358 participants in grades 6 to 10 who responded to the Canadian component of the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Social media intensity and problematic SMU were assessed using a 4-point mutually exclusive scale that contained three categories based on intensity (non-active, active, and intense SMU) and one category based on the presence of addiction-like symptoms irrespective of intensity (problematic SMU). PA was assessed for five domains (i.e., school curriculum, organized sport, exercise, outdoor play, and active transport) and dichotomized using the first quartile to represent high PA engagement in each domain. Meeting PA recommendation of 60 min per day of moderate-to-vigorous PA was calculated using the sum of the five domains. Logistic regression models were used to assess the association between SMU and PA, with active SMU used as the reference group for all models. RESULTS: Non-active SMU was associated with lower odds of meeting the daily PA recommendations and of high engagement in all five domains of PA when compared to active SMU. Intense SMU was associated with higher odds of meeting the daily PA recommendations. Problematic SMU was not associated with meeting daily PA recommendations, but it was significantly associated with lower odds of high PA engagement in the exercise domain. CONCLUSION: The findings of this study suggest that non-active SMU was significantly associated with lower PA levels. Problematic SMU was only significantly associated with lower PA levels in the exercise domain. Intense SMU was associated with higher odds of meeting the PA recommendation.

RéSUMé: OBJECTIF: Établir la relation entre l'utilisation des médias sociaux et l'activité physique chez les adolescents canadiens. MéTHODES: Nous avons utilisé les données de 12 358 participants de la 6e à la 10e année qui ont répondu au volet canadien de l'Enquête sur les comportements de santé des jeunes d'âge scolaire de 2017­2018 (HBSC). L'intensité des médias sociaux et leur utilisation problématique ont été évaluées à l'aide d'une échelle à quatre points mutuellement exclusifs contenant trois catégories basées sur l'intensité (utilisation non active, active et intense des médias sociaux) et une catégorie basée sur la présence de symptômes de dépendance indépendamment de l'intensité (utilisation problématique des médias sociaux). L'activité physique a été évaluée pour cinq domaines (c'est-à-dire le programme scolaire, le sport organisé, l'exercice, le jeu en plein air et le transport actif) et dichotomisée en utilisant le premier quartile pour représenter la participation à une activité physique élevée dans chaque domaine. Le respect de la recommandation de 60 min par jour d'activité physique modérée à vigoureuse a été calculé en utilisant la somme des cinq domaines. Des modèles de régression logistique ont été utilisés pour évaluer la relation entre l'utilisation des médias sociaux et l'activité physique, l'utilisation active des médias sociaux étant utilisée comme groupe de référence pour tous les modèles. RéSULTATS: L'utilisation non active des médias sociaux était associée à une probabilité plus faible de respecter les recommandations en matière d'activité physique quotidienne et à une participation élevée dans les cinq domaines de l'activité physique, par rapport à l'utilisation active des médias sociaux. Une utilisation intense des médias sociaux était associée à une probabilité plus élevée de respecter les recommandations en matière d'activité physique quotidienne. Une utilisation problématique des médias sociaux n'était pas associée au respect des recommandations en matière d'activité physique quotidienne, mais elle était fortement associée à une probabilité moindre de participation élevée à une activité physique dans le domaine de l'exercice. CONCLUSION: Les résultats de cette étude suggèrent que l'utilisation non active des médias sociaux est fortement associée à des niveaux d'activité physique plus faibles. Une utilisation problématique des médias sociaux n'était fortement associée à des niveaux d'activité physique plus faibles que dans le domaine de l'exercice. Une utilisation intense des médias sociaux était associée à une probabilité plus élevée de respecter la recommandation en matière d'activité physique.

Top 10 International Priorities for Physical Fitness Research and Surveillance Among Children and Adolescents: A Twin-Panel Delphi Study.

BACKGROUND: The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. OBJECTIVE: This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents. METHODS: Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel. RESULTS: There was strong between-panel agreement (panel 1: rs = 0.76, p < 0.01; panel 2: rs = 0.77, p < 0.01) in the priorities identified. The list of the final top 10 priorities included (i) "conduct longitudinal studies to assess changes in fitness and associations with health". This was followed by (ii) "use fitness surveillance to inform decision making", and (iii) "implement regular and consistent international/national fitness surveys using common measures". CONCLUSIONS: The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond.

Health associations with meeting the new Canadian 24-Hour Movement Guidelines recommendations according to body mass index classes in Canadian adults.

Background: Data on meeting the Canadian 24-Hour Movement Guidelines for adults (24-H Guidelines) and associations with health indicators by body mass index (BMI) class are needed to support public health surveillance. The aim of this study was to describe the proportion of Canadian adults meeting individual and various combinations of the 24-H Guidelines by BMI class and their association with health indicators. Data and methods: Data from the cross-sectional Canadian Health Measures Survey cycles 1 to 4 (2007 to 2015, n = 10,515 adults aged 18 to 79 years) were used. Daily time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behaviour were assessed using accelerometry. Sleep duration, recreational screen time, chronic conditions, sociodemographic characteristics, and general and mental health were self-reported. The BMI, waist circumference, blood pressure and aerobic fitness were directly measured. Respondents were classified as meeting the 24-H Guidelines when: • the MVPA was 150 minutes per week or more; • sedentary time was nine hours or less per day; • recreational screen time was three hours or less per day; • sleep duration was seven to nine hours per day for individuals aged 18 to 64 years or seven to eight hours per day for individuals aged 65 years and older. Results: Significantly fewer adults with overweight (6.1%) or class I (4.3%) and class II or III (3.9%) obesity met all three 24-H Guidelines compared with those with normal weight (9.5%). Meeting all three or two recommendations of the 24-H Guidelines was generally associated with a lower waist circumference, higher aerobic physical fitness and self-perceived general health regardless of BMI class. Interpretation: Canadian adults living with overweight and obesity are less likely to meet the 24-H Guidelines. Most of the benefits associated with meeting the 24-H Guidelines are observed regardless of BMI status.

How sedentary are Canadian adults? It depends on the measure.

Introduction: The new Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years and older recommend that adults limit daily sedentary time to eight hours or less, including three hours or less of recreational screen time. The eight-hour recommendation was centred between the evidence from research using self-reported sitting time (threshold: seven hours or less per day) and accelerometer-measured sedentary time (threshold: nine hours or less per day). The purpose of this study is to compare the percentages of Canadians meeting three different sedentary thresholds (three hours or less per day of screen time, seven hours or less per day of self-reported sitting time and nine hours or less per day of accelerometer-measured sedentary time). Methods: This analysis is based on 2,511 adults (aged 18 to 79 years) from Cycle 3 of the Canadian Health Measures Survey, in 2012 and 2013. Screen time and sitting time were assessed via self-report, and average daily sedentary time was assessed using a hip-worn Actical accelerometer. Results: Adults self-reported an average daily screen time of 3.2 hours (95% confidence interval [CI]: 3.0 to 3.5) and an average daily sitting time of 5.7 hours (95% CI: 5.4 to 6.0). According to accelerometry data, adults accumulated an average of 9.8 hours per day (95% CI: 9.7 to 9.9) of sedentary time. Adherence varied, with 57.7% meeting the self-reported recreational screen time threshold of three hours or less per day, 71.7% meeting the self-reported sitting time threshold of seven hours or less per day and 26.5% meeting the accelerometer-measured sedentary time threshold of nine hours or less per day. Interpretation: The percentage of Canadian adults meeting the three different sedentary behaviour thresholds varied widely. The findings in this article highlight the difference in sedentary time between what Canadians report versus what is measured by an accelerometer.

Chronic health effects associated with electronic cigarette use: A systematic review.

Introduction: Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods: Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results: A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions: This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among adults: An overview of reviews from high income countries.

BACKGROUND: Built environments have been implicated in the development of chronic disease, with physical activity (PA) considered one of the critical mechanisms for this relationship. Substantial growth in research on built environments and PA makes navigating the available evidence challenging. OBJECTIVE: To examine and describe the current state, strength and quality of research investigating the associations between built environments and PA domains of active living (i.e., leisure, transportation, occupational) and total PA among adults (≥18 years) from high-income OECD countries. METHODS: We conducted an overview of systematic reviews. A systematic search of six bibliographic databases and grey literature from January 2000 to May 2020. Review quality was assessed with the AMSTAR2. Results by age group were synthesized narratively and direction of association displayed using harvest plots. Certainty of the evidence was assessed using a modified GRADE approach. RESULTS: The overview included 116 systematic reviews. Most evidence was cross-sectional and of low-to-very low quality. Moderate-to-high certainty of evidence supported positive associations between environments that support active transportation (e.g., walkability, walking infrastructure, street connectivity, land-use mix) and transportation PA among adults/working-aged adults. Across all age groups, there was very low-to-moderate certainty for consistent positive associations between point of decision prompts (e.g., signs in stairwells and along paths) and all PA. Evidence from older adults was of very low certainty and largely equivocal. There was little-to-no evidence for young and middle-aged adults and occupational PA. DISCUSSION: While there has been an increase in evidence from observational and natural experiment studies, most has been related to active transportation infrastructure and point of decision prompts. There remains a need for these studies to evaluate built environments for leisure and occupational PA and among younger and older adults, and for high quality reviews to summarize this evidence. Interventions that target changes to the built environment show promise for promoting PA among adults, providing an important means to combat the global physical inactivity crisis.

The influence of removing the 10-minute bout requirement on the demographic, behaviour and health profiles of Canadian adults who meet the physical activity recommendations.

Background: Recently, the Canadian 24-Hour Movement Guidelines for Adults were released, and included a revised physical activity (PA) recommendation. The recommendation of 150 minutes per week of moderate-to-vigorous intensity PA (MVPA) was revised, from requiring that MVPA be accrued in bouts of 10 minutes or more (bouted) to having no bout requirement (non-bouted). The objective of this study was to assess whether there were differences in sociodemographic, health and fitness characteristics of Canadians who met the bouted and non-bouted PA recommendations. Data and methods: Using adult (aged 18 to 79 years) accelerometer data from three combined cycles of the nationally representative Canadian Health Measures Survey (N = 7,102), this study compared adherence to the bouted and non-bouted recommendations. Differences in sociodemographic, health and fitness measures were assessed using independent t-tests and chi-squares. Multivariate linear and logistic regressions controlling for age, sex, household education and smoking examined associations with health and fitness measures. Results: More adults met the PA recommendation using the non-bouted versus bouted (45.3% vs. 18.5%) requirement. Characteristics of those who met the bouted and only the non-bouted recommendations were similar. Exceptions among those who met only the non-bouted recommendation compared with meeting the bouted recommendation included fewer adults aged 65 years and older; lower MVPA, recreation PA and transport PA; and higher sedentary time, light PA and grip strength. Interpretation: Although the removal of the 10-minute bout requirement increased the proportion of Canadian adults who met the PA recommendation, there were no substantial differences in the sociodemographic and health characteristics of the populations captured by the bouted and non-bouted definitions. Results help to inform the transition in reporting for PA surveillance.

Workers' Activity Profiles Associated With Predicted 10-Year Cardiovascular Disease Risk.

Background There is a need to explore common activity patterns undertaken by workers and the association between these activity profiles and cardiovascular disease (CVD). This study explored the number and type of distinct profiles of activity patterns among workers and the association between these profiles and predicted 10-year risk for a first atherosclerotic CVD event. Methods and Results Distinct activity patterns from a cross-section of workers' accelerometer data were sampled from Canadian Health Measures Survey participants (5 cycles, 2007-2017) and identified using hierarchical cluster analysis techniques. Covariates included accelerometer wear time, work factors, sociodemographic factors, clinical markers, and lifestyle variables. Associations between activity profiles and high atherosclerotic CVD risk >10% were estimated using robust Poisson regression models. Six distinct activity profiles were identified from 8909 workers. Compared with the "lowest activity" profile, individuals in the "highest activity" and "moderate evening activity" profiles were at 42% lower risk (relative risk [RR], 0.58; 95% CI, 0.47, 0.70) and 33% lower risk (RR, 0.67; 95% CI, 0.44, 0.87) of predicted 10-year atherosclerotic CVD risk of >10%, respectively. "Moderate activity" and "fluctuations of moderate activity" profiles were also associated with lower risk estimates, whereas the "high daytime activity" profile was not statistically different to the reference profile. Conclusions Workers accumulating physical activity throughout the day and during recreational hours were found to have optimal CVD risk profiles. Workers accumulating physical activity only during daytime work hours were not associated with reduced CVD risk. Findings can inform alternative strategies to conferring the cardiovascular benefits of physical activity among workers. Large prospective studies are needed to confirm these findings.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries.

BACKGROUND: Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews. OBJECTIVE: Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years). METHODS: We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach. RESULTS: This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit. DISCUSSION: There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

The Physical Activity Levels and Sitting Time of Adults Living With Atrial Fibrillation: The CHAMPLAIN-AF Study.

Background: The primary goal of this study was to determine the time spent completing moderate-to-vigorous intensity physical activity (MVPA) among adults with atrial fibrillation (AF). Secondary aims examined MVPA and sitting time (ST) by AF subtypes (ie, paroxysmal, persistent, long-standing persistent, and permanent) and associations between MVPA or ST and knowledge, task self-efficacy, and outcome expectations. Methods: An observational study was conducted in the Champlain region of Ontario, Canada. AF patients completed a survey to determine MVPA and ST using the Short-Form International Physical Activity Questionnaire. Results: A total of 619 patients (66% male; median age 65 years [95% CI 64-67 years]) completed the survey. Median MVPA and ST were 100 (60-120) min/wk and 6 (5-6) h/d; 56% of patients were not meeting the Canadian 24H Movement Guidelines. Most patients (54%) did not know/were unsure of the MVPA recommendations, yet 72% thought physical activity should be part of AF management. Positive correlations were found between higher MVPA levels and the following: (i) speaking to a healthcare professional about engaging in physical activity for managing AF (ρ = 0.108, P = 0.017); (ii) greater confidence regarding ability to perform physical activity and muscle-strengthening exercise (ρ = 0.421, P < 0.01); and (iii) patient agreement that AF would be better managed if they were active (ρ = 0.205, P < 0.01). Conclusions: Many AF patients do not meet the MVPA recommendations, which may be due to lack of physical activity knowledge. Exercise professionals may help educate patients on the benefits of physical activity, improve task-self efficacy, and integrate MVPA into patient lifestyles.

Introduction: Le principal objectif de la présente étude était de déterminer le temps consacré à faire de l'activité physique modérée à vigoureuse (APMV) chez les adultes atteints de fibrillation auriculaire (FA). Les objectifs secondaires visaient à examiner l'APMV et le temps en position assise (TA) selon les sous-types de FA (c.-à-d. paroxystique, persistante, persistante de longue durée et permanente) et les associations entre l'APMV ou le TA et les connaissances, le sentiment d'auto-efficacité et les attentes de résultats. Méthodes: Nous avons réalisé une étude observationnelle dans la région de Champlain, en Ontario, au Canada. Les patients atteints de FA ont rempli une enquête pour déterminer l'APMV et le TA à l'aide du questionnaire court International Physical Activity Questionnaire (IPAQ). Résultats: Un total de 619 patients (66 % d'hommes; âge médian de 65 ans [IC à 95 % 64-67 ans]) a rempli l'enquête. L'APMV et le TPA médians étaient de 100 (60-120) min/sem et de 6 (5-6) h/j; 56 % des patients ne répondaient pas aux Directives canadiennes en matière de mouvement sur 24 heures. La plupart des patients (54 %) ne connaissaient pas les recommandations d'APMV ou n'étaient pas certains de les connaître, mais 72 % pensaient que l'activité physique devrait faire partie de la prise en charge de la FA. Nous avons observé des corrélations positives entre les degrés plus élevés d'APMV et ce qui suit : (i) le fait de parler à un professionnel de la santé de la pratique de l'activité physique pour prendre en charge la FA (ρ = 0,108, P = 0,017); (ii) la confiance accrue quant à la capacité de faire de l'activité physique et les exercices de renforcement musculaire (ρ = 0,421, P < 0,01); (iii) l'accord du patient sur le fait que la pratique de l'activité physique contribuerait à une meilleure prise en charge de la FA (ρ = 0,205, P < 0,01). Conclusions: Plusieurs patients atteints de FA ne répondaient pas aux recommandations d'APMV, possiblement en raison du manque de connaissances concernant l'activité physique. Les professionnels de l'activité physique peuvent contribuer à l'éducation des patients afin de leur faire connaître les avantages de l'activité physique, améliorer leur auto-efficacité et intégrer l'APMV à leur mode de vie.