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.

Secular trends in physical fitness and body size in Lithuanian children and adolescents between 1992 and 2012.

BACKGROUND AND METHODS: There is a paucity of data on contemporary secular trends on the different aspects of physical fitness in school-aged children and adolescents. This study presents the largest ever data set on changes in fitness between 1992, 2002 and 2012 for both genders of schoolchildren aged 11-18 years (n=16 199). Eurofit test battery was used to assess the balance, flexibility, muscular strength and power, agility and cardiorespiratory fitness. Anthropometrics were also measured and body mass index (BMI) was calculated. RESULTS: The study has shown loss of flexibility, leg muscle power, upper body strength and cardiorespiratory fitness between 1992 and 2012, although there was an improvement in abdominal muscle strength in girls, agility in boys and balance in both genders during the same period. At large, negative trends in aspects of fitness seen between 1992 and 2002 have not slowed down between 2002 and 2012. Positive trends in agility and abdominal muscle strength seen before 2002 have regressed or were reversed between 2002 and 2012, while balance continued to improve at increased pace. While the BMI continued to increase in all groups, analysis of covariance has shown that it was not the main cause of changes in fitness. CONCLUSIONS: The general decline in physical fitness in Lithuanian schoolchildren observed between 1992 and 2002 continued between 2002 and 2012, although some aspects of fitness showed a positive trend. If this general negative trend continues, it will compromise the well-being of future adults and create a serious economic burden on the society.

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.

Health-related physical fitness among schoolchildren in Lithuania: a comparison from 1992 to 2002.

AIM: Socioeconomic transformation over the previous decade may have created a less active lifestyle and a decline in fitness among Lithuanian children. The aim of this study was to analyse the differences in health-related fitness among 12-, 14-, and 16-year-old Lithuanian boys and girls from 1992 to 2002. METHODS: The height and weight of the children were measured, and the Eurofit test battery was used to analyse the children's fitness. For the analyses of differences, 2,009 children aged 12 (n = 697), 14 (n = 733), and 16 (n = 579) years were tested. RESULTS: Boys and girls of all three age groups performed better in the sit and reach test (12.4-19.8%, p<0.001) and in the 20 m shuttle run test (30.0-46.0%, p<0.001) but did fewer sit-ups (3.5-7.3%, p<0.05) in 1992 compared with the results in 2002. The girls' performance was better in the long broad jump test (4.9-5.5%, p<0.001) in 1992 than in 2002. These differences were not significantly influenced by weight, body mass index (BMI), and "height+BMI". CONCLUSIONS: There was a marked decrease in aerobic fitness and flexibility and a slight increase in abdominal muscle endurance among Lithuanian schoolchildren. Leg muscular power decreased slightly in girls but remained unchanged in boys. A decrease in daily physical activity is the most likely contributing factor to the decrease in aerobic fitness and flexibility and PE reform has not been able to compensate for this effect.

Changes in Eurofit test performance of Estonian and Lithuanian children and adolescents (1992-2002).

INTRODUCTION: Both Estonia and Lithuania have a long history of pediatric fitness testing, but due to a lack of standardized test batteries spanning a substantial number of years, secular changes in fitness test performance have not been previously reported. Using the Eurofit test battery, the aim of this study was to quantify the secular changes in fitness test performance of Estonian and Lithuanian children and adolescents during the first ten years of independence. METHODS: Two cross-sectional surveys of Estonian and Lithuanian 11- to 17-year-old tested on the Eurofit in 1992 and 2002 were compared. Secular changes were calculated by first, expressing mean values (at the country x age x sex x test level) in 2002 as a percentage of mean values in 1992, and second, by subtracting 100 from the resultant and then dividing 10 to express the changes as percentage changes per annum (p.a.). Negative values indicated secular declines, and positive values secular improvements. RESULTS: Secular changes in Eurofit test performance were calculated for 12,226 Estonian and Lithuanian children and adolescents over the 10-year period. Across all Eurofit tests, secular changes ranged on average from -0.98 to +0.49% p.a., with performances less variable for Estonian children than for Lithuanian children. Secular changes were strikingly consistent across age and sex groups. DISCUSSION/CONCLUSION: This is the first study to have described the secular changes in Eurofit test performance of children and adolescents from the Baltic states. It shows that between 1992 and 2002, changes in Eurofit performance varied among tests and were not always in line with European and global changes.