Deirdre Harrington and Michelle O'Reilly discuss the article "Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster ...randomised controlled trial" by Kirsten Corder and colleagues.
The UK Government restrictions on non-essential work in response to the coronavirus disease 2019 (COVID-19) pandemic forced millions of working aged-adults into an unplanned lifestyle change. We ...present data on changes in commuting behaviour in response to COVID-19 and describe the facilitators and barriers to switching commuting behaviours, with a specific focus on cycling and walking.
An online survey queried individuals’ transport mode to/from work before and when becoming aware of COVID-19, when restrictions were in place and the transport mode they may use once restrictions are lifted. Free-form text responses were collected on why they may switch to a sustainable commute mode in the future and what would help/allow them to achieve this. Quantitative and qualitative data on those who commuted by car (single occupant) and public transport (bus/rail/park & ride) were analysed and presented separately.
Overall, 725 car and public transport commuters responded; 72.4% were car commuters and 27.6% were public transport commuters before COVID-19. Of the car commuters, 81.9% may continue travelling by car once restrictions are lifted while 3.6% and 6.5% might change to walking and cycling, respectively. Of the public transport commuters, 49.0% might switch modes. From the free-form text responses three themes were identified: (a) perceived behavioural control towards cycling and walking (infrastructure and safety of roads, distance, weather) (b) key motivators to encourage a switch to cycling and walking (provision to support cycling, personal and environmental benefits); (c) the demands of current lifestyle (job requirements, family and lifestyle commitments).
These UK data show how the COVID-19 pandemic has been an “external shock” causing some individuals to reassess their commuting mode. This provides an opportunity for theory-based behaviour change interventions tackling motivations, barriers and beliefs towards changing commute mode.
•Some car and public transport commuters in the UK are considering a switch of transport mode once COVID-19 restrictions lift.•Positively, some will switch to cycling or walking but some bus/rail users will switch to a car for safety reasons.•Barriers and motivators have a role for car and public transport commuters when thinking about changing individual commuting mode.•The COVID-19 pandemic provides an opportunity for theory-based transport interventions and actions at individual, social and micro-physical environment levels.
PURPOSECommonly used physical activity metrics tell us little about the intensity distribution across the activity profile. The purpose of this paper is to introduce a metric, the intensity gradient, ...which can be used in combination with average acceleration (overall activity level) to fully describe the activity profile.
METHODSA total of 1669 adolescent girls (sample 1) and 295 adults with type 2 diabetes (sample 2) wore a GENEActiv accelerometer on their nondominant wrist for up to 7 d. Body mass index and percent body fat were assessed in both samples and physical function (grip strength, Short Physical Performance Battery, and sit-to-stand repetitions) in sample 2. Physical activity metrics were as followsaverage acceleration (AccelAV); the intensity gradient (IntensityGRAD from the log–log regression line25-mg intensity bins x/time accumulated in each bin y); total moderate-to-vigorous physical activity (MVPA); and bouted MVPA (sample 2 only).
RESULTSCorrelations between AccelAV and IntensityGRAD (r = 0.39–0.51) were similar to correlations between AccelAV and bouted MVPA (r = 0.48) and substantially lower than between AccelAV and total MVPA (r ≥ 0.93). IntensityGRAD was negatively associated with body fatness in sample 1 (P < 0.05) and positively associated with physical function in sample 2 (P < 0.05); associations were independent of AccelAV and potential covariates. By contrast, MVPA was not independently associated with body fatness or physical function.
CONCLUSIONAccelAV and IntensityGRAD provide a complementary description of a person’s activity profile, each explaining unique variance, and independently associated with body fatness and/or physical function. Both metrics are appropriate for reporting as standardized measures and suitable for comparison across studies using raw acceleration accelerometers. Concurrent use will facilitate investigation of the relative importance of intensity and volume of activity for a given outcome.
The activPAL has been identified as an accurate and reliable measure of sedentary behaviour. However, only limited information is available on the accuracy of the activPAL activity count function as ...a measure of physical activity, while no unit calibration of the activPAL has been completed to date. This study aimed to investigate the criterion validity of the activPAL, examine the concurrent validity of the activPAL, and perform and validate a value calibration of the activPAL in an adolescent female population. The performance of the activPAL in estimating posture was also compared with sedentary thresholds used with the ActiGraph accelerometer.
Thirty adolescent females (15 developmental; 15 cross-validation) aged 15-18 years performed 5 activities while wearing the activPAL, ActiGraph GT3X, and the Cosmed K4B2. A random coefficient statistics model examined the relationship between metabolic equivalent (MET) values and activPAL counts. Receiver operating characteristic analysis was used to determine activity thresholds and for cross-validation. The random coefficient statistics model showed a concordance correlation coefficient of 0.93 (standard error of the estimate = 1.13). An optimal moderate threshold of 2997 was determined using mixed regression, while an optimal vigorous threshold of 8229 was determined using receiver operating statistics. The activPAL count function demonstrated very high concurrent validity (r = 0.96, p<0.01) with the ActiGraph count function. Levels of agreement for sitting, standing, and stepping between direct observation and the activPAL and ActiGraph were 100%, 98.1%, 99.2% and 100%, 0%, 100%, respectively.
These findings suggest that the activPAL is a valid, objective measurement tool that can be used for both the measurement of physical activity and sedentary behaviours in an adolescent female population.
Objective
To examine the combined influence of moderate‐to‐vigorous physical activity (MVPA) and sedentary behavior on obesity in US adults.
Design and Methods
Cross‐sectional analyses were ...undertaken on a nationally representative sample of 5,083 adults from the April 2003 and June 2005 National Health and Nutrition Examination Survey. Self‐reported TV time was divided into low, moderate, and high categories. Accelerometer‐derived total sedentary and MVPA minutes divided into low, moderate, and high tertiles. The independent associations between MVPA, TV, and total sedentary time and obesity were examined using logistic regression. Participants were then cross tabulated into nine MVPA–sedentary behavior groups, and logistic regression was used to examine the combined influence of MVPA and sedentary behavior on the odds of being obese.
Results
MVPA was consistently inversely associated with obesity, regardless of sedentary behavior odds ratio (OR) = 1.80‐4.00. There were inconsistent positive associations between TV time and risk of obesity in men, but not between total sedentary time and risk of obesity in either men or women.
Conclusions
Obesity was more strongly related to MVPA than either TV time or total sedentary time in US adults. Small differences in daily MVPA (5‐10 min) were associated with relatively large differences in risk of obesity.
Abstract Objective To investigate associations between anthropometric measurements and total body fat, abdominal adipose tissue, and cardiovascular disease risk factors in a large biracial sample. ...Patients and Methods This study is limited to cross-sectional analyses of data from participants attending a baseline visit between January 26, 1996, and February 1, 2011. The sample included 2037 individuals aged 18 to 69 years: 488 African American women (24%), 686 white women (34%), 196 African American men (9%), and 667 white men (33%). Anthropometry included weight; hip circumference; waist circumference; waist-hip, waist-height, and weight-height ratios; body adiposity index; and body mass index. Body fat and percentage of fat were measured by dual-energy x-ray absorptiometry, and abdominal visceral and subcutaneous adipose tissue were measured by computed tomography. Bivariate correlations, logistic regression models, and receiver operator characteristic curves were used, and analyses were stratified by sex and race. Results In each sex-by-race group, all anthropometric measures were highly correlated with percentage of fat, fat mass, and subcutaneous adipose tissue and moderately correlated with visceral adipose tissue, with the exception of the waist-hip ratio. The odds of having an elevated cardiometabolic risk were increased more than 2-fold per SD increase for most anthropometric variables, and the areas under the curve for each anthropometric measure were significantly greater than 0.5. Conclusion Several common anthropometric measures were moderately to highly correlated with total body fat, abdominal fat, and cardiovascular disease risk factors in a biracial sample of women and men. This comprehensive analysis provides evidence of the linkage between simple anthropometric measurements and the purported pathways between adiposity and health.
School recess provides a valuable opportunity for children's daily moderate- to vigorous-intensity physical activity (MVPA). This study aimed to quantify MVPA during school recess in a representative ...sample of Scottish children and examine whether recess MVPA varied by gender, socioeconomic status, season, urban/rural residency, and recess length.
Five-day accelerometry MVPA data were analyzed from 773 children (53.9% girls, 46.1% boys, 10- to 11-y-olds) from 471 schools. Binary logistic regression explored associations between meeting/not meeting the recommendation to spend 40% of recess time in MVPA and the aforementioned risk factors. Descriptive recess data were also analyzed.
Participants spent an average of 3.2 minutes (SD 2.1) in MVPA during recess. Girls engaged in 2.5 minutes (SD 1.7) of MVPA compared with 4.0 minutes (SD 2.2) for boys. Only 6% of children met the recess MVPA recommendation. The odds of girls (odds ratio 0.09; 95% confidence interval, 0.04-0.25) meeting the recommendation was lower (P < .001) compared with boys. No statistically significant differences were observed in meeting the recommendation for the other risk factors.
Levels of MVPA during school recess are very low in Scottish children, and interventions aimed at increasing MVPA during recess are needed.
Growing concern about children and adolescent physical inactivity has made the promotion of physical activity a public health priority. International recommendations suggest children should ...accumulate at least 30 min of moderate-to-vigorous physical activity (MVPA) during school hours. This study assessed levels of objectively-measured MVPA in a large nationally representative sample of Scottish children aged 10–11. Risk factors for not meeting the school-hours MVPA recommendation were examined.
Cross-sectional.
Mean time spent in MVPA during school hours across five weekdays was measured using Actigraph accelerometry (May 2015–May 2016). Binary logistic regression, presented as odds ratio (O.R.) and confidence intervals (C.I.), explored associations between meeting/not meeting the recommendation by sex, socioeconomic status (SES), season, and urban/rural residence in 2022.
Valid data were obtained from 773 children (53.9% girls, 46.1% boys) from 471 schools. Mean daily school-hours MVPA was 29 (SD 11) minutes; 42.7% of children reached the recommendation. The odds of girls (O.R. 0.43; C.I. 0.32, 0.57) meeting the recommendation was significantly lower (p < 0.001) compared to boys. Children living in rural areas had higher odds (O.R. 1.49; C.I. 1.04, 2.15) of meeting the recommendation compared with those in urban areas (p = 0.032). No significant differences in meeting the recommendation by SES (p = 0.700). The overall trend for season was significant (p < 0.001), with lower odds of meeting the recommendation in winter compared to summer.
Most Scottish children aged 10–11 did not meet the 30 minute MVPA recommendation. Interventions to increase MVPA during school hours are essential to promote public health.
Girls Active is a physical activity programme, delivered in UK secondary schools, with the aim of increasing moderate-to-vigorous physical activity (MVPA) in girls aged 11-14 years. This study ...presents the process evaluation as part of a 14-month cluster randomised controlled trial designed to evaluate the effectiveness of the Girls Active programme and which showed no difference in the primary outcome (MVPA at 14 months) between intervention and control arms.
Quantitative and qualitative data were collected from intervention schools over the course of the 14 month trial. Feedback forms and attendance records were completed at the end of all teacher and peer leader training and review days. At 7- and 14-months, semi-structured interviews were conducted with the lead Girls Active teacher in all intervention schools (n = 10) and staff from the intervention provider (n = 4) and hub school (n = 1). At 14 months, separate focus groups with peer leaders (n = 8 schools), girls who participated in the evaluation component of the trial (n = 8 schools), and a sample of boys (n = 6 schools) were conducted. All participants in the intervention schools were asked to complete an exit survey at 14 months. Teachers (intervention and control) completed a school environment questionnaire at baseline, 7- and 14-months.
The Girls Active programme, i.e., the training and resources, appeared to be well received by teachers and pupils. Factors that may have contributed to the lack of effectiveness include: some initial uncertainty by teachers as to what to do following the initial training, a predominant focus on support activities (e.g., gathering opinions) rather than actual physical activity provision, and school-level constraints that impeded implementation.
Girls Active and what it was trying to achieve was valued by schools. The programme could be improved by providing greater guidance to teachers throughout, the setting of timelines, and providing formal training to peer leaders.
ISRCTN, ISRCTN10688342 . Registered 12 January 2015.
Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a ...setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the 'Girls Active' secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the 'Girls Active' programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, 'Girls Active' costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb 'Girls Active' strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the 'Girls Active' programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, ISRCTN10688342.
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