The World Health Organization (WHO) Global Action Plan on Physical Activity recommends adopting a systems approach to implementing and tailoring actions according to local contexts. We held group ...model-building workshops with key stakeholders in the Caribbean region to develop a causal loop diagram to describe the system driving the increasing physical inactivity in the region and envision the most effective ways of intervening in that system to encourage and promote physical activity. We used the causal loop diagram to inform how the WHO Global Action Plan on Physical Activity might be adapted to a local context. Although the WHO recommendations aligned well with our causal loop diagram, the diagram also illustrates the importance of local context in determining how interventions should be coordinated and implemented. Some interventions included creating safe physical activity spaces for both sexes, tackling negative attitudes to physical activity in certain contexts, including in schools and workplaces, and improving infrastructure for active transport. The causal loop diagram may also help understand how policies may be undermined or supported by key actors or where policies should be coordinated. We demonstrate how, in a region with a high level of physical inactivity and low resources, applying systems thinking with relevant stakeholders can help the targeted adaptation of global recommendations to local contexts.
Background: Adolescents who perceive themselves as overweight are at risk of future weight gain and increased risk of type 2 diabetes, hypertension, and poor mental health. Perceived weight may ...influence weight related behaviors (e.g., physical activity), but less is known about the relationship between adolescents' perceived weight and both perceived health and desire to exercise. We explored the association between perceived weight, perceived health, and desire to exercise in adolescents. Methods: Cross-sectional data from adolescents, ages 12-17 years, were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014). Perceived weight status (1-item; very underweight to very overweight), perceived health status (1-item; poor to excellent), and desire to exercise (1-item; strongly disagree to strongly agree) were self-reported. Ordinal logistic regression models tested associations between perceived weight and both perceived health and desire to exercise controlling for age, sex, race/ethnicity, and food insecurity. Results: Of the sample (n = 1407; mean age = 14; 51% female; 64% White), most adolescents perceived their weight to be just right (61%), and their health to be excellent (42%). Adolescents who perceived themselves as slightly or very overweight, compared to just right, had 4.5 (95% CI 3.5, 5.8) and 37.7 (95% CI 22.5, 63.2) higher odds, respectively, of perceiving themselves in worse health. Adolescents who perceived themselves as slightly or very underweight, compared to just right, had 2.94 (95% CI 0.1, 0.8) and 1.41 (95% CI 0.5, 1.0) lower odds of a greater desire to exercise. Perceptions of being slightly or very overweight were not associated with desire to exercise (p = 0.9 and 0.4, respectively). Conclusions: Current findings highlight that higher perceived weight in adolescents is negatively associated with perceived health, but not necessarily desire to exercise. Future research should explore the relationship between weight perception and other motivators of physical activity.
AbstractObjectiveTo estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate ...dementia.DesignMulticentre, pragmatic, investigator masked, randomised controlled trial.SettingNational Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.Participants494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.InterventionsUsual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.Main outcome measuresThe primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.ResultsThe average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference −1.4, 95% confidence interval −2.6 to −0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).ConclusionA moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.Trial registrationCurrent Controlled Trials ISRCTN10416500.
Physical fitness during childhood and adolescence has been identified as an important determinant of current and future health status. While research has traditionally focused on the association ...between cardio-respiratory fitness and health outcomes, the association between muscular fitness (MF) and health status has recently received increased attention.
The aim of this systematic review and meta-analysis was to evaluate the potential physiological and psychological benefits associated with MF among children and adolescents.
A systematic search of six electronic databases (PubMed, SPORTDiscus, Scopus, EMBASE, PsycINFO and OVID MEDLINE) was performed on the 20th May, 2013. Cross-sectional, longitudinal and experimental studies that quantitatively examined the association between MF and potential health benefits among children and adolescents were included. The search yielded 110 eligible studies, encompassing six health outcomes (i.e., adiposity, bone health, cardiovascular disease CVD and metabolic risk factors, musculoskeletal pain, psychological health and cognitive ability). The percentage of studies reporting statistically significant associations between MF and the outcome of interest was used to determine the strength of the evidence for an association and additional coding was conducted to account for risk of bias. Meta-analyses were also performed to determine the pooled effect size if there were at least three studies providing standardised coefficients.
Strong evidence was found for an inverse association between MF and total and central adiposity, and CVD and metabolic risk factors. The pooled effect size for the relationship between MF and adiposity was r = -0.25 (95% CI -0.41 to -0.08). Strong evidence was also found for a positive association between MF and bone health and self-esteem. The pooled effect size for the relationship between MF and perceived sports competence was r = 0.39 (95% CI 0.34-0.45). The evidence for an association between MF and musculoskeletal pain and cognitive ability was inconsistent/uncertain. Where evidence of an association was found, the associations were generally low to moderate.
The findings of this review highlight the importance of developing MF in youth for a number of health-related benefits.
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