Activity spaces are increasingly used to understand how people interact with their environment and engage in activity but their use may raise challenges regarding causal inference. We conducted a ...systematic review of findings and the methodological, analytical and conceptual issues relevant to causal inference. Studies were included if they comprised a spatial summary of locations visited, assessed any part of the causal pathway between the environment, physical activity and health, and used quantitative or qualitative methods. We searched seven electronic databases in January 2018 and screened 11910 articles for eligibility. Forty-seven studies were included for review. Studies answered research questions about features of or environmental features within activity spaces using a range of spatial and temporal summary techniques. The conceptual challenge of using activity spaces to strengthen causal inference was rarely considered, although some studies discussed circularity, temporality, and plausibility. Future studies should use longitudinal and experimental designs and consider the potential and actual use of spaces for physical activity, and their relationship with total levels of activity.
•We reviewed studies that investigated the environment-physical activity relationship using activity spaces.•Studies assessed the features of (shape or size) or within activity spaces.•A range of spatial and temporal methods were employed to define activity spaces and answer different research questions.•Most studies were cross-sectional and casual inference was rarely discussed.•Evaluation of interventions using longitudinal or qualitative data would be useful to strengthen causal inference.
ObjectivesThis systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in ...this population.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised.ResultsThe database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%–83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs.ConclusionsThe review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management.PROSPERO registration numberCRD42019133849.
Active travel is associated with greater physical activity, but there is a dearth of research examining this relationship over time. We examined the longitudinal associations between change in time ...spent in active commuting and changes in recreational and total physical activity.
Adult commuters working in Cambridge, United Kingdom completed questionnaires in 2009 and 2012, and a sub-set completed objective physical activity monitoring in 2010 and 2012. Commuting was assessed using a validated seven-day travel to work record. Moderate-to-vigorous physical activity was assessed using the Recent Physical Activity Questionnaire and combined heart rate and movement sensing. We used multivariable multinomial logistic regression models to examine associations between change in time spent in active commuting and tertiles of changes in time spent in recreational and total physical activity.
Four hundred sixty-nine participants (67% female, mean age 44 years) provided valid travel and self-reported physical activity data. Seventy-one participants (54% female, mean age 45 years) provided valid travel and objectively measured physical activity data. A decrease in active commuting was associated with a greater likelihood of a decrease in self-reported total physical activity (relative risk ratio RRR 2.1, 95% CI 1.1, 4.1). Correspondingly, an increase in active commuting was associated with a borderline significantly greater likelihood of an increase in self-reported total physical activity (RRR 1.8, 95% CI 1.0, 3.4). No associations were seen between change in time spent in active commuting and change in time spent in either self-reported recreational physical activity or objectively measured physical activity.
Changes in active commuting were associated with commensurate changes in total self-reported physical activity and we found no compensatory changes in self-reported recreational physical activity. Promoting active commuting has potential as a public health strategy to increase physical activity. Future longitudinal research would be useful to verify these findings.
There has been increased research interest in the use of active video games (in which players physically interact with images onscreen) as a means to promote physical activity in children. The aim of ...this review was to assess active video games as a means of increasing energy expenditure and physical activity behavior in children. Studies were obtained from computerized searches of multiple electronic bibliographic databases. The last search was conducted in December 2008. Eleven studies focused on the quantification of the energy cost associated with playing active video games, and eight studies focused on the utility of active video games as an intervention to increase physical activity in children. Compared with traditional nonactive video games, active video games elicited greater energy expenditure, which was similar in intensity to mild to moderate intensity physical activity. The intervention studies indicate that active video games may have the potential to increase free-living physical activity and improve body composition in children; however, methodological limitations prevent definitive conclusions. Future research should focus on larger, methodologically sound intervention trials to provide definitive answers as to whether this technology is effective in promoting long-term physical activity in children.
Background
Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden.
Objective
To synthesize qualitative ...research exploring experience of financial burden for people with multimorbidity.
Search strategy
Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted.
Inclusion criteria
Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community‐dwelling adult participant with two or more chronic conditions.
Data extraction and synthesis
Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE‐CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis.
Main results
Forty‐six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well‐being. Health insurance and government supports determine the manageability and level of costs experienced.
Discussion
Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue.
Patient or public contribution
Results were presented to a panel of people with multimorbidity to check whether the language and themes ‘resonated’ with their experiences.
Presleep activities have been implicated in the declining sleep duration of young people. A use-of-time approach may be used to describe the presleep period. The study aims were to describe the ...activities undertaken 90 minutes before sleep onset and to examine the association between activities and time of sleep onset in New Zealand young people.
Participants (N = 2017; 5-18 years) self-reported their time use as part of a national survey. All activities reported in the 90 minutes before sleep were extracted. The top 20 activities were grouped into 3 behavioral sets: screen sedentary time, nonscreen sedentary time, and self-care. An adjusted regression model was used to estimate presleep time spent in each behavioral set for 4 distinct categories of sleep onset (very early, early, late, or very late), and the differences between sleep onset categories were tested.
In the entire sample, television watching was the most commonly reported activity, and screen sedentary time accounted for ∼30 minutes of the 90-minute presleep period. Participants with a later sleep onset had significantly greater engagement in screen time than those with an earlier sleep onset. Conversely, those with an earlier sleep onset spent significantly greater time in nonscreen sedentary activities and self-care.
Screen sedentary time dominated the presleep period in this sample and was associated with a later sleep onset. The development of interventions to reduce screen-based behaviors in the presleep period may promote earlier sleep onset and ultimately improved sleep duration in young people.
Summary
Sedentary behaviors are highly prevalent in youth and may be associated with markers of physical and mental health. This systematic review and meta‐analysis aimed to quantify the age‐related ...change in sedentary behavior during childhood and adolescence. Ten electronic databases were searched. Inclusion criteria specified longitudinal observational studies or control group from an intervention; participants aged ≥5 and ≤18 years; a quantitative estimate of the duration of SB; and English language, peer‐reviewed publication. Meta‐analyses summarized weighted mean differences (WMD) in device‐assessed sedentary time and questionnaire‐assessed screen‐behaviors over 1‐, 2‐, 3‐, or more than 4‐year follow‐up. Effect modification was explored using meta‐regression. Eighty‐five studies met inclusion criteria. Device‐assessed sedentary time increased by (WMD 95% confidence interval CI) 27.9 (23.2, 32.7), 61.0 (50.7, 71.4), 63.7 (53.3, 74.0), and 140.7 (105.1, 176.4) min/day over 1‐, 2‐, 3‐, and more than 4‐year follow‐up. We observed no effect modification by gender, baseline age, study location, attrition, or quality. Questionnaire‐assessed time spent playing video games, computer use, and a composite measure of sedentary behavior increased over follow‐up duration. Evidence is consistent in showing an age‐related increase in various forms of sedentary behavior; evidence pertaining to variability across socio‐demographic subgroups and contemporary sedentary behaviors are avenues for future research.
Active travel (walking or cycling for transport) is associated with favourable health outcomes in adults. However, little is known about the concurrent patterns of health behaviour associated with ...active travel. We used compositional data analysis to explore differences in how people doing some active travel used their time compared to those doing no active travel, incorporating physical activity, sedentary behaviour and sleep.
We analysed cross-sectional data from the 2014/15 United Kingdom Harmonised European Time Use Survey. Participants recorded two diary days of activity, and we randomly selected one day from participants aged 16 years or over. Activities were categorised into six mutually exclusive sets, accounting for the entire 24 h: (1) sleep; (2) leisure moderate to vigorous physical activity (MVPA); (3) leisure sedentary screen time; (4) non-discretionary time (work, study, chores and caring duties); (5) travel and (6) other. This mixture of activities was defined as a time-use composition. A binary variable was created indicating whether participants reported any active travel on their selected diary day. We used compositional multivariate analysis of variance (MANOVA) to test whether mean time-use composition differed between individuals reporting some active travel and those reporting no active travel, adjusted for covariates. We then used adjusted linear regression models and bootstrap confidence intervals to identify which of the six activity sets differed between groups.
6143 participants (mean age 48 years; 53% female) provided a valid diary day. There was a statistically significant difference in time-use composition between those reporting some active travel and those reporting no active travel. Those undertaking active travel reported a relatively greater amount of time in leisure MVPA and travel, and a relatively lower amount of time in leisure sedentary screen time and sleep.
Compared to those not undertaking active travel, those who did active travel reported 11 min more in leisure MVPA and 18 min less in screen time per day, and reported lower sleep. From a health perspective, higher MVPA and lower screen time is favourable, but the pattern of sleep is more complex. Overall, active travel was associated with a broadly health-promoting composition of time across multiple behavioural domains, which supports the public health case for active travel.
In South Africa, overweight and obesity affect 17% of children aged 15-18. School food environments play a vital role in children's health, influencing dietary behaviours and resulting in high ...obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model.
A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or 'very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5).
We identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) "regulate what kinds of foods can be sold at schools", 2) "train school staff through workshops and discussions to improve school food environment", and affix 3) "compulsory, child-friendly warning labels on unhealthy foods".
Prioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa's childhood obesity epidemic effectively.
Increased understanding of why and how physical activity impacts on health outcomes is needed to increase the effectiveness of physical activity interventions. A recent randomized controlled trial of ...an active video game (PlayStation EyeToy™) intervention showed a statistically significant treatment effect on the primary outcome, change from baseline in body mass index (BMI), which favored the intervention group at 24 weeks. In this short paper we evaluate the mediating effects of the secondary outcomes.
To identify mediators of the effect of an active video games intervention on body composition.
Data from a two-arm parallel randomized controlled trial of an active video game intervention (n = 322) were analyzed. The primary outcome was change from baseline in BMI. A priori secondary outcomes were considered as potential mediators of the intervention on BMI, including aerobic fitness (VO2Max), time spent in moderate-to-vigorous physical activity (MVPA), and food snacking at 24 weeks.
Only aerobic fitness at 24 weeks met the conditions for mediation, and was a significant mediator of BMI.
Playing active video games can have a positive effect on body composition in overweight or obese children and this effect is most likely mediated through improved aerobic fitness. Future trials should examine other potential mediators related to this type of intervention.
Australian New Zealand Clinical Trials Registry Website: http://www.anzctr.org.au. Study ID number: ACTRN12607000632493.
PDF
