Ben J. Smith

Health-enhancing physical activity across European Union countries: the Eurobarometer study

The World Health Organisation (WHO) recommends the development of comparable national physical activity surveillance systems to assess trends within and amongst countries as the Global Strategy for Diet and Physical Activity is implemented. To date, the lack of well-standardised measurement instruments has impeded such efforts, but new methodologies are being developed for this purpose. This paper describes the usefulness of the International Physical Activity Questionnaire (IPAQ) in population samples. The Special Eurobarometer Wave 58.2 2002 covered physical activity and provided a good vehicle for assessment of health-enhancing physical activity (HEPA) in the European Union. Data from around 1,000 individuals in each of the 15 member states were collected after careful translation of the questionnaire. IPAQ scoring protocol version 2 was used for definition of activity categories. Data on the prevalence of sufficient total activity, sedentariness, frequent walking and sitting, in total and by gender across European Union (EU) countries showed consistent patterns. The prevalence of sufficient physical activity for health across the member countries was 29%. It ranged from 44% in the Netherlands to 23% in Sweden. The prevalence of sedentariness across countries was in general the mirror image. Regular walking was most prevalent in Spain. Gender was related to physical activity in that men were 1.6 times more likely than women to be sufficiently active, less likely to be sedentary and slightly more likely to sit for at least 6 hours daily. The findings suggest that two thirds of the adult populations of the European countries are insufficiently active for optimal health benefits. As the IPAQ measurement provides information about the patterns of total physical activity and inactivity, the findings indicate possibilities for targeted health promotion efforts.

Geographical influences upon physical activity participation: evidence of a ‘coastal effect’

Objective: To examine the association between geographical proximity to the coast and physical activity participation levels.

Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure

BackgroundA primary aim of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study is to examine the association between total physical activity levels (comprising occupational, household and recreational activity) and the incidence of cancer. We examined the validity and long-term repeatability of total physical activity measurements estimated from the past-year recall EPIC questionnaire, using accelerometers as an objective reference measure.MethodsParticipants included 100 men and 82 women aged 50–65 years. Criterion validity was assessed by comparing the physical activity estimates from the EPIC questionnaire with total activity estimated from the average of three separate 7-day accelerometer periods during the same (past-year) period. Long-term repeatability of the EPIC questionnaire was assessed by comparing the responses from the baseline and 10-month administrations. Past-year EPIC estimates were also compared with the Friedenreich Lifetime Total Physical Activity Questionnaire to examine whether recent activity reflected lifetime activity.ResultsAccelerometer total metabolic equivalent (MET)-hours/week were positively associated with a total physical activity index (Spearman rank correlation ρ = 0.29, 95% confidence interval (CI) 0.15, 0.42) and with non-occupational activity estimated in MET-hours/week (ρ = 0.21, 95% CI 0.07, 0.35). Stratified analyses suggested stronger correlations for non-occupational activity for participants who were male, had a lower BMI, were younger, or were not full-time workers, although the differences in correlations between groups were not statistically significant. The weighted kappa coefficient for repeatability of the total physical activity index was 0.62 (95% CI 0.53, 0.71). Spearman correlations for repeatability of components of activity were 0.65 (95% CI 0.55, 0.72) for total non-occupational, 0.58 (95% CI 0.48, 0.67) for recreational and 0.73 (95% CI 0.66, 0.79) for household activity. When past-year activity was compared to lifetime estimates of activity, there was fair agreement for non-occupational (ρ = 0.26) activity, which was greater for household activity (ρ = 0.46) than for recreational activity (ρ = 0.21).ConclusionOur findings suggest that the EPIC questionnaire has acceptable measurement characteristics for ranking participants according to their level of total physical activity. The questionnaire should be able to identify the presence or absence of reasonably strong aetiological associations when either recent or long-term activity is the responsible factor.

Television food advertising to children: the extent and nature of exposure

OBJECTIVE To describe the pattern and prevalence of food and drink advertisements to children on commercial television in Sydney, Australia, and compare these with advertising regulations set out in the Childrens Television Standards and results from a similar study in 2002. DESIGN Data were collected by recording television from 06.00 hours until 23.00 hours on all three commercial channels from Sunday 14 May 2006 to Saturday 20 May 2006 (357 h). The study analysed advertisements in two childrens viewing periods, one as defined in the 2002 study and the other according to current standards. Food advertisements were coded using 18 food categories and were analysed by time period and popular childrens programmes. RESULTS Food advertisements occurred in similar proportions during childrens viewing hours and adults viewing hours (25.5 vs. 26.9% of all advertisements, respectively), although there was a higher rate of high-fat/high-sugar food advertisements during childrens viewing hours (49 vs. 39% of all food advertisements, P < 0.001). There were even more advertisements for high-fat/high-sugar foods during popular childrens programmes, contributing to 65.9% of all food advertisements. Estimates of exposure indicate that children aged 5-12 years were exposed to 96 food advertisements, including 63 high-fat/high-sugar advertisements per week. Since 2002, there has been a reduction in overall food and high-fat/high-sugar food advertisements. CONCLUSION Despite reductions in overall levels of food advertising, children continue to experience high levels of exposure to food advertisements, which remain skewed towards unhealthy foods. Further food advertising regulation should be required to curtail the current levels of advertising of high-fat/high-sugar foods to children, to make them commensurate with recommended levels of consumption.

Promoting physical activity in general practice: a controlled trial of written advice and information materials

Objective—To investigate the impact of a simple written prescription for physical activity given by a general practitioner and the effect of supplementing this with mailed information materials about physical activity. Methods—A controlled trial was conducted in 27 general practices in New South Wales, Australia. Subjects were sequential routine care patients between 25 and 65 years old. Controls (n = 386) were recruited first, and intervention subjects two weeks later. Intervention subjects were randomised to receive a prescription only (n = 380) or a prescription plus a mailed booklet (n = 376). Self reported physical activity levels were measured by interview at baseline, 6–10 weeks, and seven to eight months. Results—By intention to treat, the average changes in minutes of total physical activity did not differ significantly between the groups. Inactive people in the prescription plus supplementary booklet group were significantly more likely than controls to report an increase in their physical activity by at least 60 min/week after 6–10 weeks (odds ratio 1.58, 95% confidence interval 1.06 to 2.35). No significant short term improvements in self reported activity were shown in the prescription only group. In the supplemented group, the proportion reporting an increase in physical activity to 3344 kJ/week at 6–10 weeks was not significant, and neither intervention group showed significant increases in any of the outcome measures at seven to eight months by intention to treat. Treatment received analysis showed greater improvements in intervention groups, especially the prescription plus booklet group, in which the odds of inactive people in this group reporting increased activity became significant at seven to eight months. Conclusions—A prescription for physical activity from a general practitioner, supplemented by additional written materials, can lead to modest short term improvements in self reported physical activity levels among inactive patients. A prescription alone was found not to be effective.

Reliability and validity of a brief physical activity assessment for use by family doctors

Objective: To evaluate the reliability and validity of a brief physical activity assessment tool suitable for doctors to use to identify inactive patients in the primary care setting. Methods: Volunteer family doctors (n  =  8) screened consenting patients (n  =  75) for physical activity participation using a brief physical activity assessment tool. Inter-rater reliability was assessed within one week (n  =  71). Validity was assessed against an objective physical activity monitor (computer science and applications accelerometer; n  =  42). Results: The brief physical activity assessment tool produced repeatable estimates of “sufficient total physical activity”, correctly classifying over 76% of cases (κ 0.53, 95% confidence interval (CI) 0.33 to 0.72). The validity coefficient was reasonable (κ 0.40, 95% CI 0.12 to 0.69), with good percentage agreement (71%). Conclusions: The brief physical activity assessment tool is a reliable instrument, with validity similar to that of more detailed self report measures of physical activity. It is a tool that can be used efficiently in routine primary healthcare services to identify insufficiently active patients who may need physical activity advice.

Parental influences on child physical activity and screen viewing time: a population based study

BackgroundParents can influence their childrens physical activity participation and screen time.This study examined the relative significance of perceived parental barriers and self-efficacy in relation to childrens physical activity participation and screen time viewing. The associations between these factors and the behaviours were analysed.MethodsCross-sectional population survey in New South Wales, Australia of parents of pre-school (N = 764), younger (Kindergarten, Grades 2 and 4; N = 1557) and older children (Grades 6, 8 and 10; N = 1665). Parents reported barriers and self-efficacy to influence their childs physical activity and screen time behaviours in a range of circumstances. Differences were examined by childs sex and age group, household income, maternal education and location of residence. The duration of physical activity and screen viewing was measured by parental report for pre-school and younger children and self-report for older children. Associations between parental factors and childrens organised, non-organised and total activity and screen time were analysed.ResultsCost, lack of opportunities for participation and transport problems were the barriers most often reported, particularly by low income parents and those in rural areas. The number of barriers was inversely related to childrens time spent in organised activity, but not their non-organised activity. Higher parental self-efficacy was positively associated with organised physical activity in the younger and older childrens groups and the non-organised activity of older children. School-age children (younger and older groups) were less likely to meet physical activity guidelines when parents reported ≥4 barriers (OR 3.76, 95% CI 1.25-11.34 and OR 3.72, 95% CI 1.71-8.11 respectively). Low parental self-efficacy was also associated with the likelihood of children exceeding screen time guidelines for each age group (pre-school OR 0.62, 95% CI 0.43-0.87; young children OR 0.56, 95% CI 0.39-0.80; and older children OR 0.57, 95% CI 0.43-0.74).ConclusionParental barriers are associated with the time that children spend in both active and sedentary pursuits. These findings highlight family, economic and environmental factors that should be addressed in programs to promote child physical activity and tackle sedentary behaviour.

Testing a hierarchy-of-effects model: pathways from awareness to outcomes in the VERB campaign 2002-2003.

BACKGROUND The McGuire hierarchy-of-effects (HOE) model, used extensively in mass-media interventions to describe the mechanisms for understanding effects, has not been tested in physical activity campaigns. DESIGN Data collected at baseline (2002) and follow-up (2003) surveys in the VERB evaluation were used in structural equation modeling to test pathways and hierarchies of campaign effects. SETTING/PARTICIPANTS Population-based cohort of youth aged 9-13 years (N=2364) for whom complete baseline and follow-up data were available. MAIN OUTCOME MEASURES Awareness of the VERB campaign, understanding of the VERB message, attitude toward being active, outcome expectations, and physical activity participation. RESULTS Among youth aged 9-13 years (tweens) in the study cohort, significant paths were identified between awareness and understanding (0.72, p<0.001) and between understanding and being physically active (0.11, p<0.05). At baseline there was a high prevalence of positive attitudes and outcome expectations, and these were not influenced by change in understanding or awareness. Among inactive tweens only, the same paths were identified except that, in this subgroup, attitude was related to physical activity (0.13, p<0.05), and awareness was more strongly related to physical activity than it was for the whole sample (0.14, p<0.01). CONCLUSIONS These findings provided limited support for the HOE model and suggest that increased awareness and understanding were the key proximal effects that led to behavior change. A distinct sequence of effects, which bypassed attitudes and outcome expectations, was found for these U.S. young people. The findings could inform the design of future campaigns to address youth physical activity.

Promotion of physical activity in primary health care: update of the evidence on interventions

This review provides an update of the evidence on the impact of physical activity (PA) interventions for patients in primary health care services. Sixteen studies published since 1999 are included. Twelve studies tested interventions of PA only and yielded good evidence that these can have a short-term (< 6 mths) impact upon behaviour. Four studies tested multiple risk factor interventions with a PA component, but the findings from these were inconclusive. There were insufficient studies to identify the attributes of effective interventions, but both brief and intensive single risk factor interventions produced short-term increases in PA. Little attention has been given in the research to the representativeness of study participants or intervention deliverers, or the potential for interventions to be transferred into routine service delivery. In light of current evidence, a reasonable approach for primary care practitioners is to undertake brief PA interventions with patients with health problems who could benefit from increased PA. Future research should pay greater attention to elements of study and intervention designs, including reach, adoption by practitioners and implementation within existing service structures, so that the public health potential of the findings can be realised.

Psychosocial Factors Related to Diet Among Women with Recent Gestational Diabetes Opportunities for Intervention

Purpose This study investigated postpartum dietary behaviors among women with recent gestational diabetes mellitus (GDM), the cognitive and social factors related to these, and preferred types of lifestyle support, in order improve the development of diabetes prevention strategies for this group. Methods Participants were a random sample of 226 women diagnosed with GDM in the prior 6 to 24 months. Telephone surveys were used to evaluate dietary behaviors, self-efficacy, social support, perceived barriers to healthy eating, and preferred methods of lifestyle support. Results Only 5% of the respondents consumed 5 servings/day of vegetables and 44% consumed 2 or more servings/day of fruit. Fried food was eaten at least twice per week by 26% of women and 50% usually consumed full-fat milk. Higher vegetable consumption was associated with self-efficacy to cook healthy foods, reporting that a healthy diet is not a difficult change and that dislike of healthy foods by other household members is not a barrier. Fruit consumption was positively related to self-efficacy when busy and when not reporting a dislike of healthy foods by others at home. Advice from a dietitian and telephone support from a health educator were the most preferred forms of health assistance. Conclusions Dietary risks factors are prevalent among women with recent GDM. Confidence and skills in cooking healthy foods, along with family food preferences and time pressures, are important influences on eating habits. Dietary change programs, informed by the beliefs and circumstances of this high-risk population, need to be developed.