Daniel B. Bornstein

Accelerometer-derived physical activity levels of preschoolers: a meta-analysis.

OBJECTIVES This study synthesized the published estimates of daily moderate-to-vigorous physical activity (MVPAd(-1)) of preschooler-age children (3-5 years). DESIGN Meta-analysis of previously published studies reporting accelerometer-derived estimates of daily MVPA of preschoolers. METHODS A comprehensive literature review was conducted to identify studies published by March 2010 that reported daily minutes of accelerometer-derived MVPA in preschool-age children (3-5 years). Random effects point estimates and 95% confidence intervals (95% CIs) were calculated based on study weighted means and standard deviations of raw accelerometer counts per minute (cpm) and reported minutes of MVPA and/or percentage of time spent in MVPAd(-1). RESULTS 29 articles representing 6309 preschoolers were included. Overall, preschoolers engaged in 42.8 min (95% CI 28.9-56.8) of MVPAd(-1), and 54.4 min (95% CI 29.9-78.9) and 45.4 min (95% CI 25.2-65.6) for boys and girls separately. This translated into approximately 5.5% (95% CI 3.7-7.2%) of time spent in MVPAd(-1), and 7.1% (95% CI 3.9-10.3%) for boys and 6.3% (95% CI 3.9-8.7%) for girls. Studies (76%) using ActiGraph accelerometers reported an average of 714 cpm (95% CI 678-751), with boys and girls having 783 cpm (95% CI 753-813) and 696 cpm (95% CI 665-727), respectively. CONCLUSIONS Interpretation of accelerometer-derived MVPA is confounded by differences in cutpoints applied within a study. Great care, therefore, should be taken when interpreting the activity levels of preschoolers to inform policy decisions, such as the development of physical activity guidelines. Hence, considerable attention is required to unify accelerometer-derived MVPA so that unbiased comparisons across studies can be made.

Pedometer-Measured Physical Activity Patterns of Youth: A 13-Country Review

CONTEXT Insufficient physical activity among young people aged 5-18 years is a global public health issue, with considerable disparities among countries. A systematic review was conducted to identify studies reporting pedometer daily steps (steps x day(-1)) in order to compile comparative, global cross-sectional data on youth physical activity patterns. EVIDENCE ACQUISITION Articles were included if they were in English, published by April 2009, and reported steps x day(-1) for boys and girls, separately, and reported steps x day(-1) for age groupings of no more than 4 years (e.g., 5-8 years) or combined no more than three grade levels (e.g., third- to fifth-graders). Studies could have been intervention-based but had to have reported baseline steps x day(-1), which would reflect unadulterated physical activity steps x day(-1) estimates. Inverse variance weighted estimates (steps x day(-1w)) were calculated for each country, and random effects models were estimated. Analyses were conducted in May and June 2009. EVIDENCE SYNTHESIS Forty-three studies, representing young people in 13 countries (N=14,200), were included. The majority of studies were from the U.S. (17/43). Overall, there was considerable variation within and among countries in steps x day(-1w). Boys and girls from European and Western Pacific regions had significantly more steps x day(-1w) than young people from the U.S. and Canada. Significantly lower steps x day(-1w) estimates for girls were observed for studies that combined measured steps x day(-1) for weekdays and weekend days, in comparison to weekdays only. CONCLUSIONS Limited sample sizes and non-population-based data preclude definitive statements regarding projected steps x day(-1) within countries. Nevertheless, these findings provide preliminary information for policymakers and researchers on the extent of the disparities among countries in the physical activity patterns of young people.

The impact of combined health factors on cardiovascular disease mortality

BACKGROUND The combined effect of modifiable health factors on the risk of cardiovascular disease (CVD) mortality has not been well established. The objective of this study was to determine the association between 5 modifiable health factors in combination on the risk of CVD mortality in a sample of adult men. METHODS A cohort of 38,110 men (aged 20-84 years and of middle and upper socioeconomic strata) was followed over time until their date of death or December 31, 2003. A health profile score (unweighted and weighted) was developed based on cardiorespiratory fitness (CRF; moderate or high vs low), self-reported physical activity (active vs inactive), smoking status (not current vs current), alcohol consumption (1-14 drinks per week vs 0 or >14 drinks per week), and body mass index (BMI; 18.5-24.9 vs >or=25.0 kg/m(2)). RESULTS During 16.1 +/- 8.4 years of follow-up and 613,571 man-years of exposure, there were 949 deaths from CVD. High CRF, normal BMI, being physically active, and not currently smoking were individually associated with reduced risk of CVD mortality after adjusting for confounders. When considered in combination, a minimum of 2 of 5 positive health factors reduced the risk of CVD mortality (hazard ratio = 0.67, 95% CI 0.49-0.91). The weighted score indicated that a combination of high CRF, not currently smoking, and normal BMI is of most clinical importance to CVD mortality (hazard ratio = 0.31, 95% CI 0.24-0.39). CONCLUSIONS Exposure to increasing numbers of beneficial health factors in adulthood reduced the risk of CVD mortality in men, and multibehavioral prevention efforts in adulthood should be encouraged.

A Review of the National Physical Activity Plans of Six Countries

BACKGROUND Architects of the United States national physical activity plan can benefit from a thorough understanding of national physical activity plans from other nations. The purpose of this paper was to search for and analyze comprehensive national physical activity plan documents that can best inform the development of the U.S. plan. METHODS Electronic databases were searched for national physical activity plan documents, yielding 252 documents from 56 countries. After eliminating documents that were not written in English, did not address physical activity primarily, and did not meet our definition of a national physical activity plan, we were left with physical activity plans from 6 countries-Australia, United Kingdom, Scotland, Sweden, Northern Ireland, and Norway. KEY RECOMMENDATIONS Architects of the U.S. plan can learn as much from what was present in many documents as from what was absent. Examples of recommended components of national plans have been identified and highlighted for each of the 6 countries. Missing from all but 1 national plan document was a detailed process for accountability. Providing a clear path and detailed process of accountability will assist greatly in measuring short- and long-term success of the U.S. plan.

Convergent Validity of Pedometer and Accelerometer Estimates of Moderate-to-Vigorous Physical Activity of Youth

BACKGROUND Pedometer step-frequency thresholds (120 steps·min-1, SPM) corresponding to moderate-to-vigorous intensity physical activity (MVPA) have been proposed for youth. Pedometers now have internal mechanisms to record time spent at or above a user-specified SPM. If pedometers provide comparable MVPA (P-MVPA) estimates to those from accelerometry, this would have broad application for research and the general public. The purpose of this study was to examine the convergent validity of P-MVPA to accelerometer-MVPA for youth. METHODS Youth (N = 149, average 8.6 years, range 5 to 14 years, 60 girls) wore an accelerometer (5-sec epochs) and a pedometer for an average of 5.7 ± 0.8 hours·day-1. The following accelerometer cutpoints were used to compare P-MVPA: Treuth (TR), Mattocks (MT), Evenson (EV), Puyau (PU), and Freedson (FR) child equation. Comparisons between MVPA estimates were performed using Bland-Altman plots and paired t tests. RESULTS Overall, P-MVPA was 24.6 min ± 16.7 vs. TR 25.2 min ± 16.2, MT 18.8 min ± 13.3, EV 36.9 min ± 21.0, PU 22.7 min ± 15.1, and FR 50.4 min ± 25.5. Age-specific comparisons indicated for 10 to 14 year-olds MT, PU, and TR were not significantly different from P-MVPA; for the younger children (5-8 year- olds) P-MVPA consistently underestimated MVPA. CONCLUSIONS Pedometer-determined MVPA provided comparable estimates of MVPA for older children (10-14 year-olds). Additional work is required to establish age appropriate SPM thresholds for younger children.

Equating accelerometer estimates among youth: The Rosetta Stone 2

OBJECTIVES Different accelerometer cutpoints used by different researchers often yields vastly different estimates of moderate-to-vigorous intensity physical activity (MVPA). This is recognized as cutpoint non-equivalence (CNE), which reduces the ability to accurately compare youth MVPA across studies. The objective of this research is to develop a cutpoint conversion system that standardizes minutes of MVPA for six different sets of published cutpoints. DESIGN Secondary data analysis. METHODS Data from the International Childrens Accelerometer Database (ICAD; Spring 2014) consisting of 43,112 Actigraph accelerometer data files from 21 worldwide studies (children 3-18 years, 61.5% female) were used to develop prediction equations for six sets of published cutpoints. Linear and non-linear modeling, using a leave one out cross-validation technique, was employed to develop equations to convert MVPA from one set of cutpoints into another. Bland Altman plots illustrate the agreement between actual MVPA and predicted MVPA values. RESULTS Across the total sample, mean MVPA ranged from 29.7MVPAmind(-1) (Puyau) to 126.1MVPAmind(-1) (Freedson 3 METs). Across conversion equations, median absolute percent error was 12.6% (range: 1.3 to 30.1) and the proportion of variance explained ranged from 66.7% to 99.8%. Mean difference for the best performing prediction equation (VC from EV) was -0.110mind(-1) (limits of agreement (LOA), -2.623 to 2.402). The mean difference for the worst performing prediction equation (FR3 from PY) was 34.76mind(-1) (LOA, -60.392 to 129.910). CONCLUSIONS For six different sets of published cutpoints, the use of this equating system can assist individuals attempting to synthesize the growing body of literature on Actigraph, accelerometry-derived MVPA.

Development of a National Physical Activity Plan for the United States.

BACKGROUND Efforts to increase population levels of physical activity are increasingly taking the form of strategic plans at national, state/regional, and local levels. The processes employed for developing such plans have not been described previously. The purpose of this article is to chronicle the processes employed in and lessons learned from developing the US National Physical Activity Plan (NPAP). METHODS The Coordinating Committee oversaw development of the NPAP. Key steps in the process included creating a private-public coalition based in the private sector, organizing the NPAP around 8 societal sectors, reviewing the evidence base for promotion of physical activity in each sector, conducting a national conference to initiate development of the NPAPs core content, ensuring broad participation in developing and refining the NPAP, and launching the NPAP through a press event that attracted national attention. RESULTS AND CONCLUSION The 3-year effort to develop the NPAP was guided by a private-public collaborative partnership involving private sector organizations and government agencies. Launched in May 2010, the NPAP included more than 250 evidence-based recommendations for changes to policy and practice at the national, state, and local levels across 8 societal sectors.

Perspectives on the National Physical Activity Plan by Texas Practitioners

209 The 2010 National Physical Activity Plan (NPAP) includes a wide-ranging set of policies, programs, and initiatives directed at increasing physical activity across the United States (US).1 It is the first comprehensive, national planning tool devoted entirely to supporting physical activity in the US. The NPAP brings together 8 disciplines in the pursuit of a multi-sector approach to promoting physical activity: public health; health care; education; mass media; business and industry; volunteer and non-profit organizations; parks, recreation, fitness, and sports; and transportation, land use, and community design.2 A companion guide for implementing the NPAP, entitled Make the Move, was developed by the National Coalition for Promoting Physical Activity.3 It includes resources, anecdotal success narratives, and sets short-term goals related to championing physical activity through the NPAP. The document provides physical activity practitioners with measurable outcomes and objectives for change as they work through the NPAP by showcasing successful examples of implementation strategies from around the US. Currently, Texas is one of only a few states to develop a state-level plan devoted entirely to physical activity planning and promotion. Most other states include physical activity as part of a chronic disease or obesity plan.4 The physical activity plan in Texas is in addition to its state-level obesity plan.5,6 Active Texas 2020 is the product of collaboration among the Governor’s Council on Physical Fitness, the University of Texas Health Science Center at Houston, the Michael and Susan Dell Center for Advancement of Healthy Living, the University of Texas at Austin, and the Austin Mayor’s Fitness Council. Like the NPAP, it is a multi-sector plan designed to incorporate stakeholders from a diverse group of community sectors.7-15

Enhancing Support for Physical Activity in Older Adults: A Public Health Call to Action

Physical activity (PA) is an effective form of primary, secondary, and tertiary prevention against a myriad of noncommunicable diseases, including cardiovascular disease, diabetes, and certain cancers. Almost 90% of older adults (65+ years) have 1 chronic disease and 65% have 2 or more chronic diseases, which create a vicious downward spiral of lower PA engagement and further incidence of disease. This carries significant economic costs, given that older adults who are active 1 to 3 days per week have 8% to 20% lower health care costs and those who are active at least 4 days per week realize an additional 8% to 11% reduction in health care costs, compared with sedentary counterparts. Despite public health interventions aimed specifically at promoting PA in older adults, they have been ineffective to thwart steadily declining PA levels and proliferating chronic diseases. This is influenced by a myriad of variables, including rapid expansion and diversification of older adults, a wideranging list of mediating variables to PA adoption and maintenance, and a public health workforce illprepared in the field of active aging. Accordingly, such complexities represent immense opportunities to realize the public health and concomitant economic benefits associated with increasing PA levels among older adults. While acting as president of the Association of State and Territorial Health Officials, Jewel Mullen discussed the importance of collaborative efforts for improving the health of older adults. The

New Perspective on Factors Related to Coalition Success: Novel Findings From an Investigation of Physical Activity Coalitions Across the United States.

CONTEXT Physical activity (PA) coalitions are a fundamental component of efforts to increase population levels of PA in the United States. Coalitions are often composed of organizational members including government agencies, for-profit corporations, and nonprofit organizations. Very little is known about PA coalitions, their organizational members, and the factors related to their success. OBJECTIVE First, this study aimed to describe the characteristics of PA coalitions across the United States. Second, the study aimed to describe the characteristics of organizational members of PA coalitions. Third, the study aimed to investigate the association between organizational membership and coalition success. DESIGN A cross-sectional design was employed to study individuals from a diverse sample of PA coalitions across the United States. A total of 120 individuals (86% response rate) completed the Member Involvement in Physical Activity Coalitions (MIPAC) survey. The MIPAC included 3 sections: (1) demographic items assessing descriptive characteristics of PA coalitions and their organizational members; (2) 3 subscales for assessing key organizational membership factors (Strategic Alignment, Organizational Alignment, and Providing Input); and (3) 2 subscales for assessing perceived coalition success. MAIN OUTCOME MEASURES Descriptive statistics characterize PA coalitions and their organizational members. Univariate analyses were employed to investigate associations between key organizational membership factors and perceived coalition success. RESULTS Statistically significant associations were observed between the key organizational membership factors (Strategic Alignment, Organizational Alignment, and Providing Input) and measures of perceived coalition success. Many PA coalitions lacked organizational members from the settings in which the coalitions strive to make change. CONCLUSIONS Physical activity coalitions and health-based coalitions overall may be more likely to succeed when they can identify ways in which their coalition provides opportunities for strategic alignment, organizational alignment, and providing input to existing and perspective organizational members. In addition, PA coalitions may benefit from engaging more organizational members from the built environment and education sectors.