Femke De Meester

Relationship between the physical environment and physical activity in older adults: A systematic review

Previous reviews on children, adolescents and adults have reported consistent relationships between several physical environmental characteristics and physical activity (PA). This systematic review aims to provide a comprehensive overview of the literature concerning the relationship between the physical environment and PA in older adults. A systematic literature search resulted in the inclusion of 31 articles. Results were inconsistent but most of the studied environmental characteristics were reported not to be related to PA. More studies in different contexts utilizing longitudinal designs, standardized, reliable and validated PA and environmental measurements and investigating possible moderating effects are definitely warranted.

Criterion distances and environmental correlates of active commuting to school in children.

BackgroundActive commuting to school can contribute to daily physical activity levels in children. Insight into the determinants of active commuting is needed, to promote such behavior in children living within a feasible commuting distance from school. This study determined feasible distances for walking and cycling to school (criterion distances) in 11- to 12-year-old Belgian children. For children living within these criterion distances from school, the correlation between parental perceptions of the environment, the number of motorized vehicles per family and the commuting mode (active/passive) to school was investigated.MethodsParents (n = 696) were contacted through 44 randomly selected classes of the final year (sixth grade) in elementary schools in East- and West-Flanders. Parental environmental perceptions were obtained using the parent version of Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Information about active commuting to school was obtained using a self-reported questionnaire for parents. Distances from the childrens home to school were objectively measured with Routenet online route planner. Criterion distances were set at the distance in which at least 85% of the active commuters lived. After the determination of these criterion distances, multilevel analyses were conducted to determine correlates of active commuting to school within these distances.ResultsAlmost sixty percent (59.3%) of the total sample commuted actively to school. Criterion distances were set at 1.5 kilometers for walking and 3.0 kilometers for cycling. In the range of 2.01 - 2.50 kilometers household distance from school, the number of passive commuters exceeded the number of active commuters. For children who were living less than 3.0 kilometers away from school, only perceived accessibility by the parents was positively associated with active commuting to school. Within the group of active commuters, a longer distance to school was associated with more cycling to school compared to walking to school.ConclusionsHousehold distance from school is an important correlate of transport mode to school in children. Interventions to promote active commuting in 11-12 year olds should be focusing on children who are living within the criterion distance of 3.0 kilometers from school by improving the accessibility en route from childrens home to school.

Interventions for promoting physical activity among European teenagers: a systematic review

BackgroundAlthough physical activity is considered to yield substantial health benefits, the level of physical activity among European teenagers is not sufficient. Adolescence is characterized by a decline in physical activity level. Many studies investigated the effectiveness of interventions promoting physical activity among young people, but none dealt with the available evidence specific for Europe. This review was conducted to summarize the effectiveness of interventions to promote physical activity among European teenagers.MethodsA systematic review was conducted to identify European intervention studies published in the scientific literature since 1995. Four databases were searched, reference lists were scanned and the publication lists of the authors of the retrieved articles were checked. The ANGELO framework was used to categorise the included studies by setting and by intervention components.ResultsThe literature search identified 20 relevant studies. Fifteen interventions were delivered through the school setting, of which three included a family component and another three a family and community component. One intervention was conducted within a community setting, three were delivered in primary care and one was delivered through the internet. Ten interventions included only an individual component, whereas the other ten used a multi-component approach. None of the interventions included only an environmental component.Main findings of the review were: (1) school-based interventions generally lead to short term improvements in physical activity levels; (2) improvements in physical activity levels by school-based interventions were limited to school related physical activity with no conclusive transfer to leisure time physical activity; (3) including parents appeared to enhance school-based interventions; (4) the support of peers and the influence of direct environmental changes increased the physical activity level of secondary school children; (5) the assumption that a multi-component approach should produce synergistic results can not be confirmed; (6) when interventions aimed to affect more than one health behaviour the intervention appeared to be less effective in favour of physical activity.ConclusionOverall, the current European literature supports the short-term effectiveness of school-based physical activity promotion programmes. The available evidence for the effectiveness in other settings is rather limited and underscores the need for further research.

Objectively measured sedentary time and physical activity time across the lifespan: a cross-sectional study in four age groups

BackgroundFrom a health perspective it is suggested to promote a positive balance between time spent in light intensity physical activity (LIPA) and sedentary behaviour (SB) (i.e. spending more time in LIPA than time spent in SB). However, no studies have reported prevalence rates of the LIPA-SB balance yet. The aim of this study was to objectively investigate the time spent in SB, in LIPA and moderate-to-vigorous intensity physical activity (MVPA) in four Belgian age groups and to explore which proportion of the population had a favorable balance between LIPA and SB and combined this with recommended amount of MVPA.MethodsAccelerometer data from 7 cross-sectional studies (N=2083) in four age groups (preschoolers, primary schoolchildren, secondary schoolchildren and adults) were aggregated. Differences in SB and PA between age groups and between men and women were determined by two-way MANCOVA. LIPA-SB balance was calculated and participants were categorized into one of four groups: (1) positive LIPA-SB balance (LIPA> SB) & sufficient MVPA (2) negative LIPA-SB balance & sufficient MVPA (3) positive LIPA-SB balance & insufficient MVPA (4) negative LIPA-SB balance & insufficient MVPA.ResultsFor the total sample, 55% of the waking time was spent in SB, 39% in LIPA and 6% in MVPA. Differences in SB between age groups was dependent from gender (p<0.001). Further, a positive LIPA-SB balance was assessed in 18% of the total sample and only 10% combined this positive balance with recommended amount of MVPA. Secondary schoolgirls were most at risk, with only 1% of the sample combining a positive LIPA-SB balance with sufficient MVPA. Another risk group was the large proportion (43%) of adult men who combined sufficient MVPA with a negative LIPA-SB balance.ConclusionA high proportion of the Belgian population is at risk if taking into account both SB and PA levels. Secondary schoolgirls have the unhealthiest SB and PA profile and are therefore an important target group for interventions both increasing MVPA and decreasing SB. In men more attention should be given in promoting a positive LIPA-SB balance independently from their compliance with the MVPA guidelines.

Active living neighborhoods: is neighborhood walkability a key element for Belgian adolescents?

BackgroundIn adult research, neighborhood walkability has been acknowledged as an important construct among the built environmental correlates of physical activity. Research into this association has only recently been extended to adolescents and the current empirical evidence is not consistent. This study investigated whether neighborhood walkability and neighborhood socioeconomic status (SES) are associated with physical activity among Belgian adolescents and whether the association between neighborhood walkability and physical activity is moderated by neighborhood SES and gender.MethodsIn Ghent (Belgium), 32 neighborhoods were selected based on GIS-based walkability and SES derived from census data. In total, 637 adolescents (aged 13-15 year, 49.6% male) participated in the study. Physical activity was assessed using accelerometers and the Flemish Physical Activity Questionnaire. To analyze the associations between neighborhood walkability, neighborhood SES and individual physical activity, multivariate multi-level regression analyses were conducted.ResultsOnly in low-SES neighborhoods, neighborhood walkability was positively associated with accelerometer-based moderate to vigorous physical activity and the average activity level expressed in counts/minute. For active transport to and from school, cycling for transport during leisure time and sport during leisure time no association with neighborhood walkability nor, with neighborhood SES was found. For walking for transport during leisure time a negative association with neighborhood SES was found. Gender did not moderate the associations of neighborhood walkability and SES with adolescent physical activity.ConclusionsNeighborhood walkability was related to accelerometer-based physical activity only among adolescent boys and girls living in low-SES neighborhoods. The relation of built environment to adolescent physical activity may depend on the context.

The use of accelerometry in adolescents and its implementation with non-wear time activity diaries in free-living conditions

Abstract The aim of this study was to evaluate the use of a non-wearing time activity diary (hereafter non-wear activity diary) when using accelerometry in adolescents to provide insight into their physical activity levels. In total, 213 Belgian adolescents (89 boys, 124 girls) were eligible for this study. Adolescents wore an accelerometer for seven consecutive days and kept a non-wear activity diary. On the last day, they completed the International Physical Activity Questionnaire for Adolescents. The differences between the accelerometer data with and without use of the non-wear activity diary were significant for all physical activity intensities according to the Wilcoxon signed rank test. Bland-Altman plots showed that with more time spent in any physical activity intensity, the difference between including and not including the non-wear activity diary increased. The correlation coefficient between the International Physical Activity Questionnaire for Adolescents and the accelerometer data increased when the non-wear activity diary was included. Differences in the percentage of adolescents reaching the physical activity recommendations between the accelerometer data only and the accelerometer with the non-wear activity diary were significant. We conclude that if the non-wear activity diary data are not included, some adolescents could be misclassified as not being physically active according to the physical activity recommendations. It is therefore recommended to use a non-wear activity diary for gaining insight into the physical activity levels of individuals.

Parental perceived neighborhood attributes: associations with active transport and physical activity among 10–12 year old children and the mediating role of independent mobility

BackgroundDuring the last decades, the use of active travel modes declined in all age groups. Childhood is a critical time to establish lifelong healthy patterns. To develop effective interventions in this age group, insight in the correlates of health behaviors and the possible mediating factors is necessary. Among children, the role of parents may not be overlooked. Therefore, this study aimed to examine the associations of parental perceptions of neighborhood environmental attributes with active transport and total physical activity in 10–12 year old Belgian boys and girls. Furthermore, this study examined the potential mediating effect of independent mobility on these associations.MethodsIn the present study, 736 10–12 year old children and their parents from 44 elementary schools in Flanders, Belgium, participated. The children were asked to wear an activity monitor and to fill in a survey questioning demographic factors and the Flemish Physical Activity Questionnaire. The parents filled in a survey concerning demographic factors, the child’s level of independent mobility and environmental perceptions (Neighborhood Environmental Walkability Scale).ResultsOverall, boys reported more active transport when parents perceived more land use mix diversity, shorter distances to school, good land use mix access, higher residential density and less pleasing neighborhood aesthetics. Higher total physical activity levels were reported when parents perceived shorter distances to school and availability of walking/cycling infrastructure. None of the associations was mediated by independent mobility in boys. Girls reported more active transport when parents perceived higher residential density, more land use mix diversity, shorter distances to school, good land use mix access, available walking/cycling infrastructure and convenient recreational facilities. Girls reported higher total physical activity levels when parents perceived high residential density, good land use mix access, well-maintained and high quality walking/cycling infrastructures and more traffic safety. Independent mobility was found to be an important mediator of these associations in girls.ConclusionsNeighborhood environmental interventions to increase children’s active transport and physical activity can be effective when combined with awareness raising programs for parents. Furthermore, among girls encouraging independent mobility may contribute to behavior change.

Physical Environmental Attributes and Active Transportation in Belgium: What About Adults and Adolescents Living in the Same Neighborhoods?

Purpose. To examine if adults and adolescents living in the same high- and low-walkable neighborhoods have different environmental perceptions and if this is reflected in distinct associations between environmental perceptions and active transportation. Design. Cross-sectional study with observational design. Setting. In Ghent, 24 neighborhoods were selected, stratified on objectively assessed walkability, and matched on neighborhood income. This resulted in four walkability/income quadrants, each consisting of six neighborhoods. Subjects. Living in the 24 neighborhoods were 1166 adults (20–65 years, 52.1% women) and 477 adolescents (13–15 years, 49.7% girls). Measures. All participants completed a sociodemographic questionnaire, the International (adults) or Flemish (adolescents) Physical Activity Questionnaire and the Neighborhood Environmental Walkability Scale. Analysis. Multilevel (two-level: participant-neighborhood) moderated regression models, using MLwiN 2.23. Results. Both adults and adolescents living in objectively high-walkable neighborhoods perceived their environment as more activity friendly than their low-walkable neighborhoods counterparts (11 out of 13 main effects walkability: p < .05). However, perceived residential density (p < .05), land use mix (p < .01), safety for cycling (p < .05), and perceived walkability (p < .001) were associated with active transportation only in adults. Conclusion. Different environmental intervention strategies are probably needed to increase active transportation in Belgian adults and adolescents living in the same neighborhoods. In adults, changing objective or perceived environmental characteristics might be effective, whereas in adolescents, the current environmental focus should be changed towards multidimensional research.

Changes in the perceived neighborhood environment in relation to changes in physical activity: A longitudinal study from childhood into adolescence.

The aim was to investigate how physical activity and the perceived neighborhood environment in children change when they enter adolescence. Also the relation between changes in the perceived environment and changes in childrens physical activity was investigated. In total, 321 children and one of their parents filled out a physical activity questionnaire and the NEWS-Y at two time points (last grade of elementary school and 2 years later). Children also wore an activity monitor. Changes in childrens physical activity were dependent on the physical activity domain. Only less than half of childrens perceived neighborhood factors changed and about half of the parental perceived neighborhood factors changed. Most of these factors changed towards higher activity friendliness. Changes in the perceived environment were only limitedly related to changes in childrens physical activity.

Which socio-ecological factors associate with a switch to or maintenance of active and passive transport during the transition from primary to secondary school?

Objectives The aim was to investigate which individual, psychosocial and physical neighborhood environmental factors associate with children’s switch to or maintenance of active/passive transport to school and to leisure time destinations during the transition from primary to secondary school. Methods Children (n = 313) filled out a questionnaire in the last year of primary school and 2 years later to assess socio-demographic characteristics and self-reported transport. One of their parents completed a questionnaire to assess parental perceptions of psychosocial and physical neighborhood environmental factors. Results The increase of the home-school distance was significantly associated with children’s switch to or maintenance of passive transport to school compared to a switch to (OR = 0.81; p = 0.03) and maintenance (OR = 0.87; p = 0.03) of active transport to school. Low SES was associated with children’s switch to active transport to school compared to maintenance of active transport (OR = 3.67; p = 0.07). For transport to leisure time destinations, other factors such as parental perceived neighborhood safety from traffic and crime (OR = 2.78; p = 0.004), a positive social norm (OR = 1.49; p = 0.08), positive attitudes (OR = 1.39; p = 0.08) (i.e. more benefits, less barriers) towards their children’s physical activity and poor walking/cycling facilities in the neighborhood (OR = 0.70; p = 0.06) were associated with children’s maintenance of active transport to leisure time destinations compared to a switch to or maintenance of passive transport. Conclusions This longitudinal study can give directions for interventions promoting children’s active transport during the transition to secondary school. It is necessary to promote different possibilities at primary school for children to use active transport when going to secondary school. Walking/cycling a part of the home-school trip can be a possible solution for children who will be living at non-feasible distances from secondary school. Providing safe neighborhoods, combined with programs for parents stimulating a positive social norm and positive attitudes towards physical activity during primary school, can be effective.