Judy Kruger

The Effectiveness of Urban Design and Land Use and Transport Policies and Practices to Increase Physical Activity: A Systematic Review

BACKGROUND Although a number of environmental and policy interventions to promote physical activity are being widely used, there is sparse systematic information on the most effective approaches to guide population-wide interventions. METHODS We reviewed studies that addressed the following environmental and policy strategies to promote physical activity: community-scale urban design and land use policies and practices to increase physical activity; street-scale urban design and land use policies to increase physical activity; and transportation and travel policies and practices. These systematic reviews were based on the methods of the independent Task Force on Community Preventive Services. Exposure variables were classified according to the types of infrastructures/policies present in each study. Measures of physical activity behavior were used to assess effectiveness. RESULTS Two interventions were effective in promoting physical activity (community-scale and street-scale urban design and land use policies and practices). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess transportation policy and practices to promote physical activity. CONCLUSIONS Because community- and street-scale urban design and land-use policies and practices met the Community Guide criteria for being effective physical activity interventions, implementing these policies and practices at the community-level should be a priority of public health practitioners and community decision makers.

Dietary and physical activity behaviors among adults successful at weight loss maintenance

BackgroundThere is limited population-based data on behavioral factors found to be important for successful weight loss maintenance among adults.MethodsData from the 2004 Styles surveys, mailed to U.S. adults aged ≥18 years were used to examine the difference in selected weight loss strategies and attitudes among persons who reported successful weight loss attempts (lost weight and able to keep it off) and persons who were not successful (previous attempts to lose weight were unsuccessful or they could not keep the lost weight off). Behaviors examined included modification of diet, leisure-time and sports activities, and self-monitoring, and barriers to weight management.ResultsAmong adults who reported losing weight or trying to lose weight, 31.0% had been successful at both losing weight and maintenance after weight loss. Successful weight loss status differed by sex, age, and current weight status. Assessment of reported weight loss strategies, found that exercising ≥30 minutes/day and adding physical activity to daily life were significantly higher among successful versus unsuccessful weight losers. Individuals who were successful at weight loss and maintenance were less likely to use over-the-counter diet products than those who were unsuccessful at weight loss. Significantly more successful versus unsuccessful weight losers reported that on most days of the week they planned meals (35.9% vs. 24.9%), tracked calories (17.7% vs. 8.8%), tracked fat (16.4% vs. 6.6%), and measured food on plate (15.9% vs. 6.7%). Successful losers were also more likely to weigh themselves daily (20.3% vs. 11.0%). There were a significantly higher proportion of successful losers who reported lifting weights (19.0%) versus unsuccessful (10.9%). The odds of being a successful weight loser were 48%–76% lower for those reporting exercise weight control barriers were influencing factors (e.g., no time, too tired to exercise, no one to exercise with, too hard to maintain exercise routine) compared to those who reported little or no influence of exercise; similarly, the odds were 48–64% lower for those who found certain dietary barriers to be influential (e.g., eat away from home too often, diet/health food costs too much).ConclusionSelf-monitoring strategies such as weighing oneself, planning meals, tracking fat and calories, exercising 30 or more minutes daily, and/or adding physical activity to daily routine may be important in successful weight loss maintenance. Leisure-time activities such as lifting weights or cooking/baking for fun are common strategies reported by those who were successful weight losers.

Effects of the Built Environment on Physical Activity of Adults Living in Rural Settings

Objective. To conduct a systematic review of the literature to examine the influence of the built environment (BE) on the physical activity (PA) of adults in rural settings. Data Source. Key word searches of Academic Search Premier, PubMed, CINAHL, Web of Science, and Sport Discus were conducted. Study Inclusion and Exclusion Criteria. Studies published prior to June 2008 were included if they assessed one or more elements of the BE, examined relationships between the BE and PA, and focused on rural locales. Studies only reporting descriptive statistics or assessing the reliability of measures were excluded. Data Extraction. Objective(s), sample size, sampling technique, geographic location, and definition of rural were extracted from each study. Methods of assessment and outcomes were extracted from the quantitative literature, and overarching themes were identified from the qualitative literature. Data Synthesis. Key characteristics and findings from the data are summarized in Tables 1 through 3. Results. Twenty studies met inclusion and exclusion criteria. Positive associations were found among pleasant aesthetics, trails, safety/crime, parks, and walkable destinations. Conclusions. Research in this area is limited. Associations among elements of the BE and PA among adults appear to differ between rural and urban areas. Considerations for future studies include identifying parameters used to define rural, longitudinal research, and more diverse geographic sampling. Development and refinement of BE assessment tools specific to rural locations are also warranted.

Intervention Programs for Arthritis and Other Rheumatic Diseases

Disability reduction or prevention programs for people with arthritis and other rheumatic conditions reduce long-term pain and disability but reach only a fraction of their target audience. Few public health professionals are aware of these programs or their benefits. The objective of this study is to review and describe packaged (ready-to-use) arthritis self-management education and exercise/physical activity programs that have had at least preliminary evaluation. Nine intervention programs (five self-management education programs, and four exercise/physical activity programs met study criteria). Several of the packaged arthritis interventions reviewed help people with arthritis and other rheumatic conditions maximize their abilities and reduce pain, functional limitations, and other arthritis-related problems. Other packaged interventions show promise in reducing pain, disability, and depression and in increasing self-care behaviors, but they need to be evaluated more extensively.

Prevalence of transportation and leisure walking among u.s. adults

OBJECTIVE This paper aims to contrast the demographic correlates of leisure and transportation walking. METHODS Using data from the 2005 National Health Interview Survey (n=31,482), this paper reports on the prevalence of transportation walking and leisure walking for U.S. adults and examines the variation in prevalence across different socio-demographic groups. The prevalence of transportation walking and leisure walking for U.S. adults (> or =5 days/week for > or =30 min/day) was calculated using data from the 2005 National Health Interview Survey. RESULTS In the United States, 41.5% of adults walked for leisure and 28.2% walked for transportation in intervals of at least 10 min. The highest prevalence of transportation walking was among black non-Hispanic men (36.0%) and Asian/Native Hawaiian/Pacific Islander women (40.5%). The highest prevalence of leisure walking was among Asian/Native Hawaiian/Pacific Islander men (42.0%) and white non-Hispanic women (46.6%). Leisure walking was most prevalent among respondents with higher incomes and education levels, whereas transportation walking increased in prevalence with education level but decreased with income level. Based on the findings, 6% of U.S. adults were considered regularly active (> or =5 days/week for > or =30 min/day) by walking for transportation and 9% were regularly active by walking for leisure. CONCLUSION Leisure and transportation walking have distinctly different demographic correlates. These differences should guide interventions aimed at influencing walking for different purposes.

Health-related quality of life, BMI and physical activity among US adults (>/=18 years): National Physical Activity and Weight Loss Survey, 2002.

Objective:To examine the association between health-related quality of life (HRQOL) and physical activity (PA).Methods:Cross-sectional data were obtained via a national telephone survey from 9173 respondents (30.9% response rate; 51.4% cooperation rate). Four indicators of HRQOL were measured: self-rated health, physically unhealthy days, mentally unhealthy days and activity limitation days. Prevalence estimates were calculated by body mass index (BMI) category and PA level. Logistic regression evaluated BMI as an effect modifier of the relationship between HRQOL and PA.Results:Inactive adults reported more fair to poor HRQOL than active adults, regardless of BMI category (P<0.001). BMI did not modify the association between PA and any of the four HRQOL indicators.Conclusion:Prevalence of low HRQOL is inversely related to PA participation, and the relationship is not altered by BMI status. Regardless of their weight status, adults should be encouraged to engage in PA.

Body Size Satisfaction and Physical Activity Levels Among Men and Women

Body size satisfaction may be an important factor associated with physical activity. We analyzed data from the 2002 National Physical Activity and Weight Loss Survey (NPAWLS), a population‐based cross‐sectional telephone survey of US adults. Multiple logistic regression models were used to examine the association of body size satisfaction on being regularly active. Participants were aged ≥18 years with complete data on weight, race/ethnicity, physical activity level, and body size satisfaction (n = 10,021). More than half of men (55.8%) and women (53.3%) who reported being very satisfied with the body size were regularly active. After adjustment for covariates, participants who reported being somewhat or not satisfied with their body size had a 13 and 44% lower odds of being regularly active, respectively, compared with those very satisfied with their body size. When stratified by race/ethnicity, this association remained in whites (P for trend <0.001), but became weaker and nonsignificant in blacks, Hispanics, or other racial/ethnic groups. Irrespective of actual weight, those who were satisfied with their body size were more likely to engage in regular physical activity than those less satisfied. Further research is needed to explore predictors of physical activity to reduce health disparities.

Trends in No Leisure-Time Physical Activity--United States, 1988-2010.

Purpose: The aim of this study was to examine trends in the prevalence of no leisure-time physical activity (LTPA) from 1988 to 2010. Method: Using the Behavioral Risk Factor Surveillance System data, 35 states and the District of Columbia reported information on no LTPA from 1988 to 1994; all states reported no LTPA from 1996 to 2010. Results: No LTPA significantly declined over two decades. Prevalence for all states declined on an average of 0.6% per year from 29.1% in 1996 to 24.1% in 2004 and stabilized from 2005 to 2010, ranging from 24.0% to 25.4%. Prevalence declined for both sexes and all racial/ethnic groups. Conclusion: While the no LTPA trends improved over two decades, one in four U.S. adults still report they do not engage in LTPA.

Is participation in occupational physical activity associated with lifestyle physical activity levels

Objective: Little is known about the prevalence of lifestyle physical activity (PA) by occupational PA (mostly sitting, walking, or heavy labor). Methods: Descriptive and adjusted multivariable logistic regression analysis of lifestyle PA (regularly active, irregularly active, inactive) and occupational activity was used (N = 6,360). Results: The prevalence of regular lifestyle activity was 45.7% among those who sit/stand, 49.6% among walkers, and 59.7% among heavy laborers. The regression analysis showed that adults working in heavy labor were almost twice as likely to be regularly active as those who sit/stand. Conclusion: Contrary to expectation, adults who engage in physically demanding work appear to be more active outside the job. Those who are sedentary at work could benefit from having access to opportunities for PA during the workday and trying to engage in activity outside of work hours.

Muscle-Strengthening Activities and Participation Among Adults in the United States

Purpose: To describe those who reported meeting the 2008 Physical Activity Guidelines for Americans (2008 Guidelines) muscle-strengthening standard of 2 or more days per week, including all seven muscle groups, and to assess the type and location of muscle-strengthening activities performed. Method: Data from HealthStyles 2009, a cross-sectional, consumer mail-panel survey, was used for analyses (n = 4,271). The prevalence estimates with 95% confidence intervals of those meeting the 2008 Guidelines standards were calculated. Pairwise t-tests were performed to examine differences between estimates, tests for linear trends were performed among age, education, and body mass index (BMI) groups, and differences and trends were considered statistically significant at p < .05. Results: Overall, 6.0% of participants reported meeting 2008 Guidelines, and there were no significant differences between sex and racial/ethnic groups. A significant linear increase was noted among education groups, with respondents who reported lower levels of educational attainment having lower levels of participation compared with respondents who reported higher levels of educational attainment. A significant linear decrease was noted among each BMI group, with those classified as underweight/normal reporting higher levels of participation, compared with those classified as obese. Free weights and calisthenics were the most common types of activities; the home was the most common location. Conclusions: Few adults reported meeting current muscle-strengthening standards. Future public health efforts to increase participation should use the most frequently reported type and location of muscle-strengthening activities outlined in this study to guide interventions and communication campaigns.