Lilian G. Perez

The implications of megatrends in information and communication technology and transportation for changes in global physical activity

Physical inactivity accounts for more than 3 million deaths per year, most from non-communicable diseases in low-income and middle-income countries. We used reviews of physical activity interventions and a simulation model to examine how megatrends in information and communication technology and transportation directly and indirectly affect levels of physical activity across countries of low, middle, and high income. The model suggested that the direct and potentiating eff ects of information and communication technology, especially mobile phones, are nearly equal in magnitude to the mean eff ects of planned physical activity interventions. The greatest potential to increase population physical activity might thus be in creation of synergistic policies in sectors outside health including communication and transportation. However, there remains a glaring mismatch between where studies on physical activity interventions are undertaken and where the potential lies in low-income and middle-income countries for population-level effects that will truly affect global health.

Progress in physical activity over the Olympic quadrennium

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.

Can Population Levels of Physical Activity Be Increased? Global Evidence and Experience

Physical inactivity is one of the most important contributors to the global burden of disease and has become a global public health priority. We review the evidence on physical activity (PA) interventions, actions, and strategies that have the greatest potential to increase PA at the population level. Using the socio-ecological framework to conceptualize PA interventions, we show that PA can be targeted at multiple levels of influence and by multiple sectors outside the health system. Examples of promoting PA on a national scale are presented from Finland, Canada, Brazil, and Colombia. A strong policy framework, consistent investment in public health programs, multi-sectoral support and actions, and good surveillance characterize each of these success stories. Increasing PA globally will depend on successfully applying and adapting these lessons around the world taking into account country, culture, and context.

Physical Activity Levels in U.S. Latino/Hispanic Adults: Results from the Hispanic Community Health Study/Study of Latinos

INTRODUCTION Physical activity (PA) prevalence among U.S. Latino/Hispanic adults of diverse backgrounds is not well known. This study describes PA among a representative sample of U.S. Latino/Hispanic adults. METHODS A population-based cohort of Hispanic/Latino adults (aged 18-74 years) participating in the Hispanic Community Health Study/Study of Latinos from March 2008 to June 2011 (N=16,415) was recruited in four urban areas from Miami, the Bronx, Chicago, and San Diego. Participants wore an Actical hip accelerometer for 1 week (n=12,253) and completed the Global Physical Activity Questionnaire (n=15,741). Data were analyzed in 2015. RESULTS Based on accelerometry, Hispanics/Latinos engaged in 23.8 minutes/day (10.3 minutes/day when only considering minutes from sustained 10-minute bouts) of moderate to vigorous PA (MVPA). Individuals of Puerto Rican and Dominican background had the most minutes/day of MVPA (32.1 and 29.1, respectively), whereas those of Cuban background had the fewest (15.3). Based on the Global Physical Activity Questionnaire, 65% of Hispanic/Latinos met the aerobic component of 2008 Physical Activity Guidelines for Americans. Men and individuals of Puerto Rican background had the most minutes/day of leisure-time MVPA (30.3 and 30.2, respectively). Individuals of Puerto Rican and Dominican background had the most minutes/day of transportation-related PA (48.7 and 39.7, respectively). Individuals of Mexican and Central American background had the most minutes/day of work-related MVPA (90.7 and 93.2, respectively). CONCLUSIONS Among Hispanics/Latinos, self-reported data provided information on the type of PA and helped explain variability identified from accelerometer-assessed PA. These findings highlight variability in PA among Hispanics from diverse ethnic backgrounds.

Evidence-Based Obesity Treatment Interventions for Latino Adults in the U.S.: A Systematic Review

CONTEXT Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. EVIDENCE ACQUISITION Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. EVIDENCE SYNTHESIS Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions. CONCLUSIONS Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

Fe en Accion/Faith in Action: Design and implementation of a church-based randomized trial to promote physical activity and cancer screening among churchgoing Latinas.

OBJECTIVES To describe both conditions of a two-group randomized trial, one that promotes physical activity and one that promotes cancer screening, among churchgoing Latinas. The trial involves promotoras (community health workers) targeting multiple levels of the Ecological Model. This trial builds on formative and pilot research findings. DESIGN Sixteen churches were randomly assigned to either the physical activity intervention or cancer screening comparison condition (approximately 27 women per church). In both conditions, promotoras from each church intervened at the individual- (e.g., beliefs), interpersonal- (e.g., social support), and environmental- (e.g., park features and access to health care) levels to affect change on target behaviors. MEASUREMENTS The studys primary outcome is min/wk of moderate-to-vigorous physical activity (MVPA) at baseline and 12 and 24 months following implementation of intervention activities. We enrolled 436 Latinas (aged 18-65 years) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer, attended church at least four times per month, lived near their church, and did not have a health condition that could prevent them from participating in physical activity. Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months. SUMMARY Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities.

Association Between Leisure-Time Physical Activity and Self-Reported Hypertension Among Brazilian Adults, 2008

Introduction Physical inactivity is a risk factor for hypertension. The objective of this study was to examine the association between self-reported leisure-time physical activity and hypertension among Brazilian adults categorized by sex and body weight. Methods The study used data from adult respondents in 26 capital cities and the Federal District to VIGITEL (N = 54,353), Brazil’s 2008 national surveillance system for risk and protective factors for chronic diseases. We conducted a multivariate logistic regression analysis to investigate the association between self-reported leisure-time physical activity and hypertension and examined whether sex or body weight modified this relationship. Results The prevalence of self-reported hypertension was high among women, older people, and people with fewer years of education. Overall, leisure-time physical activity decreased with increasing age, increased with increasing education level, and was higher among men than women. The association for leisure-time physical activity and hypertension was modified by sex but not body weight. Leisure-time physical activity reduced the odds of hypertension in men. Conclusion On the basis of self-reporting, leisure-time physical activity may be protective against hypertension in Brazilian men. Inclusion of other physical activity domains in the analyses may be necessary to fully understand the complex relationship between physical activity and hypertension by sex. In addition, public health priorities in Brazil for improving physical activity can target the entire population and not just those who are overweight or obese.

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas:

Background. Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas’ activity and sedentary levels are unclear. Aim. To examine associations of acculturation with Latinas’ domain-specific and total PA as well as sedentary time. Method. We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA (Fe en Acción/Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Results. Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Conclusions. Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas’ PA and sedentary behaviors.

Fe en Acción: Promoting Physical Activity Among Churchgoing Latinas

Objectives To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. Methods We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. Results Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. Conclusions A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.

Neighborhood social cohesion and depressive symptoms among Latinos: Does use of community resources for physical activity matter?

BACKGROUND Greater neighborhood social cohesion is linked to fewer depressive symptoms and greater physical activity, but the role of physical activity on the relationship between neighborhood social cohesion and depression is poorly understood. The purpose of the study was to examine the effects of physical activity on the association between neighborhood social cohesion and depressive symptoms. METHODS Multivariate logistic regression tested the moderation of self-reported leisure-time moderate-to-vigorous physical activity (LTMVPA) and active use of parks or recreational facilities on the association between neighborhood social cohesion and depressive symptoms among 295 randomly selected Latino adults who completed a face-to-face interview. RESULTS After adjusting for age, gender, and income, neighborhood social cohesion and depressive symptoms were inversely related (OR = 0.8; 95% CI: 0.5-1.2). Active use of parks or recreational facilities moderated the association between neighborhood social cohesion and depressive symptoms but meeting the recommendations for LTMVPA did not. Latinos who reported active use of parks or recreational facilities and higher levels of neighborhood social cohesion had fewer depressive symptoms than peers who did not use these spaces. CONCLUSIONS Future studies are needed to test strategies for promoting active use of parks or recreational facilities to address depression in Latinos.