Sara D’Haese

A life course examination of the physical environmental determinants of physical activity behaviour: A “Determinants of Diet and Physical Activity” (DEDIPAC) umbrella systematic literature review

Background Participation in regular physical activity is associated with a multitude of health benefits across the life course. However, many people fail to meet PA recommendations. Despite a plethora of studies, the evidence regarding the environmental (physical) determinants of physical activity remains inconclusive. Objective To identify the physical environmental determinants that influence PA across the life course. Methods An online systematic literature search was conducted using MEDLINE, ISI Web of Science, Scopus and SPORTDiscus. The search was limited to studies published in English (January 2004 to April 2016). Only systematic literature reviews (SLRs) and meta-analyses (MAs) of observational studies, that investigated the association between physical determinants and physical activity outcomes, were eligible for inclusion. The extracted data were assessed on the importance of determinants, strength of evidence and methodological quality. Results The literature search identified 28 SLRs and 3 MAs on 67 physical environmental characteristics potentially related to physical activity that were eligible for inclusion. Among preschool children, a positive association was reported between availability of backyard space and outdoor toys/equipment in the home and overall physical activity. The availability of physical activity programs and equipment within schools, and neighbourhood features such as pedestrian and cyclist safety structure were positively associated with physical activity in children and adolescents. Negative street characteristics, for example, lack of sidewalks and streetlights, were negatively associated with physical activity in adults. Inconsistent associations were reported for the majority of reviewed determinants in adults. Conclusion This umbrella SLR provided a comprehensive overview of the physical environment determinants of physical activity across the life course and has highlighted, particularly amongst youth, a number of key determinants that may be associated with overall physical activity. Given the limited evidence drawn mostly from cross-sectional studies, longitudinal studies are needed to further explore these associations. Registration PROSPERO CRD42015010616

The association between objective walkability, neighborhood socio-economic status, and physical activity in Belgian children

BackgroundObjective walkability is an important correlate of adults’ physical activity. Studies investigating the relation between walkability and children’s physical activity are scarce. However, in order to develop effective environmental interventions, a profound investigation of this relation is needed in all age groups. The aim of this study was to investigate the association between objective walkability and different domains of children’s physical activity, and to investigate the moderating effect of neighborhood socio-economic status in this relation.MethodsData were collected between December 2011 and May 2013 as part of the Belgian Environmental Physical Activity Study in children. Children (9–12 years old; n = 606) were recruited from 18 elementary schools in Ghent (Belgium). Children together with one of their parents completed the Flemish Physical Activity Questionnaire and wore an accelerometer for 7 consecutive days. Children’s neighborhood walkability was calculated using geographical information systems. Multilevel cross-classified modeling was used to determine the relationship between children’s PA and objectively measured walkability and the moderating effect of neighborhood SES in this relation.ResultsIn low SES neighborhoods walkability was positively related to walking for transportation during leisure time (β = 0.381 ± 0.124; 95% CI = 0.138, 0.624) and was negatively related to sports during leisure time (β = −0.245 ± 0.121; 95% CI = −0.482, −0.008). In high socio-economic status neighborhoods, walkability was unrelated to children’s physical activity. No relations of neighborhood walkability and neighborhood socio-economic status with cycling during leisure time, active commuting to school and objectively measured moderate- to vigorous-intensity physical activity were found.ConclusionsNo univocal relation between neighborhood walkability and physical activity was found in 9–12 year old children. Results from international adult studies cannot be generalized to children. There is a need in future research to determine the key environmental correlates of children’s physical activity.

Cross-continental comparison of the association between the physical environment and active transportation in children: a systematic review

BackgroundThe purpose of this systematic review was to determine the relationship between a wide range of physical environmental characteristics and different contexts of active transportation in 6- to 12-year-old children across different continents.MethodsA systematic search was conducted in six databases (Pubmed, Web of Science, Cinahl, SportDiscus, TRIS and Cochrane) resulting in 65 papers, eligible for inclusion. The investigated physical environmental variables were grouped into six categories: walkability, accessibility, walk/cycle facilities, aesthetics, safety, recreation facilities.ResultsThe majority of the studies were conducted in North America (n = 35), Europe (n = 17) and Australia (n = 11). Active transportation to school (walking or cycling) was positively associated with walkability. Walking to school was positively associated with walkability, density and accessibility. Evidence for a possible association was found for traffic safety and all forms of active transportation to school. No convincing evidence was found for associations between the physical environment and active transportation during leisure.General safety and traffic safety were associated with active transportation to school in North America and Australia but not associated with active transportation to school in Europe.ConclusionsThe physical environment was mainly associated with active transportation to school. Continent specific associations were found, indicating that safety measures were most important in relation to active commuting to school in North America and Australia. There is a need for longitudinal studies and studies conducted in Asia, Africa and South-America and studies focusing specifically on active transportation during leisure.

Behavioral determinants of physical activity across the life course: a “DEterminants of DIet and Physical ACtivity” (DEDIPAC) umbrella systematic literature review

BackgroundLow levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course.MethodsA systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616).ResultsSeventeen reviews on 35 behavioral determinants of PA were eligible for this umbrella SLR. Regardless of age, the most investigated determinants were those related with ‘screen use’ and ‘smoking’. For youth, probable positive evidence emerged for ‘previous PA’ and ‘independent mobility and active transport’ among children and adolescents. For the adult population, ‘transition to university’ and ‘pregnancy/having a child’ showed probable negative associations.ConclusionsAlthough the majority of the evidence was limited and most of the determinants were not associated with PA, this umbrella SLR provided a comprehensive overview of the associations between behavioral determinants and PA. Youth should be physically active in the early years and increase active transportation to/from school, independent mobility, and ‘free-range activities’ without adult supervision, whilst adult PA behaviors are mostly influenced by the life events. Finally, more research is needed that incorporates prospective study designs, standardized definitions of PA, objective measurement methods of PA assessment, and the use of interactionist and mediational approaches for the evaluation of different behavioral determinants influencing PA behaviors.

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.

The influence of dairy consumption, sedentary behaviour and physical activity on bone mass in Flemish children: a cross-sectional study

BackgroundThis cross-sectional study aimed to look for an association in young children between whole body bone mineral content (BMC) and areal bone mineral density (aBMD) and dairy consumption as well as sedentary behaviour (SB) and physical activity (PA). Moreover, we investigated whether there was an interaction effect between dairy consumption and SB or PA on BMC and aBMD.MethodsHealthy children (6-12 years) were recruited from primary schools. Body composition and whole body bone mass were measured with dual-energy X-ray absorptiometry (DXA), dairy consumption was assessed with a food frequency questionnaire (FFQ) and PA and SB with an accelerometer. In total, 272 children underwent a DXA scan. Complete FFQ data were available for 264 children and 210 children had matching data from accelerometry recordings. Regression analyses were used to study the associations between (1) BMC and aBMD and (2) dairy consumption, SB and PA, adjusting for age, gender, pubertal stage, height and body composition.ResultsDairy consumption was positively associated with whole body BMC and aBMD (absolute value as well as z-score), after correction for relevant confounders. SB was negatively associated with aBMD z-score and light PA was positively associated with both BMC and aBMD z-score. No gender differences were found. Moreover, an interaction effect between vigorous PA (VPA) and dairy consumption on aBMD (z-score) and BMC z-score was found, indicating that children with both high VPA and high dairy consumption had higher values for BMC and aBMD of the whole body minus the head.ConclusionAlready at young age, PA and dairy consumption positively influence whole body bone mass assessed by DXA. Moreover, this study indicates clearly that SB is negatively associated with whole body bone density. Promoting regular PA and sufficient dairy consumption in young children and limiting SB can be expected to positively influence their bone mass accumulation, which can help in the prevention of osteoporosis later in life.

Mediating Effects of Self-Efficacy, Benefits and Barriers on the Association between Peer and Parental Factors and Physical Activity among Adolescent Girls with a Lower Educational Level.

Background The prevalence of physical activity among lower educated adolescent girls is low, suggesting it is important to have insights into the complex processes that may underlie their physical activity levels. Therefore, this study aimed to examine the mediating effects of self-efficacy, perceived benefits and barriers on the associations between peer and parental variables and physical activity among lower educated adolescent girls. Methods In total, 226 girls (mean age 16.0±1.0 years; 53% technical education; 47% vocational education) from a convenience sample of 6 secondary schools in Flanders, Belgium, completed a questionnaire on their total physical activity level and related peer and parental variables (i.e. modeling of physical activity, co-participation in physical activities and encouragement to be active) and personal variables (i.e. self-efficacy to be active, and specific perceived benefits of physical activity and specific barriers to be active). Mediating effects were tested using MacKinnon’s product-of-coefficients test based on multilevel linear regression analyses. Results Higher peer and parental modeling, co-participation and encouragement were significantly related to a higher physical activity level among adolescent girls (p<0.05). Self-efficacy, the perceived benefits of having fun, being around friends or meeting new people, and not being bored and the perceived barrier of not liking physical activity mediated several associations between peer and parental variables and girls’ physical activity, with some of the mediated proportions exceeding 60%. Conclusions This study contributed to a better understanding of the complexity of how parental and peer factors work together with personal factors to influence the physical activity levels of adolescent girls with a lower educational level. Interventions should involve both peers and parents, as they may influence girls’ physical activity both directly and indirectly through the internalisation of several personal variables, such as self-efficacy to be active and the perceived benefit of having fun.

Feasibility and effectiveness of drop-off spots to promote walking to school

BackgroundDrop-off spots are locations in the proximity of primary schools where parents can drop off or pick up their child. From these drop-off spots children can walk to and from school. This pilot study aimed to investigate the feasibility and effectiveness of drop-off spots and to evaluate how drop-off spots are perceived by school principals, teachers and parents of 6-to-12-year old children.MethodsFirst, a feasibility questionnaire was completed (n = 216) to obtain parental opinions towards the implementation of drop-off spots. A drop-off spot was organized (500-800 m distance from school) in two primary schools. A within-subject design was used to compare children’s (n = 58) step counts and number of walking trips during usual conditions (baseline) and during implementation of a drop-off spot (intervention). Three-level (class-participant-condition) linear regression models were used to determine intervention effects. After the intervention, 2 school principals, 7 teachers and 44 parents filled out a process evaluation questionnaire.ResultsPrior to the intervention, 96% expressed the need for adult supervision during the route to school. Positive significant intervention effects were found for step counts before/after school hours (+732 step counts/day; X2 = 12.2; p < 0.001) and number of walking trips to/from school (+2 trips/week; X2 = 52.9; p < 0.001). No intervention effect was found for total step counts/day (X2 = 2.0; p = 0.16). The intervention was positively perceived by the school principals and parents, but teachers expressed doubts regarding future implementation.ConclusionThis pilot study showed that implementing drop-off spots might be an effective intervention to promote children’s walking to school. Implementing drop-off spots does not require major efforts from the schools and schools can choose how and when they organize drop-off spots. However, motivating teachers and involving other volunteers (e.g. parents, grandparents) may be needed. Future studies should investigate the feasibility and effectiveness of drop-off spots in a larger sample of schools.

Using an audit tool (MAPS Global) to assess the characteristics of the physical environment related to walking for transport in youth: reliability of Belgian data

BackgroundThe aim was to examine inter-rater and alternate-form reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS) Global tool to assess the physical environment along likely walking routes in Belgium.MethodsFor 65 children participating in the BEPAS-children study, routes between their individual homes and the nearest pre-defined destination were defined. Using MAPS Global, physical environmental characteristics of the routes were audited by 4 trained auditors (2 on-site, 2 online using Google Street View). Inter-rater reliability was studied for on-site and online ratings separately. Alternate-form reliability was examined by comparing on-site with online ratings.ResultsInter-rater reliability for on-site ratings was acceptable for 68% of items (kappa range 0.03–1.00) and for online ratings for 60% of items (kappa range −0.03 to 1.00). Acceptable alternate-form reliability was reported for 60% of items (kappa range −0.01 to 1.00/r range 0.31–1.00).ConclusionsMAPS Global can be used to assess the physical environment of potential walking routes. For areas where Google Street View imagery is widely covered and often updated, MAPS Global can be completed online.

Socio-cultural determinants of physical activity across the life course: a ‘Determinants of Diet and Physical Activity’ (DEDIPAC) umbrella systematic literature review

ObjectiveRegular physical activity (PA) reduces the risk of disease and premature death. Knowing factors associated with PA might help reducing the disease and economic burden caused by low activity. Studies suggest that socio-cultural factors may affect PA, but systematic overviews of findings across the life course are scarce. This umbrella systematic literature review (SLR) summarizes and evaluates available evidence on socio-cultural determinants of PA in children, adolescents, and adults.MethodsThis manuscript was drafted following the recommendations of the ‘Preferred Reporting Items for Systematic reviews and Meta-Analyses’ (PRISMA) checklist. The MEDLINE, Web of Science, Scopus, and SPORTDiscus databases were searched for SLRs and meta-analyses (MAs) on observational studies published in English that assessed PA determinants between January 2004 and April 2016. The methodological quality was assessed and relevant information on socio-cultural determinants and any associations with PA was extracted. The available evidence was evaluated based on the importance of potential determinants and the strength of the evidence.ResultsTwenty SLRs and three MAs encompassing 657 eligible primary studies investigated potential socio-cultural PA determinants, with predominantly moderate methodological quality. Twenty-nine potential PA determinants were identified that were primarily assessed in children and adolescents and investigated the micro-environmental home/household level. We found probable evidence that receiving encouragement from significant others and having a companion for PA were associated with higher PA in children and adolescents, and that parental marital status (living with partner) and experiencing parental modeling were not associated with PA in children. Evidence for the other potential determinants was limited, suggestive, or non-conclusive. In adults, quantitative and conclusive data were scarce.ConclusionsA substantial number of SLRs and MAs investigating potential socio-cultural determinants of PA were identified. Our data suggest that receiving social support from significant others may increase PA levels in children and adolescents, whereas parental marital status is not a determinant in children. Evidence for other potential determinants was limited. This was mainly due to inconsistencies in results on potential socio-cultural determinants of PA across reviews and studies.Trial registrationsThis umbrella SLR was recorded on PROSPERO (Record ID: CRD42015010616).