Tara Coppinger

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

Beverage consumption and BMI of British schoolchildren aged 9–13 years

OBJECTIVE Adequate fluid intake has been well documented as important for health but whether it has adverse effects on overall energy and sugar intakes remains under debate. Many dietary studies continue to refrain from reporting on beverage consumption, which the present study aimed to address. DESIGN A cross-sectional survey investigated self-reported measures of dietary intake and anthropometric measurements. SETTING Primary and secondary schools in south-west London, UK. SUBJECTS Boys and girls (n 248) aged 9–13 years. RESULTS Boys consumed 10 % and girls consumed 9 % of their daily energy intake from beverages and most children had total sugar intakes greater than recommended. Beverages contributed between a quarter and a third of all sugars consumed, with boys aged 11–13 years consuming 32 % of their total sugar from beverages. There was a strong relationship between consumption of beverages and energy intake; however, there was no relationship between beverage type and either BMI or BMI Z-score. Fruit juices and smoothies were consumed most frequently by all girls and 9–10-year-old boys; boys aged 11–13 years preferred soft drinks and consumed more of their daily energy from soft drinks. Milk and plain water as beverages were less popular. CONCLUSIONS Although current health promotion campaigns in schools merit the attention being given to improving hydration and reducing soft drinks consumption, it may be also important to educate children on the energy and sugar contents of all beverages. These include soft drinks, as well as fruit juices and smoothies, which are both popular and consumed regularly.

Body mass, frequency of eating and breakfast consumption in 9–13-year-olds

BACKGROUND Unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. However, debate remains around the precise eating behaviours that lead to these conditions. The present study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass index (BMI, kg m(-2) ) of youth in the UK. METHODS A total of 264 (133 boys and 131 girls) participants, aged 10-13years, completed self-report measures of dietary intake via 3-day food/drink diaries (Friday to Sunday). Trained researchers recorded height and weight to calculate the BMI. Diaries were analysed using dietplan 6 nutritional analysis software (Forestfield Software, Horsham, UK) and multivariate linear regression was used to examine any association between breakfast consumption, frequency of eating and BMI. RESULTS No relationship existed between BMI Z-score, eating frequency and breakfast consumption. However, frequent breakfast consumers had significantly lower mean (SD) BMI Z-scores [0.18(1.06) versus 0.57(1.23)] and higher intakes of iron, calcium and vitamin E than those who did not eat breakfast regularly. Those aged ≥11years consumed breakfast less frequently [0.92(0.20)] and were less likely to eat regularly [4.6(1.4)] than those aged ≤10years. CONCLUSIONS Older boys were the least likely to eat regularly and the least likely to consume breakfast. Promoting the importance of regular eating, particularly breakfast consumption to these boys, may be essential to ensure healthier, long-term eating patterns. Furthermore, the lower breakfast intakes in 11-13-year-olds and higher BMI Z-scores of those who did not eat breakfast regularly should be monitored.

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.

Socio-economic determinants of physical activity across the life course : A 'DEterminants of DIet and Physical ACtivity' (DEDIPAC) umbrella literature review

Background To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course. Methods Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus were searched for systematic literature reviews and meta-analyses of observational studies investigating the association between socioeconomic determinants of PA and PA itself (from January 2004 to September 2017). Data extraction evaluated the importance of determinants, strength of evidence, and methodological quality of the selected papers. The full protocol is available from PROSPERO (PROSPERO2014:CRD42015010616). Results Nineteen reviews were included. Moderate methodological quality emerged. For adults, convincing evidence supports a relationship between PA and socioeconomic status (SES), especially in relation to leisure time (positive relationship) and occupational PA (negative relationship). Conversely, no association between PA and SES or parental SES was found for pre-school, school-aged children and adolescents. Conclusions Available evidence on the socioeconomic determinants of PA behaviour across the life course is probable (shows fairly consistent associations) at best. While some evidence is available for adults, less was available for youth. This is mainly due to a limited quantity of primary studies, weak research designs and lack of accuracy in the PA and SES assessment methods employed. Further PA domain specific studies using longitudinal design and clear measures of SES and PA assessment are required.

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).

‘Project Spraoi’: A randomized control trial to improve nutrition and physical activity in school children

Background Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity in Europe. Consequently, there are concerns that health problems associated with this condition will present in childhood. Studies have shown that interventions based on increasing physical activity (PA) levels, reducing sedentary lifestyles and improving nutritional habits all pose protective mechanisms against obesity and its related disorders in youth. Yet, to date, there are no interventions being delivered in Ireland that concurrently target PA, nutritional habits and sedentary time amongst school children. Purpose The purpose of this study is to implement and evaluate an intervention that targets PA, nutritional habits and sedentary time in primary school children. Methods ‘Project Spraoi’ is a school based health promotion intervention, based on ‘Project Energize,’ which has been in operation in New Zealand since 2004. Measures of PA, nutritional knowledge/behaviours and health parameters including body composition, blood pressure (BP) and fitness will be gathered before and after the programme completion (24 months). For comparative purposes, we will compare these scores to a separate group who will not participate in the intervention and to counterparts partaking in Project Energize, NZ. Conclusions There is strong evidence that quality multi-component school-based programmes can increase PA, improve weight status and promote healthier dietary habits. Due to the increasing obesity levels, the implementation of such a programme that is rigorously evaluated is warranted in Ireland.

Policy determinants of physical activity across the life course: a ‘DEDIPAC’ umbrella systematic literature review

Abstract Background Despite the large number of studies and reviews available, the evidence regarding the policy determinants of physical activity (PA) is inconclusive. This umbrella systematic literature review (SLR) summarizes the current evidence on the policy determinants of PA across the life course, by pooling the results of the available SLRs and meta-analyses (MAs). Methods A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus and SPORTDiscus databases up to April 2016. SLRs and MAs of observational studies investigating the association between policy determinants of PA and having PA as outcome were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence and the methodological quality. Results Fourteen reviews on 27 policy determinants of PA were eligible for this umbrella SLR. The majority of the reviews were of moderate quality. Among children, a clear association between time spent outdoors and PA emerged. Among adults, working hours were negatively associated with PA, though evidence was limited. At the population level, community- and street-scale urban design and land use policies were found to positively support PA levels, but levels of evidences were low. Conclusions With this umbrella SLR the policy determinants of PA at individual-level and population-level have been summarized and assessed. None of the investigated policy determinants had a convincing level of evidence, and very few had a probable level of evidence. Further research is needed, preferably by using prospective study designs, standardized definitions of PA and objective measurement of PA.

Improving health through diet and exercise in children

For optimal health and growth, children need to start life as a healthy zygote and be continuously exposed to an environment that provides, in adequate quantities and quality, the many needs for life. Nutritious food and regular physical activity (PA) are two of the most fundamental requirements that support normal growth and development, with adverse early life experiences found to have lasting negative effects on health and wellbeing across the life course [1]. Breastfeeding [2] and early-in-life interventions [3] that improve the internal and external environment also have more positive influences on the life trajectory than those delivered later in life. Provision of adequate nourishment is complex; too much or too little and timing of the essential and non-essential nutrients can cause harm across the life course. As a result, a focus on foods, rather than nutrients is necessary to inform population health, policy and planning. Food-based dietary guidelines (FBDG) are simple messages that provide a basic framework to the general public on what they should be eating to foster healthy eating habits and lifestyles [4]. Universally these guidelines encourage the consumption of combinations of wholesome foods, including a variety of fruit and vegetables, good sources of protein including meat, eggs, dairy and pulses, and staples such as wholegrains and starchy vegetables for energy. There is, however, a disconnect in the food supply chain resulting in many children, from both developed and developing countries, being food insecure. Food insecurity refers to lack of access to nutritious foods in sufficient quantities to maintain good health. The foods must be culturally and socially acceptable [5]. The disconnects for the consumer at the end of the supply chain include cost, availability, time constraints for preparation and access to wholesome foods [6] and because of the added complexity of parents/carers being the sole providers of children’s food, children are also limited in their lifestyle and individual choices in relation to the foods that they predominantly consume. The ability to physically move is an inherent characteristic of living animals. However, the quality and quantity of PA provided to children is, in part, subject to the knowledge, understanding and skill of parents, families and the education system and the environment. Consequently, the opportunity to learn the fundamental movement skills (FMS) of object control, locomotion and stability for some children is limited without support of experts [7], which could ultimately lead to a lack of physical competence to participate in a broader range of activities as children age [8]. Fundamental movement skill competence is positively associated with levels of PA [9, 10] and interventions to improve FMS are effective in improving skill [11, 12] but whether such interventions can positively affect child growth and health are not yet apparent, primarily due to the short time frame often allocated to evaluation of such initiatives [13]. Traditionally, the main outcome measure of nutrition and PA trials is body mass index (BMI), which is defined as mass relative to height squared. BMI in children is a moving, or rather, growing target and increases in height and weight occur in spurts and at different times. The way that a child’s growth trajectory is assessed is against reference curves such as those provided by the World Health Organisation [14]. By focusing primarily on BMI, this view constrains understanding of other outcomes that may be equally important ‘in the desirable growth trajectory to health’. Optimal growth is not just physical size or adequate nutrients and movement. There are mental and emotional dimensions and the family, community, social and political * Elaine Rush elaine.rush@aut.ac.nz