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ObjectiveTo investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults.DesignSystematic review.Data sourcesMedline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022).Eligibility criteria for study selectionEconomic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes versus no intervention or usual care for older adults living in the community or care facilities, and reporting incremental cost-effectiveness ratio (ICER) for fall-related outcomes or quality-adjusted life years (QALY, expressed as cost/QALY) and/or intervention costs.Results31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$100 000/QALY), most results (17/24) were considered cost-effective (moderate certainty). The greatest value for money (lower ICER/QALY gained and fall prevented) appeared to accrue for older adults and those with high fall risk, but unsupervised exercise appeared to offer poor value for money (higher ICER/QALY). For care facilities (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported.ConclusionsMost economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising.PROSPERO registration numberPROSPERO 2020 CRD42020178023.

ObjectivesPhysical activity guidelines are evidence-based statements on recommended physical activity levels for good health. Guidelines, in isolation, are unlikely to increase population levels of physical activity; appropriate and effective communication is fundamental to maximising their impact. The aim of this paper is to provide a planning framework for physical activity guideline communication, including an overview of key audiences, aims and approaches.MethodsAll authors considered and agreed on the three broad issues to address by consensus. We identified key sources of evidence through scoping of the literature and our knowledge of the research area.ResultsWhether guidelines are global or national, communication of the physical activity guidelines should be informed by: (1) a situational analysis that considers the context in which the communication will take place and (2) a stakeholder analysis to determine the key target audiences for the communication and their values, needs and preferences. Audiences include policy-makers within and outside the health sector, other key stakeholders, the general public, specific population subgroups, health professionals and non-health professionals with a role in physical activity promotion. The aims and approach to communication will differ depending on the target audience.ConclusionCommunication to raise awareness and knowledge of the physical activity guidelines must be supported by policies, environments and opportunities for physical activity. Besides the intrinsic value of the physical activity guidelines, it is essential that substantial effort is put in to diligently planning, funding and implementing their communication from the outset.

ObjectiveTo investigate the association of running participation and the dose of running with the risk of all-cause, cardiovascular and cancer mortality.DesignSystematic review and meta-analysis.Data sourcesJournal articles, conference papers and doctoral theses indexed in Academic Search Ultimate, CINAHL, Health Source: Nursing/Academic Edition, MasterFILE Complete, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus and Web of Science.Eligibility criteria for selecting studiesProspective cohort studies on the association between running or jogging participation and the risk of all-cause, cardiovascular and/or cancer mortality in a non-clinical population of adults were included.ResultsFourteen studies from six prospective cohorts with a pooled sample of 232 149 participants were included. In total, 25 951 deaths were recorded during 5.5–35 year follow-ups. Our meta-analysis showed that running participation is associated with 27%, 30% and 23% lower risk of all-cause (pooled adjusted hazard ratio (HR)=0.73; 95% confidence interval (CI) 0.68 to 0.79), cardiovascular (HR=0.70; 95% CI 0.49 to 0.98) and cancer (HR=0.77; 95% CI 0.68 to 0.87) mortality, respectively, compared with no running. A meta-regression analysis showed no significant dose–response trends for weekly frequency, weekly duration, pace and the total volume of running.ConclusionIncreased rates of participation in running, regardless of its dose, would probably lead to substantial improvements in population health and longevity. Any amount of running, even just once a week, is better than no running, but higher doses of running may not necessarily be associated with greater mortality benefits.

ObjectivesTo assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.MethodsA cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.ResultsOverall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; pConclusionA multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617001265369).

Published in the Lancet in 2020, the Global Burden of Disease (GBD) 2019 provided updated disease burden rankings for 87 risk factors including behavioural and metabolic risks. GBD 2019 ranked low physical activity 19th out of 20 risk factors in terms of disability-adjusted life years, down from 10th in the equivalent 2010 GBD publication.1 The number of attributable deaths has decreased from 3.2 million in 20101 to approximately 1.2 million in 20192; both estimates are substantially lower than the Lancet 2012 physical activity series estimates (5 million deaths/year).3 GBD authors2 do not comment on this remarkable demotion of physical activity’s ranking in 2019, despite the fact that it contradicts the significant progress in the field of physical activity over the last decade.4 Here, we explore this seemingly counterintuitive downgrade to alert policy makers, health professionals and researchers about the caveats of interpreting GBD data. We also offer suggestions on how to improve future physical activity GBD estimates. Physical activity is a complex multidimensional behaviour whose health effects are determined by its intensity, duration, type (eg, aerobic vs strength training) and domain.4 GBD considered a single physical activity indicator that captures only total volume. This provides a stark contrast with how GBD treated other behaviours such as diet, which was addressed by 15 different risk factor indicators, including a diet low in seafood omega-3 fatty acids intake and low milk …

Galileo Galilei’s quote “measure what is measurable, and make measurable what is not so”\ud has particular relevance to health behaviours, such as physical activity (PA), sitting and\ud sleep, whose measurement during free living is notoriously difficult. To date, much of what\ud we know about how these behaviours affect our health is based on self-report by\ud questionnaires which have limited validity, are prone to bias, and inquire about selective\ud aspects of these behaviours. Although self-reported evidence has made great contributions\ud to shaping public health and exercise medicine policy and guidelines until now1, the ongoing\ud advancements of accelerometry-based measurement and evidence synthesis methods are\ud set to change the landscape. The aim of this editorial is to outline new directions in PA and\ud sleep related epidemiology that open new horizons for guideline development and\ud improvement; and to describe a new research collaboration platform: the Prospective\ud Physical Activity, Sitting, and Sleep consortium (ProPASS).

In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016Lancetseries on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on theLancetseries and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an ‘upstream’ public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as ‘roadmaps’ in progress to encourage moving the field of physical activity towards achieving population-level impact globally.

The COVID-19 pandemic has brought unparalleled destruction to global health, social and economic systems. To control the spread of COVID-19, most countries have enforced a societal-level lockdown. This mass disruption of civil life provides opportunities for observational ‘natural experiments’, mandating lifestyle changes overnight. Big data, such as Google Trends (GT), have been used to identify outbreaks1 and monitor risk communication strategies,2 public awareness3 and misinformation4 during COVID-19. The real-time nature of data, together with ubiquitous internet access and Google’s dominance of online search traffic, has uniquely positioned GT as a useful tool for ‘nowcasting’ social trends and lifestyle changes.5 An area of life significantly impacted by COVID-19 lockdown is physical activity. Closure of gyms and restrictions on ‘non-essential’ travel may lead to declines in overall physical activity. Conversely, changing circumstances may interrupt ‘automatic’ behavioural patterns through ‘habit discontinuity’6 leading to formation of new health habits, as demonstrated by previous research on residential relocation.7 Here, we used GT data to explore community interest in physical activity before and during COVID-19 outbreaks in Australia, the UK and the USA. We extracted GT data of nation-level online queries for the topic ‘exercise’, which included all related search terms sharing the same concept, such as ‘workouts’ and ‘fitness training’ (online supplementary file). GT normalises search data within a defined time frame and geography on a scale of …

Increasing evidence suggests that attributes of neighbourhood environments may play an important role in physical activity.1 2 However, nearly all studies in the field are cross-sectional and are subject to substantial bias.3 Residential relocation provides an opportunity for natural experiments where relocating to a new neighbourhood may ‘interrupt’ habitual behaviours and help establish new behavioural patterns.4 We conducted a systematic review on the effects of residential relocation on physical activity, walking and travel behaviour (PROSPERO registration number CRD42017077681, available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=77681).5 We found 23 …

AIMS: To test the hypothesis that total sitting time is associated with incident diabetes, after adjustment for physical activity and obesity.METHODS: 72 608 Danish adults from the DANHES cohort reported their total sitting time in 2007-2008 and were followed-up for 5 years, in relation to register-based incident diabetes mellitus. Cox regression analyses were used, and the effect-modifying influence of obesity and physical activity assessed.RESULTS: The age-sex adjusted HR for developing diabetes among those who sat 10+ h/day as compared to CONCLUSIONS: The association between total sitting time and incident diabetes is substantially moderated by physical activity and obesity. Total sitting time remains a risk factor for diabetes only in inactive and obese populations.

Media reports of the ‘new smoking’ have proliferated with little consideration of the disease burden of emergent risk factors. We consider the example of prolonged sitting in particular. The ‘new smoking’ analogy is a powerful heuristic device that draws on the well-known dangers of tobacco smoking. Such attention-grabbing ‘factoids’ are rapidly disseminated and perpetuated,1 and can be difficult to dispel later. We quantified which health risks have been called the ‘new smoking’ and consider the epidemiological evidence for and the implications of these comparisons. We searched the Factiva database for news stories containing the phrases ‘is the new smoking’ or ‘as bad as smoking’ in 2012–2016. News stories containing these phrases were independently coded for the health risk being compared with smoking, along with article characteristics (eg, headline, name of publication, date of publication). We identified 614 unique news stories that contained the target phrases. The top 10 mentioned health risks and behaviours compared with smoking are presented in table 1. The most dominant topics were sitting and obesity, with 55% and 12% of stories, respectively. The total number of ‘new smoking’ or ‘as …

We thank Chaput and colleagues1 for their comments on our recent review2 that examined the timeliness of sitting guidelines and provided a critical overview of the sedentary behaviour evidence base. To recap for the reader: we argued that evidence of sitting and health is limited and we urged caution to prevent enthusiastic but premature guideline development. Chaput and colleagues argued that the sedentary behaviour evidence base is adequate and that a provisional screen time-based benchmark is better than no benchmark at all. We see four main areas for debate and discuss them in turn. Initially, our respected international colleagues1 proposed that the field needs to move towards ‘activity mixes’ that take into account the 24-hour compositional nature of the physical activity, sedentary behaviour and sleep data. Consider a weekend day when a person goes for a 3-hour bike ride. That reduces potential sitting time by 3 hours, so these physical activity elements, moderate to vigorous physical activity (MVPA) (bike ride), and sedentary …

ObjectiveTo examine whether the associations between sedentary behaviours (ie, daily sitting/TV-viewing time) and mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity (PA).DesignHarmonised meta-analysis of prospective cohort studies. Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sedentary behaviours and into quartiles of PA (MET-hour/week).Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus and Scopus.Eligibility criteria for selecting studiesIndividual level data on both sedentary behaviours and PA and reported effect estimates for CVD or cancer mortality.ResultsNine studies (n=850 060; deaths=25 730) and eight studies (n=777 696; deaths=30 851) provided data on sitting time and CVD and cancer mortality, respectively. Five studies had data on TV-viewing time and CVD (n=458 127; deaths=13 230) and cancer (n=458 091; deaths=16 430) mortality. A dose–response association between sitting time (9%–32% higher risk; p for trend ConclusionPA modifies the associations between sedentary behaviours and CVD and cancer mortality. These findings emphasise the importance of higher volumes of moderate and vigorous activity to reduce, or even eliminate these risks, especially for those who sit a lot in their daily lives.

Background: Sedentary behaviour is a potential risk factor for chronic-ill health and mortality, that is, independent of health-enhancing physical activity. Few studies have investigated the risk of mortality associated with multiple contexts of sedentary behaviour. Objective: To examine the prospective associations of total sitting time, TV-viewing time and occupational sitting with mortality from all causes and cardiometabolic diseases. Methods: Data from 50 817 adults aged ≥20 years from the Nord-Trøndelag Health Study 3 (HUNT3) in 2006-2008 were linked to the Norwegian Cause of Death Registry up to 31 December 2010. Cox proportional hazards models examined all-cause and cardiometabolic disease-related mortality associated with total sitting time, TV-viewing and occupational sitting, adjusting for multiple potential confounders including physical activity. Results: After mean follow-up of 3.3 years (137 315.8 person-years), 1068 deaths were recorded of which 388 were related to cardiometabolic diseases. HRs for all-cause mortality associated with total sitting time were 1.12 (95% CI 0.89 to 1.42), 1.18 (95% CI 0.90 to 1.57) and 1.65 (95% CI 1.24 to 2.21) for total sitting time 4

Background Although certain types of sedentary behaviour have been linked to metabolic risk, prospective studies describing the links between sitting with incident diabetes are scarce and often do not account for baseline adiposity. We investigate the associations between context-specific sitting and incident diabetes in a cohort of mid-aged to older British civil servants. Methods Using data from the Whitehall II study (n=4811), Cox proportional hazards models (adjusted for age, sex, ethnicity, employment grade, smoking, alcohol intake, fruit and vegetable consumption, self-rated health, physical functioning, walking and moderate-to-vigorous physical activity, and body mass index (BMI)) were fitted to examine associations between total sitting and context–specific sitting time (work, television (TV), non-TV leisure time sitting at home) at phase 5 (1997–1999) and fasting glucose-defined incident diabetes up to 2011. Results Total sitting (HR of the top compared with the bottom group: 1.26; 95% CI 1.00 to 1.62; p=0.01) and TV sitting (1.33; 95% CI 1.03 to 1.88; p=0.05) showed associations with incident diabetes; once BMI was included in the model these associations were attenuated for both total sitting (1.19; 95% CI 0.92 to 1.55; p=0.22) and TV sitting (1.31; 95% CI 0.96 to 1.76; p=0.14). Conclusion We found limited evidence linking sitting and incident diabetes over 13 years in this occupational cohort of civil servants.

Our recent paper1 examined the type-specific associations between sports and all cause and cardiovascular disease (CVD) mortality. Among the wide media attention,2 CNN reported our finding as ‘Swimming, aerobics, racquet sports slash risk of death’3 and those three sports that showed the largest reductions in mortality risk (as indicated by the HR value).4 Running and football (soccer)/rugby5 showed limited beneficial associations with mortality. While it was beyond the capacity and scope of our research to undertake comparisons between different sports and explain why these three specific types of sports were associated with the largest reductions in risk, much of the media commentary2 was consumed with aetiological explanations3 5–7 of the beneficial associations that participation in certain sports conferred. On the other hand, an alternative explanation is that our findings of lower mortality did not reflect the health attributes of the examined sports but, instead, they were related to socioeconomic characteristics of the participants of certain sports. For example, as football is perceived …

Background The Olympic Games’ (OG) organisers typically hope that a diverse range of health legacies, including increases in physical activity and sport participation will result from their hosting of the OG. Despite these aspirations, the effects of the Olympics on physical activity levels remain to be demonstrated in large-scale population studies. Methods This study examined the short-term impact of the Sydney 2000 OG, using serial cross-sectional population physical activity surveys of Australian adults in November 1999 and November 2000. Random sample surveys of adults asked about physical activity participation, intention to be more active, and in 2000, response to the OG. Results There were no significant effects of the Olympics on physical activity participation among adult Australians, measured 6 weeks after the end of the Games. Total minutes of leisure-time physical activity did not change significantly between 1999 and 2000 (295–303 min/week), and the proportion reaching the recommended levels of 150 min/week did not change (56.6% and 56.8%, respectively, in 1999 and 2000). The intention to be active in the next month increased after the Games (adjusted OR 1.12, 95% CI 1.01 to 1.24), but was not associated with physical activity behaviour change. Conclusions The legacy of the OG may be apparent through new infrastructure and other urban improvements, but evidence of their influence on physical activity levels remains elusive. Without multiyear integrated and well-funded programmes to promote physical activity, the Olympic legacy of a more active community may remain more rhetoric than reality.

Background Recent estimates suggest that high body mass index (BMI), smoking, high blood pressure (BP) and physical inactivity are leading risk factors for the overall burden of disease in Australia. The aim was to examine the population attributable risk (PAR) of heart disease for each of these risk factors, across the adult lifespan in Australian women. Methods PARs were estimated using relative risks (RRs) for each of the four risk factors, as used in the Global Burden of Disease Study, and prevalence estimates from the Australian Longitudinal Study on Women9s Health, in 15 age groups from 22–27 (N=9608) to 85–90 (N=3901). Results RRs and prevalence estimates varied across the lifespan. RRs ranged from 6.15 for smoking in the younger women to 1.20 for high BMI and high BP in the older women. Prevalence of risk exposure ranged from 2% for high BP in the younger women to 79% for high BMI in mid-age women. In young adult women up to age 30, the highest population risk was attributed to smoking. From age 31 to 90, PARs were highest for physical inactivity. Conclusions From about age 30, the population risk of heart disease attributable to inactivity outweighs that of other risk factors, including high BMI. Programmes for the promotion and maintenance of physical activity deserve to be a much higher public health priority for women than they are now, across the adult lifespan.