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Despite heightened recognition of the importance of cardiorespiratory fitness (CRF) to cardiovascular (CV) health, along with updated international consensus guidelines for physical activity (PA) and sedentary behavior (SB), significant proportions of the global adult population are physically inactive, and do not meet the threshold for CRF. Physical inactivity is considered a surrogate for low CRF given that the former is defined as not reaching the recommended minimum level of PA per week to derive a health benefit. Physical inactivity remains a major global public health problem despite decades of work by various United Nations agencies, and members of the international community to improve PA levels. Given the common coupling between physical inactivity and poor health status, it is reasonable to suggest that for a significant proportion of the global population, CRF is compromised by physical inactivity. This poses a longer-term risk to morbidity and mortality. Here we provide an indicative summary of the global status of CRF and PA and reference the implications for global health. We briefly reference opportunities moving forward, including reinforcement of the importance of engaging in movement from an early age, discouraging SB, and taking a life course approach to optimise healthy living for all. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the trends and associations of maternal characteristics and birthweight among Indigenous and non-Indigenous infants. This was a retrospective population-based study. Fourteen years (2005–2018) of birthweight and perinatal health data of live-born singletons and their mothers obtained from the Tasmanian Data Linkage Unit were used to assess the trends and associations between maternal characteristics and infant birthweight using regression modelling. Compared with non-Indigenous mothers (n = 76,750), Indigenous mothers (n = 3805) had a significantly higher prevalence of risk factors during the 14-year period. Although the prevalence of prepregnancy obesity and gestational diabetes mellitus (GDM) markedly increased in both groups, the rate of increase was higher (P < 0.001) for Indigenous than non-Indigenous mothers. Smoking, alcohol consumption and illegal drug use during pregnancy reduced over the years, and there was no significant difference in the rate of reduction between the groups. Large-for-gestational-age (LGA) births increased while small-for-gestational-age (SGA) births decreased in both groups over time. In addition, high birthweight (HBW) births decreased while low birthweight (LBW) births increased. The rates of increase in LGA and LBW births and the rates of decrease in SGA and HBW births were significantly higher in Indigenous mothers compared with non-Indigenous mothers (P < 0.001 for all). The association between Indigenous ethnicity and LBW and SGA births weakened after adjusting for other confounding maternal and perinatal variables. LBW and SGA were positively associated with Indigenous ethnicity, age <18 years, smoking, alcohol consumption and illegal drug use, pre-eclampsia, underweight prepregnancy body mass index and low socio-economic status. Women with higher parity, pre-existing diabetes and prepregnancy overweight or obesity were more likely to give birth to an infant with HBW or LGA. The prevalence of risk factors for abnormal birthweight is higher among Tasmanian Indigenous mothers, contributing to a gap in birthweight outcomes between Indigenous and non-Indigenous infants. The dramatic increase in prepregnancy obesity and GDM in both groups highlight the importance of screening and management of GDM during pregnancy. Comprehensive programmes co-designed and co-managed in consultation with Indigenous people are needed to support healthy lifestyle choices among Indigenous women to address the barriers to individuals adopting behaviour change and to help close the health outcomes–related gap between Indigenous and non-Indigenous mothers and infants. [ABSTRACT FROM AUTHOR]

Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to put forward some evidence-based lessons that can be learned from how to respond to a Pandemic that relate to healthy living behaviours (HLB). A 4-step methodology was followed to conduct a narrative review of the literature and to present a professional practice vignette. The narrative review identified 8 lessons: 1) peer review; 2) historical perspectives; 3) investing in resilience and protection; 4) unintended consequences; 5) protecting physical activity; 6) school closures; 7) mental health; and 8) obesity. As in all probability there will be another Pandemic, it is important that the lessons learned over the last three years in relation to HLB are acted upon. Whilst there will not always be a consensus on what to emphasise, it is important that many evidence-based positions are presented. The authors of this paper recognise that this work is a starting point and that the lessons presented here will need to be revisited as new evidence becomes available. [ABSTRACT FROM AUTHOR]

Irrespective of geographical location, disadvantaged people are disproportionately affected by unnecessary disease and suffering caused by inequalities in health. Although equal access to opportunities for healthy living medicine regardless of legal, political, economic, or other circumstances should be a basic human right, it is increasingly improbable for scores of people, particularly in Africa, Asia, Latin America, and the Caribbean, to acquire this. In recent times, global initiatives have attempted to make 'healthy lifestyles' more equitable by pledging to be relevant to all economies, promoting prosperity, environmental protection, climate change interventions, and purposeful action to meet the needs of vulnerable populations, including women and children. Yet there remains much to be done to address and reduce the substantial international health equity gaps. Reducing disparities that disproportionately affect the lower end of social strata must entail collaborative and systemic action from important stakeholders across the whole system, an approach that translates theory and research into practice. Ideally, realist approaches that appreciate the importance of the context of problems and assume nothing works everywhere or for everyone, should be prioritised over linear/simple and non-scalable intervention strategies. [ABSTRACT FROM AUTHOR]

Traditional risk factors for cardiovascular disease (CVD) have long been the focus of preventive strategies. The impact of family stress, depression, anxiety, hostility, pessimism, job strain, social isolation, lack of purpose in life and social support, are well recognized risks for CVD development, however they are under-appreciated in clinical practice guidelines. The purpose of this article is to review the impact of acute and chronic stress on CVD risk, elaborate repositioning in guidelines, with emphasis to approaches for stress reduction. Regular exercise, both aerobic and resistance, leads to better adaptiveness to other types of stress, however, it remains unknown whether the total amount of stress one can receive before negative health effects is unlimited. Evidently, marked reductions in stress related disorders are shown following formal cardiac rehabilitation programs. Attendance of cardiac rehabilitation is highly recommended for the stress-related mortality risk reduction. Innovative approaches to offset the broad challenges that CVD pose, augmented by sustained exposure to stress, are desperately needed, but hindered by a lack of successful population-level interventions that promote lasting change. [ABSTRACT FROM AUTHOR]

COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19. [ABSTRACT FROM AUTHOR]

Figure Rating Scales (FRS) are psychometric instruments developed to measure individual's perception of physical appearance and subsequently, to determine the level of body dissatisfaction. The following systematic review summarizes existing FRSs and the techniques used to development them. A systematic search was conducted in the following databases; PubMed®, Web of Science®, Scopus® using key words "figure rating scale" AND "Stunkard". From 466 potentially relevant articles, 24 publications were included, 22 publications reporting original FRSs with the other two scales being modifications of the original for children and babies. Fifteen were figural drawings or silhouettes and nine were developed by photographic techniques, video methods or using computer software. Most of the figural scales were applicable for adults and consisted of nine images. Ten of the 15 figural scales were without facial features and four scales had minimal facial features. Technological advancements including 3D modeling have played a pivotal role in the development of FRSs. FRSs have been developed by a mix of traditional and modern techniques. The development and validation of ethnic specific FRSs using modern technology should be the priority for future studies. • Figure Rating Scales (FRS) are visual tools to assess body image and perceived body size. • FRSs have been developed by a mix of traditional and modern techniques. • FRS differ in image numbers, facial features, gender and development technique. • The development and validation of ethnic specific FRS is important for future. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and meta-analysis was to assess whether the available research to date supports the use of portion-controlled plate (PCP) and leads to reductions in body weight and improvements in other anthropometric and biochemical parameters. The systematic review summarizes existing PCPs and their impact on anthropometric and metabolic changes. A systematic search was conducted in the following databases: PubMed®, Web of Science®, Scopus®. Data were pooled using random or fixed effects meta-analysis. From 426 potentially relevant articles, 5 publications were included in this review, and 4 of which reported four different PCPs. All five studies reported a positive effect of PCP on obesity and metabolic parameters. PCP significantly reduced body weight (BW) by 2.02 kg (95% CI, −3.03 to −1.01, p < 0.0001), body mass index (BMI) by 0.87 kg m−2 (95% CI, −1.28 to −0.47, p < 0.0001) and waist circumference (WC) by 2.28 cm (95% CI, −4.57 to 0.01, p = 0.05). A non-significant reduction was observed for waist-to-hip ratio (WHR) (−0.01, 95% CI, −0.03 to 0.01, p = 0.35) during the three-month intervention period. PCP significantly decreased both BW (−1.66 kg; 95% CI, −2.69 to −0.62, p = 0.002) and percentage body weight (% BW) (−1.64%; 95% CI, −2.69 to −0.58, p = 0.002) when the intervention was undertaken for a 6-month period. Overall, results showed that portion control intervention significantly reduced BW, BMI and WC, along with a positive trend for WHR, plus biochemical and blood pressure reduction. [ABSTRACT FROM AUTHOR]

To examine the effects of aerobic training (AT) and resistance training (RT) compared to standard care on glycemic control in South Asian Sri Lankan adults with Type 2 Diabetes Mellitus (T2DM). Randomized controlled trial (RCT) with parallel-group design recruited 86 sedentary Sri Lankans (aged 35–65 years) with T2DM into aerobic training (AT, n = 28), resistance training (RT, n = 28) and control (CN, n = 30) groups. Supervised progressive exercise training consisting of 75 min per session, 2 days per week for 12 weeks was conducted. The primary outcome was pre- and post-intervention absolute change in hemoglobin A1c (HBA1c). Secondary outcomes were serum lipids, liver enzymes, chronic inflammatory status, anthropometry, body composition and blood pressure. The absolute change in HbA1c of RT vs. CN was −0.08% (95% CI, 0.8% to −0.7%, p = 0.8) and AT vs. CN was −0.22% (95% CI, 0.95% to −0.5%). Subgroup analysis (n = 49) with a high baseline HbA1c (>7.5%), absolute reduction in HbA1c in exercise groups were statistically significant (RT vs. CN was −0.37%; 95% CI 1.3% to −0.6%, p = 0.04 and AT vs. CN was −0.57%; 95% CI 1.7% to −0.6%, p = 0.03). The effect sizes (total and subgroup HbA1c >7.5%) ranged from 0.7 to 1.0 in AT, 0.4 to 1.1 in RT compared to 0.35 to 0.6 for the CN. Secondary outcomes did not significantly differ among groups. Exercise training 2 days/week improved glycemic control in Sri Lankan adults with T2DM and the effects were significant in high baseline HbA1c (>7.5%) groups (RT > AT). • First adequately powered randomized controlled exercise trial conducted in Sri Lankans with type 2 diabetes mellitus. • Exercise improved glycemic control and resistance training was more effective in patients with poor glycemic control. • Two days of exercise, 150 min per week in total was more feasible to adhere which gave the desired glycemic benefits. [ABSTRACT FROM AUTHOR]

Physical inactivity is one of the major contributing factors to the global pandemic of non-communicable diseases. Unfortunately, low levels of habitual movement and physical activity (PA) are seen in an increasing proportion of populations across low- and middle-income countries and high-income countries alike. This new normal - the inactive phenotype - is a significant contributor to multiple health and economic costs. Here we provide a brief historical overview of societal declines in PA, roughly consistent with major transitions in PA and nutrition in recent decades. This is followed by a synthesis of research evidence linking inactivity with poor health outcomes and prevention approaches needed to impact a perpetuation of poor lifestyle behaviors. A major focus of the paper is on the economic/health costs and the reduction of the inactive phenotype. In summary, we demonstrate that the consequences of insufficient PA are manifold, and if sustained, impact short and long-term health and quality of life, along with substantial economic costs. [ABSTRACT FROM AUTHOR]

COVID-19 is an ongoing global pandemic, affecting nearly 35 million people from 214 countries as at September 30, 2020 and emerging evidence suggests that obesity is a potential risk factor for communicable diseases, including viral infections. Therefore, we investigated the relationship between obesity prevalence of the total adult population and COVID-19 infection and mortality rates, in different countries. A total of 54 countries from six continents were selected. Country-specific obesity prevalence data were retrieved from the latest non-communicable diseases profiles released by the Non-communicable Diseases and Mental Health Cluster of World Health Organization, while the real time statistics from the Worldometer website were used to extract data on COVID-19 infections and mortality per million of the total population as of September 30, 2020. Obesity prevalence data ranged from 2.0% (Vietnam) to 35.0% (Saudi Arabia). Among the selected countries, the highest number of COVID-19 cases per million was documented in Qatar (n = 44,789) while the lowest was reported from Vietnam (n = 11). Highest mortality per million population due to COVID-19 infections occurred in Peru (n = 981), in contrast with the smallest number reported in Mongolia (n = 0). A significant positive correlation (r = 0.46; p < 0.001) was observed between the total number of COVID-19 infections and the prevalence of obesity. COVID-19 mortality was also significantly correlated (r = 0.34; p < 0.05) with the prevalence of obesity. Obesity prevalence in each country was significantly associated with both infection and mortality rate of COVID-19. • Obesity is associated with increased risk of viral infections including COVID-19. • Country-specific obesity prevalence was significantly associated with both infection and mortality rate of COVID-19. • Countries with high prevalence of obesity should take measures to reduce COVID-19 infections to prevent unwanted deaths. [ABSTRACT FROM AUTHOR]

Low consumption of fruit and vegetables is associated with high prevalence of non-communicable diseases, especially among South Asians. The aim of our study was to systematically review data published on fruit and vegetable intake among South Asian countries. This review included 43 studies conducted from December 1999 to 2019 among South Asians. Literature searching was undertaken in PubMed® database and World Health Organization website. The main outcomes were pooled using random effect meta-analysis. The highest fruit consumption by both men and women (2.4 servings/day) was found in Bhutan (2004) while the lowest reports (0.43 servings/day) were from Sri Lanka (2011) and Bangladesh (2002). With regard to vegetable consumption, Indians (2007) had the lowest reported intake (0.9 servings/day), while the highest value, 3.8 servings/day, was reported in Bhutanese adults (2014). When both intakes were considered, the highest (4.28; 95% CI, 4.02 to 4.55; p=0.15; I2=51%, p<0.001) and the lowest (1.83; 95% CI, 1.41 to 2.25; p<0.001; I2=100%, p<0.001) pooled mean values, were attained for Bhutan and Bangladesh, respectively. The highest percentage of respondents (86.2%) achieved the World Health Organization recommendation of five fruit and vegetables (400 g) per day in Afghanistan (2013) whereas the lowest (0%) reported in Bangladesh (2005). Residents of almost all South Asian countries appear to consume extremely low quantities of fruit and vegetables, lower than the World Health Organization recommendation. Hence, immediate initiatives should be implemented to enhance the intake of fruit and vegetables across the region. • Low intake of fruit and vegetables linked to high prevalence of non-communicable diseases, especially among South Asians. • Mostly South Asians eat extremely low amounts of fruit and vegetables, lower than World Health Organization recommendation. • Two thirds of the studies reported that men had higher consumption of fruit and vegetables than women. • There is a need for a standard reporting method at the country level, to achieve accurate and reliable results. [ABSTRACT FROM AUTHOR]

The built environment encompasses the major physical spaces, including buildings, streets, homes, schools, parks, playgrounds and other infrastructure in which we live, work and play. In an ideal world, the built environment should support and facilitate a healthy engagement in physical activity across the lifespan. However, in the context of an environment characterized by increased mechanization and urbanization, physical inactivity and higher levels of overweight and obesity, too many settings are not conducive to physical activity and/or are not safe and walkable. In the knowledge that there are multiple challenges to redress the low levels of physical activity seen in many parts of the world, this paper provides some examples of opportunities for healthy living (HL) in a built environment characteristic of an increasingly urbanized world. Particular foci include opportunities for HL fostered in child-friendly cities, in which walkability is high, and active transport is encouraged and supported. [ABSTRACT FROM AUTHOR]

Healthy living medicine (HLM) is an emerging concept that recognizes the importance of: (1) Moving more and sitting less; (2) Consuming a healthy diet at the appropriate caloric load; (3) Maintaining a healthy body weight; and (4) Not smoking. Suffice to say, HLM should be practiced by all health professionals, prescribing a personalized healthy living polypill to individuals under their care while titrating the dosage for optimal adherence and therapeutic efficacy. Traditionally, HLM, particularly when practiced in the context of physical activity and diet, is commonly viewed as an all-or-none and one-size-fits-all paradigm. As an example, there has been a dichotomous perception to physical activity messaging, where achieving anything less than 150 minutes of moderate-intensity physical activity per day is not beneficial. The same holds true for the all-or-none perception of 5 servings of fruits and vegetables per day; anything less is not beneficial. While these are certainly desirable targets, healthy living practices at levels below current guidelines portend significant health benefits. Precision medicine is defined as "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." Much of the focus in precision medicine has been directed toward genomics and only recently has the influence of environment and lifestyle been considered. This review will highlight the importance of HLM directed toward the prevention and treatment of chronic diseases in the context of precision medicine. [ABSTRACT FROM AUTHOR]

Being physically active or, in a broader sense, simply moving more throughout each day is one of the most important components of an individual's health plan. In conjunction with regular exercise training, taking more steps in a day and sitting less are also important components of one's movement portfolio. Given this priority, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. An important component of a health care professional's ability to prescribe movement as medicine is competency in assessing an individual's risk for untoward events if physical exertion was increased. The ability to appropriately assess one's risk before advising an individual to move more is integral to clinical decision-making related to subsequent testing if needed, exercise prescription, and level of supervision with exercise training. At present, there is a lack of clarity pertaining to how a health care professional should go about assessing an individual's readiness to move more on a daily basis in a safe manner. Therefore, this perspectives article clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment before prescribing an individualized movement program. [ABSTRACT FROM AUTHOR]

Noncommunicable and chronic disease are interchangeable terms. According to the World Health Organization, "they are of long duration and generally slow progression. The 4 main types of chronic diseases are cardiovascular diseases (ie, heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes." We have known about the benefits of physical activity (PA) for thousands of years. Perhaps our approach, from public health messaging to the individual clinical encounter, as to how PA and exercise are discussed and prescribed can be improved upon, with the ultimate goal of increasing the likelihood that an individual moves more; ultimately moving more should be the goal. In fact, there is an incongruence between the evidence for the benefits of physical movement and how we message and integrate PA and exercise guidance into health care, if it is discussed at all. Specifically, evidence clearly indicates any migration away from the sedentary phenotype toward a movement phenotype is highly beneficial. As we necessarily move to a proactive, preventive healthcare model, we must reconceptualize how we evaluate and treat conditions that pose the greatest threat, namely chronic disease; there is a robust body of evidence supporting the premise of movement as medicine. The purpose of this perspective paper is to propose an alternate model for promoting, assessing, discussing, and prescribing physical movement. [ABSTRACT FROM AUTHOR]

The concept of Healthy Living (HL) as a primary medical intervention continues to gain traction, and rightfully so. Being physically active, consuming a nutritious diet, not smoking and maintaining an appropriate body weight constitute the HL polypill, the foundation of HL medicine (HLM). Daily use of the HL polypill, working toward optimal dosages, portends profound health benefits, substantially reducing the risk of chronic disease [i.e., cardiovascular disease (CVD), pulmonary disease, metabolic syndromes, certain cancers, etc.] and associated adverse health consequences. To be effective and proactive, our healthcare system must rethink where its primary intervention, HLM, is delivered. Waiting for individuals to come to the traditional outpatient setting is an ineffective approach as poor lifestyle habits are typically well established by the time care is initiated. Ideally, HLM should be delivered where individuals live, work and go to school, promoting immersion in a culture of health and wellness. To this end, there is a growing interest in the use of public parks as a platform to promote the adoption of HL behaviors. The current perspectives paper provides a brief literature review on the use of public parks for HL interventions and introduces a new HealthPark model being developed in Chicago. [ABSTRACT FROM AUTHOR]

The chronic disease crisis we currently face must be addressed in rapid fashion. Cardiovascular (CV) and pulmonary diseases, diabetes as well as several forms of cancer are leading causes of morbidity and mortality globally. Collectively, these conditions have a significant impact on the quality of life of individuals, families and communities, placing an unsustainable burden on health systems. There is hope for the chronic disease crisis in that these conditions are largely preventable or can be delayed to much later in life through a timeless medicine, healthy living. Specifically, physical activity (PA), healthy nutrition, not smoking and maintaining a healthy body weight, the latter of which being predominantly influenced by PA and nutrition, are the key healthy living medicine (HLM) ingredients. Unfortunately, there is much work to be done, the unhealthy living phenotype is running rampant across the globe. Without improvements in PA, nutrition, tobacco use and body habitus patterns, there is little hope for curtailing the chronic disease epidemic that has been brought about by the dramatic increase in unhealthy living behaviors. This review highlights current trends in lifestyle behaviors, benefits associated with reversing those behaviors and potential paths to promote the increased utilization of HLM. [ABSTRACT FROM AUTHOR]

Youth participation in organised sport and physical activity is important for healthy development, growth and wellbeing. In 2014, Active Healthy Kids Australia released its inaugural Report Card on Physical Activity for Children and Young People, which synthesised the best available national- and state-level data for children and young people (<18 years). This paper provides a more detailed examination of the evidence informing the grade for Organised Sport from the 2014 Report Card, compares Australia's Organised Sport grade with other countries, identifies future directions for research and surveillance, and explores possible beneficial strategies. The Report Card highlighted that between 64% and 85% of Australians aged 5-17 years participate in organised sports, a rate higher than alternate forms of physical activity such as active transportation, active play and school based physical activity. This finding reflects Australia's position as one of the global leaders for participating in organised sport. Future research and surveillance methodologies however, need to incorporate standardised metrics that aim to capture more detailed data regarding organised sport participation. Facilitating access for all children and preventing dropout from organised sports are important initiatives to improve current levels of sport participation. However, given that 80% of Australians aged 5-17 years are not sufficiently physically active to achieve the daily recommendation, participation in sport alone is not enough to ensure that children can accrue the health benefits associated with being physically active. As such, there is a pressing need to develop strategies that engage children in other forms of physical activity such as active transportation and active play. [ABSTRACT FROM AUTHOR]

Physical activity (PA) provides numerous physiological and psychosocial benefits. However, lifestyle changes, including reduced PA opportunities in multiple settings, have resulted in an escalation of overweight and obesity and related health problems. Poor physical and mental health, including metabolic and cardiovascular problems is seen in progressively younger ages, and the systematic decline in school PA has contributed to this trend. Of note, the crowded school curriculum with an intense focus on academic achievement, lack of school leadership support, funding and resources, plus poor quality teaching are barriers to PA promotion in schools. The school setting and physical educators in particular, must embrace their role in public health by adopting a comprehensive school PA program. We provide an overview of key issues and challenges in the area plus best bets and recommendations for physical education and PA promotion in the school system moving forward. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To provide a user''s guide for selecting an appropriate method to assess sedentary behaviours among children and adolescents. Design: While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for objective (accelerometry; inclinometers; direct observation; screen monitoring devices) and subjective (self-report; parent report; and time use diaries/logs) approaches to assess sedentary behaviour Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. Methods: Expert consensus among members of the Australasian Child and Adolescent Obesity Research Network''s (ACAORN) Physical Activity and Sedentary Behaviour Special Interest Group. Results: We developed decision flow charts to assist researchers and practitioners select an appropriate method of assessing sedentary behaviour, identified attributes of each method and described five real-life scenarios to illustrate considerations associated with the selection of each method of measurement. Conclusions: It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing sedentary behaviour among youth, and are guided on selection of the most appropriate instrument/s to suit their needs. [Copyright &y& Elsevier]

Summary: Background & aim: To date, no studies have examined the validity of skinfold-based (SF) equations and Bioelectrical Impedance Analysis (BIA) in predicting body fat in children of Middle-Eastern origin. The objective of this study was to examine the predictive validity of previously published SF-based equations and BIA in estimating body fat in 8–10 year-old Lebanese children, and to develop new prediction equations for use in this population group. Methods: 158 subjects participated in the study. Percent body fat (% BF) estimates derived from SF-based equations and BIA were compared against the deuterium dilution technique (DDL). Multivariate linear regression analyses were conducted for the development of new prediction equations to estimate %BF using anthropometric variables. Results: Bland-Altman analysis showed that SF-based equations and BIA significantly underestimated %BF as compared to DDL. Mean differences in %BF ranged between 1.3 and 6.5% in boys and 4.5–9.5% in girls. New anthropometry-based equations were proposed for the prediction of %BF in Lebanese pre-pubertal children. Conclusion: Previously published prediction equations underestimated %BF in Lebanese pre-pubertal children. The validity of the new prediction equations developed in this study to estimate %BF in Lebanese children needs to be investigated in future studies. [ABSTRACT FROM AUTHOR]

Objective: Walking is commonly recommended to help with weight management. We measured total energy expenditure (TEE) and its components to quantify the impact of increasing exercise-induced energy expenditure (ExEE) on other components of TEE. Methods: Thirteen obese women underwent an 8-week walking group intervention. TEE was quantified using doubly labeled water, ExEE was quantified using heart rate monitors, daily movement was assessed by accelerometry and resting metabolic rate was measured using indirect calorimetry. Results: Four of the 13 participants achieved the target of 1500kcalwk−1 of ExEE and all achieved 1000kcalwk−1. The average ExEE achieved by the group across the 8 weeks was 1434±237kcalwk−1. Vigorous physical activity, as assessed by accelerometry, increased during the intervention by an average of 30min per day. Non-exercise activity thermogenesis (NEAT) decreased, on average, by 175kcald−1 (−22%) from baseline to the intervention and baseline fitness was correlated with change in NEAT. Conclusions: Potential alterations in non-exercise activity should be considered when exercise is prescribed. The provision of appropriate education on how to self-monitor daily activity levels may improve intervention outcomes in groups who are new to exercise. Practice implications: Strategies to sustain incidental and light physical activity should be offered to help empower individuals as they develop and maintain healthy and long-lasting lifestyle habits. [Copyright &y& Elsevier]

Abstract: Researchers and practitioners interested in assessing physical activity in children are often faced with the dilemma of what instrument to use. While there is a plethora of physical activity instruments to choose from, there is currently no guide regarding the suitability of common assessment instruments. The purpose of this paper is to provide a user''s guide for selecting physical activity assessment instruments appropriate for use with children and adolescents. While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for the use of eight physical activity assessment approaches: heart rate monitoring; accelerometry; pedometry; direct observation; self-report; parent report; teacher report; and diaries/logs. Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. A decision flow chart has been developed to assist researchers and practitioners to select an appropriate method of assessing physical activity. Five real-life scenarios are presented to illustrate this process in light of key instrument attributes. It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing physical activity, and are guided on selection of the most appropriate instrument/s to suit their needs. [Copyright &y& Elsevier]

Abstract: The Somatomorphic Matrix (SM) is a computer-based body image assessment program that allows assessment of the individual''s body image in relation to known body composition values. To date, no study has compared the SM results to the measured body composition and assessed the usefulness in multi-ethnic samples. Japanese and Australian Caucasian males underwent testing to examine the SM body image results to their measured body composition. Japanese males showed significant (p <0.01) discrepancy in their measured and the perceived ‘current’ muscularity compared with Australians. Both groups showed wide variability in the perception of their ‘current’ body composition in relation to the measured values, indicating an incomparability of the SM results to the measured results. The study also showed Japanese males to have lower consistency in the SM results than Australian males after a 12-month interval. In order to use the program in multi-ethnic populations further development of the program is recommended. [Copyright &y& Elsevier]

Physical activity is any movement of skeletal muscles that results in energy expenditure. Long-term success in weight management depends on both physical activity and dietary modification. Exercise has a pivotal role in weight management, optimising body composition by minimising fat-free mass losses and maximising fat mass loss; and, enhancing metabolic fitness. The amount and type of exercise needed to obtain health-related benefits may differ from that recommended for fitness benefits. Public health messages about exercise have focused on improvements in general health and fitness rather than on weight loss, prevention of weight gain or weight regain. About 2.5 times more exercise than the US Surgeon General''s recommendation is needed to maintain energy balance and thus maintain a certain weight. The challenge is to get the exercise prescription right at an individual level. [Copyright &y& Elsevier]

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The purpose of the present study was to evaluate the association between self-perception of body weight, weight loss approaches and measured body mass index (BMI) and waist circumference (WC) among Sri Lankan adults. Methods: A nationally representative sample of 600 adults aged ≥18 years was selected using a multi-stage random cluster sampling technique. An interviewer-administrated questionnaire was used to assess demographic characteristics, body weight perception, abdominal obesity perception and details of weight losing practices. Weight, height and waist circumference (WC) were measured and Asian anthropometric cut-offs for BMI and WC were applied. Results: Body weight mis-perception was common among Sri Lankan adults. Two-thirds of overweight males and 44.7% females considered themselves as ‘about right weight’, moreover, 4.1% and 7.6% overweight men and women reported themselves as being ‘underweight’. Over one third of both male and female obese subjects perceived themselves as ‘about right weight’ or ‘underweight’. Nearly 32% of centrally obese men and women perceived that their WC is about right. People who perceived themselves as overweight or very overweight (n =154) only 63.6% tried to lose weight (n =98), and one quarter of adults sought advice from professionals (n =39). Conclusion: Body weight misperception was common among underweight, healthy weight, overweight, and obese adults in Sri Lanka. Over 2/3 of overweight and 1/3 of obese Sri Lankan adults believe they are in right weight category or are under weight. [Copyright &y& Elsevier]

Summary: Objective: To compare the effectiveness of three waist circumference (WC) measurement sites to predict cardiovascular risk factors and metabolic syndrome (MS) in Brazilian children. Methods: 187 children (mean age=9.9±0.7 years) were evaluated for weight, height, WC at three different sites: midpoint between the lower rib and iliac crest (WC1), umbilicus (WC2), and narrowest waist (WC3). Skinfolds (triceps and subscapular) and blood pressure were also measured. Analyses for triglycerides, HDL-C and glucose were carried out in 141 children. Results: For boys, the most accurate predictor of overweight and obesity (from body mass index, BMI) and low HDL-C levels was WC3, and for high percentage of body fat (from skinfolds) was WC1. For girls, WC2 was the most accurate predictor of MS, and hypertriglyceridemia, and for overweight and obesity, high body fat percentage, and low HDL-C levels, WC3 was the best predictor. WC1 was the most accurate in the prediction of high blood pressure. Conclusions: Each WC measurement site was accurate in predicting cardiovascular risk factors and MS. However, our results indicate that WC3 was the best predictor of cardiovascular risk factors and MS in boys and girls. [Copyright &y& Elsevier]

Abstract: This study evaluated the transport practices of school children and perceived factors that influenced parental decisions regarding their child’s use of active transport to commute to school. A self-administered parental questionnaire (n =324) was used to determine the transport practices of school children and factors that influence parental decisions regarding their child’s use of active transport to school. The relationship between transportation modes (active vs. passive), distance and descriptive variables were evaluated. Despite a median commuting distance of 2.5km (0.1–28.0km), only one-third of school trips involved active transport. Children using active transport commuted shorter distances (1.5 vs. 3.6km), were older (10 vs. 8 years) and more likely to be male than those using motorised transport (P <0.05). While logistic regression revealed only commuting distance was significantly associated with an increased odds of active transport (OR 0.29, 95% CI 0.17–0.48), the most frequently reported factors influencing parental decisions regarding their child’s use of active transport were: (1) the age of child; (2) provision of safe walking paths; (3) adult supervision; (4) commuting distance, and (5) child’s fitness level. While the majority of these factors have been identified within the literature, their validity has yet to be established. [Copyright &y& Elsevier]

: BackgroundPhysical activity in adolescence has been reported to enhance physical activity in adulthood, but detailed information on the enhancing effect of different types of adolescent sports is lacking. We evaluated the association between participation in different types of adolescent sports and physical activity in adulthood.: MethodsThe sample comprised 7794 males and females who responded to the mailed questions on physical activity status at age 14 years and at age 31 years in follow-up surveys of the Northern Finland 1966 birth cohort. The associations between adolescent participation in different sports and adult physical activity was examined by multinomial logistic regression.: ResultsFrequent participation in sports after school hours in adolescence was associated with a high level of physical activity in adulthood. In males, adolescent participation in ball games, intensive endurance sports, track and field, and combat sports was associated with a high or very high level of adult activity. In females, the same applied to adolescent participation in running, orienteering, track and field, cycling, gymnastics, and riding. Adolescent participation in ball games increased participation in ball games in adulthood, especially in males, while participation in cross-country skiing, running, and orienteering provided the greatest stimulation to carry over of some endurance sport to adulthood.: ConclusionsParticipation in sports at least once a week among females and twice a week among males was associated with high level of physical activity in later life. Adolescent participation in the intensive endurance sports, and some sports that require and encourage diversified sports skills, appeared to be most beneficial with respect to the enhancement of adult physical activity. [Copyright &y& Elsevier]

Background Insufficient vitamin D status and inadequate intakes of calcium are a global concern and appear to be inversely linked to the global explosion in prevalence of the metabolic syndrome (MetS). Scope and approach This review provides an update of the current evidence on causal linkages between these nutrients and MetS. We adopted a simplified model that explored the effects of vitamin D and calcium on systemic inflammation and insulin resistance (IR), as initial derangements in the progression to MetS. We selected systematic reviews (SR) and meta-analyses (MA) of randomized controlled trials (RCTs) or large scale observational studies to better understand the evidence base in the area. Key findings and conclusions Observational data provided the best evidence for an inverse association between vitamin D status and presence of MetS. There was no convincing evidence from RCTs, except when participants with impaired glucose tolerance were studied. The influence of dietary calcium on systemic inflammation, IR and MetS has been inadequately studied to allow a firm conclusion. However, cellular and molecular evidence support a role for intra-cellular calcium in related disease states. Future long-term RCTs in adequately sampled participant groups are needed. Central to uncovering such extra-skeletal effects is the endpoint of interest, the selection of the study population, the potential of prior genotyping, consensus on ‘optimal’ vitamin D status, and the duration required of future trials. The concomitant study of mechanistic pathways in such trials could uncover potential targets for functional food development and drug therapy. [ABSTRACT FROM AUTHOR]

Energy restriction induces physiological effects that hinder further weight loss. Thus, deliberate periods of energy balance during weight loss interventions may attenuate these adaptive responses to energy restriction and thereby increase the efficiency of weight loss (i.e. the amount of weight or fat lost per unit of energy deficit). To address this possibility, we systematically searched MEDLINE, PreMEDLINE, PubMed and Cinahl and reviewed adaptive responses to energy restriction in 40 publications involving humans of any age or body mass index that had undergone a diet involving intermittent energy restriction, 12 with direct comparison to continuous energy restriction. Included publications needed to measure one or more of body weight, body mass index, or body composition before and at the end of energy restriction. 31 of the 40 publications involved ‘intermittent fasting’ of 1–7-day periods of severe energy restriction. While intermittent fasting appears to produce similar effects to continuous energy restriction to reduce body weight, fat mass, fat-free mass and improve glucose homeostasis, and may reduce appetite, it does not appear to attenuate other adaptive responses to energy restriction or improve weight loss efficiency, albeit most of the reviewed publications were not powered to assess these outcomes. Intermittent fasting thus represents a valid – albeit apparently not superior – option to continuous energy restriction for weight loss. [ABSTRACT FROM AUTHOR]