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Objectives Participation in physical activity can improve mental health and well-being, but effects are mixed. This consensus statement from Sports Medicine Australia and the Australian Psychological Society aims to provide guidance to practitioners on the ways that physical activity can be promoted to maximise benefits to mental health. Method Following the Clinical Consensus Statement protocol, an expert group comprised of eight members with expertise in physical activity and mental health articulated recommendations regarding five physical activity contextual factors: type, physical environment, delivery, domain, and social environment. Results To optimise the mental health benefits of physical activity, we recommend: i) activity selection be guided by factors associated with adherence and enjoyment as opposed to any specific type (type); ii) facilitators (i.e., teachers, coaches, instructors, practitioners) deliver organised physical activity sessions using an instructional style that satisfies individuals' basic needs for autonomy, competence and social connection (delivery); iii) participation in physical activity with others who provide support, facilitate positive interactions, or make people feel valued, so long as it does not undermine a preference to be active alone (social environment); iv) where possible and appropriate, some physical activity should be undertaken outside in pleasant natural environments (physical environment); and, v) at least some physical activity be undertaken during leisure-time or via active travel, where possible prioritising activities one personally chooses to undertake (domain). Conclusions The type, domain, physical and social environment of physical activity, as well as the way in which it is delivered, will determine mental health outcomes. Practitioners can use these recommendations to optimise the effects of physical activity on mental health. peerReviewed

Keenan A Ramsey,1 Suey SY Yeung,1 Anna GM Rojer,1 Noémie Gensous,2 Evans A Asamane,3 Justin Avery Aunger,3 Dmitriy Bondarev,4 Andrea Cabbia,5 Paul Doody,3 Barbara Iadarola,6,7 Belina Rodrigues,8,9 Muhammad R Tahir,10 Victor Kallen,10 Paola Pazienza,6,7 Nadine Correia Santos,8,9 Sarianna Sipilä,4 Janice L Thompson,3 Carel GM Meskers,1,11 Marijke C Trappenburg,12,13 Anna C Whittaker,15 Andrea B Maier1,14,16,17 1Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Faculty of Behavioural and Human Movement Sciences, Amsterdam, the Netherlands; 2Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; 3School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK; 4Gerontology Research Center & Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; 5Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; 6Personal Genomics s.r.l., Verona, Italy; 7Department of Biotechnology, University of Verona, Verona, Italy; 8Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; 9ICVS/3B’s, PT Government Associate Laboratory, Guimarães, Portugal; 10Department of Microbiology and System Biology, The Netherlands Organization for Applied Scientific Research, Zeist, the Netherlands; 11Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 12Department of Internal Medicine, Section of Gerontology and Geriatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 13Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands; 14Department of Medicine and Aged Care, @Age, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia; 15Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK; 16Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 17Centre for Healthy Longevity, @AgeSingapore, National University Health System, SingaporeCorrespondence: Andrea B Maier, Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Faculty of Behavioural and Human Movement Sciences, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands, Tel +31 20 59 82000, Email a.b.maier@vu.nlPurpose: Evidence-based guidelines on nutrition and physical activity are used to increase knowledge in order to promote a healthy lifestyle. However, actual knowledge of guidelines is limited and whether it is associated with health outcomes is unclear.Participants and Methods: This inception cohort study aimed to investigate the association of knowledge of nutrition and physical activity guidelines with objective measures of physical function and physical activity in community-dwelling older adults attending a public engagement event in Amsterdam, The Netherlands. Knowledge of nutrition and physical activity according to Dutch guidelines was assessed using customized questionnaires. Gait speed and handgrip strength were proxies of physical function and the Minnesota Leisure Time Physical Activity Questionnaire was used to assess physical activity in minutes/week. Linear regression analysis, stratified by gender and adjusted for age, was used to study the association between continuous and categorical knowledge scores with outcomes.Results: In 106 older adults (mean age=70.1 SD=6.6, years) who were highly educated, well-functioning, and generally healthy, there were distinct knowledge gaps in nutrition and physical activity which did not correlate with one another (R2=0.013, p=0.245). Knowledge of nutrition or physical activity guidelines was not associated with physical function or physical activity. However, before age-adjustment nutrition knowledge was positively associated with HGS in males (B= 0.64 (95% CI: 0.05, 1.22)) and having knowledge above the median was associated with faster gait speed in females (B=0.10 (95% CI: 0.01, 0.19)).Conclusion: Our findings may represent a ceiling effect of the impact knowledge has on physical function and activity in the this high performing and educated population and that there may be other determinants of behavior leading to health status such as attitude and perception to consider in future studies.Keywords: health knowledge, attitudes, practice, lifestyle, physical performance, aged

Adolescence is a vulnerable age for emerging mental health problems. As schools are everyday environments for children and adolescents, mental health promotion interventions may be especially effective when delivered within them. The aim of this study was to generate knowledge on mental health promotion interventions in comprehensive schools in northern Finland. First, a mental health promotion model for comprehensive schools was developed by psychiatric nurses in collaboration with school professionals in workshops in Oulu, Finland. A review of the literature, which revealed that mental health promotion in schools includes indicated, selective and universal interventions, was used as a basis for the study, together with written reports from the workshops. Secondly, school professionals from comprehensive schools with or without interventions developed in the mental health promotion model in Oulu were included in the study, and their perceptions of student well-being and mental health promotion in school were queried. The study samples consisted of school professionals from 9 intervention schools and from 49 non-intervention schools. School professionals considered that student well-being has declined and that students show a general disregard for their own well-being. Mental health promotion was regarded as a ‘core business’ of schools. Thirdly, a universal psychoeducation intervention, including lectures and group work on mental health issues, was delivered to 14-years old students in eighth grade. Students from two comprehensive schools were included, 85 pupils in 8th grade forming an intervention group and 77 a non-intervention group. The psychoeducation intervention delivered in classroom settings increased boys’ recognition of conduct disorders and altered girls’ attitudes to regard mental health disorders more as real medical conditions than as personal traits. Students reported feeling more comfortable seeking help from family members and friends than from professionals. The least likely persons from whom to seek help were school personnel, especially teachers. The most common barriers to help-seeking were concerns that the person would respond negatively, seeking help would be too embarrassing or that the offered help would not be useful. Students regarded the psychoeducation intervention as a positive experience and reported gaining useful knowledge on mental health. School professionals regard mental health interventions to be an integral part of school activity, and they appreciate the need for support and help to deal with the increasing mental health needs of students. Short school-based psychoeducation interventions can be useful to change attitudes towards mental health disorders, and informal sources of help are highly regarded by students, but the barriers to accepting professional help are still high and we need ways to lower these barriers. Tiivistelmä Erilaiset mielenterveyteen liittyvät ongelmat ovat lapsilla ja nuorilla yleisiä ja suuri osa aikuisiän mielenterveyden häiriöistä alkaa lapsuudessa tai nuoruudessa. Koulut ovat lapsille ja nuorille yhteinen ja luonnollinen ympäristö edistää lasten ja nuorten mielenterveyttä, jonka vuoksi mielenterveyden edistämisen interventiot kouluympäristöissä voivat olla erityisen vaikuttavia. Tämän tutkimuksen tavoitteena oli tuottaa tietoa mielenterveyden edistämisestä peruskouluissa. Mielenterveyden edistämisen malli peruskouluihin kehitettiin Oulussa työpajoissa yhdessä psykiatristen sairaanhoitajien sekä eri yhteistyötahojen, koulun toimijoiden sekä vanhempien ja oppilaiden kanssa. Tutkimuksen pohjana toimi kirjallisuuskatsaus, jonka mukaan mielenterveyttä edistetään kouluissa yksilö-, ryhmä- ja yleistasolla sekä työpajojen raportit. Tutkimuksessa tarkasteltiin koulujen henkilökunnan kokemuksia oppilaiden hyvinvoinnista sekä mielenterveyden edistämisen toiminnasta kouluympäristössä. Tutkimukseen osallistui henkilökuntaa 9 koulusta, joissa toteutettiin työpajoissa kehitettyjä interventioita sekä 49 koulusta, joissa ei toteutettu työpajoissa kehitettyjä interventioita. Koulun henkilökunta koki, että oppilaiden hyvinvointi on heikentynyt ja oppilaat osoittavat välinpitämättömyyttä omaa hyvinvointia kohtaan. Koulujen henkilökunnan mielestä mielenterveyden edistäminen on osa koulun perustoimintaa. Yleistason psykoedukatiivinen interventio, johon kuului opetusta sekä ryhmätöitä mielenterveyden teemoista toteutettiin 8-luokan noin 14-vuotiaille oppilaille. Tutkimukseen osallistui oppilaita kahdesta peruskoulusta, 85 oppilasta interventiokoulusta sekä 77 ei-interventiokoulusta. Luokkaympäristössä toteutettu interventio lisäsi poikien osalta käytöshäiriöiden tunnistamista ja tyttöjen asenne muuttui mieltämään mielenterveyden häiriöitä enemmän lääketieteellisenä häiriönä eikä henkilökohtaisena ominaisuutena. Oppilaat raportoivat hakevansa mieluummin apua perheen jäseniltä ja kavereilta kuin ammattilaisilta. Epätodennäköisin avun hakemisen kohde olivat koulun henkilökunta, erityisesti opettajat. Yleisimmät avun hakemisen esteet olivat pelko negatiivisesta suhtautumisesta, pelko nolostumisesta tai että avun hakemisesta ei olisi hyötyä. Oppilaat kokivat psykoedukatiivisen intervention positiivisena kokemuksena, ja he saivat sen avulla hyödyllistä tietoa mielenterveydestä. Koulun henkilökunta kokee mielenterveyden edistämisen tärkeänä osana koulun tehtävää. He kokevat, että tarvitsevat apua ja tukea vastatakseen oppilaiden kasvaviin mielenterveyden haasteisiin. Lyhyet koulussa toteutettavat psykoedukatiiviset interventiot voivat muuttaa oppilaiden asenteita mielenterveyden häiriöitä kohtaan. Nuoret arvostavat enemmän epävirallisia avun lähteitä ja kokevat avun hakemisen ammattilaisilta vaikeaksi ja minkä vuoksi onkin tärkeä löytää keinoja madaltaa kynnystä avun hakemiseen.

Recent research has recognised cycling and walking (active transport) as substantial elements contributing to sustainable mobility and public health challenges. There is less knowledge available on the integrated contributions of local-level governance processes and practical implementation of active transport promotion activities. To illustrate comprehensively the contributions of local-level activities, we defined a framework presenting transformative capacity towards active sustainable transport. The framework presents the essential elements and criteria in assessing the level of contributions towards active and sustainable mobility. Previous literature and a case study in six Finnish municipalities comprising interviews and documentary analysis were our primary research data. The Finnish experience shows that local actors can have different, yet successful, approaches in building transformative capacity towards active and sustainable transport. peerReviewed

Background Many people do not regularly participate in physical activity, which may negatively impact their health. Current physical activity guidelines are focused on promoting weekly accumulation of at least 150 min of moderate to vigorous intensity physical activity (MVPA). Whilst revised guidance now recognises the importance of making small changes to physical activity behaviour, guidance still focuses on adults needing to achieve at least 150 min of MVPA per week. An alternative ‘whole day’ approach that could motivate the public to be more physically active, is a concept called Snacktivity™. Instead of focusing on achieving 150 min per week of physical activity, for example 30 min of MVPA over 5 days, Snacktivity™ encourages the public to achieve this through small, but frequent, 2–5 min ‘snacks’ of MVPA throughout the whole day. Methods The primary aim is to undertake a feasibility trial with nested qualitative interviews to assess the feasibility and acceptability of the Snacktivity™ intervention to inform the design of a subsequent phase III randomised trial. A two-arm randomised controlled feasibility trial aiming to recruit 80 inactive adults will be conducted. Recruitment will be from health and community settings and social media. Participants will be individually randomised (1:1 ratio) to receive either the Snacktivity™ intervention or usual care. The intervention will last 12 weeks with assessment of outcomes completed before and after the intervention in all participants. We are interested in whether the Snacktivity™ trial is appealing to participants (assessed by the recruitment rate) and if the Snacktivity™ intervention and trial methods are acceptable to participants (assessed by Snacktivity™/physical activity adherence and retention rates). The intervention will be delivered by health care providers within health care consultations or by researchers. Participants’ experiences of the trial and intervention, and health care providers’ views of delivering the intervention within health consultations will be explored. Discussion The development of physical activity interventions that can be delivered at scale are needed. The findings from this study will inform the viability and design of a phase III trial to assess the effectiveness and cost-effectiveness of Snacktivity™ to increase physical activity. Trial registration ISRCTN: 64851242.

Tämä raportti esittää suositukset, tulokset ja tutkimusmenetelmät valtioneuvoston kanslian rahoittamassa Kohti eettistä ja vastuullista painopuhetta ja -käytäntöjä -hankkeessa. Hankkeen toteuttivat Suomen Sydänliitto ja Jyväskylän yliopisto, kumppaninaan Syömishäiriöliitto. Tulokset perustuvat tutkittuun tietoon lihavuuden stigmasta, kolmeen etukäteisaineistoon, hankkeen aikana järjestyttyihin työpajoihin (terveydenhuolto, liikunta, lihavuuden asiantuntijat, media, päättäjät) sekä media-analyysiin. Hankkeen aikana osallistuttiin aktiivisesti mediassa ja eri verkostoissa keskusteluun lihavuuden stigmasta. Lihavuuden stigman vaikutukset, erityisesti painoon liittyvä syrjintä, näkyvät kaikilla keskeisillä elämän alueilla yhteiskunnassamme. Olemassa olevat käytännöt, rakenteet ja prosessit tukevat paino-, ei hyvinvointikeskeistä tapaa toimia. Puhetapamme ja viestintämme lihavuudesta lisäävät lihavuuden stigmaa. Jotta edetään kohti eettistä ja vastuullista painopuhetta ja -käytäntöjä sekä vähennetään lihavuuden stigmasta johtuvia seurauksia, tarvitaan lisää tietoa ja ymmärrystä lihavuuden stigmasta koulutuksen, tutkimuksen ja arvotyöskentelyn keinoin. Lihavuuteen liittyvää viestintää on kehitettävä ja laadittava eettiset ohjeet lihavuudesta viestimiseen ja sen kuvittamiseen. Yhdenvertaisuuslakiin on lisättävä kielto syrjinnästä koon tai painon perusteella. This report presents the recommendations, results and research methods employed in a project funded by the Prime Minister’s Office titled “Towards ethical and responsible weight dialogue and practices”.The project was conducted by Finnish Heart Association and University of Jyväskylä in conjunction with Eating Disorder Association. The findings are based on research data obtained about obesity stigma, material from three previous studies, workshops (healthcare, exercise, obesity experts, media, decision-makers) as well as a media analysis. The project involved active participation in discussions regarding obesity stigma in the media and different networks. The stigma of obesity, specially weight-related discrimination, has an impact on all main areas of life in our society. The existing practices, structures and processes focus on weight and not wellbeing, and the way we talk about obesity further worsens the stigma. To be able to move towards ethical and responsible weight dialogue and practices and to reduce the impact of obesity stigma, we need to gain more information and understanding of this stigma through education, research and value training. We need to improve obesityrelated communications and create ethical guidelines for obesity communication and illustration. A ban on discrimination based on size or weight should be included in the Nondiscrimination Act. nonPeerReviewed

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Terveydenhoitolehdessä, joka oli ensimmäisen suurelle yleisölle suunnattu suomenkielinen terveysvalistuslehti, otettiin kantaa työn ja hyvinvoinnin, tai tarkemmin sanottuna, hyvän ja onnellisen elämän väliseen suhteeseen. Lähtökohtana oli, että työ oli kutsumus, jonka toteuttaminen lisäsi hyvinvointia. Joutilaisuus oli puolestaan terveydelle haitaksi. Yhteiskunnan modernisoituminen synnytti kuitenkin olosuhteita, joissa kutsumus ei päässyt kunnolla toteutumaan. 1920-luvulla lehdessä oltiin huolissaan fyysisistä työolosuhteista, seuraavalla vuosikymmenellä ihmisten henkisestä uupumuksessa. Kuormitusta lisäsivät myös kuluttaminen ja kiivastahtinen kaupunkielämä. Terveydenhoitolehti tarjosi neuvoja työelämän järjestämiseen, mutta kertoi myös siitä, kuinka vapaa-aika voitiin suunnitella niin, että lepo ja työtehon palautuminen maksimoituisivat. peerReviewed

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Physical activity is important for children’s health. However, evidence suggests that many children and adults do not meet international physical activity recommendations. Current school-based interventions have had limited effect on physical activity and alternative approaches are needed. Context, which includes school setting, ethos, staff, and sociodemographic factors, is a key and largely ignored contributing factor to school-based physical activity intervention effectiveness, impacting in several interacting ways.ConceptualizationCurrent programs focus on tightly-constructed content that ignores the context in which the program will be delivered, thereby limiting effectiveness. We propose a move away from uniform interventions that maximize internal validity toward a flexible approach that enables schools to tailor content to their specific context.Evaluation designsEvaluation of context-specific interventions should explicitly consider context. This is challenging in cluster randomized controlled trial designs. Thus, alternative designs such as natural experiment and stepped-wedge designs warrant further consideration.Primary outcomeA collective focus on average minutes of moderate-to-vigorous intensity physical activity may not always be the most appropriate choice. A wider range of outcomes may improve children’s physical activity and health in the long-term. In this paper, we argue that greater consideration of school context is key in the design and analysis of school-based physical activity interventions and may help overcome existing limitations in the design of effective interventions and thus progress the field. While this focus on context-specific interventions and evaluation is untested, we hope to stimulate debate of the key issues to improve future physical activity intervention development and implementation.

Regular physical activity is an important health promoting behavior. Yet, many adults live sedentary lifestyles, especially during their workday. The current study applies an extended theory of planned behavior model, incorporating affective attitudes and instrumental attitudes, along with habit, to predict limiting sedentary behavior and physical activity within an office environment. Theory of planned behavior constructs and habit were assessed with an online survey on a sample of 180 full-time office workers, with self-reported behavior assessed 1 week later (Mage = 25.97, SDage = 10.24; 44 males, 134 females, and 2 nonbinary). Model fit was indicated by BRMSEA (M = 0.057, SD = 0.023), B γ^ (M = 0.984, SD = 0.010) and BCFI (M = 0.959, SD = 0.026), accounting for 46.1% of variance in intention, 21.6% of variance in sedentary behavior, and 17.4% of variance in physical activity behavior. A Bayesian structural equation model revealed direct effects of instrumental attitudes and perceived behavioral control on intention to limit sedentary behavior, direct effects of intention and perceived behavioral control on limiting sedentary behavior, and direct effects of perceived behavioral control and habit on engaging in physical activity. The current study indicates intentions to be active in the office are primarily driven by beliefs about the benefits of activity and individuals' perceived level of control, rather than normative or affective beliefs. As behavior was predicted by both intention and habit, findings also indicate office-based activity is likely not always a consciously driven decision. These findings may have implications for improving activity levels in this highly sedentary population. peerReviewed

Background: Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP). Methods: A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework. Results: Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club’s intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP. Conclusion: The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP. peerReviewed

Tässä artikkelissa kuvataan hyvinvoinnin tutkimuksen ajankohtaista yhteiskunnallista tarvetta sekä Jyväskylän ja Keski-Suomen vahvuuksia ja mahdollisuuksia monialaisen hyvinvoinnin tutkimuksen toimintaympäristönä. Hyvinvointi on 2000-luvulla noussut talouskasvun rinnalle yhä selvemmin sanoitetuksi erilliseksi yhteiskunnalliseksi tavoitteeksi, ja perinteisten talousindikaattorien rinnalle on etsitty kansakuntien ja alueiden vertailuun soveltuvia hyvinvointi-indikaattoreita. Uusia hyvinvointia edistäviä ja ihmisten terveyskäyttäytymiseen vaikuttavia toimintamalleja kehitetään monialaisessa tutkijayhteisössä, ja niille on kansainvälisesti kasvavaa kysyntää. Myönteinen elämäntapoihin vaikuttaminen kestävällä tavalla on maailmanlaajuinen haaste, joka edellyttää ihmisen, yhteisön ja yhteiskunnan syvällistä ymmärtämistä. Suomella on hyvät edellytykset toimia hyvinvoinnin ja terveyden edistämisen sekä hyvinvointialan kestävän kasvun mallimaana. Keski-Suomessa on sekä kansallisesti tunnustetut edellytykset että yhteisesti ilmaistu ja tahtotila toimia hyvinvoinnin tutkimuslähtöisen kestävän kehittämisen mallimaakuntana ja edelläkävijänä. Jyväskylän yliopisto tukee tätä työtä strategiansa ”Osaava ja hyvinvoiva ihminen” mukaisella profiloitumisella. peerReviewed

Tämän kirjoituksen tarkoituksena on tuoda esiin iäkkäiden ihmisten ulkoilua ja ulkona liikkumista käsitelleitä tutkimuksia ja niiden tuloksia. Lisäksi tarkoituksena on tarkastella, mitä kaikkea hyvinvointi-käsitteen alle sijoitetaan iäkkäiden ulkoilua ja ulkona liikkumista käsittelevässä tutkimuksessa ja käsitellä sitä, miksi juuri ulkona liikkumisen sanotaan olevan iäkkäille ihmisille tärkeää. Mitä on se hyvinvointi, jota ulkoilu ja ulkona liikkuminen tuottavat, mikä rooli ulkona liikkumisen ympäristöllä on, entä mikä on se mekanismi, jolla ulkoilun ajatellaan tuovan hyvinvointia iäkkäälle? peerReviewed

Studies have shown that, on average, children’s physical activity (PA) levels in early childhood education and care (ECEC) environments are low, thus opening up the possibility of interventions. We examined the effect of the teacher-implemented one-year long ‘home-and-childcare-based intervention to promote physical activity’ (HIPPA) study on children’s PA in ECEC settings in Finland. Participating four-year-old children (N = 128) were cluster-randomised into two groups, intervention (seven childcare centres) and control (seven childcare centres), in autumn 2011. The children were observed directly during their ECEC times. Multilevel linear analysis was used to test the PA differences between the intervention conditions. Post-intervention results showed that the HIPPA intervention increased the children’s PA. To enhance the real-life effectiveness of the present multicomponent intervention, we examined methods based on the intervention’s success and found areas of development for future studies. Overall, promoting active play by ECEC personnel offers an effective way to enhance children’s PA. Furthermore, to ensure the sustainability of the intervention effects, specific changes in practice have been identified that should be transferred into the policies intended for ECEC settings. peerReviewed

Despite the prominence of fitness testing in school physical education (PE), there is a sparsity of research examining the antecedents of students’ affective experiences during fitness testing lessons. This study aimed to investigate the associations among task- and ego-involving motivational climates, perceived physical competence, physical performance, enjoyment, and anxiety during two different types of PE fitness testing lessons. Altogether, 645 Finnish students from Grade 5 (50% boys, Mage = 11.2, SD = 0.36) and Grade 8 (47% boys, Mage = 14.2, SD = 0.35) participated in two fitness testing lessons with different content (lesson 1: 20-meter shuttle run test and a test of flexibility; lesson 2: curl-ups, push-ups, 5-leaps, and a catching-throwing combination test). Students’ experiences were collected using short questionnaires immediately after the lessons. Structural equation modeling was applied to examine the direct and indirect associations among study variables. Results indicated that task-involving climate and perceived competence increased students’ enjoyment and decreased their anxiety levels whereas ego-involving climate had no effect on students’ enjoyment but increased their anxiety levels. In addition, students’ actual physical performance as a mediator between motivational climate and affects, or as a direct predictor of affects, was limited. Strategies advancing task-involving motivational climate and students’ perception of competence should be employed to increase enjoyment and decrease anxiety during PE fitness testing lessons.

Background Women with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion. Methods Patients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women’s needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences. Results Women’s primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization. Conclusion Cardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.

Background Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. Objective This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. Methods We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research—including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Results Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. Conclusions The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-040183

Background Meeting daily guidelines for physical activity, screen time, and sleep duration is associated with a host of health indicators for youth. In this cross-sectional observational study, we investigated the associations between adherence to the movement guidelines and health-related outcomes among youth with autism spectrum disorder (ASD). Methods Parents of youth with ASD (10–17 years) from seven countries and regions were invited to provide online proxy-reports for child’s movement behaviors (i.e., physical activity, sleep and screen time), and health-related outcomes (i.e., body mass index [BMI], general health, and quality of life). A series of multiple linear regression analyses were used to examine the associations between meeting movement guidelines and health-related outcomes, adjusted for covariates. Results The final sample consisted of 1165 youth with ASD. Compared with youth meeting all three guidelines, a higher BMI z-score was observed in those who met no guidelines (B = 0.62, P = 0.04), “sedentary time only” (B = 0.60, P = 0.047), and “physical activity plus sleep only” (B = 0.85, P = 0.04). Compared with meeting all three guidelines, meeting no guidelines was associated with poorer general health (B = − 0.46, P = 0.02). Further, compared with youth meeting all three guidelines, a lower quality of life score was observed in those who met no guidelines (B = − 0.47, P = 0.02) and “physical activity only” (B = − 0.62, P = 0.03). Lastly, there were dose–response associations between the number of guidelines met and all three health-related outcomes (all Ptrend Conclusions In conclusion, meeting more 24-h movement guidelines was generally associated with more favorable health-related outcomes in youth with ASD. The low level of adherence to all three guidelines (2.0%) suggests the urgent need to promote the adoption of all the guidelines in this group.

Decrease of children’s independent mobility (CIM) has worried academics, policymakers, educators and other professionals for decades. Research and policy often emphasise that promoting children’s physically active and independent transport modes as cycling is important to achieve better public health, solve environmental challenges and increase related economic benefits. Yet, cycling promotion is not a neutral process and all promotion efforts are derived from latent notions of ‘cyclists’ and ‘cycling’. This paper discusses different rationalities of childhood cycling promotion and the representations of ‘children’ as independent ‘cyclists’ they entail. We argue that in order to efficiently promote cycling across contexts, we should better understand children’s cycling experiences and meanings they ascribe to it and how their mobilities emergence in the flux of social, institutional and political relations. By applying action research to a local cycling promotion project in Finland we explore how instrumental, functional and alternative rationalities emerged and resulted in differing representations of children as cyclists. While all rationalities played a role in different stages of the project, the results highlight that alternative rationalities as children’s autonomy, positive emotions and friendships were considered the most important drivers of new cycling practices among project participants. In conclusion we propose children’s autonomous mobility as the most appropriate term to depict their cycling and other self-imposed (but relational) mobility practices. peerReviewed

Background Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the ‘Internet-based Professional Learning to help teachers promote Activity in Youth’ (iPLAY) intervention in primary schools using the RE-AIM framework. Methods We conducted a type 3 hybrid implementation-effectiveness study and collected data between April 2016 and June 2021, in New South Wales (NSW), Australia. RE-AIM was operationalised as: (i) Reach: Number and representativeness of students exposed to iPLAY; (ii) Effectiveness: Impact of iPLAY in a sub-sample of students (n = 5,959); (iii) Adoption: Number and representativeness of schools that received iPLAY; (iv) Implementation: Extent to which the three curricular and three non-curricular components of iPLAY were delivered as intended; (v) Maintenance: Extent to which iPLAY was sustained in schools. We conducted 43 semi-structured interviews with teachers (n = 14), leaders (n = 19), and principals (n = 10) from 18 schools (11 from urban and 7 from rural locations) to determine program maintenance. Results Reach: iPLAY reached ~ 31,000 students from a variety of socio-economic strata (35% of students were in the bottom quartile, almost half in the middle two quartiles, and 20% in the top quartile). Effectiveness: We observed small positive intervention effects for enjoyment of PE/sport (0.12 units, 95% CI: 0.05 to 0.20, d = 0.17), perceptions of need support from teachers (0.26 units, 95% CI: 0.16 to 0.53, d = 0.40), physical activity participation (0.28 units, 95% CI: 0.10 to 0.47, d = 0.14), and subjective well-being (0.82 units, 95% CI: 0.32 to 1.32, d = 0.12) at 24-months. Adoption: 115 schools received iPLAY. Implementation: Most schools implemented the curricular (59%) and non-curricular (55%) strategies as intended. Maintenance: Based on our qualitative data, changes in teacher practices and school culture resulting from iPLAY were sustained. Conclusions iPLAY had extensive reach and adoption in NSW primary schools. Most of the schools implemented iPLAY as intended and effectiveness data suggest the positive effects observed in our cluster RCT were sustained when the intervention was delivered at-scale. Trial registration ACTRN12621001132831.

The promotion of the physical activity (PA) of citizens has traditionally focused on improving spatial accessibility, especially in municipal administrations. However, research evidence indicates that proximity to PA environments is not a sufficient condition for increased PA. This article presents a broader model of the dimensions of the accessibility of PA, developed in cooperation between researchers and the authorities of two cities in Finland. As a result, ten dimensions affecting accessibility have been identified: spatial, temporal, physical/technological, informational, economic, legal/ administrative, cultural/attitudinal, skills related, mental and social. A special focus of attention is on the most neglected dimension: the social. In addition to the dimensional typology, the article presents a view of the PA accessibility process in which the social dimension plays a significant role as a mediating level between the enabling factors and the decisions made by individuals.

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Liikuntapsykologia kehittyi, laajentui ja ammattimaistui voimakkaasti työurani aikana. Urheilupsykologian lisäksi keskeiseksi nousi terveytensä kannalta vähän liikkuvien arviointi. nonPeerReviewed

This study aimed to identify organized sports participation patterns and their prevalence from adolescence to emerging adulthood, and the educational and family-related determinants of the patterns. Adolescents in the Finnish Health Promoting Sports Club (FHPSC) study answered a health behaviour questionnaire and reported on sports club participation at ages 15 and 19 (N = 609). In emerging adulthood, dropouts (total 41.05%; females 43.72%; males 36.56%), maintainers (30.87; 26.44; 38.33), nonparticipants (27.59; 29.32; 24.67), and joiners (0.49; 0.52; 0.44) (p =.024) were identified. A mixed multinomial logistic regression analysis showed, that male gender, as compared to female gender, increased the odds of being a maintainer rather than a nonparticipant or dropout. Among females, high achievement at school and aspiration towards upper secondary school at age 15 increased the odds of being a maintainer at age 19 rather than a nonparticipant. High achievement at school and experiencing a (strong) decrease in parental support for physical activity/sport increased the odds of being a dropout rather than a nonparticipant. Having no experience of a strong decrease in parental support increased the odds of being a maintainer rather than a dropout. Among males, aspiration towards upper secondary school increased the odds of being a maintainer or dropout rather than a nonparticipant. The most common reason for dropping out was study, which was also the most prevalent life status at age 19. The findings highlight a need for more flexible possibilities to combine organized sports participation and school studies, and the importance of parental support for physical activity/sport. publishedVersion

The symposium presents last findings on health promotion interventions in sports clubs. After a short introduction about the health promoting sports clubs (HPSC), five presentations (France, Sweden, Ireland, Finland and Netherlands) will reflect upon how sports clubs can be health promoting: in theory, from youth perspectives, by increasing physical activity level as outcome or enhancing sustainability of interventions, before opening the discussion with academic experts. Presentation 1 describes an iterative international process, implicating three groups (French sport students, French and Swedish experts) to create an intervention theory, based on the HPSC model. Presentation 2 focuses on a cross-sectional study investigating 123 Swedish youth's representation of sports clubs' role towards health promotion, identifying social dimension, environment, coaches, amount and ambition of practice as key factors. Presentation 3 is a longitudinal study among 366 adolescents, followed from age 15 to age 19, questioning the participation to organised sport practice and their orientation (leisure or competitive). Results have shown that by the age of 19, 33% of boys and 43% of girls have dropped out of organised sport, where 45% of boys and 26% of girls continued participation. Adolescents with a competitive goal orientation were more likely to continue participation. Presentation 4 is a longitudinal study among 131 youth measuring objective physical activity before and in the middle of a sport season. Principal results showed a significant change across time point, as well as differences between gender (a decrease in moderate to vigorous physical activity during games for boys and an increase for girls). Presentation 5 examined factors that influenced the sustainability of 14 Dutch sporting program aimed at increasing physical activity among inactive people 6.5 years after their implementation. Interviews with representatives of Dutch National Sports Federations and sports clubs helped to identify facilitating and impeding factors, like program adaptation, evaluation, financing and factors related to human resources. Question and Answer will be organised around the key ingredients and challenges facing the development of HPSC interventions, such as implementation of theoretical background, sport participants need consideration, complexity of outcomes evaluation of HPSC and program sustainability. nonPeerReviewed

Liikkumistottumuksista tietoa tuottava teknologia voi parantaa ihmisten elämänlaatua ja tuoda säästöjä yhteiskunnalle. nonPeerReviewed

The importance of sustained physical activity in healthy aging is well established. To achieve sustained physical activity and exercise, related self-efficacy is important. Hence, solutions to promote self-efficacy for exercise among aged people are urgently needed. Digital wellness technologies provide a potential solution, but research on their potential to promote self-efficacy for exercise is scarce and more research is needed. To address this need, this study investigates how effective is the use of a physical activity application in promoting self-efficacy for exercise among aged people. Self-efficacy levels were compared between three different time points: before taking the application into use and after 4 and 12 months of use. The results suggest that physical activity application use can be effective in promoting self-efficacy for exercise among aged people as there was an improvement in most of the self-efficacy items as well as in total self-efficacy already after 4 months of use and this improvement was sustained after 12 months of use. peerReviewed

Physical activity (PA) tracker applications have been proposed as one potential solution to the increasingly prevalent physical inactivity problem among elderly people, but their long-term potential is limited by the frequent lapses in their use. In this study, our objective is to promote the understanding of the lapsing behaviour of PA tracker applications among elderly people. More specifically, we are interested in how gender, age, and household type as well as initial PA level and technology readiness (TR) affect the risk of lapsing. As the data for the study, we use actual PA tracker application usage data as well as survey data, which were both collected in our ongoing research program and are analysed by using survival analysis. We find lapsing behaviour to be affected mainly by initial PA level as well as to some degree by TR and gender but not by age and household type. peerReviewed

Low health literacy (HL) is associated with adverse health behaviors and poor health, and brief, high-quality instruments for measuring HL in children are scarce. The Health Literacy for School-Aged Children (HLSAC) instrument is a 10-item theory-based and internationally validated tool for measuring HL. The purpose of this study was to translate and validate the HLSAC instrument among Danish school-aged children. The instrument was translated into Danish by a standardized forward-backward translation process, and then pre-tested for face validity with 61 pupils from four schools. Thereafter, the instrument was tested among 805 pupils in grades 6 to 7 (age 11–14 years) from 15 schools. When HL was modeled as one latent factor with all 10 items loading on this factor, the confirmative factor analysis showed standardized factor loadings from 0.52 to 0.75 ( p < .001) and an excellent model fit. The association between HL and food intake as a health behavior example ( p < .001, r 2 = .027) indicates the predictive validity of the instrument. The internal consistency was high (Cronbach's alpha = 0.86). Thus, a valid and reliable version of the HLSAC instrument is available in Danish for future surveys to monitor HL and guide health promotion targeting children and adolescents. [ HLRP: Health Literacy Research and Practice . 2022;6(1):e25–e29.]

Väestön terveyden ja hyvinvoinnin edistämisestä säädetään Suomessa lailla ja suosituksilla. Iäkkäiden seniorineuvolatoiminta pitää sisällään monella tavalla toteutettavaa ennaltaehkäisevää terveystarkastustoimintaa. Suomen väestörakenteen muuttuessa iäkkäiden terveyden edistäminen on entistä tärkeämmässä asemassa. Tämän tutkimuksen tarkoituksena oli kuvata iäkkäiden terveyttä edistävien seniorineuvoloiden toimintaa terveydenhoitajien näkökulmasta. Tavoitteena oli tuottaa tietoa, jota voidaan hyödyntää seniorineuvolatoiminnan kehittämisessä. Tutkittavien rekrytointi toteutettiin yhteistyössä Suomen Terveydenhoitajaliiton kanssa huhti-lokakuun 2021 välisenä aikana. Tutkittavat tavoitettiin Suomen Terveydenhoitajaliiton Facebook-sivuille tehdyn rekrytointi-ilmoituksen kautta. Tutkimukseen ilmoittautui yhteensä kahdeksan (n=8) seniorineuvolatyötä tekevää terveydenhoitajaa ja heidät kaikki rekrytoitiin tutkimukseen. Terveydenhoitajia haastateltiin avoimella haastattelulla ja aineisto analysoitiin aineistolähtöisen sisällönanalyysin menetelmällä. Kokemukset ennaltaehkäisevästä seniorineuvolatyöstä luokiteltiin kolmeen pääluokkaan: asiakasvastaanottotyön sisällön, terveydenhoitajan työn sisällön sekä seniorineuvolan asemaan liittyvä sisällön kokemuksiin. Asiakasvastaanottoja toteutettiin monipuolisesti erilaisia työkaluja käyttäen ja asiakkaan kohtaaminen oli kokonaisvaltaista. Asiakkaiden tarpeet huomioitiin ja niihin pyrittiin vastaamaan. Ytimenä toiminnassa oli asiakkaan terveystietoisuuden vahvistaminen ja siihen vaikuttaminen yleisten suositusten mukaisesti. Seniorineuvolan terveydenhoitajan työ oli kehittämistä ja monipuolisen osaamisen hallintaa. Työkokemus oli merkityksellisessä asemassa työn toteuttamisessa. Työtä tehtiin monialaisesti ja työskentely seniorineuvolassa koettiin mielekkääksi. Seniorineuvolan asemaan liittyvinä kokemuksina terveydenhoitajat nostivat esille epätietoisuuden seniorineuvolan tulevaisuudesta sekä kokemuksen siitä, että työ on merkityksellistä ikäihmisille. Tutkimuksen tulokset osoittivat terveydenhoitajien sitoutuneisuutta ja ammattitaitoisuutta ennaltaehkäisevässä seniorineuvolatoiminnassa. Hoitotieteen kannalta tutkimus on merkityksellinen, sillä seniorineuvolan terveydenhoitajien kokemuksia työstään ei ole aikaisemmin tutkittu. Tutkimustietoa voidaan hyödyntää seniorineuvolatoiminnan työn toteutuksen suunnittelussa ja laadun mittaamisessa. Tutkimus tuotti uutta tietoa seniorineuvolatyöstä, sen moninaisuudesta sekä merkityksestä iäkkäille ihmisille. Terveydenhoitajien työkokemuksella ja osaamisella oli merkitystä työn toteutuksessa. Työn haavoittuvuus niukkojen henkilöstöresurssien vuoksi oli merkittävä tieto, sillä se vaikuttaa terveydenhoitajan kokemaan työn arvostukseen ja toisaalta myös iäkkäille tarjottavan ennaltaehkäisevän palvelun saatavuuteen. Tieto terveydenhoitajien huolesta seniorineuvolatyön jatkuvuudesta oli merkityksellinen ja siihen tulisi kiinnittää huomiota. Tutkimuksen tuloksia tulisi jatkossa hyödyntää terveydenhoitajien tukemisessa ja työn kehittämisessä.

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Background Longitudinal studies demonstrate that physical activity (PA) declines on average from adolescence to early adulthood. However, some subgroups of adolescents increase activity while others decrease or maintain high or low activity. Determinants of change or maintenance of (in)activity may differ between subgroups and are valuable information for targeted health promotion. The purpose of this study was to identify PA patterns from adolescence to early adulthood, and also to explore how different activity domains and Sedentary Behaviour (SB) are associated with PA patterns. Methods The data of this observational cohort study (collected in 2013/2014 and 2017/2018) consisted of 254 Finns at age 15 and 19 participating the Health Promoting Sports Club study. K-means cluster analysis for longitudinal data was performed to identify participant clusters (patterns) based on their accelerometry-measured moderate-to-vigorous PA (MVPA). Associations of sports club participation (SC), active commuting (AC), and SB with PA patterns were examined by logistic regression analysis. Results (preliminary) Five MVPA patterns were identified: inactivity maintainers (n = 71), activity maintainers (n = 70), decreasers from moderate (to low) PA (n = 61), decreasers from high (to moderate) PA (n = 32), and increasers (n = 20). At age 15, SC participation (41-97%) and AC (47-75%) were common in all the patterns. By age 19, clear dropout from these activities was prevalent (SC participation mean 32%, AC 31-63%). Maintained SC participation was associated with a higher likelihood of belonging to the decreasers from high PA (OR = 11.2, CI = 1.4-90.0) and to the combined group of increasers and activity maintainers (OR = 3.6, CI = 1.8-7.4); also with a lower likelihood of being an inactivity maintainer (OR = 0.1, CI = 0.02-0.2). Dropout from SC was related to a higher likelihood of being a decreaser from high PA (OR = 10.9, CI = 1.3-90.7). Maintenance/adoption of AC was associated with a lower likelihood of being an inactivity maintainer (OR = 0.3, CI = 0.1-0.7). Decreased SB was related to a higher likelihood of belonging to the activity maintainers and increasers (OR = 0.96, CI = 0.93-0.98). Conclusions PA patterns diverge greatly over the transition to adulthood. Changes in SC participation, AC, and SB show different associations with diverging PA patterns. Hence, tailored PA promotion is recommended. nonPeerReviewed

Background: Achieving system-level, sustainable ‘scale-up’ of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as ‘reach without scale’, ‘planned serendipity’ and ‘simple complexity’. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders’ assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of ‘tensions’ and ‘paradoxes’, we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.

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Parental self-efficacy (PSE), a measure of the subjective competence in the parental role, has been linked with child well-being and health. Research on the influence of PSE on child eating habits is scarce, and the few studies have concentrated on certain food groups, such as vegetables or fruits, and have mostly included only maternal PSE. Thus, the aim of this study was to explore the associations between PSE (separately for mothers and fathers and as a total family-level score) and child diet quality in a cross-sectional and longitudinal study setting. PSE was measured at child ages of 1.5 and 5 years, and diet quality was measured at ages 2 and 5. Participants are from the Steps to Healthy Development (STEPS) Study (n = 270−883). We found that maternal PSE and family level PSE score were associated with child diet quality. Paternal PSE was not, but the dimension Routines was associated with child diet quality. PSE was similarly associated with child diet quality at both age points. Our results suggest that PSE is an important construct in the development of healthy dietary habits in children, and supporting parenting programs aimed at higher PSE could promote healthy diet quality in children. peerReviewed