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Background Physical inactivity is recognized as a leading global public health threat. Physical Literacy, a concept describing an individual’s prerequisites to participate in and adhere to physical activities, has been suggested to be a key concept in understanding physical activity in various populations. The aim of this study was to describe the prerequisites for physical activity among inactive adults in terms of their physical literacy and previous experience with sport and exercise and how these are interrelated. Methods Sample: 1033 physical inactive Danes. Measures: BREQ-3, ESES, the Levels of knowledge questionnaire and the physical self-confidence scale. Results Inactive Danish adult’s physical literacy scores are generally low compared to samples in other studies. Inactive adults with no or little previous experience with sport and exercise had lower levels of competences, self-efficacy and autonomous motivation for exercise and sport than the inactive with more experience. Previous sport and exercise experience was positively associated to the physical and affective domain of PL. Conclusion Previous experience with sport and exercise is very important to consider when developing sport and exercise activities for currently inactive adults as individuals with low previous experience have lower competences and autonomous motivation and therefore need lower challenges and other important attention to the motivational climate in order to ensure that the activities are motivating enough to secure continued engagement.

Introduction: It is central for public health to answer questions related to how to change health and wellbeing in populations through interdisciplinarity and health in all policies and sectors. For a school physical activity promotion initiative to be acceptable and thus feasible, the buy-in of teachers is fundamental. Therefore, school physical activity promotion should be integrated into and support teaching activities. Aims: We discuss the use of education outside the classroom as a feasible pedagogical approach that integrates and promotes physical activity for school children. Methods: We present and discuss theoretical arguments and empirical evidence to argue and illustrate that education outside the classroom is a promising approach for promoting physical activity. Results: Education outside the classroom is characterised by regular curriculum-based experiential teaching activities outside the classroom with the inclusion of physical activity as a means to pedagogical ends. School subjects are taught outside the classroom drawing on problem-based learning and experiential education. Here, physical activity is integrated without compromising curriculum goals which increases teacher buy-in and thereby intervention acceptability and feasibility. Empirical evidence suggests that education outside the classroom increases boys’ moderate to vigorous physical activity and girls’ light intensity physical activity. We contend that the mechanisms are a mix of place, pedagogy and pupil motivations. Conclusions: Education outside the classroom is a feasible and acceptable approach to public health and physical activity promotion because it is integrated into children’s everyday settings through curriculum time and applied broadly to child populations at a low cost. The practice of education outside the classroom is context-dependent and culturally bound, and practices therefore need to be adapted to the individual sociocultural context.

Background Research indicates that childhood motor competence (MC) can predict physical activity (PA) levels later in life and it has been argued that frequently engaging in a wide diversity of physical activities will eventually improve children’s MC. However, no longitudinal or experimental studies have confirmed this theoretical rationale. The aims of this study are to explore the longitudinal associations between diversified physical activities at age six and later MC and PA (time spent in moderate-to-vigorous PA) (age nine and 13). Furthermore, we explore to what extent the longitudinal association between diversified physical activity and PA is mediated by MC. Methods Longitudinal data from the Copenhagen School Intervention Study were used for this analysis, where 704 participated (69% response rate). Diversified physical activity (self-reported), MC (The Körperkoordinationstest für Kinder battery of postural stability and locomotor skills) and PA (accelerometer) were assessed in the children at age six, age nine and age 13. A total of 654 participated in at least two of the measures and, therefore, were included in the analysis. Two structural equation models were constructed, with diversified physical activity at age six and MC and PA at age nine as predictors of PA and MC at age 13. Results The data from both models demonstrated good model fit. Diversified physical activity at 6 years of age was significantly associated with physical activity and MC at age 13, when adjusting for sex, age, intervention, weight, height, and previous levels of PA and MC. Diversified physical activity at age six was also positively associated with PA and MC at age nine, which were, in turn, positively related to PA at age 13 but to a lesser degree than diversified PA at age six. The association between diversified physical activity at age six and PA at age 13 was not mediated by MC at age nine. Conclusions The results of this study indicate that diversified physical activity at age six is important for the development of MC and PA in adolescence. Increasing the diversity of children’s daily physical activities, not only the amount and intensity, seems important for future PA behavior and thereby health promotion in a life course perspective.

The rising global burden of noncommunicable diseases (NCDs) among people with low socioeconomic status (SES) has heightened awareness of the need for primary prevention programs in low-SES neighborhoods. Social inequity in health is apparent in mental, social and physical aspects of health among people living in low-SES neighborhoods. Viewing this problem from a life course perspective and adopting a vulnerable population approach points to the importance of inducing sustainable health behavior changes in children and young people living in low-SES neighborhoods. One important factor in lowering the risk of many NCDs while improving mental health is the promotion of physical activity (PA). In this paper, we argue that lowering the risk of many NCDs and improving mental health is best achieved through setting-based programs that facilitate long-term PA behavior changes in children and adolescents living in marginalized neighborhoods. Empirical evidence indicates that extrinsic motives for participating in physical activities, such as improving health, are insufficient when long-term participation is the goal. Therefore, we argue that interventions with the aim of affecting long-term PA in low-SES neighborhoods and thereby reducing social inequities in health should include activities that aim to create more intrinsic and autonomous motivations by building on more broad and positive understandings of health and participation. Here, we advocate that sports-based recreation (SR) holds several advantages. If implemented well, SR has the potential to be a health-promoting activity that is meaningful and motivating in itself and that involves physiological health-promoting aspects (e.g., PA), a social aspect (e.g., positive relations with others), and a psychological aspect (e.g., positive experiences of oneself). Further, we suggest four practicalities that should be considered when conducting interventions: the cost of participating, the location, the facilities required, and the suitability of the SR activities.

INTRODUCTION: Accelerometer-based physical activity monitoring has become the method of choice in many large-scale physical activity (PA) studies. However, there is an ongoing debate regarding the placement of the device, the determination of device wear time, and how to solve a lack of participant compliance. The aim of this study was to assess the compliance of Axivity AX3 accelerometers taped directly to the skin of 9-13-year-old children.METHODS: Children in 46 school classes (53.4% girls, age 11.0±1.0 years, BMI 17.7±2.8 kg*m) across Denmark wore two Axivity AX3 accelerometers, one taped on the thigh (n=903) and one on the lower back (n= 856), for up to ten consecutive days. Participants were instructed not to reattach an accelerometer should it fall off. Simple and multiple linear regression were used to determine associations between accelerometer wear time and age, sex, BMI percentiles, and PA level.RESULTS: Over 65% had >7 days of uninterrupted, 24h wear time for the thigh location, and 59.5% for the lower back location. From multiple linear regressions, PA levels showed the strongest association with lower wear time (thigh: β=-.231, R=.066; lower back: β=-.454, R=.126). In addition, being a boy, being older (only for lower back), and having higher BMI percentile were associated with lower wear time.CONCLUSION: Using skin-taped Axivity accelerometers, we obtained seven days of uninterrupted accelerometer data with 24h wear time per day with a compliance rate of more than 65%. Thigh placement resulted in higher compliance than lower back placement. Achieving days with 24h wear time reduces the need for arbitrary decisions regarding wear time validation, and most likely improves the validity of daily life PA measurements.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Movement integration (MI) into traditional classroom teaching is a promising opportunity for children to increase physical activity (PA). Education outside the classroom (EOtC) can be regarded as MI, and has increased children's PA in case studies. The aim of this study is to investigate the effects of EOtC on children's PA by segmenting weekly activity-related behavior into a range of day types and domains.METHODS: In a quasi-experimental design, 33 classes were recruited and participants' PA was objectively measured using accelerometers taped to the lower back. In total, 361 (10.89 ± 1.03 years) participants with 7 days of 24 h wear time per day were included in a day type PA analysis, and 194 of these participants (10.46 ± 0.99 years) provided information on time spent in specific domains (e.g. EOtC or recess) and were included in a domain-specific PA analysis. Differences in proportion of time spent in PA intensities were tested using mixed-effects regression models.RESULTS: More moderate-to-vigorous physical activity (MVPA) occurred on days with physical education (PE) than days with EOtC (girls 0.79%, p = .001, CI = .26% to 1.31%; boys 1.35%, p = .003, CI = .32% to 2.38%), while no difference was found between EOtC days and school days without EOtC and PE. Light physical activity (LPA) was higher on EOtC days than school days without EOtC and PE (girls 2.43% p < .001, CI = 1.21% to 3.65%; boys 2.08%, p < .001, CI = .69% to 3.47%) and PE days (girls 2.18%, p < .001, CI = .80% to 3.56%; boys 2.40%, p < .001, CI = .83% to 3.96%). Comparing EOtC and classroom domains, boys proportionally spent 7.95% (p < .001, CI = 3.00% to 12.90%) more time in MVPA while no difference (p = 1.000) was measured for LPA, and girls had no difference (p = .176) in MVPA, but spent 9.76% (p < .001, CI = 7.12% to 12.41%) more time in LPA.CONCLUSIONS: EOtC was implemented without the provision of additional resources and with positive effects on PA. Findings suggest EOtC as a way to provide children with an additional opportunity to accumulate PA within the existing school setting.

BACKGROUND: Education outside the classroom (EOtC) is a curriculum-based approach to teaching that has shown positive associations with children's physical activity and academic learning in small-scale case studies. The purpose of this large-scale quasi-experimental study was to determine if children who participate regularly in EOtC spend more time being physically active than children who do not.METHODS: In the 2014/2015 study TEACHOUT, classes were recruited in pairs such that each EOtC class had a non-EOtC comparison class at the same school and grade level. Participants in 17 EOtC classes and 16 comparison parallel classes across Denmark wore an Axivity AX3 accelerometer taped to the lower back for seven consecutive days. Data from 201 EOtC participants (63.3% girls, age 10.82 ± 1.05,) and 160 comparison participants (59.3% girls, age 10.95 ± 1.01) were analysed using an 'intention to treat' (ITT) approach. The amount of EOtC the participants were exposed to was monitored. Associations between time spent in different physical activity intensities and EOtC group and sex were assessed using generalised linear models adjusted for age. In a second analysis, we modified the sample using a 'per protocol' (PP) approach, only including EOtC and comparison class pairs where the EOtC class had >150 min and the comparison had RESULTS: On average, EOtC participants spent 8.4 (ITT) and 9.2 (PP) minutes more in moderate-to-vigorous physical activity (MVPA) per day than comparison participants (p < 0.05). However, EOtC boys spent 18.7 (ITT) and 20.8 (PP) minutes more in MVPA per day than comparison boys (p < 0.01), while there were no significant between-group differences for girls.CONCLUSIONS: For boys, EOtC was associated with more daily time being spent moderately and vigorously physically active. No differences were observed for girls. Implementing EOtC into schools' weekly practice can be a time- and cost-neutral, supplementary way to increase time spent in PA for boys through grades three to six.TRIAL REGISTRATION: The Scientific Ethical Committee in the Capital Region of Denmark protocol number H-4-2014-FSP . 5 March, 2014.

The aim of this study was to investigate the influence of narrative-collaborative group coaching on career development, self-reflection and the general functioning of young sports talents with the goal of achieving integration of their sports careers, educational demands and private lives. The intervention was based on a narrative-collaborative approach, with the intention of inviting the participants to share with and learn from each other. The randomised control design was based on 77 participants (questionnaire measuring recovery/stress, motivation and action control). A qualitative interview study included six participants. The group-coaching intervention had a significant effect on the scores for social recovery and general well-being. The qualitative study showed that group-coaching participants valued the shared process of meaning-making as especially valuable. Narrative-collaborative group coaching can be understood as a community psychological intervention that helps to support the development of...

BACKGROUND: Education Outside the Classroom (EOTC) is a teaching method that aims to promote schoolchildren's learning, physical activity (PA), social relations, motivation, and well-being. EOTC activities are characterized by teachers using the local environment in their teaching, and involve innovative teaching methods, child-led approaches to problem-solving, experimentation, cooperation, PA, and play. EOTC has become common practice for many teachers in Scandinavia; however, only case studies have evaluated its impacts. The TEACHOUT study aims to evaluate the impacts of EOTC on Danish schoolchildren's PA, social relations, motivation, well-being, and learning.METHODS: TEACHOUT is a quasi-experimental, cross-disciplinary study. Sixteen schools participated, containing 19 EOTC school classes and 19 parallel non-EOTC classes, with a total of 834 children aged 9 to 13 years. Measures of the children's social relations, motivation for school, well-being, and academic performance were collected at the beginning and end of the school year. Data on PA levels were collected over ten-day periods during the school year using accelerometers. The amount and characteristics of the actual EOTC provided in both EOTC and non-EOTC classes were monitored day-to-day throughout the school year, using an online teacher survey platform. The effects of EOTC are mainly analysed by comparing EOTC pupils to non-EOTC (i.e. control) pupils based on their scores on the outcome variables (i.e. school performance, well-being, motivation, and social relations) at the end of the school year, adjusting for the baseline values (from the beginning of the year). The impacts of EOTC on PA are evaluated by comparing the total as well as context-specific amounts of PA of children participating in EOTC to those of children in their parallel non-EOTC classes. Furthermore, the interdependencies between PA, social relations, well-being, motivation, and learning are explored using path analysis. To help describe and understand the processes that have led to the quantitative outcomes, qualitative case observations of children's practices and interactions in EOTC as well as classroom teaching were carried out and combined with qualitative interviews about children's perceptions of these practices.DISCUSSION: The TEACHOUT study represents a holistic multidisciplinary approach to educational and school health-promotion research through its study design and combination of scientific disciplines and methods, as well as its focus on the interdependent relations between learning, PA, social relations, well-being, and motivation. This will result in a comprehensive picture of school health promotion and children's health and well-being, which will broaden the understanding of the potential benefits of EOTC in school health promotion and primary education. These results can be used to inform and guide future policy and practice.

The purpose of this study was to investigate whether Danish children from immigrant backgrounds are less physically active than children from the ethnic majority, and to investigate the possible reasons for any differences found. Accelerometer measures of physical activity as well as questionnaire data about organised sports, family demography, resources and values were collected from 594 children of whom 67 had other ethnic background than Danish. Data were collected when the children were 6-7 years old and again later when the children were 9-10 years old. It was found that children from immigrant backgrounds were not less physically active than other children when their amounts of daily physical activity were measured by direct objective measures, despite their participation rate in organised sports being much lower. Using multiple logistic regression modelling, this study showed that lack of parental experience with organised sports and lack of economic/material resources explained much of the difference in sports participation. Children of immigrant background had significant lower participation in club sports but this did not affect their overall physical activity level.

Background:This study investigates the influence of school playground facilities on children’s daily physical activity.Methods:Participants were 594 school children measured at preschool (age 6 to 7 years) and 3 years later in third grade (518 children age 9 to 10 years) from 18 schools in 2 suburban municipalities in Denmark. Physical activity data were obtained using accelerometers. These were related to the number of permanent play facilities in school grounds and the school playground area (m2).Results:The number of play facilities in the school grounds was positively associated with all measures of children’s activity. In preschool every 10 additional play facilities the children had access to was associated with an increase in the average accelerometer counts of 14% (r = .273, P < .001) in school time and 6.9% (r = .195, P < .001) overall. For the children in third grade, access to 10 additional play facilities was associated with an increase in school time activity level of 26% (r = .364, P < .001) and an increase in overall activity level of 9.4% (r = .211, P < .001). School playground area did not affect activity levels independently of the number of permanent play facilities.Conclusion:Increasing the number of play facilities in primary school playgrounds may increase the level of children’s daily physical activity.

Background:To investigate whether the number of permanent playground facilities in schools influences objectively measured physical activity.Methods:Physical activity was measured using Actical accelerometers over 2 to 5 days in 417 children (5–12 years) from 7 schools. The number of permanent play facilities likely to encourage physical activity in individuals or groups of children (eg, adventure playgrounds, swings, trees, playground markings, courts, sandpits) were counted on 2 occasions in each school. The surface area of each playground (m2) was also measured.Results:The number of permanent play facilities in schools ranged from 14 to 35 and was positively associated with all measures of activity. For each additional play facility, average accelerometry counts were 3.8% (P < .001) higher at school and 2.7% (P < .001) higher overall. Each additional play facility was also associated with 2.3% (P = .001) or 4 minutes more moderate/vigorous activity during school hours and 3.4% (P < .001) more (9 minutes) over the course of the day. School playground area did not affect activity independent of the number of permanent play facilities. Findings were consistent across age and sex groups.Conclusion:Increasing the number of permanent play facilities at schools may offer a cost-effective and sustainable option for increasing physical activity in young children.

Community-based lifestyle intervention may offer the best means of reducing the global epidemic of childhood obesity and its consequences, yet few successful interventions have been reported. The objective was to determine whether increasing extra-curricular levels of activity could reduce weight gain in children.A controlled intervention study was conducted using standardised methods to assess outcomes. Two comparable relatively rural communities in Otago, New Zealand formed intervention and control settings. Height, weight, waist circumference and participation in physical activity (by accelerometry) were measured at baseline and at 1 year in 384 children aged 5 to 12 years representing the majority of children in this age group in intervention and control communities. Community Activity Co-ordinators were employed at each school in the intervention area. Their brief was to widen exposure to activity and engage children not interested in traditional sporting activities by encouraging lifestyle-based activities (e.g. walking) and non-traditional sports (e.g. golf and taekwondo) during extra-curricular time at school, after school and during vacations. Simple dietary advice was offered and the wider community was encouraged to participate.Average accelerometry counts at 1 year were 28% (95% CI: 11 to 47%) higher in intervention compared with control children after adjusting for age, sex, baseline values and school. Intervention children spent less time in sedentary activity (ratio 0.91, p = 0.007) and more time in moderate (1.07, p = 0.001) and moderate/vigorous (1.10, p = 0.01) activity. Adjusted mean BMI Z-score was lower in intervention relative to control children by -0.12 units (95% CI: -0.22 to -0.02).. An intervention designed to maximise opportunities for physical activity during extra-curricular time at school and during leisure time through the provision of community-based Activity Co-ordinators significantly increased participation in physical activity and slowed unhealthy weight gain in primary school-aged children.

Patients with homozygous homocystinuria are at greatly increased risk for development of atherosclerosis and thrombosis [1] . Elevated plasma levels of homocysteine (HCY) are caused by reduced enzymatic catabolism or reduced enzymatic remethylation of HCY, due to either hereditary enzyme defects or to nutrional deficiencies of vitamins functioning as cofactors. However, several recent studies have suggested that persons with mildly elevated plasma levels of HCY also are at increased risk for coronary heart disease. 2 , 3 , 4 . There are some indications that dietary n-3 polyunsaturated fatty acids (PUFAs) may offer protection against coronary heart disease 5 , 6 . Several mechanisms may be involved, including beneficial effects of n-3 PUFAs on plasma lipids, platelet and leukocyte reactivity, blood pressure and vasoreactivity [7] . Interestingly, Olszewski et al. recently found HCY-levels to be lowered 36% in 15 type IIa or IIb hyperlipemic men by n-3 PUFA supplementation. A possible beneficial effect of n-3 PUFA on the incidence of coronary heart disease was initially suggested from studies in Greenland Inuits by our group [8] . We therefore investigated plasma levels of homocystein in a group of traditionally living Greenland Inuits with a diet consisting mainly of marine food and with a very high content of n-3 PUFAs. © 1997 Elsevier Science Ltd

The effects of dietary supplementation with n-3 fatty acids on the level of cytokines and complement activation in plasma from patients with rheumatoid arthritis were examined. Thirty-two patients with active rheumatoid arthritis were included in a 12-week double-blind, randomized study of dietary supplementation with n-3 fatty acids (3.6 g per day) or placebo. The cytokines were measured in plasma before and after treatment with fish oil or placebo. In general, cytokine values at the upper limits of the calculated normal areas were found. The Interleukin-1 beta concentration in plasma was reduced significantly after 12 weeks of dietary supplementation with fish oil (p0.03). No significant difference was observed in the placebo group. The tumour necrosis factor alpha activity in plasma did not change significantly (p = 0.167). No significant changes were observed in the degree of complement activation. The clinical status of the patients was improved in the fish oil group, but not in the placebo group, judged by Ritchie's articular index (p0.02). We conclude that dietary supplementation with n-3 fatty acids results in significantly reduced plasma IL-1 beta levels in patients with rheumatoid arthritis. Even though the cytokine levels were low, the anti-inflammatory effect of n-3 fatty acids could in part be explained by their ability to decrease cytokine production.

Study objective: To determine the effect of dietary supplementation with n-3 polyunsaturated fatty acids (n-3 PUFA) on disease variables in patients with rheumatoid arthritis. Design: Multicenter, ran- domized, placebo controlled, double blind. Setting: Three Danish hospital Departments of Rheumato- logy. Patients: Fifty-one patients with active rheuma- toid arthritis. Intervention: Random allocation to 12 weeks of treatment with either six n-3 PUFA capsules (3.6 g) or six capsules with fat composition as the average Danish diet. Main results: Significant im- provement of morning stiffness and joint tenderness. No significant effect on the four other assessed clinical parameters. No serious side effects. Conclusions: Die- tary supplementation with n-3 PUFA in patients with rheumatoid arthritis improved two out of six patient reported disease parameters. Further studies are needed to clarify the more precise role of n-3 PUFA in the treatment of rheumatoid arthritis.

The combination of user-names and passwords has become the predominant method of user authentication in computer systems. Most users have multiple accounts on different systems, which impose different constraints on the length and complexity of passwords that the user is allowed to select. This is done to ensure an appropriate degree of security, but instead, it makes it difficult for users to remember their password, which results in passwords that are either insecure, but easy to remember, or written down on paper. In this paper we address the problem of usability in user authentication. We promote the use of passphrases, which provide better security and are often easier to remember than passwords. Passphrases will be significantly longer than passwords, which makes them more difficult to enter correctly on a keyboard. We solve this problem by proposing a new passphrase validation algorithm, which accepts the most common typing mistakes. The proposed algorithm has been implemented in secure hardware and integrated into a standard Unix system. We present the design, implementation and preliminary evaluation of the developed passphrase authentication prototype.