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This study examined adolescent muscle-strengthening exercise (MSE) participation at home and associated socioecological correlates during Australia’s initial COVID-19 lockdown restrictions. Adolescents (N = 731, Mage = 16.3, SD = 1.2 years, 73% female) self-reported their MSE participation in February 2020 (pre-lockdown; at a gym or at home) and April/May (during lockdown; at home only as gyms were closed). They also reported a range of potential individual, family, and home environment correlates. Remoteness and area-level socioeconomic disadvantage were also considered. Logistic regression models examined potential correlates of participation in any MSE and MSE engagement ≥3 times/week during April/May. Fewer adolescents participated in MSE during April/May (48%) than February (54%), however, the proportions that engaged in MSE ≥3 times/week were the same (30%). Prioritising being active every day (OR = 2.43, 95% CI = 1.52, 3.90), being active with sibling/s ≥ 5 days/week (OR = 2.24, 95% CI = 1.00, 5.00) and access to weights at home (OR = 2.98, 95% CI = 1.94, 4.57) were associated with higher odds of any MSE participation at home during April/May. These variables were also positively associated with MSE participation at home ≥3 times/week. Understanding how to support adolescents to prioritise being active, engage in MSE with siblings, and provide equipment may assist adolescents to engage in home-based MSE. Refereed/Peer-reviewed

Background Outdoor public recreation spaces are important settings for leisure and physical activity. Adolescents’ use of these spaces may contribute to social connectedness via social interaction with peers and the community in these settings. However, research on this topic is limited. This exploratory study examined associations of frequency of visitation and physical activity in outdoor public recreation spaces with social connectedness among adolescents in Melbourne, Australia. Methods Adolescents self-reported their frequency of visitation to parks, trails, beach/lake, and sports facilities; frequency of physical activity in a park, local street or path, and their street; and social connectedness. Separate analyses were conducted for visitation (n = 349, 15.4 ± 1.6 years, 58% female) and physical activity (n = 441, 15.4 ± 1.6 years, 59% female) using multilevel linear regression models. Results No significant associations were observed for frequency of visitation to a park (B = 0.86, 95% CI = − 0.26, 1.99), trails (B = 0.41, 95% CI = − 0.61, 1.44), beach/lake (B = − 0.44, 95% CI = − 1.46, 0.57), or sports facilities (B = 0.64, 95% CI = − 0.43, 1.70), nor for frequency of physical activity in their street (B = − 0.07, 95% CI = − 0.46, 0.31), local street/path (B = − 0.05, 95% CI = − 0.43, 0.33) or in a park (B = 0.23, 95% CI = − 0.14, 0.60) with adolescents’ social connectedness. Conclusions The findings did not support the hypothesis that visiting and being active in outdoor public recreation spaces are associated with adolescents’ social connectedness. Future research should consider the duration and context of outdoor public recreation space use (e.g., sports, socialising, relaxing alone) and whether different types and/or a combination of public spaces are more/less conducive to social connectedness.

Background Although perceptions of what constitutes physical activity (PA) may vary between culturally diverse populations, very little research has explored the perceptions of PA among Indian migrants. This study aimed to identify how PA and sedentary behaviour (SB) are defined and describe how these definitions are shaped by cultural background and migration among a sample of Indian migrants living in Australia. Methods Using an exploratory qualitative approach, semi-structured interviews were conducted with twenty-one Indian migrants living in Melbourne (10 men and 11 women; age range: 18 to 65 years). Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analyses. Results Data revealed two emerging themes: 1) Holistic perspectives related to PA, where although the majority of participants described PA as “any sort of movement”, or “physical exercise”, several of these descriptions had interwoven ideas related to the mind (mind-body connect), social, cultural, and to the outdoor environment; 2) Broader perspectives for SB, where descriptions of SB as “not having movement”, “doing nothing” or “being lazy”, were shaped with ideas of purpose and duration. Women spoke about how their perspectives of PA and SB may be shaped by native Indian experiences, particularly the gender roles, social caste, and regional subcultural norms which they perceived were important to consider among women who migrate to western settings. Conclusions Cultural background is important in shaping the perspectives of PA and SB among Indian migrants in Australia. Practitioners and researchers should consider the varying perspectives of PA to communicate and promote PA among migrant populations more effectively.

Background A high proportion of adolescents worldwide are not doing enough physical activity for health benefits. Replacing short motorised trips with walking or cycling has the potential to increase physical activity at the population level. This study aimed to estimate the proportion of short distance motorised trips that could be replaced with walking or cycling, and the potential physical activity gains by sociodemographic and trip characteristics. Methods Data were from a subsample of the NEighbourhood Activity in Youth (NEArbY) study conducted among adolescents in Melbourne. A total of 217 adolescents with at least one motorised trip completed a survey and wore a Global Positioning Systems (GPS) device for eight consecutive days. Classification of travel modes were based on speed. GPS data points were geocoded in ArcGIS. Motorised trips within walkable (1.3 km) and cyclable (4.2 km) distances were identified (threshold based on 80th percentile of walking and cycling trip distances among Victorian adolescents), and the additional physical activity minutes that could be accrued by replacing walkable or cyclable motorised trip to active trips were quantified. Multilevel linear regression was used to assess differences in physical activity minutes gain by sociodemographic and trip characteristics. Results A total of 4,116 motorised trips were made. Of these, 17% were walkable and 61% were cyclable. Replacing motorised trips by walking and cycling resulted in estimated gains of six minutes and 15 min of physical activity per day, respectively. Conclusion The sizable proportion of replaceable trips and potential physical activity gains from this shift calls for attention to improve safe and connected infrastructure to support active travel.

Background Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents’ physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies. Objective The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up. Methods RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous–intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators. Results Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous–intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time. Conclusions RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716&isReview=true International Registered Report Identifier (IRRID) RR2-10.1186/s12889-016-3945-5

Background Distinct typologies of physical activity and screen-based sedentary behaviors are common during adolescence, but it is unknown how these change over time. This longitudinal study examined the stability of activity-related behavioral typologies over the transition out of secondary school. Methods Year 11 students (penultimate school year) completed a self-report survey (baseline), which was repeated 2 years later (follow-up) (75% female, mean baseline age: 16.9 ± 0.4 years). Latent transition analysis identified typologies of physical activity and screen time behaviors and explored changes in typology membership between baseline and follow-up among those with complete data and who were not attending secondary school at follow-up (n = 803). Results Three unique typologies were identified and labelled as: 1) Sedentary gamers (baseline: 17%; follow-up: 15%: high levels of screen behaviors, particularly video gaming); 2) Inactives (baseline: 46%; follow-up: 48%: low physical activities, average levels of screen behaviors); and 3) Actives (baseline: 37%; follow-up: 37%: high physical activities, low screen behaviors). Most participants remained in the same typology (83.2%), 8.5% transitioned to a typology with a more health-enhancing profile and 8.3% transitioned to a typology with a more detrimental behavioral profile. Conclusions The high proportion within the ‘inactive’ typology and the stability of typologies over the transition period suggests that public health interventions are required to improve activity-related behavior typologies before adolescents leave secondary school.

Background TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms. Methods At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) ‘Low’ ( 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children’s physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically. Results Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children’s enjoyment, and teachers’ awareness of program benefits all facilitated delivery and sustainability. Conclusions This study demonstrated that intervention dose and fidelity increased over time, and that children’s enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia. Trial registration International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387&isReview=true

OBJECTIVES: To examine the effects of COVID-19 related 'lockdown restrictions' on Australian's (5-75 years) physical activity recommendation achievement and active recreation participation. DESIGN: Cross-sectional online survey with self and proxy-report items (where the participant was a parent). METHODS: Adults (n = 1360) and adolescents (n = 1292) reported the frequency they performed 30- or 60-min of moderate-to-vigorous physical activity (MVPA), muscle-strengthening exercises, and participation in 11 active recreation behaviours in February 2020 (pre-COVID-19) and in April/May (during lockdown restrictions). Parents also proxy-reported activity for their child (n = 147, 5-12 years). Mixed effects logistic regressions or a logistic regression (with robust sandwich estimation for variance) assessed recall differences pre- and during lockdown, and interaction by sex. RESULTS: Compared to February, in April/May children were less likely to meet MVPA recommendations (OR = 0.27, 95%CI = 0.12-0.64); adolescents males, but not females, were less likely to meet MVPA (OR = 0.71, 95%CI 0.43, 1.17) and both recommendations (OR = 0.12, 95%CI = 0.02, 0.79); and adults were more likely to meet MVPA (OR = 1.26, 95%CI = 1.01, 1.57) but less likely to meet muscle-strengthening exercise recommendations (OR = 0.76, 9%CI = 0.65, 0.89). Across age groups more participants reported walking, muscle strengthening exercises at home, and yoga/Pilates/stretching at home, and fewer performed informal sport practice and play, and recreational activities. CONCLUSIONS: Lockdown restrictions had different effects on physical activity and active recreation among age groups and by sex. Physical activity promotion strategies that target children and adolescents, at home physical activity options, active neighbourhoods, and (re)engagement in informal sport and recreational activities post-COVID-19 are critical for (re)engaging Australians in health-enhancing behaviours.

Purpose: To describe youth time-use compositions, focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity (PA), and to examine associations of these time-use compositions with cardiometabolic biomarkers. Methods: Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7–13 years old were pooled (complete cases with accelerometry and adiposity marker data, n = 782). A 9-component time-use composition was formed using compositional data analysis: time in shorter and longer bouts of sedentary behavior; time in shorter and longer bouts of light-, moderate-, or vigorous-intensity PA; and “other time” (i.e., non-wear/sleep). Shorter and longer bouts of sedentary time were defined as

Background Increasing emphasis has been placed on improving physical activity levels through multilevel interventions. This study aims to examine moderating effects of neighborhood safety (crime and traffic) and social support (from parent and sibling/peer) for physical activity in the relationship between the built environment and moderate-to-vigorous physical activity (MVPA) outside school hours among adolescents in Melbourne. Methods Data were from the NEighbourhood Activity in Youth study conducted among adolescents in Melbourne, Australia (n = 358, 15.3 (SD = 1.5) years). MVPA outside school hours was assessed by accelerometer. Built environment features within 1 km and 2 km residential buffers including recreation facilities, park area, and walkability and its components were assessed using Geographic Information Systems. Neighborhood safety, social support for physical activity and sociodemographic information were self-reported by adolescents. Multilevel linear regression models were used to estimate associations. Results Support for physical activity from sibling/peer positively moderated the relationship between recreation facilities (1 km), residential density (2 km) and MVPA. Recreation facility (count within 2 km), walkability (1 km and 2 km) and residential density (1 km) had significant positive associations with MVPA outside school hours. Conclusion The built environment appeared to have stronger facilitating effects on MVPA among adolescents who had favourable support for physical activity from their sibling or peer. Multilevel interventions that target the built environment and social factors are needed to promote MVPA outside school hours among adolescents.

Background The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents’ physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability. Methods Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status. Results Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity. Conclusions A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Background Parks are a key setting for physical activity for children. However, little is known about which park features children prefer and which features are most likely to encourage them to be active in parks. This study examined the relative importance of park features among children for influencing their choice of park for engaging in park-based physical activity. Methods Children (n = 252; 8-12 years, 42% male) attending three primary schools in Melbourne, Australia completed a survey at school. They were required to complete a series of Adaptive Choice-Based Conjoint analysis tasks, with responses used to identify the part-worth utilities and relative importance scores of selected park features using Hierarchical Bayes analyses within Sawtooth Software. Results For the overall sample and both boys and girls, the most important driver of choice for a park that would encourage them to be active was presence of a flying fox (overall conjoint analysis relative importance score: 15.8%; 95%CI = 14.5, 17.1), followed by a playground (13.5%; 95%CI = 11.9, 15.2). For the overall sample, trees for climbing had the third highest importance score (10.2%; 95%CI = 8.9, 11.6); however, swings had 3rd highest importance for girls (11.1, 95%CI = 9.3, 12.9) and an obstacle course/parkour area had the 3rd highest importance score for boys (10.7, 95%CI = 9.0, 12.4). For features with two levels, part-worth utility scores showed that the presence of a feature was always preferred over the absence of a feature. For features with multiple levels, long flying foxes, large adventure playgrounds, lots of trees for climbing, large round swings, large climbing equipment, and large grassy open space were the preferred levels. Conclusion To ensure parks appeal as a setting that encourages children to engage in physical activity, park planners and local authorities and organisations involved in park design should prioritise the inclusion of a long flying fox, large adventure playgrounds, lots of trees for climbing, large round swings and obstacle courses/parkour areas.

BACKGROUND: The association between physical activity and adiposity in preschool-aged children is unclear. OBJECTIVE: To assess the cross-sectional association between objectively measured physical activity and body fat in preschool-aged children. METHODS: In the preschool review in an Australian birth cohort study (n = 1074), mean duration and time accumulated in ≥1-min bouts of physical activity at light-intensity (LPA), moderate- to vigorous-intensity (MVPA) and light- to vigorous-intensity (LMVPA) were computed from accelerometer (ActiGraph GT3X+) data. Percent body fat was assessed by bioelectrical impedance. Associations between physical activity and percent body fat were examined by multiple regression, adjusted for accelerometer wear time, MVPA (in analyses of LPA), maternal body mass index (BMI) and maternal education. RESULTS: A total of 450 participants (n = 450) had valid data. There was evidence of associations between physical activity and adiposity: each additional hour of LVPA was associated with 0.6% (CI95 -0.2%, 1.3%) higher body fat; ≥1-min bouts of LPA was associated with 1.0% (CI95 0.1%, 1.9%) higher body fat; each additional hour of MVPA was associated with -0.8% (CI95 -1.6%, -0.1%) less body fat; and ≥1-min bouts of MVPA was associated with -1.3% (CI95 -2.5%, -0.1%) body fat. CONCLUSIONS: Among a cohort of preschool-aged children, there was evidence that more intensive physical activity assessed by an accelerometer is associated with reduced body fat.

Little is known about what park features adolescents perceive as most important for encouraging them to visit and be active and social in parks. This study examined the relative importance of park features for encouraging these behaviours among adolescents and explored differences according to gender and frequency of visitation. Adolescents were recruited from secondary schools in diverse areas of Melbourne, Australia. In Phase 1 (2018–2019), participants [n = 222; 14.0 years (SD 1.1); 46% female] rated photographs of 40 park features in an online survey, indicating the degree to which each feature encouraged them to visit, and be active and social in the park. In Phase 2 (2019–2020), the top ten-rated features from Phase 1 for each outcome (overall and by gender and frequency of visitation) were presented in Adaptive Choice-Based Conjoint tasks to another sample of participants [n = 244; 14.7 years (SD 1.3); 46% female]. The most important feature for encouraging visitation was large swings; for physical activity was sports courts; and for social interaction was a cafe. Grassy open space was important for all behaviours, and preferred park features varied among sub-groups. The results highlight which park features park planners and designers should prioritise to support active and social park use among adolescents.

Background: Although there is increasing evidence regarding children’s screen time, little is known about children’s sitting. This study aimed to determine the correlates of screen time and sitting in 6- to 8-year-old children. Methods: In 2011–2012, parents in the Healthy Active Preschool and Primary Years (HAPPY) study (n = 498) reported their child’s week/weekend day recreational screen time and potential correlates. ActivPALs™ measured children’s nonschool sitting. In model 1, linear regression analyses were performed, stratified by sex and week/weekend day and controlling for age, clustered recruitment, and activPAL™ wear time (for sitting analyses). Correlates significantly associated with screen time or sitting (P Results: Children (age 7.6 y) spent 99.6 and 119.3 minutes per day on week and weekend days engaging in screen time and sat for 119.3 and 374.6 minutes per day on week and weekend days, respectively. There were no common correlates for the 2 behaviors. Correlates largely differed by sex and week/weekend day. Modifiable correlates of screen time included television in the child’s bedroom and parental logistic support for, encouragement of, and coparticipation in screen time. Modifiable correlates of sitting included encouragement of and coparticipation in physical activity and provision of toys/equipment for physical activity. Conclusions: Interventions may benefit from including a range of strategies to ensure that all identified correlates are targeted.

Objectives To assess the feasibility and efficacy of a 6-week pilot active break program (ACTI-BREAK) on academic achievement, classroom behaviour and physical activity. Design Pilot cluster randomised controlled trial. Methods 374 children in Year 3 and 4 (74% response) were recruited from six schools across Melbourne, Australia. Schools were randomised to the ACTI-BREAK intervention or usual teaching practice. The intervention involved teachers incorporating 3 × 5 min active breaks into their classroom routine daily. Academic achievement was assessed using 1-min tests in reading and mathematics; classroom behaviour at the individual and whole class level was observed by teachers; and physical activity levels were assessed using accelerometers. Multilevel mixed effects linear regression models were conducted using intention to treat (ITT) and per protocol (PP) analyses. Results Significant intervention effects were found for classroom behaviour at the individual level (ITT B = 16.17; 95% CI: 6.58, 25.76); effects were stronger for boys (B = 21.42; 95% CI: 10.34, 32.49) than girls (B = 12.23; 95% CI: 1.52, 22.92). No effect was found for classroom behaviour at the whole class level, reading, math or physical activity. PP findings were similar. Conclusions Implementing active breaks during class time may improve classroom behaviour, particularly for boys. There was no evidence to suggest that implementing active breaks had any adverse effect on academic achievement or classroom behaviour, which may encourage classroom teachers to incorporate active breaks into their routine.

Background Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity. Methods Observational data of visitor counts and activities undertaken in the park before the installation of the new play-scape (T1), at two months (T2) and 14 months post-installation (T3) were obtained for the intervention and a control park (with no refurbishment) located in a high SEP metropolitan area. Observed sitting, standing, and moderate and vigorous-intensity physical activity were converted to yearly MET-h according to age. Costs of the play-scape and ongoing maintenance were obtained from the organisation managing the refurbishment. The incremental cost-effectiveness ratio (ICER) (ratio of incremental cost to incremental effect) was calculated based on the incremental increase in MET-h from T1 to T3 assuming a 20-year lifetime of the play-scape. Observation counts combining moderate and vigorous activity were used in the sensitivity analysis. Results When compared with T1, at T3 the new play-scape resulted in an overall incremental net gain of 114,114 MET-h (95% UI: 80,476 − 146,096) compared with the control park and an incremental cost effectiveness ratio (or cost per MET-h gained per park visitor) of AUD $0.58 (95% UI: $0.44–$0.80). The sensitivity analysis combining moderate and vigorous activity into one category showed an increase in estimated incremental MET-h of 118,190 (95% CI: 83,528 − 149,583) and a lower incremental cost per MET-h gained of AUD $0.56 (95% UI: $0.43–$0.77). Conclusions Using a benchmark of cost-effectiveness for physical activity interventions of AUD $0.60–$1.30, this study suggests that the installation of a play-scape located in a low SEP area is cost-effective based on its potential to facilitate increases in MET-h. It provides much needed preliminary evidence and requires replication elsewhere. Electronic supplementary material The online version of this article (10.1186/s12966-019-0786-5) contains supplementary material, which is available to authorized users.

Introduction This natural experiment examined the impact of the installation of outdoor fitness equipment and one multi-sports court in a park located in Melbourne, Australia on park visitation and park-based physical activity compared to a control park. Barriers and facilitators to use of this equipment among adult park visitors were also explored. Methods Park visitation and moderate-vigorous physical activity (MVPA) in the two parks were assessed before (T1, 2016) and after the intervention (T2, 2019) using observations of park visitors from children to older adults across four days (7.30am-5.00pm). The relative change in observed counts in visitors from T1-T2 in the intervention park compared to the control park was used to assess the effect of the park refurbishment. Intercept surveys regarding barriers and facilitators were conducted with adult park visitors. Results Over the three-year period, total visitor counts increased by 16% and the number of park visitors observed engaging in MVPA increased by 24% in the intervention park. However, there were no significant intervention effects on total visitor counts (IRR = 0.89, 95%CI: 0.62, 1.30) or MVPA (IRR = 0.80, 95%CI: 0.53, 1.19) relative to the control park. Examples of frequently mentioned facilitators to increase use of the sports court and fitness equipment included having someone to use the facilities with and instructional signage, and common barriers included poor weather and lack of time. Conclusions The impact of the park upgrade on visitation and MVPA was not significant. A better understanding of the broader appeal of outdoor fitness equipment and a multi-sports court among different segments of the population is needed.

Background There has been increasing interest in using wearable activity trackers to promote physical activity in youth. This study examined the short- and longer-term effects of a wearable activity tracker combined with digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas. Methods The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week, multicomponent intervention that combined a Fitbit Flex (and accompanying app), and online digital behaviour change resources and weekly challenges delivered via Facebook. RAW-PA was evaluated using a cluster-randomised controlled trial with 275 adolescents (50.2% female; 13.7 ± 0.4 years) from 18 Melbourne secondary schools (intervention n = 9; wait-list control group n = 9). The primary outcome was moderate- to vigorous-intensity physical activity (MVPA), measured using hip-worn ActiGraph accelerometers. The secondary outcome was self-reported physical activity. Data were collected at baseline, 12-weeks (immediately post-intervention), and 6-months post-intervention (follow-up). Multilevel models were used to determine the effects of the intervention on daily MVPA over time, adjusting for covariates. Results No significant differences were observed between intervention and wait-list control adolescents’ device-assessed MVPA immediately post-intervention. At 6-months post-intervention, adolescents in the intervention group engaged in 5 min (95% CI: − 9.1 to − 1.0) less MVPA per day than those in the wait-list control group. Males in the intervention group engaged in 11 min (95% CI: − 17.6 to − 4.5) less MVPA than males in the wait-list control group at 6-months post-intervention. No significant differences were observed for females at either time point. For self-reported physical activity, no significant effects were found at 12-weeks and 6-months post-intervention. Conclusions Combining a wearable activity tracker with digital behaviour change resources and weekly challenges did not increase inactive adolescents’ accelerometer-derived and self-reported physical activity levels immediately post-intervention. This contrasts previous research that has suggested wearable activity tracker may increase youth physical activity levels in the short-term. Lower engagement in MVPA 6-months post-intervention was observed for males but not for females, though it is unclear why this finding was observed. The results suggest wearable activity trackers, in combination with supporting materials, may not be effective for increasing physical activity levels in adolescents. Trial registration ACTRN12616000899448. Australian and New Zealand Clinical Trials Registry. Registered 7 July 2016.

Background Physical activity (PA) decreases and sedentary time (SED) increases across childhood, with both behaviours tracking. However, no studies have examined how accumulation patterns of PA and SED (i.e., prolonged bouts, frequency of breaks in sedentary time) change and track over time. The aim of this study was to investigate longitudinal changes in and tracking of total volume and accumulation patterns of SED, light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) among boys and girls. Methods In 2008/09 (T1), children in HAPPY (3-5y; n = 758) in Melbourne, Australia wore ActiGraph GT1M accelerometers to objectively assess SED, LPA, MPA and VPA. This was repeated at age 6-8y (T2; n = 473) and 9-11y (T3; n = 478). Ten pattern variables were computed: bouts of ≥ 5-, ≥ 10-, ≥ 15- and ≥ 20-min for SED, ≥ 1- and ≥ 5-min for LPA, ≥ 1-min for MPA, ≥ 1- and ≥ 5-min for VPA, and breaks in SED (interruptions of > 25 counts 15 s− 1). Longitudinal mixed models examined changes from T1-3, controlling for T1 age. Generalized estimating equations assessed tracking over the three time points, controlling for T1 age and time between measurements. Analyses were stratified by sex. Results Total volume and bouts of SED and SED breaks increased, while total volume and bouts of LPA decreased for both sexes. There was a small decrease in total volume of MPA for girls, but time spent in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys only. All volume and pattern variables tracked moderately for boys, except for all SED bouts ≥ 15-min, LPA bouts ≥ 5-min and MPA bouts ≥ 1-min (which tracked weakly). For girls, total SED and SED bouts ≥ 1-min tracked strongly, total volume of LPA, MPA and VPA, ≥ 5- and ≥ 10-min SED bouts, and ≥ 1-min LPA and MPA bouts tracked moderately, and SED breaks, all SED bouts ≥ 15 min, LPA bouts ≥ 5 min and all VPA bouts tracked weakly. Conclusions Patterns of SED and PA change from early to late childhood; with the exception of SED breaks and VPA, changes were detrimental. Total volumes and short bouts tended to track more strongly than longer bouts. Interventions to prevent declines in PA and increases in SED are important from early in life.

Background Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home. Objective This study aimed to examine associations between the use of digital platforms and adherence to the physical activity guidelines among Australian adults and adolescents during the COVID-19 stay-at-home restrictions in April and May 2020. Methods A national online survey was distributed in May 2020. Participants included 1188 adults (mean age 37.4 years, SD 15.1; 980/1188, 82.5% female) and 963 adolescents (mean age 16.2 years, SD 1.2; 685/963, 71.1% female). Participants reported demographic characteristics, use of digital platforms for physical activity over the previous month, and adherence to moderate- to vigorous-intensity physical activity (MVPA) and muscle-strengthening exercise (MSE) guidelines. Multilevel logistic regression models examined differences in guideline adherence between those who used digital platforms (ie, users) to support their physical activity compared to those who did not (ie, nonusers). Results Digital platforms include streaming services for exercise (eg, YouTube, Instagram, and Facebook); subscriber fitness programs, via an app or online (eg, Centr and MyFitnessPal); facilitated online live or recorded classes, via platforms such as Zoom (eg, dance, sport training, and fitness class); sport- or activity-specific apps designed by sporting organizations for participants to keep up their skills (eg, TeamBuildr); active electronic games (eg, Xbox Kinect); and/or online or digital training or racing platforms (eg, Zwift, FullGaz, and Rouvy). Overall, 39.5% (469/1188) of adults and 26.5% (255/963) of adolescents reported using digital platforms for physical activity. Among adults, MVPA (odds ratio [OR] 2.0, 95% CI 1.5-2.7), MSE (OR 3.3, 95% CI 2.5-4.5), and combined (OR 2.7, 95% CI 2.0-3.8) guideline adherence were higher among digital platform users relative to nonusers. Adolescents’ MVPA (OR 2.4, 95% CI 1.3-4.3), MSE (OR 3.1, 95% CI 2.1-4.4), and combined (OR 4.3, 95% CI 2.1-9.0) guideline adherence were also higher among users of digital platforms relative to nonusers. Conclusions Digital platform users were more likely than nonusers to meet MVPA and MSE guidelines during the COVID-19 stay-at-home restrictions in April and May 2020. Digital platforms may play a critical role in helping to support physical activity engagement when access to facilities or opportunities for physical activity outside the home are restricted.

IntroductionOnly international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese).Methods and analysisThe IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11–19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status.Ethics and disseminationEthical approval was received from each study site’s Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

usc Estimations of time spent sedentary and in various physical activity intensities may vary according to data reduction methods applied. This study compared associations between children's accelerometer data and adiposity and fitness markers using open source (mean amplitude deviation, MAD) and proprietary (counts) data reduction methods. Complete-case accelerometer, adiposity (Body Mass Index z-score, waist circumference), and fitness (cardiorespiratory, musculoskeletal) data from 118 children (10.4 ± 0.6 years, 49% girls) were analyzed. Estimates of sedentary behavior, light-, moderate-, vigorous- (VPA), and moderate- to vigorous-intensity (MVPA) physical activity were calculated using count- and MAD-based data reduction methods. Linear regression models between time in movement behaviours and fitness and adiposity markers were conducted. Significant differences in estimates of time spent in all intensities were observed between MAD-based and count-based methods. Both methods produced evidence to suggest that sedentary behavior was detrimentally, and physical activity(any intensity) was beneficially, associated with waist circumference. MVPA and VPA were beneficially associated with fitness markers using both data reduction measures. Overall, findings suggest that estimates of sedentary time and physical activity were not comparable. However, the strength and direction of the associations obtained between the different data reduction methods and adiposity and fitness outcomes were fairly comparable, with both methods finding stronger associations for VPA compared to MVPA. This suggests that future studies maybe able to pool data using different data reduction approaches when examining associations between activity and health risk factors, albeit with caution. Refereed/Peer-reviewed

Trajectories of physical activity and sedentary time (SED) may differ between subgroups of youth. The aim of this study was to identify group-based dual trajectories of physical activity and SED and explore individual, social, and environmental correlates of these trajectories. Longitudinal data (three time points, baseline 2011-2012) of Spanish youth (n = 1597, mean age = 11.94 ± 2.52, 50.9% boys) were used. Moderate-to-vigorous physical activity (MVPA) and SED were assessed objectively at each time point, and 21 potential correlates were self-reported at baseline. Parallel process growth mixture models identified shared categorical latent groups, adjusting for school and age. Multinomial logistic regression models identified baseline correlates of a given trajectory. Four shared categorical latent groups were identified: (1) stable MVPA and decreasing SED (4%); (2) stable MVPA and increasing SED (3%); (3) consistently higher MVPA (18%); and (4) stable low MVPA and slight increase in SED (75%). Multinomial logistic regression models with group 3 as reference found: negative affect (RRR = 0.90, 95% CI 0.84-0.97), parental screen-time rules (RRR = 1.15, 95% CI 1.00-1.33), and household media equipment (RRR = 1.17, 95% CI 1.05-1.30) predicted likelihood of group 1 membership; cons of reducing SED (RRR = 2.70, 95% CI 1.77-4.10) predicted likelihood of group 2 membership; and co-participation in physical activity with friends (RRR = 0.80, 95% CI 0.69-0.94), fathers' modeling of TV viewing (RRR = 1.22, 95% CI 1.02-1.47), and household media equipment (RRR = 1.16, 95% CI 1.02-1.31) predicted likelihood of group 4 membership. Results suggest that strategies to improve MVPA and SED behaviors among youth may need to be multifaceted, targeting all levels of influence.

Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

Parks are places where children can interact with others and engage in physical activity in a natural setting. Park visits can enhance children&rsquo, s social, mental, and physical health. It is therefore important to better understand how parks can be designed to ensure optimal use by children. This qualitative study explored children&rsquo, s perceptions of park features that may influence their park visits, park-based physical activity, and social interaction. Qualitative walk-along interviews were completed with 30 children (mean age 9.7 years (SD 1.3), female n = 16) in nine parks located in varying socioeconomic areas of Melbourne, Australia. As they walked through the park, children shared thoughts regarding characteristics that may influence their visitation, park-based physical activity, and social interactions. Features that would encourage visitation included: challenging and interesting play equipment, a pond and water play area, trees/greenery and shade, and full-sized basketball courts. Features most valued for physical activity included: sports courts, ovals, and equipment, open space, trees to climb, and nature/rocks. Features most valued for social interaction included: a large size, playgrounds, and picnic areas. Children offer unique and important views. Park designers should consider inclusion of these features, when (re)developing parks to support children to lead healthy and active lives.

This work was supported by the National Plan for Research, Development and Innovation (RDi) Ministry of Science and Innovation (DEP 2010-21662-C04-00). DSO was awarded a "Juan de la Cierva" postdoctoral fellowship (FJCI-2015-25867) from the Spanish Ministry of Economy, Industry, and Competitiveness. IEC is supported by the Spanish Ministry of Economy and Competitiveness (RTI2018-095284-J-100) and the Spanish Ministry of Science and Innovation (RYC2019-027287-I)., Background: Children and adolescents can be distinguished by different typologies (clusters) of physical activity and sedentary behavior. How physical activity and sedentary behaviors change over time within different typologies is not known. This study examined longitudinal changes in physical activity and sedentary time among children and adolescents with different baseline typologies of activity-related behavior. Methods: In this longitudinal study (3 annual time points) of children (n = 600, age = 9.2 § 0.4 years (mean § SD), 50.3% girls) and adolescents (n = 1037, age = 13.6 § 1.7 years, 48.4% girls), participants were recruited in Spain in 2011 2012. Latent class analyses identified typologies based on self-reported screen, educational, social and relaxing sedentary behaviors, active travel, muscle strengthening activity, and sport at baseline. Within each typology, linear mixed growth models explored longitudinal changes in accelerometer-derived moderate-to-vigorous physical activity and sedentary time, as well as time by class interactions. Results: Three typologies were identified among children (“social screenies”, 12.8%; “exercisers”, 61.5%; and “non-sporty active commuters”, 25.7%) and among adolescents (“active screenies”, 43.5%; “active academics”, 35.0%; and “non-sporty active commuters”, 21.5%) at baseline. Sedentary time increased within each typology among children and adolescents, with no significant differences between typologies. No changes in physical activity were found in any typology among children. In adolescents, physical activity declined within all typologies, with “non-sporty active commuters” declining significantly more than “active screenies” over 3 years. Conclusion: These results support the need for intervention to promote physical activity and prevent increases in sedentary time during childhood and adolescence. Adolescents characterized as “non-sporty active commuters” may require specific interventions to maintain their physical activity over time., National Plan for Research, Development and Innovation (RDi) Ministry of Science and Innovation DEP 2010-21662-C04-00, "Juan de la Cierva" postdoctoral fellowship from the Spanish Ministry of Economy, Industry, and Competitiveness FJCI-2015-25867, Spanish Ministry of Economy and Competitiveness RTI2018-095284-J-100, Spanish Government RYC2019-027287-I

Adolescents have the potential to be active in multiple places across weekdays and weekends. While the built environment features around home are known to be important for adolescents' physical activity, specific built environment features that facilitate physical activity outside the home neighbourhood are not well explored. Given that adolescents spend most days of the week at school, the built environment surrounding school may be particularly important for supporting their physical activity. This study examined cross-sectional associations of objective built environments around home and school at multiple spatial scales with accelerometer assessed moderate-to-vigorous physical activity (MVPA) across the week. Moderating effects of adolescents' age were further explored. Data from up to 417 adolescents aged 12-20 years from 18 schools in Melbourne, Australia were used. Features of the built environment around school were positively associated with MVPA on weekdays; and a wide range of built environment features around home were found to be important for MVPA during weekends. Age was found to moderate the relationship between some built environment features around both home and school and MVPA across the week. Understanding the contribution of the built environment features around both home and school with MVPA could inform policy recommendations and public health interventions for each setting.

Introduction: This cross-sectional study aimed to i) identify and characterize youth according to distinct physical activity (PA) and sedentary (SED) accumulation patterns, and ii) investigate associations of these derived patterns with cardiometabolic risk factors. Methods: ActiGraph accelerometer data from 7- to 13-yr-olds from two studies were pooled (n = 1219; 843 (69%) with valid accelerometry included in analysis). Time accumulated in >=5- and >=10-min SED bouts, >=1- and >=5-min bouts of light, and >=1-min bouts of moderate and vigorous PA was calculated. Frequency of breaks in SED was also obtained. Latent profile analysis was used to identify groups of participants based on their distinct accumulation patterns. Linear and logistic regression models were used to test associations of group accumulation patterns with cardiometabolic risk factors, including adiposity indicators, blood pressure, and lipids. Total PA and SED time were also compared between groups. Results: Three distinct groups were identified: "prolonged sitters" had the most time in sustained SED bouts and the least time in vigorous PA bouts; "breakers" had the highest frequency of SED breaks and lowest engagement in sustained bouts across most PA intensities; and "prolonged movers" had the least time accumulated in SED bouts and the most in PA bouts across most intensities. Although breakers engaged in less time in PA bouts compared with other groups, they had the healthiest adiposity indicators. No associations with the remaining cardiometabolic risk factors were found. Conclusion: Youth accumulate their daily activity in three distinct patterns (prolonged sitters, breakers, and prolonger movers), with those breaking up sitting and least time in prolonged PA bouts across the day having a lower adiposity risk. No relationships with other cardiometabolic risk factors were identified. Refereed/Peer-reviewed

Background: Longitudinal changes in child and adolescent active school transport (AST), and the mediating role of different intensities of daily physical activity (PA) levels in relation to AST and physical fitness and adiposity indicators is unclear. This study aimed to: 1) describe longitudinal changes in AST, light PA (LPA), moderate- to vigorous-intensity PA (MVPA), physical fitness and adiposity indicators over three time-points; and 2) investigate the mediating role of LPA and MVPA levels on associations between AST and physical fitness and adiposity indicators over three time-points among children and adolescents. Methods: This longitudinal study comprised 1646 Spanish children and adolescents (48.8% girls, mean age 12.5 years ±2.5) at baseline, recruited from schools in Cádiz and Madrid. Mode of commuting to school was self-reported at baseline (T0, 2011-12), 1-year (T1) and 2-year follow-up (T2). PA was assessed using accelerometers. Handgrip strength, standing long jump and cardiorespiratory fitness (CRF) assessed physical fitness. Height, weight, body mass index, waist circumference, and triceps and subscapular skinfold thickness were measured. Multilevel linear regression analyses assessed changes in AST, PA levels, physical fitness and adiposity indicators over three time-points (T0-T1-T2). Additionally, longitudinal path analysis (n = 453; mean age [years] 12.6 ± 2.4) was used to test the mediating effects of LPA and MVPA levels on the association between AST and physical fitness and adiposity indicators. Results: Multilevel analyses observed decreases in LPA between T0-T1 (β = - 11.27; p < 0.001) and T0-T2 (β = - 16.27; p < 0.001) and decreases in MVPA between T0-T2 (β = - 4.51; p = 0.011). Moreover, changes over time showed increases in handgrip between T0-T1 (β = 0.78; p = 0.028) and T0-T2 (β = 0.81; p = 0.046). Path analyses showed that AST was directly positively associated with MVPA at T1 (all, β ≈ 0.33; p < 0.001). MVPA at T1 mediated associations between AST and CRF at T2 (β = 0.20; p = 0.040), but not the other outcomes. LPA did not mediate any associations. Conclusions: Results from longitudinal path analysis suggest that participation in more AST may help attenuate declines in MVPA that typically occur with age and improve CRF. Therefore, we encourage health authorities to promote AST, as a way to increase MVPA levels and CRF among youth., This study was supported by the DEP 2010–21662-C04–00 (DEP 2010–21662- C04–01: DEP 2010–21662-C04–02: DEP 2010–21662-C04–03: DEP 2010– 21662-C04–04) grant from the National Plan for Research, Development and Innovation (R + D + i) MICINN. DCM received a scholarship Jose Castillejo scholarship (CAS18/00262) for a brief stay in the Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Australia. JV is supported by an Australian National Heart Foundation Future Leader Fellowship (ID 101928).

Background: Increased physical inactivity and sedentary behavior among children are a global health concern. Purpose: Examine associations between parents’ perceived neighborhood environment and children’s physical activity, outside time, and screen time, and whether these associations were moderated by age and socioeconomic position (SEP). Methods: Parents (N = 1212) completed a survey during the Recording and EValuating Activity in a Modified Park study. The neighborhood perceptions (social and physical environment), children’s age, physical activity, outside time, and screen time were parent-reported. The SEP was derived from the Index of Relative Socio-economic Advantage and Disadvantage. Multiple linear and logistic regressions were performed with age and SEP interactions. Results: Favorable perceptions of opportunities to be active and exercise were associated with a higher likelihood of meeting physical activity guidelines. Favorable perceptions of neighborhood ease for walking and a larger social network were also associated with more outdoor time. Moderation analyses revealed that favorable perceptions of several physical and social neighborhood environment features were associated with a higher likelihood of meeting physical activity guidelines in the high-SEP group and were negatively associated with preschoolers’ weekday screen time. Conclusion: Future neighborhood environment initiatives and interventions aiming to promote active living communities should consider differences in age and SEP.

Background: Relationships between several built environment factors and physical activity and walking behavior are well established, but internationally-comparable built environment measures are lacking. The Microscale Audit of Pedestrian Streetscapes (MAPS)-Global is an observational measure of detailed streetscape features relevant to physical activity that was developed for international use. This study examined the inter-observer reliability of the instrument in five countries. Methods: MAPS-Global was developed by compiling concepts and items from eight environmental measures relevant to walking and bicycling. Inter-rater reliability data were collected in neighborhoods selected to vary on geographic information system (GIS)-derived macro-level walkability in five countries (Australia, Belgium, Brazil, Hong Kong-China, and Spain). MAPS-Global assessments (n = 325) were completed in person along a = 0.25 mile route from a residence toward a non-residential destination, and a commercial block was also rated for each residence (n = 82). Two raters in each country rated each route independently. A tiered scoring system was created that summarized items at multiple levels of aggregation, and positive and negative valence scores were created based on the expected effect on physical activity. The intraclass correlation coefficient (ICC) was computed for scales and selected items using one-way random models. Results: Overall, 86.6% of individual items and single item indicators showed excellent agreement (ICC >= 0.75), and 13.4% showed good agreement (ICC = 0.60-0.74). All subscales and overall summary scores showed excellent agreement. Six of 123 items were too rare to compute the ICC. The median ICC for items and scales was 0.92 with a range of 0.50-1.0. Aesthetics and social characteristics showed lower ICCs than other sub-scales, but reliabilities were still in the excellent range (ICC >= 0.75). Conclusion: Evaluation of inter-observer reliability of MAPS-Global across five countries indicated all items and scales had "good" or "excellent" reliability. The results demonstrate that trained observers from multiple countries were able to reliably conduct observations of both residential and commercial areas with the new MAPS-Global instrument. Next steps are to evaluate construct validity in relation to physical activity in multiple countries and gain experience with using MAPS-Global for research and practice applications.

This study examined how children's physical activity levels during recess and lunchtime and the contribution of recess and lunchtime to daily physical activity differed across seasons. Three hundred and twenty-six children aged 8-11years from Australia participated. Physical activity was measured every 15-seconds using hip-mounted ActiGraph accelerometers for 7 consecutive days during the winter (n=246), spring (n=211), summer (n=161) and autumn terms (n=139). Data were collected 2012-2013. Time spent in light- (LPA) moderate- (MPA), vigorous- (VPA), and moderate- to vigorous-intensity physical activity (MVPA) during recess and lunchtime were calculated. Longitudinal data were analysed using multilevel analyses and adjusted for potential confounders. The results showed that compared to winter, children engaged in significantly less MVPA and VPA in spring and summer during lunchtime (p

Refereed/Peer-reviewed Little is known about whether physical activity compensation occurs and, if so, what are potential moderators of such responses. This study examined whether children's physical activity, sedentary time and energy expenditure on one day was associated with these behaviours the following day, and what factors may moderate observed associations. One hundred and twenty-seven children (8-11 years) wore an ActiGraph accelerometer for eight days. Time spent in sedentary time and physical activity was obtained. Daily energy expenditure was also assessed using a SenseWear Armband (n=98). Moderators examined were sex, age, BMI, fitness, and fundamental movement skills (FMS). Multilevel analyses were conducted using generalized mixed models. On any given day, every additional 10 minutes spent in moderate-to-vigorous physical activity (MVPA) was associated with 9.3 minutes less MVPA the following day. Every additional 10kcal expended on one day was associated with 2.9 fewer kcal expended the following day. Additional time spent sedentary on any given day was associated with less light physical activity the following day in children with lower FMS. The results are largely consistent with the compensation hypothesis, with children appearing to compensate their activity between days. Strategies to minimise potential compensatory changes may be needed for children overall rather than for specific population sub-groups. usc

Background:Little is known about the associations of preschoolers’ health behaviors with their later psychosocial wellbeing. This study investigates the association of 3- to 5-year-old children’s physical activity and electronic media use with their later social-emotional skills (6-8 years).Methods:Data were collected in 2008–2009 and 2011–2012 for the Healthy Active Preschool and Primary Years (HAPPY) Study in metropolitan Melbourne. Participants were a random subsample (n = 108) of the 567 children at follow-up. Physical activity was objectively measured using ActiGraph GT1M accelerometers; electronic media use (television viewing, sedentary electronic games and active electronic games) was parent proxy-reported. Social and emotional skills were child-reported using the Bar-On Emotional Quotient Inventory—Youth Version. Regression analyses controlled for sex, clustering by center of recruitment, and accelerometer wear time (for physical activity analyses).Results:Sedentary electronic games were positively associated with intrapersonal and stress management skills and total emotional quotient. Computer/internet use was inversely associated with interpersonal, and positively associated with stress management, skills.Conclusions:Findings suggest that physical activity is not associated with children’s psychosocial health while some types of electronic media use are. Future research should investigate the contexts in which preschoolers participate in these behaviors and potential causal mechanisms of associations.

Refereed/Peer-reviewed The directionality of the relationship between children's physical activity and sleep is unclear. This study examined the temporal and bidirectional associations between objectively measured physical activity, energy expenditure, and sleep in primary school-aged children. A subgroup of children (n = 65, aged 8-11 years) from the Fitness, Activity and Skills Testing Study conducted in Melbourne, Australia, had their sleep and physical activity assessed using the SenseWear Pro Armband for 8 consecutive days. Outcome measures included time spent in light-intensity physical activiy (LPA), moderate-to vigorousintensity physical activity (MVPA), activity energy expenditure (AEE), time in bed, total sleep time, and sleep efficiency. Multilevel analyses were conducted using generalized linear latent mixed models to determine whether physical activity on 1 day was associated with sleep outcomes that night, and whether sleep during 1 night was associated with physical activity the following day. No significant associations were observed between time in bed, total sleep time, and sleep efficiency with LPA, MVPA, and AEE in either direction. This study found no temporal or bidirectional associations between objectively measured physical activity, AEE, and sleep. Future research is needed to understand other sleep dimensions that may impact on or be influenced by physical activity to provide potential intervention targets to improve these outcomes. usc

Objective: Little is known about how the physical environment impacts physical activity behaviour among rural populations, who are typically less active and at higher risk of chronic disease than urban dwellers. The lack of individual-level instruments to assess the physical environment in rural areas limits advancement of this field. Among rural adults, this study aimed to evaluate (a) the test-retest reliability of a self-reported questionnaire of individual-level perceptions of the physical activity environment, and (b) the stability of a self-reported physical activity questionnaire. Design: Cross-sectional questionnaire repeated twice, 2 weeks apart. The questionnaire included 94 items relating to the perceived physical environment (representing nine summary scores), demographic characteristics and physical activity. Setting: Rural Australia. Participants: Rurally residing adults (≥18 years) across three Australian states.Main outcome measures: Test-retest reliability evaluated by weighted Kappa statistics(individual items) and intra-class correlations (summary scores). Results: A total of 292 participants (20% men) completed both questionnaires, on average22 days apart. Test-retest reliability of individual items ranged from weighted Kappa 0.37-0.85 (median: 0.59). Internal reliability for five summary scores was good to excellent (Cronbach's alpha: 0.81-0.97). Test-retest reliability was good to excellent for six summary scores (intra-class correlations: 0.67-0.77). Conclusions: The findings indicated good to excellent test-retest reliability for most items, particularly “fixed” constructs for this new questionnaire measuring the perceived physical environment in rural populations. This study represents an important step towards improving measurement of physical activity environments in rural populations, potentially leading to better tailored interventions to promote active and healthy living in rural areas. Refereed/Peer-reviewed

BackgroundGlobally, many children fail to meet the World Health Organization’s physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings.MethodsThe review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents; (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results; and (iv) interventions delivered under real-world conditions. Exclusion criteria: (i) efficacy trials; (ii) studies applying or testing school-based physical activity policies, and; (iii) studies targeting special schools or pre-school and/or kindergarten aged children.Results27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers’ Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results (n = 9), for planning evaluation and interpreting results (n = 8), for planning evaluation (n = 6), for intervention design (n = 4), or for a combination of designing the intervention and interpreting results (n = 3). We identified 269 factors related to barriers (n = 93) and facilitators (n = 176) for the adoption (n = 7 studies), implementation (n = 14 studies) and sustainability (n = 7 studies) of interventions.ConclusionsImplementation model use was predominately centered on the interpretation of results and analyses, with few examples of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale.Trial registrationPROSPERO (CRD42018099836).

Background Clusters of adolescents differentiated by patterns of physical activity and sedentary behavior (activity-related typologies) are common. Understanding both the characteristics of adolescents and modifiable correlates of these typologies, can help to develop interventions for those most at risk. This systematic review aimed to synthesize the socio-demographic characteristics and modifiable correlates of activity-related behavioral typologies among adolescents. Methods A systematic search of seven electronic databases was conducted to identify quantitative studies using person-oriented statistical approaches to identify activity-related behavioral typologies among 12–18 year-olds. This systematic review was registered in Prospero (registration number: CRD42016046879). Results Thirty-six studies met the inclusion criteria and were classified according to three sub-themes based on behaviors included in the typologies (1. physical activity and sedentary behavior only; 2. physical activity, sedentary behavior and risk-related behaviors; 3. physical activity, sedentary behavior and diet). Studies were mostly cross-sectional and relied on self-report measures. Methods were considerably heterogeneous, however results revealed some consistency in typologies within specific groups. For example, typologies characterized by unhealthy behavior patterns (e.g., characterized by physical inactivity, high sedentary behavior and poor diet or high risk-related behaviors) comprised more older adolescents. With the exception of socio-demographics (age, sex, body mass index and socio-economic status), very few correlates have been studied to date (mostly school-related behavioral factors and intrapersonal influences), with evidence largely from typologies comprised of physical activity, sedentary behavior and diet. Conclusions More research is needed to assess a range of modifiable correlates associated with activity-related behavior typologies among adolescents. This will allow for more targeted interventions, to achieve long-lasting, positive behavior change in adolescent populations. Electronic supplementary material The online version of this article (10.1186/s12966-019-0804-7) contains supplementary material, which is available to authorized users.

Background Active breaks in the classroom have been shown to be effective for increasing children’s physical activity, while simultaneously improving classroom behaviour outcomes. However, there is limited evidence on the feasibility and fidelity of these programs outside of the research context. The purpose of this study was to conduct a process evaluation to explore factors associated with feasibility and fidelity of a classroom active break (ACTI-BREAK) program designed to improve classroom behaviour and physical activity outcomes for children in primary (elementary) school Years 3 and 4. Methods Six schools (3 intervention; 3 control) and 374 children (74% response) were included in the ACTI-BREAK pilot cluster randomised controlled trial. The intervention involved teachers implementing 3 × 5-minute moderate-intensity ACTI-BREAKS into their classroom routines, daily. This study focuses on the responses of students (n = 138) and their teachers (n = 7) who participated in the ACTI-BREAK intervention group. Intervention fidelity was assessed by number of ACTI-BREAKS completed per class per day; minutes spent in moderate-intensity physical activity (accelerometry) per ACTI-BREAK; change in physical activity from baseline to mid- and end- intervention. Intervention feasibility was explored through telephone interviews (teachers), questionnaires and focus groups (students), and teacher observations of acute effects on classroom behaviour. Qualitative data were analysed using thematic analyses; acute effects on classroom behaviour and change in physical activity were explored using paired t-tests; questionnaire data were described as frequencies. Results Teachers implemented two ACTI-BREAKS/day on average, mostly of light-intensity physical activity. Physical activity increased from baseline to mid-, but not baseline to end-intervention; classroom behaviour improved immediately following ACTI-BREAKS. Barriers to implementation included ability for students to return to task and scheduling. Facilitators included ease of implementation, flexible delivery options and student enjoyment. Students were largely satisfied with the program and enjoyed ACTI-BREAKS that incorporated choice, imagination and challenge but did not enjoy ACTI-BREAKS that evoked silliness or were perceived as too difficult and some did not like doing ACTI-BREAKS in the confined space of their classroom. Conclusions Results indicated the ACTI-BREAK program was acceptable for students and feasible for teachers, however, some minor modifications in terms of required frequency and intensity could improve fidelity. Trial registration Australia New Zealand Clinical Trials Registry (ACTRN12617000602325). Retrospectively registered on 27 April 2017.

peer-reviewed Background: Students engage in risky health-related behaviours that influence their current and future health status. Health-related behaviours cluster among adults and differently based on sub-populations characteristics but research is lacking for university populations. Examining the clustering of health- related behaviours can inform our initiatives and strategies, while examining cluster members’ characteristics can help target those who can prosper most from health promotion efforts. This study examines the clustering of health-related behaviours in Irish university students, and investigates the relationship with students’ sex, age, field of study and accommodation type. Methods: An online survey was completed by 5672 Irish university students (51.3% male; 21.60 ± 5.65 years) during 2014. Two-step cluster analysis was used to understand how health-related behaviours (physical activity, smoking, alcohol intake, drug use and dietary habits) cluster among male and female students. Binary logistic regressions were conducted to examine the likelihood of students falling into certain clusters based on their characteristics. Results: Five cluster groups were identified in males and four in females. A quarter of males were categorised as ideal healthy with older students and those from certain fields of study having a higher likelihood of being classified in a low physical activity and poor diet (OR = 1.06–2.89), alcohol consumption (OR = 1.03–3.04), or smoking and drug use (OR = 1.06–2.73) cluster. Forty-five percent of females were categorised as ideal healthy with older females more likely to be in a low active and smoking cluster (OR = 1.03), and less likely to be in a convenience food cluster (OR = 0.96). Females from certain fields of study were also more likely to be classified in these clusters (OR = 1.59–1.76). Students living away from their family home had in increased likelihood of being in a cluster related to a higher frequency of alcohol consumption (OR = 1.72–3.05). Conclusion: Health-related behaviours cluster among this population and need to be taken into account when designing multi-health interventions and policies. These findings can be used to target student groups at risk, leading to more efficient and successful health promotion efforts. The addition of modules providing information regarding health-related behaviours are advised in all fields of study. PUBLISHED peer-reviewed

Background Adolescents engage in various combinations (typologies) of physical activity and sedentary behaviors, which impact their health and wellbeing in different ways. As such, there is a need to understand the factors that may inhibit or facilitate engagement in combinations of activity-related behaviors to help inform effective intervention strategies targeting those most in need. The aim of this study was to identify ecological correlates of adolescent physical activity and sedentary behavior typologies. Methods Cross-sectional study of 473 adolescents (15.0 ± 1.6 years, 41.4% boys) from 18 secondary schools in Melbourne, Australia. Intrapersonal, interpersonal and neighborhood-physical environmental factors were assessed via self-report surveys and Geographic Information Systems. Multinomial logistic regression models determined the relative risk ratio of membership of three homogenous activity-related behavior typologies based on the potential correlates. Results Higher levels of self-efficacy for physical activity, parental screen-time restriction rules, parental support for physical activity, sibling screen-time co-participation and perceptions of neighborhood pedestrian/traffic safety were associated with greater likelihood of adolescents being in the typology defined as highly active and low sedentary compared to the physically inactive, highly sedentary typology. Higher frequency of co-participation in screen-time with friends was associated with greater likelihood of adolescents being in the typology defined as moderately active, high screen-time compared to physically inactive, highly sedentary. Conclusions A range of intrapersonal, interpersonal and environmental correlates appear to play a role in adolescent activity-related typology membership. The findings may inform public health interventions targeting unique adolescent subgroups most at risk of poor health outcomes based on their engagement in combinations of activity-related behaviors. Electronic supplementary material The online version of this article (10.1186/s12889-019-7386-9) contains supplementary material, which is available to authorized users.

Objectives To describe cycling behaviours and examine individual, social and neighbourhood correlates of cycling among children living in socio-economically disadvantaged neighbourhoods. Design Cross-sectional. Methods Mothers of 289 children (46% boys) aged 8–15 (mean 12 ± 2.2) years living in disadvantaged neighbourhoods in Victoria, Australia were surveyed about their child’s cycling frequency and duration in a typical week. Perceptions of cycling, cycling ability, cycling behaviours and road safety were proxy- and self-reported by mothers. Shortest road distance from home to school was determined using a Geographic Information System. Multivariable logistic regression analyses examined associations between individual, social and neighbourhood variables and cycling frequency ( > once/week) and duration ( > 60 min/week). Results Overall, 70% of boys and 49% of girls cycled > once/week; rates of cycling for > 60 min/week were 60% and 32%, respectively. Children had greater odds of cycling > once/week if they enjoyed cycling for fun (OR = 13.3, 95%CI = 2.0, 86.9). Children had greater odds of cycling for > 60 min/week if they enjoyed cycling for fun (OR = 17.1, 95%CI = 1.7, 167.7) or if they were allowed to cycle on main roads (OR = 3.2, 95%CI = 1.1, 9.1). Children who had to cross several roads to access play areas had lower odds of cycling for > 60 min/week (OR = 0.3, 95%CI = 0.1, 0.7). Conclusions Future research should investigate strategies to increase children’s enjoyment of cycling, independent mobility and safe access by cycling to key destinations such as play areas.

Background:Parental modeling has been shown to be important for school-aged children’s physical activity (PA) and television (TV) viewing, yet little is known about its impact for younger children. This study examined cross-sectional and 3-year longitudinal associations between PA and TV viewing behaviors of parents and their preschool children.Methods:In 2008–2009 (T1), parents in the Healthy Active Preschool and Primary Years (HAPPY) cohort study (n = 450) in Melbourne, Australia, self-reported their weekly PA and TV viewing and proxy-reported their partner’s PA and TV viewing and their 3- to 5-year-old preschool child’s TV viewing. Children’s PA was assessed via accelerometers. Repeat data collection occurred in 2011–2012 (T2).Results:Mothers’ and fathers’ PAs were associated with PA among preschool girls at T1, but not boys. Parents’ TV viewing times were significant correlates of girls’ and boys’ TV viewing at T1. Longitudinally, mothers’ PA at baseline predicted boys’ PA at T2, whereas sex-specific associations were found for TV viewing, with mothers’ and fathers’ TV viewing at T1 associated with girls’ and boys’ TV viewing respectively at T2.Conclusions:The PA and TV viewing of both parents are significantly associated with these behaviors in preschool children. The influence of the sex-matched parent appears to be important longitudinally for children’s TV viewing.

Limited longitudinal evidence of the predictors of physical activity (PA) patterns over time exists, particularly among high-risk groups such as women living in socioeconomically disadvantaged areas. This study aimed to: 1) describe leisure-time PA (LTPA) and transport-related PA (TRPA) patterns over time; and 2) identify individual, social and physical environmental predictors of LTPA and TRPA patterns over five years. Baseline (2007–08) data were collected and analysed (2016–18) from n = 4349 women (18–46 years) from disadvantaged areas of Victoria, Australia. Three- and five-year follow-up data were collected in 2010–11 (n = 1912) and 2012 (n = 1560). LTPA and TRPA were self-reported using the International Physical Activity Questionnaire, and patterns categorised as consistently low, persistently increasing, persistently decreasing, or inconsistent. Compared to a consistently low LTPA pattern, greater family support predicted both persistent decreases (odds ratio [OR] 1.20, 95% CI 1.05–1.36) and persistent increases (OR 1.17, 95% CI 1.04–1.32) in LTPA, while access to childcare predicted inconsistent LTPA patterns (OR 1.66, 95% CI 1.03–2.65). For both LTPA and TRPA, PA enjoyment predicted persistent increases (LTPA: OR 1.05, 95% CI 1.02–1.10; TRPA: OR 1.03, 95% CI 1.00–1.07), persistent decreases (LTPA: OR 1.04, 95% CI 1.00–1.08; TRPA OR 1.04, 95% CI 0.99–1.08), and inconsistent patterns (LTPA: OR 1.04, 95% CI 1.02–1.07; TRPA: OR 1.03, 95% CI 1.01–1.06). Although directionality was inconsistent, and the magnitude of effects were small, PA enjoyment, family social support for PA and access to childcare warrant further investigation and consideration as potentially key factors impacting PA patterns among women living in socioeconomically disadvantaged areas.

Without accurate awareness of features within the built environment, the availability of a supportive built environment alone may not be sufficient to influence physical activity levels. We examined the moderating effects of concordance/discordance between selected objective and perceived built environment features in the relationship between objective built environment features and physical activity. Cross-sectional data from 465 youth aged 12–20 years from 18 schools in Melbourne, Australia were used. The relationship between trails and physical activity differed by concordance/discordance. There were positive relationships among those with concordant perceptions, but no significant differences for those with discordant perceptions. At least for trails, environmental interventions designed to enhance physical activity may be less effective if efforts are not made to enhance individuals’ awareness of their environment.