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Background: Countries in the Middle East have some of the lowest rates of physical activity and some of the highest rates of obesity in the world. Policies can influence population levels of physical activity. However, there is a dearth of research on physical activity policies in the Gulf region. This qualitative study analyses cross-sectoral barriers and facilitators for the development, implementation and evaluation of physical activity policies in Saudi Arabia and Oman, two of the largest countries in the region., Methods: Semi-structured interviews were conducted with 19 senior policymakers from the Ministries of Health, Education, and Sport in Saudi Arabia and Oman, and were examined using thematic analysis., Results: We identified seven themes related to physical activity policies in Saudi Arabia and Oman: leadership; existing policies; physical activity programs related to policies; private sector policies; challenges; data/monitoring; and future opportunities. Both countries have a central document that guides policy-makers in promoting physical activity, and the available policies in both countries are implemented via multiple programs and initiatives to increase physical activity. Compared with Oman, in Saudi Arabia, programs from the non-profit sector, represented by community groups, play a more significant role in promoting physical activity outside the government framework. The private sector has contributed to promoting physical activity in both countries, but interviewees stated that more financial support is required. Policy limitations differ between Saudi Arabia and Oman: intersectoral collaboration in Oman is limited and mainly based on individuals' own initiative, while the health transformation in Saudi Arabia tends to slow down policy implementation in relevant areas. Physical education in Saudi Arabia and Oman is similar; however, increased support and collaboration between government agencies and the private sector for out-of-school sports academies are needed., Conclusions: This study addresses key gaps in analysing physical activity policies in Gulf Cooperation Council countries. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Our insights assist policy-makers, public health officials and stakeholders in shaping effective physical activity-promoting policies, programs and interventions to prevent non-communicable diseases. Challenges identified in Saudi Arabia and Oman's policies will inform their future development., (© 2024. The Author(s).)

Competing Interests: DD reports funding from the National Health and Medical Research Council, New South Wales Health, and the Ian Potter Foundation. DS reports funding from the US National Institutes of Health and the Forest Park Foundation, royalties from Human Kinetics, consulting fees from the National Institute of Public Health of Mexico and Washington University in St Louis, lecture honoraria from Washington University in St Louis, and travel support from the National Institute of Public Health, Mexico. All other authors declare no competing interests.

Competing Interests: Competing interests: None declared.

Despite the widely publicized health benefits of physical activity, a large proportion of the world's population is insufficiently active or completely inactive. The 2018 edition of the Physical Activity Guidelines for Americans (PAGA18) was a mammoth feat that took over 2 years to complete and resulted in a 779-page report in early 2018, followed by the publication of the summary guidelines in the Journal of the American Medical Association . In this Viewpoint, the authors (1) summarize the key components of the PAGA18 with respect to adults, and (2) discuss the implications for the general public and health care practitioners. J Orthop Sports Phys Ther 2019;49(7):487-490. doi:10.2519/jospt.2019.0609 .

Background: There is limited evidence on the directionality of the associations of sitting time with physical function. This study examined the longitudinal associations of sitting time with changes in physical function, and physical function with changes in sitting time., Methos: Data from 10,027 retirees in the Social, Economic, and Environmental Factor (SEEF) population-based cohort were collected in 2006-20008 and in 2010-2011. Daily sitting time was assessed by a single-item question. Physical function was measured with the Medical Outcomes Study Physical Functioning Scale (range 0-100) with participants categorized as: no; minor; moderate; or severe limitation. General linear regression models, adjusted for covariates, were used to assess associations of sitting time with physical function for all participants and in subgroups according to sex, and categories of body mass index, physical activity, and physical function limitations., Results: Each hour of baseline sitting was associated with declines in physical function for women (0.20 units [95% confidence interval {CI} 0.04-0.37]) and those with severe functional limitations (0.65 units [95% CI 0.20-1.12]). Each unit of baseline physical function was associated with declines in sitting time for all participants (0.009 hours/day [95% CI 0.005-0.013]) and for all subgroups., Conclusions: There was limited evidence of a bidirectional association of sitting time with physical function except in women and people with severe functional limitations. Health promotion efforts are needed to address the impact of poor physical function on increases in sitting time which result in further functional declines for these subgroups of the population.

Objective: To synthesise the literature on the effects of neighbourhood environmental change through residential relocation on physical activity, walking and travel behaviour., Design: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42017077681)., Data Sources: Electronic databases for peer-reviewed and grey literature were systematically searched to March 2017, followed by forward and backward citation tracking., Eligibility Criteria: A study was eligible for inclusion if it (1) measured changes in neighbourhood built environment attributes as a result of residential relocation (either prospectively or retrospectively); (2) included a measure of physical activity, walking, cycling or travel modal change as an outcome; (3) was quantitative and (4) included an English abstract or summary., Results: A total of 23 studies was included in the review. Among the eight retrospective longitudinal studies, there was good evidence for the relationship between relocation and walking (consistency score (CS)>90%). For the 15 prospective longitudinal studies, the evidence for the effects of environmental change/relocation on physical activity or walking was weak to moderate (CS mostly <45%), even weaker for effects on other outcomes, including physical activity, cycling, public transport use and driving. Results from risk of bias analyses support the robustness of the findings., Conclusion: The results are encouraging for the retrospective longitudinal relocation studies, but weaker evidence exists for the methodologically stronger prospective longitudinal relocation studies. The evidence base is currently limited, and continued longitudinal research should extend the plethora of cross-sectional studies to build higher-quality evidence., Competing Interests: Competing interests: DD is supported by an Australian Heart Foundation Future Leader Fellowship. BN is supported through an Australian Postgraduate Award and a University of Sydney Merit Award., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Aboriginal and Torres Strait Islander people have higher rates of chronic disease and a lower life expectancy than non-Indigenous Australians. In non-urban areas these health disparities are even larger. The aim of this qualitative study was to explore perceived barriers and enablers to attending an eight-week physical activity program in a rural and regional setting which aimed to improve health outcomes, but had a low attendance rate., Methods: Thirty-four Indigenous Australians participated in the intervention from the rural (n = 12) and the regional (n = 22) community. Qualitative semi-structured individual interviews were conducted at the follow-up health assessments with 12 participants. A thematic network analysis was undertaken to examine the barriers and enablers to participation in the program., Results: Overall, there were positive attitudes to, and high levels of motivation towards, the physical activity program. Enablers to participation were the inclusion of family members, no financial cost and a good relationship with the principal investigator, which was strengthened by the community-based participatory approach to the program design. Barriers to program attendance were mostly beyond the control of the individuals, such as 'sorry business', needing to travel away from the community and lack of community infrastructure., Conclusions: More consideration is needed prior to implementation of programs to understand how community-specific barriers and enablers will affect attendance to the program., Trial Registration: ACTRN12616000497404 . Registered 18 April 2016.

Background: Indigenous Australians and New Zealanders have a significantly shorter life expectancy than non-Indigenous people, mainly due to differences in prevalence of chronic diseases. Physical activity helps in the prevention and management of chronic diseases, however, activity levels are lower in Indigenous than in non-Indigenous people., Objective: To synthesise the literature on the effects of physical activity interventions for Indigenous people in Australia and New Zealand on activity levels and health outcomes., Methods: The Cochrane Library, MEDLINE, SPORTSDiscus and PsycINFO were searched for peer-reviewed articles and grey literature was searched. Interventions targeted Indigenous people in Australia or New Zealand aged 18+ years and their primary or secondary aim was to increase activity levels. Data were extracted by one author and verified by another. Risk of bias was assessed independently by two authors. Data were synthesised narratively., Results: 407 records were screened and 13 studies included. Interventions included individual and group based exercise programs and community lifestyle interventions of four weeks to two years. Six studies assessed physical activity via subjective (n = 4) or objective (n = 2) measures, with significant improvements in one study. Weight and BMI were assessed in all but one study, with significant reductions reported in seven of 12 studies. All five studies that used fitness tests reported improvements, as did four out of eight measuring blood pressure and seven out of nine in clinical markers., Conclusions: There was no clear evidence for an effect of physical activity interventions on activity levels, however, there were positive effects on activity related fitness and health outcomes., Trial Registration: The review protocol was registered with PROSPERO (registration number: CRD42015016915 ).

Objectives: To examine the validity and reliability of the Fitbit Flex against direct observation for measuring steps in the laboratory and against the Actigraph for step counts in free-living conditions and for moderate-to-vigorous physical activity (MVPA) and activity energy expenditure (AEE) overall., Methods: Twenty-five adults (12 females, 13 males) wore a Fitbit Flex and an Actigraph GT3X+ during a laboratory based protocol (including walking, incline walking, running and stepping) and free-living conditions during a single day period to examine measurement of steps, AEE and MVPA. Twenty-four of the participants attended a second session using the same protocol., Results: Intraclass correlations (ICC) for test-retest reliability of the Fitbit Flex were strong for walking (ICC = 0.57), moderate for stair stepping (ICC = 0.34), and weak for incline walking (ICC = 0.22) and jogging (ICC = 0.26). The Fitbit significantly undercounted walking steps in the laboratory (absolute proportional difference: 21.2%, 95%CI 13.0-29.4%), but it was more accurate, despite slightly over counting, for both jogging (6.4%, 95%CI 3.7-9.0%) and stair stepping (15.5%, 95%CI 10.1-20.9%). The Fitbit had higher coefficients of variation (Cv) for step counts compared to direct observation and the Actigraph. In free-living conditions, the average MVPA minutes were lower in the Fitbit (35.4 minutes) compared to the Actigraph (54.6 minutes), but AEE was greater from the Fitbit (808.1 calories) versus the Actigraph (538.9 calories). The coefficients of variation were similar for AEE for the Actigraph (Cv = 36.0) and Fitbit (Cv = 35.0), but lower in the Actigraph (Cv = 25.5) for MVPA against the Fitbit (Cv = 32.7)., Conclusion: The Fitbit Flex has moderate validity for measuring physical activity relative to direct observation and the Actigraph. Test-rest reliability of the Fitbit was dependant on activity type and had greater variation between sessions compared to the Actigraph. Physical activity surveillance studies using the Fitbit Flex should consider the potential effect of measurement reactivity and undercounting of steps., Competing Interests: The authors have declared that no competing interests exist.

Importance: Few studies have examined how different proportions of moderate and vigorous physical activity affect health outcomes., Objective: To examine whether the proportion of total moderate to vigorous activity (MVPA) that is achieved through vigorous activity is associated with all-cause mortality independently of the total amount of MVPA., Design, Setting, and Participants: We performed a prospective cohort study with activity data linked to all-cause mortality data from February 1, 2006, through June 15, 2014, in 204,542 adults aged 45 through 75 years from the 45 and Up population-based cohort study from New South Wales, Australia (mean [SD] follow-up, 6.52 [1.23] years). Associations between different contributions of vigorous activity to total MVPA and mortality were examined using Cox proportional hazards models, adjusted for total MVPA and sociodemographic and health covariates., Exposures: Different proportions of total MVPA as vigorous activity. Physical activity was measured with the Active Australia Survey., Main Outcomes and Measures: All-cause mortality during the follow-up period., Results: During 1,444,927 person-years of follow-up, 7435 deaths were registered. Compared with those who reported no MVPA (crude death rate, 8.34%), the adjusted hazard ratios for all-cause mortality were 0.66 (95% CI, 0.61-0.71; crude death rate, 4.81%), 0.53 (95% CI, 0.48-0.57; crude death rate, 3.17%), and 0.46 (95% CI, 0.43-0.49; crude death rate, 2.64%) for reporting 10 through 149, 150 through 299, and 300 min/wk or more of activity, respectively. Among those who reported any MVPA, the proportion of vigorous activity revealed an inverse dose-response relationship with all-cause mortality: compared with those reporting no vigorous activity (crude death rate, 3.84%) the fully adjusted hazard ratio was 0.91 (95% CI, 0.84-0.98; crude death rate, 2.35%) in those who reported some vigorous activity (but <30% of total activity) and 0.87 (95% CI, 0.81-0.93; crude death rate, 2.08%) among those who reported 30% or more of activity as vigorous. These associations were consistent in men and women, across categories of body mass index and volume of MVPA, and in those with and without existing cardiovascular disease or diabetes mellitus., Conclusions and Relevance: Among people reporting any activity, there was an inverse dose-response relationship between proportion of vigorous activity and mortality. Our findings suggest that vigorous activities should be endorsed in clinical and public health activity guidelines to maximize the population benefits of physical activity.

Over the last decade, there has been a marked increase in studies about built environments and physical activity. As the number of publications is growing rapidly, literature reviews play an important role in identifying primary studies and in synthesizing their findings. However, many of the reviews of effectiveness in this field demonstrate methodological limitations that might lead to inaccurate portrayals of the evidence. Some literature reviews a priori excluded intervention studies even though they provide the strongest level of evidence. The label 'systematic review' has mostly been used inappropriately. One of the major criteria of a systematic review that is hardly ever met is that the quality of the primary studies needs to be assessed and this should be reflected in the synthesis, presentation and interpretation of results. With few exceptions, 'systematic' reviews about environments and physical activity did not refer to or follow the QUORUM or PRISMA statements. This commentary points out the usefulness of the PRISMA statement to standardize the reporting of methodology of reviews and provides additional guidance to limit sources of bias in them. The findings and recommendations from this article can help in moving forward the synthesis of evidence of effectiveness not only in built environments and physical activity, but also more broadly in exercise science and public health.

To reverse the global epidemic of physical inactivity that is responsible for more than 5 million deaths per year, many groups recommend creating "activity-friendly environments." Such environments may have other benefits, beyond facilitating physical activity, but these potential co-benefits have not been well described. The purpose of the present paper is to explore a wide range of literature and conduct an initial summary of evidence on co-benefits of activity-friendly environments. An extensive but non-systematic review of scientific and "gray" literature was conducted. Five physical activity settings were defined: parks/open space/trails, urban design, transportation, schools, and workplaces/buildings. Several evidence-based activity-friendly features were identified for each setting. Six potential outcomes/co-benefits were searched: physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. A total of 418 higher-quality findings were summarized. The overall summary indicated 22 of 30 setting by outcome combinations showed "strong" evidence of co-benefits. Each setting had strong evidence of at least three co-benefits, with only one occurrence of a net negative effect. All settings showed the potential to contribute to environmental sustainability and economic benefits. Specific environmental features with the strongest evidence of multiple co-benefits were park proximity, mixed land use, trees/greenery, accessibility and street connectivity, building design, and workplace physical activity policies/programs. The exploration revealed substantial evidence that designing community environments that make physical activity attractive and convenient is likely to produce additional important benefits. The extent of the evidence justifies systematic reviews and additional research to fill gaps.

Abstract: We examined prospectively whether persons who perceive their objectively measured high walkable environment as low walkable decrease their walking more and gain more weight than those with matched perceptions. Walkability was measured objectively using GIS. Corresponding perceptions were collected using the Neighborhood Environment Walkability Scale from 1027 urban Australian adults. Objective and perceived measures were dichotomized and categories of match and mismatch were created. Overall, walking levels decreased and BMI increased significantly over the four year follow-up period. Those who perceived high walkability, dwelling density or land use mix as low decreased their walking for transport significantly more than those with matched perceptions. Those who perceived high walkability, land use mix or retail density as low increased their BMI significantly more than those with concordant perceptions. These prospective findings corroborate recommendations from previous cross-sectional studies. Interventions to improve negative perceptions of walkability among those living in high walkable areas may be a relevant public health intervention to increase physical activity and support weight maintenance. [Copyright &y& Elsevier]