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

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

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

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

Background Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This manuscript outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs. Methods A 5-step process was undertaken by an international project team: (1) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (2) a thematic analysis to categorize items, (3) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (4) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (5) audit tool finalization though project team consensus. Results Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with three broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation & Dissemination; Evaluation & Measurement methods; Sub-national level policies; Funding & Coordination; Participative approach; Actors & Stakeholders; National sporting events; Case studies and Implicated stakeholders. Conclusions To progress HP in the sports club context it is necessary to understand existing national level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

TYKEs Elintapavalmennus -toimintamallilla haetaan pysyviä ratkaisumalleja työhyvinvoinnin kehittämiseksi ja työssä eläkeikään saakka jaksamisen tukemiseksi elintapoja muuttamalla. Toimintamallin tarve ja merkitys on hyvin tunnistettu ja perusteltu niin terveyden ja hyvinvoinnin kuin kansantalouden näkökulmasta. Toimintamallin tämänhetkinen kuvaus on johdonmukainen ja sen sovellettavuus Suomeen hyvä. Toimintamallin kehityshanke on vielä kesken, joten toimintamallin vaikuttavuudesta ja kustannusvaikuttavuudesta ei ole vielä kertynyt riittävää näyttöä. Alustavat tulokset ovat kuitenkin lupaavia. Kokemus- ja asiantuntijatiedon rinnalle tarvitaan tieteellistä tutkimusta toimintamallin vaikuttavuudesta. Myös toimintasuunnitelma kunnan sitouttamiseksi toimintamallin käyttöönottoon ja juurruttamiseen osaksi pysyvää toimintaa vaatii kehittämistä.

The share of the elderly population is increasing globally, and it is important to help them to maintain their physical activity levels and ability to function to as late an age as possible. This qualitative intervention study focused on the experiences of young elderly on the ability of a sport and wellness technology digital coach to motivate them towards physical activity as well as on what needs and wishes this group has concerning digital coaching solutions. The findings of the study show that young elderly perceive digital coaching as potential in motivating them towards physical activity by providing instructive information and motivational feedback. It was also perceived to have positive influence on their exercise self-efficacy. However, it was also apparent that digital coaching devices should be tailored for this target group and be easy to learn in order to attract interest among them. Our findings provide insights for professionals and companies in sport technology field as well as to health professionals working in health promotion with young elderly people. Overall, this research aims to address social and economical sustainability of elderly people and their physical activity. peerReviewed

Sedentary lifestyles and the lack of physical activity (PA) are a major concern among all age groups, and current generations tend to be less fit than the previous ones in the Western World. At the same time, there is an urgent need to cut transport-related carbon dioxide (CO2) emissions. Major gains can be foreseen if current car-centred lifestyles and sedentary behaviour are addressed from an integrated perspective. In this study, we explore future scenarios in the intersections of PA and active lifestyles as well as related environmental and health benefits in Finland. We used a disaggregative Delphi approach to examine the topic. Although frequently used in health-related research, Delphi has rarely been used in exploring alternative futures or non-consensus. The study design was based on a mixed-methods approach where we combined both qualitative and quantitative data analysis. Building on the experts’ perceptions on alternative futures, we formulated four scenarios for PA up to 2030, which we named Mismatch, Empowerment, Fatigue and Balance. The scenarios may be utilised as guides in developing future policies and decision-making, and to build better futures. Our scenarios demonstrate that alternatives do exist, and actions can be realigned with the positive scenarios of Empowerment and Balance. The physically inactive scenarios of Mismatch and Fatigue represent avoidable scenarios. Highlights • We explored future scenarios in the intersections of physical activity and active lifestyles. • We utilised a mixed-methods approach where we combined both qualitative and quantitative data analysis. • We formulated four scenarios: Empowerment, Balance, Mismatch and Fatigue . • Lifestyle changes of individuals are not enough - community building and active societal support are needed.

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openaire: EC/H2020/856602/EU//FINEST TWINS Funding Information: The work of TR, PB and AJP was supported by the Ministry of Education and Culture, Finland under Grants OKM/30/626/2019 and OKM/1097/626/2020 . AK received funding from NordGreen project (95322) funded by NordForsk . The work of MeS was supported by a Health Research Council of New Zealand Sir Charles Hercus Research Fellowship (# 17/013 ) MK received funding from the FinEst Twins project funded by EU H2020 (grant no. 856602 ). The funders had no role in the process of conducting and writing this scoping review. Publisher Copyright: © 2021 Elsevier Ltd Background: The social ecological approach suggests that the spatial context among other factors influence physical activity behavior. Ample research documents physical environmental effects on physical activity. Yet, to date inconsistent associations remain, which might be explained by conceptual and methodological challenges in measuring the spatial dimensions of health behavior. We review methods applied to measure the spatial contexts in the social ecological physical activity literature. Methods: Online databases and selected reviews were used to identify papers published between 1990 and 2020. A total of 2167 records were retrieved, from which 412 studies that used physical activity as a primary outcome variable, included measures of the physical environment and applied the main principles of the social ecological approach, were included. Results: Subjective approaches were the dominant method to capture the spatial context of physical activities. These approaches were applied in 67% (n=279) of the studies. From the objective approaches an administrative unit was most prevalent and was applied in 29% (n=118) of the studies. The most comprehensive objective spatial methods that capture the true environmental exposure, were used only in 2% (n=10) of the studies. Conclusions: Current social ecological physical activity research applies simple conceptualizations and methods of the spatial context. While conceptual and methodological concerns have been repeatedly expressed, no substantive progress has been made in the use of spatial approaches. To further our understanding on place effects on health, future studies should carefully consider the choice of spatial approaches, and their effect on study results.

Health literacy is a key determinant of health (1). Several studies have reported a positive association between high levels of health literacy and better health outcomes in children (2-4). For example, the WHO collaborative Health Behaviour in School-aged Children (HBSC) survey found that health literacy is one of the main factors contributing to health differences and is associated with educational outcomes such as academic achievement and post-school aspirations (4). Health literacy is a useful phenomenon in the understanding and reduction of avoidable health disparities because it can be learned and developed (4–6). However, children’s health literacy should not merely be seen as a risk factor for poor health, but also as an asset that supports the development of autonomy, empowerment and participation in promoting the common good (1, 5). According to WHO, health literacy consists of “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” (7). However, discussions about what health literacy is should not only consider the ability to use and handle externally provided (e.g. taught) information; other abilities are equally important, such as understanding one’s own wishes and preferences in health issues and being able to consider the ethical consequences of one’s actions on others and the world. peerReviewed

Previous research suggests that singing in a choir as an older adult is associated with better quality of life (QOL). However, the degree to which sociodemographic variables and level of engagement in hobbies contribute to this relationship is largely unknown. The aim of the study was to compare quality of life (QOL) of older adult choir singers with a matched sample of older adults from the general population in Finland, taking into consideration sociodemographic variables, satisfaction with health, and level of engagement in hobbies. Case-control methods were used to match a sample of 109 older adult singers with a sample of 307 older adults from the general population. Tobit regression analysis with sociodemographic covariates was used to explore observed group differences in QOL as measured by two WHOQOL-Bref domains (psychological and physical). Probit regression analysis was used to examine the effect of sociodemographic variables and engagement in hobbies and on overall QOL and satisfaction with health. As expected, sociodemographic variables were strongly associated with physical and psychological QOL. After controlling for sociodemographic variables, the older choir singers reported significantly higher ratings on physical QOL, but not psychological QOL, compared to matched controls. Additional adjustment for satisfaction with health attenuated the results. When considering the level of engagement in hobbies, older adult choir singers reported significantly higher overall QOL and satisfaction with health when compared to controls who were either actively engaged in hobbies or not active in hobbies. These results suggest that singing in a choir as an older adult may promote well-being, even after accounting for sociodemographic variables and level of engagement in hobbies.

Fyysinen aktiivisuus kannattaa. Liikuntaharjoittelu vaikuttaa myönteisesti kehon koostumukseen, fyysiseen kuntoon, toimintakykyyn, psyykkiseen hyvinvointiin ja elämänlaatuun myös niillä lapsilla ja nuorilla, joilla on kroonisia sairauksia ja liikkumisen rajoitteita. nonPeerReviewed

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Fyysisellä aktiivisuudella on myönteisiä vaikutuksia fyysiseen, psyykkiseen ja sosiaaliseen terveyteen. Siten liikunnan harrastaminen on terveyttä merkittävästi edistävä elämäntapa. Nuorten kunto on heikentynyt ja elintapoihin liittyvien sairauksien määrä kasvanut. Tutkimukset osoittavat, että lapsena ja nuorena fyysisesti aktiivisesti elänyt ihminen on todennäköisesti aikuisenakin aktiivinen. Näiden seikkojen perusteella on tärkeää, että nuorten liikuntaan liittyvää terveysosaamista kehitetään peruskoulun jälkeenkin toisen asteen koulutuksessa. Tutkimuksen tarkoitus oli tarkastella liikuntaan liittyvän terveysosaaminen kehittämistä lukion terveystiedossa. Tutkimusaineisto koostui kuuden oppikirjasarjan pakollisen Terveyden perusteet TE1 -kurssin ja syventävän Nuoret, terveys ja arkielämä TE2 - kurssin oppikirjoista. Niiden sisältöä vertailtiin terveystiedon ja liikunnan opetukselle valtakunnallisissa opetussuunnitelman perusteissa asetettuihin tavoitteisiin. Tutkimuksen lähtökohtana toimi liikunta–kunto-terveys-viitekehys (Bouchard & Shephard 1994). Sen mukaan liikunnan, kunnon ja terveyden välillä vallitsee vuorovaikutteisia yhteyksiä, ja niitä säätelevät perimä, elintavat ja yksilölliset ominaisuudet sekä sosiaaliset tekijät ja ympäristötekijät. Tutkimus oli laadullinen tutkimus, jossa oppikirjat analysoitiin sisällönanalyysin menetelmillä. Analyysi oli teoriasidonnaista edeten aluksi aineistolähtöisesti ja muuttuen lopussa teorialähtöiseksi. Tutkimustulosten mukaan oppikirjojen liikuntaan liittyvät sisällöt ovat pitkälti samanlaisia. Kaikissa kirjasarjoissa käsitellään liikunnan vaikutuksia terveyteen. Kirjoissa painottuu liikunnan vaikutukset fyysiseen terveyteen psyykkisen ja sosiaalisen terveyden käsittelyn kustannuksella. Liikunnan vaikutuksia aivotoimintaan käsitellään kolmessa kirjasarjassa kuudesta. Kirjoissa käsitellään kuntoa pääsääntöisesti yksityiskohtaisesti urheiluvalmennuksen näkökulmasta. Liikuntaohjelma laaditaan suurimmassa osassa kirjasarjoista, mutta vain osassa sen lähtökohtana ovat oppilaan arki ja omat tarpeet. Nuoren kokemusmaailman vähäinen hyödyntäminen leimaa kirjojen sisältöä. Sisältöjen jaotteluissa pakollisen kurssin kirjan ja syventävän kurssin kirjan välillä on eroja kirjasarjojen välillä. Siksi oppilaat eri kouluissa ovat eriarvoisessa asemassa opetuksen suhteen, eikä kaikilla ole sama tieto- ja taitopohja pakollisen kurssin jälkeen. Physical activity has several positive effects to health. Therefore playing sports is part of the way of life that improves health. Finnish children are having poorer condition and the amount of lifestyle-based diseases is growing. The research results indicate that a person who was living physically actively as a child and young is likely to live physically actively as an adult too. Because of these facts, teaching the knowledge and skills in sports is important even after basic education in both general upper secondary school and vocational upper secondary school. The purpose of this study was to review the teaching of sports related health literacy in the health education in general upper secondary school. The material of the research consisted of text books in the compulsory course Foundation of health TE1 and specialisation course Young people, health and everyday life TE2 from six different series of books. The content of those books was compared to goals written in the National Core Curriculum in health education and physical education. The starting point for the study was sports-conditionhealth- framework (Bouchard & Shephard 1994). According to it there are interactive connections between sports, condition and health and they are regulated by heredity, lifestyle and individual characteristics as well as social factors and environmental factors. Methodologically, the research can be defined as a qualitative study where the study books were analysed with methods to analyse the content. The analysing process was theory bonded. In the beginning the material drove the analysing process and then theory drove in the end. According the results there are no significant differences between the study books. The effects exercise has on health are presented in every series of books. The focus is on physical health at mental health’s and social health’s expense. The effects exercise has on brain activity are presented in three series of six. The physical condition is mainly approached from coaching point of view and described very detailed. The exercise programme is planned in almost every series but young people’s everyday life and needs are taking into account in only few series. The lack of exploiting the young people’s experiences is characterizing text books. There are differences between series when it comes to dividing content between books in compulsory and specialisation course. Therefore the students in different schools are unequal position: they all do not have the same knowledge when they have studied the compulsory course.

The settings approach to health promotion is a world-known concept concerning settings like city, hospital, school, and workplace. The concept has also been used in some regionally specific settings, such as island, prison, or university. However, there are still many, often noninstitutional, settings that have a lot of potential but have not yet been recognized. One of the newcomers is the youth sports club, which has the potential to reach a lot of children and adolescents and is effective, via its casual educational nature based on voluntary participation. According to research, health is an important aim for most youth sports clubs, but it has not been converted into practical actions. Indeed, the clubs often recognize the importance of healthy lifestyles, but there is a lack of understanding of what to do to reinforce it within one’s activities. That is why, on the basis of the results of the Health Promoting Sports Club survey in Finland, guidelines for clubs to enhance health promotion as a part of their activities were created. The aim of this article is to present the guidelines, theirs rationale, and practical examples.

Kunnilla on vastuu ikääntyneiden hyvinvoinnin ja terveyden edistämisessä ja ikääntyneiden palveluiden tuottamisessa. Palvelujen toteuttaminen on sidoksissa taloudellisiin resursseihin ja poliittiseen tahtoon. Suomessa on laadittu kunnallisia ja seudullisia ikääntymispoliittisia strategioita ja kehittämisohjelmia ikääntyneiden hyvinvoinnin ja terveyden edistämiseksi sekä palvelujen turvaamiseksi. Tämän tutkielman tarkoituksena on kuvata ikääntyneiden terveyden ja hyvinvoinnin edistämisen sisältöä, tavoitteita, tavoitteiden seurantaa ja arviointia kuntien ikääntymispoliittisen strategioiden näkökulmista. Tutkimuksen kohderyhmänä ovat suomalaiset kunnat ja niiden ikääntymispoliittiset strategiat (n=20). Kunnat valittiin ositetun otannan perusteella mukaan arvottujen kuntien Internet-sivuilta. Aineisto analysoitiin deduktiivisella sisällönanalyysilla. Aineisto myös kvantifioitiin analyysirungon mukaisesti. Tutkimuksen tavoitteena on auttaa ja tukea kuntia kehittämään ikääntymispoliittisten strategioiden terveyden ja hyvinvoinnin edistämisen sisältöä, tavoitteiden laadintaa, tavoitteiden seurantaa ja arviointia. Tutkimuksen tulosten mukaan strategioista 85 %:ssa oli kuvattu ikääntyneiden terveyden ja hyvinvoinnin edistämisen nykytila. Kaikista strategioista löytyi sanallisia tavoitteita terveyden ja hyvinvoinnin edistämiseksi. Eniten terveyden ja hyvinvoinnin edistämisen nykytilaa ja tavoitteita kuvasivat ilmaisut, jotka koskivat varhaista puuttumista toimintakyvyn heikkenemiseen, sairauksien hoitoon ja toimintakyvyn ylläpitämiseen. Vähiten nykytilan ilmaisuja löytyi turvalliseen, terveelliseen ja virikkeelliseen asuin- ja elinympäristöön. Terveyden ja hyvinvoinnin tavoitteista löytyi puolestaan vähiten ilmaisuja, jotka koskivat ikääntyneen osallistavia toimintoja. Ikääntymispoliittisista strategioista 85 %:ssa oli selkeästi kuvattu strategian seuranta/arviointi. Ikääntyneiden terveyden ja hyvinvoinnin edistämisellä korostetaan toiminnan laaja-alaisuutta ja sitä, että se koskettaa kaikkia kunnan hallinnonaloja. Kunnassa tulee tehdä tiivistä yhteistyötä eri hallinnonaloilla, niin että jokainen kunnan sektori pystyy sitoutumaan asetettuihin tavoitteisiin. Ikääntymispoliittisten strategioiden tavoitteita on seurattava säännöllisesti ja tehtävä arviointia ikääntyneen terveyden ja hyvinvoinnin tilasta. The aim of this study was to analyze how Finnish municipalities take into account the health and welfare promotion and how they set health and welfare promotion targets in their old age -strategies. The target group in this study was Finnish municipalities and their old age-strategies (n=20). The data was collected using stratified sampling from the randomly selected municipalities’ Internet sites. The data was analyzed with deductive content analysis. The data was also quantified. The purpose of this study is to develop health and welfare promotion planning and evaluation in Finnish municipalities. Municipalities are responsible for promotion health and welfare and also providing services for older people. Services are related to the economic resources and political will. Finland has elaborated a local and sub-regional old age- strategies and development programs for the elderly well-being and health promotion, as well as security of services. According to the results 85 % of the strategies described the current state of health and welfare promotion of elderly people. All the strategies were found verbal targets of health and welfare promotion. Most of the health and welfare promotion targets were described by the words that are related to early intervention in declining health, treatment of diseases and maintaining functional capacity. Least the current state of the terms were found in a safe, healthy and stimulating housing and living environment. Least of the health and welfare promotion targets were described by the words that are related to elderly participatory activities. Old age- strategies 85 % were clearly described in the strategy monitoring / evaluation. Elderly health and welfare promotion highlights the broad-based nature and the fact that it touches all the local government areas of the municipality. The municipality has to work closely with the various branches of government, so that every sector of the municipality is able to bind to the intended objective. Old age strategies’ targets need to be monitored on a regular basis and make the assessment of the health and well-being of the aged state.