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The high prevalence of childhood obesity has led to questions about the influence of 'obesogenic' environments on children's health. Public health interventions targeting the retail food environment around schools have been proposed, but it is unclear if they are evidence based. This systematic review investigates associations between food outlets near schools and children's food purchases, consumption and body weight. We conducted a keyword search in 10 databases. Inclusion criteria required papers to be peer reviewed, to measure retailing around schools and to measure obesity-related outcomes among schoolchildren. Thirty papers were included. This review found very little evidence for an effect of the retail food environment surrounding schools on food purchases and consumption, but some evidence of an effect on body weight. Given the general lack of evidence for association with the mediating variables of food purchases and consumption, and the observational nature of the included studies, it is possible that the effect on body weight is a result of residual confounding. Most of the included studies did not consider individual children's journeys through the food environment, suggesting that predominant exposure measures may not account for what individual children actually experience. These findings suggest that future interventions targeting the food environment around schools need careful evaluation. © 2014 International Association for the Study of Obesity.

Background Some behavioural cardiovascular risk factors are known to be high in ethnic minority groups in the UK. In 2011, about half of all Indians, Pakistanis, Bangladeshis, and black Caribbeans living in the UK were born in the UK; however, little is known about whether the prevalence of cardiovascular risk factors differs between overseas-born and UK-born ethnic minorities. We aimed to investigate the prevalence of behavioural cardiovascular risk factors in UK-born ethnic groups. A common explanation for ethnic differences in health behaviours is socioeconomic factors; therefore, we also looked to see if the reasons behind any differences within and between UK-born ethnic groups had been explored. A main aim was also to assess the quality of reports on this topic. Methods We searched Medline, Embase, and PubMed for observational quantitative manuscripts. Selected manuscripts were those published between 1990 and 2012 and reporting on UK-born adult populations of black Caribbeans, black Africans, Indians, Pakistanis, or Bangladeshis, either alone or in comparison with another subgroup of the population. Manuscripts had to report on the prevalence of dietary factors, alcohol use, tobacco use, physical activity, or obesity. The titles and abstracts of manuscripts were screened and then the selected manuscripts were read in full. References of all manuscripts read in full were searched for further manuscripts. Exclusion of reports of poor quality is conventional, which might introduce biases into the results. Because one of the aims of this review was to assess the quality of the manuscripts, manuscripts of all quality were retained in the review and assessed using a quality appraisal instrument from the report on the methods used to develop the National Institute for Health and Care Excellence Public Health guidance. Quality assessors were not masked. Findings 124 manuscripts were identified through the search strategy after duplicates were removed. 23 manuscripts were read in full and ten studies were included in the review. The included manuscripts showed some evidence of a different prevalence of behavioural cardiovascular risk factors in the UK-born ethnic groups when compared with migrants and the white British ethnic group (appendix). In Indian women, the prevalence of smoking was 3·3% in the first generation but 10·2% in the second generation. Physical activity levels were higher in the second generation for all ethnic groups included; however, levels were still lower than in the general population. Compared with the general population, one manuscript suggested higher intakes of fried foods in UK-born ethnic minority participants (33·4% of UK-born Pakistanis eating fried food three or more times a week compared with 18·4% from the white group), but lower levels of alcohol intake and tobacco use. Some manuscripts attempted to minimise their risk of bias; however, underpowered samples and failure to adjust for important confounding variables limited the generalisability of their results. Because most manuscripts did not include socioeconomic factors in their regression models, we could not assess the contribution of this to differences in risk factors. Interpretation This review revealed some evidence of a different profile of cardiovascular risk factors in UK-born ethnic minorities, as compared with the migrant generation, although explanations for these differences are inadequate. Research with theoretical approaches and adequate sample sizes is needed to firmly establish any differences in prevalence between generations of ethnic minorities. As far as we are aware, this is the first manuscript to review and assess the quality of studies that examine the prevalence of cardiovascular behavioural risk factors in UK-born ethnic minorities. A limitation of this study is that the title and abstract screening was done by one person, although the final selection of manuscripts was agreed by all authors. Funding The main authors are funded by the British Heart Foundation.

BACKGROUND: Physical inactivity contributes to poor fitness and mental health disorders. This is of concern in post-conflict low-income settings where non-communicable diseases are emerging and there is limited evidence for physical activity interventions. We examined the effects of a sport-for-development programme on adolescent physical fitness and mental health in Gulu, Uganda. METHODS: We conducted a single-blinded RCT nested within an observational study with three unbalanced parallel groups. Participants were able-bodied adolescents aged 11-14 years. The intervention comprised an 11-week voluntary competitive sport-for-development football league. Participants who did not subscribe for the intervention formed a non-registered comparison group. Boys who registered for the sport-for-development programme were randomly allocated to the intervention or wait-listed. The girls programme subscription was insufficient to form a wait-list and all registrants received the intervention. Physical fitness was assessed by cardiorespiratory fitness (multi-stage fitness test), muscular power (standing broad jump) and body composition (BMI-for-age). Mental health was measured using the Acholi Psychosocial Assessment Instrument for local depression-like (DLS) and anxiety-like (ALS) syndromes. All randomisation was computer generated and assessors were masked to group allocation. An intention-to-treat analysis of adjusted effect size (ES) was applied. RESULTS: There were 1,462 adolescents in the study (intervention: boys = 74, girls = 81; wait-list: boys = 72; comparison: boys = 472, girls = 763). At four months follow-up there was no significant effect on the boys fitness when comparing intervention vs wait-listed and intervention vs non-registered groups. However, there was a negative effect on DLS when comparing boys intervention vs wait-listed (ES = 0.67 [0.33 to 1.00]) and intervention vs non-registered (ES = 0.25 [0.00 to 0.49]). Similar results were observed for ALS for boys intervention vs wait-listed (ES = 0.63 [0.30 to 0.96]) and intervention vs non-registered (ES = 0.26 [0.01 to 0.50]). There was no significant effect on the girls for any outcomes. CONCLUSIONS: The sport-for-development league in this study had no impact on fitness and a negative effect on the mental health of participating boys. From this research, there is no evidence that voluntary competitive sport-for-development interventions improve physical fitness or mental health outcomes in post-conflict settings.

Objectives To investigate associations between modest levels of total and domain-specific (commuting, other utility, recreational) cycling and mortality from all causes, cardiovascular disease and cancer. Design Population-based cohort study (European Prospective Investigation into Cancer and Nutrition study-Norfolk). Setting Participants were recruited from general practices in the east of England and attended health examinations between 1993 and 1997 and again between 1998 and 2000. At the first health assessment, participants reported their average weekly duration of cycling for all purposes using a simple measure of physical activity. At the second health assessment, participants reported a more detailed breakdown of their weekly cycling behaviour using the EPAQ2 physical activity questionnaire. Participants Adults aged 40–79 years at the first health assessment. Primary outcome measure All participants were followed for mortality (all-cause, cardiovascular and cancer) until March 2011. Results There were 22 450 participants with complete data at the first health assessment, of whom 4398 died during follow-up; and 13 346 participants with complete data at the second health assessment, of whom 1670 died during follow-up. Preliminary analyses using exposure data from the first health assessment showed that cycling for at least 60 min/week in total was associated with a 9% reduced risk of all-cause mortality (adjusted HR 0.91, 95% CI 0.84 to 0.99). Using the more precise measures of cycling available from the second health assessment, all types of cycling were associated with greater total moderate-to-vigorous physical activity; however, there was little evidence of an association between overall or domain-specific cycling and mortality. Conclusions Cycling, in particular for utility purposes, was associated with greater moderate-to-vigorous and total physical activity. While this study provides tentative evidence that modest levels of cycling may reduce the risk of mortality, further research is required to confirm how much cycling is sufficient to induce health benefits.

Background Remote and web 2.0 interventions for promoting physical activity (PA) are becoming increasingly popular but their ability to achieve long term changes are unknown. Objectives To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control group exposed to placebo or no or minimal intervention. Search methods We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies (for example the internet, smart phones) or more traditional methods (for example telephone, mail-outs), or both. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis. Data collection and analysis At least two authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% CIs were calculated. Main results A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of the interventions on cardiovascular fitness at one year (two studies; 444 participants) was positive and moderate with significant heterogeneity of the observed effects (SMD 0.40; 95% CI 0.04 to 0.76; high quality evidence). The effect of the interventions on self-reported PA at one year (nine studies; 4547 participants) was positive and moderate (SMD 0.20; 95% CI 0.11 to 0.28; moderate quality evidence) with heterogeneity (I2 = 37%) in the observed effects. One study reported positive results at two years (SMD 0.20; 95% CI 0.08 to 0.32; moderate quality evidence). When studies were stratified by risk of bias, the studies at low risk of bias (eight studies; 3403 participants) had an increased effect (SMD 0.28; 95% CI 0.16 to 0.40; moderate quality evidence). The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels. There was no evidence of an increased risk of adverse events (seven studies; 2892 participants). Risk of bias was assessed as low (eight studies; 3060 participants) or moderate (three studies; 2677 participants). There were no differences in effectiveness between studies using different types of professionals delivering the intervention (for example health professional, exercise specialist). There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human, nor between studies that used pedometers as part of their intervention compared to studies that did not. Authors' conclusions We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA. These interventions have positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at 12 months. The effectiveness of these interventions was supported by moderate and high quality studies. However, there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups. To better understand the independent effect of individual programme components, longer term studies, with at least one year follow-up, are required.

Objectives: The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. Study design: The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. Methods: Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). Results: Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. Conclusions: The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants. © 2013 The Royal Society for Public Health.

Obesity is a major public health concern in the United States. Eating while doing other activities, including watching television can increase energy intake. However, to our knowledge, no studies have quantified and examined the eating context among adults during everyday life. Existing studies are limited because they rely predominantly on self-reported data and focus on energy intake rather than patterns of eating behavior, such as how many times people eat during the day and how long each episode lasted. Automatic images taken by the SenseCam provide objective data regarding eating behavior including when, where and with whom eating occurs. The purpose of this study is to investigate the feasibility of using a SenseCam to measure eating behavior during free living. Forty university employees and students wore a SenseCam and a Global Positioning System (GPS) for 1--5 days. The following variables were annotated from the image data using standardized protocols: presence of eating behavior, presence of other activities during eating (TV viewing, computer use), and social context. Data were analyzed using non-parametric t-tests and multilevel models to examine patterns and context of eating episodes by gender and BMI status. 171 person days of data were collected. Participants engaged in 4.8 (SD = 2.1) episodes of eating per day and median duration of each eating event was 9.7 minutes [Interquartile Range = 7.0, 14.6]. This study demonstrated the utility of using the SenseCam to assess eating behaviors in adults. Eating behaviors were successfully annotated and related to demographics and BMI.

Background Walking for physical activity is associated with substantial health benefits for adults. Increasingly research has focused on associations between walking behaviours and neighbourhood environments including street characteristics such as pavement availability and aesthetics. Nevertheless, objective assessment of street-level data is challenging. This research investigates the reliability of a new street characteristic audit tool designed for use with Google Street View, and assesses levels of agreement between computer-based and on-site auditing. Methods The Forty Area STudy street VIEW (FASTVIEW) tool, a Google Street View based audit tool, was developed incorporating nine categories of street characteristics. Using the tool, desk-based audits were conducted by trained researchers across one large UK town during 2011. Both inter and intra-rater reliability were assessed. On-site street audits were also completed to test the criterion validity of the method. All reliability scores were assessed by percentage agreement and the kappa statistic. Results Within-rater agreement was high for each category of street characteristic (range: 66.7%-90.0%) and good to high between raters (range: 51.3%-89.1%). A high level of agreement was found between the Google Street View audits and those conducted in-person across the nine categories examined (range: 75.0%-96.7%). Conclusion The audit tool was found to provide a reliable and valid measure of street characteristics. The use of Google Street View to capture street characteristic data is recommended as an efficient method that could substantially increase potential for large-scale objective data collection.

Objectives: The overall aim of this research was to describe the health-seeking behaviours (HSBs) of people in rural Makwanpur, Nepal, and to analyse the patient, household, community, health-system, knowledge and illness factors, and the psychological, social and cultural processes which explain these behaviours. Background: Much about the health status of populations and individuals can be understood by studying how people utilise their health services and the factors associated with this utilisation. HSB studies act as a starting point for the planning of health programmes and the structuring of health systems. Nepal, with its shortage of health providers and funding, its low service usage and its pluralistic medical landscape provides an interesting setting in which to examine HSBs. Most health policies in this context have been devised without taking into account the perspectives of the system users. Moreover, limited formal research on this topic has been carried out in this context. Methods: This study involved a mixed-methods, explanatory sequential design consisting of two phases – quantitative data collection followed by qualitative data collection. Quantitative data was collected using a cross-sectional household survey carried out in 2,334 households across ten VDCs in Makwanpur district between April 2011 and August 2011. Households were selected using a random sampling method. The survey asked about care-seeking in response to an acute episode of illness in the previous one month. Qualitative data was collected after the quantitative data using semi-structured household interviews (n=90) in three VDCs between November and December 2012. The Qualitative interviews were designed to compliment the quantitative findings and to determine the explicit factors associated with care decisions. Results: Of the 2,334 households surveyed,46% had at least one episode of illness in the month prior. The majority of illnesses were infectious or parasitic diseases (42%). Of those households experiencing illnesses, 69% chose to seek care outside of the home; 22% used traditional healers, 37% used allopathic providers and 12% opted for pharmacies as a first option. Sixteen did nothing to address their illnesses, sighting geography, finances, workload and lack of severity as the reasons. Regression models revealed that a host of different patient, household, community, illness, health facility and knowledge factors were associated with care decisions depending on the decision, but illness factors had the greatest impact overall on whether or not a household sought some care or care outside of the home, while household level factors had the greatest impact on the type of care sought outside of the home and the length of delays before seeking care. Patient gender had an impact on whether or not allopathic care was used at least once. Qualitative results revealed that health facility factors were also equally important in determining households’ conscious decision-making about specific providers. Conclusions: Overall it appears that people in Makwanpur are not underutilising health services as suspected. Households use certified government providers most frequently to address their illnesses, and do not rely too heavily on traditional healers or informal providers exclusively. The results indicate that while illness and household factors are important, in order to improve HSBs and increase allopathic care utilisation, a focus should be on improving health service delivery rather than on changing HSBs. However, in order to decrease delays in care-seeking, a focus should be made to reduce household-level barriers to care as well.

Stakeholders in the Sport-for-Development (SFD) sector currently implement a broad array of intervention designs and claim various cross-cutting positive results (SDPIWG, 2008). However, there is limited evidence that these programmes are effective, and thus a more focused analysis of any claimed impacts is needed (Cronin, 2011). With these points in mind, this chapter features a case study of the peace building and health-related outcomes of a SFD intervention for adolescents implemented in Gulu, Uganda — a post-conflict context in a low-income African country. The SFD sector claims to achieve social cohesion and peace building outcomes in similar settings (Kidd and MacDonnell, 2007), while SFD stakeholders also claim to positively influence physical and mental health outcomes in post-conflict populations. However, these proponents primarily cite evidence from studies conducted in adult populations living in peaceful and high-income countries (Zakus et al., 2007), so the contexts are very different. This is a crucial point: an understanding of local contexts and needs is an important part of developing and implementing SFD interventions in low-income and post-conflict settings. That same principle applies to the monitoring, evaluation and assessment of SFD programmes.

Numerous studies have demonstrated multiple health benefits of being outside and exposure to natural environments. It is essential to accurately measure the amount of time individuals spend outdoors to assess the impact of exposure to outdoor time on health. SenseCam is a wearable camera that automatically captures images. The annotated images provide an objective criterion for determining amount of time spent outdoors. In this paper we explored the use of SenseCam and Global Positioning System (GPS) devices to calculate time spent outdoors. We used the annotated SenseCam images to investigate the optimal threshold from the GPS data to best differentiate outdoor and indoor time. We analyzed the signal strength data recorded by the GPS with a Receiver Operating Characteristic (ROC) curve as well as a three-category logistic regression model. The ROC curve resulted in 79.4% sensitivity for indoor time and 84.1% specificity for outdoor time with an area under the curve of 0.927.

BACKGROUND: the growing global burden of noncommunicable diseases makes it important to monitor and influence a range of health-related behaviours such as diet and physical activity wearable cameras appear to record and reveal many of these behaviours in more accessible ways. However, having determined opportunities for improvement, most health-related interventions fail to result in lasting changes. Aim: to assess the use of wearable cameras as part of a behaviour change strategy and consider ethical implications of their use. Methods: we examine relevant principles from behavioural science theory and consider the way images enhance or change the processes which underpin behaviour change. We propose ways for researchers to instigate the use of and engagement with these images to lead to more effective and long-lasting behaviour change interventions. We also consider the ethical implications of using digital life-logging technologies in these ways. We discuss the potential harms and benefits of such approaches for both the wearer and those they meet. Discussion: future behaviour change strategies based on self-monitoring could consider the use of wearable cameras. It is important that such work considers the ethical implications of this research and adheres to accepted guidelines and principles. Copyright 2013 ACM.

Background: Cross-country differences in dietary behaviours and obesity rates have been previously reported. Consumption of energy-dense snack foods and soft drinks are implicated as contributing to weight gain, however little is known about how the availability of these items within supermarkets varies internationally. This study assessed variations in the display of snack foods and soft drinks within a sample of supermarkets across eight countries.Methods: Within-store audits were used to evaluate and compare the availability of potato chips (crisps), chocolate, confectionery and soft drinks. Displays measured included shelf length and the proportion of checkouts and end-of-aisle displays containing these products. Audits were conducted in a convenience sample of 170 supermarkets across eight developed nations (Australia, Canada, Denmark, Netherlands, New Zealand, Sweden, United Kingdom (UK), and United States of America (US)).Results: The mean total aisle length of snack foods (adjusted for store size) was greatest in supermarkets from the UK (56.4 m) and lowest in New Zealand (21.7 m). When assessed by individual item, the greatest aisle length devoted to chips, chocolate and confectionery was found in UK supermarkets while the greatest aisle length dedicated to soft drinks was in Australian supermarkets. Only stores from the Netherlands (41%) had less than 70% of checkouts featuring displays of snack foods or soft drinks.Conclusion: Whilst between-country variations were observed, overall results indicate high levels of snack food and soft drinks displays within supermarkets across the eight countries. Exposure to snack foods is largely unavoidable within supermarkets, increasing the likelihood of purchases and particularly those made impulsively. © 2013 Thornton et al.; licensee BioMed Central Ltd.

Walking and cycling are considered very important behaviours in public health. This thesis is a study of the measurement of walking, cycling and overall travel behaviour. In the first part I present a systematic review of studies comparing Global Positioning System (GPS) measured travel to self-report. I found 12 results from eight eligible studies. All studies showed self-reported journey times were greater than GPS measured times. The differences ranged from over-reporting of +2.2 to +13.5 minutes per journey. In the second part of this thesis, I describe the development of a feasible, valid and reliable method for measuring travel with automated wearable cameras (SenseCam) through field testing and two pilot studies. I compared my new method to direct observation (considered a criterion measure) and found very good agreement and reliability (inter-rater, intra-rater and inter-measure). I also present an ethical framework for the measurement of health-related behaviours using automated wearable cameras. In the third part of the thesis, I report findings from an experiment designed to assess a well known UK travel diary (The National Travel Survey). Across four locations (Oxford, UK; Romford, UK; San Diego, USA; and Auckland, New Zealand) I collected 3-4 days of SenseCam and travel diary data from n=84 participants (convenience sample). Compliance with the collection protocol was high and inspection of the crude results suggests relative agreement between measures. Analysis of matched pairs of measurements (n=1,127 journeys) suggests a significant positive bias on self-reported durations (2:08 minutes; 95% CI = 1:48 to 2:28; 95% limits-of-agreement = -9:10 to 13:26). These results suggest self-reported journey exposure is valid at a population level, though corrections according to my reported bias could be considered. The large limits of agreement on duration estimates suggest self-report may be unsuitable for assessment of individual travel behaviour.

Aims Economic evaluations provide a useful comparative approach for considering costs and consequences on patient outcomes, thus providing a foundation for effective policy and decision making.1 2 This descriptive review aims to better understand how economic evaluations of cardiac rehabilitation (CR) services are conducted to inform future research addressing the impact of a physical exercise component on cost-effectiveness. Methods Electronic databases were searched for economic evaluations of exercise-based CR programs published in English between 2000 and 2014. The methodological quality of included economic evaluations was reviewed using criteria taken from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.3 Results Fifteen economic studies met the eligibility criteria but exhibited wide variability in study perspective, time horizon, setting, comparators and included costs, with significant heterogeneity for exercise dose between interventions. Ten evaluations were based on randomised controlled trials (RCTs) with time horizons between 6–24 months, but which largely produced weak or inconclusive results. Excluding two modelling studies, only three studies utilised longer time horizons (3.5–5 years), and findings suggest exercise-based CR leads to lowered costs, reduced rehospitalisation9s and longer cumulative lifetime in the long-term. Conclusions Variability in CR program delivery and exercise dose along with weak consistency between study perspective and included costs makes it difficult to compare cost and health outcomes between studies and accumulate evidence in support of a particular exercise regime. The dominance of RCTs with their extensive patient selectivity process and exclusion of comorbid patients questions whether cost-effectiveness findings would translate to a real-world setting. The use of longer time horizons would be more compatible with a chronic condition and allow the long-term effects of exercise-based CR to be evaluated.

Background The after-school period has been described as the ‘critical window’ for physical activity (PA) participation. However, little is known about the importance of this window compared with the before and during-school period among socioeconomically disadvantaged children, and influence of gender and weight status.Methods 39 out of 156 (RR=25%) invited primary schools across 26 local government areas in Victoria, Australia, consented to participate with 856 children (RR=36%) participating in the wider study. The analysis sample included 298 Grade 4 and Grade 6 children (mean age: 11.2±1.1; 44% male) whom met minimum accelerometry wear-time criteria and had complete height, weight and health-behaviours questionnaire data. Accelerometry measured duration in daily light-intensity PA (LPA), moderate-to-vigorous PA (MVPA) and sedentary time (ST) was calculated for before-school=8–8:59, during-school=9:00–15:29 and after-school=15:30–18:00. Bivariate and multivariable linear regression analyses were conducted.Results During-school represented the greatest accumulation of LPA and MVPA compared with the before and after-school periods. Boys engaged in 102 min/day of LPA (95% CI 98.5 to 104.9) and 62 min/day of MVPA (95% CI 58.9 to 64.7) during-school; girls engaged in 103 min/day of LPA (95% CI 99.7 to 106.5) and 45 min/day of MVPA (95% CI 42.9 to 47.4). Linear regression models indicated that girls with overweight or obesity engaged in significantly less LPA, MVPA and more time in ST during-school.Conclusions This study highlights the importance of in-school PA compared with after-school PA among socioeconomically disadvantage children whom may have fewer resources to participate in after-school PA.

Background Physical activity could benefit drug users9 physiological and mental health. Previous research has suggested that physical activity levels change when drug users enter prison. Methods Twenty-five class A drug users who were new to prison answered physical activity and drug use cross-sectional questionnaires, took a submaximal fitness test and wore a pedometer for 1 week. Results Participants9 mean aerobic capacity was estimated as 49 mls O2/kg/min (±12 SD). Their mean self-reported walking distance outside of prison was 4.67 miles on an average day (±4.14 SD). Pedometer data suggest they walked a mean of 1.8 miles/day in prison. Conclusion Many class A drug users entering prison had high levels of fitness and physical activity before admission, often gained from walking. Walking activity reduced when they entered prison, posing a challenge to maintaining healthy activity levels.

Background Insufficient levels of physical activity are associated with increased morbidity and mortality for many non-communicable diseases, as identified by the Chief Medical Officer reports and WHO. However, many physical-activity-related health associations have been based on self-report measurement, which is limited by recall, comprehension, and social desirability bias. Current objective measures, such as the accelerometer, can identify episodes of physical activity. Accelerometers are unable to identify detailed type and context behavioural information. First-person point-of-view images can capture health-related behaviours, and the context in which they occur. Historically, wearable cameras were bespoke devices, with poor battery life, constructed in individual life-logging research groups. However, the SenseCam is wearable camera, able to record a full day's worth of behaviours, which other researchers now have access to. This study investigates the feasibility of the SenseCam wearable camera to objectively categorise the type and context of participants' accelerometer-identified episodes of activity. Methods A convenience sample of 52 university workers was recruited for this study from the USA (n=37) and New Zealand (n=15). Adults were given an Actical hip-mounted accelerometer (Mini-Mitter, Respironics, Bend, OR, USA) and a SenseCam (Vicon Oxford Metrics Group, UK). The device is a lightweight camera worn via a laynard around the neck. The camera has several sensors including: tri-axial accelerometer, magnetometer, ambient temperature, light level, and passive infrared. Images are captured about once every 20 s, and are based on a change in the aforementioned sensor values. The onboard clocks on the SenseCam and Actical devices were time-synchronised. Participants engaged in free-living activities for 3 days. Accelerometer data were cleaned and episodes of sedentary, lifestyle-light, lifestyle-moderate, and moderate-to-vigorous physical activity (MVPA) were identified with standard algorithms. Accelerometer episodes were manually categorised according to their context and physical-activity-compendium code as identified from time-matched SenseCam images. Findings 212 days of footage from 49 participants was analysed. SenseCam images, type and context attributes were coded for 386 randomly selected episodes, taking 63 s (95% CI 41–86) to manually code each episode. 12 categories, and 114 subcategory types, which aligned with the physical activity compendium, were identified. About a fifth of episodes could not be classified, mostly because of participant compliance issues. 311 (81%) episodes could be categorised. Of the coded data, 183 (59%) were outdoors versus 120 (39%) indoors; 104 (33%) episodes were recorded as leisure time activities, 103 (33%) transport, 57 (18%) domestic, and 47 (15%) occupational. 104 (33%) of the exemplar episodes contained direct social interaction and 67 (22%) were in social situations in which the participant was not involved in direct engagement. Interpretation Wearable cameras can provide data for objective categorisation of accelerometer-defined episodes of activity in free-living situations. However, these devices need further validation against other measures of behaviour such as direct observation. Future studies should investigate state-of-art computer vision techniques to automatically identify behaviours from SenseCam images. National surveillance systems such as Health Survey for England, Biobank, and National Health and Nutrition Examination Survey could use wearable cameras in a subset of participants to develop more appropriate accelerometer classification algorithms of free-living behaviours. Funding British Heart Foundation (grant 021/P&C/Core/2010/HPRG), Irish Health Research Board (MCPD/2010/12), and Microsoft Research PhD Scholarship Programme.

Background This study aimed to examine the experiences of walking promotion professionals on the range and effectiveness of recruitment strategies used within community based walking programmes within the United Kingdom. Methods Two researchers recruited and conducted semi-structured interviews with managers and project co-ordinators of community based walking programmes, across the UK, using a purposive sampling frame. Twenty eight interviews were conducted, with community projects targeting participants by age, physical activity status, socio-demographic characteristics (i.e. ethnic group) or by health status. Three case studies were also conducted with programmes aiming to recruit priority groups and also demonstrating innovative recruitment methods. Data analysis adopted an approach using analytic induction. Results Two types of programmes were identified: those with explicit health aims and those without. Programme aims which required targeting of specific groups adopted more specific recruitment methods. The selection of recruitment method was dependent on the respondent’s awareness of ‘what works’ and the resource capacity at their disposal. Word of mouth was perceived to be the most effective means of recruitment but using this approach took time and effort to build relationships with target groups, usually through a third party. Perceived effectiveness of recruitment was assessed by number of participants rather than numbers of the right participants. Some programmes, particularly those targeting younger adult participants, recruited using new social communication media. Where adopted, social marketing recruitment strategies tended to promote the ‘social’ rather than the ‘health’ benefits of walking. Conclusions Effective walking programme recruitment seems to require trained, strategic, labour intensive, word-of-mouth communication, often in partnerships, in order to understand needs and develop trust and motivation within disengaged sedentary communities. Walking promotion professionals require better training and resources to deliver appropriate recruitment strategies to reach priority groups.

Adipose tissue contains macrophages whose state of activation is regulated as obesity develops. Macrophage-secreted factors influence critical processes involved in adipose tissue homeostasis, including preadipocyte proliferation and differentiation into adipocytes. Macrophage-conditioned medium (MacCM) from J774A.1 macrophages protects 3T3-L1 preadipocytes from apoptosis through platelet-derived growth factor (PDGF) signaling. Here, we investigated the effect of macrophage activation on MacCM-dependent preadipocyte survival. MacCM was prepared following activation of either J774A.1 macrophages with lipopolysaccharide (LPS) or human primary monocyte-derived macrophages (MD-macrophages) with LPS or interleukin 4 (IL4). 3T3-L1 and human primary preadipocytes were induced to undergo apoptosis in MacCM, and apoptosis was quantified by cell enumeration or Hoechst nuclear staining. Preadipocyte PDGF signaling was assessed by immunoblot analysis of phosphorylated PDGF receptor, Akt, and ERK1/2. Pro-inflammatory activation of J774A.1 macrophages with LPS inhibited the pro-survival activity of MacCM on 3T3-L1 preadipocytes, despite intact PDGF signaling. Upregulation of macrophage tumor necrosis factor a (TNFα) expression occurred in response to LPS, and TNFα was demonstrated to be responsible for the inability of LPS-J774A.1-MacCM to inhibit preadipocyte apoptosis. Furthermore, MacCM from human MD-macrophages (MD-MacCM) inhibited apoptosis of primary human preadipocytes. MD-MacCM from LPS-treated macrophages, but not IL4-treated anti-inflammatory macrophages, was unable to protect human preadipocytes from cell death. In both murine cell lines and human primary cells, pro-inflammatory activation of macrophages inhibits their pro-survival activity, favoring preadipocyte death. These findings may be relevant to preadipocyte fate and adipose tissue remodeling in obesity.

Summary Background The burden of non-communicable diseases (NCDs) is disproportionately carried by low-income and middle-income countries and disadvantaged sectors of society such as prisoners. No systematic analysis has been done to assess the prevalence of poor diet, inadequate physical activity, and overweight and obesity in prisoners. We aim to synthesise current evidence and to highlight areas for action and further research. Methods We systematically searched online databases for reports published between 1948 and May, 2011. Studies were screened against eligibility criteria; two authors then independently extracted data with previously agreed proformas. The risk of bias was assessed for each study with a domain-based assessment. Data on body-mass index and physical activity were presented in forest plots; no overall estimates were calculated on account of data heterogeneity. Available data from the population subgroup most similar in terms of age and sex were used to calculate age-adjusted and sex-adjusted prevalence ratios, which estimate the likelihood of insufficient activity and obesity prevalence in prisoners compared with the national population. Findings 31 eligible studies were reported in 29 publications, including more than 60 000 prisoners in 884 institutions in 15 countries. Male prisoners were less likely to be obese than males in the general population (prevalence ratios ranged from 0·33 to 0·87) in all but one study (1·02, 0·92–1·07), whereas female prisoners were more likely to be obese than non-imprisoned women in the USA (1·18, 1·08–1·30) and Australia (prevalence ratios ranged from 1·15 to 1·20). Australian prisoners were more likely to achieve sufficient activity levels than the general population compared with prisoners in the UK (prevalence ratio 1·19, 95% CI 1·04–1·37, for women in Australia in 2009 vs 0·32, 0·21–0·47, for women in the UK; prevalence ratios ranged from 1·37 to 1·59 for men in Australia vs 0·71, 0·34–0·78, for men in the UK). Female mean energy intake exceeded recommended levels and sodium intake was about two to three times the recommended intake for all prisoners. Interpretation Contact with the criminal justice system is a public-health opportunity to promote health in this vulnerable population; the costs to the individual and to society of failing to do so are likely to be substantial. Improved monitoring and further research is essential to inform appropriate targeting of public health interventions. Funding Oxford University Department of Public Health, Oxford University Hospitals NHS Trust.

Background The effectiveness of exercise referral schemes (ERS) is influenced by uptake and adherence to the scheme. The identification of factors influencing low uptake and adherence could lead to the refinement of schemes to optimise investment. Objectives To quantify the levels of ERS uptake and adherence and to identify factors predictive of uptake and adherence. Methods A systematic review and meta-analysis was undertaken. MEDLINE, EMBASE, PsycINFO, Cochrane Library, ISI WOS, SPORTDiscus and ongoing trial registries were searched (to October 2009) and included study references were checked. Included studies were required to report at least one of the following: (1) a numerical measure of ERS uptake or adherence and (2) an estimate of the statistical association between participant demographic or psychosocial factors (eg, level of motivation, self-efficacy) or programme factors and uptake or adherence to ERS. Results Twenty studies met the inclusion criteria, six randomised controlled trials (RCTs) and 14 observational studies. The pooled level of uptake in ERS was 66% (95% CI 57% to 75%) across the observational studies and 81% (95% CI 68% to 94%) across the RCTs. The pooled level of ERS adherence was 49% (95% CI 40% to 59%) across the observational studies and 43% (95% CI 32% to 54%) across the RCTs. Few studies considered anything other than gender and age. Women were more likely to begin an ERS but were less likely to adhere to it than men. Older people were more likely to begin and adhere to an ERS. Limitations Substantial heterogeneity was evident across the ERS studies. Without standardised definitions, the heterogeneity may have been reflective of differences in methods of defining uptake and adherence across studies. Conclusions To enhance our understanding of the variation in uptake and adherence across ERS and how these variations might affect physical activity outcomes, future trials need to use quantitative and qualitative methods.

This is the protocol for a review and there is no abstract. The objectives are as follows: The main aim of the review is to determine the effectiveness of using incentive-based approaches (IBAs) (financial and non-financial) to increase physical activity in community-dwelling children and adults. A secondary objective will be to address the use of incentives to improve cardiovascular and metabolic fitness. A final objective will be to explore: - whether there are any adverse effects associated with the use of IBAs for increasing physical activity; - whether there are any differential effects of IBAs within and between study populations by age, gender, education, inequalities and health status; and - whether the use of disincentive/aversive approaches leads to a reduction in sedentary behaviour.

BACKGROUND Population level child measurement is an established international practice. However, there is limited clarity around the protocol and roles of school-based child measurement programmes (CMPs). Furthermore, questions remain about the positive and adverse outcomes associated with CMPs, as well as their longer-term sustainability. This research contributes new information by addressing these key unanswered questions. METHODS This thesis describes a three-part, mixed methods research project incorporating: a systematic literature review of existing CMPs; an in-depth case study of England’s National Child Measurement Programme; and the development, pilot implementation and evaluation of a CMP in Guernsey. This research was conducted sequentially; individual components informed and guided subsequent work. RESULTS Routine child measurement is a popular, complex and adaptive practice and offers significant epidemiological value. The principal roles of CMPs are delivery of local prevalence data and assessment of longitudinal trends. However, CMPs are often tasked with additional, diverse and changing roles that do not translate to acknowledged outcomes. Specifically, feedback of individual results represents an unproven programme element. Programme roles can evolve according to political, logistical, or other influences, without consideration of available evidence or wider-reaching implications. There is no evidence of short-term harm from CMPs. Evaluation of the pilot CMP in Guernsey demonstrated that these programmes are perceived to be feasible, acceptable and sustainable. CONCLUSIONS To maximise the broader utility of CMPs, there should be clarity and consistency around their aims, roles and outcomes. Overall, surveillance reflects the preferred programme type. All CMPs should incorporate a standardised, rigorously applied protocol and routine evaluation. These features are essential to ensure the accuracy and comparability of resultant data, as well as programme credibility. Population level CMPs should not function in isolation; instead, they should be integrated into comprehensive strategies for obesity management. This research has important implications for CMP stakeholders and the wider public health arena.

Copyright @ Queen’s Printer and Controller of HMSO 2011. This work was produced by Pavey et al. under the terms of a commissioning contract issued by the Secretary of State for Health. Background: Exercise referral schemes (ERS) aim to identify inactive adults in the primary-care setting. The GP or health-care professional then refers the patient to a third-party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the individual. Objective: To assess the clinical effectiveness and cost-effectiveness of ERS for people with a diagnosed medical condition known to benefit from physical activity (PA). The scope of this report was broadened to consider individuals without a diagnosed condition who are sedentary. Data sources: MEDLINE; EMBASE; PsycINFO; The Cochrane Library, ISI Web of Science; SPORTDiscus and ongoing trial registries were searched (from 1990 to October 2009) and included study references were checked. Methods: Systematic reviews: the effectiveness of ERS, predictors of ERS uptake and adherence, and the cost-effectiveness of ERS; and the development of a decision-analytic economic model to assess cost-effectiveness of ERS. Results: Seven randomised controlled trials (UK, n = 5; non-UK, n = 2) met the effectiveness inclusion criteria, five comparing ERS with usual care, two compared ERS with an alternative PA intervention, and one to an ERS plus a self-determination theory (SDT) intervention. In intention-to-treat analysis, compared with usual care, there was weak evidence of an increase in the number of ERS participants who achieved a self-reported 90-150 minutes of at least moderate-intensity PA per week at 6-12 months' follow-up [pooled relative risk (RR) 1.11, 95% confidence interval 0.99 to 1.25]. There was no consistent evidence of a difference between ERS and usual care in the duration of moderate/vigorous intensity and total PA or other outcomes, for example physical fitness, serum lipids, health-related quality of life (HRQoL). There was no between-group difference in outcomes between ERS and alternative PA interventions or ERS plus a SDT intervention. None of the included trials separately reported outcomes in individuals with medical diagnoses. Fourteen observational studies and five randomised controlled trials provided a numerical assessment of ERS uptake and adherence (UK, n = 16; non-UK, n = 3). Women and older people were more likely to take up ERS but women, when compared with men, were less likely to adhere. The four previous economic evaluations identified suggest ERS to be a cost-effective intervention. Indicative incremental cost per quality-adjusted life-year (QALY) estimates for ERS for various scenarios were based on a de novo model-based economic evaluation. Compared with usual care, the mean incremental cost for ERS was £169 and the mean incremental QALY was 0.008, with the base-case incremental cost-effectiveness ratio at £20,876 per QALY in sedentary people without a medical condition and a cost per QALY of £14,618 in sedentary obese individuals, £12,834 in sedentary hypertensive patients, and £8414 for sedentary individuals with depression. Estimates of cost-effectiveness were highly sensitive to plausible variations in the RR for change in PA and cost of ERS. Limitations: We found very limited evidence of the effectiveness of ERS. The estimates of the cost-effectiveness of ERS are based on a simple analytical framework. The economic evaluation reports small differences in costs and effects, and findings highlight the wide range of uncertainty associated with the estimates of effectiveness and the impact of effectiveness on HRQoL. No data were identified as part of the effectiveness review to allow for adjustment of the effect of ERS in different populations. Conclusions: There remains considerable uncertainty as to the effectiveness of ERS for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. We failed to identify any trial-based evidence of the effectiveness of ERS in those with a medical diagnosis. Future work should include randomised controlled trials assessing the cinical effectiveness and cost-effectivenesss of ERS in disease groups that may benefit from PA. National Institute for Health Research Health Technology Assessment programme

ObjectiveTo develop and apply a socio-ecological model (SEM) for healthy eating in school students, to better understand the association between factors at different levels of the SEM and pupils’ dietary choices.DesignStudent-level data, collected through anonymised questionnaires, included reported dietary choices and correlates to these; data on school approaches to food were collected through postal surveys. We used multilevel analysis to study the association of each level of the SEM on student dietary choice while controlling for factors found at other levels.SettingData were collected from secondary schools in Wales that were a part of the 2005/2006 Health Behaviour in School-aged Children (HBSC) study.SubjectsThe final sample for analysis included data from 6693 students aged 11–16 years and 289 teachers from sixty-four secondary schools in Wales.ResultsStudent interpersonal factors, an individual's social environment, had a greater association with the dietary choices students made for lunch than student intrapersonal characteristics, those that reside within the person, which were found to have a greater association with the dietary choices made outside school. School organisational factors, such as rules and policies, had a greater association with whether students ate unhealthy foods, whereas the community nature of the school had a greater association with the choosing of healthy foods.ConclusionsUsing the SEM and multilevel analysis allowed us to study how factors were associated with the choice of different foods at different times of the day by students. Interventions can use an SEM to target specific correlates and change health outcomes in the school.

Walking is a safe, accessible and low cost activity, amenable to change and known to have great potential to increase physical activity levels in sedentary individuals. The objective of this study is to estimate the proportion of the 2009 adult population of England who would attain or exceed vigorous intensity activity (>70% maximum heart rate [HR(max)]) by walking at 3 mph. We conducted predictive impact modelling using participants' (n = 1741, aged 25-64 years) cardiovascular fitness data from treadmill walking tests. We combined this data with English population estimates adjusted for age and sex to estimate the numbers of individuals that would exceed 70% HR(max) (an intensity considered sufficient for fitness gains) when walking at 3 mph (4.8 km · h(-1)). We estimate 1.5 million men (95% confidence interval [CI] 0.9-2.2 million) (from 13.4 million corresponding to 11.6% (95% CI 7.0-16.2%)) and 3.9 million women (95% CI 3.0-4.8 million) (from 13.6 million corresponding to 28.6% (95% CI 22.0-35.1%)) in England aged 25-64 years would benefit from regularly walking at 3 mph. In total, a projected 5.4 million individuals (95% CI 3.9-6.9 million) aged 25-64 (from 26.97 million corresponding to 20.1% (95% CI 14.6-25.7%)) could benefit from walking at 3 mph. Our estimates suggest a considerable number of individuals in the English population could receive fitness and health benefits by walking regularly at 3 mph. Physical activity messages that promote walking at this speed may therefore have the potential to significantly impact national fitness levels and health in England.

Background and Aims: Walking and cycling are increasingly recognized as effective forms of physical activity, an important public health priority. Urban and transport planning are more influential ...

BACKGROUND: After school is a critical period in the physical activity and sedentary behaviour patterns of young people. Interventions to promote physical activity during these hours should be informed by existing evidence. PURPOSE: The present study provides a systematic review of interventions to promote physical activity in young people conducted in the hours immediately after school. METHODS: The review was conducted in accordance with guidelines from the National Institute for Health and Clinical Excellence. Studies were located through searches of electronic databases, including MEDLINE, EMBASE, PsychINFO and ERIC. For included studies, data were extracted and methodological quality assessed using standardised forms. RESULTS: Ten papers, reporting nine studies, met inclusion criteria. Three studies reported positive changes in physical activity and six indicated no change. Evidence suggests that single-behaviour interventions may be most effective during these hours. CONCLUSION: Limitations in study design, lack of statistical power and problems with implementation have likely hindered the effectiveness of interventions in the after-school setting to date. Further work is required to develop interventions during this critical period of the day.

Background: The family unit may be an important mechanism for increasing physical activity levels, yet little is known about what types of family-based interventions are effective. This study involved a formative evaluation of a 12 week intervention to encourage walking as a family based activity. The intervention consisted of several key elements including led walks and tailored resources, as well as remote support provided via the telephone. The project aimed to explore factors associated with successful delivery of the programme and to identify areas of improvement for future implementation. Methods: A total of nine interviews were undertaken with programme staff who were involved in either the set up or delivery of the intervention. In addition, four interviews and two focus groups were undertaken with participants to explore their experiences of the programme. The analysis involved both deductive and inductive reasoning. Results: In total, 114 people participated in the programme, which included 36 adults, 10 adolescents and 68 children (≤ 10 years of age). Adult participants reported several barriers to walking including concerns over their children's behaviour and their ability to maintain 'control' of their children. Walking in a group with other families gave parents confidence to go out walking with their children and provided a valuable opportunity for social interaction for parents and children alike. The most successful walks incorporated specific destinations and an activity to undertake upon reaching the destination. Incorporating other activities along the way also helped to keep the children engaged. Conclusions: The results of this study have highlighted the important contribution that formative research can make in informing and refining a programme to increase appropriateness and effectiveness. The study has helped to highlight the key characteristics associated with delivering a successful walking intervention to young families. It is recommended that practitioners undertake formative research when developing novel health promotion initiatives to help refine the programme protocols.

Background Active travel such as walking and cycling has potential to increase physical activity levels in sedentary individuals. Motorised car travel is a sedentary behaviour that contributes to carbon emissions. There have been recent calls for technology that will improve our ability to measure these travel behaviours, and in particular evaluate modes and volumes of active versus sedentary travel. The purpose of this pilot study is to investigate the potential efficacy of a new electronic measurement device, a wearable digital camera called SenseCam, in travel research. Methods Participants (n = 20) were required to wear the SenseCam device for one full day of travel. The device automatically records approximately 3,600 time-stamped, first-person point-of-view images per day, without any action required by the wearer. Participants also completed a self-report travel diary over the same period for comparison, and were interviewed afterwards to assess user burden and experience. Results There were a total of 105 confirmed journeys in this pilot. The new SenseCam device recorded more journeys than the travel diary (99 vs. 94). Although the two measures demonstrated an acceptable correlation for journey duration (r = 0.92, p < 0.001) self-reported journey duration was over-reported (mean difference 154 s per journey; 95% CI = 89 to 218 s; 95% limits of agreement = 154 ± 598 s (-444 to 752 s)). The device also provided visual data that was used for directed interviews about sources of error. Conclusions Direct observation of travel behaviour from time-stamped images shows considerable potential in the field of travel research. Journey duration derived from direct observation of travel behaviour from time-stamped images appears to suggest over-reporting of self-reported journey duration.

Objective Describe the proportion of total moderate or vigorous physical activity (MVPA) time that is represented by specific types of physical activity among active adults. Methods We analyzed data from 4750 adult participants in the 2008 Health Survey for England who reported ≥ 30 min of MVPA on ≥ 5 days per week. The proportion of their MVPA time spent in: occupational, domestic, walking, exercise and fitness, team sports, non-team sports, outdoor pursuit, and leisure pursuit activities were calculated and averaged across 6 age categories. Results Exercise and fitness activities make up a greater proportion of total MVPA for young adults (16–24 years: men = 27%; women = 21%) than old adults (65+ years: 12%; 11%); the same is true for Team sports (16–24 years: 12%, 2%; 65+ years: 0%, 0%). Domestic activities make up a greater proportion of total MVPA time among older men and women (16–24 years: 9%, 16%; 65+ years: 34%, 38%). Walking is one of the most important contributors to total MVPA across all age groups for both sexes (range all ages: 26–42%, 37–45%). Conclusion The physical activity profile of physically active English adults varies with age. Age-specific interventions to increase physical activity among adults may be needed.

To increase young people's physical activity (PA) levels it is important to understand the correlates of PA in children and adolescents. We sought to identify factors associated with children's and adolescents' PA by reviewing systematic quantitative reviews of non-intervention research. Systematic reviews examining associations between quantitatively measured variables and PA in young people (< 19 years) from 2000-2010 were identified using electronic and manual searches. Nine systematic reviews were identified. Demographic/biological correlates of PA were age and gender. Psychological correlates of PA were positive motivation, positive body image and the existence of barriers to PA. Behavioural correlates of PA were previous PA, sport participation, smoking, and sedentary behaviour. Social/cultural correlates of PA were parental influence and social support, and environmental correlates of PA were access to facilities, distance from home to school, time spent outside, and local crime. The evidence is suggestive of a number of different types of correlates of PA for children and adolescents. Beyond age and gender, though, most are likely to have only small or small-to-moderate effects in isolation and may work best in interaction with other influences. Psychologists must look to social, organisational and community-level correlates in addition to individual correlates. © 2011 Taylor and Francis.

Purpose Most researchers who are conducting physical activity trials face difficulties in recruiting participants who are representative of the population or from specific population groups. Participants who are often the hardest to recruit are often those who stand to benefit most (the least active, from ethnic and other minority groups, from neighbourhoods with high levels of deprivation, or have poor health). The aim of our study was to conduct a systematic review of published literature of walking interventions, in order to identify the impact, characteristics, and differential effects of recruitment strategies among particular population groups. Methods We conducted standard searches for studies from four sources, (i) electronic literature databases and websites, (ii) grey literature from internet sources, (iii) contact with experts to identify additional "grey" and other literature, and (iv) snowballing from reference lists of retrieved articles. Included studies were randomised controlled trials, controlled before-and-after experimental or observational qualitative studies, examining the effects of an intervention to encourage people to walk independently or in a group setting, and detailing methods of recruitment. Results Forty seven studies met the inclusion criteria. The overall quality of the descriptions of recruitment in the studies was poor with little detail reported on who undertook recruitment, or how long was spent planning/preparing and implementing the recruitment phase. Recruitment was conducted at locations that either matched where the intervention was delivered, or where the potential participants were asked to attend for the screening and signing up process. We identified a lack of conceptual clarity about the recruitment process and no standard metric to evaluate the effectiveness of recruitment. Conclusion Recruitment concepts, methods, and reporting in walking intervention trials are poorly developed, adding to other limitations in the literature, such as limited generalisability. The lack of understanding of optimal and equitable recruitment strategies evident from this review limits the impact of interventions to promote walking to particular social groups. To improve the delivery of walking interventions to groups which can benefit most, specific attention to developing and evaluating targeted recruitment approaches is recommended.

Background Active travel to school (ATS) has been identified as an important source of physical activity for youth. However, the relationship between ATS and health-related fitness (HRF) among youth remains unclear. Methods A systematic search of seven electronic databases (EMBASE, OVID MEDLINE, PsycINFO, PubMed, Scopus, SPORTDiscus and TRIS on line) was conducted in December 2009 and studies published since 1980 were considered for inclusion. Results Twenty seven articles were identified that explored the relationship between ATS and the following aspects of HRF: weight status/body composition, cardiorespiratory fitness, muscular fitness and flexibility. Forty-eight percent of the studies that examined the relationship between ATS and weight status/body composition reported significant associations, this increased to 55% once poor quality studies were removed. Furthermore, the findings from five studies, including one longitudinal study, indicate that ATS is positively associated with cardiorespiratory fitness in youth. However, the evidence for the relationships between ATS and muscular fitness or flexibility is equivocal and limited by low study numbers. Conclusions There is some evidence to suggest that ATS is associated with a healthier body composition and level of cardiorespiratory fitness among youth. Strategies to increase ATS are warranted and should be included in whole-of-school approaches to the promotion of physical activity.

Objective To assess the impact of exercise referral schemes on physical activity and health outcomes.DesignSystematic review and meta-analysis.Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references.Study selectionDesign: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals.Population: sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes.Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent atfollow-up. We did not find any difference in outcomes between exercisereferral schemes and the other two comparator groups. None of theincluded trials separately reported outcomes in individuals with specificmedical diagnoses. Substantial heterogeneity in the quality and natureof the exercise referral schemes across studies might have contributedto the inconsistency in outcome findings.Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.

BACKGROUND: Multi‐strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown. OBJECTIVES: To evaluate the effects of community wide, multi‐strategic interventions upon population levels of physical activity. SEARCH METHODS: We searched the Cochrane Public Health Group Segment of the Cochrane Register of Studies,The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, the British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORTDiscus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platform on Diet, Physical Activity and Health; Health‐Evidence.org; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA); the US Centre for Disease Control and Prevention (CDC) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were searched and we contacted experts in the field. The searches were updated to 16 January 2014, unrestricted by language or publication status. SELECTION CRITERIA: Cluster randomised controlled trials, randomised controlled trials, quasi‐experimental designs which used a control population for comparison, interrupted time‐series studies, and prospective controlled cohort studies were included. Only studies with a minimum six‐month follow up from the start of the intervention to measurement of outcomes were included. Community wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomised individuals from the same community were excluded. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted the data and assessed the risk of bias. Each study was assessed for the setting, the number of included components and their intensity. The primary outcome measures were grouped according to whether they were dichotomous (per cent physically active, per cent physically active during leisure time, and per cent physically inactive) or continuous (leisure time physical activity time (time spent)), walking (time spent), energy expenditure (as metabolic equivalents or METS)). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated percentage change from baseline, unadjusted and adjusted. MAIN RESULTS: After the selection process had been completed, 33 studies were included. A total of 267 communities were included in the review (populations between 500 and 1.9 million). Of the included studies, 25 were set in high income countries and eight were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non‐governmental organisations (NGOs) (29 studies). None of the studies provided results by socio‐economic disadvantage or other markers of equity. However, of those included studies undertaken in high income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio‐economic communities. Nineteen studies were identified as having a high risk of bias, 10 studies were unclear, and four studies had a low risk of bias. Selection bias was a major concern with these studies, with only five studies using randomisation to allocate communities. Four studies were judged as being at low risk of selection bias although 19 studies were considered to have an unclear risk of bias. Twelve studies had a high risk of detection bias, 13 an unclear risk and four a low risk of bias. Generally, the better designed studies showed no improvement in the primary outcome measure of physical activity at a population level. All four of the newly included, and judged to be at low risk of bias, studies (conducted in Japan, United Kingdom and USA) used randomisation to allocate the intervention to the communities. Three studies used a cluster randomised design and one study used a stepped wedge design. The approach to measuring the primary outcome of physical activity was better in these four studies than in many of the earlier studies. One study obtained objective population representative measurements of physical activity by accelerometers, while the remaining three low‐risk studies used validated self‐reported measures. The study using accelerometry, conducted in low income, high crime communities of USA, emphasised social marketing, partnership with police and environmental improvements. No change in the seven‐day average daily minutes of moderate to vigorous physical activity was observed during the two years of operation. Some program level effect was observed with more people walking in the intervention community, however this result was not evident in the whole community. Similarly, the two studies conducted in the United Kingdom (one in rural villages and the other in urban London; both using communication, partnership and environmental strategies) found no improvement in the mean levels of energy expenditure per person per week, measured from one to four years from baseline. None of the three low risk studies reporting a dichotomous outcome of physical activity found improvements associated with the intervention. Overall, there was a noticeable absence of reporting of benefit in physical activity for community wide interventions in the included studies. However, as a group, the interventions undertaken in China appeared to have the greatest possibility of success with high participation rates reported. Reporting bias was evident with two studies failing to report physical activity measured at follow up. No adverse events were reported.The data pertaining to cost and sustainability of the interventions were limited and varied. AUTHORS' CONCLUSIONS: Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings in the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that the multi‐component community wide interventions studied effectively increased physical activity for the population, although some studies with environmental components observed more people walking.

SUMMARY Cardiovascular disease (CVD) is a leading cause of death throughout the world. In high income countries, the greatest burden of disease is seen in those from lower socioeconomic groups. It is therefore likely that CVD is an important issue for prisoners in the UK, the majority of whom were either unemployed or in non-skilled employment prior to imprisonment. However, there is little research examining this issue. The aim of this study was to examine the prevalence of five modifiable cardiovascular risk factors (smoking, physical activity, diet, body mass index and hypertension) in women prisoners on entry to prison and then 1 month after imprisonment. This was a prospective longitudinal study involving 505 women prisoners in England. Participants completed a questionnaire containing questions about health-related behaviours within 72 h of entering prison. The researchers measured their blood pressure, height and weight. They followed up all participants who were still imprisoned 1 month later and invited them to participate again. The results showed that women prisoners were at high risk of CVD in the future; 85% smoked cigarettes, 87% were insufficiently active to benefit their health, 86% did not eat at least five portions of fruit and vegetables each day and 30% were overweight or obese. After 1 month, there were few improvements in risk factors. This may in part reflect the fact that, unlike prisons in other high income countries, there are currently no systematic approaches which address these health issues within UK women’s prisons.

Background Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries. Methods This study was done within the framework of the EU-funded project 'Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA)', which aims to propose standardised instruments for physical activity and fitness monitoring across Europe. Quantitative studies published from 1990 up to November 2007 were systematically searched in Pubmed, Web of Science, TRIS and Geobase. In addition a survey was conducted among members of the European network for the promotion of Health-Enhancing Physical Activity (HEPA Europe) and European members of the International Physical Activity and Environment Network (IPEN) to identify published or ongoing studies. Studies were included if they were conducted among European general adult population (18+y) and used a questionnaire to assess perceptions of the physical environment. A consensus meeting with an international expert group was organised to discuss the development of a European environmental questionnaire. Results The literature search resulted in 23 European studies, 15 published and 8 unpublished. In these studies, 13 different environmental questionnaires were used. Most of these studies used adapted versions of questionnaires that were developed outside Europe and that focused only on the walkability construct: The Neighborhood Environment Walkability Scale (NEWS), the abbreviated version of the NEWS (ANEWS) and the Neighborhood Quality of Life Study (NQLS) questionnaire have been most commonly used. Based on the results of the literature review and the output of the meeting with international experts, a European environmental questionnaire with 49 items was developed. Conclusion There is need for a greater degree of standardization in instruments/methods used to assess environmental correlates of physical activity, taking into account the European-specific situation. A first step in this process is taken by the development of a European environmental questionnaire.

This research was undertaken as part of work carried out by the Scottish Physical Activity Research Collaboration (SPARColl). SPARColl is managed by NHS Health Scotland, hosted by the University of Strathclyde, Glasgow and funded by the Scottish Government. Background: Scotland has a policy aimed at increasing physical activity levels in the population, but evidence on how to achieve this is still developing. Studies that focus on encouraging real world participants to start physical activity in their settings are needed. The Walking for Well-being in theWest study was designed to assess the effectiveness of a pedometer-based walking programme in combination with physical activity consultation. The study was multidisciplinary and based in the community. Walking for Well-being in the West investigated whether Scottish men and women, who were not achieving the current physical activity recommendation, increased and maintained walking behaviour over a 12 month period. This paper outlines the rationale and design of this innovative and pragmatic study. Methods: Participants were randomised into two groups: Group 1: Intervention (pedometer-based walking programme combined with a series of physical activity consultations); Group 2: Waiting list control for 12 weeks (followed by minimal pedometer-based intervention). Physical activity (primary outcome) was measured using pedometer step counts (7 day) and the International Physical Activity Questionnaire (long version). Psychological processes were measured using questionnaires relating to the Transtheoretical Model of Behaviour Change, mood (Positive and Negative Affect Schedule) and quality of life (Euroqol EQ-5D instrument). Physiological measures included anthropometric and metabolic outcomes. Environmental influences were assessed subje ctively (Neighbourhood Quality of Life Survey) and objectively (neighbourhood audit tool and GIS mapping). The qualitative evaluation employed observation, semi-structured interviews and focus groups. A supplementary study undertook an economic evaluation. Discussion: Data analysis is on-going. Walking for Well-being in the West will demonstrate if a pedometer based walking programme, in combination with physicalactivity consultation results in a sustainable increase in walking behaviour in this sample of Scottish adults over a 12 month period. The study will examine the complex relationships between behavioural change, health consequences and the role of the environment, in conjunction with the cost effectiveness of this approach and a detailed insight into the participants' experiences of the intervention. Trial registration: Current Controlled Trials ISRCTN88907382. Publisher PDF

Background:This article aims to examine the relative contribution of occupational activity to English adults’ meeting of government recommendations for physical activity (PA).Methods:Data were extracted from a cross-sectional survey of householders in the UK via the Health Survey for England.1 In total, 14,018 adult participants were included in the analysis. Multivariate logistic regression was used to examine the odds of achieving PA recommendations with and without including occupational activity and to examine the contribution of gender and social and demographic characteristics.Results:When occupational PA was included, 36% of men and 25% of women were active at the recommended level. Once occupational PA was removed, these proportions were 23% and 19%, respectively. These results were socially patterned, most notably by age and gender.Conclusions:Occupational PA provides a substantial contribution to those meeting the government target for PA.

The aim of this study was to examine participant and scheme characteristics in relation to access, uptake, and participation in a physical activity referral scheme (PARS) using a prospective population-based longitudinal design. Participants (n = 3762) were recruited over a 3-year period. Logistic regression analyses identified the factors associated with the outcomes of referral uptake, participation, and completion (> or = 80% attendance). Participant's age, sex, referral reason, referring health professional, and type of leisure provider were the independent variables. Based on binary logistic regression analysis (n = 2631), only primary referral reason was associated with the PARS coordinator making contact with the participants. In addition to the influence of referral reason, females were also more likely (odds ratio 1.250, 95% confidence interval 1.003-1.559, P = 0.047) to agree to be assigned to a leisure provider. Referral reason and referring health professional were associated with taking up a referral opportunity. Older participants (1.016, 1.010-1.023, P < 0.001) and males were more likely to complete the referral. In conclusion, the PARS format may be less appropriate for those more constrained by time (women, young adults) and those with certain referral reasons (overweight/obesity, mental health conditions). More appropriate targeting at the point of referral could improve participation rates by revealing or addressing barriers that might later result in dropout.

OBJECTIVE: To assess the effects of interventions to promote walking in individuals and populations. DESIGN: Systematic review. DATA SOURCES: Published and unpublished reports in any language identified by searching 25 electronic databases, by searching websites, reference lists, and existing systematic reviews, and by contacting experts. REVIEW METHODS: Systematic search for and appraisal of controlled before and after studies of the effects of any type of intervention on how much people walk, the distribution of effects on walking between social groups, and any associated effects on overall physical activity, fitness, risk factors for disease, health, and wellbeing. RESULTS: We included 19 randomised controlled trials and 29 non-randomised controlled studies. Interventions tailored to people's needs, targeted at the most sedentary or at those most motivated to change, and delivered either at the level of the individual (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups, can encourage people to walk more, although the sustainability, generalisability, and clinical benefits of many of these approaches are uncertain. Evidence for the effectiveness of interventions applied to workplaces, schools, communities, or areas typically depends on isolated studies or subgroup analysis. CONCLUSIONS: The most successful interventions could increase walking among targeted participants by up to 30-60 minutes a week on average, at least in the short term. From a perspective of improving population health, much of the research currently provides evidence of efficacy rather than effectiveness. Nevertheless, interventions to promote walking could contribute substantially towards increasing the activity levels of the most sedentary.