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Introduction Les activités de renforcement des muscles et d’amélioration de l’équilibre sont associées à la prévention des maladies et des blessures. Les Directives canadiennes en matière de mouvement sur 24 heures offrent des recommandations concernant les activités de renforcement de l’appareil locomoteur et d’amélioration de l’équilibre. Entre2000 et 2014, l’Enquête sur la santé dans les collectivités canadiennes (ESCC) a intégré un module évaluant la fréquence de 22 activités physiques. En 2020, un module de réponse rapide sur le mode de vie sain (HLV-RR) posant de nouvelles questions sur la fréquence des activités de renforcement de l’appareil locomoteur et d’amélioration de l’équilibre a été intégré dans l’ESCC. Notre étude visait trois objectifs : 1) estimer et caractériser le respect des recommandations concernant les activités de renforcement de l’appareil locomoteur et d’amélioration de l’équilibre; 2) étudier les associations entre, d’une part, les activités de renforcement de l’appareil locomoteur et d’amélioration de l’équilibre et, d’autre part, l’état de santé physique et mentale et 3) analyser les tendances au fil du temps en matière de respect des recommandations (2000 à 2014). Méthodologie Nous avons estimé, à l’aide des données du module HLV-RR de l’ESCC 2020, la prévalence du respect des recommandations en fonction de l’âge. Des analyses de régression logistique multivariée ont porté sur les associations avec l’état de santé physique et mentale. Les données de l’ESCC de 2000 à 2014 ont fait l’objet de régressions logistiques visant à faire ressortir les tendances au fil du temps par sexe en matière de respect des recommandations. Résultats Les adolescents de 12 à 17 ans (56,6 %; IC à 95 % : 52,4 à 60,8) et les adultes de 18 à 64 ans (54,9 %; IC à 95 % : 53,1 à 56,8) étaient nettement plus nombreux à suivre la recommandation concernant le renforcement de l’appareil locomoteur que les adultes de 65 ans et plus (41,7 %; IC à 95 % : 38,9 à 44,5). Seulement 16 % des aînés respectaient la recommandation concernant l’amélioration de l’équilibre. Le respect des recommandations est associé à un meilleur état de santé physique et mentale. La proportion de Canadiens respectant les recommandations a augmenté entre 2000 et 2014. Conclusion Environ la moitié des Canadiens ont respecté les recommandations concernant le renforcement de l’appareil locomoteur pour leur âge. Rendre compte du respect des recommandations en matière de renforcement de l’appareil locomoteur et d’amélioration de l’équilibre assure de l’importance de ces recommandations au même niveau que celles en matière d’activité aérobique.

Introduction Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000–2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22 physical activities. In 2020, a healthy living rapid response module (HLV-RR) on the CCHS asked new questions on the frequency of muscle/bonestrengthening and balance activities. The objectives of the study were to (1) estimate and characterize adherence to meeting the muscle/bone-strengthening and balance recommendations; (2) examine associations between muscle/bone-strengthening and balance activities with physical and mental health; and (3) examine trends (2000–2014) in adherence to recommendations. Methods Using data from the 2020 CCHS HLV-RR, we estimated age-specific prevalence of meeting recommendations. Multivariate logistic regressions examined associations with physical and mental health. Using data from the 2000–2014 CCHS, sex-specific temporal trends in recommendation adherence were explored using logistic regression. Results Youth aged 12 to 17 years (56.6%, 95% CI: 52.4–60.8) and adults aged 18 to 64 years (54.9%, 95% CI: 53.1–56.8) had significantly greater adherence to the muscle/ bone-strengthening recommendation than adults aged 65 years and older (41.7%, 95% CI: 38.9–44.5). Only 16% of older adults met the balance recommendation. Meeting the recommendations was associated with better physical and mental health. The proportion of Canadians who met the recommendations increased between 2000 and 2014. Conclusion Approximately half of Canadians met their age-specific muscle/bonestrengthening recommendations. Reporting on the muscle/bone-strengthening and balance recommendations elevates their importance alongside the already recognized aerobic recommendation.

Refereed/Peer-reviewed Background: Few studies have investigated the optimal anthropometric index associated with potential cardio-metabolic risk.Using direct measures of standing height, body mass, and waist circumference, we sought to identify the optimal index fordetecting cardio-metabolic risk associated with diabetes and hypertension in a nationally representative sample of US adults Methods: Complete (non-missing) cross-sectional data from 8375 US adults aged 18–80+ years were obtained from the 2015–16and 2017–March 2020 (pre-pandemic) cycles of the National Health and Nutrition Examination Survey. The cardio-metabolic risk was identified using blood pressure and glycohemoglobin (A1c). Allometric models were used to identify the optimal anthropometric indices associated with cardio-metabolic risk. Receiver operating characteristics curves were used to verify the discriminatory ability of the identified index in comparison with other anthropometric measures. Results: The optimal anthropometric index associated with cardio-metabolic risk was waist circumference divided by body massto the power of 0.333 (WC/M0.333). The ability for this new index to discriminate those with diabetes (area under the ROC curve: 0.73[95%CI: 0.71–0.74]) and hypertension (area under the curve: 0.70 [95%CI: 0.69–0.72]) was superior to all other anthropometricmeasure/indices investigated in this study (body mass index, waist circumference, waist-to-height ratio, and waist/height0.5) Conclusions: We identified WC/M0.333 as the optimal anthropometric index for identifying US adults with hypertension anddiabetes. Instead of using body mass index (kg/m2), we recommend using WC/M0.333 in clinical and public health practice to better identify US adults at potential cardio-metabolic risk associated with hypertension and diabetes.

Background decreased muscle strength and physical function often precede disability, nursing home admission, home care use and mortality in older adults. Normative values for commonly used physical performance-based tests are not widely available for older adults but are required for clinicians and researchers to easily identify individuals with low performance. Objective to develop normative values for grip strength, gait speed, timed up and go, single-leg balance and five-repetition chair rise tests in a large population-based sample of Canadians aged 45–85 years. Methods baseline data (2011–2015) from the Canadian Longitudinal Study on Ageing was used to estimate age- and sex-specific normative values for each of the physical tests. Participants were without disability or mobility limitation (no assistance with activities of daily living or use of mobility devices). Results of the 25,470 participants eligible for the analyses 48.6% (n = 12,369) were female with a mean age of 58.6 ± 9.5 years. Sex-specific 5th, 10th, 20th, 50th, 80th, 90th and 95th percentile values for each physical performance-based test were estimated. Cross-validation (n = 100 repetitions) with a 30% holdout sample was used to evaluate model fit. Conclusions the normative values developed in this paper can be used in clinical and research settings to identify individuals with low performance relative to their peers of the same age and sex. Interventions targeting these at-risk individuals including physical activity can prevent or delay mobility disability and the resulting cascade of increasing care requirements, health care costs and mortality.

Objective To determine the association between social media use (SMU) and physical activity (PA) among Canadian adolescents. Methods We used data from 12,358 participants in grades 6 to 10 who responded to the Canadian component of the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Social media intensity and problematic SMU were assessed using a 4-point mutually exclusive scale that contained three categories based on intensity (non-active, active, and intense SMU) and one category based on the presence of addiction-like symptoms irrespective of intensity (problematic SMU). PA was assessed for five domains (i.e., school curriculum, organized sport, exercise, outdoor play, and active transport) and dichotomized using the first quartile to represent high PA engagement in each domain. Meeting PA recommendation of 60 min per day of moderate-to-vigorous PA was calculated using the sum of the five domains. Logistic regression models were used to assess the association between SMU and PA, with active SMU used as the reference group for all models. Results Non-active SMU was associated with lower odds of meeting the daily PA recommendations and of high engagement in all five domains of PA when compared to active SMU. Intense SMU was associated with higher odds of meeting the daily PA recommendations. Problematic SMU was not associated with meeting daily PA recommendations, but it was significantly associated with lower odds of high PA engagement in the exercise domain. Conclusion The findings of this study suggest that non-active SMU was significantly associated with lower PA levels. Problematic SMU was only significantly associated with lower PA levels in the exercise domain. Intense SMU was associated with higher odds of meeting the PA recommendation.

Regular physical activity prevents several non-communicable chronic conditions and premature mortality. The benefits of physical activity can be achieved through active transport, which refers to n...

We used a prevalence-based approach to estimate the economic costs associated with low muscle strength, as assessed using handgrip strength, in Canadian adults. We estimated the annual economic burden of low muscle strength at $3.0 billion, representing 2.2% of the 2021 Canadian burden of illness costs. The two most expensive chronic diseases attributable to low muscle strength were cardiovascular disease ($899 million) and type 2 diabetes ($880 million). A 10% decrease in the prevalence of low handgrip strength would save approximately $546 million per year, equivalent to an 18.1% cost reduction. Strategies to increase population-level muscle strength are needed to reduce healthcare costs and improve health. The economic cost associated with low muscle strength in Canadian adults is unknown. The total annual economic burden of low muscle strength in Canadian adults represents 2.2% of the overall burden of illness costs in 2021. We estimated that $546 million per year would be saved if the prevalence of low handgrip strength was reduced by 10%.

Background The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. Objective This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents. Methods Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel. Results There was strong between-panel agreement (panel 1: rs = 0.76, p rs = 0.77, p Conclusions The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond.

Data on meeting the Canadian 24-Hour Movement Guidelines for adults (24-H Guidelines) and associations with health indicators by body mass index (BMI) class are needed to support public health surveillance. The aim of this study was to describe the proportion of Canadian adults meeting individual and various combinations of the 24-H Guidelines by BMI class and their association with health indicators.Data from the cross-sectional Canadian Health Measures Survey cycles 1 to 4 (2007 to 2015, n = 10,515 adults aged 18 to 79 years) were used. Daily time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behaviour were assessed using accelerometry. Sleep duration, recreational screen time, chronic conditions, sociodemographic characteristics, and general and mental health were self-reported. The BMI, waist circumference, blood pressure and aerobic fitness were directly measured. Respondents were classified as meeting the 24-H Guidelines when: • the MVPA was 150 minutes per week or more; • sedentary time was nine hours or less per day; • recreational screen time was three hours or less per day; • sleep duration was seven to nine hours per day for individuals aged 18 to 64 years or seven to eight hours per day for individuals aged 65 years and older.Significantly fewer adults with overweight (6.1%) or class I (4.3%) and class II or III (3.9%) obesity met all three 24-H Guidelines compared with those with normal weight (9.5%). Meeting all three or two recommendations of the 24-H Guidelines was generally associated with a lower waist circumference, higher aerobic physical fitness and self-perceived general health regardless of BMI class.Canadian adults living with overweight and obesity are less likely to meet the 24-H Guidelines. Most of the benefits associated with meeting the 24-H Guidelines are observed regardless of BMI status.

Cardiorespiratory fitness (CRF), which reflects the overall aerobic capacity of the cardiovascular, respiratory, and muscular systems, is significantly related to health among youth. The aim of this systematic review was to identify health-related criterion-referenced cut-points for CRF among youth aged 5–17 years. A systematic search of two electronic databases (MEDLINE and SPORTDiscus) was conducted in September 2020. Only peer-reviewed studies that developed health-related criterion-referenced cut-points for CRF among youth were eligible provided they included (1) youth aged 5–17 years from the general population; (2) at least one quantitative assessment of CRF (e.g., peak oxygen uptake [ $${V}$$ O2peak]); (3) at least one quantitative assessment of health (e.g., cardiometabolic risk); (4) a criterion for health; and (5) a quantitative analysis (e.g., receiver operating characteristic [ROC] curve) of at least one health-related cut-point for CRF. A narrative synthesis was used to describe the results of the included studies. Collectively, 29 included studies developed health-related criterion-referenced cut-points for CRF among 193,311 youth from 23 countries. CRF cut-points, expressed as $${V}$$ O2peak, estimated using the 20-m shuttle run test, demonstrated high discriminatory ability (median area under the curve [AUC] ≥ 0.71) for both cardiometabolic and obesity risk. Cut-points derived from maximal cycle-ergometer tests demonstrated moderate discriminatory ability (median AUC 0.64–0.70) for cardiometabolic risk, and low discriminatory ability for early subclinical atherosclerosis (median AUC 0.56–0.63). Cut-points for CRF using submaximal treadmill exercise testing demonstrated high discriminatory ability for cardiometabolic risk, but only moderate discriminatory ability for obesity risk. CRF cut-points estimated using submaximal step testing demonstrated high discriminatory ability for cardiometabolic risk and moderate discriminatory ability for high blood pressure, while those for the 9-min walk/run test demonstrated moderate-to-high discriminatory ability for obesity risk. Collectively, CRF cut-points, expressed as $${V}$$ O2peak, demonstrated moderate-to-high discriminatory ability (median AUC ≥ 0.64) for cardiometabolic risk, obesity risk, and high blood pressure. Currently, there is too wide a range of health-related criterion-referenced cut-points for CRF among youth to suggest universal age- and sex-specific thresholds. To further inform the development of universal cut-points, there is a need for additional research, using standardized testing protocols and health-risk definitions, that examines health-related criterion-referenced cut-points for CRF that are age, sex, and culturally diverse. PROSPERO registration number: CRD42020207458.

Background: Musculoskeletal fitness is an excellent functional measure that is significantly related to health among youth. Objective: Our objective was to identify health-related criterion-referenced cut-points for musculoskeletal fitness (MSF) among youth. Methods: A systematic search of two electronic databases (MEDLINE and SPORTDiscus) was conducted in September 2020. Only peer-reviewed studies that developed health-related criterion-referenced cut-points for MSF among youth were eligible provided they included (1) youth aged 5–17 years from the general population, (2) at least one quantitative assessment of MSF (e.g., muscular strength), (3) at least one quantitative assessment of health (e.g., cardiometabolic risk), (4) a criterion for health, and (5) a quantitative analysis [e.g., receiver operating characteristic (ROC) curve] of at least one health-related cut-point for MSF. A narrative synthesis was used to describe the results of included studies. Results: Collectively, 13 studies that developed health-related criterion-referenced cut-points for MSF among 14,476 youth from 15 countries were included. Muscular strength demonstrated high discriminatory ability [median area under the curve (AUC) ≥ 0.71] for cardiometabolic risk/metabolic syndrome, sarcopenic obesity risk and bone health, and moderate discriminatory ability (median AUC 0.64–0.70) for asthma. Muscular power also demonstrated high discriminatory ability for bone health but only moderate discriminatory ability for cardiometabolic risk/metabolic syndrome and low discriminatory ability (median AUC 0.56–0.63) for cognition/academic performance. Both muscular endurance and flexibility demonstrated low discriminatory ability for musculoskeletal pain. Health-related cut-points for MSF that demonstrated significant discriminatory ability were generally higher for boys than for girls (for muscular strength and power) and generally increased with age for muscular strength and power but remained stable for flexibility. Conclusions: Data remain insufficient to establish universal health-related cut-points for MSF among youth. Despite variations in the health-related discriminatory ability of different MSF tests, handgrip strength and standing broad jump emerged as the two tests with the highest discriminatory ability. More research, using standardized testing protocols and health-risk definitions, is required to better triangulate universal health-related cut-points for MSF among youth. Refereed/Peer-reviewed

To evaluate current levels of physical activity and sedentary behaviour among pregnant and non-pregnant adults in Canada.We ascertained population-based cross-sectional data from the Canadian Community Health Survey (CCHS), 2015-2019, and from the Canadian Health Measures Survey (CHMS), 2007-2019. We included adults who were assigned female at birth and of reproductive age (ages 18-55) living in the provinces. We analyzed activity data from validated questionnaires and accelerometers.We included 53 765 adults from the CCHS and 5321 from the CHMS, weighted to represent 16 million people. Based on accelerometers, both pregnant and non-pregnant adults spent 9.5 hours per day (70% of their time) engaged in sedentary behaviour. Across all survey years, ages, and Canadian regions, pregnant adults, especially those under 35 years old, spent less time engaged in moderate-to-vigorous physical activity (MVPA) compared to non-pregnant adults. Pregnant adults reported 34.3 minutes (95% CI 30.5-38.2) and objectively accrued 14.9 minutes (95% CI 7.9-21.8) in MVPA per day - 15.1 and 8.9 fewer minutes compared to non-pregnant adults, respectively. After accounting for self-report bias, only 27.5% (95% CI 24.1-31.0) of pregnant and 41.1% (95% CI 40.4-41.9) of non-pregnant adults met the Canadian physical activity guidelines (i.e., ≥ 150 minutes of MVPA per week).Physical activity levels are remarkably low among both pregnant and non-pregnant adults, with few meeting current guidelines. Given the substantial physical and mental health benefits, more supports are needed to increase pre-pregnancy and prenatal activity in Canada.

Background: The standing broad jump (SBJ) is an excellent functional measure of explosive lower-body strength that is significantly related to health among children and adolescents. Objectives: The aim of this study was to estimate national (country-level) and international (pooled global data) temporal trends in SBJ performance for children and adolescents, and to examine the relationships between national trends in SBJ performance and national trends in health-related and socioeconomic/demographic indicators. Methods: Data were obtained from a systematic search of studies reporting temporal trends in SBJ performance for 9- to 17-year-olds, and by examining national fitness datasets. Sample-weighted regression models estimated trends at the study/dataset-country-sex-age level, with national and international trends estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in SBJ performance and national trends in health-related and socioeconomic/demographic indicators. Results: Data from 34 studies/datasets were extracted to estimate trends for 10,940,801 children and adolescents from 24 high-, 4 upper-middle-, and 1 low-income countries between 1960 and 2017. Collectively, there was a negligible (per decade) improvement in SBJ performance of 1.73 cm (95% CI 1.71–1.75), 0.99% (95% CI 0.97–1.01) or a standardized effect size of 0.07 (0.07–0.07) over the entire period, with the rate of improvement steady from the 1960s to the 1980s, slowing in the 1990s, before declining. Sex- and age-related temporal differences were negligible. Trends differed between countries, with most countries experiencing declines. National trends in SBJ performance were not significantly related to national trends in health-related and socioeconomic/demographic indicators. Conclusions: SBJ performance of children and adolescents has declined since 2000 (at least among most of the countries in this analysis) and is suggestive of a modern decline in functional explosive lower-body strength. Growing recognition of the importance of muscular fitness as a marker of population health highlights the need for continued tracking of temporal trends in SBJ, especially among low- and lower-middle-income countries for which temporal data are lacking. Refereed/Peer-reviewed

Background: Handgrip strength (HGS) is an excellent marker of functional capability and health in adults, although little is known about temporal trends in adult HGS. Objectives: The aim of this study was to systematically analyze national (country-level) temporal trends in adult HGS, and to examine the relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Methods: Data were obtained from a systematic search of studies reporting temporal trends in HGS for adults (aged ≥ 20 years) and by examining national fitness datasets. Trends in mean HGS were estimated at the country–sex–age group level by best-fitting sample-weighted linear/polynomial regression models, with national and sub-regional (pooled data across geographically similar countries) trends estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Results: Data from ten studies/datasets were extracted to estimate trends in mean HGS for 2,592,714 adults from 12 high- and 2 upper-middle-income countries (from Asia, Europe and North America) between 1960 and 2017. National trends were few, mixed and generally negligible pre-2000, whereas most countries (75% or 9/12) experienced negligible-to-small declines ranging from an effect size of 0.05 to 0.27, or 0.6 to 6.3%, per decade post-2000. Sex- and age-related temporal differences were negligible. National trends in adult HGS were not significantly related to national trends in health and socioeconomic/demographic indicators. Conclusions: While trends in adult HGS are currently limited to 14 high- and upper-middle-income countries from three continents, adult HGS appears to have declined since 2000 (at least among most of the countries in this analysis), which is suggestive of corresponding declines in functional capability and health Refereed/Peer-reviewed

Background Suicide is a behaviour that results from a complex interplay of factors, including biological, psychological, social, cultural, and environmental factors, among others. A participatory model building workshop was conducted with fifteen employees working in suicide prevention at a federal public health organization to develop a conceptual model illustrating the interconnections between such factors. Through this process, knowledge emerged from participants and consensus building occurred, leading to the development of a conceptual model that is useful to organize and communicate the complex interrelationships between factors related to suicide. Methods A model building script was developed for the facilitators to lead the participants through a series of group and individual activities that were designed to elicit participants’ implicit models of risk and protective factors for suicide in Canada. Participants were divided into three groups and tasked with drawing the relationships between factors associated with suicide over a simplified suicide process model. Participants were also tasked with listing prevention levers that are in use in Canada and/or described in the scientific literature. Results Through the workshop, risk and prevention factors and prevention levers were listed and a conceptual model was drafted. Several “lessons learned” which could improve future workshops were generated through reflection on the process. Conclusions This workshop yielded a helpful conceptual model contextualising upstream factors that can be used to better understand suicide prevention efforts in Canada.

The objective of this study was to establish cut-points to identify potential clustered cardiometabolic risk among children (aged 9–13 years) and youth (aged 14–17 years) using the modified Canadian Aerobic Fitness Test (mCAFT). Nationally representative cross-sectional data were obtained from cycles 1 and 2 (2007–2011) of the Canadian Health Measures Survey. Cardiorespiratory fitness was measured using the mCAFT, which was used to estimate peak oxygen consumption. Clustered cardiometabolic health was identified as the mean of 4 standardized variables: sum of 4 skinfolds; total cholesterol–to–high-density lipoprotein ratio; and systolic and diastolic blood pressure. In total, 2106 (49% female) participants were retained for this analysis. The optimal mCAFT cut-point for males was 49 and 46 mL·kg–1·min–1 among children and youth, respectively. Among females, the mCAFT cut-point was 46 and 37 mL·kg–1·min–1 among children and youth, respectively. In 2016–2017, 83% of females and 71% of males met the new mCAFT cut-points. The mCAFT cut-points can help identify children and youth at potential risk of poor cardiometabolic health in public health surveillance, clinical, and school-based settings. Novelty We developed new mCAFT cut-points to identify potential clustered cardiometabolic risk among Canadian children and youth. These mCAFT cut-points can be used to inform national health surveillance efforts.

Objective: To estimate national and international temporal trends in handgrip strength for children and adolescents, and to examine relationships between trends in handgrip strength and trends in health-related and sociodemographic indicators. Methods: Data were obtained through a systematic search of studies reporting temporal trends in the handgrip strength for apparently healthy 9–17-year-olds, and by examining large national fitness datasets. Temporal trends at the country–sex–age level were estimated by sample-weighted regression models relating the year of testing to mean handgrip strength.International and national trends were estimated by a post-stratifed population-weighting procedure. Pearson’s correlation squantifed relationships between national trends in handgrip strength and national trends in health-related/sociodemographic indicators. Results: 2,216,320 children and adolescents from 13 high-, 5 upper-middle-, and 1 low-income countries/special administrative regions between 1967 and 2017 collectively showed a moderate improvement of 19.4% (95% CI 18.4–20.4) or 3.8% perdecade (95% CI 3.6–4.0). The international rate of improvement progressively increased over time, with more recent values(post-2000) close to two times larger than those from the 1960s/1970s. Improvements were larger for children (9–12 years)compared to adolescents (13–17 years), and similar for boys and girls. Trends difered between countries, with relationships between national trends in handgrip strength and national trends in health-related/sociodemographic indicators negligible to-weak and not statistically signifcant. Conclusions: There has been a substantial improvement in absolute handgrip strength for children and adolescents since 1967. There is a need for improved international surveillance of handgrip strength, especially in low- and middle-income ountries, to more confdently determine true international trends. Refereed/Peer-reviewed

Meeting the physical activity (PA) and recreational screen time recommendations for children and young people is associated with several health benefits. The purpose of this study was to compare the odds of meeting PA and recreational screen time recommendations between the Canadian youth living in urban versus rural communities. We analyzed nationally representative cross-sectional data collected as part of the 2017–2018 cycles of the Canadian Community Health Survey among young people aged 12–17 years. PA and screen time were self-reported. Sex-specific multivariable logistic regression models were used to estimate the odds of meeting individual and combined PA and recreational screen time recommendations by rural and urban status after adjusting for individual, socioeconomic, and seasonal covariates. The odds of meeting the PA recommendation were not statistically significantly different among males (OR = 1.01, 95% CI: 0.86–1.18) or females (OR 1.05, 95% CI: 0.99–1.11) living in urban versus rural communities. The odds of meeting the recreational screen time recommendations were statistically significantly lower among male (OR = 0.71, 95% CI: 0.65–0.77) and female (OR = 0.71, 95% CI: 0.59–0.86) youth living in urban compared to those in rural communities. The odds of meeting the combined PA and screen time recommendations were statistically significantly lower among urban males (OR = 0.75, 95% CI: 0.71–0.81) but not females (OR = 0.82, 95% CI: 0.58–1.15) than those from rural communities. These findings suggest that residential context (i.e., urban versus rural) may have a differential impact on meeting the combined PA and screen time recommendations among the male and female Canadian youth. Future research should investigate these differences using device-based measures.

Refereed/Peer-reviewed The objective of this study was to estimate health care and health-related productivity costs associated with low cardiorespiratory fitness (CRF) in Canadian adults. We also estimated costs that would be avoided by a 10 percentage point prevalence reduction in low CRF. A prevalence-based approach was used to estimate the economic costs associated with low CRF. Three pieces of information were used: (1) the pooled relative risk estimates of adverse health outcomes consistently associated with low CRF obtained from meta-analyses of prospective cohort studies; (2) the prevalence of low CRF in Canadian men and women obtained from a nationally representative sample; and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes based on the Economic Burden of Illness in Canada data. We estimated the total annual economic burden of low CRF in Canadian adults at CAD$3.6 billion, representing 2.7% of the overall Canadian burden of illness costs in 2021. The three most expensive chronic diseases attributable to low CRF were type 2 diabetes (CAD$1.3 billion), heart disease (CAD$701 million), and depression/anxiety (CAD$565 million). Prescription drug expenditures and hospital care expenditures were the main contributors to the total economic burden. An absolute 10% reduction in the prevalence of low CRF (from 45.5% to 35.5%) would save an estimated CAD$644 million per year in costs. In conclusion, low CRF is an important contributor to the economic burden of illness in Canada. Evidence-based and cost-effective strategies that aim to increase CRF at the population level may help alleviate health care costs and improve health.

Built environments have been implicated in the development of chronic disease, with physical activity (PA) considered one of the critical mechanisms for this relationship. Substantial growth in research on built environments and PA makes navigating the available evidence challenging.To examine and describe the current state, strength and quality of research investigating the associations between built environments and PA domains of active living (i.e., leisure, transportation, occupational) and total PA among adults (≥18 years) from high-income OECD countries.We conducted an overview of systematic reviews. A systematic search of six bibliographic databases and grey literature from January 2000 to May 2020. Review quality was assessed with the AMSTAR2. Results by age group were synthesized narratively and direction of association displayed using harvest plots. Certainty of the evidence was assessed using a modified GRADE approach.The overview included 116 systematic reviews. Most evidence was cross-sectional and of low-to-very low quality. Moderate-to-high certainty of evidence supported positive associations between environments that support active transportation (e.g., walkability, walking infrastructure, street connectivity, land-use mix) and transportation PA among adults/working-aged adults. Across all age groups, there was very low-to-moderate certainty for consistent positive associations between point of decision prompts (e.g., signs in stairwells and along paths) and all PA. Evidence from older adults was of very low certainty and largely equivocal. There was little-to-no evidence for young and middle-aged adults and occupational PA.While there has been an increase in evidence from observational and natural experiment studies, most has been related to active transportation infrastructure and point of decision prompts. There remains a need for these studies to evaluate built environments for leisure and occupational PA and among younger and older adults, and for high quality reviews to summarize this evidence. Interventions that target changes to the built environment show promise for promoting PA among adults, providing an important means to combat the global physical inactivity crisis.

Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. We are grateful to the surveillance systems, including cancer registries, that generated and shared observed cancer burden data. S M Aljunid acknowledges the Department of Health Policy and Management, College of Public Health, Kuwait University for the approval and support to participate in this research project. H Ariffin acknowledges support from the Ministry of Higher Education, Malaysia (grant FRGS/1/2021/SKK0/UM/01/1). F Barra acknowledges support from Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 x 1000 anno 2019. L Belo and M Carvalho acknowledge the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A J Cohen was supported by the Health Effects Institute, Boston, MA, USA. J Conde acknowledges financial support from the European Research Council - ERC Starting Grant 848325. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. T C Ekundayo was supported by the African-German Network of Excellence in Science (AGNES), the Federal Ministry of Education and Research (BMBF) and the Alexander von Humboldt Foundation (AvH). N Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). J C Glasbey is support by a Doctoral Research Fellowship from the National Institute of Health Research (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. C Herteliu, A Pana, and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is also partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported from Operational Programme Research, Development and Education–Project, Postdoc2MUNI (number CZ.02.2. 69/0.0/0.0/18_053/0016952). M Jakovljevic acknowledges partial support through the grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J H Kauppila acknowledges research grants from Sigrid Jusélius Foundation and the Finnish Cancer Foundation. M N Khatib acknowledges support from Datta Meghe Institute of Medical Sciences (deemed-to-be-university). Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional assistance by Manipal Academy of Higher Education, Manipal. K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). M-C Li was supported by the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). G Liu acknowledges support from the CREATE Hope scientific fellowship from Lung Foundation Australia. J Liu acknowledges support from the National Natural Science Foundation (72122001). J A Loureiro was supported by Scientific Employment Stimulus (FCT; CEECINST/00049/2018). E Mathews is supported by a Clinical and Public Health Early Career Fellowship (grant number IA/CPHE/17/1/503345) from the DBT India Alliance/Wellcome Trust Department of Biotechnology, India Alliance (2018–2023). T J Meretoja was supported by an unrestricted grant from Cancer Foundation Finland sr. S Mohammed acknowledges a fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. M Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta received support from the Italian Ministry of Health at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy (RC 34/2017). U Mons is supported by the Marga and Walter Boll Foundation, Kerpen, Germany. M A Moosavi acknowledges the financial support of National Institute of Genetics Engineering and Biotechnology (NIGEB). J Musa acknowledges support from the NIH/FICK43TW011416 for research-protected time for cervical cancer research and career development at University of Jos. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support by the Fogarty International Center of the National Institutes of Health under the award number K43TW010704 for research-protected time. The content is solely the responsibility of all the authors and does not necessarily represent the official views of the National Institutes of Health. A S Oguntade acknowledges funding by a doctoral scholarship from the Nuffield Department of Population Health, University of Oxford (Oxford Population Health). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for their constant support in research collaborations. R G Pestell acknowledges support from NIH grant W81XWH1810605 Breast Cancer Research, Breakthrough Grant R21 CA235139-01. Z Z Piracha acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. R A Radhakrishnan acknowledges support from Wellcome Trust/DBT India Alliance - IA/CPHI/18/1/503927. U Saeed acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Science and Technology Program (grant number KQTD20190929172835662). H R Shahsavari acknowledges the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. A Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. D A S Silva acknowledges financing in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and D A S Silva is supported in part by CNPq-Brazil (309589/2021-5). L M L R Silva was supported by project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE). Am Singh is supported by the International Graduate Research Scholarship, University of Tasmania. R Suliankatchi Abdulkader acknowledges support from ICMR—National Institute of Epidemiology. B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. H Xiao acknowledges support from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. X Xu is supported by the University of New South Wales (Australia) Scientia Program. C Yu was supported by the National Natural Science Foundation of China (grant number 82173626) and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee (grant number WJ2019H304). Sí

The new Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years and older recommend that adults limit daily sedentary time to eight hours or less, including three hours or less of recreational screen time. The eight-hour recommendation was centred between the evidence from research using self-reported sitting time (threshold: seven hours or less per day) and accelerometer-measured sedentary time (threshold: nine hours or less per day). The purpose of this study is to compare the percentages of Canadians meeting three different sedentary thresholds (three hours or less per day of screen time, seven hours or less per day of self-reported sitting time and nine hours or less per day of accelerometer-measured sedentary time).This analysis is based on 2,511 adults (aged 18 to 79 years) from Cycle 3 of the Canadian Health Measures Survey, in 2012 and 2013. Screen time and sitting time were assessed via self-report, and average daily sedentary time was assessed using a hip-worn Actical accelerometer.Adults self-reported an average daily screen time of 3.2 hours (95% confidence interval [CI]: 3.0 to 3.5) and an average daily sitting time of 5.7 hours (95% CI: 5.4 to 6.0). According to accelerometry data, adults accumulated an average of 9.8 hours per day (95% CI: 9.7 to 9.9) of sedentary time. Adherence varied, with 57.7% meeting the self-reported recreational screen time threshold of three hours or less per day, 71.7% meeting the self-reported sitting time threshold of seven hours or less per day and 26.5% meeting the accelerometer-measured sedentary time threshold of nine hours or less per day.The percentage of Canadian adults meeting the three different sedentary behaviour thresholds varied widely. The findings in this article highlight the difference in sedentary time between what Canadians report versus what is measured by an accelerometer.