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

BackgroundThere is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability. ObjectiveThis study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children’s physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives; (2) determine use of different features and functions incorporated into the accompanying app; and (3) identify parents’ awareness of their child’s current physical activity levels. MethodsIn total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25; 21 mothers and 4 fathers) completed a Web-based survey to record their child’s activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subsample of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts. ResultsParents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports. ConclusionsMost parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children’s daily activity. However, several barriers were identified, which may impact sustained use over time; both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives.

BackgroundWearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. ObjectiveThe aim of this study was to examine the usability and acceptability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents’ awareness and use of the different functions and features in the wearable activity tracker and accompanying app. MethodsSixty adolescents (aged 13-14 years) in year 8 from 3 secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app, and were asked to use it for 6 weeks. Demographic data (age, sex) were collected via a Web-based survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the usability and acceptability of the Fitbit Flex, accompanying app, and Web-based Fitbit profile. Qualitative data were analyzed using pen profiles, which were constructed from verbatim transcripts. ResultsAdolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activities, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort and design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. ConclusionsAdolescents reported that the Fitbit Flex was easy to use and that it was a useful tool for tracking daily activities. A number of functions and features were used, including the device’s visual display to track and self-monitor activity, goal-setting in the accompanying app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have the potential to be integrated into physical activity interventions targeted at adolescents, but both the functionality and wearability of the monitor should be considered.

Particular types of physical activity (PA) hold the potential to enhance brain structure and functions across various age groups. Active travel (AT), a non-motorised human-powered mode of transportation, might be a particularly important form of PA that may enhance neuropsychological development, benefit executive and visuospatial cognitive abilities, and contribute to preventing cognitive degeneration. Accordingly, this systematic review explores the associations between AT and cognitive outcomes in all age groups. Searches were conducted in five databases. Of 2401 initial hits, 11 studies met the inclusion criteria. The studies ranged from 36 to 2702 participants, examined diverse cognitive outcomes, and were predominantly with children or adolescents. No studies among adult ages 20- to 60-years were included, while only one study among older adults was included in the review. There was some evidence of positive associations between AT and spatial and reasoning abilities. Mixed results were identified between AT and executive functioning and processing speed, and no associations between AT and general intelligence. Limitations included reliance on self-reported AT, a focus mainly on school travel, and heterogeneity of cognition measures. Overall, this review reveals insufficient evidence for an association between AT and cognitive functions across the lifespan, underscoring the need for further investigation.

Background: Population level physical activity generally does not meet recommended targets. Compared with private motor vehicle users, public transport users tend to be more physically active and financial incentives may encourage more public transport use, but these relationships are under-investigated. This paper describes the protocol of a randomised controlled trial that aimed to determine the effect of financially incentivising public transport use on physical activity in a regional Australian setting. Methods: Get BusActive! is a 9.5-month single-blinded randomised controlled trial. A convenience sample of Tasmanians aged ≥15 years will be randomised to a 14-week incentive-based intervention (bus trip target attainment rewarded by bus trip credits and weekly supportive text messages) or an active control following baseline measures and will be followed up ∼24 weeks later (maintenance phase). Both groups will receive written physical activity guidelines. The primary outcome is change in accelerometer-measured steps/day from baseline to immediately post intervention phase and maintenance phase. Secondary outcomes are change in: smartcard-measured bus trips/week; measured and self-reported minutes/week of physical activity and sitting; transport-related behaviour (using one-week travel diary), perspectives (e.g. enablers/barriers) and costs; health. Linear mixed model regression will determine group differences. Participant-level process evaluation will be conducted and intervention cost to the public transport provider determined. Conclusion: Get BusActive! will fill an important knowledge gap about the causal relationship between financially incentivised public transport use and physical activity—the findings will benefit health and transport-related decision makers. Trial registration: ACTRN12623000613606. Universal trial number: U1111-1292-3414.

BackgroundThis study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex.MethodsCross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11-19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models.ResultsAdolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found.ConclusionsThis multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures.

ObjectivesThe use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency in responses between local in-field observers and non-local remote online observers and (2) the reliability between in-country online observers and non-local remote online observers using the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features along streets in five countries.MethodsConsistency and inter-rater reliability were analyzed between local and non-local observers on a pooled database of 200 routes in five study regions (Melbourne, Australia; Ghent, Belgium; Curitiba, Brazil; Hong Kong, China; and Valencia, Spain) for microscale environmental feature subscales and item-level variables using the intraclass correlation coefficient (ICC).ResultsA local in-field versus remote online comparison had an ICC of 0.75 (95 % CI: 0.68-0.80) for the grand total score. An ICC of 0.91 (95 % CI: 0.88-0.93) was found for the local online versus remote online comparison. Positive subscales yielded stronger results in comparison to negative subscales, except for the similarly poor-performing positive aesthetics/social characteristics.ConclusionsThis study demonstrated remote audits of microscale built environments using online imagery had good reliability with local in-field audits and excellent reliability with local online audits. Results generally supported remote online environmental audits as comparable to local online audits. This identification of low-cost and efficient data acquisition methods is important for expanding research on microscale built environments and physical activity globally.

BackgroundMicroscale environmental features are usually evaluated using direct on-street observations. This study assessed inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), in an international context, comparing on-street with more efficient online observation methods in five countries with varying levels of walkability.MethodsData were collected along likely walking routes of study participants, from residential starting points toward commercial clusters in Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). In-person on the street and online using Google Street View audits were carried out by two independent trained raters in each city. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa statistics or Intraclass Correlation Coefficients (ICC).ResultsOverall mean assessment times were the same for on-street and online evaluations (22 ± 12 min). Only a few subscales had Kappa or ICC values

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

Purpose: Little is known about the experiences of school leaders adopting and implementing real-world, scaled-up physical activity interventions in the Australian educational system. Transform-Us! is a novel physical activity and sedentary behaviour intervention available to all primary schools in Victoria, Australia, since September 2018. This study explored barriers and facilitators experienced by school leaders during the adoption and early implementation phases of Transform-Us!. Design/methodology/approach: Qualitative study involving seven semi-structured telephone interviews with school leaders implementing Transform-Us! in primary schools in Victoria, Australia. Interview schedules were developed based on the theoretical domains framework (TDF). Interviews were coded using a framework analysis approach. Findings: Four key themes emerged relating to ten of the 14 TDF domains. Themes included: knowledge, goals, implementation factors and leadership. School leaders play a central role in creating a positive implementation environment including the delivery setting (classroom) and a supportive culture (knowledge sharing) in the school. The application of the TDF to the study bridges the gap between theory and practice and identifies potential future implementation strategies which may be further tested in professional practice future studies. Recommendations for increased adoption and sustained implementation related to seven core areas: presence of a school/programme champion(s); collaborative knowledge sharing; online training; school-based workshops; promotion of behavioural and mental health outcomes; teacher autonomy in delivery; and a supportive implementation environment. Originality/value: School leaders have a unique scope to influence the adoption and implementation of physical activity and sedentary behaviour interventions. This study outlines specific barriers and facilitators for implementation of a physical activity programme in the Australian educational setting and offers recommendations for programme optimisation.

Introduction Efficacious programmes require implementation at scale to maximise their public health impact. TransformUs is an efficacious behavioural and environmental intervention for increasing primary (elementary) school children’s (5–12 years) physical activity and reducing their sedentary behaviour within school and home settings. This paper describes the study protocol of a 5-year effectiveness–implementation trial to assess the scalability and effectiveness of the TransformUs programme.Methods and analysis A type II hybrid implementation–effectiveness trial, TransformUs is being disseminated to all primary schools in the state of Victoria, Australia (n=1786). Data are being collected using mixed methods at the system (state government, partner organisations), organisation (school) and individual (teacher, parent and child) levels. Evaluation is based on programme Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. RE-AIM domains are being measured using a quasi-experimental, pre/post, non-equivalent group design, at baseline, 12 and 24 months. Effectiveness will be determined in a subsample of 20 intervention schools (in Victoria) and 20 control schools (in New South Wales (NSW), Australia), at baseline, 12 and 24 months. Primary outcomes include TransformUs Reach, Adoption, Implementation and organisational Maintenance (implementation trial), and children’s physical activity and sedentary time assessed using accelerometers (effectiveness trial). Secondary outcomes include average sedentary time and moderate to vigorous-intensity physical activity on weekdays and during school hours, body mass index z-scores and waist circumference (effectiveness trial). Linear mixed-effects models will be fitted to compare outcomes between intervention and control participants accounting for clustering of children within schools, confounding and random effects.Ethics and dissemination The trial was approved by the Deakin University Human Research Ethics Committee (HEAG-H 28_2017), Victorian Department of Education, the NSW Department of Education, Australian Catholic University (2017-145R), Melbourne Archdiocese Catholic Schools and Catholic Schools NSW. Partners, schools/teachers and parents will provide an informed signed consent form prior to participating. Parents will provide consent for their child to participate in the effectiveness trial. Findings will be disseminated via peer-reviewed publications, scientific conferences, summary reports to schools and our partner organisations, and will inform education policy and practice on effective and sustainable ways to promote physical activity and reduce sedentary behaviours population-wide.Trial registration number Australian Clinical Trials Registration Registry (ACTRN12617000204347).

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

This study assessed the use of newly installed outdoor fitness equipment (OFE) designed for older adults in two urban parks in Melbourne, Australia, and explored barriers and facilitators to its use among older adults. Direct observations were conducted using System for Observing Play and Recreation in Communities (SOPARC) to assess OFE usage by older adults (≥60 years) at two time points: T1 (November 2021) and T2 (October 2022). Additionally, 140 older adults (60–86 years, 59.3% female) were interviewed at T2 to explore their perceptions of OFE. Across both parks and timepoints, OFE usage by older adults was minimal. At T1, only 0.7% of older park visitors at Park A were observed using the OFE, while no visitors at Park B were observed using it. At T2, 2.8% and 0.7% of older adults at Parks A and B, respectively, were observed using the OFE. Interviews revealed various barriers to OFE usage, including personal factors (health concerns and time constraints), lack of knowledge about the equipment, perceptions about equipment suitability, and crowding by children. Facilitators for enhancing use of OFE included promotional efforts, instructional classes, improved equipment design and encouraging social engagement. Given the minimal usage of OFE by older adults identified in this study, addressing barriers and leveraging facilitators are essential to maximize the return on public investment, promote active ageing and foster improved overall well-being among older adults. [ABSTRACT FROM AUTHOR]

The immune response to infectious diseases is directly influenced by metabolic activities. COVID-19 is a disease that affects the entire body and can significantly impact cellular metabolism. Recent studies have focused their analysis on the potential connections between post-infection stages of SARS-CoV2 and different metabolic pathways. The spike S1 antigen was found to have in vitro IgG antibody memory for PBMCs when obtaining PBMC cultures 60–90 days post infection, and a significant increase in S-adenosyl homocysteine, sarcosine, and arginine was detected by mass spectrometric analysis. The involvement of these metabolites in physiological recovery from viral infections and immune activity is well documented, and they may provide a new and simple method to better comprehend the impact of SARS-CoV2 on leukocytes. Moreover, there was a significant change in the metabolism of the tryptophan and urea cycle pathways in leukocytes with IgG memory. With these data, together with results from the literature, it seems that leukocyte metabolism is reprogrammed after viral pathogenesis by activating certain amino acid pathways, which may be related to protective immunity against SARS-CoV2.