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Background: Most youth are not meeting physical activity guidelines, and schools are a key venue for providing physical activity. School districts can provide physical activity opportunities through the adoption, implementation, monitoring, and evaluation of policies. This paper reports results of a 2009 survey of California school governance leaders on the barriers and opportunities to providing school-based physical activity and strategies to promote adoption of evidence-based policies. Methods: California school board members (n = 339) completed an 83 item online survey about policy options, perceptions, and barriers to improving physical activity in schools. Results: Board members’ highest rated barriers to providing physical activity were budget concerns, limited time in a school day, and competing priorities. The key policy opportunities to increase physical activity were improving the quantity and quality of physical education, integrating physical activity throughout the school day, supporting active transportation to/from school, providing access to physical activity facilities during nonschool hours, and integrating physical activity into before/after school programs. Conclusions: Survey findings were used to develop policy resources and trainings for school governance leaders that provide a comprehensive approach to improving physical activity in schools.
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Periodically, claims are made that excessive energy intake is the overwhelming cause of the obesity epidemic.1Cutler DM Bleich S Murray C Adams A Why is the developed world obese?.Annu Rev Public Health. 2008; 29: 273-295Crossref PubMed Scopus (253) Google Scholar, 2Swinburn BA Sacks G Hall KD et al.The global obesity pandemic: shaped by global drivers and local environments.Lancet. 2011; 378: 804-814Summary Full Text Full Text PDF PubMed Scopus (2895) Google Scholar Yet these claims discount substantial evidence about the favourable effects of physical activity on obesity prevention, maintenance of weight loss, body fat, and fat distribution, and about the major health benefits of physical activity that are independent of weight status.3Physical Activity Guidelines Advisory CommitteePhysical Activity Guidelines Advisory Committee report, 2008. US Department of Health and Human Services, Washington, DC2008Google Scholar For decades, physical activity research focused almost exclusively on the sports, leisure, and recreation domain, with a minor emphasis on occupational activity. Although walking for transportation has been a daily source of physical activity throughout human history, this domain was all but ignored in physical activity research until recently. This neglect might have been due to the near absence of walking and cycling for transportation in many countries, as a result of transportation policies that have explicitly promoted motorised travel by automobile. Ellen Flint and colleagues' longitudinal study4Flint E Webb E Cummins S Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank.Lancet Public Health. 2016; (published online Oct 28.)http://dx.doi.org/10.1016/S2468-2667(16)30006-8Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar on the use of active or public transport versus cars to commute to work, published in The Lancet Public Health, is a major advance in understanding the contribution of all modes of physical activity to obesity and other health outcomes. This study defined active commuting as walking and cycling, which were grouped together with public transport and compared with car commuting. As reviewed in the Article, several previous studies, including two prospective studies, have shown associations between active transport and weight status. An important strength of Flint and colleagues' study was the use of objectively measured body-mass index (BMI), which is preferred to self-reported BMI—a measure that is prevalent in the existing literature. With a sample of almost 6000 adults aged 40–69 years, the authors were able to examine the relation between changes in commuting mode and changes in BMI over 4 years. The main findings were that people who changed from active or public commuting to car commuting had a relative increase in BMI of 0·3 kg/m2, and those who changed from car commuting to active or public commuting had a relative decrease in BMI of 0·3 kg/m2. These results were almost identical to a previous study5Martin A Panter J Suhrcke M Ogilvie D Impact of changes in mode of travel to work on changes in body mass index: evidence from the British Household Panel Survey.J Epidemiol Community Health. 2015; (published online May 7.)https://doi.org/10.1136/jech-2014–205211Crossref Google Scholar that used self-reported BMI, strengthening confidence in the results. These 4-year changes in BMI, although statistically significant, seem small, so consideration of why the findings are likely to be underestimated is important. First, commuting to work is only one part of an individual's total transport behaviour. Because the work commute is usually the longest trip of the day, people do not usually walk or cycle to work. Walking or cycling for transport mostly occurs within neighbourhoods, for shopping, dining, or visiting friends.6Sugiyama T Neuhaus M Cole R et al.Destination and route attributes associated with adults' walking: a review.Med Sci Sports Exerc. 2012; 44: 1275-1286Crossref PubMed Scopus (215) Google Scholar Thus, Flint and colleagues' study4Flint E Webb E Cummins S Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank.Lancet Public Health. 2016; (published online Oct 28.)http://dx.doi.org/10.1016/S2468-2667(16)30006-8Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar did not reflect the full potential impact of transport behaviour on BMI. Second, as emphasised in the Article,4Flint E Webb E Cummins S Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank.Lancet Public Health. 2016; (published online Oct 28.)http://dx.doi.org/10.1016/S2468-2667(16)30006-8Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar almost all the changes in commuting mode were between cars and public transport. Although public transport is definitely an active mode of commuting, it is not as active as walking or cycling. Third, we do not know at what timepoint within the 4 years the change in commuting mode occurred. Thus, the duration of exposure to the new mode is unknown, and should not be assumed to be 4 years. An important and sobering finding was the tiny net increase in the prevalence of walking and cycling: 44 people switched from driving to walking or cycling, and 33 switched to driving, for a net gain of only 11 active commuters among almost 6000 people over 4 years. This finding suggests that not much progress has been made in the promotion of active commuting. The Lancet Series on Urban Design, Transport, and Health puts these findings in a broader context. Global trends in city planning and urban design, especially during the last half of the 20th century, favoured lower density and single-use developments that separated people's residences from daily destinations for shopping, work, and school. Even stronger trends prioritised motorised transport over all other modes and created automobile dependence in many cities. An extensive body of literature documents the negative health effects of automobile-oriented built environments on non-communicable diseases, traffic-related injuries, respiratory diseases from pollution, stress, noise, and other outcomes.7Giles-Corti B Vernez-Moudon A Reis R et al.City planning and population health: a global challenge.Lancet. 2016; (published online Sept 23.)http://dx.doi.org/10.1016/S0140-6736(16)30066-6Summary Full Text Full Text PDF Scopus (596) Google Scholar Unhealthy built environments are the result of public policies and public investments, but the initial rationales for these policies are now undermined by evidence of negative health effects. Systems modelling has shown that changing land-use practices, transportation goals, and infrastructure to increase active transport would create gains in multiple health outcomes in six diverse global cities.8Stevenson M Thompson J de Sá TH et al.Land use, transport, and population health: estimating the health benefits of compact cities.Lancet. 2016; (published online Sept 23.)http://dx.doi.org/10.1016/S0140-6736(16)30067-8Summary Full Text Full Text PDF Scopus (294) Google Scholar An encouraging finding is that cities are showing commitment to prioritising active transport over driving to achieve health, environmental sustainability, and economic development goals,9Sallis JF Bull F Burdett R et al.Use of science to guide city planning policy and practice: how to achieve healthy and sustainable future cities.Lancet. 2016; (published online Sept 23.)http://dx.doi.org/10.1016/S0140-6736(16)30068-XSummary Full Text Full Text PDF Scopus (219) Google Scholar but not enough cities are taking these actions. The evidence from Flint and colleagues' study4Flint E Webb E Cummins S Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank.Lancet Public Health. 2016; (published online Oct 28.)http://dx.doi.org/10.1016/S2468-2667(16)30006-8Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar—ie, that active and public transport contribute to improvements in BMI—provides further support for public health and medical professionals to advocate for healthier city design and transportation policies. Advocacy needs to be accompanied by ongoing collaboration and cross-sectoral efforts to ensure that health-promoting land use and transport policies are adopted, funded, implemented, and ideally, assessed. Active transport might be the best indicator of progress toward the goal of healthy cities worldwide. I report grants from the National Heart, Lung and Blood Institute, Robert Wood Johnson Foundation, Nike, California Endowment, Centers for Disease Control and Prevention, and National Institute of Diabetes, Digestive, and Kidney Diseases; personal fees from the Center for Active Design, SPARK physical activity programs/School Specialty, and Santech; non-financial support from the Urban Land Institute Conference and Oregon Chapter of the American Planning Association. Change in commute mode and body-mass index: prospective, longitudinal evidence from UK BiobankIncorporation of increased levels of physical activity as part of the commute to work could reduce obesity among middle-aged adults in the UK. Full-Text PDF Open Access
Background Between 2003 and 2008, a total of 25 partnerships funded through the Active Living by Design (ALbD) program worked to change built environments and policies in communities to help citizens be active in their daily routines. Purpose This paper systematically summarized the scope of ALbD physical projects and policy changes, described resources generated by the partnerships, and highlighted supports and barriers to the process. Methods Using a mixed-methods approach, multiple data sources, including key informant interviews, focus groups, and a web-based tracking system, were used to collect data during project implementation. Qualitative results were analyzed using systematic coding procedures to identify themes, ideas, and concepts derived from the data. Data analysis occurred in 2008–2010. Results Most of the 25 partnerships documented physical projects and policy changes in each of the following sectors: urban planning (n=16); active transportation (n=23); trails/parks/recreation/open space (n=22); communities (n=22); and schools (n=18). ALbD community partnerships were successful at generating ∼$256 million in resources beyond their initial grant, mostly through policy changes. Challenges included creating and sustaining political will and community support as well as securing technical expertise and resources. Planning and relationship building were critical to success in changing policy and implementing projects. Conclusions Although there is more to understand about how these change processes affect physical activity and health across populations and settings, as well as how social, cultural, and psychosocial factors influence community responses to the policy changes and physical projects, findings from this initiative provide a foundation for subsequent research and practice.
Objectives To examine the psychometric properties of the Neighborhood Environment Walkability Scale-Youth (NEWS-Y) and explore its associations with context-specific and overall physical activity (PA) among youth. Methods In 2005, parents of children ages 5–11 (n =116), parents of adolescents ages 12–18 (n =171), and adolescents ages 12–18 (n =171) from Boston, Cincinnati, and San Diego, completed NEWS-Y surveys regarding perceived land use mix-diversity, recreation facility availability, pedestrian/automobile traffic safety, crime safety, aesthetics, walking/cycling facilities, street connectivity, land use mix-access, and residential density. A standardized neighborhood environment score was derived. Self-reported activity in the street and in parks, and walking to parks, shops, school, and overall physical activity were assessed. Results The NEWS-Y subscales had acceptable test–retest reliability (ICC range .56–.87). Being active in a park, walking to a park, walking to shops, and walking to school were related to multiple environmental attributes in all three participant groups. Total neighborhood environment, recreation facilities, walking and cycling facilities, and land use mix-access had the most consistent relationships with specific types of activity. Conclusions The NEWS-Y has acceptable reliability and subscales were significantly correlated with specific types of youth PA. The NEWS-Y can be used to examine neighborhood environment correlates of youth PA.
The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy researchers may improve the likelihood of translating research findings into changes in environments, policies, and practices.
The International Physical Activity Questionnaire (IPAQ) is an effective instrument to determine the physical activity patterns in youth and identify the health-related outcomes of PA. The long and short IPAQ are equal forms assessing the time spent performing vigorous and moderate PA and walking during the last 7 days. The short IPAQ uses one question to assess PA in each category (vigorous, moderate and walking). The long IPAQ comprises of two questions asking about vigorous PA, six about moderate PA and three about walking. PURPOSE: To identify differences in the outcomes in MET-min/week from the long and short self-administrated version of the IPAQ to improve accuracy in explaining the findings. METHODS: The IPAQ was applied in a national sample of Czech youth aged 15-24y. The short IPAQ was completed by 890 females and 814 males in April, May September and October 2004. Long IPAQ was completed by 839 females and 751 males in April, May, September and October 2005. Data processing and clearing were done according to the Scoring Protocol for the IPAQ Long and Short Forms. To identify the differences in MET-min/week in each PA category between the short and long IPAQ forms 2×3 MANOVA was used. The statistical analysis was done separately for each sex. To determine the detailed differences between individual groups the post-hoc Scheffe test was used. RESULTS: Statistically significant differences were found in total PA expressed in MET-min/week between the long and short IPAQ forms both in females (F=12.55 p<0.0001) and males (F=5.27 p<0.006). Using the Scheffe post-hoc test we discovered the significant differences only in moderate PA in females (+427 MET-min/week p<0.0001) and males (+290 MET-min/week p<0.06). There were no significant differences between the long and short IPAQ forms in vigorous PA (female: 43 MET-min/week, male: 5 MET-min/week) and walking (female: 22 MET-min/week, male: 32 MET-min/week). The results suggest that the higher values of MET-min/week obtained from the long IPAQ form could be due to the higher number of questions asking about moderate PA. CONCLUSIONS: Both the long and short self-administrated IPAQ forms identify similar PA patterns. Assessing the volume of moderate PA shows differences therefore should be considered when explaining the findings.
