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This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300–420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change., Este documento examina as evidências da atividade física na perda de peso e adiposidade, na prevenção do ganho de peso e adiposidade e na recuperação de peso em adultos, e fornece orientações sobre as implicações para os profissionais do exercício físico. As evidências da pesquisa indicam que são necessários mais de 150 minutos, mas preferencialmente 300 minutos por semana de atividade aeróbica de intensidade moderada para evitar o ganho de peso e adiposidade, e pelo menos o extremo superior dessa gama de atividade para evitar o ganho de peso após a perda de peso. É necessário um mínimo de 300 a 400 minutos por semana de atividade aeróbica de intensidade moderada para uma perda significativa de peso e adiposidade total. Estão surgindo evidências sobre a quantidade de atividade física aeróbica necessária para reduzir a adiposidade central, e pesquisas sugerem que ela pode ser substancialmente menor do que a necessária para a perda de peso. O impacto da atividade física de alta intensidade e dos exercícios de resistência no controle de peso é incerto. Durante as consultas de controle de peso, os profissionais do exercício físico devem informar que os benefícios metabólicos e cardiovasculares à saúde podem ser obtidos por meio da atividade física em qualquer peso, independentemente da mudança de peso., Esta ponencia examina las evidencias para la actividad física en la pérdida de peso y de adiposidad, la prevención del aumento de peso y la adiposidad, así como la recuperación de peso en adultos, y provee orientación sobre las implicaciones para los profesionales del ejercicio. La evidencia de la investigación indica que se requieren > 150 minutos, pero preferiblemente 300 minutos por semana de actividad aeróbica de intensidad al menos moderada para prevenir el aumento de peso y adiposidad, y al menos el extremo superior de esta gama de actividad para prevenir la recuperación de peso después de la pérdida de peso. Para que la pérdida de peso y adiposidad total sea significativa, se requiere un mínimo de 300 a 400 minutos por semana de actividad aeróbica de intensidad, al menos, moderada. La evidencia en torno al volumen de actividad física aeróbica requerida para reducir la adiposidad central está surgiendo, y las investigaciones apuntan a que puede ser sustancialmente menor que la que se requiere para la pérdida de peso. El impacto de la actividad física de alta intensidad y el ejercicio de resistencia para la gestión del peso es incierto. Durante las consultas para la gestión del peso, los profesionales en ejercicio deben aconsejar que se pueden lograr beneficios para la salud metabólica y cardiovascular por medio de la actividad física a cualquier peso, e independientemente del cambio de peso.

Galileo Galilei’s quote ‘measure what is measurable, and make measurable what is not so’ has particular relevance to health behaviours, such as physical activity (PA), sitting and sleep, whose measurement during free living is notoriously difficult. To date, much of what we know about how these behaviours affect our health is based on self-report by questionnaires which have limited validity, are prone to bias and inquire about selective aspects of these behaviours. Although self-reported evidence has made great contributions to shaping public health and exercise medicine policy and guidelines until now,1 the ongoing advancements of accelerometry-based measurement and evidence synthesis methods are set to change the landscape. The aim of this editorial is to outline new directions in PA and sleep-related epidemiology that open new horizons for guideline development and improvement; and to describe a new research collaboration platform: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS).

Galileo Galilei’s quote ‘measure what is measurable, and make measurable what is not so’ has particular relevance to health behaviours, such as physical activity (PA), sitting and sleep, whose measurement during free living is notoriously difficult. To date, much of what we know about how these behaviours affect our health is based on self-report by questionnaires which have limited validity, are prone to bias and inquire about selective aspects of these behaviours. Although self-reported evidence has made great contributions to shaping public health and exercise medicine policy and guidelines until now,1 the ongoing advancements of accelerometry-based measurement and evidence synthesis methods are set to change the landscape. The aim of this editorial is to outline new directions in PA and sleep-related epidemiology that open new horizons for guideline development and improvement; and to describe a new research collaboration platform: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS).

Galileo Galilei’s quote ‘measure what is measurable, and make measurable what is not so’ has particular relevance to health behaviours, such as physical activity (PA), sitting and sleep, whose measurement during free living is notoriously difficult. To date, much of what we know about how these behaviours affect our health is based on self-report by questionnaires which have limited validity, are prone to bias and inquire about selective aspects of these behaviours. Although self-reported evidence has made great contributions to shaping public health and exercise medicine policy and guidelines until now,1 the ongoing advancements of accelerometry-based measurement and evidence synthesis methods are set to change the landscape. The aim of this editorial is to outline new directions in PA and sleep-related epidemiology that open new horizons for guideline development and improvement; and to describe a new research collaboration platform: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS).

Galileo Galilei’s quote ‘measure what is measurable, and make measurable what is not so’ has particular relevance to health behaviours, such as physical activity (PA), sitting and sleep, whose measurement during free living is notoriously difficult. To date, much of what we know about how these behaviours affect our health is based on self-report by questionnaires which have limited validity, are prone to bias and inquire about selective aspects of these behaviours. Although self-reported evidence has made great contributions to shaping public health and exercise medicine policy and guidelines until now,1 the ongoing advancements of accelerometry-based measurement and evidence synthesis methods are set to change the landscape. The aim of this editorial is to outline new directions in PA and sleep-related epidemiology that open new horizons for guideline development and improvement; and to describe a new research collaboration platform: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS).

Background: A combination of walking, other moderate physical activity, and vigorous physical activity is recommended for achieving good health. Vigorous activity has unique health benefits but may be less accessible to disadvantaged people. To reduce health inequity, we need to understand the differences in physical activity participation among socioeconomic subgroups and whether this is changing over time. Methods: Data from the 2002 to 2015 Adult New South Wales Population Health Surveys (164,652 responses) were analyzed to investigate trends in walking, moderate and vigorous physical activity participation by socioeconomic status as measured by educational attainment. Analysis used age- and sex-adjusted multivariable linear models that accounted for complex survey design. Results: In 2002, the highest socioeconomic group spent 18.5 (95% confidence interval, 8.2-28.8) minutes per week more than the lowest socioeconomic group being vigorously active. By 2015, this gap had steadily increased to 41.4 (95% confidence interval, 27.6-55.1) minutes per week. Inequity between groups was also found for duration of moderate activity but not for time spent walking. Conclusions: Low participation in vigorous activity in the lowest socioeconomic group is likely driving increasing inequities in physical activity and widening participation gaps over time. Barriers preventing the most disadvantaged people in New South Wales from engaging in vigorous activity should be addressed urgently.

Galileo Galilei’s quote ‘measure what is measurable, and make measurable what is not so’ has particular relevance to health behaviours, such as physical activity (PA), sitting and sleep, whose measurement during free living is notoriously difficult. To date, much of what we know about how these behaviours affect our health is based on self-report by questionnaires which have limited validity, are prone to bias and inquire about selective aspects of these behaviours. Although self-reported evidence has made great contributions to shaping public health and exercise medicine policy and guidelines until now,1 the ongoing advancements of accelerometry-based measurement and evidence synthesis methods are set to change the landscape. The aim of this editorial is to outline new directions in PA and sleep-related epidemiology that open new horizons for guideline development and improvement; and to describe a new research collaboration platform: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS).

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Children's favourite food and beverage brands use various tactics to foster positive associations and loyalty. This brand-consumer dynamic is frequently influenced by the use of implicit techniques and emotional appeals. Few studies have used physiological methods to examine the connections that brands build with children and the influence this has on their automatic responses. These techniques are potentially less prone to bias than behavioural or cognitive methods. This is the first study to explore the implicit response that children have to images of their favourite food and beverage brands using skin conductance responses as a marker of arousal. Australian children aged 8-11 years (n = 48) were recruited. Images of the participants' favourite branded food and beverage products, alongside images of the same products unpackaged, their family and friends, and neutral objects were presented in a randomised order with a standard timed interval between images. Children were significantly more aroused by branded images of their favourite food and beverage products than by their unpackaged counterparts (p < 0.042, d = 0.4). The physiological response to the branded products was similar to the response to the children's family and friends (p = 0.900, d = -0.02). These findings suggest that children may have an implicit connection to their favourite branded products.

Children's favourite food and beverage brands use various tactics to foster positive associations and loyalty. This brand-consumer dynamic is frequently influenced by the use of implicit techniques and emotional appeals. Few studies have used physiological methods to examine the connections that brands build with children and the influence this has on their automatic responses. These techniques are potentially less prone to bias than behavioural or cognitive methods. This is the first study to explore the implicit response that children have to images of their favourite food and beverage brands using skin conductance responses as a marker of arousal. Australian children aged 8-11 years (n = 48) were recruited. Images of the participants' favourite branded food and beverage products, alongside images of the same products unpackaged, their family and friends, and neutral objects were presented in a randomised order with a standard timed interval between images. Children were significantly more aroused by branded images of their favourite food and beverage products than by their unpackaged counterparts (p < 0.042, d = 0.4). The physiological response to the branded products was similar to the response to the children's family and friends (p = 0.900, d = -0.02). These findings suggest that children may have an implicit connection to their favourite branded products.

Children's exposure to unhealthy food marketing is one factor contributing to childhood obesity. The impact of marketing on children's weight likely occurs via a cascade pathway, through influences on children's food brand awareness, emotional responses, purchasing and consumption. Thus, building emotional attachments to brands is a major marketing imperative. This study explored Australian children's emotional attachments to food and drink brands and compared the strength of these attachments to their food marketing exposure, using television viewing as a proxy indicator. A cross-sectional face-to-face survey was conducted with 282 Australian children (8-12 years). Children were asked to indicate their agreement/disagreement with statements about their favourite food and drink brands, as an indicator of the strength and prominence of their brand attachments. Questions captured information about minutes/day of television viewing and the extent that they were exposed to advertising (watched live or did not skip through ads on recorded television). For those children who were exposed to advertisements, their age and commercial television viewing time had significant effects on food and drink brand attachments (p = 0.001). The development of brand attachments is an intermediary pathway through which marketing operates on behavioural and health outcomes. Reducing children's exposure to unhealthy food marketing should be a policy priority for governments towards obesity and non-communicable disease prevention.

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed "disease maps" for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial dist

Background Policies restricting children's exposure to unhealthy food marketing have been impeded by the lack of evidence showing a direct link between food advertising exposure and children's energy intake and body weight. Food advertising exposure increases children's immediate food consumption, but whether this increased intake is compensated for at later eating occasions is not known; consequently the sustained effect on diets remains unclear. Methods We conducted a within-subject, randomised, crossover, counterbalanced study across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017. Children (7-12 years, n = 160) were recruited via local schools, email networks and social media. Two gender- and age-balanced groups were formed for each camp (n = 20), randomised to either a multiple- or single- media condition and exposed to food and non-food advertising in an online game and/or a television cartoon. Children's food consumption (kilojoules) was measured at a snack immediately after exposure and then at lunch later in the day. Linear mixed models were conducted to examine relationships between food advertising exposure and dietary intake, taking into account gender, age and weight status. Results All children in the multiple-media condition ate more at a snack after exposure to food advertising compared with non-food advertising; this was not compensated for at lunch, leading to additional daily food intake of 194 kJ (95% CI 80-308, p = 0.001, d = 0.2). Exposure to multiple-media food advertising compared with a single-media source increased the effect on snack intake by a difference of 182 kJ (95% CI 46-317, p = 0.009, d = 0.4). Food advertising had an increased effect among children with heavier weight status in both media groups. Conclusion Online ('advergame') advertising combined with TV advertising exerted a stronger influence on children's food consumption than TV advertising alone. The lack of compensation at lunc

Authors' response to Letter to the Editor

This study aimed to explore the trend in population levels, as well as the correlates, of occupational and leisure sitting time in full-time employed Australian adults between 2007 and 2015. We used data from the 2007/08, 2011/12 and 2014/15 Australian Health Surveys, in which nationally representative samples of the Australian population were interviewed. Full-time (≥35 hours/week) employed respondents reported sitting time at work and during leisure on a usual workday. Trends over time and associations between socio-demographic and health-related characteristics and sitting time were analysed in the combined dataset using multivariable logistic regression models. Over 21,000 observations were included in the analyses. Across the three surveys, approximately 51% of the respondents reported ≥4 hours/workday occupational sitting time, 40% reported ≥4 hours/workday leisure sitting time, and 55% reported ≥7 hours/workday combined occupational and leisure sitting time. There were no clear trends over time. All potential correlates were associated with occupational sitting time and all but educational level were associated with leisure sitting time. The directions of the associations with gender, age and leisure-time physical activity were reversed for occupational sitting time and leisure sitting time. These findings show that the average levels of occupational and leisure sitting time on workdays were high but stable over the past decade. The observed differences in correlates of occupational and leisure sitting time demonstrate the need to assess and address sedentary behaviour domains separately in research and policy.

Background Policies restricting children's exposure to unhealthy food marketing have been impeded by the lack of evidence showing a direct link between food advertising exposure and children's energy intake and body weight. Food advertising exposure increases children's immediate food consumption, but whether this increased intake is compensated for at later eating occasions is not known; consequently the sustained effect on diets remains unclear. Methods We conducted a within-subject, randomised, crossover, counterbalanced study across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017. Children (7-12 years, n = 160) were recruited via local schools, email networks and social media. Two gender- and age-balanced groups were formed for each camp (n = 20), randomised to either a multiple- or single- media condition and exposed to food and non-food advertising in an online game and/or a television cartoon. Children's food consumption (kilojoules) was measured at a snack immediately after exposure and then at lunch later in the day. Linear mixed models were conducted to examine relationships between food advertising exposure and dietary intake, taking into account gender, age and weight status. Results All children in the multiple-media condition ate more at a snack after exposure to food advertising compared with non-food advertising; this was not compensated for at lunch, leading to additional daily food intake of 194 kJ (95% CI 80-308, p = 0.001, d = 0.2). Exposure to multiple-media food advertising compared with a single-media source increased the effect on snack intake by a difference of 182 kJ (95% CI 46-317, p = 0.009, d = 0.4). Food advertising had an increased effect among children with heavier weight status in both media groups. Conclusion Online ('advergame') advertising combined with TV advertising exerted a stronger influence on children's food consumption than TV advertising alone. The lack of compensation at lunc

Increasingly, people are collecting detailed personal activity data from commercial trackers. Such data should be able to give important insights about their activity levels. However, people do not wear or carry tracking devices all day, every day and this means that tracker data is typically incomplete. This paper aims to provide a systematic way to take account of this incompleteness, by defining adherence, a measure of data completeness, based on how much people wore their tracker. We show the impact of different adherence definitions on 12 diverse datasets, for 753 users, with over 77,000 days with data, interspersed with over 73,000 days without data. For example, in one data set, one adherence measure gives an average step count of 6,952 where another gives 9,423. Our results show the importance of adherence when analysing and reporting activity tracker data. We provide guidelines for defining adherence, analysing its impact and reporting it along with the results of the tracker data analysis. Our key contribution is the foundation for analysis of physical activity data, to take account of data incompleteness.

Our aims were to examine the efficacy of a new observational instrument 'System for Observing Outdoor Play' for detecting changes in outdoor play and chart the use of recycled and repurposed materials in the school playground during the course of an intervention to increase outdoor play. Children from one Sydney primary school were observed (N = 111; 5-12 years) using an observational instrument developed as part of the Sydney Playground Project. Data on types of activities and frequencies were collected at baseline and seven times during intervention. Use of intervention materials was consistently high and associated with increases in play-related activities (40-77%), while inactive pursuits decreased (52-31%), on average. The observational instrument proved efficacious in tracking changes in play. Modification of the school playground environment by introducing loose parts changed children's play-related behaviour; the variety of activities increased, including construction and creative play. Physical inactivity decreased. Recycled materials can increase children's creative, social and physical play.

Exposure to unhealthy food marketing stimulates children's food consumption. A child's responsiveness is influenced by individual factors, resulting in an increased vulnerability to advertising effects among some children. Whether these differential responses may be altered by different parental feeding behaviours is unclear. The purpose of this study was to determine the relationship between parental feeding practices and children's food intake responses to food advertising exposure. A randomised, crossover, counterbalanced, within subject trial was conducted across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017 with 160 children (7-12 years, n = 40/camp). Children were randomised to either a multiple media (TV and Internet) or single media (TV) condition and exposed to food (3 days) and non-food (3 days) advertising in an online game and/or a cartoon. Children's food consumption (kilojoules (kJ)) was measured at a snack immediately after advertising exposure and then at lunch later in the day. Parents completed the Child Feeding Questionnaire, and 'restriction' and 'pressure to eat' subscale scores were calculated. While food advertising affected all children in the multiple media condition, there was an increased effect on snack intake among children whose parents reported pressuring them to eat, with children consuming an additional 356 kJ after food advertising compared with non-food advertising. This was 209 kJ more than children whose parents did not pressure them to eat. In the single media condition, only children whose parents reported restrictive feeding practices ate more at lunch on food advertising days than non-food advertising days (240 kJ). These data highlight an increased susceptibility to food advertising among children whose parents report controlling feeding practices.

Exposure to unhealthy food marketing stimulates children's food consumption. A child's responsiveness is influenced by individual factors, resulting in an increased vulnerability to advertising effects among some children. Whether these differential responses may be altered by different parental feeding behaviours is unclear. The purpose of this study was to determine the relationship between parental feeding practices and children's food intake responses to food advertising exposure. A randomised, crossover, counterbalanced, within subject trial was conducted across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017 with 160 children (7-12 years, n = 40/camp). Children were randomised to either a multiple media (TV and Internet) or single media (TV) condition and exposed to food (3 days) and non-food (3 days) advertising in an online game and/or a cartoon. Children's food consumption (kilojoules (kJ)) was measured at a snack immediately after advertising exposure and then at lunch later in the day. Parents completed the Child Feeding Questionnaire, and 'restriction' and 'pressure to eat' subscale scores were calculated. While food advertising affected all children in the multiple media condition, there was an increased effect on snack intake among children whose parents reported pressuring them to eat, with children consuming an additional 356 kJ after food advertising compared with non-food advertising. This was 209 kJ more than children whose parents did not pressure them to eat. In the single media condition, only children whose parents reported restrictive feeding practices ate more at lunch on food advertising days than non-food advertising days (240 kJ). These data highlight an increased susceptibility to food advertising among children whose parents report controlling feeding practices.

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed "disease maps" for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial dist

Background: Individual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation. Methods: Data on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA "disease maps" and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage. Results: Within-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4-32.0), 69.4 (95% CI 69.1-69.7), and 56.1 (95% CI 95.8-56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12-1.29) and 1.07 (95% CrI 1.01-1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01-1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors. Conclusions: Walkability is associated with area-level preval

Physical inactivity is the fourth most important risk factor contributing to global non-communicable disease (NCD) deaths, occurring in high-, middle- and low-income countries. Building capacity in NCD prevention is a daunting task, and toward this end, an introductory open online course about physical activity (PA), exercise, and NCD prevention was developed. This was led by academics from the University of Sydney and the WHO Collaborating Centre for Physical Activity, Nutrition and Obesity. The course was designed to address the needs of participants from areas where geography and economy would often prevent them from participating in NCD training programs. Around 120 participants from four continents signed up for the six-week online course, with the greatest numbers from the host country (Australia) followed by participants from Pacific Island nations and from the Middle East. The course consisted of video lectures, quizzes, and online discussions facilitated by experts. More than a third of the participants fully completed the course, which received very positive participant evaluations. This also included completion of relevant quiz questions on each section of the PA course, and averaged over 70% correct responses. This successful online course has the potential to increase knowledge and skills about PA and prevention, as part of building global capacity in NCD prevention at low cost, and importantly within easy reach of potentially isolated practitioners.

BACKGROUND: Active Design is a relatively new concept and evaluation on its effects on healthy behaviour is lacking. OBJECTIVE: To investigate Active Design influence on workplace physical activity, sedentary behaviour, musculoskeletal complaints, and perceptions of the workplace and productivity. METHODS: Participants (n = 118 adults) moving from 14 workplaces into a new building completed an online questionnaire pre- and post-move. The questions related to health behaviours (physical activity, sitting time and sleep); musculoskeletal issues; perceptions of the office environment; productivity; and engagement. RESULTS: After the move, 68% of participants were located in an open plan building (21% before the move). In the new workplace participants tended to sit less during their work time (72% – 66%; p < 0.05) and stand more (15% – 19%; p < 0.05) while walking remained unchanged. Participants reported less lower-back pain. The new work environment was perceived as more motivating and providing better light, air quality and temperature, but less storage space. Participants reported looking forward to going to work more than before. No difference was reported in productivity related measures. CONCLUSIONS: Moving to a new Active Design building can have some physical health-promoting effects on occupants. Satisfaction with environmental characteristics tended to improve in the new building though perceptions of productivity measures were variable.

Objective: To examine trends in leisure time physical activity and inactivity in Australians aged 15 years or older from 1989 to 2011. Method: We used data from six Australian National Health Surveys conducted from 1989/90 to 2011/12 in which physical activity was assessed using comparable questions. Analyses examined trends in the prevalence of sufficient physical activity (≥150 minutes/week moderate‐to‐vigorous physical activity) and of inactivity (<30 minutes/week moderate‐to‐vigorous physical activity). Results: The proportion of sufficiently active adults was 39.2% in 1989 and 40.7% in 2011 with an overall declining trend of 0.2% per year (p=0.012). The prevalence of inactivity was 38.7% in 1989 and 37.3% in 2011; the overall time trend by year was stable (OR=0.999, p=0.242). In women, sufficient physical activity decreased by 0.3% per year from 35.5% in 1989 (p=0.025); inactivity increased from 39.5% by 0.3% per year (p=0.004). In men, sufficient physical activity prevalence was 43.1% in 1989 with a steady trend; inactivity decreased from 37.9% by 0.5% per year (p<0.0001). Conclusions: The prevalence of sufficient physical activity remains low and inactivity high. Women appear to be a key target group for intervention. Public health efforts have been ineffective over two decades for improving physical activity among Australian adults. Implications for public health: This research supports calls for a national physical activity action plan given the multitude of benefits from sufficient physical activity. Maintenance of consistent physical activity questions in future National Health Surveys will facilitate long term tracking of physical activity levels in the Australian population.

Issue addressed Only half of Australia's adult population is sufficiently physical active. One method thought to increase incidental physical activity at work is the use of stair‐promoting interventions. Stairs are readily available and stair climbing is considered vigorous physical activity. Motivational signs have been extensively and effectively trialled to increase stair use, but are they suitable for contemporary populations? Methods Participants were occupants of three selected University of Sydney buildings using the elevators or stairs. Infrared people counters were installed to monitor stair and elevator use for 24 h/day during two baseline weeks, followed by two intervention weeks, where motivational and directional signs were placed at points of choice. Results At baseline there was a large between‐building variation in the change in stair to elevator proportion, where we observed a small increase in two buildings (81-84%, odds ratio (OR): 1.16 (1.09, 1.23), and 26-27%, OR: 1.09 (1.03, 1.15)), and a decrease (30-25%, OR: 0.75 (0.72, 0.77) in the third building. Conclusions Differences in stair use among buildings could be due to building design and function. Motivational and directional signs to promote stair use showed small or nil effects. The future of interventions promoting stair use in occupational settings may need more interactive or personalised intervention methods. So what? The implications of this study are that posters to promote stair use might be a thing of the past and this should be considered in future workplace health promotion efforts to increase physical activity. More novel and interactive methods using new media are recommended.

Objective: To examine the effects of different sit-stand protocols on work-time sitting and physical activity (PA) of office workers. Methods: Participants (n = 26, 77% women, mean age 42) were randomly allocated to usual sitting (control) or one of three sit-stand protocols (intervention) facilitated by height-adjustable workstations for a 4-week period between June and August 2015. Sitting, standing, and stepping time were assessed by inclinometry (activPAL); leisure-time physical activity (LTPA) by self-report. One-way analysis of covariance (ANCOVA) and post-hoc (Bonferroni) tests explored between-group differences. Results: Compared with baseline, intervention groups reduced work sitting time by 113 minutes/8-hour workday (95% confidence interval [CI] [-147,-79]) and increased work standing time by 96 minutes/8-hour workday (95% CI [67,125]) without significantly impacting LTPA/sleep time. Conclusions: Sit-stand protocols facilitated by height-adjustable workstations appear to reduce office workers' sitting time without significant adverse effects on LTPA.

Objective: To examine the associations of physical activity (PA) and sitting time (sit) with cardio‐metabolic diseases. Methods: Cross‐sectional data from the Australian National Nutrition and Physical Activity Survey 2011-2012 (n=9,435) were used to classify adults into low and high risk groups based on their physical activity and sitting behaviour profiles. Logistic regression models examined associations between low and high risk classifications (high PA‐low sit; high PA‐high sit; low PA‐low sit; low PA‐high sit;) and socio‐demographic factors, and associations between low and high risk classifications and the prevalence of cardiovascular disease, Type 2 diabetes and metabolic syndrome. Results: These results characterise chronic disease risk based on both physical activity and sitting behaviour. Adults with the highest risk lifestyle behaviour pattern (low PA‐high sit) tended to be middle aged, male, at greater social disadvantage, smoke, report fair health, be abdominally obese and employed in administrative and driver occupations. These individuals had a substantially greater risk of cardiovascular disease and metabolic syndrome (OR=1.41, 95% CI 1.13, 1.75; OR= 2.37, 95% CI 1.63, 3.45, respectively). Conclusions: The findings highlight the importance of both sufficient physical activity and low sitting time for cardio‐metabolic health. Implications for public health: Primary prevention focus should consider physical activity and reduced sitting time as well as provision of relevant advice for cardio‐metabolic health.

Background: Individual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation. Methods: Data on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA "disease maps" and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage. Results: Within-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4-32.0), 69.4 (95% CI 69.1-69.7), and 56.1 (95% CI 95.8-56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12-1.29) and 1.07 (95% CrI 1.01-1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01-1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors. Conclusions: Walkability is associated with area-level preval

Traditionally, GPs have been responsible for physical activity (PA) assessment within the general practice setting. Multiple questionnaires are available to support uptake of PA assessment but less than 30% of patients are assessed. A range of barriers hamper uptake. Evidence indicates that practice nurses (PNs) and patients are resourceful members of the general practice team but have been underutilised. This study assessed the validity and reliability of two instruments for assessing PA, administered by PNs and patients. The study aimed to identify robust tool(s) to support the evolving role of PNs and patients in prevention and management strategies in general practice. A purposive sample of PNs and patients from general practices in Sydney was invited to participate. The results of the PN- or patient-administered general practice physical activity questionnaire (GPPAQ) and the three-question physical activity questionnaire (3Q) were compared against accelerometer activity. The study examined agreement in classification of PA levels according to Australian PA recommendations. Validity showed low-moderate correlations between accelerometer and GPPAQ (rho¿0.26), 3Q (rho¿0.45). Seven-day test-retest reliability intraclass correlation coefficients (ICCs) were 0.82-0.95 for GGPAQ and 0.94-0.98 for 3Q. Agreement with PA recommendations was moderate for GPPAQ (kappa 0.73, 95% CI, 0.56-0.85) and fair for 3Q (kappa 0.62, 95% CI, 0.47-0.78). Although 3Q demonstrated higher correlation with accelerometry, GPPAQ demonstrated higher agreement with PA guidelines. Given GPPAQ showed reasonable rigour, it may prove useful for PN and patient use.

Traditionally, GPs have been responsible for physical activity (PA) assessment within the general practice setting. Multiple questionnaires are available to support uptake of PA assessment but less than 30% of patients are assessed. A range of barriers hamper uptake. Evidence indicates that practice nurses (PNs) and patients are resourceful members of the general practice team but have been underutilised. This study assessed the validity and reliability of two instruments for assessing PA, administered by PNs and patients. The study aimed to identify robust tool(s) to support the evolving role of PNs and patients in prevention and management strategies in general practice. A purposive sample of PNs and patients from general practices in Sydney was invited to participate. The results of the PN- or patient-administered general practice physical activity questionnaire (GPPAQ) and the three-question physical activity questionnaire (3Q) were compared against accelerometer activity. The study examined agreement in classification of PA levels according to Australian PA recommendations. Validity showed low-moderate correlations between accelerometer and GPPAQ (rho¿0.26), 3Q (rho¿0.45). Seven-day test-retest reliability intraclass correlation coefficients (ICCs) were 0.82-0.95 for GGPAQ and 0.94-0.98 for 3Q. Agreement with PA recommendations was moderate for GPPAQ (kappa 0.73, 95% CI, 0.56-0.85) and fair for 3Q (kappa 0.62, 95% CI, 0.47-0.78). Although 3Q demonstrated higher correlation with accelerometry, GPPAQ demonstrated higher agreement with PA guidelines. Given GPPAQ showed reasonable rigour, it may prove useful for PN and patient use.

Background Planning and transport agencies play a vital role in influencing the design of townscapes, travel modes and travel behaviors, which in turn impact on the walkability of neighbourhoods and residents' physical activity opportunities. Optimising neighbourhood walkability is desirable in built environments, however, the population health benefits of walkability may be offset by increased exposure to traffic related air pollution. This paper describes the spatial distribution of neighbourhood walkability and weighted road density, a marker for traffic related air pollution, in Sydney, Australia. As exposure to air pollution is related to socio-economic status in some cities, this paper also examines the spatial distribution of weighted road density and walkability by socio-economic status (SES). Methods We calculated walkability, weighted road density (as a measure of traffic related air pollution) and SES, using predefined and validated measures, for 5858 Sydney neighbourhoods, representing 3.6 million population. We overlaid tertiles of walkability and weighted road density to define "sweet-spots" (high walkability-low weighted road density), and "sour- spots" (low walkability-high weighted road density) neighbourhoods. We also examined the distribution of walkability and weighted road density by SES quintiles. Results Walkability and weighted road density showed a clear east-west gradient across the region. Our study found that only 4 % of Sydney's population lived in sweet-spot" neighbourhoods with high walkability and low weighted road density (desirable), and these tended to be located closer to the city centre. A greater proportion of neighbourhoods had health limiting attributes of high weighted road density or low walkability (about 20 % each), and over 5 % of the population lived in "sour-spot" neighbourhoods with low walkability and high weighted road density (least desirable). These neighbourhoods were more distant from the city centre and scattere

Issue addressed Ecological momentary assessment (EMA) involves repeated sampling of current behaviours and experiences in real‐time at random intervals. EMA is an innovative measurement method for program evaluation, using mobile technology (e.g. smartphones) to collect valid contextual health promotion data with good compliance. The present study examined the feasibility of using EMA for measuring workplace health outcomes. Methods Twenty‐two office‐based adults were prompted at four random times per work‐day during a 5‐day period to respond to a short survey via a smartphone application. The prompting stopped when participants had either responded 12 times or the 5‐day period had ended. The questions pertained to posture, task currently being undertaken, social interactions, musculoskeletal issues, mood, and perceptions of engagement and creativity. Results In total 156 responses were collected. Nine participants completed all 12 surveys; the average completion rate was 58% (7/12). The average completion time was initially 50 s and reduced to 24 s during the later surveys. On average the participants were sitting and standing in 79% and 14% of survey instances, respectively. The participants reported they were working alone at their desks in 68% of instances. Reported productivity and stress were on average 6 and 3 out of 10, respectively, but varied up to 6-8 points within one person, hence the method appears sensitive to temporal variations in perceptions and mood. Conclusion Given the rich real‐time data, minimal participant burden and use of readily available technology, EMA has substantial potential in workplace health promotion evaluation through the measurement of participants' well being, activities, and behaviour change. So what? An in‐the‐moment method using readily available mobile technology to assess participants' perceptions, mood and activity that provides rich information with minimal participant burden is a promising way to evaluate future health

Background Occupying new, active design office buildings designed for health promotion and connectivity provides an opportunity to evaluate indoor environment effects on healthy behaviour, sedentariness and workplace perceptions. Aims To determine if moving to a health-promoting building changed workplace physical activity, sedentary behaviour, workplace perceptions and productivity. Methods Participants from four locations at the University of Sydney, Australia, relocated into a new active design building. After consent, participants completed an online questionnaire 2 months before moving and 2 months after. Questions related to health behaviours (physical activity and sitting time), musculoskeletal issues, perceptions of the office environment, productivity and engagement. Results There were 34 participants (60% aged 25–45, 78% female, 84% employed full-time); 21 participants provided complete data. Results showed that after the move participants spent less work time sitting (83–70%; P < 0.01) and more time standing (9–21%; P < 0.01), while walking time remained unchanged. Participants reported less low back pain ( P < 0.01). Sixty per cent of participants in the new workplace were in an open-plan office, compared to 16% before moving. Participants perceived the new work environment as more stimulating, better lit and ventilated, but noisier and providing less storage. No difference was reported in daily physical activity, number of stairs climbed or productivity. Conclusions Moving to an active design building appeared to have physical health-promoting effects on workers, but workers’ perceptions about the new work environment varied. These results will inform future studies in other new buildings.

Objective: The aim of this study was to evaluate the effect of an activity-based work (ABW) office environment on physical activity and sedentary behavior, work ability, and musculoskeletal discomfort. Methods: Eighty-eight office workers trialed ABW for 4 weeks. Accelerometer and self-reported outcomes were measured at baseline, end-intervention, and follow-up. Data were analyzed using linear mixed models. Results: Accelerometry measured sedentary time; sedentary breaks and step count did not significantly change from baseline to end-intervention (P = 0.13, 0.09, 0.18, respectively). Self-reported sitting-time was 14% lower, with standing-time and walking 11% and 3% higher in ABW than baseline (P < 0.01 for all). Low back pain was lower in ABW than baseline (odds ratio 2.0, 95% confidence interval 1.1 to 3.7). Work ability reduced from 8.4 to 7.8 points (P < 0.01) at follow-up. Conclusions: ABW environment appears to reduce self-reported sedentary behavior and low back pain and increase standing time.

Background: Prolonged sitting is associated with increased risk of chronic diseases. Workplace programs that aim to reduce sitting time (sit less) and increase physical activity (move more) have targeted desk-based workers in corporate and university settings with promising results. However, little is known about 'move more, sit less' programs for workers in other types of jobs and industries, such as shift workers. This formative research examines the perceptions of a 'sit less, move more' program in an Australian Emergency Call Centre that operates 24 hours per day, 7 days per week. Methods: Participants were employees (N = 39, 72% female, 50% aged 36-55 years) recruited from Emergency Services control centres located in New South Wales, Australia. The 'sit less, move more' intervention, consisting of emails, posters and timer lights, was co-designed with the management team and tailored to the control centre environment and work practices, which already included electronic height-adjustable sit-stand workstations for all call centre staff. Participants reported their perceptions and experiences of the intervention in a self-report online questionnaire, and directly to the research team during regular site visits. Questionnaire topics included barriers and facilitators to standing while working, mental wellbeing, effects on work performance, and workplace satisfaction. Field notes and open-ended response data were analysed in an iterative process during and after data collection to identify the main themes. Results: Whilst participants already had sit-stand workstations, use of the desks in the standing position varied and sometimes were contrary to expectations (e.g, less tired standing than sitting; standing when experiencing high call stress). Participants emphasised the "challenging" and "unrelenting" nature of their work. They reported sleep issues ("always tired"), work stress ("non-stop demands"), and feeling mentally and physically drained due to shift wor