Search

Abstract Background According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking. Methods We searched five databases and included studies for adults (18–65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results. Results Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting). Conclusions Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults. Trial registration PROSPERO: CRD42021283508.

Background: Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany. Methods: The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time. Results: The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls’ physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys’ prevalence remained relatively stable over the same period. Conclusions: Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high.

Background: Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18. Method: 174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347).: Discussion The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

Abstract Background Implementing environmental changes to promote healthier communities requires initial positive decisions by change agents from local politics and government. However, there is little research on what influences the change agents' decisions. This explorative, qualitative study aims to identify the personal determinants of the decision-making behavior of local change agents. Methods We conducted semi-structured interviews to assess the personal determinants of decision-making behavior among 22 change agents from local politics and government. Relevant determinants were identified through a structured content analysis of the interview transcripts using the software MAXQDA 2020. Results We found the following seven essential clusters of personal determinants of the decision-making behavior of change agents from local politics and government: Imprinting, socialization, and biography; experiences and involvement; attitudes and outcome expectations towards important issues and aspects; knowledge; emotions; personal benefits; and the perceived influences of others. Conclusions The identified personal determinants might serve as a source of understanding the decision-making behavior of change agents in community decision-making processes. Our findings can contribute to the effective planning and implementation of evidence-based multilevel interventions related to changing environmental conditions in communities and provide important information on which personal determinants should be considered when derive strategies for community health promotion within a systematic approach of developing an intervention program theory.

BackgroundAccording to socio-ecological theories, physical activity behaviors are linked to the physical and social neighborhood environment. Reliable and contextually adapted instruments are needed to assess environmental characteristics related to physical activity. This work aims to develop an audit toolbox adapted to the German context, to urban and rural settings, for different population groups, and different types of physical activity; and to evaluate its inter-rater reliability.MethodsWe conducted a systematic literature search to collect existing audit tools and to identify the latest evidence of environmental factors influencing physical activity in general, as well as in German populations. The results guided the construction of a category system for the toolbox. Items were assigned to the categories based on their relevance to physical activity and to the German context as well as their comprehensibility. We piloted the toolbox in different urban and rural areas (100 street segments, 15 parks, and 21 playgrounds) and calculated inter-rater reliability by Cohen's Kappa.ResultsThe audit toolbox comprises a basic streetscape audit with seven categories (land use and destinations, traffic safety, pedestrian infrastructure, cycling infrastructure, attractiveness, social environment, and subjective assessment), as well as supplementary tools for children and adolescents, seniors and people with impaired mobility, parks and public open spaces, playgrounds, and rural areas. 76 % of all included items had moderate, substantial, or almost perfect inter-rater reliability (κ > 0.4).ConclusionsThe audit toolbox is an innovative and reliable instrument for the assessment of the physical activity friendliness of urban and rural environments in Germany.

IntroductionDespite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023).MethodsLogistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity.ResultsRates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87–0.97). Increasing age (OR: 0.95, 95% CI: 0.93–0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88–0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65–0.84) than in boys (OR: 0.77, 95% CI: 0.66–0.88).DiscussionThis study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

Numerous findings are known to exist between dietary habits, physical activity, and child and adolescent health. Here, we will use data from the most recent Health Behaviour in School-aged Children (HBSC) study to describe dietary habits and patterns of physical activity. Using the survey data for 11-, 13- and 15-year-old students from across Germany, we report findings for key indicators of diet and physical activity for the 2017/18 cycle. By comparing these findings with data from the 2009/10 and 2013/14 survey cycles, we also consider current trends. Results from the most recent cycle show that 10.0% of girls and 16.9% of boys meet the World Health Organization’s (WHO) physical activity recommendations. Across all HBSC cycles, this is the lowest figure so far. Concerning dietary habits, 50.6% of girls and 59.0% of boys reported having breakfast every morning. Data for daily fruit, vegetable and soft drink consumption emphasises the need to promote a healthy diet among adolescents. For all indicators of physical activity and diet, differences between girls and boys are apparent. Girls’ intake of fruit and vegetables is higher and they consume fewer soft drinks, yet boys are more physically active and have breakfast more regularly. For the majority of indicators of dietary habits and physical activity, considerable inequalities relating to family affluence are observed. An important implication of the study results for dietary habits and physical activity of older children and adolescents is the need to foster settings-based approaches to promote physical activity and a healthy diet that integrate a gender-sensitive perspective.

The Health Behaviour in School-aged Children (HBSC) study is an international research project in collaboration with the World Health Organization (WHO) for over 35 years. HBSC is the largest study on child and adolescent health and one of the most important sources of data for the WHO’s international comparative health monitoring. Every four years, data on the health and health behaviour of students aged 11, 13 and 15, as well as the social contexts and conditions for growing up healthy, are collected. A total of 50 countries belong to the HBSC network, with 45 countries taking part in the 2017/18 survey. Germany has contributed to the HBSC surveys since 1993/94. For the most recent 2017/18 cycle, students at 146 schools in Germany were interviewed (response rate of schools: 15.6%). A net sample of n = 4,347 girls and boys was achieved for Germany (response rate: 52.7%). Participation was voluntary and the survey was conducted in German school years five, seven and nine (corresponding to ages 11, 13 and 15). A weighting procedure was applied to allow for representative findings on the health of children and adolescents in Germany. HBSC offers a valuable contribution to health monitoring and provides numerous starting points to identify needs, risk groups and fields of action to initiate targeted and actual needs-based measures of prevention and health promotion in the school setting.

Abstract Background Worldwide, roughly 80% of adolescents fail to meet World Health Organization (WHO) recommendations regarding physical activity, though there is substantial variation in adolescent physical activity prevalence across countries. This study explored whether country-level environmental differences explained cross-national variation in adolescent moderate- to vigorous-intensity physical activity (MVPA) and vigorous-intensity activity (VPA). Method Using the data of 138,014 11- to 15-year-olds from 29 European countries in the 2013/2014 Health Behaviour in School-aged Children (HBSC) study, multilevel regression models examined the influence of four types of country-level environmental factors (physical, socio-cultural, economic, and political) on self-reported individual-level physical activity (MVPA and VPA). Results The environmental variables explained 38% of country-level variance in MVPA and 81% of country-level variance in VPA. Lower annual average national temperature, higher community safety, lower average national household income and a weaker physical education policy were significantly associated with more MVPA. Greater urbanisation, lower annual average national temperature, higher adult physical activity and higher average national household income were significantly associated with more VPA. Conclusions The findings showed that national differences in the physical, socio-cultural and economic environment were related to adolescent physical activity. They point to potential avenues for future research looking at interactions between individual and environmental factors.

Abstract Background Low levels of physical activity (PA) and high levels of sedentary behaviour (SB) have been observed in young people. Both behaviours are detrimental for health with patterns tending to continue into adulthood. There is sustained value in establishing health habits in early years. Even though levels of SB and participation in PA differ among boys and girls, and the effectiveness of interventions to promote PA and/or prevent sedentary behaviours varies by sex/gender to date, sex/gender in systematic reviews is not yet widely considered. Additionally, while tools have been proposed, there is no consensus on the criteria to assess sex/gender in systematic reviews in the context of health promotion. The main objectives of this systematic review are to evaluate the effects of interventions on girls’ and boys’ PA and SB and to appraise the extent to which the studies have taken sex/gender into account. Methods Eleven electronic databases will be searched to identify all relevant (randomized) controlled trials. Two independent reviewers will screen studies, extract data and appraise the quality of studies. The main outcome of the studies will be a quantified measure of PA and/or SB. Risk of bias of individual studies will be assessed using the Cochrane Risk of Bias Tool for RCTs. Meta-analyses will be conducted when possible among studies with sufficient homogeneity. To evaluate sex/gender considerations in primary studies, we will use a sex/gender checklist that builds on existing tools and was developed during a 2-day, iterative process among a multidisciplinary panel of 16 experts. The GRADE framework will be used to evaluate evidence across studies for each main efficacy outcome. Discussion To our knowledge, our systematic review will be the first to analyse how sex/gender is considered in interventions promoting PA and/or reducing SB in children and adolescents in detail. The review will provide information on how sex/gender aspects have been considered in recent research and the extent to which sex/gender might impact study outcomes. Our findings will be of interest to stakeholders, health promoters, researchers and policy makers who wish to support more equal outcomes from interventions promoting PA and/or reducing SB. Trial registration PROSPERO CRD42018109528.

Active commuting (AC) provides numerous health benefits and is one way to improve physical activity in children and adolescents. Boys are more likely to use active transport modes than girls. Girls and boys benefit differently from interventions that promote AC. The aim of this systematic review is to evaluate the effects of interventions on girls and boys and to appraise the extent to which previous studies have taken sex/gender into account. Eleven electronic databases were searched to identify all relevant randomized and non-randomized controlled trials based on a priori defined eligibility criteria. Two independent reviewers screened the literature for eligibility and assessed risk of bias. Semiquantitative analyses were conducted to evaluate the effects of intervention effects by taking sex/gender aspects into account. To evaluate sex/gender considerations in interventional studies, a recently developed sex/gender checklist was applied. Twelve studies were included that examined intervention effects on AC in girls and boys. Three intervention studies showed significant effects in increasing AC, with one study favoring girls, one favoring boys, and another focusing on a single sex/gender (only girls). According to the checklist, the overall sex/gender rating highlighted a lack of information in sex/gender consideration. Studies with and without significant effects indicated no differences in the sex/gender checklist. The results indicate that sex/gender is not considered adequately in primary interventional research on AC. To evaluate the effectiveness of intervention in boys and girls, detailed analyses of sex/gender are required, and better reporting about sex/gender-specific intervention content is necessary. In future health research to promote AC, sex/gender should be systematically taken into account.

Background: Aim of this intervention study was to evaluate whether availability of standing desks in classrooms may reduce sitting time and enhance standing and stepping time during lessons and breaks. Further, we evaluated if differences in standing desk use differed by physical fitness (PF) levels of children.Methods: To assess sitting, standing and stepping during a typical school week in 3rd grade primary school children (N = 52), activPAL monitors were used at baseline: T0, 1st follow-up: T1 and 2nd follow-up: T2. At baseline, PF was measured using the standing long jump and the 6-min jog-walk to assign children as having low PF (LPF) or high PF (HPF). Standing desks were assigned randomly to intervention and control groups at T1 (group 1) and T2 (group 2) with a cross-over design. Changes of sitting, standing and stepping were analyzed to investigate intervention effects at follow-up, using linear mixed models.Results: At baseline, children spent about 60 and 30% of time sitting during lessons and breaks, respectively. After installing standing desks (T1), significantly lower proportions of sitting were observed in the intervention group 1 [−13.1%, 95%-CI: (−20.5; −5.72)] and the control group 2 [−9.78%, 95%-CI: (−17.3; −2.28)]. Compared to the baseline measurement (T0), lower proportions of sitting were particularly expressed during school breaks in group 1 and 2 after intervention in T1 [group 1: −10.3%, 95%-CI: (−16.4; −4.25)] or in T2 [group 2: −8.59%, 95%-CI: (−15.2; −1.94)]. In general, children with higher physical fitness were less sedentary and more active, but intervention effects did not differ by fitness levels.Conclusion: Standing desks provide an opportunity to reduce sedentary time during lessons and breaks at school in primary school children, but do not directly increase PA of high intensity such as stepping. Future studies should consider potential bandwagon effects caused by structural interventions.

Objective: The study aims to investigate to what extent school- and leisure time-related factors are associated with sedentary behavior during school in German and Irish children and adolescents.Methods: The study based on a sample of 198 children and adolescents surveyed in 2015. Sedentary and activity behavior were measured using the activPAL physical activity monitor. Information on socio-economic status, school- and leisure-time related factors were provided by questionnaires. Associations between school- and leisure time-related factors and sedentary time during school were estimated using linear multi-level models.Results: Access to play equipment in school was associated with reduced sitting time (hours/day) of children (ß = 0.78; 95%CI = 0.06–1.48). Media devices in bedroom and assessing the neighborhood as activity friendly was associated with increased sitting time of children (ß = 0.92; 95%CI = 0.12–1.72 and ß = 0.30; 95%CI = 0.01–0.60, respectively). The permission to use media devices during breaks was associated with increased sitting time (hours/day) of adolescents (ß = 0.37; 95% CI = 0.06–0.69). A less safe traffic surrounding at school was associated with reduced sitting time of adolescents (ß = −0.42; 95% CI = −0.80 to −0.03).Conclusion: Results suggest that school- and leisure time-related factors are associated to the sedentary behavior during school. We suggest that future strategies to reduce sedentary time should consider both contexts.

Background: The increasing prevalence of childhood obesity is a global concern. Although childhood obesity has grown as a result of a complex array of interactions among multiple behavioural, biological, and environmental factors, excessive screen time (ST) and low levels of physical activity (PA) are often discussed as causal factors. Therefore, it is beneficial to identify risky family behavioural patterns contributing to the increasing prevalence of obesity even in pre-schoolers. Objective: The main aim of the study was to assess whether parental obesity and parent-child behavioural patterns (PA and ST) affect the odds of overweight/obesity in 4-to-7-year-old preschool children. Methods: We analysed seven-day PA and ST behaviour among families with pre-schoolers that included 194 preschool children (88 girls and 106 boys) and their parents (165 mothers and 111 fathers). PA was monitored by means of unsealed Yamax pedometers for at least eight hours a day over seven consecutive days during spring (April/May) and autumn (September/October) of 2015. ST was recorded by parents on family log book sheets. To assess the odds of parents' obesity and PA/ST variables in relation to child overweight/obesity, a logistic regression (backward method) was used. Results: Most children (n = 157) reported normal weight (87 boys, 70 girls), 37 children were overweight or obese (19 boys, 18 girls). Children's excessive ST (> 1 hour/day) (OR: 5.65/33.19 on weekdays/weekends), mothers' obesity (OR: 13.80/28.84 on weekdays/weekends), mothers' excessive ST (> 2 hours/ day) (OR: 32.46 at weekends), and children's male gender (OR: 38.69 at weekends) were significantly (p < .05) associated with higher odds of overweight/obesity in the preschool children. Conclusions: Uncovering parent-child behavioural patterns provides insight into the lifestyle of families with pre-schoolers and is a source of valuable information for designing and implementing family-based intervention programmes aimed at reducing obesity. Especially, weekends provide a suitable space for the implementation of joint family programmes aimed at reducing sedentary behaviour.

Abstract Background This study focuses on the comparison of weekday/weekend parent-child behavioural patterns (step count (SC) and screen time (ST)) and answers the question of whether achieving the recommendations for daily SC (10,000) in parents also helps their preschool children achieve the recommended daily SC (11,500). Methods The participants (278 parents aged 30–45 and their 194 children aged 4–7) were randomly recruited from 10 Czech public kindergartens. The participants recorded SC (pedometer Yamax Digiwalker SW-200) and ST duration (proxy-report) for seven consecutive days (≥8 h/day) during September–October 2014 and April–May 2015. Differences between weekdays/weekends SC or ST were tested using a paired t-test. The odds of achieving the recommended daily SC for children were estimated using general logistic regression separately for weekdays and weekends. Results Only the mothers were found to have a significantly lower SC at weekends than on weekdays. All of the participants showed significantly more ST at weekends than on weekdays (daughters: 78.6 vs. 45.7 min/day, p

Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity), which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES) or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders.

Summary.Objectives: To review the epidemiological evidence on the health-enhancing physical activity recommendation of the Centers for Disease Control and Prevention (CDC) and the American College for Sports Medicine (ACSM). Methods: Review of papers written in English and German, issued after the release of the CDC/ACSM recommendation (i. e. after 1995), restricted to adults and to their physical health. Due to the large body of published data, no systematic review was performed. Instead, a representative cross-section of the published studies is presented. Results: The international epidemiological evidence supports the CDC/ACSM recommendation as a reasonable public health message. Conclusions: According to this recommendation, the daily accumulation of 30 minutes of physical activity of moderate intensity – independent of the context of physical activity (e. g. transport, leisure) – provides substantial benefits across a broad range of health outcomes for sedentary men and women. Nevertheless some controversial issues need further address. [ABSTRACT FROM AUTHOR]