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BackgroundAlthough healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults’ sedentary behavior. However, little is known about older adults’ experiences with a self-monitoring–based intervention aimed at the reduction of sedentary behavior. ObjectiveThe aim of this study is to evaluate engagement, acceptability, usability, and preliminary efficacy of a self-monitoring–based mHealth intervention developed to reduce older adults’ sedentary behavior. MethodsA mixed methods study was performed among 28 community-dwelling older adults living in Flanders, Belgium. The 3-week intervention consisted of general sedentary behavior information as well as visual and tactile feedback on participants’ sedentary behavior. Semistructured interviews were conducted to explore engagement with, and acceptability and usability of, the intervention. Sitting time was measured using the thigh-worn activPAL (PAL Technologies) accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired-samples t tests; qualitative data were thematically analyzed and presented using pen profiles. ResultsParticipants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (ie, they became more aware of their sedentary behavior) but not their actual behavior. There were mixed opinions on the kind of feedback (ie, tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants, ranging from 0 to 20 times a day. No significant reductions were found in objectively measured sitting time. ConclusionsAlthough the intervention was well perceived by the majority of older adults, no reductions in sitting time were found. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change. Trial RegistrationClinicalTrials.gov NCT04003324; https://tinyurl.com/y2p4g8hx

BackgroundWearable trackers for monitoring physical activity (PA) and total sleep time (TST) are increasingly popular. These devices are used not only by consumers to monitor their behavior but also by researchers to track the behavior of large samples and by health professionals to implement interventions aimed at health promotion and to remotely monitor patients. However, high costs and accuracy concerns may be barriers to widespread adoption. ObjectiveThis study aimed to investigate the concurrent validity of 6 low-cost activity trackers for measuring steps, moderate-to-vigorous physical activity (MVPA), and TST: Geonaut On Coach, iWown i5 Plus, MyKronoz ZeFit4, Nokia GO, VeryFit 2.0, and Xiaomi MiBand 2. MethodsA free-living protocol was used in which 20 adults engaged in their usual daily activities and sleep. For 3 days and 3 nights, they simultaneously wore a low-cost tracker and a high-cost tracker (Fitbit Charge HR) on the nondominant wrist. Participants wore an ActiGraph GT3X+ accelerometer on the hip at daytime and a BodyMedia SenseWear device on the nondominant upper arm at nighttime. Validity was assessed by comparing each tracker with the ActiGraph GT3X+ and BodyMedia SenseWear using mean absolute percentage error scores, correlations, and Bland-Altman plots in IBM SPSS 24.0. ResultsLarge variations were shown between trackers. Low-cost trackers showed moderate-to-strong correlations (Spearman r=0.53-0.91) and low-to-good agreement (intraclass correlation coefficient [ICC]=0.51-0.90) for measuring steps. Weak-to-moderate correlations (Spearman r=0.24-0.56) and low agreement (ICC=0.18-0.56) were shown for measuring MVPA. For measuring TST, the low-cost trackers showed weak-to-strong correlations (Spearman r=0.04-0.73) and low agreement (ICC=0.05-0.52). The Bland-Altman plot revealed a variation between overcounting and undercounting for measuring steps, MVPA, and TST, depending on the used low-cost tracker. None of the trackers, including Fitbit (a high-cost tracker), showed high validity to measure MVPA. ConclusionsThis study was the first to examine the concurrent validity of low-cost trackers. Validity was strongest for the measurement of steps; there was evidence of validity for measurement of sleep in some trackers, and validity for measurement of MVPA time was weak throughout all devices. Validity ranged between devices, with Xiaomi having the highest validity for measurement of steps and VeryFit performing relatively strong across both sleep and steps domains. Low-cost trackers hold promise for monitoring and measurement of movement and sleep behaviors, both for consumers and researchers.

BackgroundThere is a limited understanding of components that should be included in digital interventions for 24-hour movement behaviors (physical activity [PA], sleep, and sedentary behavior [SB]). For intervention effectiveness, user engagement is important. This can be enhanced by a user-centered design to, for example, explore and integrate user preferences for intervention techniques and features. ObjectiveThis study aimed to examine adult users’ preferences for techniques and features in mobile apps for 24-hour movement behaviors. MethodsA total of 86 participants (mean age 37.4 years [SD 9.2]; 49/86, 57% female) completed a Web-based survey. Behavior change techniques (BCTs) were based on a validated taxonomy v2 by Abraham and Michie, and engagement features were based on a list extracted from the literature. Behavioral data were collected using Fitbit trackers. Correlations, (repeated measures) analysis of variance, and independent sample t tests were used to examine associations and differences between and within users by the type of health domain and users’ behavioral intention and adoption. ResultsPreferences were generally the highest for information on the health consequences of movement behavior self-monitoring, behavioral feedback, insight into healthy lifestyles, and tips and instructions. Although the same ranking was found for techniques across behaviors, preferences were stronger for all but one BCT for PA in comparison to the other two health behaviors. Although techniques fit user preferences for addressing PA well, supplemental techniques may be able to address preferences for sleep and SB in a better manner. In addition to what is commonly included in apps, sleep apps should consider providing tips for sleep. SB apps may wish to include more self-regulation and goal-setting techniques. Few differences were found by users’ intentions or adoption to change a particular behavior. Apps should provide more self-monitoring (P=.03), information on behavior health outcome (P=.048), and feedback (P=.04) and incorporate social support (P=.048) to help those who are further removed from healthy sleep. A virtual coach (P

BackgroundWearables for monitoring physical activity (PA) are increasingly popular. These devices are not only used by consumers to monitor their own levels of PA but also by researchers to track the behavior of large samples. Consequently, it is important to explore how accurately PA can be tracked via these devices. ObjectivesThe aim of this study was, therefore, to investigate convergent validity of 3 Android Wear smartwatches—Polar M600 (Polar Electro Oy, Kempele, Finland), Huawei Watch (Huawei Technologies Co, Ltd, Shenzhen, Guangdong, China), Asus Zenwatch3 (AsusTek Computer Inc, Taipei, Taiwan)—and Fitbit Charge with an ActiGraph accelerometer for measuring steps and moderate to vigorous physical activity (MVPA) on both a day level and 15-min level. MethodsA free-living protocol was used in which 36 adults engaged in usual daily activities over 2 days while wearing 2 different wearables on the nondominant wrist and an ActiGraph GT3X+ accelerometer on the hip. Validity was evaluated on both levels by comparing each wearable with the ActiGraph GT3X+ accelerometer using correlations and Bland-Altman plots in IBM SPSS 24.0. ResultsOn a day level, all devices showed strong correlations (Spearman r=.757-.892) and good agreement (interclass correlation coefficient, ICC=.695-.885) for measuring steps, whereas moderate correlations (Spearman r=.557-.577) and low agreement (ICC=.377-.660) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for measuring steps but a variation between over- and undercounting of MVPA. On a 15-min level, all devices showed strong correlations (Spearman r=.752-.917) and good agreement (ICC=.792-.887) for measuring steps, whereas weak correlations (Spearman r=.116-.208) and low agreement (ICC=.461-.577) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for steps but under- or overestimation for MVPA depending on the device. ConclusionsIn sum, all 4 consumer-level devices can be considered accurate step counters in free-living conditions. This study, however, provides evidence of systematic bias for all devices in measurement of MVPA. The results on a 15-min level also indicate that these devices are not sufficiently accurate to provide correct real-time feedback.

BackgroundMobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. ObjectiveThe objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app “Active Coach” on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. MethodsWe recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. ResultsNo significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P

BackgroundPhysical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. ObjectiveThe aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. MethodsThe new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. ResultsA new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. ConclusionsBy applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process.

BackgroundOnline social networks offer considerable potential for delivery of socially influential health behavior change interventions. ObjectiveTo determine the efficacy, engagement, and feasibility of an online social networking physical activity intervention with pedometers delivered via Facebook app. MethodsA total of 110 adults with a mean age of 35.6 years (SD 12.4) were recruited online in teams of 3 to 8 friends. Teams were randomly allocated to receive access to a 50-day online social networking physical activity intervention which included self-monitoring, social elements, and pedometers (“Active Team” Facebook app; n=51 individuals, 12 teams) or a wait-listed control condition (n=59 individuals, 13 teams). Assessments were undertaken online at baseline, 8 weeks, and 20 weeks. The primary outcome measure was self-reported weekly moderate-to-vigorous physical activity (MVPA). Secondary outcomes were weekly walking, vigorous physical activity time, moderate physical activity time, overall quality of life, and mental health quality of life. Analyses were undertaken using random-effects mixed modeling, accounting for potential clustering at the team level. Usage statistics were reported descriptively to determine engagement and feasibility. ResultsAt the 8-week follow-up, the intervention participants had significantly increased their total weekly MVPA by 135 minutes relative to the control group (P=.03), due primarily to increases in walking time (155 min/week increase relative to controls, P

BackgroundComputer-tailored physical activity (PA) interventions delivered through the Internet represent a promising and appealing method to promote PA at a population level. However, personalized advice is mostly provided based on subjectively measured PA, which is not very accurate and might result in the delivery of advice that is not credible or effective. Therefore, an innovative computer-tailored PA advice was developed, based on objectively pedometer-measured PA. ObjectiveThe study aim was to evaluate the effectiveness of a computer-tailored, pedometer-based PA intervention in working adults. MethodsParticipants (≥18 years) were recruited between May and December 2012 from eight Flemish workplaces. These workplaces were allocated randomly to an intervention or control group. Intervention group participants (n=137) received (1) a booklet with information on how to increase their steps, (2) a non-blinded pedometer, and (3) an Internet link to request computer-tailored step advice. Control group participants (n=137) did not receive any of the intervention components. Self-reported and pedometer-based PA were assessed at baseline (T0), and 1 month (T1) and 3 months (T2) months post baseline. Repeated measures analyses of covariance were used to examine intervention effects for both the total sample and the at-risk sample (ie, adults not reaching 10,000 steps a day at baseline). ResultsThe recruitment process resulted in 274 respondents (response rate of 15.1%) who agreed to participate, of whom 190 (69.3%) belonged to the at-risk sample. Between T0 and T1 (1-month post baseline), significant intervention effects were found for participants’ daily step counts in both the total sample (P=.004) and the at-risk sample (P=.001). In the at-risk sample, the intervention effects showed a daily step count increase of 1056 steps in the intervention group, compared to a decrease of 258 steps in the control group. Comparison of participants’ self-reported PA revealed a significant intervention effect for time spent walking in the at-risk sample (P=.02). Intervention effects were still significant 3 months post baseline for participants’ daily step counts in both the total sample (P=.03) and the at-risk sample (P=.02); however, self-reported PA differences were no longer significant. ConclusionsA computer-tailored, pedometer-based PA intervention was effective in increasing both pedometer-based and self-reported PA levels, mainly in the at-risk participants. However, more effort should be devoted to recruit and retain participants in order to improve the public health impact of the intervention. Trial RegistrationClinicalTrials.gov: NCT02080585; https://clinicaltrials.gov/ct2/show/NCT02080585 (Archived by WebCite at http://www.webcitation.org/6VvQnRQSy).

BackgroundThe dramatic growth of Web 2.0 technologies and online social networks offers immense potential for the delivery of health behavior change campaigns. However, it is currently unclear how online social networks may best be harnessed to achieve health behavior change. ObjectiveThe intent of the study was to systematically review the current level of evidence regarding the effectiveness of online social network health behavior interventions. MethodsEight databases (Scopus, CINAHL, Medline, ProQuest, EMBASE, PsycINFO, Cochrane, Web of Science and Communication & Mass Media Complete) were searched from 2000 to present using a comprehensive search strategy. Study eligibility criteria were based on the PICOS format, where “population” included child or adult populations, including healthy and disease populations; “intervention” involved behavior change interventions targeting key modifiable health behaviors (tobacco and alcohol consumption, dietary intake, physical activity, and sedentary behavior) delivered either wholly or in part using online social networks; “comparator” was either a control group or within subject in the case of pre-post study designs; “outcomes” included health behavior change and closely related variables (such as theorized mediators of health behavior change, eg, self-efficacy); and “study design” included experimental studies reported in full-length peer-reviewed sources. Reports of intervention effectiveness were summarized and effect sizes (Cohen’s d and 95% confidence intervals) were calculated wherever possible. Attrition (percentage of people who completed the study), engagement (actual usage), and fidelity (actual usage/intended usage) with the social networking component of the interventions were scrutinized. ResultsA total of 2040 studies were identified from the database searches following removal of duplicates, of which 10 met inclusion criteria. The studies involved a total of 113,988 participants (ranging from n=10 to n=107,907). Interventions included commercial online health social network websites (n=2), research health social network websites (n=3), and multi-component interventions delivered in part via pre-existing popular online social network websites (Facebook n=4 and Twitter n=1). Nine of the 10 included studies reported significant improvements in some aspect of health behavior change or outcomes related to behavior change. Effect sizes for behavior change ranged widely from −0.05 (95% CI 0.45-0.35) to 0.84 (95% CI 0.49-1.19), but in general were small in magnitude and statistically non-significant. Participant attrition ranged from 0-84%. Engagement and fidelity were relatively low, with most studies achieving 5-15% fidelity (with one exception, which achieved 105% fidelity). ConclusionsTo date there is very modest evidence that interventions incorporating online social networks may be effective; however, this field of research is in its infancy. Further research is needed to determine how to maximize retention and engagement, whether behavior change can be sustained in the longer term, and to determine how to exploit online social networks to achieve mass dissemination. Specific recommendations for future research are provided.

BackgroundComputer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use. ObjectivesTo (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention. MethodsWe recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%). ResultsRecruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105–5172; F1 = 5.0, P = .04). No interaction or other time effects were found. Conclusions The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.

BackgroundLeisure-time and transport activity domains are studied most often because they are considered more amenable to intervention, but to date evidence on these domains is limited. The aim of the present study was to examine patterns of socio-demographic correlates of adults' leisure-time and transport physical activity and how these associations varied across 17 cities in 12 countries.MethodsParticipants (N = 13,745) aged 18-66 years in the IPEN Adult study and with complete data on socio-demographic and self-reported physical activity characteristics were included. Participants reported frequency and duration of leisure-time and transport activities in the last 7 days using the self-administered International Physical Activity Questionnaire-Long Form. Six physical activity outcomes were examined in relation with age, education, and sex, and analyses explored variations by city and curvilinear associations.ResultsSex had the most consistent results, with five of six physical activity outcomes showing females were less active than males. Age had the most complex associations with self-report transport and leisure-time physical activity. Compared to older people, younger adults were less likely to engage in transport physical activity, but among those who did, younger people were likely to engage in more active minutes. Curvilinear associations were found between age and all three leisure-time physical activity outcomes, with the youngest and the oldest being more active. Positive associations with education were found for leisure-time physical activity only. There were significant interactions of city with sex and education for multiple physical activity outcomes.ConclusionsAlthough socio-demographic correlates of physical activity are widely studied, the present results provide new information. City-specific findings suggest there will be value in conducting more detailed case studies. The curvilinear associations of age with leisure-time physical activity as well as significant interactions of leisure-time activity with sex and education should be further investigated. The findings of lower leisure-time physical activity among females as well as people with low education suggest that greater and continued efforts in physical activity policies and programs tailored to these high-risk groups are needed internationally.

BackgroundTo more accurately quantify the potential impact of the neighbourhood environment on adults' physical activity (PA), it is important to compare environment-PA associations between periods of the day or week when adults are more versus less likely to be in their neighbourhood and utilise its PA resources. We examined whether, among adults from 10 countries, associations between objectively-assessed neighbourhood environment attributes and moderate-to-vigorous physical activity (MVPA) varied by time of the day and day of the week. The secondary aim was to examine whether such associations varied by employment status, gender and city.MethodsThis cross-sectional study included 6,712 adults from 14 cities across 10 countries with ≥1 day of valid accelerometer-assessed MVPA and complete information on socio-demographic and objectively-assessed environmental characteristics within 0.5 and 1 km street-network buffers around the home. Accelerometer measures (MVPA min/h) were created for six time periods from early morning until late evening/night, for weekdays and weekend days separately. Associations were estimated using generalized additive mixed models.ResultsTime of the day, day of week, gender and employment status were significant moderators of environment-MVPA associations. Land use mix was positively associated with MVPA in women who were employed and in men irrespective of their employment status. The positive associations between MVPA and net residential density, intersection density and land use mix were stronger in the mornings of weekdays and the afternoon/evening periods of both weekdays and weekend days. Associations between number of parks and MVPA were stronger in the mornings and afternoon/evenings irrespective of day of the week. Public transport density showed consistent positive associations with MVPA during weekends, while stronger effects on weekdays were observed in the morning and early evenings.ConclusionsThis study suggests that space and time constraints in adults' daily activities are important factors that determine the impact of neighbourhood attributes on PA. Consideration of time-specific associations is important to better characterise the magnitude of the effects of the neighbourhood environment on PA. Future research will need to examine the contribution of built environment characteristics of areas surrounding other types of daily life centres (e.g., workplaces) to explaining adults' PA at specific times of the day.

Background: The ToyBox-intervention has increased preschool children's water consumption. This study aimed to examine if family-related determinants mediate the effects of the ToyBox-intervention on preschoolers' water consumption. Methods: Overall, 6290 preschoolers and their families from 6 European countries participated in the ToyBox-intervention and returned parental questionnaires in May/June 2012 and 2013. This study included the 3725 preschoolers/families who had complete data on water consumption, all mediators, and confounders. Mediation effects were assessed with bootstrapping procedure. Results: Regarding the intervention effects on family-related determinants, the ToyBox-intervention significantly increased water availability during meals, parental water consumption, parental encouragement to their children to drink water, and parental knowledge on water recommendations. In the multiple mediator model, all factors were independently associated with preschoolers' water consumption and mediated the intervention effect on preschoolers' water consumption (total mediation effect = 40%). After including all mediators into the model, the direct intervention effect remained significant. Conclusions: The effect of the ToyBox-intervention on preschool children's water consumption was mediated by most family-related determinants examined in this study (ie, availability, parental modeling, parental encouragement, and parental knowledge). Interventions aiming to promote water in preschoolers should target these mediators to enhance their effectiveness.

BackgroundEcological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries.MethodsA multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries.ResultsThree environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI.ConclusionsEnvironmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.

Purpose: The goals were to investigate whether extracurricular school-based sports reach students not engaging in community sports and whether extracurricular school-based sports participants are more physically active and/or autonomously motivated toward sports than nonparticipants. Method: 1526 students (48.0% boys; 85.9% Belgian natives; age = 15.34 ± 1.83y) completed validated questionnaires to assess sports participation, physical activity (PA) and sports-motivation. Multilevel regression analyses were conducted. Results: Only 28.7% of all students (n = 438), and 19.7% of students not engaging in community sports (n = 123), participated in extracurricular school-based sports. Participants were significantly more physically active [ß=44.19, S.E.=17.34, ?[superscript 2](1)=6.50, p = 0.01] and autonomously motivated [ß=0.18, S.E.=0.04, ?[superscript 2](1)=25.62, p < 0.001] than nonparticipants, even after controlling for community sports participation. Boys were more physically active and autonomously motivated than girls (p < 0.001). Conclusion: As participation is linked to higher PA-levels and autonomous motivation, increasing overall participation rates may contribute to children developing a more physically active lifestyle and achieving the PA guidelines.

Abstract Background Public parks can be an important setting for physical activity promotion, but to increase park use and the activity levels of park users, the crucial attributes related to active park use need to be defined. Not only user characteristics and structural park attributes, but also characteristics of the surrounding neighborhood are important to examine. Furthermore, internationally comparable studies are needed, to find out if similar intervention strategies might be effective worldwide. The main aim of this study was to examine whether the overall number of park visitors and their activity levels depend on study site, neighborhood walkability and neighborhood income. Methods Data were collected in 20 parks in Ghent, Belgium and San Diego, USA. Two trained observers systematically coded park characteristics using the Environmental Assessment of Public Recreation Spaces (EAPRS) tool, and park user characteristics using the System for Observing Play and recreation in Communities (SOPARC) tool. Multilevel multiple regression models were conducted in MLwiN 2.25. Results In San Diego parks, activity levels of park visitors and number of vigorously active visitors were higher than in Ghent, while the number of visitors walking and the overall number of park visitors were lower. Neighborhood walkability was positively associated with the overall number of visitors, the number of visitors walking, number of sedentary visitors and mean activity levels of visitors. Neighborhood income was positively associated with the overall number of visitors, but negatively with the number of visitors being vigorously active. Conclusions Neighborhood characteristics are important to explain park use. Neighborhood walkability-related attributes should be taken into account when promoting the use of existing parks or creating new parks. Because no strong differences were found between parks in high- and low-income neighborhoods, it seems that promoting park use might be a promising strategy to increase physical activity in low-income populations, known to be at higher risk for overweight and obesity.

Abstract Background The IPEN (International Physical Activity and Environment Network) Adult project seeks to conduct pooled analyses of associations of perceived neighborhood environment, as measured by the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated version (NEWS-A), with physical activity using data from 12 countries. As IPEN countries used adapted versions of the NEWS/NEWS-A, this paper aimed to develop scoring protocols that maximize cross-country comparability in responses. This information is also highly relevant to non-IPEN studies employing the NEWS/NEWS-A, which is one of the most popular measures of perceived environment globally. Methods The following countries participated in the IPEN Adult study: Australia, Belgium, Brazil, Colombia, Czech Republic, Denmark, Hong Kong, Mexico, New Zealand, Spain, the United Kingdom, and the United States. Participants (N = 14,305) were recruited from neighborhoods varying in walkability and socio-economic status. Countries collected data on the perceived environment using a self- or interviewer-administered version of the NEWS/NEWS-A. Confirmatory Factor Analysis (CFA) was used to derive comparable country-specific measurement models of the NEWS/NEWS-A. The level of correspondence between standard and alternative versions of the NEWS/NEWS-A factor-analyzable subscales was determined by estimating the correlations and mean standardized difference (Cohen’s d) between them using data from countries that had included items from both standard and alternative versions of the subscales. Results Final country-specific measurement models of the NEWS/NEWS-A provided acceptable levels of fit to the data and shared the same factorial structure with six latent factors and two single items. The correspondence between the standard and alternative versions of subscales of Land use mix – access, Infrastructure and safety for walking/cycling, and Aesthetics was high. The Brazilian version of the Traffic safety subscale was highly, while the Australian and Belgian versions were marginally, comparable to the standard version. Single-item versions of the Street connectivity subscale used in Australia and Belgium showed marginally acceptable correspondence to the standard version. Conclusions We have proposed country-specific modifications to the original scoring protocol of the NEWS/NEWS-A that enhance inter-country comparability. These modifications have yielded sufficiently equivalent measurement models of the NEWS/NEWS-A. Some inter-country discrepancies remain. These need to be considered when interpreting findings from different countries.

Abstract Background The development of reliable and culturally sensitive measures of attributes of the built and social environment is necessary for accurate analysis of environmental correlates of physical activity in low-income countries, that can inform international evidence-based policies and interventions in the worldwide prevention of physical inactivity epidemics. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for Nigeria and evaluated aspects of reliability and validity of the adapted version among Nigerian adults. Methods The adaptation of the NEWS was conducted by African and international experts, and final items were selected for NEWS-Nigeria after a cross-validation of the confirmatory factor analysis structure of the original NEWS. Participants (N = 386; female = 47.2%) from two cities in Nigeria completed the adapted NEWS surveys regarding perceived residential density, land use mix – diversity, land use mix – access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. Self-reported activity for leisure, walking for different purposes, and overall physical activity were assessed with the validated International Physical Activity Questionnaire (long version). Results The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.59 –0.91). Construct validity was good, with residents of high-walkable neighborhoods reporting significantly higher residential density, more land use mix diversity, higher street connectivity, more traffic safety and more safety from crime, but lower infrastructure and safety for walking/cycling and aesthetics than residents of low-walkable neighborhoods. Concurrent validity correlations were low to moderate (r = 0.10 –0.31) with residential density, land use mix diversity, and traffic safety significantly associated with most physical activity outcomes. Conclusions The NEWS-Nigeria demonstrated acceptable measurement properties among Nigerian adults and may be useful for evaluation of the built environment in Nigeria. Further adaptation and evaluation in other African countries is needed to create a version that could be used throughout the African region.

Abstract Background Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants’ response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. Methods A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 ±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10–15 minutes walk of participants’ residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants’ response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. Results A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, “Overall Activity Supportive (52% of sample)”, “High Walkable and Unsafe with Few Recreation Facilities (16%)”, “Safe with Active Transport Facilities (12%)”, “Transit and Shops Dense with Few Amenities (15%)”, and “Safe but Activity Unsupportive (5%)”. Country representation differed by type (e.g., U.S. disproportionally represented “Safe but Activity Unsupportive”). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR= 2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR= 1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA. Conclusions Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Abstract Background Active transportation has the potential to contribute considerably to overall physical activity levels in adults and is likely to be influenced by neighborhood-related built environment characteristics. Previous studies that examined the associations between built environment attributes and active transportation, focused mainly on transport-related walking and were conducted within single countries, limiting environmental variability. We investigated the direction and shape of relationships of perceived neighborhood attributes with transport-related cycling and walking in three countries; and examined whether these associations differed by country and gender. Methods Data from the USA (Baltimore and Seattle), Australia (Adelaide) and Belgium (Ghent) were pooled. In total, 6,014 adults (20–65 years, 55.7% women) were recruited in high-/low-walkable and high-/low-income neighborhoods. All participants completed the Neighborhood Environmental Walkability Scale and the International Physical Activity Questionnaire. Generalized additive mixed models were used to estimate the strength and shape of the associations. Results Proximity to destinations, good walking and cycling facilities, perceiving difficulties in parking near local shopping areas, and perceived aesthetics were included in a ‘cyclability’ index. This index was linearly positively related to transport-related cycling and no gender- or country-differences were observed. The ‘walkability’ index consisted of perceived residential density, land use mix access, proximity of destinations and aesthetics. A non-linear positive relationship with transport-related walking was found. This association was stronger in women than in men, and country-specific associations were identified: the strongest association was observed in Seattle, the weakest in Adelaide. In Ghent, the association weakened at higher levels of walkability. Conclusions For cycling, consistent correlates were found in the three countries, but associations were less straightforward for transport-related walking. Moreover, the identified neighborhood environmental correlates were different for walking compared to cycling. In order to further clarify the shape of these associations and reach more specific international guidelines for developing walkable and bikeable neighborhoods, future studies should include even more countries to maximize environmental variability.

AbstractBackgroundNeighborhood safety is inconsistently related to physical activity, but is seldom studied in developing countries. This study examined associations between perceived neighborhood safety and physical activity among Nigerian adults.MethodsIn a cross-sectional study, accelerometer-based physical activity (MVPA), reported walking, perceived crime and traffic safety were measured in 219 Nigerian adults. Logistic regression analysis was conducted, and the odds ratio for meeting health guidelines for MVPA and walking was calculated in relation to four safety variables, after adjustment for potential confounders.ResultsSufficient MVPA was related to more perception of safety from traffic to walk (OR=2.28, CI=1.13- 6.25) and more safety from crime at night (OR=1.68, CI=1.07-3.64), but with less perception of safety from crime during the day to walk (OR=0.34, CI=0.06- 0.91). More crime safety during the day and night were associated with more walking.ConclusionsPerceived safety from crime and traffic were associated with physical activity among Nigerian adults. These findings provide preliminary evidence on the need to provide safe traffic and crime environments that will make it easier and more likely for African adults to be physically active.

The study purpose was to test the effectiveness of the self-regulation eHealth intervention "MyPlan1.0." to increase physical activity (PA) in recently retired Belgian adults. This study was a randomized controlled trial with three points of follow-up/modules (baseline to 1-week to 1-month follow-up). In total, 240 recently retired adults (intervention group [IG]: n = 89; control group [CG]: n = 151) completed all three modules. The IG filled in evaluation questionnaires and received "MyPlan1.0.", an intervention focusing on both pre- and post-intentional processes for behavioural change. The CG only filled in evaluation questionnaires. Self-reported PA was assessed using the long International Physical Activity Questionnaire, usual week version. Repeated-measures multivariate analysis of variances were conducted in SPSS 22.0. On the short-term (baseline to 1 week), the intervention significantly increased walking for transport (IG: +11 min/week, CG: -6 min/week; P < 0.01). On the intermediate-term (baseline to 1 month), the intervention increased transport-related walking (IG: +14 min/week, CG: +6 min/week; P < 0.01), leisure-time walking (IG: +26 min/week, CG: -14 min/week; P < 0.10), leisure-time vigorous PA (IG: +16 min/week, CG: -4 min/week; P < 0.01), moderate-intensity gardening (IG: +4 min/week, CG: -34 min/week; P < 0.10) and voluntary work-related vigorous PA (IG: +28 min/week, CG: +13 min/week; P < 0.10). Results show that our eHealth intervention is effective in recently retired adults. Future studies should include long-term follow-up to examine whether the effects persist over a longer period.

Background: In Self-Determination Theory (SDT), a well-validated macro-theory on human motivation, a distinction is made between internally controlling teaching practices (e.g. guilt-induction and shaming) and externally controlling practices (e.g. threats and punishments, commands). While both practices are said to undermine students' motivation, they would do so through somewhat differential motivational processes. Unfortunately, the relevance of the conceptual distinction between internally and externally controlling strategies has not been examined systematically. In the context of sport and physical education (PE), most studies on controlling teaching have either measured controlling teaching in an undifferentiated way or have focused on one particular feature of controlling teaching. Purpose: The purpose of this study was to provide a more fine-grained picture on the differential de-motivational effects of internally and externally controlling teaching strategies in the domain of PE. Participants: A total of 925 students with an average age of 15.80 years (±1.99) coming out of 92 classes taught by 22 different PE teachers participated in the present study. Data analysis: Data on perceived controlling teaching style and students' motivation were analyzed within a multilevel framework from both a variable-centered (regression analyses) and person-centered approach (cluster analyses). Results: We found evidence for a distinction between perceived internally and externally controlling teaching. Both teaching styles were strongly related to each other (r = 0.54). At the level of zero-order correlations, both internally and externally controlling teaching related negatively to students' intrinsic motivation and identified regulation and related positively to introjected regulation, external regulation, and amotivation. However, when both teaching styles were included simultaneously as predictors of motivation in the regression analyses, only internally controlling teaching predicted poor quality and low quantity of motivation. A cluster analysis revealed different profiles of perceived controlling teaching style, with two profiles being characterized by either high or low levels of the two types of controlling teaching and other profiles displaying elevated or reduced levels of one of the types of controlling teaching. This person-centered analysis confirmed that particularly students who perceive their PE teacher as internally controlling are likely to report poor-quality motivation. Conclusion: Controlling teaching (and internally controlling teaching in particular) is related to maladaptive motivational outcomes. As such, it can be advised to PE-practitioners to refrain from using controlling strategies when teaching students. More research is needed to identify the conditions under which teachers' behavior is perceived as externally and/or internally controlling.