Behavioural determinants of physical activity across the life course: a "Determinants of Diet and Physical Activity" (DEDIPAC) umbrella literature review

Background Low levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course. Methods A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616). Results Seventeen reviews on 35 behavioral determinants of PA were eligible for this umbrella SLR. Regardless of age, the most investigated determinants were those related with ‘screen use’ and ‘smoking’. For youth, probable positive evidence emerged for ‘previous PA’ and ‘independent mobility and active transport’ among children and adolescents. For the adult population, ‘transition to university’ and ‘pregnancy/having a child’ showed probable negative associations. Conclusions Although the majority of the evidence was limited and most of the determinants were not associated with PA, this umbrella SLR provided a comprehensive overview of the associations between behavioral determinants and PA. Youth should be physically active in the early years and increase active transportation to/from school, independent mobility, and ‘free-range activities’ without adult supervision, whilst adult PA behaviors are mostly influenced by the life events. Finally, more research is needed that incorporates prospective study designs, standardized definitions of PA, objective measurement methods of PA assessment, and the use of interactionist and mediational approaches for the evaluation of different behavioral determinants influencing PA behaviors

Socio-cultural determinants of physical activity across the life course: a 'Determinants of Diet and Physical Activity' (DEDIPAC) umbrella systematic literature review

Objective Regular physical activity (PA) reduces the risk of disease and premature death. Knowing factors associated with PA might help reducing the disease and economic burden caused by low activity. Studies suggest that socio-cultural factors may affect PA, but systematic overviews of findings across the life course are scarce. This umbrella systematic literature review (SLR) summarizes and evaluates available evidence on socio-cultural determinants of PA in children, adolescents, and adults. Methods This manuscript was drafted following the recommendations of the ‘Preferred Reporting Items for Systematic reviews and Meta-Analyses’ (PRISMA) checklist. The MEDLINE, Web of Science, Scopus, and SPORTDiscus databases were searched for SLRs and meta-analyses (MAs) on observational studies published in English that assessed PA determinants between January 2004 and April 2016. The methodological quality was assessed and relevant information on socio-cultural determinants and any associations with PA was extracted. The available evidence was evaluated based on the importance of potential determinants and the strength of the evidence. Results Twenty SLRs and three MAs encompassing 657 eligible primary studies investigated potential socio-cultural PA determinants, with predominantly moderate methodological quality. Twenty-nine potential PA determinants were identified that were primarily assessed in children and adolescents and investigated the micro-environmental home/household level. We found probable evidence that receiving encouragement from significant others and having a companion for PA were associated with higher PA in children and adolescents, and that parental marital status (living with partner) and experiencing parental modeling were not associated with PA in children. Evidence for the other potential determinants was limited, suggestive, or non-conclusive. In adults, quantitative and conclusive data were scarce. Conclusions A substantial number of SLRs and MAs investigating potential socio-cultural determinants of PA were identified. Our data suggest that receiving social support from significant others may increase PA levels in children and adolescents, whereas parental marital status is not a determinant in children. Evidence for other potential determinants was limited. This was mainly due to inconsistencies in results on potential socio-cultural determinants of PA across reviews and studies

A life course examination of the physical environmental determinants of physical activity behaviour: A “Determinants of Diet and Physical Activity” (DEDIPAC) umbrella systematic literature review.

Background: Participation in regular physical activity is associated with a multitude of health benefits across the life course. However, many people fail to meet PA recommendations. Despite a plethora of studies, the evidence regarding the environmental (physical) determinants of physical activity remains inconclusive. Objective: To identify the physical environmental determinants that influence PA across the life course. Methods: An online systematic literature search was conducted using MEDLINE, ISI Web of Science, Scopus and SPORTDiscus. The search was limited to studies published in English (January 2004 to April 2016). Only systematic literature reviews (SLRs) and meta-analyses (MAs) of observational studies, that investigated the association between physical determinants and physical activity outcomes, were eligible for inclusion. The extracted data were assessed on the importance of determinants, strength of evidence and methodological quality. Results: The literature search identified 28 SLRs and 3 MAs on 67 physical environmental characteristics potentially related to physical activity that were eligible for inclusion. Among preschool children, a positive association was reported between availability of backyard space and outdoor toys/equipment in the home and overall physical activity. The availability of physical activity programs and equipment within schools, and neighbourhood features such as pedestrian and cyclist safety structure were positively associated with physical activity in children and adolescents. Negative street characteristics, for example, lack of sidewalks and streetlights, were negatively associated with physical activity in adults. Inconsistent associations were reported for the majority of reviewed determinants in adults. Conclusion: This umbrella SLR provided a comprehensive overview of the physical environment determinants of physical activity across the life course and has highlighted, particularly amongst youth, a number of key determinants that may be associated with overall physical activity. Given the limited evidence drawn mostly from cross-sectional studies, longitudinal studies are needed to further explore these associations

Associations of environmental and lifestyle factors with lung function in youth and adulthood.

Numerous factors influence lung function throughout the life course. Exposure to risk factors such as passive smoke or respiratory infections early in life have the potential to affect lung function already during lung development and growth. Such insults may result in respiratory impairment, a higher susceptibility to chronic lung diseases, and abnormal lung function decline in adulthood. Although the main determinants of lung function variability are sex, age, height, and ethnicity, the inter-subject variability increases in older age, indicating a complex interplay of early life, environmental, and lifestyle factors throughout life. While many studies have identified factors that are associated with lung function, most examined only one or a few factors at specific periods of life or focused on specific lung diseases as outcomes. Research on the effects of diverse early and current factors at a certain stage or among lung-healthy populations is rare. Therefore, the purpose of this thesis was to investigate on a population-based level which factors are associated with lung function at two periods in life, in adolescence at the stage of almost finalized lung growth and adulthood during age-related lung function decline, respectively. A further aim was to determine which domains of respiratory function obtainable by spirometry, i.e. lung volume or airway function, are involved in the associations found. Cross-sectional analyses were carried out in adolescents using data from the two German birth cohorts GINIplus and LISAplus at the 15-year follow-up and further in adults aged 45-89 years using population-based data of the KORA cohort studies. Early life events as well as current environmental and lifestyle factors were investigated in adolescents representing the stage of lung growth, while analyses at the stage of age-related lung function decline focused on environmental and lifestyle factors in adulthood. In adolescents, emphasis was put on the analysis of aeroallergen sensitization as it is associated with a higher risk of developing allergic respiratory diseases. Although the prevalence of sensitization to aeroallergens at age 15 years was high among adolescents with asthma or allergic rhinitis, the grade of sensitization to aeroallergens i.e. no sensitization up to polysensitization was not associated with lung volume or airway function in lung-healthy adolescents or those with asthma or rhinitis. Moreover, the associations of early life (e.g. parental atopy and education, birth weight, breastfeeding, peak weight velocity, and lower respiratory tract infections), current lifestyle and environmental factors (e.g. active smoking, serum vitamin D concentration, body mass index (BMI), and exposure to air pollution or second-hand smoke), and allergic diseases (e.g. asthma, rhinitis, and allergen sensitization) with spirometric lung function were analyzed. Besides the well-known determinants sex, height, and asthma, weight gain and pulmonary infections during infancy, as well as current BMI, indoor second-hand smoke exposure and serum vitamin D concentration were identified as prevalent factors associated with lung function in 15-year-olds. Overall, the results found for current environmental and lifestyle factors indicated associations with both lung volume and airway function, whereas weight gain and pulmonary infections in early life were consistently associated with lower airway function. However, early life events explained in median less than 5% of the variance, whereas at least Summary 5 75% was captured by sex and height. Nevertheless, small effects already present during the stage of lung growth might have the potential to modify lung function in adolescence. In adults, environmental and lifestyle factors were analyzed using questionnaire-based information on five quality of life health domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Because self-reported physical functioning was found to be associated with lung function, information on health domains was complemented by the investigation of self-reported physical activity levels. Moreover, the association between physical activity and lung function was more deeply analyzed using rarely investigated German population-based data on physical activity, obtained by accelerometers. Physical activity levels, duration pattern and associations with common chronic diseases including asthma and chronic obstructive pulmonary disease were analyzed. Furthermore, the association of time spent in moderate to vigorous physical activity (MVPA) with spirometric lung function, and additionally with measures of pulmonary gas exchange and respiratory muscle strength was examined in lung-healthy participants. Overall, adults spent about two thirds of the day in sedentary activity, whereas the median time spent in MVPA was only 3%. About 87% of MVPA was accumulated in MVPA bouts of less than 10 minutes, indicating sporadic activity instead of exercise. MVPA was lower among older and obese subjects, while common chronic diseases were not associated with time spent in MVPA. In lung-healthy adults, the most active participants had slightly higher volumetric indices, i.e. about 150 ml higher forced vital capacity and forced expiratory volume in 1 second compared to the least active participants which would correspond to a normal age-related decline of about 6 years. In line with this finding, self-reported inactivity, i.e. no or sporadic exercise, was negatively associated with spirometric volumes. This tendency was further supported by the associations found between slightly lower spirometric volumes and reporting problems with mobility and usual activities, respectively, whereas no associations were found for the other health domains. In summary, the results presented suggest that at the stage of lung growth in adolescence, specific early life events such as weight gain or pulmonary infections should be considered particularly in studies of airway function and, furthermore, that physical activity might be associated with lung volumes in lung-healthy adults representing the period of age-related lung function decline. Although these findings are not generalizable to other populations and the effect sizes found were small, the results nevertheless highlight the need to consider specific factors for the investigation of lung volumes and airway function at different age periods in life. Moreover, studies determining factors associated with lung function already in lung-healthy populations might help define starting points for early health interventions