Perceived characteristics of the environment associated with active travel: development and testing of a new scale

Background Environmental characteristics may be associated with patterns of physical activity. However, the development of instruments to measure perceived characteristics of the local environment is still at a comparatively early stage, and published instruments are not necessarily suitable for application in all settings. We therefore developed and established the test-retest reliability of a new scale for use in a study of the correlates of active travel and overall physical activity in deprived urban neighbourhoods in Glasgow, Scotland. Methods We developed and piloted a 14-item scale based on seven constructs identified from the literature (aesthetics, green space, access to amenities, convenience of routes, traffic, road safety and personal safety). We administered the scale to all participants in a random postal survey (n = 1322) and readministered the scale to a subset of original respondents (n = 125) six months later. We used principal components analysis and Varimax rotation to identify three principal components (factors) and derived summary scores for subscales based on these factors. We examined the internal consistency of these subscales using Cronbach's alpha and examined the test-retest reliability of the individual items, the subscale summary scores and an overall summary neighbourhood score using a combination of correlation coefficients and Cohen's kappa with and without weighting. Results Public transport and proximity to shops were the items most likely to be rated positively, whereas traffic volume, traffic noise and road safety for cyclists were most likely to be rated negatively. Three principal components – 'safe and pleasant surroundings', 'low traffic' and 'convenience for walking' – together explained 45% of the total variance. The test-retest reliability of individual items was comparable with that of items in other published scales (intraclass correlation coefficients (ICCs) 0.34–0.70; weighted Cohen's kappa 0.24–0.59). The overall summary neighbourhood score had acceptable internal consistency (Cronbach's alpha 0.72) and test-retest reliability (ICC 0.73). Conclusion This new scale contributes to the development of a growing set of tools for investigating the role of perceived environmental characteristics in explaining or mediating patterns of active travel and physical activity

Recruiting hard-to-reach populations to physical activity studies : evidence and experiences

Most researchers who are conducting research with a public health focus face difficulties in recruiting the segments of the population that they really want to reach. This symposium presented evidence and experiences on recruiting participants to physical activity research, including both epidemiological and intervention based studies. Results from a systematic review of recruitment strategies suggested that we know little about how best to recruit and highlighted the need for researchers to report this in more detail, including metrics of reach into the target population such as number, proportion, and representativeness of participants. Specific strategies used to optimise responses to a population-based mail survey were presented such as study promotion, survey design, multiple mailings, and personal engagement. Finally, using place based recruiting via schools or places of worship to target ethnic minority youth were discussed. Overall the symposium presenters suggested that we need to learn more about how best to recruit participants, in particular those typically under-represented, and that researchers need to apportion a similar amount of planning effort to their recruitment strategies as they do the their research design. Finally we made a plea for researchers to report their recruitment processes in detail

The impact of retirement on physical activity

Most adults do not achieve the levels of physical activity currently recommended for a healthy lifestyle. Population surveys suggest that there is a linear decline of activity levels with age, yet physical activity has many health benefits for older adults. If these are to be more widely adopted among older people, health policy and promotion require an understanding of the factors that influence decreasing activity with age. This study examined the patterns of physical activity of 699 participants in the West of Scotland Twenty-07 Study who were aged 60 years when interviewed in 1991 and followed up four to five years later. It examined the factors that influenced whether or not the subjects achieved currently recommended levels of activity, by applying random effects models with a seasonal adjustment. It was found that higher levels of physical activity associated with a healthier lifestyle, and that socio-economic factors played a minor role in determining the level of physical activity. A substantial amount of physical activity occurred at work but was lost by those who had retired, for while those who were not working were more physically active at home or at leisure than those in work, the majority of the sample did too little physical activity outside work to compensate for the loss of work-based activity. One conclusion is that health promotion initiatives that encourage people to become more physically active should be targeted at those who are about to retire

Do pedometers motivate people to walk more?

Physical activity confers many important health benefits. The 'active living message' recommends that adults should accumulate 30 ruin of moderate-intensity physical activity (e.g. brisk walking) on most--preferably all--days of the week, but the populations of most developed countries are not meeting this target. Walking is one mode of activity that most people can do without skills, equipment, facilities or extra expense and walking has less bias in terms of age, sex and social class than facility-based exercise. Thus we need to investigate interventions that promote walking

Using Organisational Cultural Theory to understand workplace interventions to reduce sedentary time

Sedentary behaviour has been shown to have a negative impact on health. As such, prolonged sitting in the workplace is being increasingly seen as a public health problem. Multi-component interventions to reduce sedentary time at work are being used as a way of addressing the different environmental, personal and organisational influences on sedentary behaviour. The role of the organisational context on behaviour has rarely been explored in depth or theorised in the sedentary workplace behaviour literature yet a rich body of theory and evidence exists outside the field. The current article applies an organisational cultural framework for exploring how organisational factors and dynamics impact on sedentary behaviour in the workplace. Empirical data are taken from a qualitative study of office workers’ responses to a ‘sit less’ initiative. Thirteen in-depth interviews and documentary analysis were conducted to help elucidate the ways in which organisational assumptions, strategy, structures, activities, operations, actions and norms combine to constrain reduced sitting time at work. The article offers a theoretical approach to understanding how organisational culture can influence interventions aimed at encouraging people to sit less in the workplace. It also offers an opportunity to consider how intervention design can better account for the ‘whole systems’ of an organisation and how ‘sit less’ initiatives can be positioned within them

Evaluating health effects of transport interventions: methodologic case study

Background: There is little evidence about the effects of environmental interventions on population levels of physical activity. Major transport projects may promote or discourage physical activity in the form of walking and cycling, but researching the health effects of such “natural experiments” in transport policy or infrastructure is challenging. Methods: Case study of attempts in 2004–2005 to evaluate the effects of two major transport projects in Scotland: an urban congestion charging scheme in Edinburgh, and a new urban motorway (freeway) in Glasgow. Results: These interventions are typical of many major transport projects. They are unique to their context. They cannot easily be separated from the other components of the wider policies within which they occur. When, where, and how they are implemented are political decisions over which researchers have no control. Baseline data collection required for longitudinal studies may need to be planned before the intervention is certain to take place. There is no simple way of defining a population or area exposed to the intervention or of defining control groups. Changes in quantitative measures of health-related behavior may be difficult to detect. Conclusions: Major transport projects have clear potential to influence population health, but it is difficult to define the interventions, categorize exposure, or measure outcomes in ways that are likely to be seen as credible in the field of public health intervention research. A final study design is proposed in which multiple methods and spatial levels of analysis are combined in a longitudinal quasi-experimental study

The relationship and effects of golf on physical and mental health:A scoping review protocol

Introduction Golf is a sport played in 206 countries worldwide by over 50 million people. It is possible that participation in golf, which is a form of physical activity, may be associated with effects on longevity, the cardiovascular, metabolic and musculoskeletal systems, as well as on mental health and well-being. We outline our scoping review protocol to examine the relationships and effects of golf on physical and mental health. Methods and analysis Best practice methodological frameworks suggested by Arksey and O'Malley, Levac et al and the Joanna Briggs Institute will serve as our guide, providing clarity and rigour. A scoping review provides a framework to (1) map the key concepts and evidence, (2) summarise and disseminate existing research findings to practitioners and policymakers and (3) identify gaps in the existing research. A three-step search strategy will identify reviews as well as original research, published and grey literature. An initial search will identify suitable search terms, followed by a search using keyword and index terms. Two reviewers will independently screen identified studies for final inclusion. Dissemination We will map key concepts and evidence, and disseminate existing research findings to practitioners and policymakers through peer-reviewed and non-peer reviewed publications, conferences and inperson communications. We will identify priorities for further study. This method may prove useful to examine the relationships and effects of other sports on health.</p

Effects of an exercise and hypocaloric healthy eating intervention on indices of psychological health status, hypothalamic-pituitary-adrenal axis regulation and immune function after early-stage breast cancer : a randomised controlled trial

INTRODUCTION: Many women experience emotional distress, depression and anxiety after a diagnosis of breast cancer. Psychological stress and depression have been associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation that may adversely affect immune system functioning and impact upon survival. This study investigated the effects of a lifestyle intervention on indices of psychological health status, HPA axis regulation and immune function in overweight women recovering from early-stage breast cancer treatment. METHODS: A total of 85 women treated for breast cancer 3 to 18 months previously were randomly allocated to a 6-month exercise and hypocaloric healthy eating program plus usual care or usual care alone (control group). Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice, supplemented by weekly nutrition seminars. Depressive symptoms (Beck Depression Inventory version II: BDI-II), perceived stress (Perceived Stress Scale: PSS), salivary diurnal cortisol rhythms; inflammatory cytokines (IL-6 and Tumor necrosis factor-α), leukocyte phenotype counts, natural killer (NK) cell cytotoxicity and lymphocyte proliferation following mitogenic stimulation were assessed at baseline and 6-month follow up. RESULTS: Compared with the control group, the intervention group exhibited a reduction in depressive symptoms (adjusted mean difference, 95% confidence intervals (95% CI): -3.12, -1.03 to -5.26; P = 0.004) at the 6-month follow-up but no significant decrease in PSS scores (-2.07, -4.96 to 0.82; P = 0.16). The lifestyle intervention also had a significant impact on diurnal salivary cortisol rhythm compared with usual care alone, as evidenced by an increase in morning salivary cortisol at the 6-month follow-up (P <0.04), indicating a change in HPA axis regulation. Women in the control group had higher total leukocyte, neutrophil and lymphocyte counts in comparison to the intervention group at the 6-month follow-up (P ≤0.05), whereas there was no difference in NK cell counts (P = 0.46), NK cell cytotoxicity (P = 0.85) or lymphocyte proliferation responses (P = 0.11) between the two groups. CONCLUSION: Our results show that the lifestyle intervention resulted in a reduction in depressive symptoms and a normalisation of HPA axis regulation. Such changes could have important implications for long-term survival in women recovering from early-breast cancer treatment. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN08045231

Data-as-a-Service Platform for Delivering Healthy Lifestyle and Preventive Medicine: Concept and Structure of the DAPHNE Project

Background: Overweight and obesity is related to many health problems and diseases. The current obesity epidemic, which is a major health problem, is closely related to a lack of physical activity, high levels of sedentary behavior, and increased energy intake; with evidence to show increasing incidence of these issues in the younger population. Tackling obesity and its comorbid conditions requires a holistic approach encompassing attention on physical activity, healthy diet, and behavioral activation in order to enable and maintain meaningful and long-term weight loss and weight maintenance. Objective: The objective of the Data-as-a-Service Platform for Healthy Lifestyle and Preventive Medicine (DAPHNE) project is to develop a breakthrough information communications technology (ICT) platform for tracking health, weight, physical activity, diet, lifestyle, and psychological components within health care systems, whereby the platform and clinical support is linked. Methods: The DAPHNE platform aims to deliver personalized guidance services for lifestyle management to the citizen/patient by means of (1) advanced sensors and mobile phone apps to acquire and store continuous/real-time data on lifestyle aspects, behavior, and surrounding environment; (2) individual models to monitor their health and fitness status; (3) intelligent data processing for the recognition of behavioral trends; and (4) specific services for personalized guidance on healthy lifestyle and disease prevention. It is well known that weight loss and maintenance of weight loss are particularly difficult. This tool will address some of the issues found with conventional treatment/advice in that it will collect data in real time, thereby reducing reliability issues known with recalling events once they have passed and will also allow adjustment of behavior through timely support and recommendations sent through the platform without the necessity of formal one-to-one visits between patient and clinician. Patient motivation/compliance is a particular issue with conventional weight loss regimes; DAPHNE aims to increase the individuals’ awareness of their own behavior and fosters their accountability. Results: The project has been funded and the research work has started. Results for the validation of the different components is due imminently. Conclusions: In contrast with previous existing solutions, the DAPHNE project tackles the obesity problem from a clinical point of view, designing the different interfaces for its use by patients (adults and children), physicians, and caregivers. A specific design for children and adolescent patients treated for obesity has been followed, guided by pediatric physicians at hospitals in Europe. The final clinical validation of the DAPHNE platform will be carried out in different European hospitals, testing the platform in both adolescents and adults