The links between adolescent biological maturity, physical activity and fat mass development, and subsequent cardiometabolic risk in young adulthood

The metabolic syndrome has become a major public health challenge world-wide and, at least in the industrialized world, the prevalence of the metabolic syndrome is increasing. There is evidence to show that biological and lifestyle risk factors for metabolic syndrome are present in adolescence, which suggests that the antecedents of the disease may lie in early life. The period of adolescence is characterized by a decline in physical activity (PA; lack of PA is a lifestyle risk factor for metabolic syndrome) and an increase in fat mass deposition (a biological risk factor for metabolic syndrome). Therefore, investigating how the development of these two variables relates to adult cardiometabolic risk is important to fuel early intervention. A factor which has the potential to influence these two risk factors, and thus ultimately the metabolic syndrome, is the timing of biological maturity (i.e. whether an individual is early, average or late maturing when compared to peers of the same age). The influence of biological maturity has largely been overlooked in previous research; therefore, the general objective of this thesis was to investigate the associations between biological maturity, adolescent PA and fat mass development, and young adult cardiometabolic risk. Three studies were necessary to realize this objective, and together help to elucidate the role of biological maturity in the adolescent decline in physical activity, fat development, and the development of adult metabolic syndrome. Ultimately, this information will aid in the development and implementation of interventions to decrease prevalence of metabolic syndrome. Study 1: The purpose of study 1 was to investigate whether observed gender differences in objectively measured PA in children (8 to 13 years) are confounded by biological maturity differences. Methods: Four hundred and one children (194 boys and 207 girls) volunteered for this study. An Actigraph accelerometer was used to obtain 7 consecutive days of minute-by-minute PA data on each participant. Minutes of moderate to vigorous PA per day (MVPA), continuous minutes of MVPA per day (CMVPA), and minutes of vigorous PA per day (VPA) were derived from the accelerometer data. Age at peak height velocity (APHV), an indicator of somatic maturity, was predicted and individuals aligned by this biological age (years from APHV). Gender differences in the PA variables were analyzed using a two-way (gender X age) ANOVA. Results: Levels of PA decreased with increasing chronological ages in both genders (

Evaluation of the implementation of an intervention to improve the street environment and promote walking for transport in deprived neighbourhoods

Background Levels of physical activity remain low, particularly in deprived areas. Improving the street environment to promote walking for transport using a community engagement approach is a potential strategy to increase physical activity. An understanding of the implementation of this intervention approach is needed to facilitate further research, replication and scale-up. The aim of this study was to evaluate the implementation of the Fitter for Walking (FFW) intervention in deprived neighbourhoods. Methods FFW was delivered in five regions of England between August 2008 and March 2012 and aimed to use a community engagement approach to improve the street environment to promote walking for transport. Implementation was assessed in relation to reach; dosage; implementation processes and adaptation; and factors influencing implementation. Three data sources were used: focus groups and face-to-face interviews with coordinators; implementation logs; and participation records. Results Reach: 155 community groups participated in FFW engaging 30,230 local residents. Dosage: A wide variety of environmental improvements were implemented by local authorities (LAs) (42 projects) and by communities (46 projects). Examples of LA-led improvements included removal of encroaching vegetation, new/improved pedestrian signage, new dropped kerbs/kerb improvements and new, repaired or improved footpaths. Examples of community-led improvements include planting bulbs, shrubs or bedding plants, clean-up days and litter pick-ups. In 32 projects, no environmental improvements were implemented. Promotional and awareness-raising activities were undertaken in 81 projects. Examples included led walks, themed walks, development of maps/resources to promote improved routes and community events. Processes and adaptation: The need for a planning phase, a preparatory phase, and a delivery phase with a four step process were identified. Adaptability to local context was important. Factors influencing implementation: Five key themes were identified in relation to the barriers and facilitators of implementing FFW: local knowledge and contacts; intervention delivery; coordinator role; working with LAs and other partners; and working with communities. Conclusions FFW is one of few reported interventions which have used a community engagement approach to change the street environment to promote walking for transport in deprived neighbourhoods. Delivering these types of interventions is complex and requires considerable resource and time. A set of recommendations and an implementation framework are proposed for future delivery of this and similar types of programme

Getting a GRIP (getting research into practice) on movement integration in the school classroom

In adults prolonged sitting is detrimentally associated with a number of health sequela including type 2 diabetes, cardiovascular diseases and all-cause mortality, and it has been suggested these negative health consequences may not be fully protected against by participation in physical activity. Altering ubiquitous environments for children to increase their opportunities to break or reduce extended sitting is therefore of key public health interest. Emerging research shows that physical activity can be introduced into the school classroom, through short activity breaks and by integrating movement into the learning of core academic content. This may help to improve children’s time on task, enjoyment of learning, and in some cases academic outcomes. This discussion paper briefly highlights some of the key research on movement integration in the classroom, discusses potential challenges and facilitators of implementation at a variety of levels (e.g. teacher, school, external stakeholder) and presents an ongoing, innovative programme (CLASS PAL) as a case study of one approach to get research on classroom movement integration into routine teaching practice

A sports-based intervention for pupils excluded from mainstream education: A systems approach to intervention acceptability and feasibility

Pupil referral units educate young people excluded from mainstream education within England, UK. Exclusion is related to reduced continuation with education and training, unemployment, and an increased likelihood of entrance into the criminal justice system. Sport has been consistently used to improve reintegration into education. However, evidence surrounding sports interventions in this setting is sparse and/or lacks detail surrounding acceptability and feasibility. Systems-based approaches highlight the complexity of multi-component interventions. The current study aimed to independently evaluate the acceptability and feasibility of a co-produced sport-based intervention. The intervention used sport, mentorship, education, reflection, and role models to promote health, pro-social, behavioural, and educational outcomes. Conducted in one local authority pupil referral unit within the midlands, England, a sample of 38 pupils (n = 3 females), five support staff, eight teachers, eight mentors and three stakeholders participated in the evaluation. The intervention was evaluated through a multi-method approach which incorporated observation, interviews, visual methods, a pre-experimental study, and examination of school-level data. Data were analysed through an iterative process framed through inductive reasoning, and descriptive statistics. Layers of data were triangulated to produce a systems-map. Within a complex system of social networks and individual differences, the intervention components interacted to influence pupil health and behaviour. Findings suggested that sport is an acceptable and feasible conduit to support mentorship. Participation in sport can mitigate some challenges to engaging in reflection, education, and identifying role models. Challenges relating to acceptability and feasibility could be improved through adopting a robust co-production process beyond simple design centred ‘co-creation’, consideration of emotional and health literacy of pupil cohorts, and deliberation of the factors which shape long-term implementation and sustainability. Research should understand the extent to which our systems-map is replicable in a range of settings

Chronic obstructive pulmonary disease (COPD), illness narratives and Elias's sociology of knowledge

This paper draws on Elias’s sociology of knowledge to provide a critical assessment of illness narratives. Focusing on a cohort of chronic obstructive pulmonary disease (COPD) patients (n=26), the paper employs a comparative analysis of mixed method data derived from qualitative interviews, quantitative questionnaires, and physiological and accelerometer testing. The article firstly compares four narratives conveyed in interviews with the broader paradigmatic approach to illness narratives and existing COPD-specific studies. It then explores the relationship between these ‘stories’ and COPD patients’ biographical contingencies (e.g. age, wealth, context of diagnosis) and embodied condition (e.g. co-morbidities, lung function), demonstrating how illness narratives are shaped by both broader social structural factors and embodied experience. Invoking Elias we further find that different narrative subthemes are varyingly affected by patients’ emotional engagement and ontological security and thus that people are differently enabled or constrained to present illness narratives that are consistent with their broader social and physical condition. Consequently, while narratives, social structure and embodied experience are interdependent, our reading of ‘truth’ must be sensitive to the social positioning of the ‘teller’ and the specific content being relayed. The paper therefore presents a more systematic, comparative, bio-psycho-social analysis than has hitherto been produced

Sitting time and obesity in a sample of adults from Europe and the USA

Obesity is a risk factor for many chronic diseases and the prevalence is increasing worldwide. Research suggests that sedentary behaviour (sitting) may be related to obesity.To examine the association between sitting time and obesity, while controlling for physical activity, in a large international sample.5338 adults from the UK, USA, Germany, Spain, Italy, France, Portugal, Austria and Switzerland self-reported their total daily sitting time, physical activity, age, height and weight. BMI (kg/m(2)), total physical activity (MET-minutes/week) and sitting time (hours/day) were derived. Participants were grouped into quartiles based on their daily sitting time (8 hours/day) and logistic regression models explored the odds of being obese versus normal weight for each sitting time quartile.Participants in the highest sitting time quartile (≥8 hours/day) had 62% higher odds of obesity compared to participants in the lowest quartile (<4 hours/day) after adjustment for physical activity and other confounding variables (OR = 1.62, 95% CI = 1.24-2.12, p<0.01).Sitting time is associated with obesity in adults, independent of physical activity. Future research should clarify this association using objective measures of sitting time and physical activity to further inform health guidelines

Lack of knowledge of physical activity guidelines: Can physical activity promotion campaigns do better?

Objectives: To identify the prevalence of knowledge of the current UK physical activity guidelines which were introduced in 2011 and prior physical activity guidelines (30 min on 5 days each week) within two large samples of UK adult's. To investigate whether knowledge of physical activity guidelines differs according to demographics such as ethnicity, age, education and employment status. Design: Descriptive cross-sectional study comparing two distinctive adult samples. Setting: National survey and online-administered survey conducted in England. Participants: The 2007 Health Survey for England provides data on knowledge of physical activity guidelines from 2860 UK adults (56% women, 89% white, 63% under 45 years old). In 2013, an online survey was disseminated and data were collected from 1797 UK adults on knowledge of the most recent physical activity guidelines. The 2013 sample was 70% women, 92% white and 57% under 45 years old. All adults in both samples were &gt;18 years old and without illnesses/disorders likely to restrict physical activity. Main outcomes: Knowledge of physical activity guidelines in 2007 and 2013. Demographic correlates of knowledge of moderate-to-vigorous physical activity guidelines. Results: 18% of the 2013 sample accurately recalled the current physical activity guidelines compared with 11% of the 2007 sample who accurately recalled the previous guidelines. The differences in knowledge of physical activity guidelines existed for marital status, gender, age, education and employment status within both 2007 and 2013 samples (p&lt;0.05). Men with lower education and employment status (unemployed including student and retired) and older adults were less likely to know physical activity guidelines (p&lt;0.05). Knowledge of physical activity guidelines remained higher in the 2013 sample after controlling for demographic differences ( p&lt;0.05). Conclusions: Disadvantaged population groups are less knowledgeable about physical activity guidelines. Although knowledge of physical activity guidelines appears to have increased in recent years demographic disparities are still evident. Efforts are needed to promote health information among these groups