Inequalities in physical activity – 2

Background: The Canadian Institutes of Health Research (CIHR) offer resources and support to promote Indigenization and EDIA (Equity, Diversity, Inclusion, and Accessibility) in Canadian health research. However, there is a notable absence of practical guidance, limiting optimal engagement and integration of these valued and crucial research priorities. Purpose: To develop priorities and recommendations for enhancing Indigenization and EDIA in physical activity and health research. Methods: This three-phased project comprised: 1) a mapping review, 2) a survey of post-secondary administrators leading physical activity or kinesiology departments/faculties, and 3) a two-day qualitative focus group meeting involving six kinesiology researchers with intersectional identities. The six researchers convened on Treaty 7 territory, Banff, Alberta, in February 2024 for the two-day meeting. This gathering provided a dedicated time and space for the researchers to share their lived experiences and formulate specific priorities and recommendations. Results: There was strong agreement to focus on three key audiences—academic institutions, funding agencies, and academic societies—centred around three core areas: 1) providing clear and distinctive definitions and actions pertaining to Indigeneity and EDIA, 2) establishing and fostering the creation of a culture of Indigenization and EDIA through engaging various actors as agents of change, and 3) promoting “top-down” sustainable and systemic changes by challenging existing merit systems rooted in a colonial patriarchy. Conclusions: The focus group identified a crucial need for clear and distinctive definitions, cultural transformation, and systemic changes to enhance Indigenization and EDIA in physical activity and health research in Canada and beyond. Specific actions are provided for each of the three target audiences. Practical implications: These insights lay a foundation for actionable recommendations that can guide future directions and initiatives of academic institutions, funding agencies, and academic societies, collectively fostering meaningful and sustainable advancements in Indigenization and EDIA. Funding: This project is supported by CIHR.

Background: Culturally relevant physical activity can increase collective well-being and promote healthy behaviors for health equity. The World Health Organization recently highlighted the importance of cultural insights for health and noted this promising area is underexplored and underutilized globally. Program Delivery: In Hawai‘i, questions about culturally relevant activities, including hula, outrigger canoe paddling, and spearfishing were added to the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS collects nationally harmonized data on preventive health practices and risk behaviors in the adult population. States can ask optional questions of relevance to their communities to give critical insights for health promotion that engages cultural preferences and strengths. Evaluation: Disaggregated data collected showed engagement in hula and paddling was highest among Native Hawaiian and Pacific Islander communities. For example, almost 1 in 2 Native Hawaiians reported engaging in hula– a cultural practice with high physical activity demands that is being used as a tool for improving cardiometabolic health. Nationally harmonized measures may not capture such data of relevance to local community and cultural preferences. Conclusions: The state level surveillance was possible from community relationships and systems and trust built over time. These led to the collection of insightful data on culturally relevant physical activity measures using BRFSS as well as ongoing health promotion activities in partnership with communities and other sectors. Practical Implications: Implementing culturally relevant hula-based health programs and other similar programs engaging community strengths and preferences in physical activity are important, underutilized tools for health promotion and equity. This work provides practical and innovative insights for research and practice locally and globally. Funding: Hawai’i State Department of Health’s Chronic Disease Prevention and Health Promotion Division, through a contract with UH Office of Public Health Studies and the Chin Sik and Hyun Sook Chung Endowed Chair in Public Health Studies.

Purpose: Insufficient physical activity (PA) is a well-known risk factor for noncommunicable diseases. Yet studies show that the level of PA among French adults remains inadequate, and unevenly across the population. This work studies the factors associated with PA in French population to identify inequalities and adapt public health strategies.

Methods: Data come from two complementary cross-sectional population-based surveys (Esteban 2014-2016 and Health Barometer 2021). Using the RPAQ in Esteban study produced detailed data on the nature, types and domains of PA in 2678 French adults. The data collected in the Health Barometer were less detailed, but the size of this survey (n=24514 for mainland France; n=6519 for the overseas territories) allowed analysis of PA levels according to sub-national territories and detailed socio-demographic characteristics. Samples have been compared by adjusted Wald tests and design-based Pearson tests (gender-stratified, weighted and standardized data). Multivariate models (with odds ratio) identified the factors associated with PA levels.

Results: The results highlighted social and territorial inequalities in PA practice in France: residents of northeastern regions are less active, as are older people (OR=0.6), those living in large cities (OR=0.7) and those with lower levels of education (ORwomen=0.7; ORmen=0.9). The most obvious difference concerns gender, with only half of women sufficiently active (compared with 4/5 of men). This relates to the domains and characteristics of PA. Women do more low-intensity PA, linked to home and family duties, which are still highly gendered and hamper achievement of the WHO recommendations.

Conclusions: This study shows the inequalities in PA in France, and the need to target public health strategies accordingly. In addition to targeted actions, it is necessary to act at a systemic level, by making living environments more conducive to PA, for all, i.e. by increasing walkability, active mobility, and practice opportunities such as active design projects.

Background: Natural outdoor environments such as beaches are important settings for people to engage in physical activity. However, the quality and safety of beaches can differ across neighbourhoods, with higher socioeconomic status (SES) neighbourhoods having disproportionately better access to natural blue spaces. Purpose: This study examined the physical activity promoting features and amenities of beaches and how these differed by neighbourhood SES. Methods: Beaches (n=76) in Perth, Western Australia were audited using a modified version of the BlueHealth Environmental Assessment Tool (BEAT). The BEAT tool assesses the health enhancing features and activities taking place in blue spaces. Regression analysis examined associations between beaches features and activities conducted in and around beaches and how this varied by neighbourhood SES. Significance was set at a 2-sided P < .05. Results: Compared with low SES neighbourhoods, beaches in high SES suburbs had significantly higher scores of greenspace quality, lifeguard patrols and footpath networks. Significantly more people visited beaches in high SES areas, compared with beaches in low SES areas. Walking, dog walking, and swimming were the most common activities at beaches regardless of neighbourhood SES. Across all neighbourhoods’ swimming was more common at beaches with lifeguards. In low SES suburbs dog walking was associated with higher quality footpath networks around the beach. There were no significant associations between general walking and beach features. Conclusions: Preliminary findings suggest beaches in high SES areas possess features more likely to be associated with physical activity and safety. Practical implications: These findings should be considered by those involved in urban planning, preservation of natural spaces and physical activity promotion, particularly in low SES areas. Funding: PG and EA were supported by an Australian Government Research Training Scholarship. HC was supported by a National Heart Foundation Future Leader Fellowship (#102549).

Background: Features of neighbourhoods, including green space, have been shown to shape obesity and health in adults. However, research is predominantly from Europe and North America. Purpose: We explored the cross-sectional association of geospatially-derived indicators of neighbourhood greenness, tree cover and built-up areas with overweight and obesity in Bangladesh. We tested whether associations varied by urbanicity and household income. Methods: We used data from 42,081 Bangladeshi adults enrolled in South Asia Biobank between 2017-2022. Using a geographical information system, we constructed a 500m buffer around home address. We quantified greenness using the normalized difference vegetation index. We quantified tree cover and built-up areas using the WorldCover dataset. Adjusted regression models explored the association of (a) greenness; (b) tree cover and (c) built up areas with overweight and obesity defined using (i) body mass index; (ii) waist circumference and (iii) waist-hip ratio. We tested for interactions by urbanicity and household income. Results: 49% of participants were overweight or obese. Higher greenness was associated with lower odds of overweight and obesity across body mass index (OR=0.90, 95%CI 0.86 to 0.93), waist circumference (OR=0.87, 95%CI 0.84 to 0.90) and waist-hip ratio (OR=0.87, 95%CI 0.84 to 0.91). Conversely, higher amounts of built-up areas were associated with higher odds of overweight and obesity across body mass index (OR=1.10, 95%CI 1.08 to 1.11), waist circumference (OR=1.08, 95%CI 1.07 to 1.10) and waist-hip ratio (OR=0.87, 95%CI 0.84 to 0.91). Associations were strongest in urban participants. Tree cover associations were not statistically significant. Conclusions: In Bangladeshi adults, higher greenness and lower amounts of built-up areas were associated with more favourable body composition, particularly in urban dwellers. Practical implications: This study aligns with others indicating beneficial associations of green space with health, and with policy to support greening of cities. Funding: National Institute for Health Research (16/136/68, 133205).

Background: Despite being referred to as a “healthy choice”, access to leisure-time physical activity (LPA) remains a privilege in most societies worldwide, especially in low- and middle-income countries (LMICs). An equity lens is critical for understanding and reverting this current scenario. Purpose: To describe between and within-country socioeconomic inequalities in LPA worldwide and by World Bank country-income groups. Methods: Data were sourced from the World Health Organization (WHO) STEPwise approach to surveillance (STEPS) database. Proportion of participants meeting WHO physical activity guidelines with LPA was derived from Global Questionnaire of Physical Activity (GPAQ) data. Socioeconomic status was estimated by levels of formal education, standardized across countries as none, primary (incomplete and complete primary), secondary (incomplete and complete secondary, technical, and professional education), and higher (incomplete and complete undergraduate at the university, graduate courses). Slope Index of Inequality (SII) was used to assess absolute inequality. World Bank income groups classification was used for between-country group comparisons. Results: In total, data from 68 countries were analyzed (9 High-income, 16 Upper middle-income, 28 lower middle-income and 15 low-income). LPA inequalities were consistently identified in all countries. Within countries, average LPA prevalence was approximately 20 percentage points (p.p.) among those with no formal education compared to those with higher levels of education. Afghanistan, Ecuador, Malawi, and Vanuatu had the largest absolute gaps between the extreme levels of education (above 40 p.p). LPA prevalence among those in the lowest level of education in low-income countries was approximately 35 p.p. lower than among those with the highest level of education in high-income countries. Conclusions: Between and within-country socioeconomic inequalities in LPA are marked in all income classification of countries. Practical implications: Domain-specific and equity oriented public policies to promote LPA are urgent at national and global levels.

Background: Little is known about when socioeconomic inequalities in physical activity among women emerge across the lifespan. Purpose: To examine socioeconomic inequalities in physical activity among mid-age Australian women over a period of 21 years. Methods: This prospective study used data from the 1946-51 Cohort of the Australian Longitudinal Study on Women’s Health. Physical activity was self-reported every three years from 1998 (age 47-52) to 2019 (age 68-73). Data from participants who responded to at least 7 out of 8 surveys were included in the analyses (N=7,104). Time/age changes in the proportion of participants who met the physical activity guidelines over 21 years were analysed according to the highest qualification reported at the baseline survey, as a proxy of socioeconomic position. Results: In 1998, 57% of the total sample met the guidelines, with no marked differences according to the highest qualification reported [relative difference between women with no formal qualification and those with higher education: 1.07; 95%CI: 0.99-1.17]. Overall prevalence increased over to 65% in 2016, falling back to 59% in 2019. However, among women with no formal qualification, there was no significant change in the proportion of participants who met the guidelines, while there was an increase among those with higher education (from 55% in 2000 to 74% in 2018, and 68% in 2021). By 2021, the relative difference between the lowest and highest qualification groups had increased to 1.39 (95%CI: 1.28-1.51). Conclusions: Socioeconomic inequalities play a crucial role in shaping physical activity trajectories in women during the transition from midlife to older age. Practical implications: Public health policies have been ineffective in addressing physical inactivity among disadvantaged groups during this life stage, and they should specifically target those with the least advantage. Funding: This research is supported by a National Health and Medical Research Council Investigator Grant (APP2008702).