Monitoring physical activity

Background: Investigators from low-, middle-, and high-income countries representing all inhabited continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire’ (GAC-PAQ). The GAC-PAQ addresses multiple gaps in global physical activity (PA) surveillance (e.g., omission of some PA domains, insufficient cultural adaptation, underrepresentation of rural areas in questionnaire validation studies). Purpose: To assess the comprehensibility of the GAC-PAQ among 7- to 17-year-olds and one of their parents/guardians. Methods: Child-parent dyads from 15 countries (N=250) participated in a cognitive interview. Structured by PA domain (i.e., school, chores, work/volunteering, transport, free time, outdoor time), interviews were conducted in 13 different languages to enhance inclusivity. Participants were asked about the clarity of the questions and response options and encouraged to provide suggestions to facilitate completion of the questionnaire. Images were included to help participants in answering questions about PA intensity. Results: In general, participants found the questionnaire to be comprehensive. Adolescents found it easier than children to answer the questions. Several children struggled to answer questions about the duration of recess and lunch periods, the intensity of activities, and/or concepts related to income, travel modes, active trips, and organized activities. Many parents were unsure about the frequency, duration, and intensity of their children’s PA at school, and/or recommended using more culturally-relevant images. Some participants misunderstood the concept of activities that “make you stronger” (intended to assess resistance activities) and/or struggled to differentiate between work, volunteering, and chores. Conclusions: Participants’ feedback was used to develop a revised, simplified, and culturally-relevant GAC-PAQ, which will be pilot-tested in an app that will include country-specific images and narration. Further research is needed to assess the reliability and validity of the revised GAC-PAQ. Practical implications: Findings have implications for the development of PA questionnaires and PA surveillance. Funding: Canadian Institutes of Health Research.

Background: The Global Matrix (GM), launched a decade ago, initially included two Latin American countries among its first 15 participants. Today, eight Latin American countries have developed Report Cards on physical activity (PA) for children and adolescents. Purpose: This study aims to analyse longitudinal trends in grades for the 10 key indicators included in the GM over the past ten years in the Latin American region (GM1.0, 2014; GM2.0, 2016; GM3.0, 2018; GM4.0, 2022). Methods: Data from published Report Cards were analysed for Argentina (GM4.0), Brazil (GM2.0, GM3.0, GM4.0), Chile (GM2.0, GM3.0, GM4.0), Colombia (GM1.0, GM2.0, GM3.0, GM4.0), Ecuador (GM3.0), Mexico (GM1.0, GM2.0, GM3.0, GM4.0), Uruguay (GM3.0, GM4.0), and Venezuela (GM2.0, GM3.0). Mean averages were calculated using the GM methodology, and the number of indicators with incomplete grades was identified by country and edition. Longitudinal analysis used GM3.0 as the baseline due to its comprehensive ten indicators. Results: Five of the eight countries were included in the longitudinal analysis. Argentina and Ecuador participated in one edition, and Venezuela in two, but without including GM4.0. Brazil showed no change in average indicator grades between 2018 and 2022. Other countries exhibited a positive increase of 0.5 to 0.8 points. Latin American countries, on average, demonstrated a 9.3% relative increase in grades from 2018 to 2022. Incomplete grades varied, with Brazil (GM3.0, GM4.0) having none and Venezuela (GM2.0) having six. Conclusion: A limited number of Latin American countries have consistently developed Report Cards. The trend analysis indicates an improvement in average grades from 2018 to 2022, however many indicators lack sufficient data for grading. Practical Implications: The increase in research capacity on PA for children and adolescents in Latin America and the information provided can help inform policies to promote healthier and more active lifestyles in Latin American children and adolescents. Funding: None.

Background: The steps required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours are unclear. Purpose: To identify how to improve surveillance of movement behaviours, from the perspective of experts. Methods: This Delphi Study involved 62 experts from the International Study of Movement Behaviours in the Early Years (SUNRISE) and the Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: 1) Funding, 2) Capacity Building, 3) Methods, 4) Other Issues. Expert participants ranked 40 items on a 5-point Likert scale from ‘extremely’ to ‘not at all’ important. Results: We received 62 responses to Round 1 of the Survey and 59 to Round 2. The top identified priority was increased funding for surveillance- this would underpin the other priority actions identified: establishment of regional hubs to support surveillance; development of standardised surveillance protocols; improved measurement methods; improved human capacity in surveillance of human movement behaviours; greater stakeholder awareness of World Health Organisation (WHO) movement behaviour guidelines and strategies. We found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30). There was a lack of agreement on using private funding for surveillance or surveillance research. Conclusions. This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally. Practical implications: This work identifies the steps required for the desired transformation in the surveillance of movement behaviours throughout childhood and adolescence. Experts wish to avoid a narrow surveillance focus, for example only on moderate to vigorous physical activity (MVPA). Greater focus on the surveillance of specific domains and contextual factors might be more practical for population-level monitoring of trends over time, understanding inequalities, and responses to changes in policy. Funding: None.

Background: Physical activity surveillance systems are important for public health monitoring but rely mostly on self-report measurement of physical activity. Integration of device-based measurements in such systems can improve population estimates, however this is still relatively uncommon in existing surveillance systems. Purpose: This systematic review aims to create an overview of the methodology used in existing device-based national PA surveillance systems. Methods: Four literature databases (PubMed, Embase.com, SPORTDiscus and Web of Science) were searched, supplemented with backward tracking. Articles were included if they reported on population-based (inter)national surveillance systems measuring PA, sedentary time and/or adherence to PA guidelines. When available and in English, the methodological reports of the identified surveillance studies were also included for data extraction. Results: This systematic literature search followed the PRISMA guidelines and yielded articles on one or multiple waves of 15 different national and one international surveillance system. The included studies showed substantial variation between (waves of) systems in number of participants, response rates, population representativeness and recruitment. In contrast, the methods were similar on data reduction definitions (e.g. minimal number of valid days, non-wear time and necessary wear time for a valid day). Conclusions: The results of this review indicate that few countries use device-based PA measurement in their surveillance system. The employed methodology is diverse, which hampers comparability between countries and calls for more standardized methods as well as standardized reporting on these methods. Practical implications: The results from this review can help inform the integration of device-based PA measurement in (inter)national surveillance systems. Funding: This work was supported by Amsterdam Public Health research institute and Statistics Netherlands.

Background: Physical behaviour is typically measured using questionnaires, but this methodology has inherent biases. Accelerometers have been used supplementarily, but it is costly at scale. The Motus system, employing wireless and cloud-based technology, has demonstrated feasibility in work environment surveillance. The system has an associated smartphone application for users to deliver contextual information, (de)activate their sensor and upload data. Purpose: This study evaluates Motus’ feasibility in public health surveillance of physical behaviour, focusing on recruitment, participation, and administrative burden. Methods: Web-based respondents of the Danish National Health Survey (DNHS)-2023 were invited to assess physical behaviour using Motus. Feasibility was assessed as administrative burden (time, effort, resources) and participation (acceptance, compliance, wear time). A subsample wore the sensor for two weeks to assess Hawthorne’s effect. Participant characteristics were obtained through national registries and the DNHS-2023. Results: Of 6,993 invited, 1,617 (23.1%) accepted and 1,050 (64.9%) completed the study. We had a 75.3% return-rate of sensors; 93.1% returned among finishers, 44.7% returned among dropouts. Participants in the accelerometer study exhibited higher education (long higher education: 22.4% vs. 16,8%), met guidelines for physical activity more often (52.2% vs 45.1%), smoked less (daily/occasional smokers: 8.5% vs 13.5%) and reported better health (excellent, very good, good: 81.9% vs. 78.7%) than DNHS-2023 respondents. Study administration totalled 267 hours, averaging 9.9 minutes per participant. Tasks included equipment packing (7.8%), digital sensor-participant linking (23.2%), disinfection upon return (4.1%) and communication with participants (64.8%).In the two-week subsample, no significant differences were observed in physical behaviour between first and second week of measurement. Conclusions: Public health surveillance of physical behaviour using Motus system seems feasible. However, before it can be used for data collection in large scale public health surveillance, solutions for minimizing sensor loss, administrative hours and selection bias are needed.

Background: Regular physical activity plays a significant role in disease prevention and mental well-being. However, women and pregnant women are generally less active than men. Purpose: To examine the physical activity prevalence and temporal trends among men, non-pregnant, and pregnant/postpartum women in Mexico from 2006 to 2022. Methods: Adult data (20-65 years; n= 98,230) from 2006, 2012, 2018, and 2022 of the National Health and Nutrition Surveys (ENSANUT) were compiled and analyzed. Physical activity was assessed using the IPAQ short form. Sociodemographic characteristics and pregnant/postpartum status were determined through a questionnaire. Multivariate logistic and generalized linear regression models were fitted to estimate physical activity prevalence and trends. Results: The adjusted prevalence of meeting physical activity guidelines decreased from 2006 to 2022 among men (n=42,129; 87.2-82.0%, p-trend<0.001), non-pregnant (n=54,166; 86.6-78.9%, p-trend<0.001), and pregnant/postpartum women (n=1,935, 80.7-66.9%, p-trend=0.183). The prevalence was consistently lower among pregnant/postpartum women compared to men and non-pregnant women across all survey years, and among non-pregnant women compared to men in 2018 (all p-values<0.05). Among men, there were downward trends in minutes per week of moderate-to-vigorous physical activity between 2006-2012 (p<0.001) with no significant differences afterwards (p=0.303). Among non-pregnant and pregnant/postpartum women, downward trends were observed between 2006-2012 and 2012-2018 (all p-values <0.001), followed by upward trends between 2018-2022 (all p-values<0.05). Regional analyses showed that the 2018-2022 upward trend was significant for all woman across three of the nine regions of Mexico, with the largest increases observed in Mexico City and the central region. Conclusion: Despite recent increasing physical activity levels among women, gender disparities in Mexico persist, particularly among pregnant/postpartum women. Practical Implications: Tailored interventions with a gender-focused approach are urgently needed to enhance physical activity levels in Mexico, particularly among women and during pregnancy and postpartum periods. Funding: ENSANUT is funded by the Mexican Ministry of Health.

Background: Despite numerous health benefits associated with physical activity, about 80% of adolescents do not meet the recommended minimum level of moderate to vigorous intensity physical activity (MVPA). Engaging in easily accessible activities such as walking and cycling are recommended to increase physical activity; however, little is known about the contribution of common everyday activities to MVPA and total PA (TPA) in adolescents across seasons. Purpose: To examine the contribution of different walking speeds, running, and cycling to MVPA and TPA in male and female adolescents across seasons. Methods: This cross-sectional study included 5,199 adolescents (mean age 15.9 years, standard deviation [SD] 1.8, range 13-19, 56.6% females) from the Norwegian HUNT study. Participants wore two accelerometers on the thigh and lower back to determine MVPA (defined as moderate/brisk walking [>4.0 km/h], running, and cycling), and TPA (MVPA plus slow walking [≤4.0 km/h]). Results: Mean MVPA (min/week) across seasons was 300 (IQR 187-383, 42% of TPA) for males and 253 (IQR 159-322, 39% of TPA) for females. Moderate/brisk walking constituted 69-76% of MVPA across seasons. Adolescents aged 13-16 years were more active than adolescents aged 16-19 (mean MVPA 306 min/week [IQR 196-393], versus 234 min/week [IQR 148-298]). Adolescents spent 146 min/week (IQR 83-193) more in MVPA, during summer than winter. Conclusions: Moderate/brisk walking is the main contributor to MVPA in adolescents. MVPA is considerably lower in the age group 16-19 years compared to 13-16 years. MVPA is higher during summer and lowest during winter and MVPA ’s relative proportion of TPA remains stable throughout adolescence. Practical implications: Slow walking is the dominant physical activity throughout adolescence. Replacing a proportion of slow walking with moderate or brisk walking might be a possible target for interventions aimed at increasing MVPA. Funding: NTNU Health, Norwegian University of Science and Technology (grant no. 81771516).