Physical activity guideline development

Background: The World Health Organization and many national health bodies have released physical activity and sedentary behaviour guidelines. However, there is variation in the quality of guideline development processes, the types of evidence considered, and how evidence is appraised, which may partly explain inconsistencies in existing guidelines. Purpose: To develop international consensus on the methodological standards applied to the development of future physical activity and sedentary behaviour guidelines. Methods: We used a three round modified Delphi study. Participants with expertise in physical activity and/or guideline development rated a series of statements on expert involvement; the types of evidence and study designs considered; and the utilisation of formal approaches in guideline development processes. Consensus was defined as group agreement of ≥80%. Results: 23 participants from eight countries reached consensus that 1) a range of stakeholders should be involved in different stages of the guideline development process (evidence review, production of recommendations, messaging, and guideline dissemination); 2) previous study-level synthesised evidence must be included in evidence reviews and individual studies can be included if published after the most recent review or where review evidence is unavailable; 3) parallel randomised controlled studies must be included, prospective cohort studies should be included, and predictive modelling, cross-over trials, non-randomised trials and case control studies can be included in review processes; and 4) formal approaches should be utilised to assess the quality of individual primary studies, the reporting and quality of systematic reviews, and the overall process for grading evidence. Conclusions: Consensus on who should be involved, the types of evidence and study designs that should be considered, and the need for formal quality assessments was achieved. Practical implications: The findings provide a set of methodological standards to improve consistency and rigour in the development of future physical activity and sedentary behaviour guidelines.   Funding: None

Background: Physical literacy has gained considerable traction across physical activity, sport, health, and education sectors, leading to an abundance of definitions and interpretations worldwide. However, implementing and advocating for physical literacy becomes challenging when the concept holds different meanings for different individuals and organisations. ‘Uniting’ perspectives on the concept could catalyse efforts to adopt, support and promote physical literacy in practice. Purpose: This study aimed to develop a physical literacy consensus statement for England that was accessible for those working in research, policy, and practice. Methods: Phase one included a review of the evidence, a first national stakeholder consultation, and focus groups with children and young people. Phase two included a modified-Delphi methodology and co-development of the draft statement with an expert panel of sixty researchers and stakeholders from around fifty organisations. Phase three included a second national consultation on the draft statement. Phase four involved further co-development and an online survey with the expert panel to revise the statement. Results: Consensus was established on a definition: Physical literacy is our relationship with movement and physical activity throughout life. The statement also included five key messages encompassing (1) Understanding physical literacy, (2) Why physical literacy matters, (3) Supporting physical literacy, (4) Our experiences affect our physical literacy, and (5) Physical literacy is personal. Conclusion: The consensus statement is for sector professionals and practitioners and provides a shared understanding of what physical literacy, why it is important and how it can be supported. Future research should evaluate the implementation and the impact of the consensus statement. Practical implications: By understanding, supporting, and adapting to the diverse needs and preferences of everyone, practitioners can play a pivotal role in enhancing physical literacy – an intrinsic driver for engagement in movement and physical activity behaviours. Funding: The National Lottery and Sport England

Background. Guidelines are important tools for disseminating evidence-based dose-response recommendations. Purpose. To perform a literature review to identify physical activity, sedentary, and sleep recommendations worldwide and to compare the World Health Organization (WHO) with those reported worldwide. Methods. A systematic literature review for all age groups was carried out using the systematic steps of the Cochrane Handbook for Systematic Reviews. Medline, Embase, and CINHAL databases were used for scientific literature and Google, GoPA and WHO webpages were reviewed for grey literature documents. In addition, we emailed local physical activity and/or health researchers or authorities to verify if the guidelines posted within these web pages were the most current and officials within the country. All documents published in all languages between January 1st, 2015, and March 1st, 2023. were included. The quality of articles and documents was evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II). Results. Sixty-nine scientific articles, and information from 59 countries coming from either Google, GoPA, or WHO web pages were identified and verified by local researchers or authorities. A higher percentage of high-income countries had three behavior recommendations compared to middle and low-income countries. In total, more than half of countries adopted WHO recommendations. Pregnant and postpartum women and children under 5 years were the groups with fewer recommendations among countries. Of those countries that do not adopt guidelines from WHO, fourteen countries developed their own guides. Several discrepancies were observed among guides including wording (minimum, average), and age groups (3-4 years or 3-5 years). Conclusions. More than 50 countries have guidelines, however, countries with lower incomes and vulnerable populations do not have complete recommendations or guides for their population. Practical implications Efforts are needed to help these countries to generate or adapt current guidelines. Funding. Bloomberg Philanthropies

Background: In 2020 the World Health Organization (WHO) released the first international physical activity guideline for people living with disability. However, the evidence informing the guideline was not specific to people with traumatic brain injury (TBI), nor the rehabilitation setting. Purpose: To develop an Australian physical activity clinical practice guideline for health professionals working with people with moderate-to-severe TBI. Methods: We used a Grading of Recommendations Assessment, Development and Evaluation (GRADE) ADOLOPMENT approach to determine whether to ‘adapt’ or ‘adopt’ the WHO guideline or develop de novo recommendations. We established guideline leadership and development groups, conducted a systematic review to identify direct evidence in moderate-to-severe TBI, and reviewed guidelines in other health conditions (e.g., stroke) to identify indirect evidence. To inform future implementation, we conducted an audit of Australian brain injury rehabilitation services and qualitative consultations with key stakeholders. Results: The clinical practice guideline developed incorporated 10 de novo recommendations to support health professionals’ clinical decision-making and increase uptake of physical activity by people of all ages living with moderate-to-severe TBI. Twenty-six brain injury services were audited, with 54-100% of services prescribing physical activity interventions consistent with the guideline recommendations, indicating feasibility. Data from stakeholder focus groups indicated good acceptability of physical activity interventions, however barriers to implementation e.g., identifying and accessing community physical activity, were identified. Conclusions: The GRADE ADOLOPMENT process resulted in de novo recommendations to support increased physical activity participation for people with moderate-to-severe TBI. There remains a need for more direct evidence in this population, as well as research to evaluate how the guideline can be implemented into clinical practice. Practical implications: Physical activity interventions tailored to the individual’s goals and needs should be standard clinical practice for health professionals working with people with moderate-to-severe TBI. Funding: Australian Medical Research Future Fund TBI Mission, 2020 (MRF2009099).

Background The UK 2019 Physical Activity Guidelines state that muscle strengthening activities, such as carrying heavy bags, gardening, stair climbing, going to the gym and yoga, should be done at least 2 days per week. Purpose The current study aims to identify the activities that people engage in to meet these guidelines. Methods Adults aged 18 to 64 years old living in the United Kingdom completed an online survey covering participation in nine different types of muscle strengthening activities. Crosstabulation and Pearson Chi-Square test were used to examine the distribution of muscle strengthening activity types, separately in males and females. Results 77% of the 620 who completed the survey self-reported meeting the guidelines, with higher participation in males (81%) than females (75%). Of those who self-reported not meeting the guidelines, 96% did actually meet the guidelines when carrying heavy bags and stair climbing were included. Stair climbing (92% males; 95% females) and carrying heavy bags (89% males; 90% females) were also frequently reported in adults who met the guidelines. Notable sex differences were found for other activities with males participating more in weight machines (57% males, 40% females, p=0.002) and resistance exercises (80% males, 70% females, p=0.033), and females participated in more holistic exercise (33% males, 55% females, p<.001). Conclusion Many people misreport not meeting the muscle strengthening guidelines unless daily living activities are explicitly stated. Whether these activities (promoted in the guidelines) are sufficient to increase muscle strength and confer associated health benefits remains to be established. Clear differences were also apparent between men and women in the kinds of activities they perform to meet the guidelines. Practical Implications This information may be important in developing more personalised interventions to increase participation in muscle strengthening activities. Funding NDR is funded by the Government of Malaysia under Majlis Amanah Rakyat.

Background: The World Health Organization and national health bodies of many countries have released physical activity guidelines (with many also covering sedentary behaviour). Despite significant overlap in the body of evidence reviewed, the resultant sets of guidelines are not always consistent. Purpose: This study involved a review of the processes used to develop global and national physical activity and sedentary behaviour guidelines and examined the extent to which they conform with minimum methodological standards. Methods: The most recent national and global physical activity guidelines for children and youth and/or adults (any language) were eligible for inclusion if they were developed through a formal review process. We rated each set of guidelines as high, medium, or low quality in relation to each item in domain 3 (rigour of development) of the Appraisal of Guidelines for Research and Evaluation 2 (AGREE 2) tool. We extracted data on nine sets of guidelines from seven jurisdictions (WHO, Australia, Canada, Japan, the Netherlands, UK, and US). Results: We observed variation in the quality of guideline development processes across jurisdictions and across different elements of AGREE 2. The strongest ratings related to the criteria for selecting the evidence being clearly described and stating an explicit link between the recommendations and the supporting evidence. The weakest ratings related to the methods for formulating the recommendations being clearly described, and the guidelines being externally reviewed by experts prior to publication. Conclusion: Against different elements of AGREE 2, the quality of guideline development processes was highly variable across jurisdictions. Reaching agreement on acceptable guideline development processes, as well as the inclusion and appraisal procedures of different types of evidence, would strengthen and align future physical activity and sedentary behaviour guidelines. Practical implications: This study highlights the need to establish consensus on the minimum standards for guideline development. Funding: None

Background: China’s urbanization resulted significant challenges for the physical activity (PA) of children from both from urban and rural areas. Purpose: Investigating the disparities in WHO guideline adherence among urban and rural Chinese preschoolers. Method: The study recruited 1,304 children aged 3.0–4.9 across urban and rural regions in China ( rural children: 47.7%). PA was assessed using 24-hour accelerometry over three consecutive days. Demographic information, child sedentary screen time (SST), outdoor time (OT), and sleep duration (SD) were reported by parents. Descriptive and logistic regression analyses were conducted using SPSS 26. Results: Urban children (UC) adherence to WHO guidelines for PA (≥ 3 h daily PA, including ≥1 h daily moderate- to vigorous-intensity PA), SST (< 1 h/day), OT (＞ 2 h/day), and SD (10-13 h/day) are at 47.7%, 69.2%, 57.5%, and 66.6% respectively, while rural children (RC) show compliance rates of 56.4%, 52.4%, 60.6%, and 64.7%. The urban-rural differences were particularly notable in PA and SST. RC had higher adherence to PA guidelines compared to UC overall and across ages and genders (OR = 1.4 ~ 2.3, 95% CI= 1.0–3.0),. This difference in PA was pronounced among families with higher education, rather than the families with lower education. On the contrary, RC were less likely to meet SST guidelines compared to UC, both overall and across ages and genders (OR = 0.4–0.6, 95% CI: 0.3–0.8). This urban-rural gap in SST is more apparent in higher educated families. Conclusions: Overall and across age and gender categories, RC outperformed UC PA and RC consistently show excessive SST. These disparities are more evident among families with higher education. Practical implications: Disparities in physical activity between urban and rural children, influenced by urbanization and digital access, necessitate tailored public health interventions, particularly for families with lower education levels.