Short Orals: Physical activity policy

Background: Although Canada has a high capacity for physical activity research, surveillance, and policy, physical inactivity in Canada remains a growing concern. Purpose: The present study aims to make a bibliometric analysis of physical activity and health research in Canada and assesses existing national level physical activity surveillance and policy measures. Methods: Articles including data collected in Canada were extracted from a systematic review conducted by the Global Observatory for Physical Activity (GoPA!) which contained physical activity and health publications between 1950-2019. Publication trends were analyzed, as well as author affiliation. Publications were categorized into five areas (1. Surveillance; 2. Correlates and determinants; 3. Health consequences; 4. Interventions; and 5. Policy). Physical activity surveillance systems were assessed based on the inclusion of clear periodicity, instruments used, and age inclusivity. Policy was examined for the presence of a standalone physical activity plan/policy, and for the existence of national physical activity guidelines. Results: Of the >23,000 worldwide publications identified from the systematic review; 1,962 articles were attributed to Canada. While the number of publications has increased substantially over time by decade (1980s: 34 articles vs 2010s: 1288 articles), the upward trend appears to have changed more recently when observing publications annually. In Canada, most publications have focused on surveillance (37%), with few articles on interventions (7%). The Canadian Health Measures Survey (CHMS) and the Canadian Community Health Survey (CCHS) collect self-report physical activity data routinely, while the CHMS also collects accelerometer data. Canada is fortunate to have a standalone physical activity plan, “A Common Vision”, in addition to 24-Hour movement guidelines for various populations. Conclusions: Through collaborative and coordinated action, Canada remains well equipped to tackle physical inactivity. Practical implications: Continued efforts are needed to enhance sustained awareness of existing physical activity promotion resources to increase physical activity. Funding: N/A.

Background: Physical activity (PA) is essential to promote and maintain good physical and mental health, but many individuals do not meet recommendations. Policies that support physical activity promotion (PAP) within primary healthcare (PHC) settings are a key tenet of a comprehensive, systems-wide approach to increase PA and help prevent and manage many NCDs, including cancers. The fourth Building Momentum report sets out the emerging evidence for the benefits of promoting PA in PHC, and explains why designing and enacting such policies is good for individual health and economies. This report uniquely offers a global perspective on policy developments.

Policy Components: Currently, many countries lack policies on delivering PA interventions in PHC, despite evidence for effectiveness. Governments can use policy to encourage PA, taking action across multiple sectors to target where we live, learn, work and play. Our report outlines processes necessary for successful policy development, including: using evidence, building partnerships and shared policy objectives between stakeholders; and the importance of local contexts and an equity-in-all-policies approach to reduce barriers to participation.

Evaluation: Research, writing and publication were managed by WCRF International. A literature review evaluated current evidence and policies, and interviews were conducted with subject-matter experts.
The report had two rounds of review, including by interviewees, PA experts, WCRF Network colleagues and Policy Advisory Group, and WHO.

Conclusions: Well-designed policy on PAP in PHC is a key opportunity to improve the short- and long-term health and wellbeing of populations. Some regions have seen an increase in countries with national protocols on PA in PHC, while others have decreased. With NCDs annually accounting for 41 million deaths globally, there is an urgent need for policies to help people to be more active—PAP promotion in PHC is an important tool in achieving this.

Practical Implications/Funding:The authors declare no competing interests or funding.

Background: Previous surveys indicate that children with chronic medical and mental health conditions (CMC) do not meet physical activity (PA) guidelines in Toronto, Canada. Specific barriers surrounding PA programming and city infrastructure may contribute to limited PA participation.

Purpose: To identify barriers to and priorities for PA programming and infrastructure based on experiences of children with CMC, caregivers, policy makers, healthcare-professionals/researchers, and community partners.

Methods: The Delphi method was used to identify barriers and priorities in three rounds. Survey invitations were sent to children with CMC recruited from clinics at The Hospital for Sick Children; representatives of patient advocate societies; Toronto city council members, healthcare-providers, and community recreation partners. Invitation response rates were calculated as the sum of: “No”, “Yes”, and “Next Round” responses. In round 1, participants identified priorities and barriers through open-ended questions. Round 2 presented priorities in grouped topics. Respondents voted on the most important priorities within each topic.  In round 3, priority rankings under each topic were presented and respondents reappraised their round 2 rankings.

Results: A 72% (93/130) response rate was obtained in round 1. Respondents to survey questions, (n=59, 64%, Female) ages12-65 years (mean 34 years) included 20 CMC/caregivers, 27 healthcare-providers/researchers, 8 community partners, and 4 city councillors. In round 2 [78% response rate (68/87)] we identified 8 topics and up to 20 priorities per topic including: Staffing qualifications, PA program type, required PA program supports, barriers, informational needs, PA infrastructure needs, supports, and barriers. The top 3 priorities within each topic will be determined from round 3 and shared at this conference.

Conclusions: Partnerships with policy makers, healthcare-providers/researchers, community leaders, children with CMCs and caregivers to identify needs, barriers, and active living solutions has led to identifying 8 key topic areas to target in future research and policy priorities.

Funding: CIHR developmental grant

Background: In Puerto Rico (PR), chronic diseases account for over half of all deaths, with physical inactivity being a major risk factor. In the Americas, the median deaths attributed to physical inactivity in this region are 9.4%, underscoring the urgent need for targeted interventions. Purpose: The purpose of this study was to 1) describe the 2015 and 2020 physical activity (PA) profile of PR, and 2) propose recommendations for promoting PA research, policy, and surveillance in Puerto Rico. Methods: A comparison of 2015 and 2020 data from the PR Country Card provided by the Global Observatory for Physical Activity (GoPA) was conducted. Country Cards data is collected from reputable sources such as the World Bank, the United Nations, research databases, and the Behavioral Risk Factor Surveillance Survey (BRFSS). The methodology ensured standardized indicators for global comparability. Country contacts identified and facilitated data collection and review—a meticulously revised process involving country representatives and GoPA experts. Country Card data consisted of demographics, mortality, PA prevalence, surveillance, policy status, and research indicators. Results: In 2015, the BRFSS data indicated a PA prevalence of 34% in PR, decreasing by 20% in 2020. No data on mortality due to inactivity and no national standalone plan focused on PA was available. From 2015 to 2020, research output experienced a slight increase, with a change in global ranking from 61st to 58th position. Conclusions: The PR Country Card is valuable for raising awareness by identifying critical gaps in PA surveillance, research, and policy. Practical implications: Proposed recommendations include establishing a dedicated PA health monitoring system, integrating PA into standalone national public health plan initiatives, and establishing an inter-institutional coalition for PA research. Multi-sector efforts from policymakers, researchers, and stakeholders are crucial toward meaningful progress in improving PA engagement and mitigating chronic disease in PR. Funding: N/A

Background: Equity in health promotion in general and in physical activity (PA) promotion is important. However, many PA interventions either fail to close this gap or even exacerbate health inequities. Consequently, WHO has highlighted that policy action is required “to accelerate progress in reaching those being left behind because of poor health and in preventing others from falling behind”. Purpose: This study aimed to increase our understanding of the links between policy and equity in PA by (a) identifying the influence of policy on equity in PA and (b) examining the influence of PA on aspects of health equity in general. Methods: A rapid literature review was conducted using relevant scientific databases. Results: Evidence on the effectiveness of PA policies for the promotion of health equity was identified for several political sectors. Relevant areas include equitable access to sport facilities, to programs across different settings; to green and blue spaces and places for PA; and to adequate supervision for those with special needs. Policy development processes can also promote health equity by involving organizations that represent different population groups. In turn, increased PA may contribute to overall health equity if its protective health benefits (e.g. in relation to cardiovascular risk factors) are experienced by large segments of the population. Conclusions: PA policies can contribute to the promotion of equity. By enabling larger segments of the population to access PA infrastructures and offers, such policies may also contribute to greater health equity in societies overall. Practical implications: The results of this review were used to expand an existing tool for physical activity policy benchmarking (PA-EPI) to include aspects of health equity (PA-EPIQ). Funding: ERA4Health, GA N° 101095426 of the EU Horizon Europe Research and Innovation Programme

Background: The growing burden of non-communicable diseases (NCDs) creates a need for effective public policy to change systems instead of individuals and create supportive contexts that reduce NCDs and health inequity. A determinant of disease reduction is physical activity (PA). Many countries have policies in place, but the implementation of those policies is unknown. Purpose: To show how six countries, namely, Germany, Ireland, Lithuania, Netherlands, Poland and Romania intend to make cross-country comparisons on the extent of implementation of PA policies and their health equity impact. Methods: An innovative tool, the PA-Environment Policy Index modified for Equity (PA-EPIQ) will be used to test and promote policy evaluation and benchmarking as a tool to improve policy implementation in six countries. Mixed methods including evidence synthesis, document analysis and case reports will ‘evidence ground’ countries’ policy implementation status in relevant domains, e.g. health, sport, education, transport, urban design. Quantitative and qualitative evidence validation with policymakers will ensure the comprehensive representation of government action. While engagement with stakeholders –both experts and citizens – from each country will independently assess the evidence on their governments’ action, comparing it to international best practice. Results: IMPAQT will generate six country-specific policy index scores, which will be translated into report cards containing critical implementation gaps and policy recommendations for each country. It will also bring the individual country reports together and create a unified report for citizens, scientific communities, policymakers and the European Parliament. Conclusion: IMPAQT is based on scientific research as well as the involvement of policymakers, experts and citizens through a co-production approach in six EU countries. Transnational comparisons will provide international benchmarks for healthy and equitable PA policy environments. Practical Implication: IMPAQT is an innovative project focusing on how to enhance health equity in physical activity policy development and monitoring.

Background Numerous tools have been developed to monitor physical activity (PA) policies but only a limited number of them is designed specifically for the local level. Purpose As existing tools for local PA policy monitoring focus often on in-depth data collection in single municipalities, this exploratory study aimed to analyse potentials for scaling up local physical activity policy monitoring initiatives. Methods To generate knowledge on local PA policy monitoring, a qualitative iterative research design was adopted, including (a) the mapping of indicators of established local PA policy monitoring tools and (b) a co-construction process with policy-makers in France and Germany. The co-construction process generated data on facilitators and barriers for large-scale policy monitoring. Results The comparison of established tools provided a systematic overview of indicators and processes used to monitor local PA policy. Based on the co-construction process, a shortlist of indicators with a high relevance for the involved municipalities was created, considering the perspective of policy-makers from different sectors and countries. Conclusions The results show that a strategy for scaling up local PA policy monitoring can be developed based on a co-construction process with policymakers. However, only a limited number of municipalities was involved in this explorative study. Further research is needed to validate the findings for France and Germany, and to test the transferability of this strategy to other countries. Practical implications Policymakers can develop a strategy for scaling up local level PA policy monitoring that is tailored to a specific country or region based on the results of this study. Funding This project has received funding by BayFrance under the grant agreement number FK-06-23.

Background: Lowering speed limits from 50 to 30km/h are key in promoting physical activity. Still, implementing 30km/h limits remains challenging. Purpose: We examine how local decision-makers justify and implement 30 km/h policies, and whether physical activity benefits were considered. We also studied urban-rural and neighbourhood socio-economic status(SES) differences herein. Methods: Two researchers independently searched traffic decision documents from the Official Gazette of the Kingdom of the Netherlands to obtain all speed limit implementations in Amsterdam and Rotterdam and four rural municipalities between 2016-2022. One researcher extracted data using a customized form, including justifications and additional physical measures, which was checked by the second researcher. Traffic documents were integrated in a geographic database. Descriptive statistics about road length, justifications and implementation aspects were provided for the whole sample and separately for urban and rural areas and (in planned analysis) neighbourhood SES. Results: We identified 47 documents covering 40km road length. Common justifications for 30km/h were traffic safety (N=20), vulnerable cyclists or pedestrians (N=8), livability (N=6), changes in local mobility (N=5), and child/school environments (N=5). No documents described physical activity benefits as justification for 30km/h. A minority of implementations included additional physical measures, mainly speed bumps (N=9) and/or pedestrian crossings (N=6). Larger shares of road length changed into 30km/h in rural (0.6%) than urban (0.4%) areas. In rural municipalities, pragmatic reasons such as lower nearby speed limits were often mentioned as compared to safety concerns and livability in urban municipalities. Conclusions: Traffic safety is proposed as main benefit of 30km/h, while wider physical activity impacts are rarely put forward, even though car-light environments are known to be conductive towards physical activity. Practical implications: Research should further highlight physical activity impacts of 30km/h. Considering these impacts can increase acceptance among the general population and policy-makers for 30km/h limits. Funding: Vital Cities and Citizens.

Background: It is recognised that the existence of guidelines alone is unlikely to lead to changes in health behaviours at the population level. It is necessary to provide adequate information to influence a wide range of policies and practices. Purpose: To compare the material including policy documents and physical activity guidelines, used in the development and implementation of physical activity policies in Japanese municipalities by administrative departments and municipality population size. Methods: We conducted this study as a part of C-PAT (City PAT) study which aimed to understand the situation of physical activity policies in municipalities (Oida et al. 2024). This included 272 cities, wards, towns, and villages in Japan. Six administrative departments (health, sports, education, urban planning, transport, and environment) were asked to conduct the survey. The survey items of this study were ‘status of formulation and implementation of policies’ and ‘policy documents and material referred to’. Results: The response rate to the C-PAT was 37.7%. The results showed that the most common documents referred to when formulating policies were the national plans of administrative departments. Only 20.4% of the health department respondents indicated that they referred to Japan’s national physical activity guidelines. Reference rates were 2.5% in the sports department, 0% in the education department, 1.5% in the urban planning department, 2.5% in the transport department, and 0% in the environment department. Smaller population sizes tended to result in less use of documentary material. Conclusions: In the 2018 survey, the rate at which Japan’s physical activity guidelines are being used in the development and implementation of municipal physical activity policies was low. Practical implications: Revised guidelines were released in Japan in 2023. This study showed that increased awareness of these guidelines for local government physical activity related departments is needed. Funding: JSPS KAKENHI (JP17K01806)