Symposia

Symposium Purpose: Technology is becoming ever more engrained in everyday life on a global level. Smart and wearable devices continue to evolve and offer new opportunities to monitor and change movement behaviours. Physical activity patterns can now be measured more precisely, in greater detail, and for longer periods of time, linking to other health indicators for better data-driven insights into health. Furthermore, effective behavioural change techniques can be more easily delivered in engaging and attractive ways and on a scale that was, until recently, unimaginable. But with these opportunities come important challenges, including data privacy and security, digital disparities, and sustaining physical activity behaviour change on a population level. Critical discussions are needed on how to move forward in this space, knowing that technology will only become more prevalent globally and that no one should be left behind. We must harness its potential to impact positive change for all. Symposium Overview: We will explore the opportunities and challenges afforded by technology in the physical activity and health space. We invite three presenters working in different domains of digital health to present a holistic overview of current innovations and future perspectives around technology for physical activity and health. These topics will include: 1. Guidelines: How technology can deliver data-driven insights into physical activity behaviours and health outcomes, and how these insights can inform future physical activity guidelines 2. Surveillance: New device-based methods to measure physical activity patterns and what that means for guideline surveillance 3. Interventions: How innovations in technology can be used to support and maintain population level physical activity behaviour change A critical panel discussion with invited guests from the field and led by the World Health Organization will conclude the session by focusing on: 1. How technology will impact future guidelines and surveillance, and 2. What are the critical joint actions needed to realise positive change? Chair: Dr Jacqueline Mair, Singapore-ETH Centre, Singapore Presenter 1: Professor (Manos) Emmanuel Stamatakis, The University of Sydney, Australia Presenter 2: Dr Elroy Aguiar, The University of Alabama, USA Presenter 3: Dr Jacqueline Mair, Singapore-ETH Centre, Singapore Discussant: Dr Fiona Bull, World Health Organization, Switzerland Abstract 1: Guidelines; Emmanuel Stamatakis Title: Wearable device-based evidence on physical activity and health: present and future Background: Most evidence (>90%) used for physical activity and sedentary behaviour guideline development comes from questionnaire-based studies. Purpose: To discuss recent epidemiological evidence on wearable device-based physical activity and mortality/non-communicable disease outcomes and provide directions for maximising the contribution of wearable-based evidence to forthcoming guidelines and clinical practice. Methods: We will review recent (2015 -2024) landmark epidemiological accelerometery studies that estimated associations with health outcomes including mortality, CVD, and cancer. We will synthesise findings from individual studies, harmonised meta-analyses, and wearables data consortia, and discuss the implications of such evidence in future guideline formation. We will highlight implications for data collection and processing methods (including machine learning), and comment on the generalisability of existing findings. Results: An increasingly large volume of device-based evidence is being published. Almost all evidence comes from western high-income countries. Existing studies have utilised accelerometric sensors placed on the waist, wrist, or thigh, while standard sensors found in consumer wearables such as heart rate monitors, gyroscopes, and altimeters are absent. Large-scale cohorts and consortia have provided novel and complementary insights into the health impact of device-measured physical activity. There is a clear trend towards niche aspects of movement behaviours (e.g. VILPA) and holistic examination of the 24-hour day, including sleep. Conclusions: Wearable device-based research on the health effects of physical activity and sedentary behaviour has accelerated in recent years and will continue to do so in the foreseeable future. However, critical gaps remain, including research in LMICs where wearables evidence is virtually absent. Practical implications: it is likely that wearable device-based evidence will shape major aspects of movement behaviour guidelines in the next decade. Tight collaborations between key organisations and such as the WHO, ISPAH, the ProPASS consortium, and industry/device manufacturers are needed to expand wearables evidence beyond high income countries. Funding: None Abstract 2: Surveillance; Elroy J Aguiar, Cristal J. Benitez, Katherine Sullivan, Michael V. Fedewa Title: Beyond steps per day: Characterization of physical activity using a comprehensive system of step-based metrics Background: Steps per day is a widely reported metric that captures ambulatory physical activity (PA). However, it is often criticized for only reflecting daily volume of PA, while ignoring intensity, a central tenet of PA guidelines. Step-based metrics, encompassing both steps per day and effort/intensity-based expressions of stepping (peak-cadence and cadence bands), are becoming increasingly popular as a comprehensive method of evaluating ambulatory PA. Purpose: To characterize PA levels of a sample of young women from the United States using step-based metrics. Methods: Young women (N=50, age=22.0±4.1 years, BMI 24.4±4.4 kg/m2) wore an accelerometer on their waist for 7 days. Accelerometer data were downloaded in 1-min epochs and processed into step-based metrics (steps/day, peak-cadence indices, and cadence bands [steps/min]) using a custom R package. Summary statistics (median [IQR]) were calculated, and daily volume of PA was classified using a Graduated Step Index: basal activity <2500; limited activity 2500–4999; low active 5000–7499; somewhat active 7500–9999; active 10,000–12499, and highly active ≥12500 steps/day. Results: Summary statistics were as follows: steps per day 8709 [5934-11275], peak 1-min cadence 121.0 [114.6-130.5] steps/min, and peak 30-min cadence 103.6 [80.6-115.2] steps/min. Participants spent 298.4 [254.5-346.3] min in incidental stepping (1–19 steps/min), and 31.1 [15.1–51.1] min at a cadence corresponding to moderate-to-vigorous PA (MVPA; ≥100 steps/min). Participants were classified (count, %) as: basal activity (n=0, 0%), limited activity (n=8, 16%), low active (n=15, 30%), somewhat active (n=8, 16%), active (n=13, 26%), highly active (n=6, 12%). Conclusions: Approximately half (54%) of young women were classified as physically active (7500 steps/day), and half performed between 15 and 51 min/day of MVPA. Practical implications: Step-based metrics can be used to comprehensively describe daily volume, intensity, and pattern of step accumulation. Further studies should explore associations between step-based metrics and health outcomes among young women. Funding: None Abstract 3: Interventions; Jacqueline Mair, Sarah Edney, Esther Na, Thitikorn Topothai, Xin Hui Chua, Müller-Riemenschneider Title: Population-wide mobile health interventions promoting healthy movement behaviours: a systematic review of real-world evidence Background: Despite the development of numerous mHealth interventions promoting healthy movement behaviours, few have achieved real-world implementation at the necessary scale for population health impact. Purpose: To summarise findings from a systematic review of mHealth interventions promoting healthy movement behaviours in real-world settings. Methods: Systematic searches of five databases (Medline, Embase, Scopus, Web of Science, PsycINFO) and Google Scholar were conducted. Included studies were those implemented at scale, using mHealth, and targeting physical activity, sedentary behaviour, or sleep. Data were extracted on study and intervention design, movement behaviour outcomes, and implementation indicators. Risk-of-bias was assessed using the Effective Public Health Practice Project tool. Results: After screening 7134 records, 21 interventions reported in 39 studies were included. Most interventions (92%) were conducted in high-income countries, and in terms of scale, 5% were implemented citywide, 48% across part of a country, 29% across an entire country, and 19% globally. Smartphone apps and wearables were the most used (71% each), followed by text messages (14%) and tablets (10%). The median number of participants reached was n=7,944. Where data were available, participation rates ranged from 1.2% to 28.6% and adherence rates (actual use versus intended use) ranged from 20%-83%. Fifteen interventions (71%) reported positive effects on movement behaviours and 1 (4.8%) reported no change. Almost half (48%) of the interventions reviewed are currently still active. Conclusions: mHealth interventions promoting healthy movement behaviours are being implemented at scale, effectively reaching large populations. Short-term effectiveness in changing movement behaviours is evident but sustaining long-term change requires attention. However, current evidence is limited to high-income countries and heterogeneous study designs and methodologies pose challenges for direct intervention comparisons. Practical Implications: While mHealth interventions can effectively influence movement behaviours at scale in the short term, addressing their sustainability is crucial to achieve population health impact. Funding: None

Purpose: 1. To overview evidence on physical activity programs for older adults and people with disabilities. 2. To showcase approaches that are suitable for delivery at scale. 3. To brainstorm other possible approaches and ways to increase global collaboration and resource sharing. Description: Older people and people with disabilities face additional barriers to being active and as a result many are less active than other sections of the population. Older people and people with disabilities are different but overlapping population groups with some similarities in the likelihood of mobility impairment, need for program adaptation, and contact with health services. There is a mounting body of evidence on the effectiveness of programs and services for older people and people with disabilities. This symposium will commence with an overview of current evidence regarding physical activity for older people and people with disabilities using the framework of the WHO Global Action Plan on Physical Activity. Reviews of: programs and services for older adults, including those in low and middle income countries; sport for older adults; and sport and recreation for people with physical and intellectual disabilities will be summarised. Symposium speakers will then showcase different initiatives that promote physical activity for older people and people with disabilities that may be suitable for scale up. Evaluations of programs involving phone coaching (CHANGE, COMEBACK trial programs), web-based support (Active women over 50, online yoga), and group exercise (REACT) will be presented. Insights from promoting frame running (a form of adaptive running) for people with disabilities around the world will also be presented and insights from qualitative work and consultation with people with lived experience will be shared. There will be a facilitated discussion with the audience to brainstorm other initiatives and opportunities for global collaboration in development, implementation and evaluation of programs that promote physical activity for older people and people with disabilities at scale. Chair: Prof Cathie Sherrington, University of Sydney, Australia. Presenter 1: Prof Anne Tiedemann, University of Sydney, Australia. Presenter 2: Prof Afroditi Stathi, University of Birmingham, UK. Presenter 3: A/Prof Leanne Hassett, University of Sydney, Australia. Presenter 4: Craig Carscadden PLY MBE, Worldability Sport, UK Discussant: A/Prof Karen Milton, University of East Anglia, UK. Abstract 1. Presenter 1: Prof Anne Tiedemann, University of Sydney, Australia. Abstract title: Online delivery of physical activity behaviour change programs: key ingredients for success with people aged 50+. Background: Online delivery of programs that promote physical activity has the advantage of convenience, accessibility, and low cost. Online approaches are particularly appealing to some older people and those in diverse locations. Purpose: To describe the key ingredients and participant impressions of three remotely-delivered physical activity promotion programs in: a) the CHANGE trial (n=600), including health coaching and activity trackers, for people aged 60+; b) the SAGE yoga trial (n=700), an online group-based yoga program, for people aged 60+; and c) the Active Women over 50 program (n=60), an information, coaching and support program for women aged 50+. Methods: Three RCTs were conducted to evaluate the effectiveness of the physical activity promotion programs. Process evaluations, involving qualitative interviews and self-report surveys, conducted alongside the RCTs, evaluated the mechanisms for program effectiveness and participant enjoyment. Results: All programs were well adhered to and demonstrated benefits for physical activity and health outcomes. Central to these benefits, important aspects of health coaching that empowered older people to increase physical included trusting relationships, deep listening, flexibility, and realistic, collaborative goal setting. Facilitation of social networks and accountability, life-stage health information and positive framing to support self-responsibility were also key to success. Conclusions: Online delivery of physical activity behaviour change programs to people aged 50+ is feasible, effective and likely to be cost-effective. Online programs have the potential to be offered affordably at scale and are well received by many people. Practical implications: Older people value the convenience and accessibility of remotely delivered physical activity behaviour change programs involving health coaching and supervised exercise. Successful delivery is underpinned by tailored information and resources to suit the target audience, development of therapeutic alliance and trusting relationships. Funding: The CHANGE and SAGE trials were funded by the National Health and Medical Research Council of Australia. Abstract 2. Presenter 2: Prof Afroditi Stathi, University of Birmingham, UK. Abstract title: Scaling up the REtirement in ACTion (REACT) group-based intervention targeting older adults with mobility limitations. Background: Mobility limitation in older age reduces quality of life, generates substantial health and social care costs and increases mortality. Purpose: The REtirement in ACTion (REACT) trial established that a community-based, active ageing intervention can prevent decline in physical functioning in older adults already at increased risk of mobility limitations. Methods: We recruited 777 older adults (mean age 77.6 yrs (SD 6.8 yrs); 66% female; with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] mean score 7.37, (SD 1.56) from three sites (Bristol/Bath; Birmingham; Exeter) in England. In terms of ethnicity (95.11% white) and deprivation, the sample was representative of the UK population of people 65+. Participants were randomly assigned to receive three healthy ageing sessions (n = 367) or a 12-month, group-based, multimodal programme including group exercise, social and behavioural maintenance sessions (n = 410) delivered by qualified exercise specialists. Results: At 24-month follow-up, SPPB scores were significantly greater in the intervention arm than in the control arm. Difference in lower limb function was clinically meaningful at both 12 and 24 months. The health economic analysis indicated substantial quality-of-life and health economic benefits within the 24-month trial window and across a lifetime horizon. Conclusions: A relatively low-resource, 1-year multimodal exercise, social and behavioural maintenance intervention helps older adults to improve and retain physical functioning for at least 24 months. Currently, together with community organisations we are co-producing a strategy for rolling out REACT nationally. Practical implications: REACT is currently being rolled out in Bristol, UK. Key successes include reaching an ethnically diverse population, good adherence to the programme and adoption of REACT by diverse organisations. Points for attention include ways to refine the referral process and create a sustainable strategy to meet demand for REACT exercise instructors. Funding: The NIHR-PHR Programme (13/164/51). BNSSG ICB Ageing Well Programme. Abstract 3. Presenter 3: A/Prof Leanne Hassett, University of Sydney, Australia. Abstract Title: Physical activity coaching and text messages for adults with walking difficulties: The ComeBACK trial Background: Impaired mobility is a common and serious form of physical disability. Physical activity participation has enormous untapped potential to improve mobility and overall health in this population, however interventions need to be developed and evaluated that meet the needs of this population and are scalable. Purpose: To develop and evaluate two scalable physical activity interventions (an enhanced and a less intensive intervention) for adults with walking difficulties. Methods: A 3-arm pragmatic randomised controlled trial was conducted. Adults with self-reported walking difficulties were randomised to one of three groups receiving the following 6-month interventions: 1) Coaching to ComeBACK (physiotherapy assessment, physical activity plan, fortnightly physiotherapy-led phone health coaching supported with activity monitors and resources); 2) Texting to ComeBACK (single session of tailored phone advice, physical activity plan, text messages and resources); 3) Texting to ComeBACK Later. Intervention development was informed by stakeholder input, theories of behaviour change, and guided by the PRACTIS implementation and scale-up framework. Benefits of the interventions and intervention components were rated by participants on a 0 to 10 scale. Results: 512 participants were randomised into the trial. Participants were on average older adults (mean(SD): 69(10)) with majority female (76%). The Coaching to ComeBACK intervention was rated as very beneficial (mean(SD): 8.4(1.6)) with the health coaching and Fitbit the highest rated components (8.7(1.7) each) and website resources the least (5.3(2.8)). The Texting to ComeBACK intervention was rated as less beneficial than the coaching intervention (5.9 (2.8)), however the single session of tailored phone advice was rated as a very beneficial component (8.3(1.9)). Conclusions: These results indicate tailored phone-based interventions to increase physical activity in adults with walking difficulties are well received by most participants. Practical implications: Phone-based health coaching is a scalable and valued physical activity intervention in adults with disability. Funding: Australian NHMRC project grant (APP1145739). Abstract 4. Presenter 4: Craig Carscadden PLY MBE, Paralympian, Chief Development Officer, Worldability Sport, UK Abstract title: Runfree project: global support of Frame Running Background: Frame Running is a form of adaptive running. It allows individuals with severe motor and co-ordination impairments to run, with the help of a three wheeled frame. The frame provides the individual with the necessary support and stability which allows them to ambulate. It is one of the few activities that gives individuals with this level of impairments the opportunity to participate in aerobic exercise. Program delivery: The Runfree project developed a strategic event series concept around the sport of Frame Running. The concept comprises replicable and adaptable tools with practical recommendations on how to reach out and engage people with cerebral palsy and related neurological conditions to take part in Frame Running at a local and national level. The tools include resources on how to hold a ‘Have a Go’ day, an entry level competition, a coaching course, and awareness raising measures including an animated video. Evaluation: Tools were created and piloted on how to hold a Frame Running Have a Go day, an entry level competition and a coaching course. Awareness raising materials were developed including an animated video. 17 different tools were created in total for the RUNFREE project, all of which are available on the RUNFREE website in three languages. A graphic is available which shows how the tools work together and everything is free to download and translate as appropriate. Due to the success of the project the tools have now been translated into 6 languages including Cantonese, Japanese and Arabic. The Introduction to Frame Running Workshop is now being delivered regularly worldwide either in person or online to coaches, teachers, and physiotherapists by World Abilitysport or other organisations. It has also been incorporated into Athletics Federations training resources. Conclusions and practical implications: The tools created by the project have been the catalyst for the growth of Frame Running. Funding: Erasmus+ Programme of the European Union

Regular symposium Title: Physical activity behaviour and promotion from a systems perspective. Purpose: To encourage reflection and discussion on the role and implications of adopting a systems perspective for physical activity (PA) behaviour and promotion. Description: It is well-recognized that physical inactivity is a persistent, complex problem driven by factors and social actors operating and dynamically interacting across multiple levels over time. Acting upon the complex system that shapes and perpetuates PA behaviour requires that those working for more active societies are well equipped to understand and work with PA from a systems perspective. This symposium will go beyond a call to arms, provoking, supporting, and encouraging reflection to strengthen research and action informed and oriented by systems science. In this symposium, four presentations (totalling 40 minutes) will highlight multiple research and action implications of adopting a systems perspective in key areas in PA behaviour and promotion: (1) defining physical activity behaviour and promotion from a complex systems perspective; (2) inequalities in physical activity as an emergent feature of a complex system; (3) maximising policy impact to reduce physical inactivity in a complex system; and (4) systems approaches to scaling up PA promotion actions. In addition to the presentations, an open discussion with the audience will be facilitated by the discussant and chair around two main themes: (1) Q&A about presentations (10 minutes); (2) implications and next steps for the field (15 minutes). The remaining time will be used by the chair to introduce the symposium (5 minutes) and then by the discussant to share their views on the presentations (5 minutes). Chair (Name and Affiliation): Dr Peter Gelius, Friedrich-Alexander-Universität Erlangen-Nürnberg. Presenter 1 (Name and Affiliation): Dr Leandro Garcia, Queen’s University Belfast. Presenter 2 (Name and Affiliation): Ms Sophie Jones, Queen’s University Belfast. Presenter 3 (Name and Affiliation): Dr Karen Milton, University of East Anglia. Presenter 4 (Name and Affiliation): Dr Harriet Koorts, Deakin University. Discussant/moderator (Name and Affiliation): Dr James Nobles, Leeds Beckett University. Presentation #1: Defining physical activity behaviour and promotion from a complex systems perspective. Background: there has been multiple attempts to approach physical activity behaviour and promotion using a systems lens. However, in general, these attempts do not provide a systems-based definition of physical activity, limiting the transformative potential of systems approaches for physical activity research and action. Purpose: to offer a discussion about how physical activity patterns can be defined from a complex systems perspective, alongside implications for research and practice. Methods: we describe the current attempts towards more holistic views of physical activity, and then build on them to provide the premises for a definition of physical activity grounded in complex systems theory. Results: we argue that physical activity patterns are the observable result (or emergent feature) of a system (the components of which are conventionally called ‘drivers’), and that those patterns are generated by the system’s configurational state. The generative aspect is a key distinction from previous attempts to define physical activity, and implies, among other things, that (a) the same physical activity patterns can be reached by many different system’s configurations (equifinality), (b) physical activity as an emergent feature is scale dependent, e.g., collective patterns are not simply the sum of individual behaviours, and (c) physical activity patterns at higher levels are constrained by the configurational states of lower-level systems (modular hierarchical structures and second-order emergence). Conclusions: we offer a definition of physical activity grounded in complex systems theory, which we believe is needed to unleash the full transformative potential of systems-based approaches for physical activity research and action. Practical implications: full adoption of a systems perspective for physical activity implies a series of changes in the way we think about and do research and practice, going from what we measure (systems’ configurations?) to guidelines development and content (physical activity levels or configurational states?). Funding: None. Presentation #2: Inequalities in physical activity as an emergent feature of a complex system. Background: inequalities in physical activity are well documented; however, progress on reducing these inequalities is proving difficult. We argue that a complex system perspective is needed, specifically to acknowledge inequalities in physical activity as an emergent feature of a complex system. Purpose: to offer a discussion about inequalities as an emergent feature of a complex system due to dynamic interactions that produce patterns of behaviour, alongside an applied example to help visualise our argument and demonstrate how to operationalise the perspective argued. Methods: following a discussion of why a different perspective is needed to reorientate our thinking of inequalities, we highlight a conceptual model that was developed to understand the various mechanisms and factors which interact to produce collective patterns and income inequalities in leisure-time physical activity. Results: building on our proposition that inequalities in physical activity are an emergent feature of a complex system, a conceptual model will be presented to demonstrate how this perspective can be utilised. The conceptual model contains psychosocial, economic, environmental and social factors, which all dynamically interact to shape an individual’s decision to practice leisure time physical activity. Conclusions: through our discussion and the conceptual model presentation, we argue the need to acknowledge inequalities in physical activity as an emergent feature of a complex system arising from multiple interactions between complex systems parts. Practical implications: the approach we propose allows a nuanced and broader understanding of inequalities in physical activity as an emergent feature of a complex system and, consequently, improves our ability to develop systems-informed interventions and policies. Funding: Northern Ireland Department for the Economy. Presentation #3: Maximising policy impact to reduce physical inactivity in a complex system – the application of adaptive approaches. Background: physical inactivity is a ‘wicked problem’, shaped and sustained by the dynamics, uncertainties, and unpredictability of a complex system. This has led to increased recognition of the need to adopt a ‘systems approach’ to physical activity promotion to achieve sustainable, systemic changes in interventions and behaviours at scale. Purpose: to discuss why a systems perspective, and adaptive policy approach in particular, is relevant to reducing physical inactivity, and the implications of this for policymaking. Methods: we will describe current systems approaches to policy formation in public health and illustrate how the concept of ‘adaptive policies’ could be beneficial. Using multiple examples, we will demonstrate how a systems perspective can inform the development of policies, and how the principles of adaptive policymaking might be applied to addressing physical inactivity. Results: using a range of examples, we will illustrate how adaptive policies could be used to overcome common system archetypes in physical activity promotion. We argue that there are situations in which adaptive policymaking would help to achieve the long-term, systemic changes that are required globally to change population levels of physical activity. Conclusions: it is important to support policymakers to move away from short-term ‘fixes’, to considering the steps needed to reconfigure the physical activity system to support populations to be more active. A key challenge is to develop policies that are designed to be adaptable across a range of different future scenarios, and embrace uncertainty and long-term adaptability. Practical implications: there is a need to shift the approach to policymaking away from solely ‘static’ policies, to considering adaptive approaches that are more suited to uncertainty and changing conditions. Funding: None. Presentation #4: Systems approaches to scaling up: systematic review and narrative synthesis of evidence for four NCD risk factors. Background: systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale-up in physical activity/nutrition promotion or NCD prevention more generally. Purpose: to present a systematic review which sought to: (i) synthesise evidence on systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs, and (ii) explore how systems approaches have been conceptualised and used in intervention implementation / scale-up. Methods: seven electronic databases were searched during 2016-2021. Eligible studies targeted either physical inactivity, tobacco use, alcohol consumption or diet, or described evaluation of an intervention planned for or scaled up. Studies were categorised as (i) high, (ii) moderate, or (iii) no use of a systems approach, using narrative synthesis following PRISMA guidelines. Results: twenty-one intervention studies were included; 19% (n=4) explicitly used systems thinking to inform intervention design, implementation and scale-up. Five studies (‘high use’) planned and implemented scale-up, focussing on relations between system elements, using system changes to drive impact at scale. Seven studies (‘moderate use’) considered systems elements impacting scale-up but did not require achieving system-level changes from the outset. Nine studies (‘no use’) worked at multiple levels, but complexity of the system and relations between system elements was not articulated. Conclusions: for researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice. Practical implications: greater guidance is needed on what is required to adopt or support a systems approach to scaling up, and how to communicate and operationalise systems approaches in research and practice. We recommend using frameworks that incorporate systems thinking perspectives and adopt new ways of accounting for the complex systems in which interventions are implemented. Funding: Deakin University Deans Fellowship, and NHMRC Leadership Level 2 Fellowship (APP 1176885).

Purpose: To explore the impact of the 2012, 2016, 2021 The Lancet Physical Activity Series and provide an overview of the main results of an upcoming series.

Description: Publishing in The Lancet journal is particularly significant due to its visibility, extensive reach and considerable influence on public health and medical practice worldwide. As such, The Lancet Physical Activity Series of 2012, 2016, and 2021 provided a platform for wide dissemination of research findings on high-priority topics in the physical activity field. The overarching aim of the series was to advance the understanding and promotion of physical activity worldwide. This Symposium will include four presentations starting with a historical perspective and impact of The Lancet Physical Activity Series coupled with an overview of the three past series. Presentations 2-4 will follow with an overview of the new, forthcoming papers intended to be included in a 4th Lancet Physical Activity series. These presentations will delve into critical new topics including (a) health equity and a paradigm shift positing physical activity as not solely relevant to Non-Communicable Diseases (NCDs) but adopting a syndemics approach, (b) examining the nexus between physical activity and climate change/environmental sustainability, and (c) the importance of scaling up effective physical activity policies globally. Presentation one (Professor Pedro Hallal) will summarize key findings and contributions of the three series over the last decade and how the past series are positioned as a significant effort for advancing the science of physical activity and related fields. Presentation two (Associate Professor Deborah Salvo) will introduce the first paper of the 4th series exploring how the current age of syndemics presents interacting global crises of infectious diseases, NCDs, mental health problems, persistent health inequities, and climate change; all of which can benefit from physical activity. Presentation three (Professor Erica Hinckson) will reinforce the dual goal of bringing together the physical activity and climate agendas to address human and planetary health by urgently taking a multisectoral collaborative approach that will focus on comprehensive and holistic actions through policy change. Finally, Presentation four (Assistant Professor Andrea Ramirez Varela) will provide a critical reflection on monitoring global physical activity policies to assess progress in national and global physical activity and NCD prevention policies to guide efforts, inform decision-making, and drive actions aimed at fostering healthier populations and mitigating the prevalence of physical inactivity for the future.
This symposium will share learnings from research teams across six world regions with an emphasis on discussion, reflection and vision to guide the future of physical activity in the next decades to come.

Chair: Professor Pedro Hallal, University of Illinois at Urbana-Champaign, USA

Presenter 1: Professor Pedro Hallal. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA.

Presenter 2: Associate Professor Deborah Salvo. Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, USA.

Presenter 3: Professor Erica Hinckson, Department of Physical Activity and Nutrition, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand

Presenter 4: Assistant Professor Andrea Ramirez Varela. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.

Discussants/moderators (panel): alphabetical order
-Professor Adrian Bauman, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney.
-Professor Harold Kohl III, Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA.
-Professor Jim Sallis, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California USA.
-Associate Professor Melody Ding. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia.
-Professor Michael Pratt. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA; Institute of Public Health, University of California San Diego. San Diego, USA.
-Professor Rodrigo Reis, Brown School, Washington University in St. Louis. St. Louis, USA.
-Professor Ulf Ekelund, Department of Sport Medicine, Norwegian School of Sport Sciences. Oslo, Norway.

Abstract 1: History and impact of The Lancet physical activity series (2012, 2016, 2021)
Background: In 2012, The Lancet introduced its inaugural series on Physical Activity (PA) during the 2012 Summer Olympic Games, shedding light on the alarming statistic that physical inactivity contributes to over 5 million global deaths annually, a figure equivalent to smoking-related deaths. Subsequent series in 2016 and 2021 emphasized the pressing need for addressing the substantial healthcare burden associated with physical inactivity, focusing on sedentary behaviour, disability, and at-risk populations.
Purpose: We explore the decade-long legacy of The Lancet PA series and leverage the insights gained to explore a new series.
Methods: Using bibliometric assessment and other methods we synthesized the accumulated knowledge and experience over the past decade and impact of the series on the physical activity and public health fields. Particularly, we explored citations, mentions, comparisons to other Lancet series, users by country and profession, and policy utilisation.
Results: The Lancet Series have profoundly impacted the physical activity and public health fields. In this presentation, we will elaborate on the nature of the impact on research, teaching and policy.
Conclusions: The legacy left by The Lancet PA series will provide the platform for a new direction in physical activity research that better informs policy and practice.
Practical implications: Lessons learnt are expected to have practical implications for public health, policy development, and international collaboration. The insights gained are well placed to inform evidence-based strategies for addressing global challenges through targeted interventions related to physical activity, and therefore contributing to the advancement of public health agendas worldwide.

Abstract 2: Reconceptualising physical activity for the age of syndemics using a global equity lens.
Background: The public health and medical communities generally recognise the importance of physical activity for preventing and controlling noncommunicable diseases (NCDs). However, its importance for addressing other major global issues is less well-recognised.
Purpose: This paper uses a global equity lens to shed light on the benefits of physical activity, above and beyond NCD prevention and control, for the age of syndemics (co-occurring pandemics and major global challenges).
Methods: Using nationally representative WHO data from 68 countries, we conducted a harmonized analysis of domain-specific physical activity for leisure, transport, and work; using equity plots and slope indices to quantify socioeconomic and gender-based inequalities. Next, we systematically scoped the literature of physical activity studies during the COVID-19 pandemic, as this recent global crisis underscored the public health relevance of physical activity for the age of syndemics.
Results: Pre-pandemic data revealed within- and between-country socioeconomic inequalities, with higher prevalence of leisure physical activity in higher-income countries and groups; and higher prevalence of utilitarian physical activity in lower-income countries and groups. Gender-based inequality data analysis is underway. The scoping reviews of COVID-19 and physical activity studies showed that (a) physical activity inequalities may have widened due to COVID-19; (b) physical activity was inversely associated with adverse COVID-19 related outcomes, underscoring the often-unrecognized importance of physical activity for infectious disease and immunity; and (c) physical activity may have buffered some of the negative mental health consequences of the COVID-19 pandemic, underscoring its mental health benefits.
Conclusions: The current age of syndemics is challenged by the global crises of infectious diseases and NCDs, mental health problems, persistent health inequalities, and climate change; all of which can benefit from physical activity.
Practical Implications: It is critical to reconceptualise physical activity as a factor with high relevance to multiple elements of modern-day syndemics.

Abstract 3: Living, moving, and playing on a sustainable and healthy planet: the urgency of combining physical activity and climate change agendas
Background: Climate change is the most dangerous self-inflicted catastrophe ever experienced by humanity, and physical inactivity is responsible for more than 5 million deaths per year worldwide.
Purpose: We have an opportunity to align and mobilise policy, research, and action toward the dual goals of mitigating climate change risks and promoting human health through physical activity.
Methods: We conceptualise the interconnection between frameworks on physical activity and climate change across ISPAH’s Strategies that Work for Physical Activity using applied systems thinking tools. We also address unintended consequences, consider inequities, and offer analytical frameworks for further research. Physical activity is in many ways reciprocally linked to climate change.
Results: Physical activity solutions can supplement the response to climate change. We propose a framework for action whereby advancing physical activity promotion can simultaneously reduce health and environmental inequities, mitigate climate change, and adapt both environment and behaviour long term for a changing climate.
Conclusions: Advancing physical activity and climate change agendas equitably must consider context and input from vulnerable populations, including low-income country residents and ancestral knowledge from indigenous peoples.
Practical implications: The dual goal of bringing together physical activity and climate agendas to address human and planetary health must be prioritised urgently, taking a multisectoral collaborative approach focusing on comprehensive and holistic actions through policy change and budget reprioritisations. These changes will require developing policy frameworks, providing financial incentives, mandating sustainable practices, and launching educational and awareness campaigns that prioritise physical activity for the dual goal of protecting the environment and individual health.

Abstract 4: Two-decade progress of national and global physical activity policy
Background: Physical activity policy has the potential to play an important role in conjoining multiple societal sectors to generate supportive environments that increase population physical activity.
Purpose: The purpose of this project was to document trends in the global status of physical activity policy.
Methods: We evaluated global physical activity policy changes from 2004 to 2023 based on policy monitoring from the Global Observatory for Physical Activity (GoPA!) in 217 countries.
Results: The data arranged by GoPA! highlights a notable increase from 2012 (year of the first The Lancet Physical Activity Series) onwards in the prevalence of national physical activity policies over the past two decades. Approximately nine in ten (89.4%) countries now have formal written policies; either a national NCD policy including physical activity or a standalone physical activity policy. A greater number of standalone policies was seen in the European region compared to other World Health Organization ((WHO) regions. Persistent gaps exist in policy and guideline availability in Africa, South-East-Asia, and low-income countries. In virtually all countries evaluation of policy implementation was poor. The majority of policies around the world were time-limited and, without action, will end before or in 2030, the year by which the WHO seeks to reduce global risk factors and wants to achieve a 15% relative reduction in physical inactivity.
Conclusions: Many advances in policy monitoring systems and tools have been made since 2012, but systematic global monitoring for physical activity policy, including implementation and evaluation, has yet to be achieved.
Practical implications: Monitoring global physical activity policies to assess progress in national and global physical activity and NCD prevention policies serves to guide efforts, inform decision-making, and drive actions aimed at fostering healthier populations and mitigating the prevalence of physical inactivity.
Funding: Global Observatory for Physical Activity (GoPA!)

Purpose: The aim of this symposium is to discuss physical activity (PA) policy and the role of the PA community in meeting the challenges policy interventions require to be successful. Description: The promotion of PA requires an ecological and multi-level, as well as comprehensive whole system approach. The audience for this symposium is the PA community, i.e. the researchers, policymakers and practitioners responsible for advancing evidence-based actions for the promotion of PA across the whole of society. Presentation one will challenge the PA communities’ lack of knowledge of the status of physical activity policy globally. It will chart the progress of PA policy over the last decade, sharing a systematic process for developing a PA policy database, the building blocks of a robust monitoring system. Presentation two presents an evidence synthesis showing how active transport used policy to enhance opportunities for walking and cycling during the COVID-19 pandemic. The lessons learned could prove fruitful in terms of leveraging windows of opportunity for the future. Presentation three challenges our ability as a PA community to react in a timely, evidence-informed manner to ‘windows of opportunity’, sharing learnings from qualitative research, it asks if the PA community understand how to garner commitment from national policymakers to prioritise and advance the PA policy agenda when the time is right. Presentation four is a reflection; it acknowledges that PA requires upstream policies across multiple sectors to address the challenge of physical inactivity. It uses evidence from other prevention related policy areas e.g. tobacco, alcohol etc. to inform the needed direction of PA policy, our shared understanding of the ‘policy issue’, our consensus on ‘policy framing’ and how collaboratively we prioritise action across multiple, sometimes competing, sectors. It asks are we –as a PA community –up to the challenge? This symposium will share learnings from research teams across four continents with an emphasis on discussion, reflection and self-evaluation in relation to the future of physical activity policy in the post pandemic period and beyond. Outline: Chair: Catherine Woods, Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland. Presenter 1: Andrea Ramírez Varela, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA. Presenter 2: Michael Pratt, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA. Presenter 3: Katja Siefken, Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany. Presenter 4: Adrian Bauman, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia Discussants: Academic: Catherine Woods, Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland. Policymaker: Wanda Wendel-Vos, Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands Abstract 1: Development of the Global Observatory for Physical Activity Policy Directory: GoPA! – PD tool Andrea Ramírez Varela (1), Adrian Bauman (2), Catherine Woods (3), Harold Kohl III (1,4), Katja Siefken (5), Wanda Wendel-Vos (6), J. Jaime Miranda (7), Juliana Mejía Grueso (8), Pedro C Hallal (9), Michael Pratt (10,11). Affiliations: 1. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA. 2. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia. 3. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland. 4. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA. 5. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany. 6. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands, 7. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia. 8. Global Observatory for Physical Activity – GoPA!. 9. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA. 10. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA. 11. Institute of public Health, University of California San Diego. San Diego, USA. Background: National-level policies are important ingredients for improving public health, but effectiveness of such policies for addressing population-wide physical inactivity is unknown. Purpose: The purpose of this project was to create a comprehensive inventory of global national governmental physical activity policies, enabling cross-country comparison of policy indicators. Methods: We developed a directory of worldwide national physical activity policy documents in 2023. Publicly available national data were consulted and compiled into an ongoing repository of the Global Observatory for Physical Activity (GoPA!). Using a variety of search strategies, data were gathered for physical activity policy indicators: 1) standalone (exclusive) policies for physical activity, 2) non-communicable disease (NCD) plans including physical activity, 3) physical activity guidelines, 4) quantitative targets, 5) comprehensive or multisectoral approaches, and 6) implementation plans with enablers (tasks and subtasks, budgets, timelines-timeframe, collaborators). Results: The GoPA! policy directory comprised 1,005 documents from 217 countries. Overall, 15.2% [95% CI 13.1-17.6] were standalone physical activity policies, 43.5% [95% CI 40.4-46.6] were NCD plans including physical activity, 19.7% [95% CI 17.3-22.3] were physical activity guidelines, 9.2% [95% CI 7.4-11.1] had a comprehensive or multisectoral approach including more than three sectors to implement the policy, 23.6% [95%CI 21.0-26.3] had quantitative targets, 42.8% [95%CI 39.7-45.9] outlined an implementation plan with at least one enabler and 8.9% [95%CI 7.2-10.8] incorporated all enablers. Conclusions: The policy directory offers important insights into the diverse approaches to promote and sustain physical activity, providing a comprehensive audit of physical activity policies around the world. Practical implications: The policy directory repository of documents is a comprehensive and centralized resource that enhances accessibility, facilitates cross-country comparisons, and ultimately contributes to a deeper understanding of global physical activity policies for policymakers and researchers. Funding: Global Observatory for Physical Activity (GoPA!). Abstract 2: Policy window opportunities for active transportation during the COVID-19 pandemic: a systematic review Michael Pratt (1,2), Juliana Mejía Grueso (3), Katja Siefken (4), Adrian Bauman (5), Catherine Woods (6), Harold Kohl III (7,8), Wanda Wendel-Vos (9), J. Jaime Miranda (10), Pedro C Hallal (11), Justin Richards (12), Andrea Ramírez Varela (7). Affiliations: 1. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA. 2. Institute of Public Health, University of California San Diego. San Diego, USA. 3. Global Observatory for Physical Activity – GoPA! 4. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany. 5. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia. 6. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland. 7. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA. 8. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA. 9. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands. 10. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia. 11. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA. 12. Te Hau Kori, Te Herenga Waka – Victoria University of Wellington, Wellington, Aotearoa, New Zealand. Background: The COVID-19 pandemic brought unprecedented challenges, yet it also created opportunities for active transportation and urban design policies’ implementation. Purpose: The purpose of this study was to determine and evaluate the emergence of policy windows during the first three years of the COVID-19 pandemic that could directly and/or indirectly benefit physical activity. Methods: Systematic review conducted in 2/2023 across multiple databases (PubMed, Scopus, ProQuest – Coronavirus Research Database, Web of Science, WHO COVID-19 Research Database, PsycInfo, and SPORTDiscus). Articles published between 1-12/2022 were included. Data extraction included general study characteristics, policy cycle stages and, characteristics of policy windows based on Kingdon’s Multiple Streams Framework. Results: 3,746 articles were identified in the search and after applying the selection criteria twelve studies were selected for data extraction. These studies reported evidence on 74 case-study cities across 26 countries that implemented public policies that were directly or indirectly related to physical activity. Predominantly the case-study cities were located in the Americas (56.8%), Europe (27.0%) and high-income countries (77.0%). These studies focused on everyday mobility and transportation alternatives that could also mitigate SARS-CoV-2 transmission in the population. In 83.3% of studies, the five stages of the policy cycle (agenda-setting, formulation, adoption, implementation, evaluation) were identified and, the convergence of problem, policy and politics streams during this public health global crises led to legislative actions and emergency measures for the rapid implementation of active transportation infrastructure while supporting social distancing to avoid SARS-CoV-2 transmission. Conclusions: The COVID-19 pandemic opened a policy window across multiple world regions, indirectly influencing physical activity promotion through the implementation of active transportation and urban design policies. Practical implications: Political circumstances facilitated policy solutions that underscored potential synergies and collaborations between multiple sectors to implement effective public policies that may benefit physical activity. Funding: Global Observatory for Physical Activity (GoPA!) Abstract 3: Promoting Physical Activity amidst the COVID-19 Pandemic: Priorities for the Post-COVID-19 Era Katja Siefken (1), Juliana Mejía Grueso (2), Adrian Bauman (3), Harold Kohl III (4,5), Catherine Woods (6), Wanda Wendel-Vos (7), J. Jaime Miranda (8), Pedro C Hallal (9), Michael Pratt (10,11), Justin Richards (12), Andrea Ramirez Varela (4) Affiliations: 1. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany. 2. Global Observatory for Physical Activity – GoPA! 3. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia. 4. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA. 5. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA. 6. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland. 7. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands, 8. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia. 9. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA. 10. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA. 11. Institute of Public Health, University of California San Diego. San Diego, USA. 12. Te Hau Kori, Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand Background: Evidence suggests that there is a significant knowledge gap regarding priorities, opportunities and barriers associated with fostering physical activity on a global scale for the post-pandemic future. Purpose: The purpose of this study was to describe the perspective about the promotion of physical activity during the COVID-19 pandemic, along with post-COVID-19 priorities and recommendations for the global health future. Methods: Cross-sectional survey conducted between April and November 2023. Target audiences were the Global Observatory for Physical Activity (GoPA!) Country Contacts and key informants/influential stakeholders from around the world on physical activity policy implementation. Results: In total, 104 GoPA! contacts and key informants completed the survey (response rate of 40%), collectively representing 67 countries. Most participants represented countries from Europe and the Americas (60.6%) and high-income countries (58.7%). These respondents highlighted that pandemic response plans explicitly included physical activity promotion and predominantly emphasized creating more opportunities than restrictions for physical activity in contrast with other countries. Priorities for advancing post-COVID-19 physical activity promotion, included enhancing policy frameworks, developing comprehensive, equitable, up-to-date, and implementable national and subnational physical activity policies and plans. There was a perceived need for somewhat greater commitment from national decision-makers to prioritize physical activity policies and promotion. Promoting the synergy between mental health and social cohesion through physical activity promotion was emphasized by experts. Conclusions: Elevating physical activity promotion to a top position on public health agendas is crucial for the post-pandemic era. Practical implications: The diversity of contexts and high dependence on culture, the varying institutional, financial, and technical policy capacity, the shifting mid- and long-term political commitment; and the dynamic nature of intersectoral coordination and cooperation need to be taken into account for enhancing physical activity promotion in the post-pandemic era. Funding: Global Observatory for Physical Activity (GoPA!) Abstract 4: Considerations for advancing the physical activity policy agenda: A reflection. Adrian Bauman (1), Catherine Woods (2), Wanda Wendel-Vos (3), Harold Kohl III (4,5), Andrea Ramírez Varela (5), Katja Siefken (6), J. Jaime Miranda (7), Juliana Mejía Grueso (8), Pedro C Hallal (9), Michael Pratt (10,11). 1. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia. 2. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland. 3. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands. 4. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA. 5. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA. 6. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany. 7. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia. 8. Global Observatory for Physical Activity – GoPA! 9. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA. 10. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA. 11. Institute of Public Health, University of California San Diego. San Diego, USA. Practice/Policy Abstracts Background: Public health policies have an important role in prevention as they facilitate the implementation of evidence-based interventions and strategies targeting whole populations and communities. The progress in physical activity is policy is poor. Policy Components: There are structural elements that are common to effective NCD prevention policies. These include problem definition, consensus that the issue is preventable, an understanding of the complexities of the issue and its hypothesized solutions. Finally, the realization of the need for action, and its prioritization by relevant political actors across whole of government and by civil society. Evaluation: As an example, tobacco policy has been relatively successful. It has a long history, describes a small set of unhealthy behaviours, has universal and uncontested recognition of its hazardous effects, is underpinned by an agreed consensus based Framework Convention on Tobacco Control (FCTC) which is often legislated, and is regularly monitored and enforced. Physical activity policy has been less successful. It has a shorter history, requires action in a multiplicity of different contexts and settings to support a meaningful increase in physical activity for everybody. While consensus on physical activity guidelines exists, there is no robust, regular monitoring of policy outcomes. It therefore runs the risk of being everyone’s job, but nobody’s responsibility. Conclusions: A clear standalone, single-issue physical activity policy, will define physical activity as a priority area for health and a co-benefit for other sectors. It will provide a framework for action, foster multi-sector coordination and collaboration, articulate national physical activity guidelines, and targets for action, clarify implementation goals, roles, resources, responsibilities and outputs. If robustly monitored with regulatory enforcement it has the potential to tackle population physical inactivity. Practical implications: The global status of physical activity policy and its advancement as an intervention requires collective collaborative action from the physical activity community. Funding: No funding

Purpose: Implementing interventions targeting the built and social neighborhood environment could reduce physical inactivity and counteract the inequalities in activity participation seen among youth. For such interventions to be successful, they must be planned with the end-users in mind, but how and with whom do we organize the co-creation, and when should stakeholder involvement take place? The aim of this symposium is to compare four different ways for co-creating environmental interventions aimed at promoting active living in youth and discuss their strengths and limitations. This symposium will clarify the role of different stakeholders, and the various ways to proceed, for more effective co-creation projects in the future. Description: A variety of models for co-creation processes exist. These differ according to when in the process co-creation takes place, the level of collaboration between stakeholders and the benefit for the end-users. The symposium will present and discuss four research projects in three European countries involving youths as a user group, but where the approaches to the co-creation process differed. In the Netherlands, researchers in the LIKE project co-created actions together with end users to promote children’s and adolescents’ physical activity. In Denmark, the project Move the Neighborhood explored how to improve public open spaces in deprived neighborhoods through co-creation with children, teachers, and urban designers, while in the YoPA project, adolescents participated as co-researchers with researchers in a co-creation process improving the built environment in youth clubs in deprived neighborhoods. In Norway municipal planners were responsible for developing new public open spaces together with adolescents and professional advisors in six municipalities. Experiences, including potential impact on end users of the processes will be communicated. Strengths and limitations of the examples and how to organize future co-creation projects for promoting physical activity in the young population will be discussed with the audience. Chair: Ingeborg Pedersen, Department of Public Health Science, Norwegian University of Life Sciences, Aas, Norway Presenter 1: Charlotte Skau Pawlowski, Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Presenter 2: Line Madsen, Department of Sports Science and Clinical Biomechanics, World Playground Research Institute. University of Southern Denmark, Odense, Denmark Presenter 3: Ellinor Moe, Department of Public Health science, Norwegian University of Life Sciences, Aas, Norway Presenter 4: Teatske Altenburg, Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, The Netherlands and Amsterdam Public Health, Health Behaviours and chronic disease, Amsterdam, The Netherlands Discussant/moderator: Jasper Schipperijn, Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Evaluation of a public open space intervention co-designed with children from a Danish deprived neighbourhood Charlotte Skau Pawlowski1, Tanja Schmidt1, Jonas Vestergaard Nielsen1, Jens Troelsen1, Jasper Schipperijn1 1Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark Background: Knowledge on how to improve public open spaces in deprived neighbourhoods to increase active living among children is scarce. Purpose: The aim was to explore if involving children from a deprived neighbourhood in designing and creating playable installations in a public open space influenced their use of this space. Methods: The design process took place at the local public school during craft and design classes, one day a week from January to May 2017. The process included two grade 5 classes (11-12-years-old)(n=39 children), two teachers, and was facilitated by three urban designers using different co-design tools and methods. To gain knowledge of the co-design process, two focus group interviews were conducted with 12 randomly selected children, and individual interviews were conducted with the teachers and designers. Results: Use slightly increased for a few children, but many of the involved children did not use the public open space after intervention. The process evaluation revealed aspects that could explain why most of the children did not use the space after intervention. The children felt left-out during the transformation from drawings to final design and construction. The difficult part was that also other stakeholders, neighbors, rules for playground safety, construction, and costs were needed to be taken into account by the designers. It also became clear that the time frame of the co-design process hindered the designers in creating a new culture around the intervention site. Conclusions: Our research highlighted challenges associated with how the children perceived their role in the process. Practical implications: To avoid these challenges, future co-design projects would benefit from being comprehensively planned in collaboration with all stakeholders having a clear alignment of expectations from the beginning. Funding: The study was funded by The Danish foundation TrygFonden, The Danish Foundation for Culture and Sports Facilities YoPA; A Youth-centred Participatory Action towards co-created implementation of socially and physically activating environmental interventions Line Madsen*, Marie-Louise Haurum** , Jasper Schipperijn*, Charlotte Skau Pawlowski* * Department of Sports Science and Clinical Biomechanics, World Playground Research Institute, University of Southern Denmark, Odense, Denmark ** Department of Health Science and Technology, Aalborg University Background: A vast majority of teenagers do not meet guidelines for healthy movement behaviours, posing major risks for developing multiple non communicable diseases. Sustainable implementation of lifestyle interventions focused on teenagers as a key challenge. YoPA includes four intervention sites: Osogbo (NG), Soweto (SA), Amsterdam (NL) and Aalborg (DK). Purpose: YoPA focuses on co-creating and implementing socially and physically activating environmental interventions to improve the lifestyle of teenagers facing vulnerable life situations. Teenagers actively participate as co-researchers in local co-creation groups, engaging key stakeholders through a participatory approach. Methods: In Nørresundby, Aalborg, two co-creation groups of 15 adolescents from deprived youth centers engaged in bi weekly co creation meetings from December 2023 to July 2024 facilitated by a researcher. The adolescents participated as co-researchers during two phases of the co-creation process. The initial phase focused on mapping the local system, while the subsequent phase centered on tailoring socially and physically activating environmental interventions. The evaluation of the co-creation process focused on the adolescents’ perspective on the co-creation process, implementation, and their adoption. Two focus group interviews were conducted with participating adolescents in December 2023 and June 2024, respectively. Participant registrations was collected during each meeting to register participation maintenance, and the adolescents wrote notes after each meeting, creating their own diary of the process. Observations and field notes were recorded four times throughout the co-creation process. Results: Results will be presented at the ISPAH congress in October 2024. Practical implications: Scientifically, YoPA contributes to adolescent health research, offering innovative methods for behavior change and education. Beyond theoretical implications, the project serves as a comprehensive educational opportunity, fostering insights into PA and decision-making processes, potentially motivating increased PA participation. Funding: EU Horizon funded project (EU Project ID: 101095423). Rethinking who’s the expert: lessons learned from co-creating public open spaces with adolescents. Ellinor Moe, Emma Nordbø, Camilla Ihlebæk and Ingeborg Pedersen Department of Public Health science, Norwegian University of Life Sciences, Norway Background: Implementing built environment interventions in local communities to reduce physical inactivity and loneliness among youth is a prioritized task in Norwegian municipalities. In the Eastern parts of Norway, six municipalities have co-created public open spaces (POS) together with different stakeholders. Purpose: The study aimed to explore what planners and adolescents a priori found to be the most important factors for a POS to be used, and to investigate planners’ experiences of co-creating public open spaces with adolescents. Methods: 27 planners (municipality employees and professional advisors/consultants) and 29 adolescents participated in group interviews, of these 21 planners and 20 adolescents also answered a questionnaire rating the importance of a variety of factors related to the use of the POS. Results: The planners and adolescents agreed that social factors were most important to promote use of the POS. However, a significant discrepancy in rated importance of factors related to design and opportunities for activity at the POS was discovered between the two stakeholder groups. The planners experienced the adolescents as a source of inspiration and motivation, and they were impressed by their knowledge and commitment. However, to use the adolescents’ knowledge in an optimal way for developing the POS, the co-creation processes had to be initiated at the right time, and the co-creation methods and tools had to be continuously adapted to each project. Conclusions: Acknowledging the adolescents as experts and adapting the co-creation process accordingly made the planners feel more confident during the development of the POS and resulted in a changed view of their own role. Practical implications: Successful co-creation and use of POS requires that planners are open-minded, acknowledge the capacity of youth, and adapt their role and methods throughout the planning process. Funding: The Research Council of Norway, nr. 326799. Collaborating with adolescent co-researchers to co-create actions promoting 10-14-year-olds’ healthy lifestyle: the LIKE project Teatske Altenburg1,2, Helga Emke1,2,3, Coosje Dijkstra1,2,3, Stef Kremers4, Mai Chin A Paw1,2 Affiliations 1 Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands 2 Amsterdam Public Health, Health Behaviours and chronic disease, methodology, Amsterdam, The Netherlands 3 Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, the Netherlands 4 Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, the Netherlands Background Within the LIKE project, youth-centred Participatory Action Research (PAR) was combined with methods from systems dynamics to co-create actions in the physical and social environment to promote adolescents’ healthy lifestyle behaviours. Purpose The aim of the present study was to evaluate the process of PAR with adolescents. Methods Adolescents were recruited from 2 primary and 2 secondary schools in a disadvantaged neighbourhood in Amsterdam East. Four PAR groups including 4-8 adolescent researchers (aged 10-14) and 1-2 academic researchers met weekly during 3 to 4 school years (September 2018-December 2021). Data on the process of collaborating with adolescents and other involved stakeholders to co-create, implement, and evaluate actions was collected through research logs (by academic researchers), reflection forms (by both adolescent and academic researchers) and (focus group) interviews (with adolescent researchers and involved stakeholders). Results Adolescent researchers and involved stakeholders experienced the collaboration as beneficial (e.g. co-learning) and satisfactory (e.g. fun). Adolescents indicated that the process was based on shared decision-making (e.g. selecting research activities, developing actions). Academic researchers experienced sharing power with adolescents and making methods from systems dynamic adolescent-friendly as challenging. Co-created actions targeted different systems levels, primarily taking the form of one-time pilot initiatives. Academic researchers experienced recruiting and engaging stakeholders for sustainable implementation of the co-created actions as the biggest challenge in the implementation process. Conclusion Following a democratic process of shared decision making, we succeeded in implementing co-created actions. However, actions were mostly one-time pilot initiatives, stressing the importance of stakeholder support for sustainable implementation of actions. Practical implications Future studies are recommended to engage (potentially) relevant stakeholders preferably from the start of the project and invest in the development of adolescent-friendly systems dynamic methods. Funding The Netherlands Cardiovascular Research Initiative and the Netherlands Organisation for Health Research and Development (ZonMw), CVON2016–07 LIKE.

Purpose: Ideally, physical activity interventions that work would be scaled-up and sustained to achieve a population health benefit. However, this is seldom achieved—only about 5% of effective physical activity interventions are scaled-up. Even fewer are sustained. The purpose of this symposium is to share and discuss the approaches we have relied upon to successfully scale-up and sustain physical activity interventions in community and school settings. Description: In this symposium we blend the science of scale-up and sustainment with our more than 20-years’ experience implementing and scaling-up effective physical activity interventions. Animated with real-world examples, presenters will 1) introduce scale-up pathways and the crucial need to adapt an intervention and its implementation for scale-up; 2) discuss the need to co-identify, name, define and specify implementation strategies across the scale-up process and partner levels (e.g., community organizations; schools); 3) present approaches and discuss risks and opportunities when evaluating scaled-up interventions; and 4) differentiate between sustainment and sustainability, and discuss approaches and challenges sustaining effective interventions. We will close with a brief synopsis of key research gaps that might be addressed to advance scale-up and sustainment science in physical activity research. Chair: Adrian Bauman, Emeritus Professor, University of Sydney Presenter 1: Heather McKay, Professor, University of British Columbia Presenter 2: Luke Wolfenden, Professor, University of Newcastle Presenter 3: Lindsay Nettlefold, Senior Researcher, University of British Columbia Presenter 4: Nicole Nathan, MRFF Investigator Fellow, University of Newcastle Discussant: Adrian Bauman, Emeritus Professor, University of Sydney — PRESENTER 1: Dr. Heather McKay, Professor, University of British Columbia Title: Scaling-up physical activity interventions–Is there a secret sauce? Purpose: Despite the known benefits of implementing effective health-promoting (physical activity) interventions, only about 5% are ever delivered at scale. During scale-up, it is often necessary to adapt implementation strategies and the intervention itself to achieve ‘best fit’ for specific settings and populations. Here we describe scale-up and discuss the need to co-adapt interventions for different contexts; we animate concepts using real world case studies. Background: Implementation and scale-up coexist on a continuum or within a ‘program life cycle’ that spans development, implementation, maintenance, and dissemination/scale-up. To impact population health, interventions that ‘work’ must be implemented at large scale. Despite this critical need to scale-up, most interventions never make it out of controlled research environments, and few plan for implementation at broad scale in real world settings. Methods: Scale-up is a process, not an endpoint. We highlight the need to ‘begin with the end in mind’—engage partners/end users early, at the outset of program during intervention planning. We define scale-up, describe different pathways for scaling-up and introduce levels of influence as outlined in scale-up frameworks. Although adapting for scale-up is not without controversy, we delve into the need to adapt (simply defined as ‘to make fit’)’ as scale-up proceeds. Results: The scale-up process can be daunting, and there is no secret sauce. However, with key partnerships and a commitment to doing so — scale-up is possible. Conclusion: It is important for researchers to design evidence-based scalable interventions, obtain ‘buy-in’ from relevant partners that support the scale-up process, and co-adapt interventions to achieve ‘best fit. Practical implications: Attendees will gain a greater understanding of scale-up processes and challenges; knowledge can be used to plan for scale-up of their own evidence-based interventions, in future. Funding: Canadian Institutes of Health Research — PRESENTER 2: Dr. Luke Wolfenden, Professor, University of Newcastle Title: Implementation strategies–the key to successful scale-up and sustainment? Purpose: To explore the role of implementation strategies in supporting the scale-up and sustainment of physical activity interventions. Here we discuss the role of implementation strategies in achieving these two outcomes. Background: Implementation is a key step in the scale-up process. Sustainment of scaled-up programs is warranted when interventions are implemented with enough fidelity and achieve beneficial effects for individuals and communities. We will explore how implementation strategies are used, and the role they play in successfully implementing and scaling-up an intervention. Methods: We will present the findings of systematic reviews that characterise the use of implementation strategies in scale-up efforts; their effects on implementation outcomes, and the extent to which these effects are sustained over time. We will use case studies to illustrate strategies that may be particularly important to achieve desired outcomes, and how they may differ at small versus large scale. Results: We will present evidence describing how implementation strategies are used during scale-up of physical activity programs (e.g., strategies delivered via modes or using infrastructure at relatively low cost). We address the impact of strategies and their potential effectiveness when ‘scaling-up’ programs (‘scale-up penalty’). ‘Best-bet’ implementation strategies for fostering sustainment will also be discussed. Conclusion: It is important for researchers to deploy implementation strategies during the scale-up process. Strategies should still be relevant when implementing an intervention ‘at scale’ and maintain (or strengthen) beneficial effects long-term. Practical implications: Attendees will understand the critical role of implementation strategies for the scale-up and sustainment of physical activity interventions. New knowledge will help researchers select appropriate implementation strategies to guide their own scale-up initiatives. Funding: National Health and Medical Research Council — PRESENTER 3: Dr. Lindsay Nettlefold, Senior Researcher, University of British Columbia Title: Evaluating physical activity interventions – adapting approaches as scale-up proceeds Purpose: In this presentation we will discuss evaluation methods and consider real-world challenges when assessing implementation and impact of physical activity interventions during scale-up. Background: Evaluation is key to implement, adapt and scale-up physical activity interventions. As scale up proceeds, research priorities change—this has implications for study design and measurement approaches. Across the program lifecycle, the main focus of the evaluation shifts from the impact of the intervention on participant-level outcomes (efficacy; quantitative methods) towards a greater focus on effectiveness (mixed methods) and factors that influence implementation of the intervention (qualitative methods). Similarly, as scale-up proceeds, the proportion of the evaluation focused on implementation of the intervention compared to implementation strategies may also change. Methods: We have been implementing, scaling-up and evaluating a health promotion intervention called Choose to Move since 2015. We will use Choose to Move as a case study to illustrate how the evaluation focus and methods have changed over time. Results: Our evaluation data has been used in a number of ways: 1) to assess the impact of Choose to Move; 2) understand what facilitators and barriers our delivery partners experience; 3) guide adaptations to the program and the implementation strategies; and 4) encourage prospective partners (e.g., funders, delivery partners) and participants to engage. Conclusion: A purposeful and strategic evaluation plan is essential to guide implementation and scale-up of physical activity interventions. Ultimately, data support a constant knowledge to action approach, sustained delivery of effective interventions and long-term health benefits. Practical implications: Attendees will gain a greater understanding of the role, focus, and challenges of evaluation during implementation and scale-up. This knowledge can be used to guide evaluation of their own evidence-based interventions, in future. Funding: Canadian Institutes of Health Research — PRESENTER 4: Dr. Nicole Nathan, MRFF Investigator Fellow, University of Newcastle Title: Sustainment: What happens to physical activity programs when implementation support ends? Purpose: Here we address the challenge of sustaining efficacious physical activity interventions. We explore strategies to maintain delivery and impact of evidence based interventions (EBIs) over time. To do so we utilize case studies from schools, early care and education (ECEC) settings. Background: In health promotion, researchers have made significant progress adopting and implementing physical activity interventions in schools and ECEC settings. However, sustaining effective programs remains a substantial challenge. Only 23% of public health and clinical interventions endure beyond two years. This squanders investments and diminishes potential long term health benefits. Methods: We will present qualitative findings from case-study analysis of physical activity initiatives implemented in Australian schools and ECEC over a 20yr period. We used Inductive thematic analysis to analyse and derive emergent patterns, themes, and insights from the data. Results: We identified the following themes: • Design for sustainment from the outset: Early involvement and integration of knowledge users and policy makers is critical. • Leadership support is essential: Committed and engaged leaders, co-designed strategies, the provision of relevant resources and active endorsement are all crucial for success. • Provide ongoing education and training: Staff turnover challenges EBI sustainability; this emphasizes the importance of continuous education and training. • Routine monitoring facilitates sustainability: Establish valid measures, as inconsistencies in defining and measuring sustainability pose challenges. Conclusion: Failure to sustain EBIs undermines health system investments. Policymakers, practitioners, and researchers must carefully select sustainable innovations, and plan for sustainment at the outset of the project. Practical Implications: We provide insights into sustainment for researchers, practitioners and policymakers. Sustained impact is possible with early planning, engaged leaders, continuous education, and continually monitoring strategies for EBIs. Funding: National Health and Medical Research Council

Regular symposium submission Title: Inequalities in physical activity among children from low- and middle-income countries: evidence from the SUNRISE International Study. Purpose: 1) To present evidence from five low- or middle-income countries on differences in participation in physical activity between children living in urban and rural areas; 2) to provide insights on how to address inequities based on level of rurality in each of the countries; and 3) to provide a forum for researchers from underrepresented countries to present their work to an international audience. Description The chair will introduce the speakers and provide a brief introduction on the SUNRISE Study and how it aims to address inequalities at a global level, especially by providing data from low- and middle-income countries (LMICs) and, within LMICs, on differences between urban and rural locations (10 mins). Each speaker will then present for 8 minutes with 2 minutes for audience questions after each presentation (50 mins). At the conclusion, there will be an active moderated discussion with the audience focusing on addressing urban-rural inequalities in physical activity in LMICs (15mins). TOTAL=75mins. Chair: Anthony Okely, University of Wollongong, Australia Presenter 1: Gabriela Argumedo, Instituto Nacional de Salud Pública, Mexico Presenter 2: Chalchisa Abdeta, University of Wollongong, Australia and Adama Hospital Medical College, Ethiopia Presenter 3: Tawonga Mwase-Vuma, University of Malawi, Zomba, Malawi Presenter 4: Denise Koh, Universiti Kebangsaan Malaysia, Selangor, Malaysia Presenter 5: Amine Ltifi, University of Manouba, Tunis, Tunisia Moderator: Alex Florindo, University of São Paulo, Brazil   Title: Rural and urban settings differences on 24h movement behaviours levels in Mexican preschoolers: the SUNRISE pilot study in Mexico. Authors: Gabriela Argumedo,1 Deborah Salvo,2 Armando Olvera, 1 Daniel Velázquez, 1 Anthony Okely,3 Alejandra Jáuregui1 Affiliations: 1 Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico. 2The University of Texas at Austin College of Education Department of Kinesiology and Health Education. 3Early Start, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia [email protected]. Background: In Mexico, more children (aged 10-14 years) in rural settings meet physical activity and screen time recommendations, compared to their urban counterparts1. There is currently no known data available regarding children’s sleep time in Mexico.2 To date, these figures are unknown among Mexican children under 5 years of age. Purpose: To identify differences in physical activity, sleep, and screen time, namely 24h movement behaviours, among Mexican children under 5 years of age living in urban and rural settings. Methods: Cross-sectional study among children aged 3-4 years attending Early Childhood Education and Care centres located in urban and rural settings. Physical activity and sleep time were objectively measured with an ActiGraph (GT3X, GT3X+) accelerometer worn on children’s waist for seven days, while screen time and sleep time were reported by caregivers. Results: Of the 139 Mexican children who participated in the study, 87 had valid accelerometry data (rural=37%, urban= 63%). Children in rural settings spent more time in total physical activity (M=234.7 min/day, SD=61.0 vs. M=204.2min/day, SD=48.8, p=0.01) than those in urban settings, respectively. No significant differences were identified in the time spent in moderate- to vigorous-intensity physical activity (M=113.1 min/day, SD=34.3 vs. M=99.2min/day SD=33.3, p=0.07 respectively), screen time (rural: M= 82.1 min/day, SD=83.8 vs. urban: M=92.0 min/d, SD=61.4, p=0.53), or sleep time (rural: M= 11 hours/day, SD=1.3 vs. urban: M=10.7 hours/day, SD=1.0, p=0.26). Conclusions: Consistent with nationally representative data for older children, results from this study of children in Mexico suggest that those aged 3-4 years living in rural settings are more physically active than their urban counterparts. Practical implications: It is important to implement a national surveillance system of movement behaviours among children under 5 years of age, and to strengthen physical activity participation among this age-group, particularly among those living in urban settings. Funding: Fogarty Grant A66864. References: 1. Shamah-Levy, T., Vielma-Orozco, E., Heredia-Hernández, O., Romero-Martínez, M., Mojica-Cuevas, J., Cuevas-Nasu, L., Santaella-Castell, JA., & Rivera-Dommarco, J. (2020). Encuesta Nacional de Salud y Nutrición (ENSANUT) 2018-19. Resultados Nacionales. https://www.insp.mx/produccion-editorial/novedades-editoriales/ensanut-2018-nacionales. 2. Instituto Nacional de Salud Pública. (2016). Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Informe de Resultados. In Informe final de resultados. https://doi.org/10.21149/8593   Title: Compliance with the global 24-hour movement guidelines among rural and urban pre-schoolers in Malawi: The SUNRISE Malawi Study Authors: Tawonga W. Mwase-Vuma1,2, Xanne Janssen2, Anthony D. Okely3, Janine J. Kayange1, Kar Hau Chong3, Penny Cross3, Seth Evance1, and John J. Reilly2 Affiliations: 1 Centre for Social Research, University of Malawi, Zomba, Malawi. 2 Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland. 3 Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Australia. Background: Despite the publication of the World Health Organization (WHO) guidelines on physical activity (PA), sedentary behaviours, and sleep for the under-fives in 2019, there is currently limited evidence on compliance with the guidelines from low-income countries. Purpose: We examined the levels of meeting the total PA, sedentary behaviours, and sleep guidelines among Malawian 3-4 year olds, and determined sex and urban/rural differences in meeting the guidelines. Methods: This study comprised 417 children (51.5% girls; mean age 4.0 years) from 24 urban and rural childcare centres in Malawi. The child’s total PA was assessed using step-count data from hip-worn ActiGraph GT3X accelerometers worn continuously for at least five consecutive days. Children were classed as meeting the TPA guideline if they averaged 11,500 steps/day. Parents reported their child’s sedentary screen time, sleep duration, and sociodemographic characteristics. Descriptive analyses were conducted to describe the levels of meeting the guidelines and 95% confidence intervals (CI) were calculated. Sex and urban/rural differences were assessed using a chi-squared test. All analyses accounted for post-stratification weights and were conducted in Stata. Results: Of the 417 pre-schoolers, 75.9% were from rural settings. Children accumulated an average of 24,269 steps/day (standard error [SE]=391) and reportedly spent a daily average of 43.0 (SE=7.1) minutes in screen time and 11.2 (SE=0.1) hours of sleep. The overall prevalence of meeting the TPA, sedentary screen time, sleep, and combined guidelines were 98.4% (95% CI=96.0–99.4), 79.4% (95% CI=71.2–85.7), 90.6% (95% CI=87.3–93.2), and 70.5% (95% CI: 62.4–77.4), respectively. An exceptionally high proportion of children from rural settings met the sedentary screen and combined guidelines compared to their urban counterparts (p<0.05). No sex differences were observed in meeting the guidelines. Conclusions: A very high proportion of Malawian pre-schoolers aged 3-4 years in our sample met the WHO guidelines. Children from rural settings were more physically active than their urban counterparts, suggestive of a ‘pre-physical activity transition’ environment. Practical implications: The very physically active children from rural than urban settings is suggestive of a ‘pre-physical activity transition’ environment. Targeted interventions are needed to promote and sustain physical activity behaviours to delay the transition and improve childhood health. Funding: Sir Halley Stewart Trust (2674)   Title: Adherence to the WHO Guidelines and Associations with Socio-demographic Factors: The SUNRISE Ethiopia Study Authors: Chalchisa Abdeta1*, Dylan Cliff1, Katharina Kariippanon2, Alem Deksisa3, Sileshi Garoma3, Debrework Tesfaye4, Kar Hau Chong2, Devan Antczak1, Anthony D. Okely2 Affiliations: 1Early Start, School of Education, University of Wollongong, Wollongong, Australia 2Early Start, School of Health and Society, University of Wollongong, Wollongong, Australia 3Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia 4Department of Sport Sciences, Wolaita Sodo University, Wolaita, Ethiopia Background: The World Health Organisation (WHO) has called for more evidence on 24-hour movement behaviours from low-income countries. Purpose: We examined the proportion of Ethiopian children (3.0-4.9 years) who met the WHO guidelines on physical activity, sedentary behaviour and sleep for children under the age of five, and differences between children who lived in urban and rural areas. Methods: A cross-sectional study was conducted in Adama and Lume Woreda, Ethiopia. Children were recruited through kindergartens and rural villages. Physical activity and sleep were measured using ActiGraph. Accelerometers raw data were processed using the “PhysicalActivity” package, and subsequently, the “PhysActBedRest” package was used in the R software to identify sleep periods using a decision tree algorithm. Sedentary screen time and restrained sitting were parent-reported. Multivariable logistic regression models tested associations between meeting the WHO guidelines and socio-demographic factors. Results: A total of 430 children participated in the study. More than half the children (58.0%) met all the WHO guidelines. A higher proportion met the physical activity (96.1%) and sleep guidelines (91.9%) compared to the sedentary screen time guideline (63.5%). Children who lived in rural areas were more likely to meet the sedentary behaviour (84.6% vs 38.2%, AOR= 7.31; 95%CI: 3.93, 14.02), sleep (98.6% vs 83.8%, AOR= 8.60; 95%CI: 3.55, 23.73) and combined (81.3% vs 30.1%, AOR= 7.41; 95%CI: 4.04, 13.97) guidelines than those who lived in urban areas. Conclusions: A high proportion of Ethiopian children met the WHO guidelines. Children from rural areas were more compliant than their urban counterparts. Strategies to reduce screen time and promote healthy movement behaviours in urban areas are needed. Practical implications: Most rural preschool children met WHO movement guidelines than those who lived in urban areas. This study helps to fill the evidence gap seen in Africa and supports healthy childhood development in Ethiopia. Funding: CA is supported by a Higher Degree Research Scholarship funded by the University of Wollongong, Australia.   Title: Impact of Urban-Social Divide on 24-hour Movement Behaviours among Preschool Children in Malaysia: Preliminary Results from SUNRISE Study Authors: Denise Koh1, Cho Li Bing1, Wong Jyh Eiin2, Poh Bee Koon2, Anthony D Okely3 Affiliations: 1School of Education and Community Well-being, Faculty of Education, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia. 2Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia 3School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong NSW 2522, Australia Background: Understanding movement behaviours among preschool children is important as health behaviours begin at a young age and track into adulthood. The WHO’s 2019 guidelines recommend that children aged 3-4 years should participate in at least 180 minutes daily of physical activity (PA) daily including at least 60 minutes daily of moderate-to-vigorous-intensity PA (MVPA), <60 minutes daily of sedentary time (ST), and 10-13 hours quality sleep including naps. Purpose: This study aims to explore differences in time spent on three main behaviours, namely PA, sedentary behaviour and sleep, between urban and rural children. Methods: This cross-sectional study involved preschool children aged 4 years recruited from urban and rural localities in Peninsular Malaysia. PA and ST were measured using Actigraph GT3X+ accelerometers worn on the waist for five consecutive days, from Monday to Friday. Children with at least one 24-hour day of data were included in this analysis. Sleep was measured via a parents’ questionnaire. Results: A total of 81 children completed the study protocol. There was good representation from urban (51.8%, n=42) and rural (48.2%, n=39) areas. Children from rural areas significantly more time in total PA (Urban:149.4±46.6 minutes/day vs Rural:175.6±54.7 minutes/day, p=0.02). However, no significant differences were found in MVPA (Urban: 65.5±29.2 minutes/day vs Rural: 79.2±31.5 minutes/day, p=0.05); ST (Urban:103.2±102.5 minutes/day vs Rural:91.3±76.9 minutes/day, p=0.56) and sleep (Urban:10.4±1.2 hrs/day vs Rural:10.5 ±0.9 hrs/day, p=0.55). Conclusion: Children in rural areas were more active throughout the day compared to their urban counterparts. The average ST was above the recommended <60 minutes/day among urban and rural children. Practical Implications: Urban localities need more child-friendly outdoor spaces where parents feel safe bringing their young children for active play outdoors. Funding: This research is funded by the Research University Grant by Universiti Kebangsaan Malaysia (GUP-2018-142)   Title: Exploring urban-rural differences in 24-hour movement behaviours among Tunisian preschoolers: Insights from the SUNRISE Study. Authors: Mohamed-Amine Ltifi1, Olfa Turki1,2, Ghaith Ben-Bouzaiene1, Kar_Hau Chong3, Anthony D. Okely3, Mohamed-Souhaiel Chelly1,2. Affiliations: 1: Research Laboratory (LR23JS01) « Sport Performance, Health & Society», Higher Institute of Sport and Physical Education of Ksar Saîd, University of Manouba, Tunis, Tunisia. 2: Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Tunis, Tunisia 3: Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia. Background: Little is known about differences in physical activity among children from urban and rural areas in low- to middle-income countries and some previous investigations revealed disparities in physical activity levels among children and adolescents residing in urban and rural environments. Purpose: We aimed to: (i) assess the proportion of preschool-aged children (3.0-4.9 years) meeting the global movement guidelines, and (ii) examine urban-rural differences in health and behaviour outcomes. Methods: Urban and rural location was based on national classifications. Physical activity (waist-worn ActiGraph); sleep duration, screen time and movement behaviors; Gross and fine motor skills (Lower body strength and mobility, Supine-Timed up and go (S-TUG), One-leg standing balance test, hand grip dynamometer, 9-hole peg-board test); and executive functions (visual-spatial working memory and inhibition) were assessed in 112 preschoolers (n=50 boys, 33 rural), (n=63 girls ,41 rural). Results: Only 18% of children met all movement guidelines, with 53% and 41% meeting the recommendations for sedentary screen time and total physical activity, respectively. A large proportion of children (81%) met the recommended sleep duration of 10-13 hours per day. A significantly lower proportion of children living in urban residential settings met each of the recommendations compared with their rural counterparts. Conclusions: Urban girls adhered more to the recommended sleep duration, while rural boys were more physically active. Urban boys spent more time in front of screens than rural boys, while rural girls had less screen time. Practical implications: There is a clear need to promote healthy movement behaviours among preschool-aged children in Tunisia through targeted interventions that address the unique challenges related to urban/rural residence. Funding: The SUNRISE Coordinating Centre is supported by a NHMRC Investigator Grant awarded to Prof Anthony Okely (APP1176858).

Purpose This symposium aims to address an important question: ‘Is more physical activity always better?’ through nuanced considerations of the context of physical activity, such as domains, other physical behaviours and overall lifestyle composition. Description Regular physical activity is known to offer a range of health benefits. Recent physical activity guidelines and public health messages tend to focus on the message of ‘move more, sit less’, implying that there are no upper limits to the benefits of physical activity. The latest epidemiological evidence tends to reveal a curve-linear dose-response relationship between physical activity and most health outcomes, suggesting a reduced ‘return on investment’ at the higher end of physical activity. Evolutionary biology evidence suggests that human energy expenditure tends to plateau towards the higher end, indicating an inherent self-regulating mechanism to reach energy equilibrium. This symposium will start with an overview of the current evidence on physical activity, from epidemiological, physiological and evolutionary biological perspectives. The chair will introduce the concept of energy expenditure equilibrium and the hypothesis of “sweet spots” between activities and recovery. The main presentations will involve three presenters who tackle physical activity in unconventional ways. Rather than examining the total volume of physical activity as done by most epidemiological studies, they considered various intensities of physical activity within the context of other physical behaviours and domains. Presenters also examined a broad range of health outcomes, such as cardiometabolic risk, fitness, pains, and all-cause mortality. Findings from the three presentations share a common theme: more physical activity doesn’t always lead to better health outcomes, and there is a balance to be struck between physical activity and recovery (sedentary behaviour or sleep). The symposium will end with an interactive discussion about the equilibrium between physical activities and recovery, and why the context of the physical activity matters. This symposium challenges the current paradigm of physical activity and health and has potentially important implications for future physical activity and sedentary behaviour guidelines and health promotion strategies and messaging. Chair (Name and Affiliation): Ding (Melody) Ding, PhD, Sydney School of Public Health, Faculty of Medicine and Health, the University of Sydney, Australia Presenter 1 (Name and Affiliation): Nidhi Gupta, PhD, Department of Musculoskeletal Disorders and physical work load, National Research Centre for the Working Environment, Copenhagen, Denmark Presenter 2 (Name and Affiliation): Stavros Kyriakidis, MSc, Department of Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Copenhagen, Denmark and Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Presenter 3 (Name and Affiliation): Sebastien Chastin, PhD, Glasgow Caledonian University, the United Kingdom; Ghent University, Belgium; the University of South Australia, Australia) Discussant/moderator (Name and Affiliation): Andreas Holtermann, PhD, Department of Musculoskeletal Disorders and physical work load, National Research Centre for the Working Environment, Copenhagen, Denmark Presentation 1 Are 24-hour physical behaviour profiles similarly associated with various health outcomes? Background: Although more moderate-to-vigorous physical activity and less sedentary time individually affect health similarly, their impact may be different when combined with other 24-hour behaviours like standing, light-intensity activity, and sleep. For example, a high-intensity-behaviors profile may improve cardiorespiratory health but when paired with prolonged standing and less sedentary time, it might increase musculoskeletal pain. Purpose: We explored if 24-hour physical behaviour profiles are consistently associated with various health outcomes. Methods: 807 workers wore thigh accelerometers and logged sleep and work time for 1-4 days. Using latent profile analyses, individuals were categorized into four distinct physical behaviours profiles; “Chimpanzees” (reference; work; sedentary=197 min, standing=145 min, physical activity=117 min, leisure; physical activity=114 min, standing=121 min, and time in bed=440 min, n = 226), “Lions” (more active work and less active leisure, n=179), “Ants” (more active work and leisure n=244), and “Koalas” (more inactive generally, n=158). Direct measures assessed cardiorespiratory fitness and systolic blood pressure, while back pain and general health were self-reported. Linear and logistic regression models, adjusted for confounders, evaluated the associations between profiles and cardiorespiratory fitness, systolic blood pressure, back pain, and self-rated health. Results: Compared with Chimpanzees; Ants had similar outcomes but reported higher levels of poor health (p<0.05). Lions were associated with lower cardiorespiratory fitness (p<0.01) but lower systolic blood pressure (p<0.05) and tended (p=0.08) to have less back pain. Koalas were associated with higher systolic blood pressure (p<0.05) and lower cardiorespiratory fitness (p<0.01) but similar self-rated health and back pain. Conclusion: Our study indicates that the direction of the association of 24-hour behaviour profiles with various outcomes is not consistent. Similar future studies are needed using a prospective study design. Practical recommendations: Research, guidelines, and communication about 24-hour behaviour profiles may be much more complex than for specific single physical behaviours (e.g. MVPA and sedentary behaviour). Funding None declared. Presentation 2 The “sweet spots” of domain-specific physical activity for preventing back pain: a prospective accelerometer study Background: High levels of occupational physical activity are associated with back pain while the opposite is the case for leisure-time physical activity. Contrasting effects like this have often been termed the “physical activity paradox”. However, the patterns of occupational and leisure-time physical activity associated with the lowest risk of back pain or (a.k.a, the “sweet spot”, have achieved less attention. Purpose: We investigated the “sweet spots” (i.e. lowest 5% risk) for back pain from occupational and leisure-time physical activity. Methods: Three-hundred-ninety-six eldercare workers from 20 nursing homes participated. Physical activity was measured for 4 working days using thigh-worn accelerometry. Back pain intensity was reported monthly on a scale from 0-10 over 1-year. A mixed-effects model regressed occupational and leisure-time physical activity against back pain, adjusted for confounders. The “sweet spots“ associated with the 5% lowest risk for back pain were defined as the occupational composition of sitting, standing, light, and moderate-to-vigorous physical activity and the leisure-time composition of sitting, standing, light, moderate-to-vigorous physical activity and sleep, respectively. Results: The occupational composition associated with the lowest risk of back pain – the occupational “sweet spot”– consisted of 70.6% sitting, 18.2% standing, 5.4% light physical activity, and 5.8% moderate-to-vigorous physical activity. The leisure-time “sweet spot”– consisted of 18.6% sitting, 26.6% standing, 0.9% light physical activity, 8.6% moderate-to-vigorous physical activity, and 45.3% of sleep. Conclusions: Compared with the observed occupational composition, the occupational “sweet spot” was towards more sitting and light physical activity time while compared to the observed leisure-time composition, the leisure-time “sweet spot” was towards more standing, moderate-to-vigorous physical activity and sleep time. These clear differences in the “sweet-spots” further support “the physical activity paradox”. Practical implications: The domain-specific “sweet spots” of physical activity should be considered in future guidelines, recommendations and public health interventions. Funding SOSU-pulje Presentation 3 Striking the right balance: evidence to inform combined physical activity and sedentary behaviour recommendations Background: Public health guidelines and policy documents tend to provide recommendations for physical activity and sedentary behaviour separately despite these behaviours being interlinked and co-dependent. In addition. Crucial evidence gaps were identified during the development of the World Health Organization Guidelines on physical activity and sedentary behaviour regarding: (1) the joint association of physical activity and sedentary time with health outcomes and (2) the benefits of light-intensity physical activity. Purpose: We report alternative ways to present combined recommendations of physical activity and sedentary behaviour for future guidelines and review how current evidence can be used to deliver recommendations for the public to strike the right balance of time between moderate-to-vigorous-intensity physical activity, light-intensity physical activity and sedentary time. Methods: The study adopts a compositional approach to quantify the dose–response associations between the balance of time spent in physical activity and sedentary time with all-cause mortality. The method is applied directly to the NHANES dataset and in reprocessing the results of previous large cohort studies, meta-analyses and federated analyses. Results: A similar curvilinear dose relationship between the ratio of time spent in moderate-intensity physical activity/sedentary behaviour and risk of mortality is observed across all cohorts and studies, implying a universal relationship. Public health guidelines should consider adopting recommendations expressed as a balance of over 2.5 minutes of moderate-to-vigorous physical activity per hour of daily sitting, which provides quantitative guidance for moderate-to-vigorous intensity physical activity, light-intensity physical activity and sedentary behaviour in one number. Conclusions: There is a consistent dose-response between the composition of time spent in moderate-to-vigorous intensity physical activity, light-intensity physical activity and sedentary behaviour and all-cause mortality. Practical implications: This balance could be a pragmatic way to inform the public in future recommendations. Funding: None

Purpose: To provide reasoning, evidence and strategies for how physical activity can be promoted within healthcare systems. Description: The World Health Organization Global Action Plan on Physical Activity (WHO GAPPA) has set a target of a 15% relative reduction in the global prevalence of physical inactivity in adults and in adolescents by 2030. To achieve this target, the GAPPA sets out 20 policy actions with action 3.2 recommending countries implement and strengthen physical activity assessment and counselling as part of universal health care. However, healthcare systems around the world are still struggling to implement and scale-up physical activity promotion as part of routine care. Common barriers reported by health professionals include insufficient resources, time, knowledge, skills, training, protocols, reimbursement, and organisational routines that do not enable physical activity promotion to be embedded into care. This symposium will present public health initiatives and research underway in three countries (the Netherlands, Australia, and United Kingdom) that have sought to train health professionals and embed physical activity promotion within healthcare systems and evaluated the effectiveness of this work. We will present current evidence on effectiveness of physical activity promotion in healthcare, present models of brief physical activity counselling that can be used in healthcare (e.g., 5As and COM-B) and strategies for training the health workforce including links to free online resources. We will share learnings from our different contexts about what has worked and what hasn’t worked and what we think could be improved. A moderated discussion will facilitate engagement with the audience to discuss some of the challenges and opportunities to implementing and scaling up physical activity promotion within healthcare systems. We aim for attendees to take away knowledge and resources on physical activity promotion for use in their local healthcare context to help improve physical activity promotion in healthcare globally. Chair: Associate Professor Leanne Hassett, The University of Sydney Presenters: Dr Ingrid Rosbergen, University of Applied Sciences, Leiden, Netherlands Development of the person-centered Keep Moving Support Tool integrating behavioral change science and design research. Dr Anita Feleus, Rotterdam University, Netherlands How to support health professionals to effectively integrate a physical activity-counselling tool in clinical practice. Associate Professor Leanne Hassett, The University of Sydney Adapting and implementing the 5As model of physical activity counselling within hospital settings in Australia. Dr Stephen Barrett, Bendigo Health and Latrobe University, Australia Complexities and context in the scale-up of a physical activity coaching intervention: A process evaluation. Associate Professor Anna Lowe, Sheffield Hallam University, The United Kingdom Embedding Physical Activity in Healthcare through the Physical Activity Clinical Champions Programme: co-design and implementation. Moderator: Professor Catherine Sherrington, The University of Sydney Abstract 1: Title: Development of the person-centered Keep Moving Support tool integrating behavioral change science and design research. Authors ICM Rosbergen1, AE Hesselink1,, A Feleus2, G Kloek3,4, PC Siemonsma1 Corresponding author 1Ingrid Rosbergen, PHD, Research group Self-Management in Physical Therapy and Human Movement Care, Department of Physical therapy, Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands; Tel: +31 (0)6 3927 3941; email: [email protected] Affiliations 1. Research group Self-Management in Physical Therapy and Human Movement Care, Department of Physical Therapy, Faculty of Health, University of Applied Sciences Leiden, The Netherlands 2. Research Center Innovations in Care and Department of Physiotherapy, Rotterdam University of Applied Sciences, the Netherlands 3. Research group Healthy Lifestyle in a Supporting Environment and Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague 4. Research group Smart and Health School, Saxion University of Applied Sciences, Enschede, The Netherlands Background Supporting patients to achieve healthy physical activity levels can enhance their meaningful community participation. However, healthcare interventions rarely result in sustained physical activity. Person-centered interventions that incorporate behavioral science to empower patients’ self-management are needed. Purpose To develop a Keep Moving Support tool that supports healthcare professionals in using behavioral change techniques to enhance patients’ self-management in achieving sustained physical activity. Methods The theoretical Behavior Change Wheel, including the COM-B (Capability, Opportunity, Motivation and Behavior component), and a scoping review on effective behavior change techniques (19 reviews, 33 RCTs) formed the framework for the design of the support tool. Design research using context mapping sessions (8 with 38 clients) and storytelling (12 clients, 11 professionals) guided the creation of physical activity profiles. Co-creation sessions (n=3) with professionals shaped the decision support tool. Prototypes were tested, followed by a feasibility study with healthcare professionals. Results The combined data led to the Keep Moving Support tool including 6 physical activity profiles and a behavior change decision tool. Patients use the physical activity profiles to outline their personal movement behavior through circling what they recognize about themselves. In the subsequent consultation, healthcare professionals and patients discuss the profiles and the decision tool leads them stepwise to person-centered physical activity counseling and behavior change techniques. Together, they arrange actions to enhance physical activity. The feasibility study involving 52 patients indicated that the tool supports an active patient role, insight into needs and context, and shared decision-making, but health professionals perceived delivery of behavior change techniques as challenging. Conclusions The Keep Moving Support tool holds promise to support professionals in physical activity counseling. Practical implications Supporting professionals in applying person-centered behavior change techniques can enhance patients’ self-management in physical activity. Funding Taskforce for Applied Research SIA (RAAK.PUB05.029), Vital Delta (SPR.VG01.006) and Medical Delta. Abstract 2: Title: How to support health professionals to effectively integrate a physical activity-counselling tool in clinical practice. Authors A Feleus1, ICM Rosbergen2, M Bik2, JM Dallinga3, S van Rongen3, PC Siemonsma2, AE Hesselink2 Affiliations 1. Research Center Innovations in Care and Department of Physiotherapy, Rotterdam University of Applied Sciences, the Netherlands 2. Research group Self-Management in Physical Therapy and Human Movement Care, Department of Physical Therapy, Faculty of Health, University of Applied Sciences Leiden, The Netherlands 3 Research group Healthy Lifestyle in a Supporting Environment and Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague and Research group Smart and Health School, The Netherlands Corresponding author 1Anita Feleus, PHD, Research Center Innovations in Care and Department of Physiotherapy, Rotterdam University of Applied Sciences, the Netherlands e-mail: [email protected] phone: +31-6 36155096 Background Facilitating an active lifestyle within healthcare is experienced as both important and challenging. The Keep Moving Support Tool (KMS-tool) was developed in co-creation with patients and professionals to support physical activity counselling and seems successful. However, application in daily clinical practice needs attention. Purpose To support physiotherapists in the use of the KMS-tool in clinical practice using an implementation strategy and participative action research. Methods The implementation strategy was developed using the existing models, CFIR and COM-B, and included interviews and co-creation sessions. Participative action research was conducted in 3 physiotherapy clinics in primary care. Through individual and group contact, barriers and facilitators for implementing the KMS-tool were identified and addressed by the researchers. Results Seven physiotherapists included 20 patients. Information was gathered through 14 observations, 19 interviews (12 patients; 7 physiotherapists), 9 clinic meetings (3/practice), electronic patient files (n=20), and learning community meetings (n=2). Reported barriers were unfamiliarity with physical activity counselling, uncertainty about meeting patient expectations, lack of time, not part of routine, feeling incompetent incorporating behaviour change techniques, and lacking communication skills. Solutions were explored and blended education and supporting materials developed along the way to support professionals’ beliefs, knowledge and skills. They included: an e-learning including training of the KMS-tool and implementation strategies, adjustments to the KMS-tool to improve user-friendliness promotional materials, and a training day on communication techniques and behaviour change. A hybrid implementation effect study with the adjusted KMS-tool is currently underway with results available at time of presentation. Conclusions By using Participative Action Research, the KMS-tool and its implementation were adapted to the needs of physiotherapists and patients. Practical implications Participatory Action Research can assist in tailoring support for professionals in integrating physical activity counselling in clinical practice. Funding Dutch Taskforce for Applied Research SIA (RAAK.MKB15044), Vital Delta (SPR.VG01.006) and Medical Delta. Abstract 3: Title: Adapting and implementing the 5As model of physical activity counselling within hospital settings in Australia. Author Hassett L1,2 Affiliations 1 Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; 2 Sydney Health Partners, Sydney, Australia Correspondence Leanne Hassett, PhD, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; e-mail: [email protected] phone: +61408241708 Background The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to support physiotherapists working in a health district in Australia to deliver the 5As model of physical activity counselling within routine hospital care. Purpose The purpose of this paper is to describe the implementation strategies used with physiotherapy teams within the BEHAVIOUR trial and the adaptations to the 5As physical activity counselling required to meet the needs of the local context. Methods A hybrid type II implementation-effectiveness cluster randomised controlled trial. Thirty teams of physiotherapists across six hospitals were randomised to receive implementation support immediately or delayed. A survey of physiotherapists was conducted prior to the trial commencing as a local behavioural diagnosis framed within the COM-B behaviour change theoretical model. The Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) were used to consider suitability of implementation strategies and adaptations required to the 5As counselling intervention to be context specific and have potential for scalability within the Australian healthcare setting. Results Survey of 84 physiotherapists identified implementation strategies need to primarily build clinicians’ Capabilities (knowledge and skills) and Opportunities (resources for community referral) to deliver physical activity counselling. The following implementation strategies were delivered to teams of physiotherapists; education, training, tailored strategies to address community referral barriers, creation of a learning collaborative across the district, team facilitation, and audit and feedback. Identified adaptations to physical activity counselling included adjusting for different patterns of practice across different settings (e.g., inpatient and outpatient), student involvement and patients with diverse health conditions and cultural backgrounds. Conclusions Context is important when considering implementation and adaptation of physical activity interventions. Practical implications Context needs to be evaluated as physical activity interventions are scaled-up. Funding Australian MRFF preventive health grant (APP1201086). Abstract 4: Title: Complexities and context in the scale-up of a physical activity coaching intervention: A process evaluation Authors S Barrett1, 2, S Begg2, P O’Halloran3, A Dunford1, M Kingsley2,4 Affiliations 1. Bendigo Health, Bendigo, Victoria, Australia. 2. Holsworth Research Initiative, La Trobe University, Bendigo, Victoria, Australia. 3 Centre for Sport and Social Impact, La Trobe University, Melbourne Victoria, Australia. 4 Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand. Corresponding author Stephen Barrett, PhD, Research and Innovation, Bendigo Health, Bendigo, Victoria, Australia. e-mail: [email protected] phone: +61419599708 Background The Healthy4U telephone coaching intervention demonstrated cost-effectiveness as a place-based strategy to increase physical activity among ambulatory secondary care patients. During ambulatory appointments at a major tertiary hospital, surgeons identified individuals that may benefit from increasing physical activity, and referred them to the telephone coaching program. Trial results indicated that individuals engaged in the telephone coaching intervention exhibited lower health service utilisation compared to those in the control group. Subsequently, funding was secured to extend the intervention to encompass five additional small hospitals within the state of Victoria, Australia, spanning a 12-month duration. The funds were intended to support facilitating referrals to telephone coaching for secondary care patients in these hospitals, providing place-based strategies 0 improve physical activity. Purpose To detail findings on the planning and real-world implementation of a physical activity intervention in five additional hospitals. Methods A mixed methods process evaluation protocol was developed. Quantitative data, including participant questionnaires and responses to recruitment materials is collected throughout the project’s duration. Semi-structured interviews with participants and health service stakeholders will explore the factors that influenced referrals to the program. The qualitative data will be analysed thematically. These data will be mapped against the steps of the the PRACTical planning for Implementation and Scale-up (PRACTIS) guide and reported at individual, provider and organisational levels. Results The timeframes for this project are July 2023 to June 2024. All five hospitals have been engaged and recruitment is ongoing. Results will be available at time of presentation. Conclusions We will detail how the implementation of this program were adapted to the needs of patients and hospitals. Practical implications Real-world studies examining effects of short-term funding to scale-up of programs across multiple hospitals are rare. Funding Funding was received from the Planned Surgery Recovery and Reform program, Department of Health, Victorian Government.   Abstract 5: Title: Embedding Physical Activity in Healthcare through the Physical Activity Clinical Champions Programme: co-design and implementation Authors Lowe, A1 Affiliations 1National Centre for Sport & Exercise Medicine, Sheffield Hallam University, Sheffield, United Kingdom. Corresponding author Associate Professor Anna Lowe, National Centre for Sport & Exercise Medicine, Sheffield Hallam University, Sheffield, United Kingdom. e-mail: [email protected] phone: 07584 154 597 Background A substantial proportion of the UK population fails to meet national physical activity guidance and those with long term health conditions are significantly more likely to be inactive. Healthcare professionals have been identified as key agents in supporting physical activity behaviour change but limited confidence, knowledge and skill in this area may prevent their impact from being optimised. Program Delivery The Physical Activity Clinical Champions (PACC) programme was launched in 2014, it is a national education programme that was initially funded by Sport England and delivered by the Office for Health Improvement and Disparities in England. The PACC programme is a peer-to-peer education programme that is delivered by a national network of trained clinicians who delivered a standardised education session to other healthcare professionals. The training aims to increase healthcare professionals’ knowledge, skills, and confidence to integrate conversations about physical activity into routine clinical practice in England, with the longer-term aim of contributing to increases in physical activity levels at population-level. Evaluation The programme evaluation indicates that the training is well received by healthcare professionals, and is effective in increasing their confidence, knowledge and skills. The training attracts healthcare professionals who don’t routinely talk about physical activity in their clinical interactions. The programme has scaled and to date, over 40,000 professionals in England have received training. Conclusions The programme is now under new leadership and our challenge is to transform it into a sustainable, co-designed and equitable model. Practical implications In this session we will discuss the co-design process, including ways in which stakeholders were involved and how the prototype model was developed. We’ll draw on implementation science frameworks as we describe how the model was shaped, tested and refined. We will also share plans for further scale and spread. Funding This program was initially funded by Sport England.

Symposium Title: Development of health promotion in sports clubs: interventions, key skills, successes and challenges Purpose: This symposium will discuss the implementation of health promotion in sports clubs, to highlight interventions, key skills, current successes and challenges Description: Beyond promoting their sports, sports clubs can have a broader health and sport promotion role. Previous work has shown that health promotion in sports clubs is complex, due to their voluntary nature, their lack of know-how and the high turnover of club managers and coaches. The present symposium will discuss how sports clubs can promote health, several successes and challenges, as well as skillsets and leverages for health promotion actions. The first presentation will focus on the development of a health promoting sports club intervention in France through intervention mapping; highlighting how to co-create such interventions. The second will reflect on the evaluation of an Irish community-based initiative, ‘Ireland Lights Up”, hosted by sports clubs; showcasing the challenges when monitoring health promotion actions in sports clubs. The third presentation will explore what Dutch sports clubs do an can do to promote mental health and the successes and challenges they encounter during implementation. The fourth presentation will use a socio-ecological approach to explore factors influencing sports drop-out among Swedish youth. The fifth presentation will present results from a literature review on sport coaches’ skillsets and training needs to promote health. A discussion will be engaged with the audience on how to foster health promotion actions in sport organizations, especially by considering different conceptualizations of the relationship between health promotion and sport: health promotion in sport, through sport and health- promoting sport concepts. Chair: Susanna Geidne, Örebro University Presenter 1: Stacey Johnson, Institut de Cancérologie de l’Ouest et l’Université Côte d’Azur Presenter 2: Nicola Briggs, South East Technological University Presenter 3: Linda Ooms, Mulier Institute Presenter 4: Beatrix Alguren, University of Gothenburg Presenter 5: Kevin Barros, Université de Lorraine Discussant/moderator: Aurélie Van Hoye, Université de Lorraine Title: Development of a health promoting sports club intervention: an intervention mapping process analysis Authors: Aurélie Van Hoye, Stacey Johnson, Florence Rostan, Fabienne Lemonnier, Benjamin Tezier, Susanna Geidne, Alex Donaldson & Anne Vuillemin Presenter: Stacey Johnson Background: The development of health promotion interventions in sports clubs remains a challenge. Intervention implementation in real world settings must be context dependent and specific to each sports club’s needs and objectives. Purpose: This study mapped and analyzed the development of the multi-phase PROSCeSS intervention, designed to support sports club’s implementation of the health promoting sports club (HPSC) approach. Methods: A case study design was used to determine how the 6-step intervention mapping method (needs assessment, matrix of change, theory of action, program design, plan for adoption and implementation and evaluation) was applied to develop the PROSCeSS intervention. Results: The main findings include a literature review and concept mapping study as the needs assessment, a Delphi study and HPSC intervention framework to design the matrix of change, a case study among sports clubs and sports federations to select the theory of action, the intervention co-construction to create the program, results from a pilot study to validate the plan for adoption and implementation and employment of the e-PROSCeSS questionnaire and hybrid type-3 protocol as an evaluation method. Conclusions: The research design used to develop the PROSCeSS intervention has several challenges including 1) the quality of evidence for intervention design, 2) the robustness and definition of ‘theory-based’ interventions, 3) the scale for intervention development and 4) the specificity of settings-based interventions leading to difficulty to determine appropriate evaluation methods. Nevertheless, it highlights research in action and displays how intervention development and implementation are recursive rather than linear and the necessity of including target populations along all phases of program design and implementation. Practical implications: Settings-based interventions should consider multi-phase participatory research approaches to allow for translation from research into context specific practice. Funding: This research was a partnership between Santé publique France, Université Côte d’Azur and Université de Lorraine. Title: Study protocol: Capturing success factors in ‘Ireland Lights Up’—a sports-based community walking initiative. Ms Nicola Briggs, Dr Barry Lambe, Dr Noel Richardson, Professor Niamh Murphy & Dr Aisling McGrath South East Technological University Background: Community-based physical activity (PA) initiatives, such as ‘Ireland Lights Up’ (ILU), supported by the Gaelic Athletic Association (GAA) and community partners, demonstrate effectiveness in enhancing PA and improving mental, social, and physical health outcomes. However, there is limited evaluation of ILU’s impact or implementation. Purpose: This study aims to measure ILU’s effectiveness in GAA clubs, assess its impact on health and wellbeing, and explore its potential implementation in other Irish National Governing Bodies of Sport. Methods: The research, guided by implementation science and using a mixed methods approach, will identify determinants of successful implementation across participant, club, organisation, and system levels. Barriers and facilitators will be identified, and strategies to enhance impact and sustainability will be proposed. The study will apply a hybrid type-two effectiveness-implementation design through the RE-AIM and Practical Robust Implementation and Sustainability Model (PRISM) frameworks. Results: With a focus on engaging socially disadvantaged groups and countering physical inactivity trends, the research aims to maximise ILU’s implementation, serving as a model for other community-based approaches. Emphasising the wellbeing of vulnerable populations, the study will explore ILU’s unique role in enhancing social connectedness in local communities, addressing measurement, engagement strategies, and reaching vulnerable populations. Conclusions: The study’s original contribution to physical activity, health promotion, and sports clubs for health lies in developing a mechanism for engaging underserved, isolated, and vulnerable populations. The findings will provide a valuable opportunity to evaluate ILU at scale, impacting population health and developing a template for other National Governing Bodies of Sport to replicate or adapt the ILU implementation model. Practical Implications: Ultimately, the research seeks to address societal health challenges and promote inclusive community-based initiatives, offering practical implications for enhancing the reach, effectiveness, adoption, implementation, and sustainability of ILU. Funding: Funded by the SETU PhD Scholarship Programme. Title: Promoting mental health within sports clubs: opportunities and challenges Linda Ooms, Wikke van Stam Mulier Institute, The Netherlands Background: Regular participation in physical activity in a social context, such as in a sports club, can have mental health benefits. Purpose: To examine what Dutch sports clubs do and can do to stimulate the mental health of their participants. Methods: Online questionnaires were sent to Dutch sport clubs (n=313). Furthermore, online group interviews were conducted with representatives of sport clubs (n=1) and of six sport initiatives (n=6) that were aimed at stimulating the mental health of participants. Also, participants in these sport initiatives (n=10) were interviewed individually. Results: Only 5% of Dutch sports clubs have specific sport offer aimed at stimulating mental health. No need for specific offer and a lack of qualified trainers were the main reasons for not having such specific offer. Also, other challenges were mentioned related to the topic of mental health in general, such as not being able to recognize people with mental health problems. Nonetheless, sports clubs can have attention for mental health in more implicit ways. The results from the sport initiatives, for example, showed that personal attention for people is very important, both during and outside an activity: people want to be heard and seen. Moreover, sports clubs could collaborate with mental health professionals to learn more about how to recognize and guide people with mental health problems. Conclusions: Only a few Dutch sports clubs have specific sport offer aimed at stimulating the mental health of participants. Sports clubs experience different challenges considering the topic of mental health. Nonetheless, there are different opportunities for sports clubs to contribute to mental health in a positive way. Practical implications: The results of this research can support sports clubs in their decisions to stimulate the mental health of their participants. Funding: This research was funded by the Dutch Ministry of Health, Welfare and Sport.   Title: The importance of socio-ecological factors for continuing with organized sports – an adolescent’s perspective Beatrix Algurén Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Sweden Background: While the potential of sport to promote health and physical activity is well accepted, the rate of adolescents’ drop-out from organized sport has continuously increased during the last decade. Purpose: The aim of present study was to investigate and compare how adolescents perceive importance of various factors of leadership, athletic development, social environment and wellbeing aspects for their continued participation in sport. Methods: A cross-sectional online survey with a total of 43 factors was conducted in 2018. Adolescents aged 15 years or older and active in at least one sport club ranked on a 5 point Likert-scale the importance of each factor for their continuing with sport. Data were analyzed by univariate and inferential statistics. Results: A total of 631 adolescents (63% female) answered the survey whereof 65% were team sport athletes, 67% had an elite ambition level. Fun (92%), and ‘developing athletic abilities’ (90%) were the top most important factors. Leaders’ ability to listening and creating a safe environment were more crucial for females, whereas peaking the team/individual was more vital for males. ‘Performing regardless results’ and ‘Sport for growing self-esteem’ were more important for athletes with elite ambition level than those with non-elite ambition level (p0.001). Conclusions: The results revealed as many as 40 factors that were assessed as very or extremely important for continuing sport participation by all respondents. At the same time, they uncovered differences regarding gender, sport and ambition level. Practical implications: To prevent dropouts, leaders such as coaches, parents and sport club organizations should consider the complexity and the individuality of driving forces for continuation. A primary goal should be, independent of gender, team- or individual sports and ambition level, should be to create an ‘enjoyment-climate’ and a holistic perspective on individual development. Funding: None Title: Defining Health Promoting Sports Coaches: a systematic review Authors: Barros K., Vuillemin, A., Rostan F., Lemmonier F., Tezier B. & Van Hoye, A. Presenter: Kevin Barros Background: Coaches play a key role in sports participants experience, and their contribution to physical, mental and social health of participants is important, especially through the informal educational nature of sport. Purpose: Based on PRISMA-P guidelines and recorded on PROSPERO, this literature review aims to identify coaches’ HP skills, needs in terms of format and content in regard to HP education, leverage and barriers to develop HP coaches’ practices, using a holistic health approach. Methods: Six databases were searched using keywords ‘coach’ and ‘health promotion’. Inclusion criteria were 1) English peer-review publication, 2) targeting coaches as population, 3) describing HP training, skills or actions. Two-thousand eighty-five articles were retrieved and screened by 2 authors on Rayyan. Studies content were extracted on an excel sheet for inclusion and thematic analysis was carried out on interest criteria of the following subject as coaches’ skills, skills to develop, barriers, leverages, tools and strategies. Authors assess the quality and risks of bias using the AMSTAR-2. Results: On the 166 full-text screened, 33 studies were included. Key skills identified were being a role model, having communication skills, developing a specific pedagogy and acting on participants health. Key actions were implemented through role modeling, pedagogy and communication. Key barriers were the lack of time, education, confidence, social development abilities and health literacy. A major gap was observed in know how on program implementation beyond knowledge of their principles. Conclusions: This literature review identify key mechanisms, barriers and leverage to enhance coaches HP implementation, classified in 4 categories: role model, communication, social development, health support. Practical implications: Coaches education, but also experience in HP activities implementation and health literacy enhancement are required to implement HP in sports clubs. Funding: A partnership between Santé Publique France, Université de Lorraine and Université Côte d’Azur allowed and supported this work.

The importance of playgrounds for children’s active outdoor play

Purpose: The purpose of this symposium is to present an overview of the importance of playgrounds for children’s active outdoor play

Description: Active outdoor play is important for children’s health and development, and playgrounds can provide good places for play. But how do we create good playgrounds in public open spaces, early childhood education and care (ECEC) and schools, that children like to use for active outdoor play? What works, for which type of children, in which context?
In this symposium, four presentations from the United States, Australia and Denmark will shed light on the importance of playgrounds in different settings for children’s active outdoor play. Furthermore, the presentations will include multiple novel methods to measure active outdoor play, and will highlight the importance of engaging children and other stakeholders in the development of new playgrounds.
Together, the presentations will provide valuable information that can help policy makers and city planners prioritize investing in the right playgrounds, for the right context.

Chair: Jasper Schipperijn, World Playground Research Institute, University of Southern Denmark

Presenter 1: Hayley Christian, Telethon Kids Institute, Perth, Australia

Presenter 2: Deborah Salvo, The University of Texas at Austin, Austin, USA

Presenter 3: Charlotte Pawlowski, World Playground Research Institute, University of Southern Denmark

Presenter 4: Aaron Hipp, North Carolina State University, Raleigh, USA

Discussant/moderator: Jasper Schipperijn, World Playground Research Institute, University of Southern Denmark

Presentation 1:
Designing play spaces to promote preschoolers physical activity at early childhood education and care (ECEC)

Authors: Hayley Christian1,2, Jasper Schipperijn3, Pulan Bai1,2, Stewart Trost4

1Telethon Kids Institute, The University of Western Australia, Perth, Australia
2School of Population and Global Health, The University of Western Australia, Perth, Australia
3World Playground Research Institute, University of Southern Denmark, Odense Denmark
4School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia

Background: ECEC is an important setting to promote preschooler physical activity. The outdoor physical environment has significant potential to influence preschoolers’ physical activity while attending ECEC. Few interventions or studies using device-based measures of children’s physical activity and the ECEC physical environment have been undertaken.

Purpose: Summarize findings from multiple PLAYCE cohort sub-studies investigating the impact of the ECEC outdoor physical environment on young children’s physical activity.

Methods: Wave 1 findings from the ‘Play Spaces and Environments for Children’s Physical Activity’ (PLAYCE) cohort study will be presented and summarised. In wave 1, 1596 preschoolers aged 2–5 years and their parents were recruited from 104 ECEC services across Perth, Western Australia. Physical activity was measured by 7-day accelerometry and GPS. The Environment and Policy Assessment and Observation (EPAO) Instrument and Nearmap aerial imagery captured the ECEC physical environment.

Results: Sandboxes, portable play equipment (balls, slides, floor play equipment) and natural grassed areas were positively associated with preschooler physical activity. The addition of new portable equipment including balls, slides, twirling and floor play equipment resulted in intervention children being more active at follow-up. Spatial data confirmed physical activity hot spots were most common in outdoor open areas and areas with fixed play equipment and natural features.

Conclusions: Fixed and portable play equipment, natural features, and the amount of running space in ECEC outdoor areas and its location in relation to other play areas are important for facilitating physical activity in preschoolers.

Practical implications: Since few preschoolers meet daily energetic play recommendations while at ECEC,
the findings can support ECEC providers to optimize outdoor physical environments and encourage more active play among preschoolers.

Funding: The PLAYCE Study was funded by the Western Australian Health Promotion Foundation (Healthway #32018). HC is supported by an Australian National Heart Foundation Future Leader Fellowship (#102549).

Presentation 2:
Identifying priorities for improving playground access equity in Austin, Texas, USA: a mixed-methods, community-engaged study

Authors: Deborah Salvo,1 Case Garza,1 Eugen Resendiz1
1 People, Health and Place Lab, Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, Texas, USA

Background: Parks and playgrounds are critical built environment resources for children’s health and development. For many children, playgrounds are the only place for physical activity practice after school, on weekends, and/or during non-school months.

Purpose: To characterize playground access (in)equity in Austin, Texas, USA; and to engage key stakeholders and community members for identifying priorities for playground improvements.

Methods: This study uses a mixed-methods approach. Using GIS, we are mapping all playgrounds in Austin, Texas, and identifying neighbourhoods with high versus low playground availability. We will explore differences in playground access by underlying sociodemographic characteristics of neighbourhoods (income, race/ethnic composition of residents) to diagnose inequities. We are further collecting audit-based and imagery (photography) data in 8 low-income neighbourhoods with high proportions of minoritized residents, to assess the current upkeep/quality of playgrounds in these areas. Additionally, a systematic organizational mapping exercise is underway to identify key people, groups, organizations, and agencies with an interest or influence on playground improvement, renovations, maintenance, and programming. Finally, we are conducting 2-5 key stakeholder/community-member semi-structured interviews with representatives of key sectors (parks and recreation, public safety, environmental protection, placemaking community-based groups), to identify priorities for playground improvements.

Results: Data collection is underway, and will finalize in early May, 2023. Final results will be presented at ISPAH 2024.

Conclusions: Ensuring equity in access to playgrounds is critical for promoting healthy development in children, and for achieving physical activity and health equity.

Practical implications: Using a data-driven approach to identify high need areas, and engaging key stakeholders, including key public sectors are critical approaches for informing the design and implementation of contextually-responsive programs to improve playground access and utilization in high need areas.

Funding: This study was partially funded by the World Playground Research Institute, University of Southern Denmark.

Presentation 3:
How to design activating school playgrounds for 9-12 year-olds

Authors: Charlotte Skau Pawlowski¹, Thea Toft Amholt2, Jasper Schipperijn¹
1World Playground Research Institute, University of Southern Denmark, Odense Denmark
2Center for Clinical Research and Prevention, Frederiksberg Hospital, Frederiksberg, Denmark

Background: School playgrounds are a unique place to promote physical activity for children. However, physical activity on school playgrounds decreases when children get older. Several of our studies have shown that there is a relation between school playground design and physical activity among older schoolchildren.

Purpose: The aim was to compile our evidence and develop recommendations for designing activating school playgrounds for 9-12 year-olds.

Methods: We have compiled our evidence from two school playground studies in Denmark conducted between 2016-2022. In each of the mixed-methods studies, we looked at the relation between physical activity among 9-12-year-olds and school playground design. Using combined accelerometer and GPS data, we identified which type of schoolyard features were used for physical activity. Using go-along interviews, we identified six types of children with different activity preferences. Combining data, we identified which schoolyard features were used by which type of children.

Results: To stimulate active use by 9-12-year-olds, school playgrounds should contain a variety of features such as secluded social areas where they can hang out with each other, areas with age-appropriate physical challenges such as high climbing frames that creates a feeling of risk-taking, sports features such as ball game areas, as well as features for non-competitive activities. Finally, it is important that there is a good balance between paved and natural, vegetated surfaces in the schoolyard.

Conclusions and practical implications: If school playgrounds are designed and built with the right features such as secluded hang-out areas, areas with age-appropriate physically challenging features, as well as sports area, and areas for non-competitive activities, 9-12 years-olds will actively use them, which positively influences their total daily physical activity levels.

Funding: This study was funded by KOMPAN, a large international playground company. KOMPAN has not had any influence on the methods, results or conclusion.

Presentation 4:
Child’s Play: What can we learn from AI-based – clustering algorithms?
Authors: J. Aaron Hipp¹, Jae In Oh1, Morgan Hughey2
1North Carolina State University, Raleigh, NC, USA
2College of Charleston, Charleston, SC, USA

Background: The study of playgrounds has traditionally been via observations, though use of GPS and accelerometers are becoming more frequent. Use of monitoring devices provide more nuanced understanding of use of space, intensity of activities, and where current playspaces may be under-activated.

Purpose: We recruited a diverse sample of youth from playgrounds located in economically-disadvantaged neighborhoods to understand activity intensity on playgrounds, attribute preference, and play clusters within and between playground amenities.

Methods: 5 – 10 year olds wore an accelerometer and GPS during a playground visit. Each playground amenity was mapped with a handheld Trimble GPS. GPS and accelerometer data, with 15 second epochs, were joined using HABITUS software. Clusters of play, or play episodes, were created using the ArcGIS density-based clustering algorithm, OPTICS. Clusters were set with a minimum of five consecutive points (1 minute) and maximum distance of 6m between points. OPTICS output provides clusters of play across an individual’s wear-time allowing for the visualization and description of play across time and space.

Results: The dataset included 40,000 15s epochs of playground use from 321 youth. OPTICS identified 1,727 play episodes. The average playground visit included five three-minute episodes of play. 37% of play episodes occurred on playsets, followed by 8% of episodes on swing sets. 43% of play episodes occurred across or between different play areas within playgrounds (e.g., playing on the slide and then running directly to the swings).

Conclusions: Youth play episodes are varied and often between or beyond provided play equipment. Further research is necessary into the layout and design of equipment that best invites active, creative play and incites return visits.

Practical implications: Understanding play episodes on playgrounds can inform the design of specific playground equipment, layout of diverse amenities across a playground, and help activate under-used spaces.

Funding: Robert Wood Johnson Foundation

Overall abstract for the symposium Purpose: The primary purpose of this symposium is to discuss innovative aspects of physical activity measurement provided by work performed in a currently ongoing collaborative European research project (WEALTH). Description: The symposium will start with an introduction by the Chair (Jean-Michel Oppert, France) on the topic of physical activity monitoring in real-life settings and the needs for improved objective assessment in health surveillance surveys at national and international level. The first presentation (Alan Donnelly, Ireland) will provide an overview of the WEALTH project which main objectives are to develop standardized machine learning (ML) data processing techniques for accelerometer data and to test the feasibility of employing Ecological Momentary Assessment (EMA) to link physical activity and dietary data. The recruitment of participants across four European centers, and the data collection protocol using four accelerometer devices and an Ecological Momentary Assessment (EMA) app during a 9-day monitoring phase will be detailed. The second presentation (Tomas Vetrovsky, Czech Republic) will explain the EMA protocol combining time-based and event-based surveys to label free-living data measurement and assess environmental, social, and psychological contexts of physical and eating behaviors. The third presentation (Christoph Buck, Germany) will detail how ML models are trained and externally validated for prediction of physical and eating behaviors, based on wrist-worn accelerometry. EMA information is then used to refine classifiers of physical behaviors. The fourth presentation (Greet Cardon, Belgium) will focus on the feasibility and acceptability of methods under study and will use an online voting tool to interact with the audience and get the perspective of the researcher/policy maker. The final part of the symposium led by the Discussant (Sebastien Chastin, UK) will strongly involve the audience to get feedback on methods and results from the project and why, when and how they could be used to improve health surveillance surveys. Chair: Jean-Michel Oppert, Sorbonne Paris Nord University, France Presenter 1: Alan Donnelly, University of Limerick, Ireland Presenter 2: Tomas Vetrovsky, University of Hradec Kralove and Charles University, Czech Republic Presenter 3: Christoph Buck, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Germany Presenter 4: Greet Cardon, Ghent university, Belgium Discussant: Sebastien Chastin, Glasgow Caledonian University, UK Individual abstracts for each presenter Presenter 1: ALAN DONNELLY, Limerick University, Ireland Title: The WEALTH Project Background: The WEALTH project (wearable sensor assessment of physical and eating behaviors) is a five-country European partnership focused on the development of improved measurement methods for physical behaviors and their impact on eating behaviors. Purpose: To develop standardized machine learning data processing techniques for research grade and commercially accessible accelerometer device data, and to test the feasibility of employing Ecological Momentary Assessment (EMA) to link physical activity behaviors and dietary behaviors. Methods: 600 adult participants were recruited (150 from four European centers) to simultaneously wear four accelerometer devices including two wearables (ActiGraph GTX3, ActivPAL3M, FitBit Charge 5 and Skagen Falster Gen 6) for nine days. Physical and eating behaviors were labelled using feedback from event-triggered and random EMA questions. Anthropometric measures including height, weight and grip-strength were recorded, and participants completed three web-based SACANA 24-hour dietary recall questionnaires. Accelerometer and EMA data were employed to: 1) develop machine learning data-processing techniques to identify activity behaviors, and 2) test the feasibility of using triggered EMA to assess the link between physical and eating behaviors. Participants completed study feasibility questionnaires at the end of the measurement period. Results: Data collection will be completed by March 2024, and data processing and analysis is currently underway. The large-scale data collection will generate a database which can be interrogated to develop novel methods to explore the relationship between physical and eating behaviors. Conclusions: The WEALTH project has illustrated the feasibility of employing combined accelerometry and event triggered and random EMA questions to study physical and eating behaviors in large populations. Practical implications: The WEALTH project methods will be shared at the end of the project and will demonstrate that such methods can be used in national and international surveillance studies. Funding: ERA-Net HDHL-INTIMIC (grant agreement No 727565). Presenter 2: TOMAS VETROVSKY, University of Hradec Kralove and Charles University, Czech Republic Title: Ecological Momentary Assessment (EMA): Real-Life Instantaneous Behavior Assessment Background: Accurate measurements of physical behaviors (PB) and eating behaviors (EB), along with their context, as determined using Ecological Momentary Assessment (EMA), are crucial for understanding the determinants of healthy lifestyles. The WEALTH project aims to develop data processing methods for accelerometer data through a combination of machine learning and EMA. Purpose: To report on the EMA data collection process undertaken within the WEALTH project. Methods: The study included a 9-day free-living EMA data collection using the HealthReact system. Participants aged 18-64 years were recruited from four centers (Ireland, Germany, France, Czechia). The EMA protocol combined self-initiated, time-based, and event-based surveys to assess the environmental, social, and psychological contexts of PB and EB. Participants were instructed to self-report EB after each meal, snack, or drink (excluding water). Additionally, they received six time-based surveys daily. Finally, event-based surveys were triggered by near-real-time data from the Fitbit activity tracker following episodes of walking (5min, ≥60 steps/min, max. 4/day), running (5min, ≥140 steps/min, max. 4/day), or prolonged sitting (20min, 0 steps, max. 3/day). Results: Among the enrolled participants (n=455), an average of 4.4 self-initiated reports of EB per day were recorded. Beyond the six daily time-based surveys, participants were prompted to complete, on average, 4.6 event-based surveys daily, of those x triggered by walking, y by running, and z by prolonged sitting. The response rates for the time-based surveys and those triggered by walking, running, and prolonged sitting were 58%, 65%, 59%, and 66%, respectively. Conclusions: The collected EMA data will be instrumental in developing and validating machine learning algorithms for detecting PB and EB and their contexts. Practical implications: The results will be applicable for surveillance and monitoring at the population level, as well as in public health interventions promoting healthy PB and EB. Funding: ERA-Net HDHL-INTIMIC (grant agreement No 727565). Presenter 3: CHRISTOPH BUCK, BIPS, Germany Background: The development of new machine learning (ML) algorithms for behavior classification creates the need for further collection of high-quality data. Based on scripted studies for labeled data assessment, recent ML behavior classifiers show high accuracy mostly in a similar study design, but perform lower based on free-living data. Purpose: To develop and improve ML models for physical behavior classification considering scripted and free-living labeled data. Methods: In the WEALTH study, we collected data from 600 participants in four European countries conducting a two-hour scripted study were participants followed a behavior protocol, followed by a nine-day free-living data assessment, where data labelling was supported by ecological momentary assessment (EMA) to identify time stamps of similar behaviors. Classifiers of physical behaviors were modeled based on raw tri-axial accelerometer data from three different sensors, i.e. Actigraph GT3x, ActivPal and 25hz smartwatch data. We used multiple ML methods ranging from random forests as a benchmark model to convolutional neural networks (CNN) as deep learning applications. Based on the scripted study, holdout validation was conducted for model development, and models were further calibrated using free-living sensor data identified by EMA labels. Results: Our models will be able to classify physical behaviors such as sitting walking, cycling and running, with high accuracy, whereas first results indicate lower specificity for high intensity behaviors due to extensive variation in raw accelerometry data. Conclusions: Based on EMA labeled free-living sensor data, development of ML models for physical behaviors will show improved performance for classification from tri-axial sensor data based on free-living study designs. Practical implications: The developed ML models will allow behavior classification particularly for easy to apply wrist worn wearables, particularly smartwatches, that can be implemented in large surveillance studies. Funding: ERA-Net HDHL-INTIMIC (grant agreement No 727565). Presenter 4: GREET CARDON, Ghent University, Belgium Title: Feasibility and acceptability of technology to provide physical activity and dietary behavior. Background: Technology to provide real-time, valid physical activity and dietary behavior data holds potential for advanced monitoring and surveillance in adults. The WEALTH project advances the assessment and monitoring of physical and dietary behaviors by maximizing the use of data collected from multiple commonly available measurement devices by standardized data analysis and using a Machine Learning data processing platform and by linking advanced processing of activity data with triggered Ecological Momentary Assessments questioning. Purpose: We aimed to assess the feasibility and acceptability in study participants and in researchers / policy makers when applying these methods for health behavior assessment. Methods: As part of the WEALTH project a convenience sample of about 150 participants from 4 countries (Ireland, Germany, France, Czech Republic) filled out a questionnaire (29 questions, 5-point likert scale) after wearing 4 devices (Fitbit, ActivPAL, Skagen, Actigraph) and receiving smart phone based surveys (self-initiated and time based) for 9 days. Results: Data collection in participants is currently ongoing and will be finalized in February 2024. Results will be presented for e.g.: comfort to wear the devices, ease of handling, comfort of data sharing, ease of responding to smart phone surveys, reactivity on smart phone surveys, technological ease, ease of compliance, privacy issues, general acceptance of the study. Making use of an online voting tool (Mentimeter) in the current presentation the audience will furthermore be asked to rate the feasibility and acceptance of the presented WEALTH methodology to get the perspective of the researcher/policy maker. Conclusions: Conclusions will be drawn on the feasibility and acceptability of the methodology both from the perspective of study participants as from the researcher/policy maker perspective. Practical implications: Findings will inform improvements needed in order to harness the potential of technology to provide real-time, valid data for monitoring and surveillance. Funding: ERA-Net HDHL-INTIMIC (grant agreement No 727565).

Title: Striving for global equity in physical activity: insights from the Active Healthy Kids Global Alliance Purpose: To explore the Active Healthy Kids Global Alliance’s evolving strategies in global physical activity surveillance and promotion for children and adolescents, emphasizing its actions for the integration of justice, equity, diversity, inclusion, and sustainability in its future endeavors. Description: The symposium delves into the Active Healthy Kids Global Alliance’s (AHKGA) pioneering role in advancing global surveillance and promotion of physical activity among children and adolescents, integrating principles of justice, equity, diversity, inclusion, and sustainability into current and future initiatives. There will be a brief introduction by the chair/discussant, followed by three presentations and then a facilitated question-and-answer session at the end. The symposium opens with an in-depth exploration of AHKGA’s journey, from its inception in 2014 to its subsequent far-reaching impact. Through the harmonized development of Report Cards across jurisdictions globally, the AHKGA efforts have resonated across sectors, resulting in a wealth of scholarly presentations, publications, strategic collaborations and impact. This presentation underlines AHKGA’s pivotal role in advocating for children’s and adolescent’s physical activity on a global scale. The second presentation showcases AHKGA’s pursuit to minimize inequities in children’s and adolescent’s physical activity surveillance and promotion. Analyses of Global Matrix Initiatives (1.0-4.0) demonstrate a progressive increase in EDI-focused data inclusion. AHKGA’s strategic endorsements, committee formations, and future commitments demonstrate its proactive stance, leading to concrete actions to address prevailing dis-parities and foster inclusive pathways for underserved children and adolescents. Finally, the third presentation introduces an analysis comparing Global Matrix data and UN Sustainable Development Goals (SDGs) country scores. Analyzing data from 57 countries/jurisdictions, this novel approach reveals associations between specific SDGs and key physical activity indicators for children and adolescents. These findings high-light the interconnectedness between childhood physical activity promotion and the global SDGs agenda, offering insights into their alignment and impact. Chair (Name and Affiliation): Dr. Salomé Aubert – Active Healthy Kids Global Alliance, Avignon, France. Presenter 1 (Name and Affiliation): Dr. Mark S. Tremblay – Children’s Hospital of East-ern Ontario Research Institute, Ottawa, ON, Canada. Presenter 2 (Name and Affiliation): Dr. Taru Manyanga – Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada. Presenter 3 (Name and Affiliation): Dr. Diego A. S. Silva – Department of Physical Ed-ucation, Sports Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil. Discussant/moderator (Name and Affiliation): Dr. Salomé Aubert – Active Healthy Kids Global Alliance, Avignon, France.   Presentation 1 Title: Active Healthy Kids Global Alliance Global Matrix: History, Activities, and Impact Background: Interest and concern regarding childhood physical (in)activity has grown in recent decades. Physical activity practitioners, leaders, scholars, and researchers have collaborated in a variety of ways to try and combat progressive, pervasive and per-nicious childhood inactivity trends. Purpose: To introduce the Active Healthy Kids Global Alliance (AHKGA); describe its history, activities, and impact; and explain the Global Matrix initiative. Methods: Using AHKGA records, analyses of Global Matrices data, consolidation of published findings, aggregation of evaluations of organizational activities, and summar-ies of impacts across sectors in a variety of countries, key highlights of AHKGA history, activities and impact were extracted. Results: AHKGA was founded in 2014 and incorporated in 2018. Its primary activity has been the harmonized development of Report Cards in jurisdictions around the world that are aggregated to create a “Global Matrix” of grades to help identify areas of concern and inform improvements. Global Matrices were released in 2014 (15 countries/jurisdictions), 2016 (38 countries/jurisdictions), 2018 (49 countries/jurisdictions), and 2022 (57 coun-tries/jurisdictions). The various AHKGA activities have resulted in >300 scholarly and professional presentations and >200 peer-reviewed publications that have been cited >6,000 times. AHKGA has strategic partnerships with several other leading physical ac-tivity organizations. Conclusions: Over the past decade the AHKGA has become an important organization promoting physical activity for children and youth around the world. In developing and releasing four Global Matrices involving 70 jurisdictions, the AHKGA has had significant impact across a variety of sectors. Practical implications: The AHKGA provides an infrastructure and network to power the global movement to get kids moving through thought leadership, knowledge translation and mobilization, capacity building, and advocacy. This is facilitated by sustainable partnerships and cross-sectoral collaborations that enable best-practice exchanges, networking and cross-fertilization. Funding: Nothing to declare. Presentation 2 Title: Active Healthy Kids Global Alliance’s drive to promote equity, diversity, inclusion in opportunities for child physical activity: where we are and where we are going. Background: As research, interventions, and policies to address insufficient physical activity among children and adolescents have intensified, efforts and initiatives to mini-mize inequities in opportunities for physical activity have also increased. Purpose: To highlight Active Healthy Kids Global Alliance (AHKGA)’s global efforts to promote equity, diversity, and inclusion in its previous and future Global Matrix Initiatives. Methods: Published and unpublished data from AHKGA’s Global Matrix (1.0-4.0) initia-tives, ongoing surveys, and planning documents for Global Matrix 5.0 were used. Results: Progressively more countries/jurisdictions from Global Matrix 1.0 to 4.0 (0/15; 0%; 2/38; 5%; 3/49; 6%; 8/57; 14%) respectively, have included at least some data relat-ed to children and adolescents with a disability (CAWD). From the 159 Report Cards de-veloped for the four Global Matrix initiatives, 124 (78%) have included disaggregated da-ta for at least one area of equity, diversity, and inclusion (EDI). For Global Matrix 4.0, AHKGA endorsed the International Federation for Adapted Physical Activity (IFAPA)’s harmonized development and release of a Global Matrix of fourteen Para Report Cards, leading to an official partnership. Survey data from Para Report Card leaders and AHKGA’s network members show that the majority, 82% and 68% respectively, support integrating data for CAWD in future Report Cards. Additional AHKGA EDI promotion in-cludes the creation of a JEDI committee and a requirement of future Global Matrix partic-ipants to commit to collect and include disaggregated EDI data whenever possible. Conclusions: AHKGA’s multi-pronged efforts, strategic partnerships, and ongoing plans to promote EDI in physical activity for children and adolescents, have raised awareness of gaps, led to concrete actions, and will contribute to reducing the existing inequities in physical activity opportunities. Practical implications: AHKGA’s deliberate initiatives, proactive planning, and strategic partnerships provide a practical and inclusive pathway to addressing inequalities in op-portunities for physical activity among underserved children and adolescents. Funding: Nothing to declare. Presentation 3 Title: Physical Activity Report Card Indicators and the United Nations Sustainable Development Goals: Insights from Global Matrix 4.0 Background: The World Health Organization (WHO) recognizes that physical activity (PA) during childhood is crucial for healthy development and the attainment of several Sustainable Development Goals (SDGs). Purpose: To explore the associations between 10 key indicators of PA for children and adolescents assessed in the Global Matrix 4.0 project and the United Nations (UN) SDGs. Methods: Data from 57 countries/jurisdictions that participated in the Global Matrix 4.0 project were used. The UN SDGs indicators are sourced from the SDG Transformation Center, which publishes each country performance for each of the 17 SDGs. Given the robust evidence supporting plausible links between PA and SDGs 3 (good health and well-being), 9 (industry, innovation, and infrastructure), 11 (sustainable cities and com-munities), 13 (climate action), and 16 (peace, justice, and strong institutions), these SDGs were investigated. Results: Countries/jurisdictions with good performance in achieving SDG 3, SDG 9, and SDG 16 had higher grades than countries/jurisdictions with poor performance in achiev-ing these SDGs for the indicators Organized Sports and PA, Community and Environ-ment, and Government Investments and Strategies. In relation to the achievement of SDG 11, countries/jurisdictions with good performance had higher grades than coun-tries/jurisdictions with poor performance for the indicator Government Investments and Strategies. Countries/jurisdictions with good performance in achieving SDG 13 had low-er grades than countries/jurisdictions with poor performance in achieving SDG 13 for the indicators Community and Environment, and Government Investments and Strategies. Conclusions: Organized Sports and PA, Community and Environment, and Government Investments and Strategies were the indicators that demonstrated differences between countries/jurisdictions with good and poor performance in achieving the SDGs. Practical implications: Promoting PA in childhood is related to achieving the SDGs. Funding: Nothing to declare.

Symposium Abstract Title: People, Health and Place in Latin America and Latino Communities: Lessons for Global Physical Activity Promotion Purpose: To present and discuss the advancements and gaps on people, health and place research in Latin America and Latino Communities in United States, underscoring policy and practice physical activity research and promotion lessons for the region and the globe. Description: Physical inactivity remains a global public health concern and it remains at highest levels, particularly among most vulnerable populations. Latin America and Latino communities experience greatest levels of social, economic, health and spatial disparities and the highest levels of physical inactivity in the world. As communities across the globe are experiencing growing inequalities and inequities, physical activity research, policy and capacity in the region can help informing our global physical activity community efforts to reduce physical inactivity worldwide. This symposium will provide an opportunity to present and discuss research findings among communities experiencing high levels of both physical inactivity and, social and spatial inequalities in United States, Mexico and Brazil. Dr. Reis (United States and Brazil), will chair the session, and Dr. Salvo (United States), Dr. Jauregui (Mexico) and Dr. Hino (Brazil) will present the findings from their studies focusing on people, health and place in their regions highlighting the inequalities and physical activity contextual factors. Dr. Reis will then reflect on how the findings may inform physical activity research, practice and policy in communities experiencing high levels of inequalities across the globe. Chair: Rodrigo Siqueira Reis, PhD; People, Health & Place Research Unit, Brown School, Washington University in Saint Louis (USA); Federal University of Parana (Brazil). Presenter 1: Adriano Akira Ferreira Hino, PhD; Graduate Program in Health Sciences; Pontifical Catholic University of Parana, Curitiba, Brazil. Presenter 2: Alejandra Jauregui; Departamento de Actividad Física y Estilos de Vida Saludables, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México Presenter 3: Deborah Salvo, PhD; People, Health & Place Lab, Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, Texas, USA Discussant/moderator: Rodrigo Siqueira Reis, PhD; People, Health & Place Research Unit, Brown School, Washington University in Saint Louis (USA); Federal University of Parana (Brazil). Research Abstract 1 Title: Environmental correlates of physical activity in Brazil: results from a systematic review Adriano Akira Hino, Cassiano R. Rech, Danielle Macedo, Thamires G. Coco, Isabella R. Souza, Paulo H. Guerra Background: Environmental correlates have been recently studied across different part of the Brazil across lifespan, however, no studied has summarized these evidence. Purpose: The purpose of this study was to describe the environmental correlates of physical activity in Brazil. Methods: A systematic review of literature was conducted following the PRISMA statement. The searches were conducted until December of 2021 in ten electronic databases combining key-words designed to identify correlates of physical activity studies in Brazil (PROSPERO# CRD42021258588). Were included original quantitative observational studies, published in peer-reviewed journals, had the physical activity as outcome and conducted in Brazil. Environmental correlates were identified manually and systematically during the data extraction. The consistency of the association was evaluated using the proportion of association stratified by age-group. Results: A total of 95 studies included at least one environmental correlate. The majority of environmental correlates studies were published after 2017, using subjective measures of the environmental variables, with adults (18 to 59 years old) adopting a cross-section design. Most of 1,357 associations identified were related to safety (crimes and traffic related), access to physical activity sources, sanitation, garbage and pollution conditions and presence of sidewalk/bike paths. Access to physical activity sources, density of public transit and use of public spaces were consistently associated to higher physical activity levels. Conclusions: The studies on environmental correlates have increased in Brazil. Some consistent associations were identified, however, most of the associations were from cross-sectional studies, using subjective measures of environmental and physical activity variables and focusing on adults. Practical implications: Future studies should incorporate longitudinal design, subjective and objective measures of environment and focused on children. Funding: This study was supported by National Council for Scientific and Technological Development (CNPq) under the process no. 443193/2020-7 Research Abstract 2 Built Environment and Physical Activity Research in Mexico: Lessons Learned Over the Past 10 Years Alejandra Jauregui, César Hernández-Alcaraz, Eugen Resendiz, Deborah Salvo Background: Compelling evidence links physical activity with environmental characteristics in high-income countries; evidence among low- and middle-income countries is scarce, but suggests differences to what has been reported for high-income countries. Purpose: To describe the associations observed and lessons learned over the past 10 years while assessing Mexico’s built environment’s effects on physical activity. Methods: We compiled the evidence produced in Mexico over the past 10 years regarding the association between built environmental features and physical activity. The main overarching findings of these studies were extracted and summarized. Results: Access to parks, public open spaces, aesthetics, safety from crime, and access to public transportation are important correlates of physical activity among Mexicans, namely active travel and leisure time physical activity. However, studies in Mexico have found no association or counterintuitive associations for other environmental features usually thought to be important for increasing activity levels, such as the walkability index or its individual components (street connectivity, land-use mix, residential density). Counterintuitive findings suggest that physical activity in Mexico may be occurring despite the lack of adequate environmental conditions, probably due to the necessity to get from one place to another. Findings also suggest differences in these associations between females and males, as well as an inequitable distribution of environmental features conducive to more physical activity, favoring high-income neighborhoods. Conclusions: Findings contrast with those reported in high-income countries, underscoring the importance of considering the local context when developing strategies to promote physical activity in Mexico. They also highlight the importance of improving the conditions under which necessity-driven physical activity. Practical implications: Findings underscore the importance of using contextually relevant evidence to inform local physical activity policy and practice. Funding: CDC Foundation, SALURBAL, Canadian Institutes of Health Research (CIHR), International Health Grant, the Public Health Agency of Canada (PHAC), and Fulbright-García Robles. Research Abstract 3 Contrasting environments for physical activity in the United States versus Latin America among Latino immigrants Deborah Salvo, Aine O’Connor, Eugen Resendiz, Carolina Andrade, Nancy Perez-Flores, Alejandra Jauregui, Cesar Hernandez, Michael Park, Leopoldo Cabassa Background: Immigrant populations face multiple health and social challenges, including rapidly shifting patterns and levels of physical activity. In this study, we contrast the characteristics of neighbourhood environments in the United States (US) with those of origin-country environments among recent immigrants from Latin America; as well as their pre-migration to post-migration physical activity levels. Methods: Using online survey panel methods, we recruited and collected data from 210 recent immigrants from Latin America (<10 years in the US). Adapted versions of the Past-Week Modifiable Physical Activity Questionnaire (PW-MAQ), and of the Abbreviated Neighbourhood Environment Walkability Scale (NEWS) were used to assess pre-migration and post-migration physical activity and neighbourhood environments. Results: Data analysis will be finalised by the ISPAH 2024 Congress. Results to be presented will contrast key neighbourhood environment constructs before and after migration to the US, including: perceived measures of (a) residential density, (b) destination accessibility, (c) public open space availability, (d) public transit availability, (e) safety from crime, (f) safety from traffic, and (g) pedestrian and cycling infrastructure. The sample will be characterised based on their degree of pre- to post-migration change in physical activity levels. Conclusions: Studies from Latin America have shown that an important source of physical activity is active travel, due to economic necessity and ubiquitous public transit options in Latin American cities. Latin American studies also report that settings for social interaction are critical for promoting active leisure among Latinos. It is possible that the stark change in neighbourhood environments experienced by Latin American immigrants contributes to physical activity declines. Practical Implications: Latino immigrants have lower levels of physical activity (particularly in the leisure domain) than their white counterparts. Understanding context change among immigrants is critical for designing culturally-appropriate solutions to support healthier transitions and active living this high-need group.

Purpose: To explore the development of a leading international consortium of observational studies of physical behaviours, including its challenges, scientific potential, future directions and long-term goals.

Description: The development of international consortia of observational studies of physical behaviours offers unprecedented opportunity to understand links between movement health and disease, and to meet global public health priorities. Since its inception in 2017 the ProPASS (Prospective Studies of Physical Activity, Sedentary Behaviour and Sleep) consortium, has developed at pace to include more 30 large observational studies from 5 continents, and is ideally placed to inform the next generation of physical activity guidelines and promotion.

In this symposium we will share the historical journey and development of ProPASS, its success to date, exciting emergent workstreams and a vision for the future. The symposium will include three presentation sessions, during which delegates will hear from 6 members of the ProPASS leadership group, followed by an interactive panel discussion featuring some of our esteemed international collaborators.

In the first of these talks, Professors Emmanuel Stamatakis (University of Sydney) and Mark Hamer (University College London) will set out the ProPASS mission and its potential future impact, and share valuable insights regarding opportunities and challenges created by ProPASS success and continued growth. Presentation two will focus on key success from the last 12 months. Dr Jo Blodgett (University College London) and Dr Matthew Ahmadi (University of Sydney) will describe the first papers from analyses of the ProPASS pooled data resource which focus on cardiometabolic health and associations with intensity, duration, and type of movement behaviours. In our third presentation, led by Associate Professor Annemarie Koster (Maastricht University) with Dr Jo Blodgett and Dr Matthew Ahmadi, delegates will have the opportunity to hear about new directions and exciting emergent workstreams involving compositional approaches, exploration of device-measured sleep volume and variability, and of physical activity micropatterns.

The symposium will close with an interactive panel discussion where delegates and our expert panel can consider key questions and share ideas on the topic: ‘The present and future of observational physical behaviour research: the role of wearables’.

Chair: Dr Richard Pulsford. Faculty of Health and Life Science. University of Exeter, United Kingdom

Presenters
Session 1:
– Professor Emmanuel Stamatakis. Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,
– Professor Mark Hamer, Institute of Sport Exercise & Health, UCL, London, United Kingdom

Session 2:
– Dr Joanna M Blodgett. Institute of Sport Exercise & Health, UCL, and University College London Hospitals NIHR Biomedical Research Centre, London, UK
– Dr Matthew Ahmadi. Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

Session 3:
– Dr Joanna M Blodgett. Institute of Sport Exercise & Health, UCL, and University College London Hospitals NIHR Biomedical Research Centre, London, UK
– Dr Matthew Ahmadi. Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
– Associate Professor Annemarie Koster. Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands

Abstract 1: Vision and potential impact of the ProPASS consortium: securing the longevity of large international physical activity collaborations

Speakers: Emmanuel Stamatakis, Mark Hamer

Background: The Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS) was launched in 2017 to spearhead the transition to wearables-based evidence for physical activity, sedentary behaviour, and sleep guidelines development. ProPASS currently involves c>100 collaborators and nearly 30 cohort studies. As an international consortium, ProPASS is unique in that it was not set up merely as a data resource, its activities include methodology development, prospective expansion to new cohorts including a formal ISPAH partnership focused on LMICs, and support of Early Career Researchers.

Purpose: To outline the scope, vision, and future potential impact of ProPASS, and share with the ISPAH community the lessons learnt during its development.

Methods: We will first discuss how ProPASS emerged, its vision and the strategy for achieving it, the challenges faced, and its current and likely future impact. The second part of this session will focus on funding strategy and challenges and will highlight the road ahead for the next 4-5 years when the work for the development of the next WHO Guidelines will likely commence.

Results: Despite adverse funding conditions commonly encountered in epidemiological research, ProPASS has grown very fast and is already making an impact in the broader fields of physical behaviour and physical activity. However, its trajectory to date alone is not guarantee of future success. As ProPASS grows so does its breadth of activities and its resource needs. This creates opportunities for more impact but also poses threats on its longevity.

Conclusions: Although ProPASS stands on solid foundations, the next 5 years are critical in determining to what extend ProPASS will fulfil its vision. The support of organisations like ISPAH and its community, will likely be critical for its success.

Practical implications: We will share with the ISPAH Congress insights and lessons learnt from the ProPASS consortium and highlight future directions.

Abstract 2. Key successes from ProPASS consortium: first published papers from six cohorts from our pilot resource

Speakers: Joanna M Blodgett, Matthew Ahmadi

Background: Here we summarise results from the first empirical papers from ProPASS, published in the last year in the European Heart Journal and Diabetologia.

Purpose: We investigated: i) interdependent associations of moderate-vigorous physical activity (MVPA), light intensity PA (LIPA), standing, sedentary behaviour (SB) and sleep with cardiometabolic outcomes; and ii) dose-response associations between activity type (standing, walking, stair climbing, fast walking/running) and cardiometabolic outcomes.

Methods: We pooled data from six cohort studies (n>15,000). Raw accelerometer data was re-processed using the ActiPASS software. For aim i, we conducted compositional logistic regression to explore associations between various compositions of time spent in movement behaviors and six cardiometabolic outcomes, and investigate various behavioural reallocation modelling estimates. For aim ii, we employed generalized linear models with splines to investigate dose-response relationships between activity types and each outcome.

Results: Aim i) More MVPA and less time spent sedentary – relative to sleeping, standing and light activity – was associated with better cardiometabolic outcomes. Less than 10min/day of reallocation of other behaviours into MVPA was associated with significant improvements in outcomes. Aim ii) Accumulating >5 min/day (z-score= -0.14 [-0.24, -0.03] of stair climbing or >64 min/day (-0.14 [-0.25, -0.02] of walking was associated with more favourable composite cardiometabolic health. Every additional minute of stair climbing up to 12 min/day was associated with a similar rate of change as running for the same time interval

Conclusions: Findings on 24-hour movement behaviours may guide more personalised guidance on how an individual can modify their 24-hour movement for cardiometabolic benefits. Findings on cardiometabolic health and durations of different activities of daily living and posture may guide future interventions involving lifestyle modification.
Practical implications: This session will share with the ISPAH Congress audience initial evidence from the ProPASS consortium experience to date and introduce future areas of research.

Practical implications: This session will share with the ISPAH Congress audience initial evidence from the ProPASS consortium experience to date and introduce future areas of research.

Abstract 3. New directions and emergent findings from the first ProPASS resource

Annemarie Koster, Joanna M Blodgett, Matthew Ahmadi

Background: The health benefits of moderate to vigorous physical activity and sleep are well-described. Much less is known about the patterns of physical activity and health and in particular the potential health benefits of very short activity bouts in daily living. Further, fewer studies have investigated the full spectrum of daily movement behaviours (including sleep) and assess their interdependencies on health outcomes.

Purpose: In this session we present results from ongoing analysis from the ProPASS consortium on the i) association between activity micropatterns and ii) sleep duration and regularity with cardiometabolic outcomes; iii) compositional individual participant data analyses on sedentary behaviour, sleep, standing, walking (light and fast) and exercise-like behaviours with blood pressure.

Methods: In the first ProPASS recourse we harmonised data from over 15,000 participants across six international cohort studies. Outcomes included body mass index, waist circumference, high-density lipoprotein cholesterol, total cholesterol, triglycerides, HbA1c, systolic blood pressure and diastolic blood pressure.

Results: We will use generalised linear models with splines to examine dose-response associations between micropatternns of physical activity (aim i) and sleep (aim ii) with cardiometabolic outcomes. We will conduct compositional data analysis to examine associations between different compositions of time spent in movement behaviours and each blood pressure outcome, including examining minimal and optimal reallocation of time between behaviours (aim iii).

Conclusions: These studies will provide insight into associations of novel aspects of physical behaviour and health and how reallocating time in one behaviour by another behaviour affects health.

Practical implications: This session shows the scientific value of the first ProPASS resource for novel research on physical behaviour and health.

Funding (all abstracts): British Heart Foundation Special Grant (SP/F/20/150002); NHMRC (Australia) Investigator Grant (APP1194510); NHMRC Ideas Grant (APP1180812); Cancer Research UK Prevention and Population Grant (PRCPJT-Nov23/100005); PAL Technologies; University of Sydney Research Accelerator (SOAR); WUN, The Worldwide Universities Network; Charles Perkins Centre, University of Sydney.