Most children attend early childhood education care settings (ECEC settings), commonly known as nurseries in the United Kingdom. ECEC settings provide opportunities to improve health through improved nutritional quality and physical activity for young children. There is evidence from the US that the NAPSACC intervention improves nutrition and physical activity in ECEC settings. We adapted NAPSACC for the UK and investigated its fidelity, acceptability and sustainability within a multi-centre trial. Embedded process evaluation within a 12-month cluster randomised controlled trial with 52 ECEC settings (25 intervention and 27 control). The NAPSACC UK intervention comprised two six-month cycles of nutrition and activity self-assessment, staff workshops and goal setting, supported by public health practitioners. Data included: observations during training and workshop delivery, questionnaires to practitioners and ECEC setting staff; 11 interviews with practitioners who delivered the intervention, 11 ECEC setting managers, 5 commissioners, and two focus groups with the research team. Document analysis of self-assessment and goal setting forms was undertaken. Thematic analysis was conducted with both deductive and inductive codes, a coding framework and triangulation across data sources. Three-quarters (19/25) of intervention ECEC settings implemented the NAPSACC intervention across one cycle. Only 40% implemented a second cycle, mainly due to delays in scheduling staff workshops caused by sector-wide staffing challenges. ECEC setting managers valued the opportunity to reflect on practice and the support offered by the practitioner. ECEC setting staff highly rated the workshops and valued support given by public health practitioners. 83% of nutrition and 70% of physical activity goals set by the ECEC settings were achieved (fully or partially) and self-assessment scores increased, with greater gains for ECEC settings implementing two cycles. ECEC setting managers planned to maintain the changes made but varied in their intention to continue self-assessment and goal-setting processes. Despite sector-wide staffing challenges, we saw high engagement from ECEC settings in self-assessment and setting goals to improve child nutrition and activity. However, future development and use of NAPSACC UK need to be considered in the context of a lack of measurable impact on objective measures of child health and the significant challenges of staff capacity and time. ISRCTN33134697, 31/10/2019.
While Canadian First Nations communities actively participate in sport, cultural, and land-based activities, they face various barriers to physical activity. Despite calls for increased support at all government levels, access to suitable programs for those with chronic conditions in particular remains limited. As part of an ongoing partnership between the University of British Columbia and Carrier Sekani Family Services (CSFS), this qualitative study aimed to explore current values, perceived barriers, and potential facilitators of physical activity among people living with chronic health conditions in rural and remote First Nations communities in northern British Columbia. This qualitative study is part of a larger mixed-methods, community-based participatory action project with CSFS titled Niwh Yizt’iyh Hilht’iz Nets’eelh’iyh – “Strengthening our Bodies”. Semi-structured interviews, with optional Photovoice, were conducted with participants aged 12 years and older who had at least one chronic condition and belonged to First Nations communities served by CSFS. Participants were recruited from a prior community-based physical activity survey study that captured brief information on current physical activity experiences in their community. Data were analyzed using reflexive thematic analysis, guided by Indigenous Wholistic Theory (a framework emphasizing the interconnected and cyclical physical, mental, emotional, and spiritual dimensions of health and wellness) to ensure cultural relevance. Coding progressed from semantic to latent themes, supported by NVivo and reflexive journaling. Interviews were conducted with 29 participants from three communities (69% female, mean age: 55 years old), all managing various chronic conditions such as diabetes, arthritis, and cardiovascular disease. The identified themes were: 1) Integrating cultural values with physical activity to manage chronic disease, 2) Cultural disconnection: A barrier to health and physical activity, and 3) Community approaches to facilitate physical activity in chronic disease. Together, these themes highlight the role of culture, supportive community structures, and tailored approaches in physical activity engagement. To strengthen physical activity programming, service providers should ensure initiatives are aligned with community values, address identified barriers, and encourage locally recognized facilitators. These insights will empower health care organizations and communities to develop targeted, inclusive strategies for physical activity programming tailored to individuals with chronic conditions.
Scale-up (i.e., the intentional effort to increase the reach and impact of an intervention) of effective school-based interventions is recommended to improve public health nutrition and prevent chronic disease. However, limited evidence to guide effective scale-up exists. This study aimed to assess the effectiveness of a theoretically designed multi-component scale-up intervention, designed using the Theoretical Domains Framework and Behavior Change Wheel, to increase the adoption of an evidence-based school nutrition program (SWAP IT) within primary schools in NSW Australia. We also identify any differences in the characteristics of schools adopting the program and describe the fidelity of delivering, and reach of each scale-up strategy. A parallel-group randomised controlled trial was conducted across 11 Local Health Districts (LHD) in New South Wales Australia (n = 337 schools). Primary schools which had not previously adopted the SWAP IT school nutrition program and used an existing parent communication app (Audiri) in each LHD were randomised to receive a theoretically designed multi-component scale-up intervention (n = 169 schools) or to a waitlist control, exposed to a single discrete scale up strategy (n = 168 schools). The scale-up intervention consisted of nine scale-up strategies: three ‘vertical’ strategies aiming to increase LHD Health Promotion Units capacity to scale-up and six ‘horizontal’ strategies aiming to overcome school barriers to adopting the programs. The primary outcome was school adoption of SWAP IT objectively assessed via electronic records at 6-months, assessed via logistic regression adjusting for baseline and stratification variables. Following the 6-month multi-component scale-up intervention, significantly more schools in the scale-up intervention group (n = 67/169, 40%) had adopted the SWAP IT program compared to schools in the control group (n = 0/168, 0%) (p < 0.001). Schools with a higher enrolment of Aboriginal and Torres Strait Islander students were more likely to adopt the program (p = 0.02), however no other school characteristics were associated with program adoption. Most scale-up strategies were delivered by LHD Health Promotion Units to schools with high fidelity (72–100%), however reach of the strategies varied widely (4-100%). A theoretically designed approach to scale-up, increased schools’ adoption of an evidence-based school nutrition program across a large and socio-economically and geographically diverse population. Program adoption rates were similar across socio-demographic and geographic characteristics. This approach can inform efforts of improving public health nutrition equitably through large scale adoption of school nutrition initiatives. The trial was prospectively registered on 13/02/2023 with the Australian New Zealand Clinical Trials Registry (ACTRN12623000145606). https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12623000145606.
Maintaining long-term engagement in physical activity (PA) and following nutrition recommendations after rehabilitation is challenging for people with Parkinson’s. Sustained behavioural change requires more than initial education; person-centred, self-management support may be key to maintain health-promoting routines. However, structured follow-up is often lacking. Digital health interventions, including mobile health (mHealth), offer scalable solutions to provide ongoing support beyond rehabilitation. This study aimed to examine the effect of an individualised, mHealth support programme targeting self-management of PA, and nutrition on physical capacity, nutritional status, HRQOL, Physical function and engagement in PA in people with Parkinson’s. A single-blind, two-arm randomised controlled trial evaluating the effects of a six-month individualised mHealth self-management support programme on physical capacity and related outcomes in people with Parkinson’s following inpatient interdisciplinary rehabilitation. Participants were randomly assigned (1:1) to an intervention group (mHealth); monthly remote consultations plus activity tracker, or a control group; usual care. The primary outcome was physical capacity (6MWT). Secondary outcomes were nutritional status (PG-SGA SF), Health Related Quality of Life (PDQ-39), physical function and engagement in PA (self-reported PA and activity tracker data). Linear mixed models for repeated measures were used to assess group differences over time. A total of 100 participants (40% female, mean age 67,5 years) were randomised (50 per group). At six months we observed significant between-group differences on 6MWT in favour of the intervention group (mean: 33.1 m; 95% CI: 14.8 to 51.3; p < 0.001; effects size = 0.75). Significant between-group differences were also observed in PDQ-39 SI(mean: -6.1; 95% CI: -9.5 to -2.8; p < 0.001; effect size 0.93) and in physical activity frequency (p = 0.02; effect size = 0.51). Additionally, the mHealth group significantly increased their daily steps (p = 0.006) and weekly intensity minutes (p = 0.042). No significant differences were found for nutritional status, or physical function. The six-month mHealth self-management support programme improved physical capacity, Health Related Quality of Life, and physical activity in people with Parkinson’s post-rehabilitation. These findings highlight the potential of scalable, person-centred digital self-management support interventions to sustain health-promoting behaviours beyond clinical settings. The study was registered on ClinicalTrials under the code NCT04945876: https://clinicaltrials.gov/expert-search?term=NCT04945876. First registration March 1, 2021. The online version contains supplementary material available at 10.1186/s12966-026-01888-y.
Despite the proven benefits of physical activity during breast cancer treatment, many women reduce their practice after diagnosis. A better understanding of how the neighborhood environment influences physical activity behavior could help optimize strategies for physical activity in breast cancer patients undergoing cancer treatment. This study examined associations between perceived neighborhood environment and physical activity among breast cancer patients undergoing treatment and engaged in a physical activity program. Participants were 313 breast cancer patients enrolled in the DISCO physical activity intervention trial (NCT03529383). In the present observational analysis (DiscoSpace), cross-sectional (at baseline) and longitudinal (during intervention) associations between perceived neighborhood environment and physical activity were investigated. The perceived neighborhood environment was assessed using the ALPHA questionnaire, physical activity and physical functioning were evaluated through the Recent Physical Activity Questionnaire (self-reported physical activity) and the 6-Minute Walk Test (to measure the 6-Minute Walk Distance (6MWD)). Associations were estimated through mixed linear regression models. Better perceived cycling and walking infrastructures and network were associated with higher self-reported physical activity at baseline (total infrastructures: β = 0.226, 95% CI (0.063;0.388); network: β = 0.161, 95% CI (0.008;0.314)). Perceived distance to local facilities was inversely associated with 6MWD at baseline (β=-11.363, 95% CI (-20.607;-2.118)). The perception of densely populated neighborhoods (β=-0.306, 95% CI (-0.494;-0.117)) was associated with a smaller increase in self-reported physical activity during the intervention, after adjustment for trial arm. These associations varied according to women’s socioeconomic status and municipality class. The perceived neighborhood environment and socioeconomic characteristics of women with breast cancer should be given greater consideration for developing effective programs to promote physical activity in this population. The online version contains supplementary material available at 10.1186/s12966-026-01909-w.
General parenting describes a parents’ overall approach to parenting across situations, creating the emotional climate of the parent–child relationship. Some general parenting constructs have been associated with children’s health behaviors. However, overprotective parenting—marked by excessive involvement and control with limited autonomy support relative to the child’s developmental level—remains largely understudied in relation to preschoolers’ physical activity (PA) and screen time (ST), as do the potential moderating effects of sociodemographic variables in these associations. Therefore, we examined the associations of overprotection with PA and ST among Finnish preschoolers and explored whether parental education or children’s sex moderated these associations. This cross-sectional study included 798 Finnish 3–6-year-olds and their parents from the DAGIS Survey. Parents completed an overprotection scale from an item-reduced version of the Comprehensive General Parenting Questionnaire. Children’s ST was parent-reported via a seven-day diary, while PA was measured with Actigraph accelerometers (for seven days). Weekday, weekend, and overall averages were computed for ST, moderate-to-vigorous physical activity (MVPA), and total physical activity (TPA). Linear mixed-effects models were used for analyses. The models were adjusted for the child’s age and sex, parental education, number of children in the household, birth order, and questionnaire respondent (mother/father). Moderation by sex and education was tested by adding the corresponding interaction terms to the models. Children’s weighted averages were 71 min of MVPA, 398 min of TPA, and 76 min of ST per day. Overprotection was inversely associated with weekend MVPA (B: -3.49, 95%CI: -6.50; -0.48), weekend TPA (B: -9.94, 95%CI: -16.56; -3.34), and overall average TPA (B: -5.70, 95%CI: -10.78; -0.64). No associations with ST were found, nor were any associations moderated by sex or parental education. These results suggest an association between higher overprotection and lower PA among preschool-aged children regardless of child sex and parental educational level. We hypothesize that overprotective parents may, for example, restrict children’s PA due to safety concerns. Although the mechanisms and causality of the associations found require further investigation, identifying and addressing overprotective parenting could be beneficial in PA-promoting interventions. The online version contains supplementary material available at 10.1186/s12966-026-01910-3.
Social factors shape health behaviors and contribute to persistent inequalities, especially in the Global South. However, few studies have examined how intersecting social identities influence physical activity in low- and middle-income countries. This study explored social inequalities in leisure-time (LTPA) and transport physical activity (TRPA) through the lens of intersectionality among individuals living in São Paulo, Brazil. Longitudinal data from 978 participants of the Health Survey of São Paulo: Physical Activity and Environment cohort were analyzed from three waves: 2014/2015, 2020/2021, and 2023/2024. Physical activity was measured using the long-form International Physical Activity Questionnaire (IPAQ). To capture intersectional social disadvantage, a Multiple Jeopardy Index was constructed by combining sex, race/skin color, and educational level, with scores ranging from 0 (lower vulnerability) to 4 (higher vulnerability). Associations between Jeopardy Index and physical activity in both domains were assessed using multilevel Poisson regression models, considering repeated measures nested within three hierarchical levels: observations, individuals, and census tracts. Individuals in the highest vulnerability groups (female, belonging to racial or ethnic minority groups, and with low educational attainment) consistently reported lower levels of LTPA over time. In fully adjusted models, participants in higher vulnerability Jeopardy categories 3 and 4 showed significantly lower prevalence of LTPA compared to the lower vulnerability reference group (category 0: male, White, and highly educated), with prevalence ratios of 0.72 (95% CI: 0.57-0.91) and 0.62 (95% CI: 0.49-0.80), respectively. A clear inverse gradient and significant dose-response trend was observed (p < 0.001). Regarding TRPA, prevalence was higher among males and younger participants, and also more frequent among individuals from racialized or minority groups and those with a high school education. However, no significant associations were found between the Jeopardy Index and TRPA in any model. Persistent and widening inequalities in LTPA were observed among Brazilians over a 10-year period, with intersections of sex, race/skin color, and education disproportionately affecting the most vulnerable groups, particularly women from racialized or minority groups with lower educational attainment. Public policies and programs should prioritize socially disadvantaged groups by promoting inclusive and sustained opportunities for leisure-time activity.
Aromatase inhibitors (AI) are used to treat hormone-receptor-positive breast cancer, but have several side effects that often lead to premature discontinuation/switch. Physical activity (PA) can attenuate side effects and improve quality of life. However, most cancer survivors fail to meet PA guidelines. Theory-based PA interventions are effective in breast cancer survivors, but scarce. PAC-WOMAN tested the effects of two PA promotion interventions (supervised exercise vs brief counseling) on primary outcomes – PA, sedentary behavior, quality of life –, and secondary outcomes – body composition, fitness, physical function, sleep, body image, depression, psychological well-being, pain, and motivational variables – in women on AI. This pragmatic randomized controlled trial included 110 women with stage I-III hormone-receptor-positive breast cancer on AI (56.1 ± 7.6 yr; 28.1 ± 5.9 kg/m2; 23.4 ± 20.1 months on AI), randomized to: 1) brief PA counseling (PAC); 2) structured exercise (ExG); 3) waiting-list control. Primary and secondary outcomes were evaluated with validated instruments at the end of the intervention period. Repeated measures’ Anovas, adjusted for age, AI duration, body mass index and chronic diseases, were conducted. Bonferroni corrections were applied (significance level at p < 0.0083). Significant group-by-time interactions were observed for moderate-vigorous PA (MVPA), exercise motivations and affect, muscle strength and leg endurance (p ≤ 0.008). Objectively measured PA showed no significant effects in either intervention group, except for a near-significant MVPA increase of 107 min/week [95% CI: 4; 209] over time in ExG. Larger improvements were observed in all self-reported PA indicators in ExG, while PAC revealed gains only in light PA and active choices. ExG improved global health status, physical functioning and physiological indicators (e.g., fitness, body composition) over time; PAC enhanced future perspectives, body image functioning, breast symptoms, and other psychological outcomes, with changes in depressive symptoms (-1.4 [-2.4; -0.3]) and life satisfaction (0.8 [0.2; 1.5]) approaching significance. PAC-WOMAN showed that ExG and PAC yielded distinct benefits for breast cancer survivors on AI. ExG improved total PA, fitness, physical function, physical quality of life, and alleviated pain symptoms. PAC primarily enhanced light PA and psychological outcomes such as body image and life satisfaction. Together, these findings highlight the potential scalability of PAC alongside the robust physical benefits of ExG. April 2023 – NCT05860621; https://doi.org/10.17605/OSF.IO/ZAQ9N; UMIN000050945. The online version contains supplementary material available at 10.1186/s12966-026-01873-5.
Most European adolescents do not meet recommended levels of physical activity (PA), increasing their risk of long-term health issues and contributing to the burden of non-communicable diseases. To address this public health challenge, there is a need for evidence-based, age-specific frameworks that identify the key determinants influencing PA behaviours during adolescence, a critical developmental stage for habit formation. This study developed the EUropean Physical Activity Determinants framework for Adolescents (EU-PAD-A) and identified the most important and modifiable factors that can inform targeted interventions and public policy. Using Group Concept Mapping analysis, 240 experts contributed to the identification, sorting, and rating of PA determinants for adolescents. A total number of 110 determinants were grouped into nine thematic clusters. Determinants were rated for importance and modifiability, with 53% (n = 58) scoring high on both dimensions. To refine priorities for policy and practice, a focus group of experts and a survey involving 60 policy makers and stakeholders were conducted. This process led to the identification of the top 10 actionable determinants, defined as those rated highly for importance and modifiability by experts and for impact and feasibility by policy makers and stakeholders, including availability of indoor and outdoor PA facilities, beliefs about PA, and inclusive school programs. The results highlight school, family, and socio-cultural environments as critical settings for intervention. The EU-PAD-A framework offers a novel, interdisciplinary, and age-specific tool for understanding and addressing the complex drivers of adolescent PA. It provides concrete, consensus-based guidance for designing policies and programs that are feasible, impactful, and grounded in scientific evidence. As such, it represents an important step toward improving PA levels and reducing sedentary behaviour among adolescents across Europe. The online version contains supplementary material available at 10.1186/s12966-026-01878-0.
Current methods for assessing the healthfulness of 24-hour movement behaviours (sleep, sedentary time, light physical activity, moderate-to-vigorous physical activity) use binary classifications that fail to capture their continuous and compositional nature. This study introduces a percentile-based scoring and visualization approach to evaluate the healthfulness of movement behaviour time-use compositions, using social-emotional development in early childhood as an example. This cross-sectional study includes 560 children aged 1.2–2.9 years and 1,500 children aged 3.0-4.9 years from Sleep and Activity Database for the Early Years (SADEY), an international accelerometer repository of young children’s movement behaviours. Sedentary time, light physical activity, and moderate-to-vigorous physical activity were measured using accelerometers. Sleep duration was parent-reported. Social-emotional development was assessed using age- and sex-normalized scores from the Strengths and Difficulties Questionnaire. Linear regression models with compositional covariates were used to model associations between movement behaviours and Strengths and Difficulties Questionnaire scores. Representative grids containing all possible time-use compositions (in 5 min/d increments) of sleep, sedentary time, light physical activity, and moderate-to-vigorous physical activity were developed. The regression models were applied to each time-use composition in the grid, and the predicted scores were ranked to create percentile scores for different movement behaviour time-use compositions. The 24-hour movement behaviour composition was associated with all five Strengths and Difficulties Questionnaire scores in both age groups (p ≤ 0.01). The grids contained 17,577 and 16,535 possible time-use compositions for 1–2 and 3–4-year-olds, respectively. Time-use compositions ranked at the 0th percentile had the least sleep and highest sedentary time, while those ranked at the 100th percentile had the most sleep and least sedentary time. Across the central range of the percentile score distribution (e.g., rankings between the 25th to 75th percentiles), some very different time-use compositions had the same percentile score. Interactive visualization tools were presented to enable real-time exploration of percentile scores for various movement behaviour time-use compositions. This study introduces a novel approach to evaluate the health benefits of movement behaviours. This approach moves beyond traditional binary cutoffs to recognize the gradual improvements in health that occur with small changes in behaviours, and that there are multiple pathways to achieving the same health benefits. The online version contains supplementary material available at 10.1186/s12966-026-01907-y.
Life satisfaction is a key indicator of quality of life among older adults. This systematic review and meta-analysis synthesised evidence on the association between life satisfaction and health behaviours such as smoking status, alcohol use, physical activity, diet/nutrition, and sleep among older adults aged 60 years and older. The review was conducted and reported following the PRISMA guidelines. We searched the electronic databases MEDLINE, APA PsycINFO, Web of Science, CINAHL, and Global Health from inception to 10 January 2025 for observational studies reporting an association between life satisfaction and health behaviours. Two independent reviewers completed article screening, data extraction, and risk of bias assessment. The result was summarised through a narrative synthesis, and meta-analysis was completed using CMA (version 4). The 56 included studies were conducted across 22 countries between 1990 and 2025. The pooled mean age and female proportion were 70.59 years (95% CI: 68.98, 72.21) and 58.0% (95% CI: 55.1, 60.7), respectively. Narrative synthesis showed that most studies found quality sleep and/or 7–8 h of sleep (77.3%), a higher physical activity level (69.1%), and a regular intake of fruit and vegetables and/or a balanced diet regularly (52.9%) were significantly associated with higher life satisfaction. Smoking and alcohol use were associated with lower life satisfaction in 33.3% and 15.8% of the analysis, respectively. The meta-analysis showed that higher physical activity levels (r = 0.12, p = 0.003) were associated with higher life satisfaction. Only four studies on physical activity met the criteria for meta-analysis, and no studies on other health behaviours did. Quality sleep and/or 7–8 h of sleep, a higher physical activity level, and regularly eating fruit and vegetables and/or a balanced diet are associated with higher life satisfaction. The review provides evidence for policymakers, healthcare workers, caregivers, and society to encourage healthy behaviours that foster healthy ageing. Future studies should use standardised instruments to assess health behaviours and life satisfaction, facilitating cross-study comparisons and the meta-synthesis of research findings. PROSPERO (CRD42023441386). The online version contains supplementary material available at 10.1186/s12966-026-01877-1.
Physical activity policy, systems, and environmental changes (PSEs) are effective but complex public health interventions. PSEs are increasingly being implemented through Cooperative Extension, a national system historically focused on individual-level direct education. Researchers have begun conducting contextual inquiry studies, but the extent to which they have matched barriers and facilitators to specific implementation strategies is unknown. This study seeks to understand common barriers and facilitators to integrating physical activity PSEs in Extension and identify implementation strategies selected in response. A systematic review was conducted in June 2025 using three databases and two Extension-specific journals, with search terms focused on Extension; barriers, facilitators, and contextual factors; PSEs; and physical activity. Studies were included if they (1) were original, peer-reviewed articles, theses, or dissertations, (2) took place within Extension, (3) investigated integration of physical activity PSEs, (4) included barriers, facilitators, or contextual factors, (5) were in English, and (6) were published from 2014 to present. Two authors independently reviewed titles and abstracts for inclusion/exclusion, reviewed full text of remaining articles, and extracted data based on the Implementation Research Logic Model. Frequencies and proportions were calculated to tabulate data. Thirteen studies met inclusion criteria. Outcomes of interest were most commonly implementation (n = 9, 69%), adoption (n = 3, 23%), and maintenance (n = 3, 23%). Contextual inquiry was most commonly based on the Consolidated Framework for Implementation Research (n = 5, 38%) or no framework (n = 5, 38%). Studies using a framework predominantly collected data on the individuals (n = 6, 46%) or outer setting (n = 6, 46%) domains. Common barriers were individual capability, local conditions, and intervention complexity (each n = 6, 46%). Common facilitators were partnerships and connections (n = 7, 54%) and individual capability (n = 6, 46%). Most studies (n = 8, 62%) provided recommendations based on findings, although these were not explicitly labeled as implementation strategies. Results provide implications for improving contextual inquiry and implementation strategy selection in Extension. Contextual inquiry should be based on a determinant framework to understand multi-level influences on PSE integration. Otherwise, critical barriers within the inner setting may be overlooked. Specific matching processes should be used to engage key individuals in selecting implementation strategies that address specific barriers.
Postpartum women frequently experience declines in physical activity (PA) resulting from lifestyle changes, caregiving demands, and physical recovery, which increases the risk of long-term physical and mental health issues. While behavioral strategies can promote PA, few interventions address the lifestyle-related barriers specific to postpartum women using objective PA measures, and remote, group-based approaches remain underexplored. This study evaluated the efficacy of an 8-week remotely delivered, group-based PA intervention in increasing objectively measured PA, exercise-related self-efficacy, and psychosocial well-being among postpartum women. In this web-based, two-arm randomized controlled trial, 175 postpartum women (2–6 months postpartum) in Japan were allocated to either an intervention (n = 89) or waitlist control group (n = 86). The intervention combined weekly instructor-led online group sessions with a structured home-based exercise program, incorporating behavioral strategies grounded in self-determination and social cognitive theories. The primary outcome was daily moderate-to-vigorous PA (MVPA) measured via triaxial accelerometers. The secondary outcomes included daily step counts, health-related quality of life (HRQoL; Short Form-12 Health Survey version 2), sense of coherence (SOC; Sense of Coherence Scale), and exercise self-efficacy (decisional balance for exercise). Analyses used generalized estimating equations adjusting for baseline values and age. Retention was 98%–99%, with 94% attending at least four of six classes. Compared with controls, the intervention significantly increased MVPA by 5.97 min/day (95% confidence interval [CI]: 1.34, 10.60; p = 0.012) and daily steps by 576 (95% CI: 73, 1079; p = 0.025). SOC increased by 4.14 points (95% CI: 1.70, 6.58; p < 0.001) and exercise self-efficacy increased (balance score difference: 2.74; 95% CI: 0.71, 4.78; p = 0.008), mainly because of reduced perceived barriers. No significant changes in HRQoL were observed. This remote, group-based PA intervention, designed to accommodate the lifestyle demands of the postpartum period, effectively increased PA and enhanced psychosocial resources in postpartum women. By fostering self-efficacy, peer support, and accessible home-based participation, this program may support both short- and long-term physical and mental health. These findings highlight the potential of scalable online PA programs to overcome common postpartum barriers. University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR): UMIN000053478, registered 31 January 2024. The online version contains supplementary material available at 10.1186/s12966-026-01897-x.
Healthy Eating and Active Living Taught at Home (HEALTH) is an evidence-based intervention (EBI) embedded in Parents as Teachers (PAT) home visiting to improve weight outcomes among mothers. Public health impact of HEALTH relies on EBI coverage (accessibility, acceptability, usage). Therefore, the purpose of this study is to identify coverage strengths/gaps which can inform dissemination and implementation (D&I) strategies to increase HEALTH coverage. We conducted descriptive analyses using baseline data and home visitor documentation of PAT visits from the HEALTH D&I study, which took place during COVID-19. Coverage was measured by expanding on RE-AIM with the adapted Shengelia et al. Access, utilization, quality, and effective coverage framework and included: accessibility (home visitor referrals to HEALTH), acceptability (mother self-report satisfaction), usage (number of visits mothers received from the home visitor, proportion of HEALTH content delivered, proportion of HEALTH lessons delivered). In the HEALTH D&I study, 67% of home visitors made at least one referral to HEALTH; however, 33% made no HEALTH referrals. The average number of referrals was 2.05 (SD = 2.38). Most mothers (80%) were satisfied with HEALTH. The average number of visits mothers received was 13.91 (SD = 10.62). On average 39% of all 24 HEALTH lessons, 66% of the eight core HEALTH lessons, and 33% of the HEALTH handouts were delivered. Only 26% of mothers received all 8 core HEALTH lessons. These lessons focus on goals and basic information on healthy eating and physical activity (e.g., Your Health Goals, Let’s Get Moving!, Making Healthy Beverage Habits) and make up the core section of the HEALTH curriculum. This study demonstrates integration of D&I frameworks to evaluate D&I outcomes and offers insights into strategies for EBIs in community settings and insights into service delivery during COVID-19. Findings show strong EBI coverage (acceptability) and gaps (accessibility; usage) supporting the need for implementation strategies to increase adoption (e.g., building partner relationships, choosing strategic partners, ) and support implementation (e.g., facilitate peer learning, create program guide). NCT03758638 (https//clinicaltrials.gov/study/NCT03758638), registered Nov 29, 2018.
Poor diet quality has been associated with greater risk of people developing overweight and obesity, type 2 diabetes, cardiovascular disease, and osteoarthritis. For each of these conditions, weight management is recommended in respective guidelines. Current weight management interventions, such as the Healthy Weight for Life™ (HWFL) program that uses meal replacements, have not been assessed for impact on diet quality. Further, the role of a dietitian providing medical nutrition therapy (MNT) in conjunction with the HWFL program has not been evaluated. MNT is an evidence-based approach where dietary interventions are tailored to the individuals needs, medical history, lifestyle, and dietary preferences. Therefore, the primary aim of this pilot study is to evaluate the feasibility, acceptability and preliminary impact of adding personalised (MNT) consultations to the HWFL program on diet quality. Secondary outcomes include weight and osteoarthritis scores . An 18-week randomised control trial was undertaken, with eligible HWFL program participants randomised to either usual care arm (HWFL program) or HWFL + MNT. A food frequency questionnaire was used to assess diet quality (% energy from nutrient-dense core food) and provide intervention participants with personalised feedback on food and nutrient adequacy of their dietary patterns. Weight and knee osteoarthritis outcomes using the hip and knee osteoarthritis outcome scores, were self-reported and used to assess outcomes. Project acceptability was assessed by process evaluation questionnaire. An intention-to-treat analysis was undertaken using generalised linear mixed models with post-estimations reported as mean (95% CI). Forty participants (75% female, 62 ± 10years, 78% osteoarthritis) enrolled in the study. Baseline diet quality was poor (34% energy from non-core foods). Post-intervention both intervention and usual care groups significantly improved their diet quality and reduced weight, but there were no significant differences between groups. Sub-scores for knee osteoarthritis function significantly improved in the intervention compared to the control group (mean between group difference 17.4, 95% CI 1.6, 33.1), though after correcting for multiple testing this was no longer significant. Overall intervention acceptability was high. Both the intervention and usual care arms significantly improved diet quality. All intervention participants found MNT was highly acceptable. For those with knee osteoarthritis significant improvements in knee osteoarthritis function was reported in the intervention group. This should be further explored in future interventions. Australian New Zealand Clinical Trials Registry (ACTRN12623001062617). The online version contains supplementary material available at 10.1186/s12966-026-01885-1.
Continuous glucose monitoring (CGM) may facilitate behavior modifications among individuals with diabetes. However, existing evidence regarding its effectiveness remains inconsistent. This study aimed to evaluate the effectiveness of CGM in improving physical activity and diet for people with diabetes using both qualitative and quantitative approaches. We searched PubMed, Cochrane, Embase, and Web of Science on October 13, 2024 to identify studies utilizing CGM in people of any age with any type of diabetes that reported outcomes related to physical activity and/or diet and were eligible for systematic review. Randomized controlled trials in which CGM was used as the main intervention and whose outcomes could be quantitatively synthesized were included in the meta-analysis. The initial search identified 13,128 records, then 28 studies met the inclusion criteria for the systematic review. Of these, 10 and 8 studies were included in the meta-analysis of physical activity and diet, respectively. Compared with controls, CGM significantly increased daily physical activity time (MD: 16.21 min/day, 95% CI: 10.26 to 22.16; P<0.0001) (low-certainty evidence). In addition, CGM significantly reduced daily caloric intake (-70.81 kcal/day, -132.93 to -8.69; P = 0.03) (low-certainty evidence) and carbohydrate consumption (-19.88 g/day, -27.74 to -12.01; P < 0.00001) (low-certainty evidence) versus controls. CGM significantly increased daily physical activity time and reduced both caloric intake and carbohydrate consumption in adults with diabetes. Future high-quality, large-scale randomized controlled trials are warranted to confirm these associations and to clarify the mechanisms underlying CGM’s behavioral effects across diverse diabetes populations. International Prospective Register of Systematic Reviews (PROSPERO; CRD42024609764). The online version contains supplementary material available at 10.1186/s12966-025-01870-0.
How schoolchildren distribute their time between movement behaviours may be impacted by the neighbourhood environment. Few studies have investigated the associations between the physical and social environment and the full movement behaviour composition, including times spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour, and sleep, and their findings are inconsistent. Therefore, our aim was to investigate this association in a large, national-representative sample of schoolchildren from major cities and regional/remote areas. We used data from the Longitudinal Study of Australian Children and the Child Health CheckPoint study, collected among 1230 child-parent pairs (child age range: 10–12 years). Parents were asked about neighbourhood general safety, access to destinations and services, and social capital and cohesion. Children’s time spent in MVPA, LPA, sedentary behaviour, and sleep was assessed using wrist-worn GENEActiv accelerometers. The associations between the physical and social environment characteristics (independent variables) and movement behaviour composition expressed as isometric log ratio coordinates (dependent variables) were examined using multiple linear regression analyses, adjusted for age, body mass index, pubertal status, sex, and socioeconomic position. Among schoolchildren from regional/remote areas, access to destinations and services (Pillai’s trace = 0.030; p = 0.010), as well as social capital and cohesion (Pillai’s trace = 0.024; p = 0.032) were associated with movement behaviour composition. In specific, better access to destinations and services was associated with higher MVPA and lower LPA, while higher social capital and cohesion were associated with higher MVPA and LPA, and lower sedentary behaviour (with negligible changes in the remaining movement behaviours). We did not find a significant association between general safety and the movement behaviour composition among schoolchildren from regional/remote areas (Pillai’s trace = 0.005; p = 0.641) or any significant associations among schoolchildren from major cities (p > 0.050 for all). These findings highlight the importance of access to destinations and services, as well as social capital and cohesion, in shaping the movement behaviour composition among schoolchildren from regional/remote areas. More research is needed to draw conclusions about the association between neighbourhood environment and movement behaviour composition among schoolchildren from major cities. The online version contains supplementary material available at 10.1186/s12966-026-01879-z.
Children and adolescents with intellectual and developmental disabilities (IDD) are at greater risk for obesity and poor obesogenic behaviors (e.g., physical activity, screen time, diet, sleep) than their typically developing counterparts. The Structured Days Hypothesis (SDH) suggests that in typically developing children and adolescents, obesogenic behaviors worsen during periods of reduced structure (e.g., weekend or summer vacation). However, children and adolescents with IDD have unique factors that may alter how structure (i.e., pre-planned, segmented, adult supervised, out-of-home programs) influences obesogenic behaviors. Therefore, the objective of this systematic review and meta-analysis is to examine obesogenic behaviors during periods of more and less structure among children and adolescents with IDD. A comprehensive search of PubMed, PsycINFO, Embase, and Web of Science was performed through the end of 2024 based on the PICO framework. Studies were eligible if they included youth with IDD and measured obesogenic behaviors across contexts with differing degrees of structure. Two reviewers independently completed the screening process, extracted all relevant information, and evaluated methodological quality using the NHLBI tool. Results were synthesized using fixed- and random-effects meta-analyses and visually represented with forest plots. A total of 4,236 papers were screened with 323 full-text articles retrieved. After screening, 33 total studies were identified (physical activity = 23, sedentary behaviors = 12, sleep = 11, diet = 1). Meta-analyses indicated that the standardized mean difference of physical activity (Random = 0.27, [95%CI: 0.13-0.40], p < 0.00), and diet (0.16, [95%CI: 0.03-0.29], p = 0.02) aligned with the SDH while sleep (Random = -0.01, [95%CI: -0.16-0.14], p = 0.88), sedentary and screen time (Random = -0.01, [95%CI: -0.38-0.36], p = 0.95) did not align. Periods of greater structure were associated with more favorable physical activity and diet outcomes among children and adolescents with IDD, although evidence for dietary behaviors was limited. Findings support the relevance of the SDH in this population while highlighting substantial gaps in the literature, including small study numbers and methodological heterogeneity. Future research using rigorous, longitudinal designs is needed to better understand the relationship between structure and obesogenic behaviors among children and adolescents with IDD.
Increasing population-level physical activity (PA) requires system-level policy action. However, public policies targeting the general population, without addressing socially disadvantaged populations, might unintentionally increase socioeconomic inequities in PA. This is particularly concerning since disadvantaged groups are less likely to meet PA recommendations to begin with. This systematic review assesses evidence on the effects of public policies on equity in PA. A literature search was performed in seven bibliographic databases on May 7, 2024, in collaboration with a librarian. Studies were included if they a) focused on changes in PA behaviour, PA proxies, or the PA environment as outcomes, b) examined public policy as the independent variable, and c) included a low socioeconomic status (SES) (sub)population. Screening was done in duplicate. Key data extracted included: public policy information, target population and/or SES subgroup measures, PA outcomes, and equity-related findings. Policies were grouped into domains aligned with the eight investments of the International Society for Physical Activity and Health and categorized based on their impact on inequities: reduction, increase, no effect, or mixed effects. Out of 10,350 records screened, 81 studies were included. Results showed that 27% of the public policies reduced inequities, 38% had no effect, 10% increased them, and 25% had mixed effects. The fewest PA policies were identified in the healthcare (n = 2) and workplace (n = 0) domains, the most in the community-wide domain (n = 22). Based on the available evidence, the school, transport, community-wide, and mass media policy domains most frequently demonstrated potential to reduce inequities in PA and/or to benefit high and low SES populations equally. Policies that most consistently reduced inequities or had a neutral equity effect included a) infrastructure policies, b) financial incentives supporting active transport, c) multi-component school-based PA and health policy programmes, d) school physical education policies, and e) policies supporting mass media campaigns. Conversely, urban design and sport for all policies varied in their effects on inequities. Most policies do not appear to exacerbate inequities. Policies in the school, transport, community-wide, and mass media domains show particular promise for promoting PA in an equitable way. These findings offer valuable insights for future policymaking. The online version contains supplementary material available at 10.1186/s12966-026-01880-6.
The epidemic of non-communicable diseases related to lifestyle movement behaviors is rising rapidly in Africa, with adolescents increasingly affected by physical inactivity, excessive sedentary behavior, poor sleep, being overweight or obese, as well as mental health challenges. While evidence supports the importance of social and physical environmental factors in improving adolescents’ health, understanding these issues among African adolescents remains limited. Insights from evidence from low- and middle-income countries (LMICs), which are often underrepresented in research on environmental influences on movement behaviors and health, may be relevant to certain Western contexts, especially those in resource-constrained settings. This narrative review aims to synthesize findings from available literature on social and physical environmental correlates of movement behaviors, body weight status, and well-being among adolescents in Nigeria, an LMIC in Africa. We searched electronic databases, including PubMed, Scopus, Google Scholar, and African Journals Online, for original research articles published prior to January 2025 on socioenvironmental factors and movement behaviors, body weight status, and well-being among Nigerian adolescents (aged 10–20 years). Each study underwent screening and data extraction by two reviewers. Study quality was assessed with the modified Downs and Black checklist, and data were analyzed using narrative synthesis. A total of 25 articles met the inclusion criteria, all of which were cross-sectional studies. The review suggested that social class, school settings, peer relationships, family structure, electronic device use in the bedroom, neighborhood walkability features, availability of open recreational spaces, and urbanization were important socioenvironmental factors related to multiple movement behaviors and health outcomes among Nigerian adolescents. Some of these relationships were modified by gender and socioeconomic status. The evidence from this narrative review highlighted the need for more prospective and intervention studies to understand how environmental factors may promote healthier movement behaviors, enhance health, and overall well-being among Nigerian adolescents. The results could be used by researchers, policymakers, and stakeholders, including school administrators, urban planners, health professionals, parents, and community organizations who are interested in how social and physical environments contribute to adolescents’ movement behaviors, health, and well-being in resource-constrained settings. The online version contains supplementary material available at 10.1186/s12966-026-01904-1.