The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
Sun
200 papers
Development and evaluation of wrist- and thigh-worn accelerometer algorithms using self-training machine learning models for classification of activity type and posture: towards device placement-agnostic methods in the ProPASS consortium.
Ahmadi MN, Koemel N, Biswas R … +14 more , Holtermann A, Koster A, Atkins A, Pulsford R, Del Pozo Cruz B, Rangul V, Mitchell J, Blodgett J, Hettiarachchi P, Svartengren M, Granat M, Clark B, Hamer M, Stamatakis E
Int J Behav Nutr Phys Act · 2026 Jul · PMID 42393677 · Full text
BACKGROUND: Wearable accelerometers are widely used in health research, but differing placements (e.g. wrist vs. thigh) hinder harmonising activity classification across studies. Prior studies report 1.5- to 2.0-fold dif...
BACKGROUND: Wearable accelerometers are widely used in health research, but differing placements (e.g. wrist vs. thigh) hinder harmonising activity classification across studies. Prior studies report 1.5- to 2.0-fold differences in physical activity level by wear location, hampering data comparability, and compromising the potential for pooling data to develop consortia and carrying out Meta- and Individual Participant Data analysis. Although supervised machine learning is increasingly used in wearables research, its reliance on extensive labelled data limits its use in free-living datasets. Semi-supervised learning offers an efficient alternative by using laboratory collected labelled data to iteratively self-train models on unlabelled free-living data. Using a self-training approach, the aim of this study was to train and evaluate algorithms for wrist- and thigh-worn devices to facilitate harmonisation of posture and activity type classification between placements. METHODS: A total of 146 participants aged 30-75 years completed either structured laboratory-based activity trials or one of two independent free-living assessments while wearing Axivity AX3 accelerometers on the wrist and thigh. For each placement, a supervised Random Forest classifier was initially trained using a labelled laboratory dataset (n = 40) to classify sitting, standing, walking, running, stair climbing, and cycling - and then re-trained using self-training on free-living data (n = 53, independent to the laboratory study sample). The final models were validated using another hold-out free-living independent dataset (n = 53) with ground-truth activity labels obtained via direct video observation. Overall model comparison and performance was assessed using accuracy, kappa statistic, and F1 scores. Individual activity class comparison and performance was evaluated using equivalence testing, confusion matrices, and coefficient of variation between the wrist and thigh estimates. RESULTS: During a total of 43,800 min, of which 19,080 min were in the hold-out dataset, both self-trained models achieved high overall classification accuracy: 91.8% (SD = 6.8%) for the wrist and 95.1% (SD = 5.4%) for the thigh. The overall F1 score was 88.2 (SD = 9.6%) for the wrist classifier and 90.1 (SD = 9.3%) for the thigh classifier. Equivalence testing demonstrated that both classifiers produced activity duration estimates statistically equivalent to ground-truth for all activity types except stair climbing. Confusion matrices for the wrist demonstrated very good to excellent (88% - 97%) classification accuracy for sitting, walking, running, and cycling, and good accuracy for standing and stair climbing (71%-78%). For the thigh, classification performance was very good to excellent (83% - 98%) across sitting, standing, walking, running, and cycling, with good accuracy for stair climbing (75%). The coefficient of variation values ranged from 0.022 for running to 0.140 for standing. CONCLUSION: These findings highlight the potential of self-training models to support harmonisation of wearable accelerometer data collected using different wear placements. Self-training models reduce reliance on extensive labelled data and demonstrated high activity type classification accuracy for both wrist- and thigh-worn accelerometers, with a high degree of agreement and equivalence with ground-truth data across almost all activity types.
Association of early childhood lifestyle patterns with overweight in preschoolers and timing of adiposity rebound.
Baietto M, Le Gal C, Descarpentrie A … +10 more , Lecorguillé M, Cissé AH, Bernard JY, Tafflet M, Pilato J, van der Waerden J, de Lauzon-Guillain B, Charles MA, Heude B, Lioret S
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42351177 · Full text
BACKGROUND: An unhealthy diet, excessive screen time, low levels of physical activity and suboptimal sleep are known risk factors for childhood overweight and obesity (OW/OB). These energy balance-related behaviors tend...
BACKGROUND: An unhealthy diet, excessive screen time, low levels of physical activity and suboptimal sleep are known risk factors for childhood overweight and obesity (OW/OB). These energy balance-related behaviors tend to co-occur and combine into "lifestyle patterns" (LPs) that may have a synergistic effect on OW/OB. However, few studies have examined these LPs before preschool age, and none investigated the possible involvement of parental feeding practices (e.g., breastfeeding and timing of complementary feeding), non-screen leisure activities and sleep quality. We aimed to identify such LPs during the first 2 years of life and assess their associations with OW/OB at age 5 years and age at adiposity rebound (AR). METHODS: Participants were children from the French nationwide ELFE (Etude Longitudinale Française depuis l'Enfance) birth cohort. We used principal component analysis of 18 items characterizing parental feeding practices and children's energy balance-related behaviors (n = 13,121) to derive LPs. We analyzed the associations of LPs with OW/OB at age 5 years (International Obesity Task Force definition; n = 8,388) and age at AR (in days; n = 7,845) using multivariable logistic and linear regression models, respectively. RESULTS: We identified three LPs: "Early complementary feeding, discretionary consumption, high screen time", "Balanced diet, non-screen leisure activities", and "Healthy feeding practices, low dairy consumption, suboptimal sleep" patterns. The first pattern was positively associated with OW/OB at age 5 years (OR [95% CI] = 1.09 [1.03, 1.16] per 1-SD increase) and inversely associated with age at AR (β [95% CI] = - 12.1 days [- 19.1; -5.0] per 1-SD increase). No association was observed for the second LP. For the third pattern, no clear evidence of associations was found, although the effect sizes were comparable to those of the first LP (OR = 1.07 [0.99; 1.15]; β = -7.6 days [- 15.5; 0.3] per 1-SD increase). CONCLUSION: These results emphasize the perinatal period as a critical window for the emergence of interrelated lifestyle behaviors associated with OW/OB. They highlight the need for interventional studies to evaluate the effectiveness of early, integrated, multi-behavioral strategies to prevent childhood obesity.
Mobility measures and waking-day movement behaviour composition among older adults: a compositional data analysis of the McMaster Monitoring My Mobility study.
Hakimi S, Kirkwood R, Phillips SM … +2 more , Zheng R, Beauchamp MK
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42337742 · Full text
BACKGROUND: Mobility is a cornerstone of healthy ageing typically assessed using self-report and performance-based measures. Recent research suggests these measures are poor proxies for real-world mobility. Device-derive...
BACKGROUND: Mobility is a cornerstone of healthy ageing typically assessed using self-report and performance-based measures. Recent research suggests these measures are poor proxies for real-world mobility. Device-derived measures of real-world mobility reflect the relative proportions of time a person allocates to sedentary behaviour (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) that together form the waking-day movement behaviour composition. The aim of this study was to examine the associations between commonly used mobility measures and the waking-day movement behaviour composition in older adults. METHODS: A cross-sectional analysis of data from over 1200 older adults ≥ 65 years of age from the baseline cohort (2022-2024) of the McMaster Monitoring My Mobility (MacM3) study was conducted. Compositional data analysis was used to examine the associations between 6 self-report and 10 performance-based measures of mobility and multiple components of the waking-day movement behaviour composition and establish differences in movement behaviours according to different levels of mobility. Examples of included measures are the Physical Activity Scale for the Elderly (PASE) and Timed Up and Go (TUG). RESULTS: Data from 1227 older adults (73.6 ± 5.3 years) were analysed. Significant differences in waking-day movement behaviour composition were found across the self-report and performance-based mobility measures. Older adults with lower mobility accumulated more SB and less MVPA throughout the day. For example, those with poorer TUG performance accumulated 34 more minutes/day of SB, and 22 min/day less of MVPA compared to those with better performance. The PASE, 400-meter walk, and fast gait speed tests were the strongest indicators of real-world mobility; however, the effect sizes were small. No measure showed a significant association with LIPA. CONCLUSIONS: Traditional self-report and performance-based measures of mobility are associated with the waking-day movement behaviour composition in older adults; however, their ability to explain real-world mobility is limited and varies across measures. The lack of association between any of the measures and LIPA is surprising, given that older adults spend most of their time in this activity intensity. These findings challenge the widespread use of traditional mobility measures to make inferences about real-world mobility.
Effect of breaking up prolonged sitting with physical activity on executive function: a three-level meta-analysis.
Huang Z, Yin M, Li G … +7 more , He J, Yi Q, Zhuang M, Wu B, Toledo MJL, Wongpipit W, Xu W
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42337595 · Full text
BACKGROUND: Prolonged sitting has been associated with adverse effects on cognitive function, and interrupting sitting with physical activity (PA) may help mitigate these effects. However, evidence regarding the effects...
BACKGROUND: Prolonged sitting has been associated with adverse effects on cognitive function, and interrupting sitting with physical activity (PA) may help mitigate these effects. However, evidence regarding the effects of PA breaks on executive function remains limited. In addition, it remains unclear how intervention characteristics may be associated with variations in effect estimates. This study aims to synthesize evidence from randomized trials on the effects of PA breaks on executive function, and to identify potentially effective intervention characteristics through moderator analysis. METHODS: A systematic search was conducted in Web of Science, PubMed, Embase, Scopus, Cochrane Library, APA PsycINFO, and SPORTDiscus from database inception to April 25, 2026, for randomized trials investigating the effects of PA breaks during sedentary time on executive function. Although the eligibility criteria allowed randomized controlled trials, randomized crossover trials, and cluster-randomized trials, all studies included in the final synthesis used randomized crossover designs. Risk of bias was assessed using the Cochrane Risk of Bias Tool version 2 for crossover trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations framework. A random-effects three-level meta-analytic model was applied to analyze main effects, exploratory moderator effects, publication bias, and sensitivity analyses. RESULTS: Twenty-two randomized crossover trials were included, comprising 123 effect sizes from 418 participants. Low certainty evidence suggests that, compared with uninterrupted sitting, PA breaks may be associated with a small improvement in executive function (Hedges' g = 0.13, 95% CI [0.03, 0.23], p = 0.01), particularly working memory (Hedges' g = 0.17, p = 0.02). Regrading performance metrics, reaction time (RT) performance (Hedges' g = 0.18, p < 0.01) showed a significant positive effect, whereas accuracy showed no significant effect. Exploratory moderator analyses provided preliminary evidence that intervention characteristics may be related to variations in executive function outcomes. Light-intensity activities showed a favorable pooled estimate (Hedges' g = 0.19, p < 0.01), while moderate-intensity activities did not show a significant pooled effect. For activity type, walking (Hedges' g = 0.12, p = 0.03) and stair climbing (Hedges' g = 0.70, p = 0.01) showed significant pooled effects, although the estimate for stair climbing was based on a small number of studies. Regarding frequency, 60-minute interruption intervals showed the largest pooled estimate (Hedges' g = 0.30, p = 0.01). Break duration was not a statistically significant moderator (p = 0.06), although using 3-5 min breaks showed significant pooled effect (Hedges' g = 0.16, p = 0.02). CONCLUSIONS: Interrupting prolonged sitting with PA is associated with small acute improvements in executive function, especially in the working memory and RT performance. Moderator analyses suggested that intervention characteristics such as activity intensity, type, and frequency may contribute to heterogeneity in effects. While the certainty of evidence is low and some subgroup estimates are based on a limited number of studies, these findings provide preliminary guidance for optimizing intervention design and highlight the need for further high-quality research. TRIAL REGISTRATION: CRD420251004155.
Effect of classroom physical activity breaks on learning behaviors and academic achievements in university students: a systematic review.
Deng Q, Wu C, Yang L
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42323623 · Full text
BACKGROUND: College students' prolonged sedentary behavior due to heavy academic burdens impairs cognitive functions and academic performance. Classroom physical activity breaks have been studied in younger students, but...
BACKGROUND: College students' prolonged sedentary behavior due to heavy academic burdens impairs cognitive functions and academic performance. Classroom physical activity breaks have been studied in younger students, but evidence among college students remains limited. This study aims to systematically evaluate the effects of classroom physical activity breaks on academic-related outcomes among college students, including classroom engagement, academic emotions, attention, and academic performance. METHODS: A comprehensive literature search was conducted across databases, including PubMed, Web of Science, and ERIC (EBSCOhost), covering all publications up to May 2025, supplemented by manual search and citation tracking. RESULTS: A total of 5,813 records were initially identified, and 20 studies met the inclusion criteria. Overall, classroom physical activity breaks were positively associated with improvements in sustained attention, emotional engagement, and positive academic emotions. However, findings for selective attention, behavioral engagement, negative emotions, and academic performance were mixed or inconclusive, with several studies reporting non-significant effects and one study reporting a negative effect on selective attention. CONCLUSIONS: Physical activity breaks in the classroom improved students' learning behaviors and may also contribute to enhanced academic outcomes. This study highlights that, provided teaching efficiency is not compromised, the integration of classroom physical activity breaks represents a viable and impactful educational intervention.
Development and validation of a healthy lifestyle and behavioral score for predicting metabolic syndrome: evidence from a 24-year longitudinal health check-up cohort in Taiwan.
Cambia JM, Chan TC
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42316260 · Full text
BACKGROUND: Metabolic syndrome (MetS) is a multifactorial condition characterized by obesity, hypertension, hyperglycemia, and dyslipidemia, often resulting from unhealthy lifestyle and behavioral patterns. This study ai...
BACKGROUND: Metabolic syndrome (MetS) is a multifactorial condition characterized by obesity, hypertension, hyperglycemia, and dyslipidemia, often resulting from unhealthy lifestyle and behavioral patterns. This study aimed to develop and validate a Healthy Lifestyle and Behavioral Scale (HLBS) that reflects the combined influence of key pillars of lifestyle medicine and to examine its longitudinal association with MetS risk in a large Taiwanese cohort. METHODS: Data were drawn from 201,123 participants of the Mei Jau Health Management Institution between 2000 and 2023. Item selection followed a rigorous construct validation process and selection criteria, including exploratory and confirmatory factor analyses, item response theory modeling, and reliability testing. We then combined the HLBS components such as diet, physical activity, sleep, and substance use, and performed a log binomial generalized estimating equation model to assess its risk association with MetS development. RESULTS: The HLBS demonstrated acceptable model fit and strong internal consistency. Moderate (RR = 1.12; 95% CI = 1.09-1.16) and low (RR = 1.46; 95% CI = 1.41-1.50) adherence to healthy lifestyle behaviors were associated with an increased risk of developing MetS compared with high adherence, and each HLBS component independently contributed to elevate MetS risk. Stratified analyses showed consistent linear associations across all age and sex groups, with stronger effects observed among adults and the elderly. CONCLUSIONS: The HLBS provides a reliable, culturally adapted tool for assessing lifestyle behaviors and identifying populations at risk for metabolic disorders. These findings emphasize the importance of promoting comprehensive lifestyle interventions to reduce MetS risk in the general population.
Co-designing policy, practice, and research directions for whole-school physical activity: towards sustainable culture change.
Chalkley A, Helme Z, Silva E … +25 more , Boom S, Archbold V, Bingham D, Singh A, Bloom A, Pesce C, Webster CA, Riley-Gibson E, van Sluijs E, McLoughlin G, Kåre Resaland G, Salmon J, Bartholomew J, Willumsen J, Mägi K, Clifford L, Foweather L, Mandelid MB, Kull M, Lander N, Nathan N, Vazou S, Fairclough S, Tammelin T, Daly-Smith A
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42304483 · Full text
BACKGROUND: Whole-school physical activity (WSPA) approaches are recognised globally as a key investment for increasing children's activity levels. Their success depends on translating national policy into effective scho...
BACKGROUND: Whole-school physical activity (WSPA) approaches are recognised globally as a key investment for increasing children's activity levels. Their success depends on translating national policy into effective school practices through systems-level thinking and multi-stakeholder collaboration. This study aimed to use an experience-based co-design process to produce and prioritise future directions for WSPA policy, practice and research by engaging international stakeholders to identify key roles, needs, and actionable recommendations. METHODS: The co-design process took place during a two-day international conference on Whole-School Physical Activity (#WSPA2024). Adopting a design thinking approach, 152 international stakeholders representing 16 countries engaged in two co-design workshops. Participants included professionals representing the policy (n = 64), practice (n = 26), or research (n = 62) sectors. Participants undertook tasks in either same stakeholder or mixed stakeholder groupings to explore and prioritise future needs for policy, practice, and research related to WSPA. All discussions were audio recorded, transcribed verbatim, and analysed using inductive thematic and content analysis. Prioritised actions were synthesised and recommendations to support the future of WSPA were drafted. Stakeholders reviewed the drafted recommendations and proposed modifications using an online questionnaire. RESULTS: Twenty-four recommendations (10 for policymakers, eight for practitioners, and six for researchers) to prioritise and plan for WSPA were developed. These are represented by six interlinked themes reflecting conditions for change: systems thinking, partner engagement and collaboration, equity and inclusion, evidence-based and action orientated, knowledge mobilisation, support and capacity building. CONCLUSIONS: WSPA approaches should be viewed as a long-term systems change agenda requiring aligned policy, adaptable practice, and innovative research. The WSPA recommendations provide a platform for multi-sector collaboration, co-production, and investment in scalable, context-sensitive solutions.
Interventions for positive parental feeding practices in low-income households: a scoping review.
Akhir MAM, Sulaiman N, Zalbahar N … +1 more , Hamsan H
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42304447 · Full text
BACKGROUND: Parental feeding practices play a critical role in shaping children's dietary behaviours and self-regulation during early childhood. These practices are particularly important in low-income households, where...
BACKGROUND: Parental feeding practices play a critical role in shaping children's dietary behaviours and self-regulation during early childhood. These practices are particularly important in low-income households, where structural constraints, including household food insecurity (HFI), may influence how feeding guidance is implemented and sustained. Although a growing number of interventions aim to promote positive parental feeding practices, there remains limited synthesis of how contemporary programmes are conceptualised, designed, and delivered within low-income contexts, including the extent to which feeding-related components, implementation strategies, and contextual factors such as HFI are addressed. METHODS: A comprehensive literature search was conducted across PubMed, CINAHL, and EMBASE using predefined search terms. The study selection followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR guidelines. Eligible studies included intervention programmes targeting parental feeding practices among low-income families with young children. RESULTS: Sixteen articles representing fifteen unique interventions published between 2015 and 2025 were included. The parenting-focused domain was the most common, followed by digital, multicomponent, and home-based nutrition education and skill-building domains. Across interventions, responsive feeding emerged as the most consistently targeted and improved construct, regardless of delivery mode or setting. Interventions incorporating active skill-building strategies such as coaching, modelling, and guided practice were more consistently associated with changes in parental feeding behaviours than those relying primarily on information provision. Explicit integration of HFI into the intervention design was limited; only a small number of interventions (n = 3) measured or directly addressed food insecurity, while others (n = 2) addressed related constraints implicitly through food provision, stress reduction, or improvements in home food availability. The effects on child anthropometric outcomes were generally limited and inconsistent. CONCLUSIONS: Contemporary feeding interventions in low-income households demonstrate substantial conceptual convergence around responsive feeding yet vary widely in implementation strategies and attention to structural context. Findings suggest that feeding practices, meal structure, and the home food environment may represent more appropriate intermediate indicators of intervention success than anthropometric outcomes in early childhood. Future interventions should prioritise theory-driven, skill-based designs and more explicitly integrate household food insecurity and related contextual constraints to enhance relevance, equity, and sustainability. TRIAL REGISTRATION: Open Science Framework (OSF), January 12, 2026 (DOI: https://doi.org/10.17605/OSF.IO/RHSBF.
Characterizing device-measured sleep in observational health research using compositional data analysis: a systematic review.
St Laurent CW, Balbim GM, Brown DMY … +7 more , Kracht CL, Pfledderer CD, Groves CI, Holesovsky CD, Randolph GAT, Rodheim K, Burkart S
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42298642 · Full text
Compositional data analysis (CoDA) is widely used to examine the associations between one's balance of movement behaviors (sedentary behavior, physical activity, and sleep) and health outcomes. Existing reviews have prim...
Compositional data analysis (CoDA) is widely used to examine the associations between one's balance of movement behaviors (sedentary behavior, physical activity, and sleep) and health outcomes. Existing reviews have primarily focused on reporting standards for physical activity and sedentary behavior, but have not considered the contribution of sleep reporting to our understanding of CoDA.Purpose To characterize device-based sleep data measurement, processing, and reporting in studies using CoDA to examine associations between movement behaviors and health indicators.Methods A systematic search was conducted in seven databases, along with supplemental strategies (forward and backward citation searches and expert review). Observational studies published since 2015 that employed CoDA approaches using isometric log-ratio transformations to examine the associations between movement behavior compositions utilizing device-based measures of sleep and health outcomes were included. Data extraction included items based on sleep actigraphy measurement, processing, and reporting practices recommended by the American Academy of Sleep Medicine. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess study quality.Results Among the 70 included studies (n = 60 cross-sectional, n = 10 longitudinal), few articles reported key sleep measurement and processing information. Most articles (n = 67) included only one sleep component in the time-use composition, and less than half of the articles (n = 29) acknowledged sleep-related limitations. Reports were classified as having good (n = 60) or poor (n = 10) study quality.Conclusions This review identified inconsistencies in the measurement, processing, and reporting of device-measured sleep in studies using CoDA. Varying protocols and reporting on sleep data processing highlight the need for adoption of current standardized approaches and reporting practices. Future research should prioritize transparency and consistency to improve the validity and comparability of findings on sleep's role as a key component of the integrative 24-h approach to health.
Towards sustainable futures: development and validation of a Food Education Scale (FES) for upper elementary students in Taiwan.
Lai LJ, Tseng TA
Int J Behav Nutr Phys Act · 2026 Jun · PMID 42288850 · Full text
BACKGROUND: Food education has become an important policy priority in Taiwan following the enactment of the Food and Agriculture Education Act. However, empirically validated instruments for assessing food literacy among...
BACKGROUND: Food education has become an important policy priority in Taiwan following the enactment of the Food and Agriculture Education Act. However, empirically validated instruments for assessing food literacy among elementary school students remain limited. This study aimed to develop and validate a Food Education Scale (FES) for measuring food literacy among upper elementary school students in Taiwan. METHODS: The scale was developed based on the six principles of Taiwan's Food and Agriculture Education Act and Nutbeam's (2000) framework of functional, interactive, and critical literacy. A two-dimensional framework integrating food education content and literacy competencies was constructed. Through expert review, pilot testing, and large-scale survey administration, a 36-item questionnaire was finalized. The formal survey included 400 upper elementary students from 12 schools across northern, central, southern, and eastern Taiwan. Reliability and construct validity were assessed using Cronbach's α, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) to demonstrate satisfactory construct, convergent, and discriminant validity. RESULTS: The results indicated that the FES demonstrated satisfactory psychometric properties. Internal consistency for all dimensions exceeded the recommended threshold (Cronbach's α > 0.70), and both EFA and CFA supported the scale's overall construct validity. In terms of performance patterns, students scored relatively higher in the dimensions related to cherishing food and reducing waste as well as food culture inheritance, while comparatively lower scores were observed in balanced dietary concepts and local production-local consumption. Differences in food literacy were also associated with school types, regional contexts, and family food practices. CONCLUSIONS: The Food Education Scale provides a validated instrument for assessing food literacy among upper elementary school students in Taiwan. The findings provide a validated, policy-aligned instrument for assessing children's food literacy and offer practical guidance for curriculum design and sustainability-oriented food education policies.
The effect of the Baby-Feed website intervention on diet quality in healthy infants: a randomized controlled trial.
Gatto A, Paes-Leme M, Acosta S … +4 more , Leon M, Reingevurts G, Coccia C, Palacios C
Int J Behav Nutr Phys Act · 2026 May · PMID 42216037 · Full text
BACKGROUND: Current infant diet recommendations are often not followed by caregivers, impacting their infant's diet quality. Incorporating diet guidelines with real-time feedback via technology may improve infant diet qu...
BACKGROUND: Current infant diet recommendations are often not followed by caregivers, impacting their infant's diet quality. Incorporating diet guidelines with real-time feedback via technology may improve infant diet quality, helping mitigate future obesity risk. This study reports the effectiveness of the Baby-Feed website in improving diet quality among US infant caregivers compared to controls. This website was designed using trusted behavior-change theories to provide real-time feedback on infant diets, show current infant diet recommendations, and monitor progress. METHODS: Primary infant caregivers (English or Spanish-literate) with internet access, cellphone text capability, and willing to participate in the full study were enrolled into a parallel-group, randomized controlled trial. Infant diet quality was assessed by the total Diet Quality Index Score (DQIS) at baseline (~ 4 months old) and at the end of the study (~ 9 months old). The DQIS (0-55) is scored as: for 0-5.9 months, 15 points for exclusive and 10 points for partial breastfeeding, and 5 points for formula, while other foods score 5 if not introduced and 0 if introduced; for 6-12 months, appropriate intake of each food group (including formula) scores 5 (2.5 if slightly off, 0 if outside recommendations), with same score for breastfeeding. Total DQIS was categorized as ≥45 (excellent) or below. Data were analyzed with ANCOVA or logistic regression, adjusting for infant age and energy intake. RESULTS: One hundred fifty-five participants were randomized, and 150 were included in the analysis (76 in the intervention group and 74 in the control group). At the end of the intervention, infant total DQIS was higher in the intervention group (44.6 ± 6.53) than in the control group (42.5 ± 7.5) in both the unadjusted (p = 0.036) and adjusted models (p = 0.046). Also, infants in the control group had twice the odds of having an infant total DQIS below excellent (adjusted OR = 2.00; 95% CI: 1.012-3.950; p = 0.046) compared to the intervention group. CONCLUSIONS: Using the Baby-Feed website for 6 months improved the quality of infant diets. This could be a tool to help caregivers follow current infant diet recommendations with real-time feedback. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT05990439.
Maintenance of physical activity gains among Latina teens: 12-month findings from the Chicas Fuertes randomized controlled trial.
Castro E, Carson J, Greenstadt E … +8 more , Olivera B, Dunsiger S, Higgins M, Godino J, Marcus B, Meyer D, Zive M, Larsen B
Int J Behav Nutr Phys Act · 2026 May · PMID 42215952 · Full text
BACKGROUND: Only about three percent of Latina teens are sufficiently active. As Latinas have a higher prevalence of lifestyle-related chronic health conditions, such as diabetes, compared to non-Latinas, targeted interv...
BACKGROUND: Only about three percent of Latina teens are sufficiently active. As Latinas have a higher prevalence of lifestyle-related chronic health conditions, such as diabetes, compared to non-Latinas, targeted interventions that increase and maintain moderate-to-vigorous-intensity physical activity (MVPA) are needed. Chicas Fuertes is a 12-month multi-channel mHealth physical activity intervention for Latina teens shown to increase MVPA over the first six months. The purpose of this study was to test the effectiveness of Chicas Fuertes for maintaining Latina teens' initial physical activity gains over the subsequent six months. METHODS: In a randomized controlled trial, Latina teens, aged 13 -18 and underactive, participated in Chicas Fuertes or served as a control. The intervention group initially received a Fitbit, a one-on-one coaching session and two check-in calls, access to a personalized website, tailored text messages, and daily Instagram content while the control group received only a Fitbit. From six to 12-months, the intervention group received a short coaching call and continued access to the tailored digital media content. Weekly minutes of MVPA were assessed at baseline, six, and 12-months with hip-worn Actigraph GT3X+ accelerometers and the 7-Day Physical Activity Recall Interview. Mixed effects regressions were conducted to examine between-group differences in MVPA at twelve months, with models of accelerometer data adjusting for device wear-time. RESULTS: Of the 160 participants (Mage= 15.9 ± 1.6),137 completed the 12-month follow-up. More than half (69%) identified as second-generation and reported a household income of ≤$50,000 (62%). Weekly minutes of MVPA gained at six months were maintained at twelve months in Chicas Fuertes participants compared to control. Intervention participants had increased median changes in accelerometry-measures, 10.00 (IQR=13), compared to decreases observed in the control, -5 (IQR=21). Median changes in self-reported measures 13 (IQR=32) among intervention compared to 5 (IQR=26) among control. CONCLUSIONS: Chicas Fuertes was able to support maintenance of objective and self-reported MVPA gains from six months to twelve months with tapered support. Digital technologies that Latina teens commonly use can be leveraged to increase dissemination and implementation of physical activity interventions at a relatively low cost, ultimately enhancing health equity among Latina teens. TRIAL REGISTRATION: ClinicalTrials.gov NCT04190225. Registered on November 20, 2019.
Rethinking public health in the digital food era.
Gupta A, Fraser K, Cameron AJ
Int J Behav Nutr Phys Act · 2026 May · PMID 42204728 · Full text
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The mind-eat program leads to greater improvements in mindful, emotional, and external eating compared to intuitive eating-oriented education in adults with overweight or obesity: a randomized controlled trial.
Van Beekum M, Rodhain A, Shankland R … +14 more , Chetouane S, Jullien-Durmont D, Rouzic CL, Myzia J, Guiraudou M, Kemba Y, Boegner C, Bonnet JB, Attalin V, Jalek A, Sultan A, Leys C, Péneau S, Avignon A
Int J Behav Nutr Phys Act · 2026 May · PMID 42163359 · Full text
BACKGROUND: Mindful eating interventions target behavioral and emotional processes involved in eating, but most structured programs have been evaluated in English-speaking settings and often compared with passive control...
BACKGROUND: Mindful eating interventions target behavioral and emotional processes involved in eating, but most structured programs have been evaluated in English-speaking settings and often compared with passive controls. This randomized controlled trial assessed the effectiveness of the Mind-Eat program, a structured mindfulness-based intervention, versus treatment as usual consisting of a therapeutic patient education (TPE) program grounded in intuitive eating principles, in adults with overweight or obesity. METHODS: In this single-center trial, 66 adults with overweight or obesity were randomized (1:1) after oral agreement. Of these, 56 completed baseline assessment, and 46 with baseline and at least one post-baseline assessment were included in the modified intention-to-treat analysis. The Mind-Eat group completed eight weekly experiential sessions plus one follow-up session, while the comparator group followed the department's usual TPE pathway. Assessments were conducted at baseline, post-intervention (week 8), and follow-up (week 12). The primary outcome was change in mindful eating, measured with the validated Mind-Eat Scale. Secondary outcomes included disordered and intuitive eating behaviors, psychological well-being, trait mindfulness, physical activity, and weight. Analyses used linear mixed-effects models. RESULTS: Significant Group × Time interactions favored the Mind-Eat group for mindful eating at week 8 (β = - 0.40, p = .002, d = - 1.32) and week 12 (β = - 0.31, p = .02, d = - 1.02). Compared with treatment as usual, Mind-Eat was also associated with greater reductions in emotional eating (and greater improvements in intuitive eating and trait mindfulness. Improvements were observed in both groups across several outcomes. No between-group differences were found for restrained eating, perceived stress, anxiety, depression, physical activity, or weight. CONCLUSIONS: The Mind-Eat program was associated with greater improvements in mindful eating and key eating-related behaviors, particularly emotional and external eating, than an intuitive eating-oriented TPE program delivered as treatment as usual. These findings support the added value of structured mindfulness-based experiential training in obesity care. However, they should be interpreted in light of attrition and the absence of short-term weight effects. TRIAL REGISTRATION: The study protocol is recorded at Clinicaltrials.gov under the number: NCT06157411.
Effect of parent-focused interventions for screen use on developmental outcomes in young children: a systematic review and meta-analysis.
Machell A, Ewin C, Horwood S … +2 more , Downing KL, Hesketh KD
Int J Behav Nutr Phys Act · 2026 May · PMID 42163356 · Full text
INTRODUCTION: Parents are a key target for interventions promoting healthy screen use in young children, but no review has evaluated the effect of such parent-focused interventions on developmental outcomes in early chil...
INTRODUCTION: Parents are a key target for interventions promoting healthy screen use in young children, but no review has evaluated the effect of such parent-focused interventions on developmental outcomes in early childhood. The objective of this study was to conduct a systematic review and meta-analyses of the effects of parent-focused interventions for screen use on young children's social-emotional, cognitive, and physical development, as well as proximal indicators of development including sleep and physical activity. A secondary objective was to assess their impact on children's screen use. METHODS: Eight databases were searched with publication dates between 2007 and March 2025. Randomised controlled trials of parent-focused interventions targeting screen use in children (birth-5.99 years) were included if they reported outcomes related to both child screen use and development. Stata was used to undertake meta-analyses using multilevel random effects models to estimate effects for outcomes with data from at least three papers. RESULTS: In total, 10 studies (11 papers) were eligible for inclusion, with eight studies (n = 1,776 participants) providing sufficient data to be included in meta-analyses of at least one outcome. Interventions targeted screen use duration (n = 8 studies), screen use before bed (n = 1 study) and screen content (n = 1 study; 2 papers). Interventions achieved reductions in social-emotional problems (ES=-0.32 (95%CI:-0.51,-0.12)), externalizing behaviors (ES=-0.31 (95%CI:-0.56,-0.05)) and screen time (ES=-0.92 (95%CI:-1.66,-0.18)). Few interventions (n = 2) targeted aspects of screen use other than duration (e.g. content quality and timing). Larger effects were achieved for interventions that were underpinned by a theory and incorporated a range of established behavior change techniques, compared to interventions that did not incorporate these aspects. Few studies explored intervention effects on physical activity, body mass index, cognitive development and/or motor skills, and heterogenous sleep outcomes were reported, making it difficult to draw definitive conclusions regarding these outcomes. CONCLUSIONS: Few parent-focused interventions for screen use were identified and most targeted screen use duration. Future intervention studies may consider targeting aspects of screen use other than duration (e.g. content quality), and evaluating their feasibility and acceptability for parents, compared to interventions targeting screen use duration. The protocol was prospectively registered on PROSPERO (ID: CRD420250654905).
Physical activity and mood in daily life - a multi-burst ambulatory assessment study disentangling state and trait components of within-person associations.
Olfermann R, Reinhard I, Benedyk A … +8 more , Berhe O, Rehder J, Giurgiu M, Braun U, Ebner-Priemer U, Tost H, Meyer-Lindenberg A, Reichert M
Int J Behav Nutr Phys Act · 2026 May · PMID 42135841 · Full text
BACKGROUND: Physical activity (PA) and mood are associated in daily life. Prior studies showed that these associations are moderated by contextual factors (e.g., weather conditions) and differ between individuals. Yet, i...
BACKGROUND: Physical activity (PA) and mood are associated in daily life. Prior studies showed that these associations are moderated by contextual factors (e.g., weather conditions) and differ between individuals. Yet, it remains unclear to what extent associations between PA and mood reflect stable, person-specific characteristics or fluctuate over time. METHODS: We examined the temporal stability of within-person PA-mood associations derived from three one-week ambulatory assessments across three consecutive years in 65 adolescents and young adults. Mood was assessed via e-diaries, and PA was recorded with accelerometers. Multilevel models estimated the effects of preceding PA on mood. Between-person differences and within-person stability were quantified by random-effect variances and correlations across participants and weeks. RESULTS: As hypothesized, PA was positively associated with subsequent energetic arousal (β = 4.88, p < .001) and valence (β = 1.27, p = .042) but negatively with calmness (β = -1.86, p = .003). Intraclass Correlation Coefficients indicate that 64%, 44%, and 80% of variance of the weekly PA-mood associations of individuals are attributable to between-person differences, while 36%, 56%, and 20% of variance are accounted for by within-person fluctuations in associations of PA with energetic arousal, valence, and calmness, respectively. CONCLUSIONS: For the first time, we show that PA-mood associations reflect a combination of both stable 'trait' components (between subjects) and 'state' variability (within subjects). Both have important implications for personalized and context-sensitive intervention approaches, such as just-in-time adaptive interventions. Future research is needed to unravel which situational components and person characteristics shape the variability of associations.
Physical activity, falls, and dementia risk in adults aged ≥ 60: evidence from three cohorts.
Yang J, Zhang M, Hou M … +2 more , Liu H, Fan H
Int J Behav Nutr Phys Act · 2026 May · PMID 42106826 · Full text
BACKGROUND: Falls and physical inactivity are both linked to increased dementia risk, but their joint impact has not been well studied. It remains unclear whether physical activity can mitigate the elevated dementia risk...
BACKGROUND: Falls and physical inactivity are both linked to increased dementia risk, but their joint impact has not been well studied. It remains unclear whether physical activity can mitigate the elevated dementia risk after a fall and whether it also lowers the likelihood of future falls. METHODS: We used data from 44,488 adults aged ≥ 60 years in three cohorts. Falls and physical activity were self-reported. Incident dementia was tracked during follow-up. Cox proportional hazards models estimated the associations of falls with dementia and physical activity with dementia and falls, stratified by fall history. RESULTS: Over a median follow-up of 5.9-7.9 years, 3,492 dementia cases were identified. Falls were associated with a 70% higher risk of dementia (pooled HR = 1.70, 95% CI: 1.57-1.84). In the no-fall group, compared with inactivity, low, moderate, and high physical activity were progressively associated with lower risks of dementia (HRs = 0.63, 0.53, 0.43) and falls (HRs = 0.77, 0.68, 0.58). These protective effects were consistent among fallers, with similar dose-response gradients. CONCLUSIONS: Falls substantially increased dementia risk. Higher levels of physical activity were linked to lower risks of both dementia and falls, regardless of fall history.
The physical activity health paradox: what is it, why might it happen, and where to go from here?
Quinn TD, Prince SA, Pronk NP … +1 more , Barone Gibbs B
Int J Behav Nutr Phys Act · 2026 May · PMID 42104355 · Full text
BACKGROUND: The "physical activity health paradox" posits that physical activity done during work (occupational physical activity [OPA]) may not yield the health benefits consistently observed for leisure-time physical a...
BACKGROUND: The "physical activity health paradox" posits that physical activity done during work (occupational physical activity [OPA]) may not yield the health benefits consistently observed for leisure-time physical activity (LTPA) and, in some cases, may be harmful. Given the broad implications for such a paradox, which contradicts current public health guidelines for physical activity, we conducted a narrative, non-systematic review to discuss the current epidemiological and mechanistic evidence on the topic to inform opportunities for research and practice moving forward. EPIDEMIOLOGICAL EVIDENCE: Epidemiological evidence shows that LTPA is reliably protective against mortality and cardiovascular disease, whereas OPA has mixed or adverse associations. Several recent meta-analyses found higher all-cause mortality risk among men with high vs low OPA and found LTPA to potentially mitigate this OPA risk. Studies with device-measured OPA further highlight potential heterogeneity by OPA task and context. These conclusions remain limited by low quality evidence due to heterogeneous OPA exposure measurements, referent group selection, challenges in study design, and varied confounder adjustments. MECHANISTIC EVIDENCE: Mechanistically, four interrelated pathways that may explain the observed presence of a paradox have been proposed and preliminarily tested: (1) acute cardiovascular strain catalyzed by long-duration OPA with little recovery; (2) downstream vascular changes such as greater arterial stiffness, blunted baroreflex sensitivity, and maladaptive cardiac remodeling from chronic OPA exposure; (3) systemic inflammation associated with high OPA levels; and (4) modifiers such as low cardiorespiratory fitness and high psychosocial stress amplifying strain, inflammation, and risk. Current evidence is limited by reliance on cross-sectional or between-subject designs, crude OPA classification, and limited mechanistic interventions. CONCLUSIONS: Unlike the clear benefits from LTPA, research findings examining the health effects of OPA remain mixed. While uncertainty remains, the balance of evidence suggests that OPA is less beneficial to health than LTPA which should be considered in public health messaging. Advancing the field will require multidimensional OPA exposure assessment, rigorous study designs, and evaluation of mechanism-driven outcomes to clarify causal pathways and identify feasible intervention targets to promote health in workers with physically demanding jobs.
Using the Implementation Leadership Scale (ILS) for nutrition incentive programs in the food retail context.
Marriott JP, Byker Shanks C, Calloway EE … +5 more , Yaroch AL, Prickitt J, Melendrez B, Knauer N, Houghtaling B
Int J Behav Nutr Phys Act · 2026 May · PMID 42092881 · Full text
BACKGROUND: The Implementation Leadership Scale (ILS) is widely used to measure implementation leadership for health innovations. While used often in behavioral health and other clinical settings, it remains untested in...
BACKGROUND: The Implementation Leadership Scale (ILS) is widely used to measure implementation leadership for health innovations. While used often in behavioral health and other clinical settings, it remains untested in community public health contexts such as food retail. Healthy food retail strategies, including nutrition incentive programs, could benefit from measuring and subsequently strengthening leadership support to facilitate effective implementation. The objective of this study was to test the suitability of an adapted ILS to measure leadership support for a nutrition incentive program implemented in a brick-and-mortar food retail setting. METHODS: As part of a larger evaluation, a multidisciplinary team of practitioners, evaluators, and food retail representatives created a modified version of the ILS suitable for the food retail context. Food retailer staff and management from one privately-owned grocery chain who participated in implementing a nutrition incentive program for Supplemental Nutrition Assistance Program (SNAP) shoppers in Southern California completed a survey that included the adapted ILS. Of the 522 survey respondents from the larger evaluation, 473 retailers including management and staff provided complete responses for the ILS. We assessed construct validity, internal consistency reliability, and measurement invariance using differential item functioning (DIF) analyses, Cronbach's alpha, confirmatory factor analysis (CFA), and multiple-group CFA for the adapted ILS. RESULTS: DIF analyses indicated minimal evidence of measurement bias. The CFA supported the original four-factor ILS structure, with excellent internal consistency for the knowledgeable, supportive, and perseverant subscales and fair consistency for the proactive subscale. Further, the demonstrated measurement invariance between management and staff highlights the robustness of the ILS and its potential for assessing alignment or discrepancies in perceptions of implementation leadership between management and staff within food retail organizations. CONCLUSIONS: Findings suggest that the adapted ILS is a valid and reliable tool for measuring implementation leadership support for nutrition incentive programs in a food retail setting in the US. Future research should examine the adapted ILS across diverse food retail environments and healthy food retail strategies to improve its generalizability and applicability.
Social inequalities in leisure-time and transport-related physical activity through the lens of intersectionality: 10-year longitudinal study in Brazil.
Miranda AAM, Santana DD, Schwingel A … +6 more , Turner GM, Hurley KL, Edwards KL, Keye S, Hallal PC, Florindo AA
Int J Behav Nutr Phys Act · 2026 May · PMID 42087196 · Full text
BACKGROUND: 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 activi...
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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