The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
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200 papers
The experiences of night shift workers following three different dietary weight loss interventions: a qualitative study using behaviour change theory.
Davis C, Kleve S, Huggins CE … +1 more , Bonham MP
Int J Behav Nutr Phys Act · 2025 May · PMID 40437584 · Full text
BACKGROUND: Shift workers are an estimated 15%-30% of the workforce in developed countries, who are disproportionally at risk of living with overweight or obesity. Dietary guidance is a component recommended for obesity...
BACKGROUND: Shift workers are an estimated 15%-30% of the workforce in developed countries, who are disproportionally at risk of living with overweight or obesity. Dietary guidance is a component recommended for obesity management, however lacks consideration of the lifestyle and circadian disruption experienced by night shift workers. There is a lack of evidence addressing both weight loss and the metabolic consequences of eating at night. Intermittent fasting (IF) may provide metabolic benefits if fasting is aligned with night shifts. The Shifting Weight using Intermittent Fasting in night shift workers study compares three weight-loss interventions: 1) continuous energy restriction (CER); or twice-per-week IF with 2) fasting during night shifts or 3) day fasting. This study aims to explore the experiences of participants while following the interventions to understand how intervention features and external enablers or barriers influence engagement. METHODS: Forty-seven semi-structured interviews (22 baseline, 25 follow-up) were conducted with 33 participants. Eighteen participants also completed optional fortnightly audio diaries to enrich data collected on experiences over time. Interviews and diaries were analysed using the five-steps of framework analysis and themes were deductively mapped to behaviour change frameworks and the social-ecological model. RESULTS: Analysis resulted in seven major themes and 27 subthemes. Three main themes describe intervention factors influencing engagement: 1) Simplicity and ease, 2) Support and accountability, and 3) An individualised approach is sometimes needed. Four themes described external factors to the interventions influencing engagement: 4) Personal motivation and attitudes, 5) Physiological influences of eating behaviours, 6) Social support at home and work, and 7) Work structure and environment. CONCLUSIONS: Across all three interventions, participants valued the ease of interventions, which was the clear dietary prescription and focus on two days per week for IF, or a focus on small changes for CER. Behavioural regulation and providing meals/snacks were identified as critical features. Modifications to address identified enablers/barriers include: providing flexible fasting periods; addition of fatigue management initiatives; increased focus on non-weight related health changes during periods of slowed weight-loss; implementation in workplace settings to harness social support; and providing a healthier food environment.
Parental use of structure-based and autonomy support feeding practices with children with avid eating behaviour: an Ecological Momentary Assessment study.
Edwards KL, Pickard A, Farrow C … +6 more , Haycraft E, Herle M, Llewellyn C, Croker H, Kininmonth A, Blissett J
Int J Behav Nutr Phys Act · 2025 May · PMID 40437547 · Full text
BACKGROUND: Avid eating is an eating profile which confers greater risk for childhood obesity and can be challenging for parents to manage. Using Ecological Momentary Assessment (EMA), we have previously shown that paren...
BACKGROUND: Avid eating is an eating profile which confers greater risk for childhood obesity and can be challenging for parents to manage. Using Ecological Momentary Assessment (EMA), we have previously shown that parental mood, feeding goals, and eating context determine parents' use of coercive and indulgent feeding practices. Parents have also reported using specific noncoercive practices which provide structure (e.g., modelling) or autonomy support (e.g., nutrition education) when feeding children with avid eating behaviour more effectively. However, research is yet to examine the momentary predictors of these adaptive feeding practices. METHOD: This EMA study aimed to examine parental mood, goals, and context as momentary predictors of parents' use of noncoercive feeding practices during daily feeding interactions with preschool children (3-5-years-old) with an avid eating profile. Parents (N = 109; females n = 85) completed a 10-day EMA period which assessed momentary mood, feeding goals, feeding practices, and contextual factors. RESULTS: Parents were more likely to use structure-based feeding practices when feeding goals were health-related, the atmosphere was positive or neutral, or when parents initiated eating occasions. Parents were also more likely to use autonomy support feeding practices when their feeding goals were health-related or when parents initiated eating occasions. Encouraging children to eat or negotiating with children about how much or what food to eat was significantly associated with a negative atmosphere during eating occasions. CONCLUSIONS: Together, our findings show that parental mood, feeding goals and context are momentary predictors of parents' use of noncoercive feeding practices to manage children's avid eating behaviour. Further work is needed to examine whether supporting parents to prioritise health-related goals at mealtimes increases the use of adaptive, noncoercive feeding practices.
Usage and effectiveness of strategies to sit less and move more: evaluation of the BeUpstanding™ national implementation trial.
Healy GN, Winkler EAH, Mulcahy SK … +2 more , Brakenridge CL, Goode AD
Int J Behav Nutr Phys Act · 2025 May · PMID 40437510 · Full text
BACKGROUND: Addressing prolonged workplace sitting is an identified priority. A national implementation trial of BeUpstanding™ - an online workplace intervention supporting teams of desk-based workers to sit less and mov...
BACKGROUND: Addressing prolonged workplace sitting is an identified priority. A national implementation trial of BeUpstanding™ - an online workplace intervention supporting teams of desk-based workers to sit less and move more - successfully reduced worker sitting time in a large sample of workers. However, it is unclear which strategies workers used to sit less and move more, how usage changed following intervention, and how this related to changes in work activity and sitting. METHODS: BeUpstanding collected data from staff before and after the 8-week champion-delivered intervention regarding self-reported work behaviours (percentage of worktime sitting and moving; percentage sitting in prolonged bouts) and the usage (0 = never to 4 = always/nearly always) of 21 sit less/move more strategies (13 emphasised 'move more'). Strategy usage during versus before intervention were compared via linear mixed models. Strategy usage (0-4) and changes (-4-4) were tested in relation to post-intervention behaviours and behaviour changes using linear mixed models. Interaction tests and conditional inference trees compared strategies in their effectiveness. RESULTS: Across 1614 staff (43.1 ± 11.3 years; 66% female) from 66 workplaces, the number of strategies used at least sometimes averaged 9.56 (SE = 0.19) pre-intervention. Strategy usage increased significantly (p < 0.05) in the number of strategies used (2.45 [95% CI: 2.18, 2.73], p < 0.001), mean strategy usage (0.37 [0.33, 0.41], p < 0.001), move-more strategy usage, and for every strategy except active travel. Every strategy was used by > 10% of staff following intervention. Strategy usage and changes were significantly associated with all behaviours and behaviour changes (all p < 0.01). There were significant differences in the strength of these associations between strategies (p < 0.05) and for move-more strategies versus other strategies (p < 0.05); however, no strategies were statistically counterproductive. Conditional inference trees identified various combinations of strategies whose usage predicted outcomes. CONCLUSIONS: All strategies showed acceptability (used by > 10%), most were modifiable (increased with intervention), and, to varying degrees, their usage was associated with work behaviours. Findings suggest all 21 strategies are suitable for Australian desk-based workers to select based on personal and contextual fit. Strategies most strongly linked with all behaviours or targeted behaviours (i.e., increasing movement) might be emphasised to enhance effectiveness. TRIAL REGISTRATION: ACTRN12617000682347. The trial was prospectively registered on the 12th May, 2017 (ACTRN12617000682347) before the soft launch online and last updated on the 11th June 2019, before the national implementation trial recruitment commenced (12th June, 2019).
Trajectories of plant-based dietary patterns and their sex-specific associations with cardiometabolic health among young Australian adults.
Marchese LE, McNaughton SA, Hendrie GA … +6 more , Machado PP, O'Sullivan TA, Beilin LJ, Mori TA, Dickinson KM, Livingstone KM
Int J Behav Nutr Phys Act · 2025 May · PMID 40426187 · Full text
BACKGROUND: Plant-based diets are associated with favourable cardiovascular health markers. Although increasingly consumed among younger demographics, it is unclear how plant-based diet quality tracks from adolescence to...
BACKGROUND: Plant-based diets are associated with favourable cardiovascular health markers. Although increasingly consumed among younger demographics, it is unclear how plant-based diet quality tracks from adolescence to young adulthood, and how this impacts cardiovascular health later in life. Thus, this study aimed to explore trajectories of plant-based dietary patterns from adolescence to young adulthood and investigate associations with cardiometabolic health markers in young Australian adults. METHODS: Longitudinal data from 417 participants from the Raine Study were included. Semi-quantitative food frequency questionnaires conducted at 14, 20, and 27 years of were used to derive three plant-based diet quality index scores: an overall plant-based diet (PDI), a healthy plant-based diet (hPDI), and a less healthy plant-based diet (uPDI). Markers of cardiometabolic health included waist circumference, blood lipids, and blood pressure obtained at 14 and 28 years of age. Group-based trajectory modelling was used to describe plant-based diet quality trajectory groups from adolescence to young adulthood. Multivariate linear regression models were used to investigate associations with cardiovascular health markers. RESULTS: Plant-based diet quality trajectory groups were different by sex, but remained relatively stable over the life stages, with participants remaining either above or below average diet quality at all time points. Associations with cardiovascular health outcomes differed between the sexes, with the hPDI having the greatest number of associations for females, and the uPDI for males. Being female with a higher hPDI score was associated with lower insulin (β = -1.11 (95% CI -2.12, -0.09)), HOMA-IR (β = -0.25 (95% CI -0.48, -0.01)), systolic blood pressure (β = -2.75 (95% CI -5.31, -0.19)), and hs-CRP (β = -1.53 (95% CI -2.82, -0.23)), and higher HDL-cholesterol (β = 0.13 (95% CI -0.03, 0.23)) compared to females with lower hPDI scores. Being male in the higher scoring uPDI group was associated with higher waist circumference (β = 3.12 (95% CI 0.61, 5.63)), waist-to-height ratio (β = 0.02 (95% CI 0.01, 0.03)), insulin (β = 1.54 (95% CI 0.33, 2.76)), HOMA-IR (β = 0.35 (95% CI 0.07, 0.63)), and hypertension status (β = 6.60 (95% CI 1.04, 42.00)) when compared to the lower scoring uPDI group. CONCLUSIONS: This study provides new insights into how plant-based diets track across adolescence into adulthood, impacting on cardiometabolic risk factors differently for males and females. Findings highlight the importance of early sex-specific interventions in adolescence to reduce future risk of cardiovascular-disease.
A cluster randomized factorial trial of school-lunch salad bars and marketing on elementary students' objectively measured fruit and vegetable consumption.
Adams MA, Todd M, McEntee ML … +4 more , Yu TY, Ohri-Vachaspati P, Richards TJ, Bruening M
Int J Behav Nutr Phys Act · 2025 May · PMID 40420203 · Full text
BACKGROUND: Schools in the United States play a crucial role in promoting healthy eating habits. Despite numerous public health efforts, children's consumption of fruits and vegetables (FVs) still fall short of recommend...
BACKGROUND: Schools in the United States play a crucial role in promoting healthy eating habits. Despite numerous public health efforts, children's consumption of fruits and vegetables (FVs) still fall short of recommended amounts. Advocates have promoted school lunch salad bars as an effective strategy to increase primary students' FV consumption, but rigorous research has lagged behind their efforts. This study evaluated the effectiveness of introducing school lunch salad bars, FV marketing, and the combination of both on elementary students' objectively measured fresh FV selection and consumption. METHODS: A cluster-randomized factorial trial was conducted among 13 elementary schools from 12 public school districts participating in the U.S. National School Lunch Program with more than 50% of students eligible for free or reduced lunch. Schools were assigned randomly to one of four conditions: Salad Bar with FV Marketing (n = 4), Salad Bar-only (n = 3), FV Marketing-only (n = 3), and wait-listed control (n = 3). The conditions were assessed at three measurement waves. Students' (N = 3,080) aggregated fresh FV selection and consumption were measured via digital scales (grams) using objective plate waste methodology. Zero-inflated negative binomial models were used to examine differences in consumption (accounting for excess zeros and overdispersion) by condition and wave. RESULTS: No significant differences were observed for students selecting FVs across any condition. In contrast, after ten weeks of exposure, stand-alone school lunch salad bars significantly increased students' consumption of FV (IRR = 1.84, 95% CI 1.12, 3.04) compared to the wait-listed control. Findings for FV marketing alone suggested increased consumption (IRR = 1.60, 95% CI 0.97, 2.64) relative to control, but were non-significant and inconclusive. Salad bars in combination with FV marketing showed the strongest effect on FV consumption relative to the wait-list control, with a significant increase observed at ten weeks (IRR = 2.07, 95% CI 1.29, 3.31). CONCLUSIONS: Stand-alone salad bars are effective at increasing elementary students' FV consumption after a minimum of ten weeks. The combined intervention of salad bars and FV marketing demonstrated the greatest improvement in FV consumption. These findings support the promotion of salad bars in schools as a strategy to increase FV consumption among students. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03283033 (preregistered on: 9/14/2017).
The impact of narratives and active video games among black and hispanic children with overweight and obesity: a randomized controlled trial.
Lu AS, Baranowski T, Barreira TV … +7 more , Fleischman A, Green MC, Huang SY, Lee IM, Levitsky LL, Noubary F, Thompson D
Int J Behav Nutr Phys Act · 2025 May · PMID 40420195 · Full text
BACKGROUND: Overweight and obesity disproportionately affect Black and Hispanic children who also play more video games. Narratives, coupled with home-based active video games (AVGs), may enhance PA and mitigate these di...
BACKGROUND: Overweight and obesity disproportionately affect Black and Hispanic children who also play more video games. Narratives, coupled with home-based active video games (AVGs), may enhance PA and mitigate these disparities. This study tested the effect of narrative-enhanced home-based AVGs among predominantly Black and Hispanic children with overweight and obesity. METHODS: This 6-month three-group RCT recruited 135 children aged 7-14 from pediatric clinics in Boston, MA (January 2020 - May 2022) during the COVID-19 pandemic. Participants were randomized into: [Narrative + AVG], receiving an Xbox/Kinect with six AVGs interspersed with a narrative animation Ataraxia (72 episodes over six months), which accompanied the AVGs; [AVG Only], receiving the Xbox/Kinect and AVGs without narrative animation; and [Waitlist Control], receiving the intervention post-RCT. The primary outcome was objectively assessed daily moderate-to-vigorous PA (MVPA). Secondary outcomes included body composition (fat and lean mass, total region fat), BMI%, fasting insulin, glucose, lipid panel (Cholesterol, HDL, LDL, and Triglycerides), and C-reactive protein. Assessments occurred at baseline, 3, and 6 months. It was hypothesized that [Narrative + AVG] would outperform [AVG Only], which would outperform [Waitlist Control]. RESULTS: 79 children completed all three visits (Age = 10.9 ± 1.7; 63% Boys; 62% Black; 25% Latino; 11% Mixed; and 1% Asian). No statistically significant improvements in MVPA were observed within any condition at 3 or 6 months. A post-hoc exploratory analysis revealed that over the first three months, [Narrative + AVG] increased daily MVPA by 6.8 min compared to [Waitlist Control]. Over the same period, the [AVG Only] group exhibited 815 g less lean mass gain and 7.2 mg/dL lower HDL cholesterol levels relative to the [Waitlist Control]. CONCLUSIONS: While neither narrative-enhanced AVGs nor AVGs alone consistently increased daily MVPA across the 6-month RCT, participants in the narrative AVGs group demonstrated greater daily MVPA compared to the control group during the initial three months. During this same period, the AVG-only group exhibited reduced lean mass gain and lower HDL cholesterol levels compared to the waitlist control. The added advantage of narratives was inconclusive, likely due to implementation challenges encountered during the pandemic. These findings highlight the need for addressing these challenges in future research in a fully powered study. TRIAL REGISTRATION: Active Video Games on Physical Activity (Main Trial), NCT04116515. Registered December 25, 2019, https//clinicaltrials.gov/study/NCT04116515.
Typology of out-of-home eaters: a description of sociodemographic, lifestyle, nutritional and environmental characteristics in the NutriNet-Santé cohort.
Meyer E, Allès B, Berlivet J … +9 more , Péneau S, Bellicha A, Touvier M, Langevin B, Pointereau P, Lairon D, Hercberg S, Kesse-Guyot E, Baudry J
Int J Behav Nutr Phys Act · 2025 May · PMID 40420193 · Full text
BACKGROUND: The out-of-home (OOH) food sector holds the potential to promote healthier and more sustainable diets on a large scale given the high number of people eating OOH regularly. However, information about socioeco...
BACKGROUND: The out-of-home (OOH) food sector holds the potential to promote healthier and more sustainable diets on a large scale given the high number of people eating OOH regularly. However, information about socioeconomic and dietary characteristics of OOH eaters is limited. This study aimed to identify a typology of OOH consumers by frequency and type of meal consumed OOH and their associated sociodemographic, lifestyle, nutritional, and environmental characteristics. METHODS: Based on a sub-sample of adults of the French NutriNet-Santé cohort who completed a food frequency questionnaire and a questionnaire on OOH consumption habits in 2014 (n = 29,140, mean age: 53.6 (SD = 14.0) years, 74.3% women), we conducted a Multiple Factor Analysis followed by a clustering procedure. AN(C)OVA models were then used to examine the associations between the identified clusters and socio-demographic, lifestyle, and diet-related characteristics (using dietary scores and environmental indicators including greenhouse gas emissions, land use and energy consumption). RESULTS: We identified five clusters based on their OOH consumption patterns: Weekday-only eaters (19%), Frequent weekday and weekend eaters (24%), Organic eaters (6%), Weekend and evening eaters (19%), and Home-only eaters (32%). Weekday-only eaters were younger, more likely to be professionally active and to have children at home than the other groups. Frequent weekday and weekend eaters, with the highest OOH consumption, had the lowest dietary quality and the highest diet-related environmental impacts and consisted mostly of younger women with higher socioeconomic status. Organic eaters, often living in urban areas and following specific diets such as vegan or vegetarian ones, had the best dietary quality and the lowest diet-related environmental impacts. Weekend and evening eaters and Home-only eaters had a higher proportion of retired individuals, with Weekend and evening eaters also showing a greater proportion of high-income individuals. CONCLUSIONS: Our findings indicate a lower dietary quality and higher dietary environmental impacts among frequent OOH eaters, whereas those with higher organic consumption showed opposite trends. This study contributes to the understanding of different OOH consumer characteristics and could provide a basis for further research in the field. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT03335644).
Accelerometer measurement error in a randomized physical activity intervention trial in breast cancer survivors was nondifferential but attenuated the intervention effect.
Rogers LQ, Midthune D, Dodd K … +9 more , Bowles H, McAuley E, Courneya KS, Barrett B, Razis S, Hunter GR, Carter SJ, Carroll RJ, Kipnis V
Int J Behav Nutr Phys Act · 2025 May · PMID 40420153 · Full text
BACKGROUND: Physical activity reduces morbidity and mortality risk in cancer survivors, but a meaningful proportion of this vulnerable population are physically inactive. Targeted interventions can help cancer survivors...
BACKGROUND: Physical activity reduces morbidity and mortality risk in cancer survivors, but a meaningful proportion of this vulnerable population are physically inactive. Targeted interventions can help cancer survivors adopt a more active lifestyle, but the efficacy of these interventions must be rigorously evaluated in randomized controlled intervention trials. A major barrier to such trials involves the difficulty in obtaining unbiased estimates of physical activity in free-living conditions. METHODS: We conducted a randomized controlled trial of a 3-month intervention designed to increase physical activity vs. usual care in breast cancer survivors (n = 316). The primary outcome was change in physical activity as estimated by hip-worn accelerometer (MTI/Actigraph, models GT1M and GT3X). The trial included a sub-study (n = 106) wherein unbiased measures of total energy expenditure (doubly labeled water), and resting energy expenditure (indirect calorimetry) were collected. A linear mixed measurement error model characterized the structure of measurement error in accelerometry-estimated physical activity energy expenditure (PAEE), and corrected for bias in the estimated intervention effect due to measurement error. RESULTS: Bias in the accelerometer estimates was related to true PAEE (p < 0.001) and baseline body mass index (p < 0.001) but was not related to age (p = 0.13). After correcting for measurement error, the estimated intervention effect at 3 months (change from baseline in PAEE in the intervention arm minus change in the control arm) was 77 kcal/day (95% confidence interval (CI) = 31-125), compared to 48 kcal/day (95% CI = 22-75) when measurement error was ignored. These results indicate a 20% (21%) increase in PAEE kcal x d (kcal x kg × d) at month 3 relative to baseline for the corrected model vs. 14% (15%) for the uncorrected model. There was no evidence that measurement error in accelerometry-estimated PAEE was differential (differed by treatment arm) in the trial (p = 0.86). CONCLUSIONS: Measurement error in accelerometer-estimated PAEE can attenuate the effect size related to intervention effects in randomized controlled trials of physical activity interventions. Sub-studies that collect unbiased measures of PAEE can be used to correct for this short-coming. TRIAL REGISTRATION: ClinicalTrials.gov; NCT00929617; registered 06/26/2009; https://clinicaltrials.gov/study/NCT00929617.
Effect of physical activity on changes in weight and aerobic capacity during an 18-month behavioral weight loss intervention.
Creasy SA, Ostendorf DM, Kaizer L … +5 more , Rosenberg R, Breit MJ, Bessesen DH, Melanson EL, Catenacci VA
Int J Behav Nutr Phys Act · 2025 May · PMID 40399945 · Full text
BACKGROUND: The objective of this secondary analysis was to examine the effect of MVPA and the time of day that MVPA (i.e., morning vs. evening) is performed on long-term changes in body weight and aerobic capacity. METH...
BACKGROUND: The objective of this secondary analysis was to examine the effect of MVPA and the time of day that MVPA (i.e., morning vs. evening) is performed on long-term changes in body weight and aerobic capacity. METHODS: Adults with overweight and obesity (n = 105) enrolled in an 18-month behavioral weight loss intervention involving a reduced calorie diet and a supervised exercise program. Participants were encouraged to increase their bouted MVPA (i.e., MVPA accumulated in bouts ≥ 10 min) to 300 min/wk. Body weight, body composition, aerobic capacity, and physical activity were assessed at 0, 6, 12, and 18 months. Participants were categorized based on whether they increased bouted MVPA by ≥ 150 min/wk during the supervised exercise program. Linear regression was used to examine the effect of increasing bouted MVPA on weight loss and aerobic capacity. Similar methods were used to examine the effect of time of day of MVPA on weight loss and aerobic capacity. RESULTS: Participants who increased bouted MVPA by ≥ 150 min/wk during the supervised exercise program had greater weight loss, fat loss, and increases in aerobic capacity at 18 months compared to participants who increased bouted MVPA by < 150 min/wk. Amongst participants who increased bouted MVPA by ≥ 150 min/wk, the time of day of MVPA had no significant effect on weight loss or aerobic capacity. CONCLUSIONS: Increasing bouted MVPA by ≥ 150 min/wk improves weight loss and aerobic capacity during a behavioral weight loss intervention which includes caloric restriction. MVPA earlier and later in the day is beneficial for weight management and cardiorespiratory fitness. TRIAL REGISTRATION: Clinicaltrials.gov (NCT01985568) on October 24, 2013.
Adherence to the planetary health diet is associated with slower cognitive decline: a prospective cohort analysis of Chinese older adults.
Tang L, Yu X, Qiu C … +4 more , Lu Y, Wang Y, Liu F, Zhu X
Int J Behav Nutr Phys Act · 2025 May · PMID 40380205 · Full text
BACKGROUND: The EAT-Lancet commission has proposed a planetary health reference diet (PHD) aiming to improve human health and global environmental sustainability. Emerging evidence suggests that high-quality diet is a mo...
BACKGROUND: The EAT-Lancet commission has proposed a planetary health reference diet (PHD) aiming to improve human health and global environmental sustainability. Emerging evidence suggests that high-quality diet is a modified risk factor cognitive decline. However, population-based evidence in relation to the association between this diet and cognitive decline is scarce. METHODS: This prospective cohort study examined data from the China Health and Nutrition Survey (CHNS) during 1997-2011.We included 3404 adults aged 60 years and older with normal cognition at baseline. Dietary intake was assessed using 3-day 24 h dietary recalls combined with weighing methods and cognitive function was assessed using repeated measures of the Telephone Interview for Cognitive Status-modified (TICS-m). The Planetary Health Diet Index (PHDI) was based on 14 food groups and a total score from 0 to 140. Higher scores indicated greater adherence to the PHDI. We used linear mixed model with random intercepts and slope to evaluate the association between PHDI score and cognitive decline adjusting for demographic, health, and lifestyle confounders. RESULTS: During a median follow-up of 12 years, higher adherence to the PHDI was associated with a slower decline in memory and global cognition. Participants in the highest quintile of PHDI adherence had significantly slower memory decline (B = 0.025, 95%CI:0.000-0.049, P for trend = 0.019) and global cognitive decline (B = 0.020, 95%CI:0.004-0.037, P for trend = 0.029) compared to those in the lowest quintile. Stratified analyses revealed that physical activity modified these associations (P < 0.05). Among participants engaging in vigorous physical activity, those in the highest PHDI quintile exhibited an attenuated annual memory decline (B = 0.070, 95%CI:0.010-0.130, P for trend = 0.013) and global cognitive decline (B = 0.045, 95%CI:0.003-0.086, P for trend = 0.037) compared to those in the lowest quintile. CONCLUSION: Higher adherence to the PHD was associated with slower cognitive decline in older Chinese adults. Physical activity, particularly vigorous physical activity, may enhance the cognitive benefits of this dietary pattern. These findings highlight the potential dual benefits of sustainable dietary patterns for both environmental and cognitive health.
Associations between parental perceptions of neighbourhood environments and active travel to school: IPEN Adolescent study.
Timperio A, Duncan S, Akram M … +18 more , Molina-García J, Van Dyck D, Barnett A, Salonna F, Rm A, Sallis JF, Vorlíček M, Hinckson E, Cain KL, Conway TL, Wan Muda WAM, Moran M, Oyeyemi AL, Pizarro A, Reis RS, Rezwan SM, Schipperijn J, Cerin E
Int J Behav Nutr Phys Act · 2025 May · PMID 40375328 · Full text
BACKGROUND: Studies of correlates of active transport to and from school (ATS) focus mainly on children, have a limited conceptualisation of ATS trips, lack heterogeneity in built environments, and rarely consider effect...
BACKGROUND: Studies of correlates of active transport to and from school (ATS) focus mainly on children, have a limited conceptualisation of ATS trips, lack heterogeneity in built environments, and rarely consider effect modifiers. This study aimed to estimate associations of parent-perceived neighbourhood environment characteristics with self-reported ATS among adolescents from 14 countries, and whether associations differ by sex, city/region, and distance to school. METHODS: Observational cross-sectional design. Data were from the International Physical activity and Environment Network (IPEN) Adolescent study and included 6302 adolescents (mean age 14.5 ± 1.7 years, 54% girls) and a caretaker from 16 diverse sites. Adolescents self-reported usual travel to and from school by walking and bicycling (days/week) and time it would take to walk. Parents completed the Neighbourhood Environment Walkability Scale for Youth (13 scores computed). Generalised additive mixed models estimated associations of parent neighbourhood perceptions with 1) any active transport to/from school, 2) regular walking (5-10 times/week), 3) regular cycling to/from school, and 4) profiles of ATS generated using latent profile analyses. Interactions were also explored. RESULTS: Overall, 58.7% reported any ATS, 39.9% regularly walked, 7.7% regularly cycled, and four profiles of ATS were identified: walk to and from school; walk from school; cycle to and from school; no ATS. Distance to school was negatively associated with all outcomes, though evidence was weak for regular cycling to/from school. Land use mix - diversity was positively related to all ATS outcomes except those related to cycling. Accessibility and walking facilities were associated with higher odds of any ATS, regular walking to/from school, and the profile walking to and from school. Residential density was negatively related to regular cycling to/from school. Positive associations were observed between traffic safety and any ATS, and between safety from crime, aesthetics, and odds of regular cycling to/from school. Distance to school, adolescent sex, and city moderated several associations. CONCLUSIONS: Parent perceptions of compact, mixed-use development, walking facilities, and both traffic and crime-related safety were important supportive correlates of a range of ATS outcomes among adolescents in high- and low-middle-income countries. Policies that achieve these attributes should be prioritised to support more widespread ATS.
Spillover effect of a dietary intervention on physical activity in a randomized controlled trial with colorectal cancer patients.
Henriksen HB, Kolle Å, Stenling A … +6 more , Paur I, Bøhn SK, Brøto P, Tronstad TS, Blomhoff R, Berntsen S
Int J Behav Nutr Phys Act · 2025 May · PMID 40346639 · Full text
BACKGROUND: Randomized controlled studies (RCTs) targeting dietary changes may also lead to other, untargeted changes in lifestyle habits, as spillover effects. In particular, the isolated impact of the dietary intervent...
BACKGROUND: Randomized controlled studies (RCTs) targeting dietary changes may also lead to other, untargeted changes in lifestyle habits, as spillover effects. In particular, the isolated impact of the dietary intervention may be difficult to separate due to spillover effects from changes in physical activity and physical function. Therefore, the aim of this study was to investigate the spillover effect of a one-year dietary intervention in post-surgery colorectal cancer patients by comparing the changes in physical activity and physical function between the diet intervention group and the control group in a randomized controlled trial, called the CRC-NORDIET study. METHODS: Men and women, aged 50-80 years were randomized into either the intervention group (n = 240) or the control group (n = 229). Both groups received similar incentives on physical activity. Activity sensors were used to collect data on physical activity at baseline, 6 months, and 12 months. Physical function was estimated by results from handgrip strength, 30 s sit-to-stand test and 6-min walking test. Anthropometric measurements and body composition were also measured. RESULTS: We found a significantly higher increase in moderate-to-vigorous intensity physical activity (MVPA) of 0.18 h per day from baseline to 6 months in the diet intervention group compared to the control group, respectively. However, the spillover effect of the dietary intervention on physical activity diminished to 0.10 h per day at 12 months follow-up which was not statistically significantly different (p = 0.24) from the control group. All measures of physical function increased in both groups from baseline to 6 months with no further increase at the 12-month follow-up. CONCLUSIONS: The dietary intervention did not induce a significant spillover effect on physical activity after 12 months of baseline, which was the main timepoint of the intervention. Providing identical physical activity guidance to both study groups during the 12-month intensive dietary intervention period, ensured comparable levels of physical activity across both study groups. This approach facilitated the isolation and analysis of the dietary intervention's effects on primary endpoints, as well as effects of behaviour interventions in secondary preventions, such as the CRC-NORDIET study. TRIAL REGISTRATION: The study is registered on the National Institutes of Health Clinical Trials website ( www. CLINICALTRIALS: gov ; Identifier: NCT01570010).
Developing an implementation fidelity measure for a family healthy weight program.
Golden CA, Estabrooks PA, Heelan KA … +6 more , Bartee RT, Porter GC, Pereira EL, Abbey BM, Michaud TL, Hill JL
Int J Behav Nutr Phys Act · 2025 May · PMID 40329342 · Full text
BACKGROUND: Measuring implementation fidelity is crucial yet proves challenging. While observational methods are considered the gold standard, their practicality in geographically dispersed community settings is often li...
BACKGROUND: Measuring implementation fidelity is crucial yet proves challenging. While observational methods are considered the gold standard, their practicality in geographically dispersed community settings is often limited by resource constraints. Engaging community members as paid research staff is a potential strategy to develop local capacity to conduct direct observations. This paper reports on the development and preliminary utility of a fidelity measure for a community-based family healthy weight program (FHWP), Building Healthy Families (BHF), and a method to hire and train local community members to conduct direct observation. METHODS: A consensus process guided the development of a comprehensive fidelity measure for direct observation. We piloted and refined the measure using a qualitative iterative approach with observers. Communities delivering BHF were geographically dispersed up to 450 miles resulting in the development of a training protocol to hire and train local community members as direct observers. Inter-rater agreement of ≥ 85% with an expert observer was required for observers to independently assess BHF sessions. RESULTS: A multidimensional fidelity measure for direct observation was developed specific to the core components of BHF and the session structure and process. The training method successfully prepared community-based observers (n = 5) to conduct fidelity assessments with the same quality as the trained research team observers (n = 3). Inter-rater agreement ≥ 85% with an expert observer was achieved on all training sessions. The fidelity measure demonstrated strong utility, effectively capturing multiple dimensions of fidelity and provided actionable insights to support consistent and high-quality implementation across community settings. CONCLUSIONS: This study provides a systematic approach to assessing implementation fidelity of a FHWP in micropolitan and surrounding rural areas. Our approach to hiring and training local community members as direct observers enhanced the feasibility of measuring implementation fidelity across multiple geographically dispersed settings and established a model for ongoing assessments.
Development and evaluation of the COntextualised and Personalised Physical activity and Exercise Recommendations (COPPER) Ontology.
Braun M, Carlier S, De Paepe A … +3 more , De Backere F, De Turck F, Crombez G
Int J Behav Nutr Phys Act · 2025 May · PMID 40325420 · Full text
BACKGROUND: Personalised recommendations for action and coping plans for physical activity (PA) may reduce user burden and increase plan quality. Ontologies are a promising alternative to existing black-box approaches fo...
BACKGROUND: Personalised recommendations for action and coping plans for physical activity (PA) may reduce user burden and increase plan quality. Ontologies are a promising alternative to existing black-box approaches for creating such personalised recommendations as they are able to integrate knowledge from domain experts, input from end-users and data. Here, we report the development of an ontology of physical activities action and coping plans relevant for primary prevention. METHODS: Ontology specification was carried out using literature research, requirement analysis using use case scenarios, and decision-tree workshops. Conceptualisation combined input from existing theories and classification systems, end-users, domain experts and data sets to create lists of concepts, labels, definitions, properties and relationships. Logic rules were created during ontology formalization, and the entire ontology was translated into Web Ontology Language using Protégé. The ontology was checked for logical consistency. The process was evaluated using the Open Biomedical and Biological Ontology (OBO) Repository Principles, and the resulting recommendations using competency questions and use cases. RESULTS: The ontology consists of an upper-level ontology, and lower-level ontologies for personal profile, planning, activity, context, barrier, and coping strategy. The final ontology consists of 288 classes, 9 data properties and 64 object properties. Development followed OBO ontology design principles. The ontology is logically and structurally consistent, and resulting recommendations were deemed relevant based on competency questions and use cases. CONCLUSIONS: This is the first ontology focusing on physical activity that (1) follows OBO design principles, including being openly available, (2) includes profile and context information and (3) maps knowledge regarding barriers and coping strategies. It can be used as the base of decision-support systems for action and coping planning for physical activity in primary prevention in Western-European adults, and is easily adaptable to other target groups. Challenges and opportunities of ontologies in health promotion are discussed.
Impact of a multi-component implementation strategy to increase outdoor free play opportunities in early childhood education and care (ECEC) services: the get outside get active (GOGA) randomised controlled trial.
Yoong SL, Pearson N, Giles L … +14 more , Lamont H, Wolfenden L, Jones J, Lecathelinais C, Naylor PJ, Okely A, Nathan N, Reilly K, Lorch R, Wiggers J, Jackson J, Lum M, Gillham K, Grady A
Int J Behav Nutr Phys Act · 2025 May · PMID 40312713 · Full text
BACKGROUND: Increased outdoor free play is associated with health and developmental benefits for preschool-aged children. It is therefore recommended that early childhood education and care (ECEC) services provide increa...
BACKGROUND: Increased outdoor free play is associated with health and developmental benefits for preschool-aged children. It is therefore recommended that early childhood education and care (ECEC) services provide increased time for outdoor free play. This study seeks to understand the impact of a multi-component implementation strategy (Get Outside Get Active) on ECEC service provision of opportunities for outdoor free play. METHODS: This was a parallel-group randomised controlled trial involving 84 ECEC services located in one region of New South Wales, Australia. Forty-one services were randomised to a 6-month multi-component implementation strategy or to a usual care group (n = 43). To increase total scheduled outdoor free play time, services were supported to modify their routines to increase provision of outdoor free play and/or indoor-outdoor free play opportunities (whereby children are allowed to move freely between indoor and outdoor spaces). The primary trial outcome, mean minutes per day of outdoor free play opportunities provided in ECEC services, was measured at baseline, 6-months (primary endpoint), and 18-months. Secondary outcomes were mean minutes of indoor-outdoor free play only and proportion implementing indoor-outdoor free play for the full day. The quality of the movement environment was assessed using direct observations in 30 ECECs at 6 months only. RESULTS: At 6 months, the intervention group showed a significant increase in mean daily minutes of outdoor free play (61.3 min; 95% CI 2.5 to 120.01; p = 0.041) and indoor-outdoor free play (59.1 min; 95% CI 9.1 to 109.1; p = 0.021) relative to the control group. However, no significant between-group differences were observed at 18 months. The proportion implementing a full-day indoor-outdoor program (OR 1.97; 95% CI 0.81 to 4.78; p = 0.196) and the quality of movement environments did not differ between groups at 6 months. CONCLUSIONS: The implementation strategy significantly increased outdoor free play opportunities in ECEC services post-intervention, though the between group effects were not sustained at 18 months. Future research should focus on ensuring the long-term impact of implementation strategies and understanding the factors driving changes in control group behaviour. TRIAL REGISTRATION: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000987864).
Shifts in food consumption patterns in the Levant: a systematic review of the last six decades.
Basha H, Shalash A, Wahdan Y … +1 more , Abu-Rmeileh NME
Int J Behav Nutr Phys Act · 2025 Apr · PMID 40275353 · Full text
BACKGROUND: Food consumption patterns have changed tremendously since the mid-twentieth century, with a rapid global nutritional shift raising concerns, particularly in disadvantaged regions such as the Eastern Mediterra...
BACKGROUND: Food consumption patterns have changed tremendously since the mid-twentieth century, with a rapid global nutritional shift raising concerns, particularly in disadvantaged regions such as the Eastern Mediterranean region (EMR). Given that food intake is very context-specific, this research examines food consumption patterns in Jordan, Lebanon, Palestine, and Syria, representing the contemporary Levant region. METHODS: A systematic review was conducted by searching PubMed, EMBASE, Web of Science, and CINAHL. The eligibility criteria were to include only original peer-reviewed observational studies reporting individual-level food consumption among local Jordanians, Lebanese, Palestinians, and Syrians. Extracted data were synthesized through descriptive statistics and presented in tables and charts. The risk of bias was assessed using the tool developed by Hoy et al. for prevalence studies. RESULTS: A total of 43 articles that measured and reported food consumption at the individual level for the populations in these countries were included. Findings reveal that in the 1960s, diets in the region were primarily local, seasonal, and plant-based, with moderate to low animal product intake. By the 1990s, a noticeable shift occurred, marked by increased consumption of processed foods, refined carbohydrates, and animal products, with minimal increase in fruit and vegetable intake. Most studies were conducted in Lebanon, limiting the generalizability of findings across the Levant countries. CONCLUSION: This review presents an understanding of food consumption changes on the level of food items, food groups, and dietary patterns specific to the Levant. Future studies on food consumption patterns should prioritize national surveys using valid, reliable, and cultural-specific measurement tools and provide detailed, age-disaggregated dietary data. Public health interventions are needed to address the ongoing dietary shift, which is unfolding amid political instability, economic crises, and food insecurity.
Relative validity of the Chrono-Nutrition Behavior Questionnaire (CNBQ) against 11-day event-based ecological momentary assessment diaries of eating.
Murakami K, Shinozaki N, McCaffrey TA … +3 more , Livingstone MBE, Masayasu S, Sasaki S
Int J Behav Nutr Phys Act · 2025 Apr · PMID 40275345 · Full text
BACKGROUND: A growing number of studies have investigated chrononutrition-related variables in relation to health outcomes. However, only a few questionnaires specifically designed for assessing chrononutrition-related p...
BACKGROUND: A growing number of studies have investigated chrononutrition-related variables in relation to health outcomes. However, only a few questionnaires specifically designed for assessing chrononutrition-related parameters have been validated. We aimed to examine the relative validity of the Chrono-Nutrition Behavior Questionnaire (CNBQ) against 11-day event-based ecological momentary assessment (EMA) diaries of eating. METHODS: Informed by previous research, we developed the CNBQ for the comprehensive assessment of chrononutrition-related parameters, including sleep variables, eating frequency, timing of eating, duration of eating occasions, duration of eating windows, and time interval between sleep and eating, for workdays and non-workdays separately. Between February and April 2023, a total of 1050 Japanese adults aged 20-69 years completed the online CNBQ and subsequently kept event-based EMA food diaries for 11 days, including 6.5 workdays and 4.5 non-workdays on average. RESULTS: Mean differences between estimates derived from the CNBQ and the EMA food diaries were < 10% for most of the variables examined, both for workdays (27 of 33; 82%) and non-workdays (25 of 33; 76%), and for variables based on differences between workdays and non-workdays, such as eating jetlag (5 of 6; 83%). Spearman correlation coefficients between estimates based on the CNBQ and estimates based on the EMA food diaries were ≥ 0.50 for 26 variables (79%) on workdays and 22 variables (67%) on non-workdays (e.g., mid-sleep time; total eating frequency; timing of first eating occasion, last eating occasion, first meal, and last meal; duration of first meal and last meal; duration of eating window; eating midpoint; and time interval between wake time and first eating occasion and between last meal and sleep time), and 2 variables based on differences between workdays and non-workdays (e.g., eating jetlag base on breakfast timing). Bland-Altman analysis showed that the limits of agreement were wide and that the bias of overestimation by the CNBQ was proportional as mean estimates of the CNBQ and EMA food diaries increased. CONCLUSIONS: These findings suggest that the relative validity of the CNBQ justifies its use in estimating mean values and ranking individuals for the majority of chrononutrition-related parameters.
Targeting mental health and wellbeing in women who have experienced gender-based violence through moderate-vigorous physical activity: a systematic review.
Baker T, Mundell N, Koorts H … +4 more , Pebole M, Rosenbaum S, Ganakas E, Teychenne M
Int J Behav Nutr Phys Act · 2025 Apr · PMID 40275282 · Full text
BACKGROUND: Gender-based violence (GBV) is associated with high rates of psychopathology (i.e., depression, anxiety, post-traumatic stress disorder) in victim-survivors. Existing research has demonstrated that physical a...
BACKGROUND: Gender-based violence (GBV) is associated with high rates of psychopathology (i.e., depression, anxiety, post-traumatic stress disorder) in victim-survivors. Existing research has demonstrated that physical activity is beneficial for mental health and wellbeing across various populations. However, it is currently unclear whether moderate-vigorous physical activity (MVPA) is efficacious for victim-survivors of GBV. Therefore, this systematic review aims to understand 1) the acceptability and feasibility of leisure-time MVPA interventions for victim-survivors of GBV, 2) the efficacy of leisure-time MVPA interventions for mental health and wellbeing in this cohort, and 3) the implementation strategies used in the development of such interventions. METHODS: Four databases were searched from inception to January 2024. Leisure-time MVPA intervention studies that reported on at least one measure of mental health or wellbeing for self-identified/biological women who had lived experience of GBV were eligible. RESULTS: Eleven studies met inclusion criteria, and analysis revealed a range of different types of MVPA (n = 5) and mental health/wellbeing outcomes measured (n = 9). The main findings include: 1) feasibility and acceptability of MVPA for victim-survivors was enhanced where trauma and violence-informed (TVI) practices were used in the development and delivery of interventions. 2) There was a lack of clarity and consistency around TVI practice in physical activity intervention research. 3) Leisure-time MVPA may be positively associated with mental health and wellbeing. CONCLUSIONS: Limited evidence exists regarding the impact of MVPA on mental health and wellbeing for this important population group. Future studies should embed TVI strategy within the design, delivery, and implementation of interventions.
Associations of different types of physical activity and sedentary behavior with self-rated health in children and adolescents: a systematic review of research from 2010 to 2024.
Liang Y, Zhu X, Yang JH … +5 more , Wang F, Zhang D, Yang X, Chen S, Liu Y
Int J Behav Nutr Phys Act · 2025 Apr · PMID 40259330 · Full text
BACKGROUND: Self-rated health (SRH) is one of the common measures to evaluate individuals' overall health. Many studies have explored the associations between different types of physical activity (PA), sedentary behavior...
BACKGROUND: Self-rated health (SRH) is one of the common measures to evaluate individuals' overall health. Many studies have explored the associations between different types of physical activity (PA), sedentary behavior (SB), and SRH in children and adolescents. These studies report inconsistent findings and sometimes highlight gender differences. This systematic review aims to synthesize findings to provide a comprehensive evaluation of these associations. METHODS: English-language articles published between January 2010 and September 2024 were systematically searched through Web of Science, PubMed, and EBSCOhost databases. Following PRISMA guidelines, we included 47 studies in this review that meet eligibility criteria. Study quality was assessed using the National Institutes of Health's study quality assessment tool for observational cohort and cross-sectional studies. RESULTS: The majority of study findings show that ≥ 60 min/day of moderate-to-vigorous PA (≥ 4 days/week), vigorous PA (≥ 3 days/week or ≥ 4 times/week), out-of-school PA (≥ 2 days/week), and sports participation are significantly positive associated with SRH. Additionally, evidence suggests that SB (e.g., watching TV and doing homework) generally shows no significant association with SRH. More study findings support that PA is positively associated with boys' SRH than that of girls. CONCLUSIONS: Findings show significant positive associations between PA and SRH, particularly those of vigorous and moderate-to-vigorous intensity, while the association between SB and SRH requires further investigation beyond TV and video game/computer times. Evidence of gender differences in the associations suggests the potential need for targeted strategies to enhance SRH in girls.
The effects of physical activity on mental health in adolescents with attention-deficit hyperactivity disorder: a randomized controlled trial.
Liu C, Yang Y, Wong SH … +2 more , Leung A, Sit CH
Int J Behav Nutr Phys Act · 2025 Apr · PMID 40247314 · Full text
BACKGROUND: Adolescents with attention-deficit hyperactivity disorder (ADHD) represent a high-risk population with an elevated likelihood of developing mental health disorders. Physical activity (PA) has emerged as a pro...
BACKGROUND: Adolescents with attention-deficit hyperactivity disorder (ADHD) represent a high-risk population with an elevated likelihood of developing mental health disorders. Physical activity (PA) has emerged as a promising intervention to enhance mental health in youth. However, no studies to date have comprehensively examined the immediate and sustained effects of PA, especially aerobic exercise-based PA, on mental ill-being-including internalizing problems (e.g., depression, anxiety, and stress) and externalizing problems (e.g., aggression)-as well as on two other critical indicators of mental health: psychological well-being (e.g., resilience) and cognitive function (e.g., inhibitory control) in adolescents with ADHD. Therefore, this study aimed to investigate whether an aerobic exercise-based PA intervention could elicit immediate and sustained benefits for mental health outcomes, including internalizing problems, externalizing problems, psychological well-being, and cognitive function, in adolescents with ADHD. METHOD: This study was an assessor-masked, multicenter, randomized clinical trial. A total of 88 adolescents with ADHD were enrolled. Eligible participants were randomized in a 1:1 ratio to either the exercise group or the control group. Participants in the exercise group attended a 60-min session of aerobic exercise once a week for 12 weeks. Depression, anxiety, stress, aggression, and resilience were assessed using self-report questionnaires, and inhibitory control was evaluated through computer-based neurocognitive tasks. Assessments were conducted at baseline (T0), at the end of the intervention (T1), and 3 months following the intervention (T2). RESULTS: The 80 eligible participants included 72 (90%) males with a mean age of 14.74 (± 1.59) years. Generalized estimating equation analyses revealed that the current PA intervention resulted in significantly better and sustained improvements in depression, anxiety, stress, and inhibitory control. Compared to the control group, the exercise group showed a significant increase in resilience at T1, but this effect was not sustained at T2. No significant reduction in aggression was found. CONCLUSIONS: The current aerobic exercise-based PA intervention was found to be effective in reducing depression, anxiety, and stress, as well as in promoting inhibitory control and resilience in adolescents with ADHD. The current findings suggest that an aerobic exercise-based PA intervention may be an alternative or adjunctive approach to enhancing mental health, particularly in alleviating internalizing problems, in this population. TRIAL REGISTRATION: ChiCTR, ChiCTR2400087025. Registered 17 July 2024-Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=230614 .
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