The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
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200 papers
Men's preconception diet quality patterns predict supportive food parenting practices: evidence from a longitudinal cohort study.
De Oliveira MH, Lo BK, Lee MM … +9 more , Armbruster S, Grafft N, Park IY, Cantu-Aldana A, Bauer KW, Coley RL, Haneuse S, Davison K, Haines J
Int J Behav Nutr Phys Act · 2026 May · PMID 42067938 · Full text
BACKGROUND: Food parenting practices play a vital role in shaping children's food intake, yet evidence linking fathers' earlier diet patterns to later parenting is limited. This study examined the association between fat...
BACKGROUND: Food parenting practices play a vital role in shaping children's food intake, yet evidence linking fathers' earlier diet patterns to later parenting is limited. This study examined the association between fathers' diet quality patterns during their adolescence and food parenting practices during fatherhood. METHODS: Data were drawn from Fathers & Families (F&F), a father-based cohort that recruited participants from an ongoing cohort in the United States that has followed participants since adolescence. Participants (n = 584) reported their dietary intake during adolescence (ages 10-18) using a Youth/Adolescent Food Frequency Questionnaire across multiple survey waves (1996-2011), and reported their food parenting practices using an online survey completed in 2021-2022. Fathers' diet quality patterns during their adolescence were derived from Healthy Eating Index-2020 (HEI-2020) scores using sequence analysis and hierarchical clustering. Associations between these adolescent diet quality patterns and food parenting practices (coercive control, structure, autonomy support) were estimated with ordinal logistic regression, adjusting for sociodemographic covariates and family meal frequency measured during adolescence. RESULTS: Three diet quality patterns were identified in adolescence: Low HEI-2020 (50.0%), Declining HEI-2020 (36.5%), and Increasing HEI-2020 (13.5%). Compared to those with Low HEI-2020, fathers demonstrating Increasing HEI-2020 had higher odds of using supportive food parenting practices with their preschool-aged children including higher use of structure-based food parenting practices (OR = 1.93, 95%CI [1.18-3.18]) and lower use of coercive control-based food parenting practices (OR = 0.57, 95%CI [0.36-0.91]). CONCLUSIONS: Improving men's diet quality during adolescence may have enduring benefits, promoting not only healthier adult eating patterns but also more supportive food parenting practices as fathers.
Contextual factors influencing the integration of physical activity policy, systems, and environmental interventions in the cooperative extension system: a systematic review.
Palmer S, Shaw E, Grocke-Dewey M … +3 more , Corlew K, Flournoy L, Balis LE
Int J Behav Nutr Phys Act · 2026 Apr · PMID 42063144 · Full text
BACKGROUND: Physical activity policy, systems, and environmental changes (PSEs) are effective but complex public health interventions. PSEs are increasingly being implemented through Cooperative Extension, a national sys...
BACKGROUND: Physical activity policy, systems, and environmental changes (PSEs) are effective but complex public health interventions. PSEs are increasingly being implemented through Cooperative Extension, a national system historically focused on individual-level direct education. Researchers have begun conducting contextual inquiry studies, but the extent to which they have matched barriers and facilitators to specific implementation strategies is unknown. This study seeks to understand common barriers and facilitators to integrating physical activity PSEs in Extension and identify implementation strategies selected in response. METHODS: A systematic review was conducted in June 2025 using three databases and two Extension-specific journals, with search terms focused on Extension; barriers, facilitators, and contextual factors; PSEs; and physical activity. Studies were included if they (1) were original, peer-reviewed articles, theses, or dissertations, (2) took place within Extension, (3) investigated integration of physical activity PSEs, (4) included barriers, facilitators, or contextual factors, (5) were in English, and (6) were published from 2014 to present. Two authors independently reviewed titles and abstracts for inclusion/exclusion, reviewed full text of remaining articles, and extracted data based on the Implementation Research Logic Model. Frequencies and proportions were calculated to tabulate data. RESULTS: Thirteen studies met inclusion criteria. Outcomes of interest were most commonly implementation (n = 9, 69%), adoption (n = 3, 23%), and maintenance (n = 3, 23%). Contextual inquiry was most commonly based on the Consolidated Framework for Implementation Research (n = 5, 38%) or no framework (n = 5, 38%). Studies using a framework predominantly collected data on the individuals (n = 6, 46%) or outer setting (n = 6, 46%) domains. Common barriers were individual capability, local conditions, and intervention complexity (each n = 6, 46%). Common facilitators were partnerships and connections (n = 7, 54%) and individual capability (n = 6, 46%). Most studies (n = 8, 62%) provided recommendations based on findings, although these were not explicitly labeled as implementation strategies. CONCLUSIONS: Results provide implications for improving contextual inquiry and implementation strategy selection in Extension. Contextual inquiry should be based on a determinant framework to understand multi-level influences on PSE integration. Otherwise, critical barriers within the inner setting may be overlooked. Specific matching processes should be used to engage key individuals in selecting implementation strategies that address specific barriers.
Development and usability of a mobile ecological momentary assessment platform for dietary surveillance in the U.S.
Schembre SM, Jospe MR, Weiss R … +7 more , Taylor CA, Bedrick EJ, Somerville J, Felrice J, Richardson KM, Dunton GF, Thomson CA
Int J Behav Nutr Phys Act · 2026 Apr · PMID 42035119 · Full text
BACKGROUND: Dietary surveillance is critical for addressing diet-related chronic diseases, yet traditional methods like 24-hour dietary recalls and food frequency questionnaires suffer from recall bias, high respondent b...
BACKGROUND: Dietary surveillance is critical for addressing diet-related chronic diseases, yet traditional methods like 24-hour dietary recalls and food frequency questionnaires suffer from recall bias, high respondent burden, and inaccurate portion size estimation. Mobile ecological momentary dietary assessment (mEMDA) enables real-time dietary capture, reducing memory load and minimizing reactivity. This study describes the user-centered development and iterative usability testing of Edna, a research-quality mEMDA platform for large-scale, low-burden dietary surveillance. Edna integrates real-time self-report with an image-supported, demographically inclusive food list derived from NHANES data and automated linkage to USDA nutrient databases. Here, we describe Edna’s development and usability in diverse U.S. adults. METHODS: Three sequential rounds of iterative, user-centered development and usability testing were conducted between June 2024 and June 2025. Participants (N = 146 U.S. adults, ages 19–65 years) were recruited nationally through recruited nationally through an online research volunteer registry using stratified sampling by age, sex, BMI, and geographic region. Participants were randomly assigned to event-contingent or interval-contingent sampling conditions and asked to log all dietary intake for 14 consecutive days. Development refinements were guided by quantitative usability metrics and structured participant feedback through daily surveys and end-of-study questionnaires between rounds. Primary outcomes included System Usability Scale (SUS) scores, percentage of days with logged entries (engagement), and interval completion (interval-contingent only). The app was iteratively refined between rounds based on user feedback until SUS scores plateaued (change < 3 points). Statistical analyses included independent samples t-tests and ANOVA. RESULTS: SUS scores increased from 71.7 (SD = 23.0) in Round 1 to 78.8 (SD = 19.3) in Round 3, exceeding the digital health app benchmark of 68. Engagement ranged from 92.5 to 97.6% of study days, and interval completion among interval-contingent users ranged from 76 to 87%. Participants rated portion-size images as clear and culturally inclusive, with 94% reporting excellent overall experience. CONCLUSIONS: Edna achieved above-average usability and engagement, demonstrating that mEMDA is acceptable for population-level dietary surveillance. These findings support integration of EMA-based tools into routine public health nutrition monitoring to capture dietary behaviors more dynamically with reduced burden compared to traditional assessment methods.
Implementation and effectiveness of a food education intervention to promote plant-based foods: a partially cluster-randomized controlled trial.
Vepsäläinen H, Kinnunen S, Niinistö S … +12 more , Forma L, Itkonen ST, Korhonen TE, Korkalo L, Kuusipalo H, Meinilä J, Nissinen K, Raulio S, Sambell R, Åkerlund M, Virtanen SM, Erkkola M
Int J Behav Nutr Phys Act · 2026 Apr · PMID 42021333 · Full text
BACKGROUND: Legumes can substitute for meat and are thus a particularly important food group for environmental sustainability. As the use of legumes among Finnish children is marginal, there is potential for a substantia...
BACKGROUND: Legumes can substitute for meat and are thus a particularly important food group for environmental sustainability. As the use of legumes among Finnish children is marginal, there is potential for a substantial increase in their consumption. However, food education delivered through early childhood education and care (ECEC) settings has rarely focused specifically on environmentally sustainable foods, such as legumes. This study describes the implementation and effectiveness of an ECEC-delivered food education intervention within the FoodStep study. METHODS: The partially cluster-randomized FoodStep intervention aimed to increase the supply of vegetables, legumes, fruits, berries, and sustainable fish while reducing the provision of other animal-based foods in the intervention ECEC centres. The control centres maintained their regular menus. Food education materials and training were included to support the acceptability of the menu changes. Based on implemented food education activities reported by the ECEC professionals during the 10-month intervention, the ECEC centres were classified into high-intensity intervention (n = 5), low-intensity intervention (n = 6), and control group (n = 12). Parents of the participating 3- to 5-year-old children (n = 86) reported their child’s willingness to taste foods using a five-point scale. Food consumption was assessed using two separate food frequency questionnaires: (1) foods consumed outside ECEC and (2) foods consumed in ECEC. We used linear mixed models to examine the effectiveness of the food education intervention in increasing food acceptance and consumption. RESULTS: Commonly implemented food education activities were sensory food education, books and drama, gardening, and crafting. Compared with the control group, the children in the high-intensity intervention group showed higher acceptance of (β = 4.27, 95% CI − 0.03 to 8.57, p = 0.06), and consumed more, legumes at the follow-up (β = 1.18, 95% CI 0.31 to 2.06, p = 0.01). No statistically significant associations were observed for the other food groups. CONCLUSIONS: ECEC-delivered food education interventions accompanied by accessible materials and activities can help to promote sustainable diets in children by increasing the acceptability and consumption of environmentally sustainable foods, such as legumes. To encourage sustainable diets, menu modifications should be supplemented with pedagogic food education activities in ECEC centres. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05249946) November 29, 2021.
Intervention development to reduce sedentary behaviour among adults: a qualitative investigation using the Behaviour Change Wheel.
Harsanyi H, Slot N, Parkinson R … +13 more , Morielli AR, Jeyapalan A, Holmes E, Flynn S, Campbell T, Quan H, Zeng Y, Yang J, Singh S, Vena J, Biddle S, Friedenreich CM, Yang L
Int J Behav Nutr Phys Act · 2026 Apr · PMID 42015269 · Full text
BACKGROUND: Reducing prolonged sedentary behaviour is recommended to improve population health. The development of behaviour change interventions requires understanding context-specific determinants, which may differ acr...
BACKGROUND: Reducing prolonged sedentary behaviour is recommended to improve population health. The development of behaviour change interventions requires understanding context-specific determinants, which may differ across domains of transportation, occupational, and leisure time sedentary behaviour. This study aimed to use the Behaviour Change Wheel to inform the development of domain-specific intervention strategies for reducing prolonged sedentary behaviour among Canadian adults. METHODS: One-on-one semi-structured interviews were conducted with a diverse sample of adult participants from across Canada. Determinants of reducing prolonged sedentary behaviour were identified through thematic analysis and characterized according to their relevance to domains of transportation, occupational, and leisure time sedentary behaviour. The Behaviour Change Wheel and Behaviour Change Techniques Taxonomy (BCTTv1) were used to identify intervention strategies, components, and modes of delivery specific to and across behavioural domains. RESULTS: Thirty participants were interviewed (63% women, 60% age 25–44, and 50% identified as white). While all participants endorsed potential benefits of and personal goals related to reducing prolonged sedentary time, many had difficulty implementing these changes in their day-to-day life. Most participants identified leisure time as the domain in which they were most keen to reduce prolonged sedentary time. Barriers to reducing sedentary behaviour varied by domain: transportation-related barriers were primarily linked to physical opportunity, occupational barriers to social opportunity, and leisure time barriers to automatic motivation. Intervention techniques including prompts/cues, self-monitoring, and goal setting were identified to overcome barriers to reducing sedentary behaviour across domains. Restructuring the physical and social environment were identified as being particularly significant for enabling behaviour change in transportation and occupational domains, respectively. CONCLUSIONS: Individual-level interventions, such as goal-oriented prompts or cues, may be well-suited to reducing leisure time sedentary behaviour. In contrast, multilevel interventions, including organizational social restructuring and urban planning policy changes may be needed to address significant opportunity-related barriers in occupational and transportation domains.
Long-term impacts of co-designed sustainable park improvements on physical activity and other wellbeing behaviours: a 7-year natural experimental study in a deprived urban area.
Benton JS, Anderson J, Morley A … +7 more , Ye J, Barker E, Wu T, Macintyre VG, Rothwell J, Dennis M, French DP
Int J Behav Nutr Phys Act · 2026 Apr · PMID 42015265 · Full text
BACKGROUND: Creating or improving urban parks is a promising intervention for promoting physical activity (PA). However, robust natural experimental evidence of effectiveness remains limited, particularly regarding long-...
BACKGROUND: Creating or improving urban parks is a promising intervention for promoting physical activity (PA). However, robust natural experimental evidence of effectiveness remains limited, particularly regarding long-term impacts. We previously showed that co-designed, sustainable urban park improvements in a deprived UK area increased walking and other wellbeing-related behaviours up to 15 months post-intervention. We now examine whether these effects were sustained five years post-intervention (seven years after baseline). METHODS: Two intervention sites were matched to two comparison sites, with two additional nearby comparison sites included to assess wider neighbourhood trends. Outcomes were assessed using systematic observations at baseline (2018), 15 months post-intervention (2021), and five years post-intervention (2025). The primary outcome was change in the number of people walking; secondary outcomes included vigorous PA, sedentary behaviour, social interactions, and taking notice of the environment. Multilevel mixed-effects negative binomial regression models compared changes between intervention and comparison sites, adjusting for day of week, time of day, and precipitation. Additional analyses compared 15-month (2021) and five-year (2025) follow-ups to assess how intervention effects evolved over time. Intercept surveys assessed self-reported outdoor space use at baseline (2019; n = 217) and follow-up (2025; n = 232). RESULTS: From baseline to five years post-intervention, walking at the intervention sites significantly increased by 70% relative to the comparison sites (IRR = 1.70, 95% CI 1.02–2.82). Significant increases were also observed for sedentary behaviour, social interactions, and taking notice of the environment. Comparison of the 15-month and five-year follow-ups indicated some attenuation of intervention effects over time. Observations at nearby comparison sites suggested that these effects were not attributable to wider neighbourhood trends. The largest increases in observed park use were among young people and non-white ethnic groups. Intercept surveys corroborated the observational findings, showing significantly greater increases in self-reported outdoor space use in the intervention area. CONCLUSIONS: Co-designed, sustainable urban park improvements can generate long-term increases in walking and other wellbeing-related behaviours in deprived urban areas, with effects persisting for at least five years. Urban green space interventions, which can target areas with the greatest need, therefore represent an effective long-term strategy for increasing PA. STUDY PROTOCOL: Study protocol published in Open Science Framework before the first follow-up data collection finished ( https://osf.io/zqgcn ). Date of registration: 18 August 2020.
Bridging the intention-behavior gap in physical activity among pregnant women with gestational diabetes mellitus: a qualitative study of self-control strategy use and dynamics.
Liu Q, Xie F, Yang Z … +8 more , Guo P, Zhao R, Jin Y, Wang X, Zhang W, Li S, Liu H, Feng S
Int J Behav Nutr Phys Act · 2026 Apr · PMID 42010575 · Full text
BACKGROUND: Although pregnant women with gestational diabetes mellitus (GDM) often intend to engage in physical activity (PA), they may struggle to translate these intentions into action. Self-control could support PA go...
BACKGROUND: Although pregnant women with gestational diabetes mellitus (GDM) often intend to engage in physical activity (PA), they may struggle to translate these intentions into action. Self-control could support PA goal pursuit among this population, as it enables individuals to prioritize health goals over immediate rewarding temptations, such as the urge to rest or sedentary leisure. However, the role of self-control has received limited attention in the existing studies. Therefore, this study aimed to explore how pregnant women with GDM use self-control to bridge the gap between PA intention and behavior in daily life. METHODS: A descriptive qualitative study was conducted. 24 pregnant women with GDM were recruited using purposive sampling at a tertiary hospital in Hangzhou City, Zhejiang Province, China, from April to May 2025. Data were collected through semi-structured interviews and analyzed using qualitative content analysis. RESULTS: Three themes were identified: conflict between the pursuit of PA goals and temptations, context-adaptive self-control strategies for PA, and dynamics of self-control for PA during pregnancy. Despite strong PA intentions driven by concerns for maternal and fetal health, pregnant women with GDM reported conflicts between their goals and temptations, with rationalization of temptations emerging as a key psychological process linked to reduced PA engagement. To manage this conflict, pregnant women with GDM employed four types of self-control strategies: internal drive strategies based on health cognition and self-motivation, autonomous construction of external supervision strategies, technology-enabled strategies, and behavioral automation strategies. Self-control for PA was found to be dynamic in response to metabolic, physical, and psychosocial contexts, characterized by feedback-driven goal adjustment, strategies switching, self-control failure coping, and self-control motivation fluctuation throughout pregnancy. CONCLUSIONS: This study provides a self-control perspective to better understand and promote PA engagement in pregnant women with GDM. Healthcare providers may consider supporting these women to identify and reappraise rationalizations of temptations, develop a personalized repertoire of self-control strategies with technological support, and foster self-control motivation for PA habit formation.
Measuring change in school-based practices that promote children's healthy eating and active living: a psychometric study.
Rider CD, Baig R, Kao J … +3 more , Hewawitharana SC, Woodward-Lopez G, Brown MW
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41998760 · Full text
BACKGROUND: Public health interventions targeting youth nutrition and physical activity often focus on changing policies, systems, and environments (PSE) in schools. To support rigorous evaluation of PSE efforts, this st...
BACKGROUND: Public health interventions targeting youth nutrition and physical activity often focus on changing policies, systems, and environments (PSE) in schools. To support rigorous evaluation of PSE efforts, this study examined whether the School Site-Level Assessment Questionnaire (SLAQ), a self-assessment instrument for schools serving grades kindergarten through 12 (K-12), was sufficiently sensitive to measure changes in schools’ nutrition and physical activity practices in response to interventions. METHODS: This longitudinal, observational study included 69 K-12 schools in low-income California communities that completed School SLAQs in two consecutive school years (2022 and 2023) and reported PSE and/or nutrition education interventions in school year 2022. Wilcoxon signed-rank and paired t-tests compared changes in nutrition and physical activity practices measured by the School SLAQ between years among schools with relevant interventions. RESULTS: Statistically significant increases in median nutrition (by 0.06, p < 0.001; effect size [ES] = 0.42) and PA (by 0.07, p < 0.001; ES = 0.64) overall domain scores were observed among schools implementing corresponding interventions. Statistically significant increases were also observed in six of nine practice areas: school meal and beverage quality (by 0.04 [95% CI: 0.002–0.07]), meal environment and promotion (by 0.04 [95% CI: 0.01–0.08]), non-meal food and beverage quality and promotion (by 0.09 [95% CI: 0.05–0.13]), non-physical education physical activity opportunities (by 0.09 [95% CI: 0.02–0.17]), physical activity facilities (by 0.07 [95% CI: 0.03–0.12]), and nutrition education (by 0.10 [95% CI: 0.01–0.18]), among schools implementing corresponding interventions. CONCLUSION: The School SLAQ is, to our knowledge, the only tool demonstrated to measure changes in the K-12 school nutrition and physical activity environment. This comprehensive and valid instrument can be a valuable tool for schools and public health partners when planning and evaluating the effectiveness of school-based PSE interventions, as well as measuring the impact of policy initiatives.
Compositional movement behaviours and preschool children's social-emotional development.
Christian H, Adams EK, Hoorn SV … +5 more , George P, Nathan A, Trost SG, Schipperijn J, Carson V
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41992309 · Full text
BACKGROUND: Individually, sufficient physical activity and sleep and limited sedentary behaviour are associated with favourable social-emotional development in preschool-aged children. However, these behaviours are inter...
BACKGROUND: Individually, sufficient physical activity and sleep and limited sedentary behaviour are associated with favourable social-emotional development in preschool-aged children. However, these behaviours are interdependent. Thus, we examined the effect of preschool children’s 24-hour movement behaviour compositions (physical activity, sedentary time, sleep) on social-emotional development. METHODS: Wave one data from the PLAY Spaces and Environments for Children’s Physical Activity (PLAYCE) cohort study (Perth, Western Australia) were utilised (1,073 children aged 2-5-years). Daily physical activity, sedentary time, and sleep were measured using accelerometry and parent-report surveys. Social-emotional development was measured using the parent-reported Strengths and Difficulties Questionnaire. Compositional data analysis examined associations between movement behaviour compositions and social-emotional development. RESULTS: Movement behaviour compositions were significantly associated with total difficulties (p = 0.008), emotional problems (p = 0.04), peer problems (p = 0.031) and hyperactivity (p = 0.002). More sleep and energetic play, relative to other movement behaviours, were associated with better social-emotional development. Reallocating light-intensity activity and games to sleep and sedentary behaviour were associated with better social-emotional development. After separating sedentary behaviour into screen time and quiet play, reallocating screen time and light-intensity activity and games in favour of quiet play were associated with better social-emotional development. CONCLUSION: Reallocating some of the daily time spent in light-intensity activities and games and screen time to sleep and energetic play could be beneficial for preschool children’s social-emotional development. Future movement behaviour composition studies should examine different types of sedentary behaviour as well as the longitudinal impact of movement behaviour composition on children’s social-emotional development.
Effects of exercise on multiple health outcomes in children and adolescents with overweight or obesity: a meta-analysis of 176 randomized controlled trials and its implications for global obesity prevention.
Men J, Wang P, Wang J … +11 more , Zhu G, Yu Z, Wu S, Zhang Y, An W, Li Z, Ma R, Zhang R, Li S, Wang Y, Liu P
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41992201 · Full text
BACKGROUND: The continuing rise in overweight and obesity among children and adolescents portends a life-course public-health crisis. Although evidence has been accumulating that exercise interventions improve health in...
BACKGROUND: The continuing rise in overweight and obesity among children and adolescents portends a life-course public-health crisis. Although evidence has been accumulating that exercise interventions improve health in those with overweight or obesity, few studies have integrated multidimensional health outcomes within a unified analytical framework. To systematically evaluate the effects of exercise interventions on multidimensional health outcomes—including anthropometric, cardiometabolic, cardiorespiratory, and mental health indicators—among children and adolescents with overweight or obesity, and to explore implications for global obesity prevention and control. METHODS: Six databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Data) were searched from inception to January 10, 2025, for randomized controlled trials of exercise interventions in children and adolescents with overweight or obesity. Data were pooled using random- or fixed-effects models, as appropriate. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB 2.0), and the certainty of evidence was rated with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The protocol was registered with PROSPERO (CRD420251169879). RESULTS: A total of 176 trials (11,696 participants from 32 countries) were analyzed. Exercise interventions significantly reduced body mass index (MD: −1.25 kg m−2, 95% CI: −1.51 to −0.98), waist circumference (MD: −2.86 cm, 95% CI: −3.52 to −2.20), and body fat percentage (MD: −2.39, 95% CI: −2.81 to −1.96); improved cardiorespiratory fitness (maximal oxygen consumption MD: 2.83 mL kg−1 min−1, 95% CI: 2.17 to 3.50; peak oxygen uptake MD: 2.56 mL kg−1 min−1, 95% CI: 1.86 to 3.27); and lowered resting heart rate (MD: −2.89 bpm, 95% CI: −3.82 to −1.97). Cardiometabolic indicators also improved, with reductions in systolic blood pressure (MD: −3.90 mmHg, 95% CI: −5.34 to −2.46) and diastolic blood pressure (MD: −1.70 mmHg, 95% CI: −2.68 to −0.71); total cholesterol (MD: −0.35 mmol/l, 95% CI: −0.43 to −0.27), triglycerides (MD: −0.23 mmol/l, 95% CI: −0.28 to −0.17), and low-density lipoprotein cholesterol (MD: −0.28 mmol/l, 95% CI: −0.35 to −0.20) decreased, accompanied by an increase in high-density lipoprotein cholesterol (MD: 0.08 mmol/l, 95% CI: 0.05 to 0.10). Fasting glucose (MD: −0.20 mmol/l, 95% CI: −0.26 to −0.13) and fasting insulin (MD: −3.93 µU/mL, 95% CI: −4.80 to −3.06) also declined. Regarding mental health, exercise improved self-esteem (SMD: 0.18, 95% CI: 0.04 to 0.33) and self-worth (SMD: 0.25, 95% CI: 0.10 to 0.39), although the evidence for effects on depression and anxiety was limited. The observed effects varied across prespecified subgroups defined by exercise dose and type, region, country income level, sex, and obesity or metabolic phenotypes. CONCLUSIONS: Exercise interventions consistently improved multidimensional health outcomes in children and adolescents with overweight or obesity, showing dose- and type-dependent effects with greater benefits in higher-risk groups. These findings underscore the value of exercise as a key strategy to address obesity, while recognizing that political and economic barriers may hinder policy translation. Future research should refine intervention approaches and strengthen pathways from evidence to policy implementation.
The effect of increasing availability of vegetarian meals on their sales in worksite cafeterias: a stepped-wedge cluster randomised controlled trial.
Becker E, Garnett EE, Scarborough P … +9 more , Cummins S, Savory B, Huse O, Thompson C, Brock J, Clark M, Renzella J, White M, Pechey R
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41987270 · Full text
BACKGROUND : Reducing meat consumption is critical for planetary health and could benefit public health. Restructuring food environments – such as increasing vegetarian meal availability – has been shown to influence die...
BACKGROUND : Reducing meat consumption is critical for planetary health and could benefit public health. Restructuring food environments – such as increasing vegetarian meal availability – has been shown to influence dietary choices in online and university canteen settings. However, evidence from more diverse populations is limited. METHODS : We conducted a stepped-wedge cluster-randomised controlled trial in six English worksite cafeterias over seven weeks. The intervention involved replacing one meat-based meal on the lunch menu with a vegetarian option. Likelihood of selecting a vegetarian meal (primary outcome) was analysed in a logistic regression with random intercept for cafeteria and fixed effect for time. Secondary outcomes included nutritional and sustainability markers (e.g., kilocalories, greenhouse gas (GHG) emissions), revenue, and food waste. Interviews with cafeteria staff and customers explored intervention acceptability and barriers. RESULTS : The intervention encompassed 26,170 meal sales over 42 site-weeks. The intervention increased the likelihood of selecting a vegetarian meal by 41% [95% CI: 28 to 55]. Per-meal kilocalories were reduced by 26.1 [95% CI -34.4 to -17.7], and per-meal GHGs by 0.16 kg CO2-eq [-0.22 to -0.11]. No significant negative impacts on business outcomes such as cafeteria revenue (-98.43 GBP [-436.03 to 239.17]) or food waste (-8.25 kg [-48.38 to 31.87]; -61.64 GBP [-306.80 to 183.53]) were found. Customers and staff reported that the intervention was acceptable, non-intrusive, and easy to implement, with concerns about customer dissatisfaction and food waste not confirmed by our data. Suggestions for improvement included greater attention to pricing and taste to further encourage uptake. CONCLUSIONS : Increasing the availability of vegetarian meals in cafeterias can significantly shift food choices and reduce environmental impact and calories consumed, without compromising business outcomes, and should be considered an effective strategy for sustainability and public health in diverse food service settings. TRIAL REGISTRATION NUMBER: This study is registered with the ISRCTN registry, ISRCTN36918695.
A systematic review and meta-analysis on the effectiveness of if-then plans - in a strict sense - to facilitate fruit and vegetable consumption in adults.
Melum SK, Martiny-Huenger T
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41987207 · Full text
BACKGROUND: A fruit-and-vegetable rich diet is important in the prevention of non-communicable diseases. If-then plans, or implementation intentions, are proposed to facilitate behavior change by formulating plans that l...
BACKGROUND: A fruit-and-vegetable rich diet is important in the prevention of non-communicable diseases. If-then plans, or implementation intentions, are proposed to facilitate behavior change by formulating plans that link perceivable cues and goal-directed responses. We investigated the effectiveness of if-then planning interventions to facilitate fruit and vegetable intake in adults, with a strict focus on if-then planning procedures and excluded procedures representing conventional planning. METHODS: A systematic review (MEDLINE, Embase, and PsycInfo; last searched April 3rd, 2025) and meta-analysis was conducted. Included studies were randomized controlled trials, testing the effect of if-then plans on fruit and/or vegetable intake against active control groups. RESULTS: Ten articles were identified as eligible, including 12 comparisons (N = 2399) with intervention-outcome periods of 1 week to 24 months. If-then planning participants reported consuming approximately a quarter of a portion of fruit and vegetable per day more than participants in the control groups (MD = 0.29, 95% CI: 0.11; 0.48). CONCLUSION: A central limitation of the analysis is that all included studies are based on self-reported fruit and vegetable consumption. While the effect size of the investigated intervention is small, its low resource requirements make it an accessible option for promoting fruit and vegetable consumption.
Dose-response relationship between physical activity and subjective sleep quality in patients with insomnia: a systematic review and Bayesian meta-analysis of randomized controlled trials.
Huang Z, Zhang Y, Xu W
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41965648 · Full text
BACKGROUND: Insomnia is a prevalent public health concern with significant consequences for well-being. While physical activity (PA) is recognized as a beneficial non-pharmacological intervention, its precise dose-respon...
BACKGROUND: Insomnia is a prevalent public health concern with significant consequences for well-being. While physical activity (PA) is recognized as a beneficial non-pharmacological intervention, its precise dose-response relationship with subjective sleep quality remains insufficiently quantified. This study aimed to systematically evaluate the efficacy of PA on subjective sleep quality in patients with insomnia and to quantitatively delineate the dose–response relationship using Bayesian meta-analysis. METHODS: A systematic search was conducted across Web of Science, PubMed, Embase, PsycINFO, and the Cochrane Library from inception to February 2026. Randomized controlled trials (RCTs) investigating the effects of PA on subjective sleep quality in participants diagnosed with insomnia were included. A Bayesian random-effects meta-analysis was performed to calculate pooled effect sizes (Hedges’g) with 95% Credible Intervals (CrI). Dose–response relationships were modelled using restricted cubic splines to identify minimum and optimal dosages. Dosage was expressed as the weekly volume in MET-minutes (Metabolic Equivalent of Task × minutes/week). The certainty of evidence was assessed using the GRADE approach. RESULTS: 24 RCTs involving 1,591 participants were included. Bayesian synthesis indicated low evidence that PA significantly improves subjective sleep quality compared with inactive controls (Hedges’g = -0.56, 95% CrI: -0.68, -0.45). Dose–response analysis revealed a non-linear “L-shaped” relationship. Benefits accrued rapidly at lower volumes, with a minimum effective dose estimated at 100 METs-min/week. The therapeutic effect peaked at an optimal dose of approximately 650 METs-min/week (Hedges’g = -0.64, 95% CrI: -0.85, -0.44), beyond which additional volume yielded diminishing marginal returns. Moderation analyses indicated that the effect was more pronounced in adults (Hedges’ g = -1.00) than in older adults (Hedges’ g = -0.51), and was consistent across different diagnostic methods and measurement instruments. Various types of exercise, including aerobic, strength, mind-body, and multicomponent training, all demonstrated beneficial effects. CONCLUSIONS: Physical activity is an effective treatment for insomnia, characterized by an L-shaped dose–response curve. The relationship is characterized by a rapid initial benefit at low volumes, with a statistically significant response observed at 100 MET-min/week and a plateau in effect occurring at approximately 650 MET-min/week, beyond which additional volume yields diminishing returns. TRIAL REGISTRATION: CRD420251172873.
Socioeconomic inequalities in exposure to neighbourhood environments for physical activity: a systematic review.
van de Geest JDS, Cuenca VC, Schoonmade LJ … +4 more , Cereijo L, Mora DJ, Meijer P, Lakerveld J
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41957802 · Full text
BACKGROUND: Insufficient physical activity (PA) is a major behavioural determinant of obesity and other noncommunicable diseases. Although the health benefits of PA are well established, many populations, particularly so...
BACKGROUND: Insufficient physical activity (PA) is a major behavioural determinant of obesity and other noncommunicable diseases. Although the health benefits of PA are well established, many populations, particularly socioeconomically disadvantaged groups, remain insufficiently active. Neighbourhood characteristics play an important role in shaping population physical activity (PA) levels, for example through walkable streets, bikeable infrastructures, playgrounds, green- and blue spaces, and sport facilities. However, PA-supportive environments may be unequally distributed across SEP groups. This systematic review provides a comprehensive synthesis of evidence on socioeconomic inequalities in neighbourhood environments that promote PA across different life stages in high-income countries. METHODS: In February 2024, we systematically searched Medline, Embase, Web of Science Core Collection, and Scopus. Eligible studies were quantitative primary research examining objective measures of neighbourhood PA-promoting environments alongside at least one individual- or area-level socioeconomic indicator. Titles and abstracts were screened with ASReview, and full texts were screened manually in duplicate. Data were extracted with a predefined form, and risk of bias was assessed with an adapted version of the AXIS tool. We synthesised our findings narratively and by reported proportions of associations indicating disadvantaged exposure, advantaged exposure, or no statistically significant difference for people with lower SEP. RESULTS: A total of 250 studies were included. Overall, people with lower SEP were more likely to live in areas with (components of) walkable and bikeable infrastructure, and to have playgrounds nearby, but less likely to have access to formal sports facilities. For other PA-promoting environments, findings were largely null. Patterns varied across age groups, study regions, statistical approaches, and SEP indicators. CONCLUSIONS: Populations with lower SEP were more exposed to walkability components, bikeability, and playgrounds, but less exposed to sports facilities. For most other environments, no clear differences were found. Socioeconomic inequalities in exposure to PA environments are nuanced rather than uniform. This complexity highlights the need to consider multiple environmental features together and to tailor equity-focused interventions to local contexts.
Association of physical and social neighbourhood environment with movement behaviours among schoolchildren: a compositional data analysis.
Xing R, Rachele JN, Loh V … +2 more , Dumuid D, Pedišić Ž
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41952153 · Full text
BACKGROUND: How schoolchildren distribute their time between movement behaviours may be impacted by the neighbourhood environment. Few studies have investigated the associations between the physical and social environmen...
BACKGROUND: How schoolchildren distribute their time between movement behaviours may be impacted by the neighbourhood environment. Few studies have investigated the associations between the physical and social environment and the full movement behaviour composition, including times spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour, and sleep, and their findings are inconsistent. Therefore, our aim was to investigate this association in a large, national-representative sample of schoolchildren from major cities and regional/remote areas. METHODS: We used data from the Longitudinal Study of Australian Children and the Child Health CheckPoint study, collected among 1230 child-parent pairs (child age range: 10–12 years). Parents were asked about neighbourhood general safety, access to destinations and services, and social capital and cohesion. Children’s time spent in MVPA, LPA, sedentary behaviour, and sleep was assessed using wrist-worn GENEActiv accelerometers. The associations between the physical and social environment characteristics (independent variables) and movement behaviour composition expressed as isometric log ratio coordinates (dependent variables) were examined using multiple linear regression analyses, adjusted for age, body mass index, pubertal status, sex, and socioeconomic position. RESULTS: Among schoolchildren from regional/remote areas, access to destinations and services (Pillai’s trace = 0.030; p = 0.010), as well as social capital and cohesion (Pillai’s trace = 0.024; p = 0.032) were associated with movement behaviour composition. In specific, better access to destinations and services was associated with higher MVPA and lower LPA, while higher social capital and cohesion were associated with higher MVPA and LPA, and lower sedentary behaviour (with negligible changes in the remaining movement behaviours). We did not find a significant association between general safety and the movement behaviour composition among schoolchildren from regional/remote areas (Pillai’s trace = 0.005; p = 0.641) or any significant associations among schoolchildren from major cities (p > 0.050 for all). CONCLUSIONS: These findings highlight the importance of access to destinations and services, as well as social capital and cohesion, in shaping the movement behaviour composition among schoolchildren from regional/remote areas. More research is needed to draw conclusions about the association between neighbourhood environment and movement behaviour composition among schoolchildren from major cities.
REFRESH-daily: a short 10-item questionnaire for evaluating behavior change towards healthier and more environmentally sustainable diets.
Fresán U, Boronat A, Buekers J … +3 more , de la Torre R, König LM, Chevance G
Int J Behav Nutr Phys Act · 2026 Apr · PMID 41923253 · Full text
BACKGROUND: Short dietary questionnaires for measuring environmentally sustainable healthy diets in daily life are scarce. REFRESH-daily (Rapid Evaluation FoR Environmentally Sustainable Healthy diets daily) is a brief 1...
BACKGROUND: Short dietary questionnaires for measuring environmentally sustainable healthy diets in daily life are scarce. REFRESH-daily (Rapid Evaluation FoR Environmentally Sustainable Healthy diets daily) is a brief 10-item questionnaire developed to fill this gap. It is administered daily and aggregates intake data to capture weekly dietary patterns and its alignment with dietary recommendations. This study aimed to evaluate its internal consistency, relative validity, construct validity, as well as end-user acceptability. METHODS: A validation study was conducted among 106 adults in Spain. Participants completed REFRESH-daily for seven days via a mobile application, alongside a 7-day digital food diary as the reference method. Internal consistency was assessed using Cronbach’s alpha. Relative validity was evaluated through multi-level Bland–Altman analyses comparing REFRESH-daily with food diary data. Construct validity was tested by examining associations between REFRESH-daily score and food consumption, nutrient intake, estimated health risks based on the Global Burden of Disease framework, and environmental impact via Life Cycle Assessment methodology. Likert-scales were used to assess acceptability. RESULTS: REFRESH-daily showed good internal consistency (Cronbach’s alpha = 0.71). Relative validity analyses showed a small mean difference of 0.3 points (out of 10) between REFRESH-daily and food diary scores. Higher REFRESH-daily scores were associated with greater intake of whole plant-based foods, health-promoting nutrients, lower estimated disease risks, and reduced environmental impacts. User acceptability was high. CONCLUSIONS: REFRESH-daily is a valid, reliable and user-friendly tool for assessing alignment with environmentally sustainable healthy diets. Its ease of use and sensitivity to subtle dietary shifts make it particularly well-suited for the integration into behavioral dietary interventions serving as a key tool for tracking progress and informing feedback in research and applied settings.
Implementation of Change Club action plans to promote built environment change in rural communities.
Graham ML, Lewis EC, Villarreal DL … +8 more , Folta SC, Volpe LC, Eldridge GD, Hanson KL, Marshall GA, Maddock JE, Nelson ME, Seguin-Fowler RA
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41918127 · Full text
BACKGROUND: Rural United States communities often experience disproportionate burdens of obesity, cardiovascular disease, diabetes, and premature mortality. Built environment constraints, including limited sidewalks, rec...
BACKGROUND: Rural United States communities often experience disproportionate burdens of obesity, cardiovascular disease, diabetes, and premature mortality. Built environment constraints, including limited sidewalks, recreation facilities, and access to nutritious foods, may restrict opportunities for adoption and maintenance of healthy eating and physical activity behaviors. Civic engagement approaches empower residents to assess community needs, develop action plans, and implement policy, systems, and environmental (PSE) strategies. However, few randomized trials have examined implementation of PSE strategies and their impacts in rural adult populations. This study evaluated implementation of Cooperative Extension-led Change Club (CC) community project action plans aimed at facilitating PSE change in six rural and micropolitan Texas and New York intervention communities. Presently, we document implementation outcomes and identify factors that may have influenced implementation using the Consolidated Framework for Implementation Research (CFIR). METHODS: CCs followed a 24-module curriculum facilitated by trained Extension educators. Approved action plans were provided with seed money to target diet and physical activity PSE changes. Implementation outcomes regarding the action plans were tracked through educator reports, interviews, and proposals. CFIR factors were assessed during the early stages of action plan implementation using interviews with educators and participant residents. RESULTS: All six intervention communities implemented action plans, most of which had multiple components. Each prioritized environmental changes and most focused on addressing physical activity. Implementation timing and continuity varied, influenced by external factors such as weather and local approvals. CFIR analysis identified beliefs about feasibility, stakeholder engagement, and group decision-making as key factors influencing implementation. CONCLUSIONS: Rural CCs successfully launched a variety of built environment initiatives. This implementation evaluation highlights pathways and barriers related to scaling rural civic engagement strategies. TRIAL REGISTRATION: Clinical Trial #NCT05002660 (August 2021).
Committed to climate action? Opportunities for scientific societies to lead the change we need in the world.
Dogra S, Reis R, Hinckson E … +9 more , Ferguson T, Cerin E, Wolfson JA, Chastin S, Van Dyck D, Chillón P, Abu-Omar K, Palmeira AL, ISBNPA Climate Action Committee
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41913208 · Full text
The climate crisis is undoubtedly compromising human and planetary health. As behaviour change scientists, we must reflect on the behaviours we are promoting, as well as the research and professional practices we engage...
The climate crisis is undoubtedly compromising human and planetary health. As behaviour change scientists, we must reflect on the behaviours we are promoting, as well as the research and professional practices we engage in, to ensure we are prioritizing human and planetary health. This commentary focuses on issues within the scope of scientific/academic societies by sharing our journey as the Climate Action Committee for the International Society for Behavioural Nutrition and Physical Activity. First, we provide details on the structure and function of our committee, then we provide insights into the GHG emissions associated with running our society, and finally, we report on our journey thus far, sharing the strategies we have identified that align with current evidence on climate change. We also address the tensions associated with climate action within scientific societies, and hope to begin a dialogue with others to come up with creative solutions that continue to support research and researchers, while addressing the urgency of our climate crisis.
Overprotective parenting and preschoolers' physical activity and screen time: cross-sectional findings from the DAGIS survey.
Rahkola J, Vepsäläinen H, Lehto R … +9 more , Gerards S, Gubbels J, Kailaheimo-Björkqvist J, Launistola H, Maukonen M, Sajaniemi N, Erkkola M, Roos E, Ray C
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41896964 · Full text
BACKGROUND: General parenting describes a parents’ overall approach to parenting across situations, creating the emotional climate of the parent–child relationship. Some general parenting constructs have been associated...
BACKGROUND: General parenting describes a parents’ overall approach to parenting across situations, creating the emotional climate of the parent–child relationship. Some general parenting constructs have been associated with children’s health behaviors. However, overprotective parenting—marked by excessive involvement and control with limited autonomy support relative to the child’s developmental level—remains largely understudied in relation to preschoolers’ physical activity (PA) and screen time (ST), as do the potential moderating effects of sociodemographic variables in these associations. Therefore, we examined the associations of overprotection with PA and ST among Finnish preschoolers and explored whether parental education or children’s sex moderated these associations. METHODS: This cross-sectional study included 798 Finnish 3–6-year-olds and their parents from the DAGIS Survey. Parents completed an overprotection scale from an item-reduced version of the Comprehensive General Parenting Questionnaire. Children’s ST was parent-reported via a seven-day diary, while PA was measured with Actigraph accelerometers (for seven days). Weekday, weekend, and overall averages were computed for ST, moderate-to-vigorous physical activity (MVPA), and total physical activity (TPA). Linear mixed-effects models were used for analyses. The models were adjusted for the child’s age and sex, parental education, number of children in the household, birth order, and questionnaire respondent (mother/father). Moderation by sex and education was tested by adding the corresponding interaction terms to the models. RESULTS: Children’s weighted averages were 71 min of MVPA, 398 min of TPA, and 76 min of ST per day. Overprotection was inversely associated with weekend MVPA (B: -3.49, 95%CI: -6.50; -0.48), weekend TPA (B: -9.94, 95%CI: -16.56; -3.34), and overall average TPA (B: -5.70, 95%CI: -10.78; -0.64). No associations with ST were found, nor were any associations moderated by sex or parental education. CONCLUSIONS: These results suggest an association between higher overprotection and lower PA among preschool-aged children regardless of child sex and parental educational level. We hypothesize that overprotective parents may, for example, restrict children’s PA due to safety concerns. Although the mechanisms and causality of the associations found require further investigation, identifying and addressing overprotective parenting could be beneficial in PA-promoting interventions.
Associations between perceived neighborhood environment and physical activity among breast cancer patients engaged in a physical activity program concomitant to cancer treatment: cross-sectional and longitudinal analyses in the DISCO trial (DiscoSpace).
Langlois M, Grassot L, Fournier B … +8 more , Trédan O, Dupuis C, Maire A, Sueur A, Praud D, Fervers B, Pérol O, His M
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41882725 · Full text
BACKGROUND: Despite the proven benefits of physical activity during breast cancer treatment, many women reduce their practice after diagnosis. A better understanding of how the neighborhood environment influences physica...
BACKGROUND: Despite the proven benefits of physical activity during breast cancer treatment, many women reduce their practice after diagnosis. A better understanding of how the neighborhood environment influences physical activity behavior could help optimize strategies for physical activity in breast cancer patients undergoing cancer treatment. This study examined associations between perceived neighborhood environment and physical activity among breast cancer patients undergoing treatment and engaged in a physical activity program. METHODS: Participants were 313 breast cancer patients enrolled in the DISCO physical activity intervention trial (NCT03529383). In the present observational analysis (DiscoSpace), cross-sectional (at baseline) and longitudinal (during intervention) associations between perceived neighborhood environment and physical activity were investigated. The perceived neighborhood environment was assessed using the ALPHA questionnaire, physical activity and physical functioning were evaluated through the Recent Physical Activity Questionnaire (self-reported physical activity) and the 6-Minute Walk Test (to measure the 6-Minute Walk Distance (6MWD)). Associations were estimated through mixed linear regression models. RESULTS: Better perceived cycling and walking infrastructures and network were associated with higher self-reported physical activity at baseline (total infrastructures: β = 0.226, 95% CI (0.063;0.388); network: β = 0.161, 95% CI (0.008;0.314)). Perceived distance to local facilities was inversely associated with 6MWD at baseline (β=-11.363, 95% CI (-20.607;-2.118)). The perception of densely populated neighborhoods (β=-0.306, 95% CI (-0.494;-0.117)) was associated with a smaller increase in self-reported physical activity during the intervention, after adjustment for trial arm. These associations varied according to women’s socioeconomic status and municipality class. CONCLUSIONS: The perceived neighborhood environment and socioeconomic characteristics of women with breast cancer should be given greater consideration for developing effective programs to promote physical activity in this population.
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