The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
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200 papers
Development and application of a scoring and visualization approach for 24-hour movement behaviours: an example based on social-emotional development in early years children.
Zahran S, Dumuid D, Tremblay MS … +15 more , Cliff DP, Antczak D, Aadland E, Anam EA, Aadland KN, Christian H, Burley J, Draper CE, Silva DAS, van Sluijs EMF, Olds TS, Stanford T, Santos R, Zhang Z, Janssen I
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41872857 · Full text
BACKGROUND: Current methods for assessing the healthfulness of 24-hour movement behaviours (sleep, sedentary time, light physical activity, moderate-to-vigorous physical activity) use binary classifications that fail to...
BACKGROUND: Current methods for assessing the healthfulness of 24-hour movement behaviours (sleep, sedentary time, light physical activity, moderate-to-vigorous physical activity) use binary classifications that fail to capture their continuous and compositional nature. This study introduces a percentile-based scoring and visualization approach to evaluate the healthfulness of movement behaviour time-use compositions, using social-emotional development in early childhood as an example. METHODS: This cross-sectional study includes 560 children aged 1.2–2.9 years and 1,500 children aged 3.0-4.9 years from Sleep and Activity Database for the Early Years (SADEY), an international accelerometer repository of young children’s movement behaviours. Sedentary time, light physical activity, and moderate-to-vigorous physical activity were measured using accelerometers. Sleep duration was parent-reported. Social-emotional development was assessed using age- and sex-normalized scores from the Strengths and Difficulties Questionnaire. Linear regression models with compositional covariates were used to model associations between movement behaviours and Strengths and Difficulties Questionnaire scores. Representative grids containing all possible time-use compositions (in 5 min/d increments) of sleep, sedentary time, light physical activity, and moderate-to-vigorous physical activity were developed. The regression models were applied to each time-use composition in the grid, and the predicted scores were ranked to create percentile scores for different movement behaviour time-use compositions. RESULTS: The 24-hour movement behaviour composition was associated with all five Strengths and Difficulties Questionnaire scores in both age groups (p ≤ 0.01). The grids contained 17,577 and 16,535 possible time-use compositions for 1–2 and 3–4-year-olds, respectively. Time-use compositions ranked at the 0th percentile had the least sleep and highest sedentary time, while those ranked at the 100th percentile had the most sleep and least sedentary time. Across the central range of the percentile score distribution (e.g., rankings between the 25th to 75th percentiles), some very different time-use compositions had the same percentile score. Interactive visualization tools were presented to enable real-time exploration of percentile scores for various movement behaviour time-use compositions. CONCLUSIONS: This study introduces a novel approach to evaluate the health benefits of movement behaviours. This approach moves beyond traditional binary cutoffs to recognize the gradual improvements in health that occur with small changes in behaviours, and that there are multiple pathways to achieving the same health benefits.
"There's no better medicine than my outdoors": understanding the importance of physical activity in rural and remote First Nations communities in Northern British Columbia, Canada.
Chopra S, Holyk T, Maddocks S … +2 more , Huot S, G Camp P
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41864951 · Full text
BACKGROUND: While Canadian First Nations communities actively participate in sport, cultural, and land-based activities, they face various barriers to physical activity. Despite calls for increased support at all governm...
BACKGROUND: While Canadian First Nations communities actively participate in sport, cultural, and land-based activities, they face various barriers to physical activity. Despite calls for increased support at all government levels, access to suitable programs for those with chronic conditions in particular remains limited. As part of an ongoing partnership between the University of British Columbia and Carrier Sekani Family Services (CSFS), this qualitative study aimed to explore current values, perceived barriers, and potential facilitators of physical activity among people living with chronic health conditions in rural and remote First Nations communities in northern British Columbia. METHODS: This qualitative study is part of a larger mixed-methods, community-based participatory action project with CSFS titled Niwh Yizt’iyh Hilht’iz Nets’eelh’iyh – “Strengthening our Bodies”. Semi-structured interviews, with optional Photovoice, were conducted with participants aged 12 years and older who had at least one chronic condition and belonged to First Nations communities served by CSFS. Participants were recruited from a prior community-based physical activity survey study that captured brief information on current physical activity experiences in their community. Data were analyzed using reflexive thematic analysis, guided by Indigenous Wholistic Theory (a framework emphasizing the interconnected and cyclical physical, mental, emotional, and spiritual dimensions of health and wellness) to ensure cultural relevance. Coding progressed from semantic to latent themes, supported by NVivo and reflexive journaling. RESULTS: Interviews were conducted with 29 participants from three communities (69% female, mean age: 55 years old), all managing various chronic conditions such as diabetes, arthritis, and cardiovascular disease. The identified themes were: 1) Integrating cultural values with physical activity to manage chronic disease, 2) Cultural disconnection: A barrier to health and physical activity, and 3) Community approaches to facilitate physical activity in chronic disease. Together, these themes highlight the role of culture, supportive community structures, and tailored approaches in physical activity engagement. CONCLUSION: To strengthen physical activity programming, service providers should ensure initiatives are aligned with community values, address identified barriers, and encourage locally recognized facilitators. These insights will empower health care organizations and communities to develop targeted, inclusive strategies for physical activity programming tailored to individuals with chronic conditions.
The independent and combined effect of price increase and price labelling on sugar-sweetened beverage vending machine sales in an Australian university: a factorial randomised controlled trial.
Blake MR, Dancey J, Cameron AJ … +3 more , Peeters A, Brimblecombe J, Orellana L
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41851732 · Full text
BACKGROUND: No studies have examined how price increases on unhealthy drinks in university vending machines impact customer purchasing or vendor financial implications. Vending machines often display prices only upon pro...
BACKGROUND: No studies have examined how price increases on unhealthy drinks in university vending machines impact customer purchasing or vendor financial implications. Vending machines often display prices only upon product selection, hindering consumers’ price evaluation. OBJECTIVE: To assess the independent and combined effects of (i) a 20% price increase on unhealthy drinks, and (ii) prominent labels displaying the price below each product, on the healthiness of customer purchases and revenue in university vending machines. DESIGN: Two-year 2 × 2 factorial cluster randomized controlled trial (March 2020 to February 2022). Machines were clustered by proximity. Itemised weekly sales data were collected for 33 weeks pre-trial and 103 weeks during the trial. Six-monthly audits assessed treatment maintenance. PARTICIPANTS/SETTING: Sixty vending machines across four campuses of a university in Victoria, Australia, with 59 machines analyzed. INTERVENTION: Machine groups were randomly allocated to four conditions: (i) 20% price increase on unhealthy drinks (‘Price Increase Only’); (ii) prominent labels displaying the price below each product (‘Price Label Only’); (iii) ‘Price Increase + Price Label’; and (iv) no price increase or labels (‘Control’). MAIN OUTCOME MEASURES: The primary outcome was the change from pre-trial mean of volume percentage of unhealthy drinks sold per machine per week. Secondary outcomes included volume percentage of healthier drinks sold per week and revenue. STATISTICAL ANALYSES: Sales data were analysed using linear mixed models with machine cluster and machine as random effects; and fixed effects for price, label, price × label, pre-trial mean outcome, teaching period, COVID-19 lockdowns, and season. RESULTS: Mean volume percentage of unhealthy drink sales was higher for the ‘Price Label Only’ compared to ‘Control’ condition (6.34 percentage points, 95%CI: 1.85, 10.82), percentage of unhealthy drink units sold, and energy and total sugar content of drinks sold, and lower for volume and unit percentage of unhealthy drink sales. No other significant differences were observed for the primary or secondary outcomes. CONCLUSIONS: This study in university vending machines found no impact of a 20% unhealthy drink price increase, and an increase in volume sales of unhealthy drinks in response to prominent price labelling only. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12620000206921 (prospectively registered 20 February 2020).
Associations of eating context with dietary quality, satiety, and postprandial blood glucose in free-living Singaporean adults during 9 days of intensive digital phenotyping.
Turton L, Yao J, Rebello SA … +3 more , Sim X, Müller-Riemenschneider F, van Dam RM
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41851724 · Full text
BACKGROUND: Eating behaviors are shaped by contextual factors such as where people eat, who they eat with, and their activities and mood during meals. However, data on these determinants of food choice in Asian populatio...
BACKGROUND: Eating behaviors are shaped by contextual factors such as where people eat, who they eat with, and their activities and mood during meals. However, data on these determinants of food choice in Asian populations are limited. We examined how eating context is associated with dietary quality, satiety, and postprandial blood glucose levels in an urban Asian population. METHODS: We analyzed data from up to 1291 Singapore residents aged 21–69 years (20,629 meals) in the Continuous Observations of Behavioral Risk Factors in Asia (COBRA) study. Over nine consecutive days, participants completed smartphone-based ecological momentary assessments six times per day, reporting meal composition, location, companions, concurrent activities, and premeal hunger, tiredness, stress, and happiness. We calculated diet quality scores for each meal (range 0–10). Masked continuous glucose monitors recorded interstitial glucose every 15 min, from which the 2-hour postprandial glucose was derived using incremental area under the curve. We estimated associations using generalized estimating equations, adjusting for sociodemographic, lifestyle, clinical, and other contextual factors. RESULTS: Meals were consumed at home (60%), hawker centers (local open-air food courts) (14%), the workplace (11%), other restaurants (9%), fast-food restaurants (2%), or other locations. Compared with home meals, diet quality was significantly lower at all out-of-home locations, particularly at fast-food restaurants (β: -0.70; 95% CI: -0.82, -0.57) and hawker centers (β: -0.56; CI: -0.63, -0.48). Postprandial glucose was higher after meals at hawker centers (β: 30.11 mmol/L*minute; CI: 20.11, 40.11) and the workplace (β: 17.48; CI: 4.34, 30.62) than at home. Eating with friends was associated with lower postprandial glucose than eating alone. Higher premeal happiness was associated with modestly higher diet quality, whereas greater premeal hunger was associated with higher postprandial glucose. CONCLUSIONS: In this urban Asian setting, eating location was a key determinant of meal quality and postprandial glycemic response. Hawker centers and fast-food restaurants were associated with worse diet quality, and hawker centers and workplace venues with higher postprandial glucose. Interventions that support home-prepared meals and promote healthier food options when eating away from home may improve cardiometabolic health.
Social and physical environmental correlates of movement behaviors, body weight status, and well-being among adolescents in Nigeria: a youth-centered participatory action project narrative review.
Oyeyemi AL, Ogunleye AB, Okafor AC … +3 more , Kollipara N, ChinAPaw MJM, Omotoso DR
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41840724 · Full text
BACKGROUND: The epidemic of non-communicable diseases related to lifestyle movement behaviors is rising rapidly in Africa, with adolescents increasingly affected by physical inactivity, excessive sedentary behavior, poor...
BACKGROUND: The epidemic of non-communicable diseases related to lifestyle movement behaviors is rising rapidly in Africa, with adolescents increasingly affected by physical inactivity, excessive sedentary behavior, poor sleep, being overweight or obese, as well as mental health challenges. While evidence supports the importance of social and physical environmental factors in improving adolescents’ health, understanding these issues among African adolescents remains limited. Insights from evidence from low- and middle-income countries (LMICs), which are often underrepresented in research on environmental influences on movement behaviors and health, may be relevant to certain Western contexts, especially those in resource-constrained settings. This narrative review aims to synthesize findings from available literature on social and physical environmental correlates of movement behaviors, body weight status, and well-being among adolescents in Nigeria, an LMIC in Africa. METHODS: We searched electronic databases, including PubMed, Scopus, Google Scholar, and African Journals Online, for original research articles published prior to January 2025 on socioenvironmental factors and movement behaviors, body weight status, and well-being among Nigerian adolescents (aged 10–20 years). Each study underwent screening and data extraction by two reviewers. Study quality was assessed with the modified Downs and Black checklist, and data were analyzed using narrative synthesis. RESULTS: A total of 25 articles met the inclusion criteria, all of which were cross-sectional studies. The review suggested that social class, school settings, peer relationships, family structure, electronic device use in the bedroom, neighborhood walkability features, availability of open recreational spaces, and urbanization were important socioenvironmental factors related to multiple movement behaviors and health outcomes among Nigerian adolescents. Some of these relationships were modified by gender and socioeconomic status. CONCLUSIONS: The evidence from this narrative review highlighted the need for more prospective and intervention studies to understand how environmental factors may promote healthier movement behaviors, enhance health, and overall well-being among Nigerian adolescents. The results could be used by researchers, policymakers, and stakeholders, including school administrators, urban planners, health professionals, parents, and community organizations who are interested in how social and physical environments contribute to adolescents’ movement behaviors, health, and well-being in resource-constrained settings.
Leaders like us: landscape of physical activity leadership programmes for underserved young women in England.
Crowther J, Dogra SA, Barber S … +2 more , Ali N, Hall J
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41827058 · Full text
BACKGROUND: Despite growing advocacy for youth-led and inclusive physical activity provision, there remains limited evidence on how to effectively support underserved young women aged (16–25) and those from minoritised g...
BACKGROUND: Despite growing advocacy for youth-led and inclusive physical activity provision, there remains limited evidence on how to effectively support underserved young women aged (16–25) and those from minoritised genders into Physical Activity leadership roles. METHODS: We used a two-phase sequential design. Phase 1 involved systematic mapping of 53 PA leadership programmes in England to describe programme focus, target populations, delivery models and stated outcomes. Phase 2 comprised seven online focus groups with 41 practitioners involved in designing, delivering or overseeing such programmes. Mapping data were summarised using descriptive statistics and narrative synthesis; focus group data were analysed using hybrid inductive–deductive framework analysis informed by Critical Positive Youth Development and feminist–intersectional lenses. RESULTS: Only a minority of mapped programmes were explicitly designed for girls and young women from underserved groups. Programmes most commonly operated through school- or club-based delivery, using modular learning, mentoring and cascaded models, with fewer incorporating financial support, digital delivery or clearly defined progression routes. Practitioners described how recruitment frequently relied on institutional gatekeepers and digital communication, raising concerns about who is reached and who is missed. They emphasised the importance of relational and culturally grounded recruitment and support, care-oriented infrastructures, and broader conceptualisations of leadership that include advocacy, representation and community influence. CONCLUSION: Combining systematic mapping with practitioner insights provides an integrated descriptive and interpretive picture of current provision. The findings indicate uneven targeting of underserved girls and young women and variable support for their progression into leadership roles. Enhancing equity in PA leadership development will require attention to recruitment practices, relational support and progression pathways that recognise diverse forms of youth leadership.
Recess and after-hours behavior patterns associated with community schoolyard transformations.
Hazlehurst MF, Wolf KL, Simmons C … +4 more , Evans S, Steiner MK, Garrett KA, Tandon PS
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41827029 · Full text
BACKGROUND: Spending time in nature and physical activity are both linked to better health outcomes for children. School environments provide the potential for multiple interventions to promote healthy behaviors. Transfo...
BACKGROUND: Spending time in nature and physical activity are both linked to better health outcomes for children. School environments provide the potential for multiple interventions to promote healthy behaviors. Transforming these existing public spaces to serve broader activity functions provides opportunities to support healthy child development and to increase nature access for local communities. METHODS: Our quasi-experimental design capitalized on a community-engaged schoolyard redesign and redevelopment project completed at two elementary schools in Tacoma, Washington, USA, led by the Trust for Public Land. Renovations included painting paved surfaces, installation of new play structures, adding walking paths and log seating areas, and planting trees. We used a validated momentary time sampling observational tool, the System for Observing Outdoor Play Environments in Neighborhood schools (SOOPEN), before and after for two schools undergoing the transformation and a control school. Moderate-to-vigorous physical activity (MVPA) and within-group behaviors in the schoolyard were observed. We used a difference-in-difference approach to estimate the effect of the schoolyard renovation on behavior during recess, and on community use of the schoolyard outside of school hours. RESULTS: The schoolyard transformation was associated with a 1.51-times greater increase (95% CI: 0.95, 2.40) in MVPA during recess at intervention schools compared to the control school, although this association was only statistically significant among groups of boys. After renovation, MVPA was highest in grassy areas at one school (69%), but highest in paved zones with newly painted markings at the other (75%). Renovations were not associated with changes in the prevalence of prosocial behavior during recess, which was high at baseline. The schoolyard transformation was also associated with increased community use outside of school hours, especially for groups of children (5.8-times [95% CI: 1.4, 23.8] greater increase in use over time at renovation schools compared to the control school). CONCLUSIONS: Schoolyard transformations have the potential to increase schoolyard use and physical activity both during and outside of school hours, if campuses are open to community use. Additional rigorous research can inform future projects to support the health of school-age children and address inequities in distribution of community greenspaces.
A theoretically designed scale-up intervention increases adoption of an effective school nutrition program 'SWAP IT': outcomes of a randomised trial.
Sutherland R, Herdegen D, Jones J … +15 more , Barnes C, Nathan N, Robertson K, Rayward A, Bauman A, McFadyen T, Milat A, Morgan P, Reeves P, Oldmeadow C, Yoong S, Cobcroft M, Chiu S, Wiggers J, Wolfenden L
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41826957 · Full text
BACKGROUND: Scale-up (i.e., the intentional effort to increase the reach and impact of an intervention) of effective school-based interventions is recommended to improve public health nutrition and prevent chronic diseas...
BACKGROUND: Scale-up (i.e., the intentional effort to increase the reach and impact of an intervention) of effective school-based interventions is recommended to improve public health nutrition and prevent chronic disease. However, limited evidence to guide effective scale-up exists. This study aimed to assess the effectiveness of a theoretically designed multi-component scale-up intervention, designed using the Theoretical Domains Framework and Behavior Change Wheel, to increase the adoption of an evidence-based school nutrition program (SWAP IT) within primary schools in NSW Australia. We also identify any differences in the characteristics of schools adopting the program and describe the fidelity of delivering, and reach of each scale-up strategy. METHODS: A parallel-group randomised controlled trial was conducted across 11 Local Health Districts (LHD) in New South Wales Australia (n = 337 schools). Primary schools which had not previously adopted the SWAP IT school nutrition program and used an existing parent communication app (Audiri) in each LHD were randomised to receive a theoretically designed multi-component scale-up intervention (n = 169 schools) or to a waitlist control, exposed to a single discrete scale up strategy (n = 168 schools). The scale-up intervention consisted of nine scale-up strategies: three ‘vertical’ strategies aiming to increase LHD Health Promotion Units capacity to scale-up and six ‘horizontal’ strategies aiming to overcome school barriers to adopting the programs. The primary outcome was school adoption of SWAP IT objectively assessed via electronic records at 6-months, assessed via logistic regression adjusting for baseline and stratification variables. RESULTS: Following the 6-month multi-component scale-up intervention, significantly more schools in the scale-up intervention group (n = 67/169, 40%) had adopted the SWAP IT program compared to schools in the control group (n = 0/168, 0%) (p < 0.001). Schools with a higher enrolment of Aboriginal and Torres Strait Islander students were more likely to adopt the program (p = 0.02), however no other school characteristics were associated with program adoption. Most scale-up strategies were delivered by LHD Health Promotion Units to schools with high fidelity (72–100%), however reach of the strategies varied widely (4-100%). CONCLUSIONS: A theoretically designed approach to scale-up, increased schools’ adoption of an evidence-based school nutrition program across a large and socio-economically and geographically diverse population. Program adoption rates were similar across socio-demographic and geographic characteristics. This approach can inform efforts of improving public health nutrition equitably through large scale adoption of school nutrition initiatives. TRIAL REGISTRATION: The trial was prospectively registered on 13/02/2023 with the Australian New Zealand Clinical Trials Registry (ACTRN12623000145606). https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12623000145606 .
Feasibility, acceptability and preliminary impact on diet quality of the Healthy Weight for Life™ + medical nutrition therapy; a randomised controlled pilot study.
Clarke ED, Britton GM, Hedditch N … +3 more , Gallagher R, Donnelly H, Collins CE
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41808186 · Full text
BACKGROUND: Poor diet quality has been associated with greater risk of people developing overweight and obesity, type 2 diabetes, cardiovascular disease, and osteoarthritis. For each of these conditions, weight managemen...
BACKGROUND: Poor diet quality has been associated with greater risk of people developing overweight and obesity, type 2 diabetes, cardiovascular disease, and osteoarthritis. For each of these conditions, weight management is recommended in respective guidelines. Current weight management interventions, such as the Healthy Weight for Life™ (HWFL) program that uses meal replacements, have not been assessed for impact on diet quality. Further, the role of a dietitian providing medical nutrition therapy (MNT) in conjunction with the HWFL program has not been evaluated. MNT is an evidence-based approach where dietary interventions are tailored to the individuals needs, medical history, lifestyle, and dietary preferences. Therefore, the primary aim of this pilot study is to evaluate the feasibility, acceptability and preliminary impact of adding personalised (MNT) consultations to the HWFL program on diet quality. Secondary outcomes include weight and osteoarthritis scores . METHODS: An 18-week randomised control trial was undertaken, with eligible HWFL program participants randomised to either usual care arm (HWFL program) or HWFL + MNT. A food frequency questionnaire was used to assess diet quality (% energy from nutrient-dense core food) and provide intervention participants with personalised feedback on food and nutrient adequacy of their dietary patterns. Weight and knee osteoarthritis outcomes using the hip and knee osteoarthritis outcome scores, were self-reported and used to assess outcomes. Project acceptability was assessed by process evaluation questionnaire. An intention-to-treat analysis was undertaken using generalised linear mixed models with post-estimations reported as mean (95% CI). RESULTS: Forty participants (75% female, 62 ± 10years, 78% osteoarthritis) enrolled in the study. Baseline diet quality was poor (34% energy from non-core foods). Post-intervention both intervention and usual care groups significantly improved their diet quality and reduced weight, but there were no significant differences between groups. Sub-scores for knee osteoarthritis function significantly improved in the intervention compared to the control group (mean between group difference 17.4, 95% CI 1.6, 33.1), though after correcting for multiple testing this was no longer significant. Overall intervention acceptability was high. CONCLUSION: Both the intervention and usual care arms significantly improved diet quality. All intervention participants found MNT was highly acceptable. For those with knee osteoarthritis significant improvements in knee osteoarthritis function was reported in the intervention group. This should be further explored in future interventions. TRIAL REGISTRATION : Australian New Zealand Clinical Trials Registry (ACTRN12623001062617).
Effects of exercise on cognitive function in patients with depression: a three-level meta-analysis with dose-response and exploratory mediation analyses.
Liu C, Chen R, Jia S … +3 more , Guo Z, Wei C, Wang X
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41808180 · Full text
BACKGROUND: Cognitive impairment is common among individuals with depression and contributes to functional impairment and poor treatment outcomes. Exercise, as a non-pharmacological intervention, has been increasingly re...
BACKGROUND: Cognitive impairment is common among individuals with depression and contributes to functional impairment and poor treatment outcomes. Exercise, as a non-pharmacological intervention, has been increasingly recognized as a promising approach for improving cognitive function. However, the dose-response relationship underlying these effects remains poorly understood, and the mechanisms through which exercise may influence cognition or depressive symptoms have yet to be clarified. To address these gaps, this study used a three-level meta-analysis to quantify the effects of exercise on cognitive function in depression, examine potential moderators and dose-response patterns, and conduct an exploratory mediation analysis testing whether cognitive changes mediate exercise-related improvements in depressive symptoms. METHODS: We searched China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, Embase, the Cochrane Library, and PubMed for experimental studies evaluating the effects of exercise interventions on cognitive function in patients with depression, from database inception to May 30, 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was graded with GRADEpro. Three-level meta-analyses were conducted with the metafor package in R. RESULTS: Thirty-one studies, including 2,324 participants with depression, were included. Exercise type included aerobic, resistance/strength training, mind-body practices, and multicomponent exercises. Exercise frequency ranged from 1 to 5 sessions per week; intervention duration from 3 to 16 weeks; and exercise intensity was categorized as low, moderate, or moderate to high. Session duration ranged from 30 to 180 min. A three-level meta-analysis showed that exercise improved cognitive function (Hedges’ g (g) = 0.24; 95% confidence Interval (CI), 0.14 to 0.33; p < 0.001). Moderator analyses indicated significant influences of exercise intensity, inpatient status, intervention content, study design, and weekly exercise time (all p < 0.05). Moderate-intensity interventions produced the largest gains (g = 0.36; 95% CI, 0.23 to 0.50; p < 0.05). Dose-response modelling suggested that weekly exercise volumes below approximately 176 min may yield limited benefit (prediction interval crossing zero). In an exploratory mediation analysis, the indirect effect of exercise on depressive symptoms via cognition was insignificant (a×b = 0.02; 95% CI, -0.00 to 0.04), corresponding to a proportion mediated of 5.3%. CONCLUSIONS: Exercise is associated with improvements in cognitive function among individuals with depression. Rather than indicating a universal recommended dose, the dose–response analysis revealed a minimum weekly activity threshold, with cognitive benefits becoming more likely when moderate-intensity exercise exceeds approximately 176 min per week. Current evidence does not support cognitive improvement as the primary mediating pathway through which exercise influences depressive symptoms, and this finding should be interpreted cautiously. Further multicenter randomized controlled trials with rigorous methodology and standardized cognitive assessments are needed to refine modality-specific dose-response patterns and clarify potential mediating pathways. TRIAL REGISTRATION: PROSPERO registration number CRD42025645011.
A systematic scoping review of urban food environment research, interventions, and measurement approaches in eight low- and middle-income countries.
Margolies A, Amunga D, Choo EM
Int J Behav Nutr Phys Act · 2026 Mar · PMID 41787533 · Full text
BACKGROUND: Food environments in low- and middle-income countries (LMICs) are undergoing rapid transformation, particularly in urban and peri-urban settings. These shifts—characterized by changes in food retail landscape...
BACKGROUND: Food environments in low- and middle-income countries (LMICs) are undergoing rapid transformation, particularly in urban and peri-urban settings. These shifts—characterized by changes in food retail landscapes, consumer purchasing behaviors, and the availability and affordability of nutritious foods—have significant implications for nutrition. Yet, the key characteristics of these environments, such as food desirability, convenience, accessibility, and marketing influences, remain underexplored. This systematic scoping review synthesizes evidence published between 2001 and 2023 across eight LMICs (Bangladesh, Sri Lanka, Philippines, Kenya, Ghana, Ethiopia, Rwanda, Peru) to examine how urban and peri-urban food environments shape dietary behaviors and nutrition outcomes. METHODS: Guided by a conceptual framework encompassing nine key food environment dimensions—availability, prices, marketing and regulation, vendor and product properties, accessibility, affordability, desirability, convenience, and sustainability—we analyzed descriptive, associative, and intervention studies. We searched Scopus and Web of Science, identified 1,609 records, and included 251 studies in the review. RESULTS: As might be expected in a growing body of evidence, most research is descriptive, with limited causal or intervention-based evidence. Studies frequently focus on characteristics of informal vendors, sociocultural factors influencing shifts in dietary choice toward unhealthier options, and the proliferation of ultra-processed foods, especially near schools and in informal markets. Associations between food environment and nutrition outcomes, such as elevated BMI and overweight, are often linked to supermarket and fast-food access, though these relationships are frequently confounded by socioeconomic variables. Methodological inconsistencies in defining and measuring food environment dimensions limit cross-context comparability. Only seven intervention studies were identified, with few demonstrating significant improvements in diet or nutrition. CONCLUSIONS: This review highlights critical evidence gaps in urban food environments in LMICs and underscores the need for standardized measurement and robust evaluations of diet-related interventions. Strengthening this evidence base is essential to inform food policy, urban planning, and public health strategies that promote healthier diets for populations in rapidly urbanizing settings.
Effects of remote group-based exercise on physical activity and well-being in postpartum women: a randomized controlled trial.
Nomura Y, Fukano M, Kashiwabara K … +1 more , Haruna M
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41736089 · Full text
BACKGROUND: Postpartum women frequently experience declines in physical activity (PA) resulting from lifestyle changes, caregiving demands, and physical recovery, which increases the risk of long-term physical and mental...
BACKGROUND: Postpartum women frequently experience declines in physical activity (PA) resulting from lifestyle changes, caregiving demands, and physical recovery, which increases the risk of long-term physical and mental health issues. While behavioral strategies can promote PA, few interventions address the lifestyle-related barriers specific to postpartum women using objective PA measures, and remote, group-based approaches remain underexplored. This study evaluated the efficacy of an 8-week remotely delivered, group-based PA intervention in increasing objectively measured PA, exercise-related self-efficacy, and psychosocial well-being among postpartum women. METHODS: In this web-based, two-arm randomized controlled trial, 175 postpartum women (2–6 months postpartum) in Japan were allocated to either an intervention (n = 89) or waitlist control group (n = 86). The intervention combined weekly instructor-led online group sessions with a structured home-based exercise program, incorporating behavioral strategies grounded in self-determination and social cognitive theories. The primary outcome was daily moderate-to-vigorous PA (MVPA) measured via triaxial accelerometers. The secondary outcomes included daily step counts, health-related quality of life (HRQoL; Short Form-12 Health Survey version 2), sense of coherence (SOC; Sense of Coherence Scale), and exercise self-efficacy (decisional balance for exercise). Analyses used generalized estimating equations adjusting for baseline values and age. RESULTS: Retention was 98%–99%, with 94% attending at least four of six classes. Compared with controls, the intervention significantly increased MVPA by 5.97 min/day (95% confidence interval [CI]: 1.34, 10.60; p = 0.012) and daily steps by 576 (95% CI: 73, 1079; p = 0.025). SOC increased by 4.14 points (95% CI: 1.70, 6.58; p < 0.001) and exercise self-efficacy increased (balance score difference: 2.74; 95% CI: 0.71, 4.78; p = 0.008), mainly because of reduced perceived barriers. No significant changes in HRQoL were observed. CONCLUSIONS: This remote, group-based PA intervention, designed to accommodate the lifestyle demands of the postpartum period, effectively increased PA and enhanced psychosocial resources in postpartum women. By fostering self-efficacy, peer support, and accessible home-based participation, this program may support both short- and long-term physical and mental health. These findings highlight the potential of scalable online PA programs to overcome common postpartum barriers. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR): UMIN000053478, registered 31 January 2024.
Effects of healthy lifestyles on the association between food security and all-cause mortality risk.
Gao J, Li C, Chen H … +4 more , Li ZH, Liu D, Liu SY, Mao C
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41736085 · Full text
BACKGROUND: Food insecurity is associated with increased mortality risk, but whether this association is modified by lifestyle behaviors in the general adult population remains unclear. METHODS: We analyzed seven NHANES...
BACKGROUND: Food insecurity is associated with increased mortality risk, but whether this association is modified by lifestyle behaviors in the general adult population remains unclear. METHODS: We analyzed seven NHANES cycles (2005–2018) including 41,161 adults (≥ 18 years). Food security was categorized per USDA guidelines. Four lifestyle factors—smoking status, alcohol consumption, physical activity, and sleep duration (< 6.5, 6.5-<7.5, or ≥ 7.5 h/night)—were assessed via standardized questionnaires, and a healthy lifestyle score (0–4) was constructed by summing these four components. All-cause mortality was determined through linkage to the National Death Index through December 31, 2019. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality across food security categories and by healthy lifestyle score, adjusting for demographic and socioeconomic characteristics, health status indicators (BMI, history of diabetes, hypertension, hypercholesterolemia, and health insurance coverage), and dietary factors (total daily energy intake and overall diet quality). We conducted prespecified subgroup analyses by age (< 65 vs. ≥ 65 years), sex, and health insurance status, and performed sensitivity analyses. RESULTS: During 204,944 person-years of follow-up, 2835 total deaths occurred. Food insecurity was associated with higher all-cause mortality (HR 1.85 [95% CI, 1.60–2.14]; P < 0.001). In joint analyses restricted to food-insecure adults, compared with those with the most unfavorable behaviors, participants who never smoked had a 51% lower hazard of mortality (HR, 0.49 [95% CI, 0.39–0.61]), those who never drank alcohol had a 27% lower hazard (HR, 0.73 [95% CI, 0.56–0.97]), those with moderate/regular physical activity had a 32% lower hazard (HR, 0.68 [95% CI, 0.49–0.96]), and those reporting sleep duration of 6.5-<7.5 h/night had a 26% lower hazard (HR, 0.74 [95% CI, 0.55–0.98]). The healthy lifestyle score showed a graded inverse association, among food-insecure adults, having 3–4 versus 0 healthy behaviors was associated with a 61% lower hazard of death (HR, 0.39 [95% CI, 0.23–0.66]). Associations were stronger among participants aged < 65 years and were robust in sensitivity analyses. CONCLUSION: Food insecurity is significantly associated with higher all-cause mortality risk, while healthy lifestyle behaviors can effectively buffer this risk, especially in food-insecure adults.
Effects of a school-based cycling intervention on commuting to school behavior and device-measured activity in Spanish adolescents: the PACO cluster-randomized controlled trial.
Campos-Garzón P, Huertas-Delgado FJ, Cadenas-Sanchez C … +3 more , Molina-García J, Barranco-Ruiz Y, Chillón P
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41736046 · Full text
BACKGROUND: Active commuting to/from school (ACS) is associated with multiple health and societal benefits, yet school-based interventions have shown limited success in changing adolescents’ commuting behavior, and their...
BACKGROUND: Active commuting to/from school (ACS) is associated with multiple health and societal benefits, yet school-based interventions have shown limited success in changing adolescents’ commuting behavior, and their effects on psychosocial factors remain unclear. This study primarily examined the effects of a school-based cycling intervention on the usual mode and frequency of ACS, and ACS-related psychosocial outcomes in Spanish adolescents. Secondary outcomes included device-measured sedentary time and physical activity (PA). METHODS: A cluster-randomized controlled trial was conducted in eight Spanish secondary schools. A total of 256 adolescents (45.7% girls; mean age 14.4 years) were allocated to an intervention (n = 127) or control group. The intervention consisted of four weekly sessions delivered during Physical Education classes over one month, combining cycling theory, skills training in closed circuits, and supervised on-road cycling in urban environments. Outcomes were assessed at baseline and post-intervention and included usual mode and weekly frequency of ACS, perceived barriers to ACS, basic psychological need satisfaction in ACS, motivation for ACS, and device-measured sedentary time and PA across daily segments. RESULTS: No significant between-group effects were observed for usual mode or frequency of ACS, nor for device-measured sedentary time or PA. Most psychosocial outcomes did not differ between groups. However, perceived environmental/safety barriers increased in the intervention group compared with controls (Δ = 0.22, p = 0.041). Moderation analyses showed that girls in the intervention group reported greater increases in amotivation for ACS than girls in the control group (Δ = 0.54, p = 0.018). Per-protocol analyses revealed higher external motivation (Δ = 0.40, p = 0.029) and amotivation (Δ = 0.38, p = 0.037) in the intervention group, with stronger effects among girls and adolescents from higher socioeconomic backgrounds. CONCLUSIONS: The school-based cycling program did not change the commuting behavior or device-measured activity. Instead, participation was associated with increased awareness of environmental/safety barriers and higher amotivation, particularly among girls. Per-protocol analyses also revealed increases in external motivation and perceived barriers, particularly among girls and high-SES adolescents. These findings suggest that short-duration, skills-focused cycling interventions may heighten perceived constraints without being sufficient to support behavior change. Future programs may require longer duration, autonomy-supportive delivery, and complementary built environmental and family-level strategies to effectively promote ACS among adolescents. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT03937336).
Accessibility, acceptability, and usage during COVID-19 of the evidence-based intervention Healthy Eating and Active Living Taught at Home (HEALTH): implications for implementation strategies.
Gilbert A, Haire-Joshu D, Morshed AB … +3 more , Schwarz CD, Kemner A, Tabak RG
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41731558 · Full text
BACKGROUND: Healthy Eating and Active Living Taught at Home (HEALTH) is an evidence-based intervention (EBI) embedded in Parents as Teachers (PAT) home visiting to improve weight outcomes among mothers. Public health imp...
BACKGROUND: Healthy Eating and Active Living Taught at Home (HEALTH) is an evidence-based intervention (EBI) embedded in Parents as Teachers (PAT) home visiting to improve weight outcomes among mothers. Public health impact of HEALTH relies on EBI coverage (accessibility, acceptability, usage). Therefore, the purpose of this study is to identify coverage strengths/gaps which can inform dissemination and implementation (D&I) strategies to increase HEALTH coverage. METHODS: We conducted descriptive analyses using baseline data and home visitor documentation of PAT visits from the HEALTH D&I study, which took place during COVID-19. Coverage was measured by expanding on RE-AIM with the adapted Shengelia et al. Access, utilization, quality, and effective coverage framework and included: accessibility (home visitor referrals to HEALTH), acceptability (mother self-report satisfaction), usage (number of visits mothers received from the home visitor, proportion of HEALTH content delivered, proportion of HEALTH lessons delivered). RESULTS: In the HEALTH D&I study, 67% of home visitors made at least one referral to HEALTH; however, 33% made no HEALTH referrals. The average number of referrals was 2.05 (SD = 2.38). Most mothers (80%) were satisfied with HEALTH. The average number of visits mothers received was 13.91 (SD = 10.62). On average 39% of all 24 HEALTH lessons, 66% of the eight core HEALTH lessons, and 33% of the HEALTH handouts were delivered. Only 26% of mothers received all 8 core HEALTH lessons. These lessons focus on goals and basic information on healthy eating and physical activity (e.g., Your Health Goals, Let’s Get Moving!, Making Healthy Beverage Habits) and make up the core section of the HEALTH curriculum. CONCLUSIONS: This study demonstrates integration of D&I frameworks to evaluate D&I outcomes and offers insights into strategies for EBIs in community settings and insights into service delivery during COVID-19. Findings show strong EBI coverage (acceptability) and gaps (accessibility; usage) supporting the need for implementation strategies to increase adoption (e.g., building partner relationships, choosing strategic partners, ) and support implementation (e.g., facilitate peer learning, create program guide). TRIAL REGISTRATION: NCT03758638 (https//clinicaltrials.gov/study/NCT03758638), registered Nov 29, 2018.
Effectiveness of a female community health volunteer-led physical activity education intervention on accelerometer-derived outcomes in semi-urban Nepal: an open-label, cluster randomised controlled trial.
Shrestha R, Paudel S, Rijal A … +12 more , Adhikari TB, Gradidge PJ, Khatri B, Neupane D, Skejø SD, Vaidya A, Sanders T, Lonsdale C, Subedi N, Koirala S, Kallestrup P, Nielsen RØ
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41731554 · Full text
BACKGROUND: Physical inactivity is a growing public health challenge in low- and middle-income countries (LMICs), yet evidence on scalable, community-based interventions remains limited. We evaluated the effectiveness of...
BACKGROUND: Physical inactivity is a growing public health challenge in low- and middle-income countries (LMICs), yet evidence on scalable, community-based interventions remains limited. We evaluated the effectiveness of a Female Community Health Volunteers (FCHVs)-led, home-based educational programme in promoting physical activity in semi-urban Nepal. METHODS: We conducted a six-month, open-label, cluster-randomised controlled trial among adults in 14 wards of Pokhara, Nepal, with seven clusters each assigned to intervention or control. Trained FCHVs made three home visits, one per month, delivering two-hour sessions promoting physical activity, using materials co-designed with guidance from the Theory of Planned Behaviour. The main outcome was the change in daily device-measured moderate-to-vigorous physical activity (MVPA) from baseline to follow-up. RESULTS: Among 264 participants (132 in the intervention arm and 132 in the control arm; mean age 49.6 years; 67.5% women) in intention-to-treat analysis, device-measured MVPA declined over six months. However, compared with the control group, the intervention group had a 9.80 min/day smaller decline in non-bout MVPA (95% CI: 0.41–19.18; p = 0.041) and a 4.53 min/day smaller decline in MVPA accumulated in ≥ 10-min bouts (95% CI: 0.29–8.77; p = 0.036). Positive effects were observed in between-group average acceleration (+ 1.84 mg, p = 0.035). CONCLUSIONS: Although MVPA declined in both groups over six months, the FCHV-led, home-based educational intervention attenuated this decline compared to usual care. These findings suggest that existing health volunteer-led education may contribute to maintaining physical activity levels in semi-urban populations. TRIAL REGISTRATION: Trial registration clinicaltrials.gov Identifier: NCT06386692.
Mapping determinants of alternative protein food intake across 13 European countries: food system stakeholders' perspectives.
Zaleskiewicz H, Kulis E, Szczuka Z … +23 more , Banik A, Alcat G, Ávila C, Cardoso I, Başak Coşkun F, Kornafel A, Mai L, Kolden Midtbø L, Misiakowska J, Oblak M, Miličić V, Queiroz P, Sabbatini G, Sandvad B, Siwa M, Solibakke P, Stejnarová Š, Stollewerk K, Strube R, Tsapa E, Voyatzakis A, Xaxiri E, Luszczynska A
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41715197 · Full text
BACKGROUND: Using the system mapping approach, this study aimed to map the system of potential determinants of including alternative protein food (APF) into the daily diet across 13 European countries. We also aimed to i...
BACKGROUND: Using the system mapping approach, this study aimed to map the system of potential determinants of including alternative protein food (APF) into the daily diet across 13 European countries. We also aimed to identify key leverage points in the systems, which are determinants that are most interconnected with other determinants in the system. Similarities in leverage points and feedback loops found across the system maps were investigated. METHODS: Food system stakeholders (N = 166; including food producers, food processors, policy makers, nutritionists, consumers, etc.) participated in 17 system mapping workshops, conducted in Austria, the Czech Republic, Denmark, France, Germany, Greece, Italy, Norway, Portugal, Slovenia, Spain, Turkey, and Poland. Group model building methods were applied to develop 17 maps. Centrality indices were calculated, feedback loops were identified, and similarities between countries were explored. RESULTS: Key leverage points that were common across 6–8 maps included: consumer education and knowledge about APF, social norms, encouragement, advertising and influencers’ impact. Other common identified leverage points (present in 3–4 maps) were: health-related perceptions, curiosity/fear of novelty, national food culture, perceptions of ultra-processing, sustainability issues, and animal welfare issues. Overall, stakeholders emphasized consumers as central actors in the food system. Feedback loops identified in the study, revealed some common within-country pathways. For example, half of the feedback loops shown in the Italian maps included a potentially reinforcing upward spiral. Stakeholders perceived that higher APF product safety may facilitate advertising APF (e.g., as healthy), which in turn could increase consumers’ curiosity and/or beliefs that APF is healthy and sustainable. This was perceived as facilitating local development and job creation, food prices reduction, and further developments in food safety. CONCLUSIONS: The findings offer new insights into the complexities of European food systems and may contribute to the broader uptake of APF. Identifying leverage points and feedback loops may inspire food system stakeholders to design novel interventions. For example, these interventions could involve influencers to familiarize consumers with APF, promote knowledge about healthiness and safety of APF, as well as link APF consumption with positive emotions and social approval.
Post-rehabilitation self-management support on physical activity and nutrition, including mHealth, improves physical capacity, physical activity, and health related quality of life in people with Parkinson's- results from a randomised controlled trial.
Alnes SR, Laerum-Onsager E, Bye A … +4 more , Vistven A, Franzén E, Holst M, Brovold T
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41703544 · Full text
BACKGROUND: Maintaining long-term engagement in physical activity (PA) and following nutrition recommendations after rehabilitation is challenging for people with Parkinson’s. Sustained behavioural change requires more t...
BACKGROUND: Maintaining long-term engagement in physical activity (PA) and following nutrition recommendations after rehabilitation is challenging for people with Parkinson’s. Sustained behavioural change requires more than initial education; person-centred, self-management support may be key to maintain health-promoting routines. However, structured follow-up is often lacking. Digital health interventions, including mobile health (mHealth), offer scalable solutions to provide ongoing support beyond rehabilitation. This study aimed to examine the effect of an individualised, mHealth support programme targeting self-management of PA, and nutrition on physical capacity, nutritional status, HRQOL, Physical function and engagement in PA in people with Parkinson’s. METHODS: A single-blind, two-arm randomised controlled trial evaluating the effects of a six-month individualised mHealth self-management support programme on physical capacity and related outcomes in people with Parkinson’s following inpatient interdisciplinary rehabilitation. Participants were randomly assigned (1:1) to an intervention group (mHealth); monthly remote consultations plus activity tracker, or a control group; usual care. The primary outcome was physical capacity (6MWT). Secondary outcomes were nutritional status (PG-SGA SF), Health Related Quality of Life (PDQ-39), physical function and engagement in PA (self-reported PA and activity tracker data). Linear mixed models for repeated measures were used to assess group differences over time. RESULTS: A total of 100 participants (40% female, mean age 67,5 years) were randomised (50 per group). At six months we observed significant between-group differences on 6MWT in favour of the intervention group (mean: 33.1 m; 95% CI: 14.8 to 51.3; p < 0.001; effects size = 0.75). Significant between-group differences were also observed in PDQ-39 SI(mean: -6.1; 95% CI: -9.5 to -2.8; p < 0.001; effect size 0.93) and in physical activity frequency (p = 0.02; effect size = 0.51). Additionally, the mHealth group significantly increased their daily steps (p = 0.006) and weekly intensity minutes (p = 0.042). No significant differences were found for nutritional status, or physical function. CONCLUSIONS: The six-month mHealth self-management support programme improved physical capacity, Health Related Quality of Life, and physical activity in people with Parkinson’s post-rehabilitation. These findings highlight the potential of scalable, person-centred digital self-management support interventions to sustain health-promoting behaviours beyond clinical settings. TRIAL REGISTRATION: The study was registered on ClinicalTrials under the code NCT04945876: https://clinicaltrials.gov/expert-search?term=NCT04945876 . First registration March 1, 2021.
An environmental physical activity and nutrition intervention in early childhood education and care settings: process evaluation of the NAPSACC UK multi-centre cluster RCT.
Cooper J, Hannam K, Chambers S … +8 more , Reid T, Jago R, Toumpakari Z, Simpson SA, Pallan M, Cochrane M, Kipping R, Langford R
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41689017 · Full text
BACKGROUND: Most children attend early childhood education care settings (ECEC settings), commonly known as nurseries in the United Kingdom. ECEC settings provide opportunities to improve health through improved nutritio...
BACKGROUND: Most children attend early childhood education care settings (ECEC settings), commonly known as nurseries in the United Kingdom. ECEC settings provide opportunities to improve health through improved nutritional quality and physical activity for young children. There is evidence from the US that the NAPSACC intervention improves nutrition and physical activity in ECEC settings. We adapted NAPSACC for the UK and investigated its fidelity, acceptability and sustainability within a multi-centre trial. METHODS: Embedded process evaluation within a 12-month cluster randomised controlled trial with 52 ECEC settings (25 intervention and 27 control). The NAPSACC UK intervention comprised two six-month cycles of nutrition and activity self-assessment, staff workshops and goal setting, supported by public health practitioners. Data included: observations during training and workshop delivery, questionnaires to practitioners and ECEC setting staff; 11 interviews with practitioners who delivered the intervention, 11 ECEC setting managers, 5 commissioners, and two focus groups with the research team. Document analysis of self-assessment and goal setting forms was undertaken. Thematic analysis was conducted with both deductive and inductive codes, a coding framework and triangulation across data sources. RESULTS: Three-quarters (19/25) of intervention ECEC settings implemented the NAPSACC intervention across one cycle. Only 40% implemented a second cycle, mainly due to delays in scheduling staff workshops caused by sector-wide staffing challenges. ECEC setting managers valued the opportunity to reflect on practice and the support offered by the practitioner. ECEC setting staff highly rated the workshops and valued support given by public health practitioners. 83% of nutrition and 70% of physical activity goals set by the ECEC settings were achieved (fully or partially) and self-assessment scores increased, with greater gains for ECEC settings implementing two cycles. ECEC setting managers planned to maintain the changes made but varied in their intention to continue self-assessment and goal-setting processes. CONCLUSIONS: Despite sector-wide staffing challenges, we saw high engagement from ECEC settings in self-assessment and setting goals to improve child nutrition and activity. However, future development and use of NAPSACC UK need to be considered in the context of a lack of measurable impact on objective measures of child health and the significant challenges of staff capacity and time. TRIAL REGISTRATION: ISRCTN33134697, 31/10/2019.
Predictors of long-term maintenance of changes in fruit and vegetables intake: a longitudinal analysis within a randomized controlled community trial.
de Carvalho MCR, Lopes ACS
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41654919 · Full text
BACKGROUND: Individual characteristics can be associated with maintaining adequate FV intake over time. Thus, we aimed to identify factors associated with maintaining changes in fruit/vegetable (FV) intake at 48 months....
BACKGROUND: Individual characteristics can be associated with maintaining adequate FV intake over time. Thus, we aimed to identify factors associated with maintaining changes in fruit/vegetable (FV) intake at 48 months. METHODS: Longitudinal analysis of data from a randomized trial carried out in a health promotion service, including individuals with positive changes in FV intake after intervention. FV intake was assessed at 48 months, compared to 12 months to identify whether maintenance was associated with demographics, health data, stages of change, self-efficacy, and decisional balance, using multivariate regression. RESULTS: We included 2,232 participants, 88.4% were women, 46.6% were maintainers at 48 months. Maintainers were older, had lower schooling and baseline FV intake, had been in the service for longer, and increased FV intake between 12 and 48 months while non-maintainers decreased it. Being older or in the service for 36 + months were associated with 1% and 30% higher odds of maintenance; higher baseline FV intake and self-efficacy were associated with 1% and 2% lower odds of maintenance. CONCLUSIONS: Maintenance of changes in FV intake was associated with higher age, a longer time in the service, and lower baseline FV intake and self-efficacy. Health promotion services should aim for participant retention, and interventionists should pay attention to participants who might face more barriers for maintenance. TRIAL REGISTRATION: RBR-9h7ckx. Date of registration: August 12, 2015.
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