The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
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200 papers
Digital health interventions for promoting adults lifestyle behaviors: who is being left behind? An evidence synthesis of social inequality.
Jiang J, Zhong Q, Yin Z … +3 more , Zhou Q, Wang Y, Yan Z
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41652584 · Full text
BACKGROUND: Digital health interventions have gained increasing prominence worldwide and demonstrate substantial potential for promoting healthy lifestyle behaviors. However, accumulating evidence suggests that not all p...
BACKGROUND: Digital health interventions have gained increasing prominence worldwide and demonstrate substantial potential for promoting healthy lifestyle behaviors. However, accumulating evidence suggests that not all population groups benefit equally from these interventions, raising concerns about persistent social inequalities in access, engagement, and outcomes. METHODS: This study conducted an umbrella review to systematically synthesize evidence from review-level studies that examined social inequality indicators in digital health interventions targeting lifestyle behaviors among adults. Comprehensive searches were performed across seven electronic databases, identifying 41 eligible reviews published between January 2000 and June 2025. Data were extracted on targeted behavioral domains, intervention outcomes, and reported social inequality indicators. RESULTS: The included reviews primarily focused on interventions targeting physical activity and diet, followed by sedentary behavior and sleep, with behavioral outcomes serving as the main evaluation metrics. Among social inequality indicators, age, gender, and place of residence were most frequently reported. In contrast, indicators such as income, race/ethnicity, socioeconomic status, education, digital health literacy, and employment were substantially underrepresented. This uneven distribution indicates significant gaps in the current evidence base and suggests that the differential effects of digital health interventions across social groups may be underestimated or overlooked. CONCLUSIONS: Current review-level evidence on digital health interventions insufficiently captures the full spectrum of social inequalities shaping intervention access, engagement, and benefits. To support more equitable and inclusive health promotion strategies, future research should systematically incorporate a broader range of social inequality indicators and conduct in-depth analyses of the mechanisms underlying unequal intervention effects across diverse demographic and socioeconomic groups.
The development of the EUropean Physical Activity Determinants framework for Adolescents (EU-PAD-A): a mixed-methods concept mapping study within the DE-PASS COST action.
Fusco A, Cortis C, Mork PJ … +13 more , Conte D, Di Rocco F, Festino E, Izzicupo P, Orrù S, Nordstoga AL, Papale O, De Maio M, Presta V, Rocliffe P, Capranica L, MacDonncha C, Condello G
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41645223 · Full text
BACKGROUND: Most European adolescents do not meet recommended levels of physical activity (PA), increasing their risk of long-term health issues and contributing to the burden of non-communicable diseases. To address thi...
BACKGROUND: Most European adolescents do not meet recommended levels of physical activity (PA), increasing their risk of long-term health issues and contributing to the burden of non-communicable diseases. To address this public health challenge, there is a need for evidence-based, age-specific frameworks that identify the key determinants influencing PA behaviours during adolescence, a critical developmental stage for habit formation. METHODS: This study developed the EUropean Physical Activity Determinants framework for Adolescents (EU-PAD-A) and identified the most important and modifiable factors that can inform targeted interventions and public policy. Using Group Concept Mapping analysis, 240 experts contributed to the identification, sorting, and rating of PA determinants for adolescents. RESULTS: A total number of 110 determinants were grouped into nine thematic clusters. Determinants were rated for importance and modifiability, with 53% (n = 58) scoring high on both dimensions. To refine priorities for policy and practice, a focus group of experts and a survey involving 60 policy makers and stakeholders were conducted. This process led to the identification of the top 10 actionable determinants, defined as those rated highly for importance and modifiability by experts and for impact and feasibility by policy makers and stakeholders, including availability of indoor and outdoor PA facilities, beliefs about PA, and inclusive school programs. CONCLUSIONS: The results highlight school, family, and socio-cultural environments as critical settings for intervention. The EU-PAD-A framework offers a novel, interdisciplinary, and age-specific tool for understanding and addressing the complex drivers of adolescent PA. It provides concrete, consensus-based guidance for designing policies and programs that are feasible, impactful, and grounded in scientific evidence. As such, it represents an important step toward improving PA levels and reducing sedentary behaviour among adolescents across Europe.
Obesogenic behaviors during structured periods among children and adolescents with intellectual and developmental disabilities: a systematic review and meta-analysis.
Kiely KP, Brazendale K, Hill M … +11 more , Burkart S, Beets MW, Adams EL, Armstrong B, St Laurent C, Hogan A, White Iii JW, Finnegan O, Culverhouse J, Holmes A, Weaver RG
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41645179 · Full text
BACKGROUND: Children and adolescents with intellectual and developmental disabilities (IDD) are at greater risk for obesity and poor obesogenic behaviors (e.g., physical activity, screen time, diet, sleep) than their typ...
BACKGROUND: Children and adolescents with intellectual and developmental disabilities (IDD) are at greater risk for obesity and poor obesogenic behaviors (e.g., physical activity, screen time, diet, sleep) than their typically developing counterparts. The Structured Days Hypothesis (SDH) suggests that in typically developing children and adolescents, obesogenic behaviors worsen during periods of reduced structure (e.g., weekend or summer vacation). However, children and adolescents with IDD have unique factors that may alter how structure (i.e., pre-planned, segmented, adult supervised, out-of-home programs) influences obesogenic behaviors. Therefore, the objective of this systematic review and meta-analysis is to examine obesogenic behaviors during periods of more and less structure among children and adolescents with IDD. METHODS: A comprehensive search of PubMed, PsycINFO, Embase, and Web of Science was performed through the end of 2024 based on the PICO framework. Studies were eligible if they included youth with IDD and measured obesogenic behaviors across contexts with differing degrees of structure. Two reviewers independently completed the screening process, extracted all relevant information, and evaluated methodological quality using the NHLBI tool. Results were synthesized using fixed- and random-effects meta-analyses and visually represented with forest plots. RESULTS: A total of 4,236 papers were screened with 323 full-text articles retrieved. After screening, 33 total studies were identified (physical activity = 23, sedentary behaviors = 12, sleep = 11, diet = 1). Meta-analyses indicated that the standardized mean difference of physical activity (Random = 0.27, [95%CI: 0.13-0.40], p < 0.00), and diet (0.16, [95%CI: 0.03-0.29], p = 0.02) aligned with the SDH while sleep (Random = -0.01, [95%CI: -0.16-0.14], p = 0.88), sedentary and screen time (Random = -0.01, [95%CI: -0.38-0.36], p = 0.95) did not align. CONCLUSIONS: Periods of greater structure were associated with more favorable physical activity and diet outcomes among children and adolescents with IDD, although evidence for dietary behaviors was limited. Findings support the relevance of the SDH in this population while highlighting substantial gaps in the literature, including small study numbers and methodological heterogeneity. Future research using rigorous, longitudinal designs is needed to better understand the relationship between structure and obesogenic behaviors among children and adolescents with IDD.
Bidirectional associations between smart device use and body mass index among children aged 3 to 5 years: a longitudinal study.
Chakranon P, Huang JP, Au HK … +7 more , Chiou H, Lin CL, Chen YY, Mao SP, Kim P, Hsu HW, Chen YH
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41639908 · Full text
BACKGROUND: The increase in smart device use, including smartphones and tablets, among young children has raised concerns about its impact on health, particularly on body mass index (BMI). However, the bidirectional asso...
BACKGROUND: The increase in smart device use, including smartphones and tablets, among young children has raised concerns about its impact on health, particularly on body mass index (BMI). However, the bidirectional associations between smart device use and BMI in preschoolers remain unclear. This study examined the longitudinal associations, considering the moderating effects of mother-child interactions and child sex. METHODS: Data were obtained from the Longitudinal Examination Across Prenatal and Postpartum Health in Taiwan, a cohort study conducted in Taipei, Taiwan. In total, 590 preschoolers were assessed at ages 3, 4, and 5 years. Smart device use, BMI z-scores, and mother-child interaction quality were evaluated using validated parent-reported questionnaires. The random-intercept cross-lagged panel model was used to investigate bidirectional associations, adjusting for stable confounders. Multiple-group models examined the moderating effects of mother-child interactions and child sex. Model estimates were reported as standardized coefficients. RESULTS: Higher BMI z-scores at age 4 years were linked to increased device use at age 5 years (β = 0.36; 95% CI, 0.05-0.67). Multiple-group models revealed that among dyads with lower mother-child interactions, higher device use at age 3 years was associated with higher BMI at age 4 years (β = 0.40; 95% CI, 0.07 to 0.72), which was subsequently linked to greater device use at age 5 years (β = 0.50; 95% CI, 0.10 to 0.90). Additionally, higher device use at age 4 years was associated with higher BMI at age 5 years (β = 0.65; 95% CI, 0.31 to 1.00). A similar bidirectional pattern was observed among boys, while no significant cross-lagged associations were found among girls. In contrast, high-quality mother-child interactions revealed higher device use at age 4 years was associated with lower BMI at age 5 years, suggesting a protective role against prolonged device use and subsequent BMI increases. CONCLUSIONS: Our study indicates bidirectional associations between smart device use and BMI among preschoolers, emphasizing the protective role of high-quality mother-child interactions. Interventions should focus on enhancing parent-child relationships, limiting device use, and promoting active engagement. Future studies should investigate the effect of media content and children's self-regulation on these associations.
The impact of public policy on socioeconomic equity in physical activity: a systematic review.
Heuvelman F, Birkholz L, Tcymbal A … +15 more , Lakerveld J, Beulens JWJ, Woods C, Abu-Omar K, Volf K, Sandu P, Jankauskiene R, Gobis A, Wachnicka J, Żukowska J, Gelius P, Schoonmade LJ, Messing S, den Braver NR, IMPAQT consortium
Int J Behav Nutr Phys Act · 2026 Feb · PMID 41639714 · Full text
BACKGROUND: Increasing population-level physical activity (PA) requires system-level policy action. However, public policies targeting the general population, without addressing socially disadvantaged populations, might...
BACKGROUND: Increasing population-level physical activity (PA) requires system-level policy action. However, public policies targeting the general population, without addressing socially disadvantaged populations, might unintentionally increase socioeconomic inequities in PA. This is particularly concerning since disadvantaged groups are less likely to meet PA recommendations to begin with. This systematic review assesses evidence on the effects of public policies on equity in PA. METHODS: A literature search was performed in seven bibliographic databases on May 7, 2024, in collaboration with a librarian. Studies were included if they a) focused on changes in PA behaviour, PA proxies, or the PA environment as outcomes, b) examined public policy as the independent variable, and c) included a low socioeconomic status (SES) (sub)population. Screening was done in duplicate. Key data extracted included: public policy information, target population and/or SES subgroup measures, PA outcomes, and equity-related findings. Policies were grouped into domains aligned with the eight investments of the International Society for Physical Activity and Health and categorized based on their impact on inequities: reduction, increase, no effect, or mixed effects. RESULTS: Out of 10,350 records screened, 81 studies were included. Results showed that 27% of the public policies reduced inequities, 38% had no effect, 10% increased them, and 25% had mixed effects. The fewest PA policies were identified in the healthcare (n = 2) and workplace (n = 0) domains, the most in the community-wide domain (n = 22). Based on the available evidence, the school, transport, community-wide, and mass media policy domains most frequently demonstrated potential to reduce inequities in PA and/or to benefit high and low SES populations equally. Policies that most consistently reduced inequities or had a neutral equity effect included a) infrastructure policies, b) financial incentives supporting active transport, c) multi-component school-based PA and health policy programmes, d) school physical education policies, and e) policies supporting mass media campaigns. Conversely, urban design and sport for all policies varied in their effects on inequities. CONCLUSIONS: Most policies do not appear to exacerbate inequities. Policies in the school, transport, community-wide, and mass media domains show particular promise for promoting PA in an equitable way. These findings offer valuable insights for future policymaking.
Vigorous intermittent lifestyle physical activity (VILPA) and mortality risk among US adults: a wearables-based national cohort study.
Koemel NA, Ahmadi MN, Biswas RK … +5 more , Thøgersen-Ntoumani C, Teixeira-Pinto A, Chow CK, Harezlak J, Stamatakis E
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41612409 · Full text
BACKGROUND: Vigorous intermittent lifestyle physical activity (VILPA) completed through normal daily living may offer a time-efficient avenue to accrue physical activity in a behaviourally sustainable manner. However, no...
BACKGROUND: Vigorous intermittent lifestyle physical activity (VILPA) completed through normal daily living may offer a time-efficient avenue to accrue physical activity in a behaviourally sustainable manner. However, no research to date has explored its association with mortality in a nationally representative population. This study aimed to examine the dose-response association between VILPA and mortality risk in a nationally representative sample of US adults. METHODS: This study included a nationally representative sample of 3293 US adults from the 2011-14 National Health and Nutrition Examination Survey (NHANES) who self-reported no participation in structured exercise (52.3% female; mean age: 50.7 [SD: 16.6 years]. The dose-response relationship between VILPA and all-cause mortality was estimated using multivariable-adjusted cubic splines. Average daily frequency (bouts/day) and duration (minutes/day) of VILPA bouts lasting up to one minute were measured using a wrist-worn accelerometer. RESULTS: Over the mean (SD) 6.7 (1.4) year follow-up period, 290 all-cause mortality events occurred. Compared to the referent point (0 bouts per day), there was an L-shaped dose-response association where the median frequency (5.3 bouts per day) was associated with a 44% lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.39, 0.82). The dose response curve was less steep beyond approximately 8 bouts per day (HR: 0.46; 95% CI: 0.28, 0.77). Findings for the median frequency of VILPA bouts (5.3 bouts per day) remained consistent after excluding participants with poor health (HR: 0.51: 95% CI: 0.29, 0.87) and those who completed no VILPA (HR: 0.57: 95% CI: 0.38, 0.86). When excluding adults with prevalent cardiovascular disease or cancer at baseline (n = 2,731, 152 events), the dose-response relationship was similar, although the 95% CIs crossed unity for most of the curve (e.g. median frequency of VILPA bouts HR: 0.68: 95% CI: 0.41, 1.11). CONCLUSIONS: In a nationally representative sample of US adults, short bursts of intermittent vigorous physical activity were associated with a lower risk of mortality. Excluding those with prevalent cardiovascular disease and cancer led to attenuated dose-response curves and wider confidence intervals, suggesting that the observed relationships may, at least partly, be driven by existing disease-induced reverse causation. While these results highlight some potential of VILPA as a time-efficient source of activity, additional observational studies with longer follow up and larger sample sizes are warranted.
Association between life satisfaction and health behaviours among older adults: a systematic review and meta-analysis.
Alumona CJ, Scott DR, Aladejebi T … +6 more , Kalu ME, Onyeso OK, Odole AC, Vogelsang L, Singleton J, Awosoga OA
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41588526 · Full text
BACKGROUND: Life satisfaction is a key indicator of quality of life among older adults. This systematic review and meta-analysis synthesised evidence on the association between life satisfaction and health behaviours suc...
BACKGROUND: Life satisfaction is a key indicator of quality of life among older adults. This systematic review and meta-analysis synthesised evidence on the association between life satisfaction and health behaviours such as smoking status, alcohol use, physical activity, diet/nutrition, and sleep among older adults aged 60 years and older. METHODS: The review was conducted and reported following the PRISMA guidelines. We searched the electronic databases MEDLINE, APA PsycINFO, Web of Science, CINAHL, and Global Health from inception to 10 January 2025 for observational studies reporting an association between life satisfaction and health behaviours. Two independent reviewers completed article screening, data extraction, and risk of bias assessment. The result was summarised through a narrative synthesis, and meta-analysis was completed using CMA (version 4). RESULTS: The 56 included studies were conducted across 22 countries between 1990 and 2025. The pooled mean age and female proportion were 70.59 years (95% CI: 68.98, 72.21) and 58.0% (95% CI: 55.1, 60.7), respectively. Narrative synthesis showed that most studies found quality sleep and/or 7–8 h of sleep (77.3%), a higher physical activity level (69.1%), and a regular intake of fruit and vegetables and/or a balanced diet regularly (52.9%) were significantly associated with higher life satisfaction. Smoking and alcohol use were associated with lower life satisfaction in 33.3% and 15.8% of the analysis, respectively. The meta-analysis showed that higher physical activity levels (r = 0.12, p = 0.003) were associated with higher life satisfaction. Only four studies on physical activity met the criteria for meta-analysis, and no studies on other health behaviours did. CONCLUSIONS: Quality sleep and/or 7–8 h of sleep, a higher physical activity level, and regularly eating fruit and vegetables and/or a balanced diet are associated with higher life satisfaction. The review provides evidence for policymakers, healthcare workers, caregivers, and society to encourage healthy behaviours that foster healthy ageing. Future studies should use standardised instruments to assess health behaviours and life satisfaction, facilitating cross-study comparisons and the meta-synthesis of research findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42023441386).
Effectiveness of supervised vs brief counselling physical activity promotion interventions in breast cancer survivors on aromatase inhibitors: the PAC-WOMAN randomized controlled trial.
Carraça EV, Rodrigues B, Franco S … +6 more , Nobre I, Jerónimo F, Ilharco V, Silva PF, Palmeira AL, Silva MN
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41572331 · Full text
BACKGROUND: Aromatase inhibitors (AI) are used to treat hormone-receptor-positive breast cancer, but have several side effects that often lead to premature discontinuation/switch. Physical activity (PA) can attenuate sid...
BACKGROUND: Aromatase inhibitors (AI) are used to treat hormone-receptor-positive breast cancer, but have several side effects that often lead to premature discontinuation/switch. Physical activity (PA) can attenuate side effects and improve quality of life. However, most cancer survivors fail to meet PA guidelines. Theory-based PA interventions are effective in breast cancer survivors, but scarce. PAC-WOMAN tested the effects of two PA promotion interventions (supervised exercise vs brief counseling) on primary outcomes – PA, sedentary behavior, quality of life –, and secondary outcomes – body composition, fitness, physical function, sleep, body image, depression, psychological well-being, pain, and motivational variables – in women on AI. METHODS: This pragmatic randomized controlled trial included 110 women with stage I-III hormone-receptor-positive breast cancer on AI (56.1 ± 7.6 yr; 28.1 ± 5.9 kg/m2; 23.4 ± 20.1 months on AI), randomized to: 1) brief PA counseling (PAC); 2) structured exercise (ExG); 3) waiting-list control. Primary and secondary outcomes were evaluated with validated instruments at the end of the intervention period. Repeated measures’ Anovas, adjusted for age, AI duration, body mass index and chronic diseases, were conducted. Bonferroni corrections were applied (significance level at p < 0.0083). RESULTS: Significant group-by-time interactions were observed for moderate-vigorous PA (MVPA), exercise motivations and affect, muscle strength and leg endurance (p ≤ 0.008). Objectively measured PA showed no significant effects in either intervention group, except for a near-significant MVPA increase of 107 min/week [95% CI: 4; 209] over time in ExG. Larger improvements were observed in all self-reported PA indicators in ExG, while PAC revealed gains only in light PA and active choices. ExG improved global health status, physical functioning and physiological indicators (e.g., fitness, body composition) over time; PAC enhanced future perspectives, body image functioning, breast symptoms, and other psychological outcomes, with changes in depressive symptoms (-1.4 [-2.4; -0.3]) and life satisfaction (0.8 [0.2; 1.5]) approaching significance. CONCLUSIONS: PAC-WOMAN showed that ExG and PAC yielded distinct benefits for breast cancer survivors on AI. ExG improved total PA, fitness, physical function, physical quality of life, and alleviated pain symptoms. PAC primarily enhanced light PA and psychological outcomes such as body image and life satisfaction. Together, these findings highlight the potential scalability of PAC alongside the robust physical benefits of ExG. TRIAL REGISTRATION: April 2023 – NCT05860621; https://doi.org/10.17605/OSF.IO/ZAQ9N ; UMIN000050945.
Effects of continuous glucose monitoring on physical activity and diet in diabetes: a systematic review and meta-analysis.
Peng M, Shen P, Kim KJ
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41566380 · Full text
BACKGROUND: Continuous glucose monitoring (CGM) may facilitate behavior modifications among individuals with diabetes. However, existing evidence regarding its effectiveness remains inconsistent. This study aimed to eval...
BACKGROUND: Continuous glucose monitoring (CGM) may facilitate behavior modifications among individuals with diabetes. However, existing evidence regarding its effectiveness remains inconsistent. This study aimed to evaluate the effectiveness of CGM in improving physical activity and diet for people with diabetes using both qualitative and quantitative approaches. METHODS: We searched PubMed, Cochrane, Embase, and Web of Science on October 13, 2024 to identify studies utilizing CGM in people of any age with any type of diabetes that reported outcomes related to physical activity and/or diet and were eligible for systematic review. Randomized controlled trials in which CGM was used as the main intervention and whose outcomes could be quantitatively synthesized were included in the meta-analysis. RESULTS: The initial search identified 13,128 records, then 28 studies met the inclusion criteria for the systematic review. Of these, 10 and 8 studies were included in the meta-analysis of physical activity and diet, respectively. Compared with controls, CGM significantly increased daily physical activity time (MD: 16.21 min/day, 95% CI: 10.26 to 22.16; P<0.0001) (low-certainty evidence). In addition, CGM significantly reduced daily caloric intake (-70.81 kcal/day, -132.93 to -8.69; P = 0.03) (low-certainty evidence) and carbohydrate consumption (-19.88 g/day, -27.74 to -12.01; P < 0.00001) (low-certainty evidence) versus controls. CONCLUSIONS: CGM significantly increased daily physical activity time and reduced both caloric intake and carbohydrate consumption in adults with diabetes. Future high-quality, large-scale randomized controlled trials are warranted to confirm these associations and to clarify the mechanisms underlying CGM’s behavioral effects across diverse diabetes populations. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO; CRD42024609764).
Participatory design of built environment strategies to enhance movement, wellbeing, and quality of life among incarcerated men.
Giné-Garriga M, Palma C, Signo S … +7 more , Isanta C, Romeva R, Portillo SA, King AC, Cortés MA, Ballester D, Sebastiani EM
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41566349 · Full text
BACKGROUND: The global prison population has grown by 5% since 2020, intensifying existing challenges to inmate health and well-being. Incarcerated individuals experience disproportionately high levels of sedentary behav...
BACKGROUND: The global prison population has grown by 5% since 2020, intensifying existing challenges to inmate health and well-being. Incarcerated individuals experience disproportionately high levels of sedentary behaviour (SB), which increases their risk of physical and mental health problems. Although regular physical activity (PA) can mitigate these risks, correctional settings often present environmental and institutional barriers that limit opportunities for movement. While modifying built environments has shown promise for promoting PA in community settings, limited research has explored these strategies in prisons. This study applied a community science, co-creation approach to identify inmate-informed, context-specific solutions to reduce SB and enhance PA within a prison setting. METHODS: The study was conducted in a Spanish male prison with 26 adult inmates. Based on facility-use records and self-reported activity/sedentary levels, 13 highly active and 13 inactive inmates were purposively selected to capture diverse perspectives. Participants took part in structured workshops using the Our Voice community science framework. With the Our Voice Discovery Tool mobile app, they documented environmental barriers and facilitators to PA through geo-tagged photos and audio or text comments while moving through prison spaces. Data sources included workshop transcripts, facilitator notes, and app-generated digital content, which were analyzed using Braun and Clarke’s codebook thematic approach. Participants then proposed and ranked potential solutions using an Eisenhower Matrix, and these were later refined with input from prison staff and policymakers. RESULTS: Six major themes influencing movement opportunities emerged: (1) activities, (2) spaces, (3) equipment and materials, (4) staff and support, (5) regulation-related limitations, and (6) scheduling. In total, 39 inmate-generated strategies were identified, 31 of which were rated as high priority. Low-difficulty actions included improved maintenance of activity areas, expanded access to equipment, and more flexible use of existing spaces. Participants emphasized that socially supportive environments were essential to motivation, adherence, and mental well-being. CONCLUSIONS: The study demonstrates the feasibility and value of participatory community science in correctional settings. Involving incarcerated individuals in designing PA solutions generates practical, context-appropriate strategies and supports greater health equity. This approach offers a scalable model for institutions aiming to reduce SB and promote PA through built-environment improvements.
Effects of a music-visual guided physical activity promotion program for adults with intellectual disability in supported care settings: a cluster-randomized controlled trial.
Cheng HY, Chair SY, Choi KC … +5 more , Wong KK, Tang WL, Ali MU, Sit JWH, Fung E
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41547837 · Full text
BACKGROUND: Adults with intellectual disabilities (ID) in supported care settings face significant cardiometabolic health disparities, exacerbated by barriers to physical activity (PA). Sustainable, theory-driven interve...
BACKGROUND: Adults with intellectual disabilities (ID) in supported care settings face significant cardiometabolic health disparities, exacerbated by barriers to physical activity (PA). Sustainable, theory-driven interventions are essential to address these challenges and promote cardiovascular health in this vulnerable population. This study evaluated the effectiveness of a novel music-visual guided PA intervention (MVgPA) in increasing moderate-to-vigorous PA time, improving self-efficacy and interest in PA, and enhancing functional exercise capacity among adults with ID in supported care settings. It also assessed the intervention’s acceptability among participants and care staff. METHODS: In a 25-week cluster-randomized controlled trial, 16 supported care settings (N = 238 adults with mild-to-moderate ID) were randomized 1:1 to MVgPA (n = 8 settings, 120 participants; staff training plus twice-weekly 75-minute music-paced, visually cued PA sessions) or usual care (n = 8 settings, 118 participants). The Information-Motivation-Strategy (IMS)-based MVgPA intervention targeted knowledge, motivation, and practical strategies. The primary outcome was accelerometer-measured moderate-to-vigorous PA time. Secondary outcomes included functional exercise capacity (6-minute walk test), exercise self-efficacy (Baseline Interview Questionnaire), and PA interest (visual analogue scale). Outcomes were measured at baseline, 13, and 25 weeks, and analyzed using three-level mixed-effects models accounting for clustering, repeated measures, and individual variability. RESULTS: No significant between-group differences emerged in moderate-to-vigorous PA time. Compared to controls, the MVgPA group showed significant improvements in functional exercise capacity at 13 weeks (Time*Group interaction coefficient, β: 20.89, 95% CI: 7.81 to 33.98, p = 0.002) and 25 weeks (β: 16.78, 95% CI: 2.44 to 31.12, p = 0.02); exercise self-efficacy at 13 weeks (β: 0.60, 95% CI: 0.10 to 1.10, p = 0.02) and 25 weeks (β: 0.96, 95% CI: 0.42 to 1.49, p < 0.001), and PA interest at 13 weeks (β: 1.22, 95% CI: 0.48 to1.96, p = 0.001) and 25 weeks (β:1.76, 95% CI: 0.98 to 2.55, p < 0.001). All intervention settings committed to sustaining MVgPA post-trial. The trial achieved 100% participant retention and demonstrated high acceptability (staff willingness scores: 4 to 6/6). CONCLUSIONS: The IMS-based MVgPA intervention significantly improved functional and psychosocial outcomes associated with cardiovascular health in adults with ID, despite no increase in objectively measured PA. The intervention’s high acceptability and sustainability support its scalable implementation in supported care settings. TRIAL REGISTRATION: The study protocol was registered at ClinicalTrials.gov (NCT04938999) https://clinicaltrials.gov/study/NCT04938999?term=NCT04938999&rank=1 on 2021-06-25.
Feasibility of the "LvL UP" trial: a pilot sequential multiple assignment randomised trial of an adaptive, holistic mHealth lifestyle coaching intervention.
Zheng S, Castro O, Mair JL … +15 more , Jabir AI, Tan SYX, Shenoi A, Negi S, Mathews RR, Koh RWS, Yan X, Chakraborty B, Tai ES, van Dam RM, von Wangenheim F, Fleisch E, Griva K, Kowatsch T, Müller-Riemenschneider F
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41485014 · Full text
BACKGROUND: Mobile Health (mHealth) interventions are promising for addressing the growing burden of noncommunicable diseases and common mental disorders but often focus on single domains and lack adaptability. LvL UP ("...
BACKGROUND: Mobile Health (mHealth) interventions are promising for addressing the growing burden of noncommunicable diseases and common mental disorders but often focus on single domains and lack adaptability. LvL UP ("Level Up") is a holistic mHealth lifestyle coaching intervention that integrates physical activity, diet, and emotional regulation. It provides blended coaching support through an app-based conversational agent with adaptive human support. This pilot trial assessed the feasibility of delivering the LvL UP intervention and implementing its adaptive procedures using a sequential multiple assignment randomised trial (SMART) design. METHODS: This eight-week pilot trial was conducted from 29 March to 1 August 2024. We recruited adults in Singapore aged 21-59 at risk of chronic conditions. Participants were randomised 2:1 to the intervention (LvL UP app with a peer supporter-LvL UP Buddy) or comparison (control app with educational resources). After four weeks, non-responders (defined as completing < 6 digital coaching sessions or rated session usefulness < 4/5) were re-randomised 1:1 to continue or receive three additional motivational interviewing (MI)-informed sessions with a human coach; responders remained on their original allocation. Primary outcomes included feasibility indicators: recruitment, LvL UP Buddy enrolment, non-responder rate, trial retention, data completion rate, and intervention engagement. Secondary outcomes measured changes from baseline to eight weeks in mental well-being, psychological distress, physical activity, sleep duration, and fruit and vegetable intake. Six progression criteria were prespecified to guide advancement to a definitive trial. RESULTS: Of the 458 individuals screened, 394 were eligible, and 123 were enrolled (82 interventions; 41 controls). Most intervention participants (95.1%) were paired with a LvL UP Buddy. Thirty-eight participants (46.3%) were non-responders; of those assigned to MI-informed sessions, 52.6% (10/19) completed all three. Eight-week retention was high (91.5% intervention; 92.7% control), with 12.2% missing data. Positive trends were observed in mental well-being (2.12, 95% CI [-0.58, 4.82]), psychological distress (-0.94 [-2.08, 0.20]), and sleep duration (0.49 h/week [0.17, 0.82]). The study met five of six prespecified progression criteria: recruiting ≥ 60 participants within six weeks, achieving ≥ 75% retention, maintaining ≤ 20% missing data, obtaining a 40-60% non-responder rate, and showing a positive change in ≥ 1 health-related outcome. The digital coaching session adherence fell below the target (39.5% vs. 70%). CONCLUSIONS: LvL UP was feasible to deliver and evaluate using a SMART design. The results provide strong operational guidance and a solid foundation for the refinement and implementation of a fully powered trial. TRIAL REGISTRATION: ClinicalTrials.gov, TRN: NCT06360029, Registration date: 7 April 2024.
Every move counts: but some more than others.
Hillsdon M, Metcalf B, Newton JN … +2 more , Wanigatunga AA, Schrack JA
Int J Behav Nutr Phys Act · 2026 Jan · PMID 41484632 · Full text
BACKGROUND: Physical activity (PA) plays an essential role in reducing the risk of non-communicable diseases and improving health and well-being. However, current PA guidelines do not adequately reflect emerging evidence...
BACKGROUND: Physical activity (PA) plays an essential role in reducing the risk of non-communicable diseases and improving health and well-being. However, current PA guidelines do not adequately reflect emerging evidence on the importance of the relationship between patterns of PA bout duration and health outcomes. MAIN TEXT: This paper explores the limitations of evidence based on self-reported, aggregated measures of PA, and advocates for greater use of time series data from accelerometers to describe daily patterns of PA bout duration. Time series data offer insights into how PA is accumulated in different bout lengths and how such patterns impact health, independent of total weekly volume of PA. Evidence from accelerometer-based studies of the association between patterns of PA bout duration and health outcomes challenges the revised World Health Organisation guideline that 'every move counts toward better health'. CONCLUSION: By highlighting the novel nature of time series data and their corresponding patterns of PA bout duration, this paper aims to challenge current public health guidelines and inform the development of future guidelines, surveillance, policies, and interventions to prevent morbidity and mortality.
Impact of free summer day camp on physical activity behaviors and screentime of elementary-age children from low-income households: a randomized clinical trial.
Beets MW, Burkart S, Pfledderer CD … +7 more , Adams E, Weaver RG, Armstrong B, Brazendale K, Zhu X, Chen B, McLain A
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41466370 · Full text
BACKGROUND: To examine the efficacy of providing free summer day camp (SDC) to children from low-income families on changes in physical activity, time spent sedentary, and screentime. METHODS: Across three summers (2021-...
BACKGROUND: To examine the efficacy of providing free summer day camp (SDC) to children from low-income families on changes in physical activity, time spent sedentary, and screentime. METHODS: Across three summers (2021-2023), we randomized 422 children (8.2 ± 1.5yrs, 48% female, 51% Black, 69% at or below 200% Federal Poverty Level, 30% food insecure) from seven elementary schools to one of two conditions: summer as usual (control, n = 199) or free SDC for 8-10wks (intervention, n = 223). Accelerometry measured activity (moderate-to-vigorous PA [MVPA] and time spent sedentary) and parent daily report of screentime were measured using a 14-day in April/May (school) and July (summer). Intent-to-treat analysis examined changes in behaviors between school and summer. Exposure models examined differences in behaviors during summer on days when children attended vs. did not attend a SDC in both intervention and control children. RESULTS: Intent-to-treat models indicated in the summer children in the intervention group accumulated + 15.0 min/day (95CI 12.0 to 18.0) more MVPA and spent - 29.7 min/day (-37.7 to -21.8) less time sedentary and - 14.1 min/day (-23.9 to -4.3) on screens, compared to children in the control group. Exposure models indicated, on days children attended SDCs, they accumulated more MVPA (+ 26.1 min/day, 22.5 to 29.7), and spent less time sedentary (-63.5 min/day, -72.9 to -54.1) and on screens (-9.5 min/day, -20.1 to 1.2), compared to days when children did not attend SDC. CONCLUSIONS: Policies targeting upstream structural factors, such as universal access to existing community SDCs during summer, could lead to improvements in health behaviors among children from low-income households. CLINICAL TRIALS: GOV: NCT04072549.
Physical activity interventions among children and adolescents in China: a scoping review through an equity lens.
Li M, Liu Y, Gu Y … +1 more , Sum RKW
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41430685 · Full text
BACKGROUND: Equity in health promotion is essential to ensuring fair opportunities for children to engage in physical activity (PA). While China has implemented numerous PA interventions, little is known about how these...
BACKGROUND: Equity in health promotion is essential to ensuring fair opportunities for children to engage in physical activity (PA). While China has implemented numerous PA interventions, little is known about how these programs address or overlook equity considerations. This scoping review synthesizes evidence on equity measures in PA interventions among Chinese children. METHODS: A scoping review was conducted following the guidance of PROGRESS-Plus framework to assess equity measures across PA interventions for children in China. Published studies were analysed to identify equity-related indicators including place of residence, ethnicity, occupation, sex, education, and household income. This review was registered on OSF registries ( https://osf.io/zbfpd ). RESULTS: Sixty-five individual interventions were identified. Equity considerations were rarely explicit. Most interventions were concentrated in well-developed cities, with only two conducted in rural regions. Male participants slightly outnumbered females. Children from families with lower parental education or occupational status, as well as those from ethnic minoritised groups and children who are left-behind or displaced, were consistently underrepresented. While a number of interventions focused on children with health issues, these efforts were not intentionally designed to address PA inequities. CONCLUSIONS: Equity considerations are largely absent from PA interventions for Chinese children. The disproportionate region and sex focus, combined with neglect of rural, minority, and disadvantaged groups, suggests these interventions may unintentionally widen health disparities. Future efforts should apply an equity lens in PA interventions by prioritizing underserved children and considering upstream, policy-level strategies to promote fair and inclusive PA opportunities.
Effects of mHealth interventions to prescribe resistance training: a systematic review and meta-analysis of randomized controlled trials.
Cox ER, Beacroft S, Jansson AK … +7 more , Wade L, Duncan MJ, Lubans DR, Robards SL, Leitner M, Gutberlet N, Plotnikoff RC
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41430613 · Full text
BACKGROUND: This review evaluated the efficacy of resistance training mHealth interventions for improving neuromuscular fitness and resistance training participation. It also explored how resistance training is prescribe...
BACKGROUND: This review evaluated the efficacy of resistance training mHealth interventions for improving neuromuscular fitness and resistance training participation. It also explored how resistance training is prescribed through mHealth, and the theoretical frameworks and behavior change techniques (BCTs) employed. METHODS: MEDLINE (OVID), Embase (OVID), Emcare (OVID), SPORTDiscus, Web of Science, Scopus and Cochrane (CINAHL) were searched from January 2010 to February 2025. Randomized controlled trials published in English, targeting adults, that prescribed resistance training via an mHealth platform and measured at least one outcome of neuromuscular fitness or resistance training participation were included. RESULTS: From the 12,059 records identified, 32 RCTs were included. mHealth-delivered resistance training interventions produced a small, statistically significant improvement in neuromuscular fitness compared with no intervention/usual care (Cohen’s d = 0.18, 95% CI [0.08, 0.28], p < .001, 18 studies). There was a significant, moderate effect for lower body neuromuscular fitness outcomes, but no significant effect for upper body outcomes. Only two studies measured changes to resistance training participation, precluding meta-analysis on this outcome. Studies targeted mostly clinical populations and used mobile applications or websites. Majority of studies included bodyweight exercises, prescribed via videos or pictures, along with text description. Exercise prescription was generally poorly reported across studies. Only 7 studies used a theoretical framework to inform their intervention. All studies incorporated BCTs (17 discrete BCTs used), with a focus on providing instruction and demonstrating behavior. CONCLUSIONS: mHealth is a potentially scalable, effective method of prescribing resistance training. Better reporting of exercise prescription, along with clearer grounding in established theoretical frameworks, is recommended. REVIEW REGISTRATION: The review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42025641142).
Correction to: Does optimizing choose to move - a health‑promoting program for older adults - enhance scalability, program implementation and effectiveness?
Nettlefold L, Macdonald HM, Gould JS … +3 more , Bauman A, Szewczyk Z, McKay HA
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41422020 · Full text
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Effects of a teacher-led social cognitive theory-based multicomponent movement education program on preschoolers' fundamental movement skills and physical activity: the PA-REALITY cluster-randomized controlled trial.
Ha AS, Zeng T, Chan MHM … +4 more , Chan CHS, Okely AD, Leung SKY, Ng JYY
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41419942 · Full text
BACKGROUND: A growing body of studies has shown that fundamental movement skills (FMS) and physical activity (PA) are crucial for preschoolers' development. However, most Hong Kong preschoolers still do not meet the WHO...
BACKGROUND: A growing body of studies has shown that fundamental movement skills (FMS) and physical activity (PA) are crucial for preschoolers' development. However, most Hong Kong preschoolers still do not meet the WHO guidelines for PA and demonstrate poor FMS performance. The present study examined the effectiveness of physical activity routines, education, assessment, literacy, and information technology application in young children (PA-REALITY), a social cognitive theory-based movement education program led by preschool teachers. METHODS: Twenty-nine preschools signed up for the program and were cluster-randomized into an experimental group (15 preschools) and a wait-list control group (14 preschools). Totally 440 (age = 4 ± 0.95 years; 54.5% male) preschoolers took part in the baseline test and 349 preschoolers from 26 schools took part in the post-test (10 months). We delivered intervention contents including teacher workshops, teaching materials (booklet, simple sports equipment), and a mobile application to teachers. At baseline and post-test (10 months), respectively, preschoolers' FMS proficiency, PA, and executive function (EF) were assessed using objective tools. Mixed-linear models using intention-to-treat analyses were used to examine intervention effects. RESULTS: Participants in the experimental group showed significant improvements in catch (B = 0.37, p < .001) and moderate-to-vigorous PA (B = 4.49, p = .04) at 10 months, compared with participants in the wait-list control group. No effects were found for total PA other FMS and EF outcomes. CONCLUSIONS: The PA-REALITY intervention improved some FMS outcomes and MVPA at 10 months. These results highlight the important roles of teachers in developing children's movement skills and PA. Continuous professional development training for teachers may be an effective and sustainable way to improve existing practices.
Free summer programming on elementary-aged children's food and beverage consumption: a randomized clinical trial.
Savidge MC, Burkart S, Pfledderer CD … +8 more , Adams EL, Weaver RG, Armstrong B, Brazendale K, Zhu X, Chen B, McLain A, Beets MW
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41419931 · Full text
PURPOSE: During summer vacation, many children in households with low income lose access to federally-funded, healthful school meals. Summer day camps (SDCs) provide access to healthful meals and a structured environment...
PURPOSE: During summer vacation, many children in households with low income lose access to federally-funded, healthful school meals. Summer day camps (SDCs) provide access to healthful meals and a structured environment; yet low-income families often cannot afford SDCs which may influence food/beverage consumption. This study examined the impact of receiving a free SDC versus experiencing summer as usual (SAU) on dietary intake during summer among children from low-income families. METHODS: Parent-child dyads (N = 422; child age: 8.2 ± 1.5 yrs; 48% female; 51% Black) were recruited over 3 years (2021–2023) from schools serving families with low-income. Children were randomized to receive 8–10 weeks of free SDC (intervention) or SAU (control). Parents completed daily diaries for 14 days during school (April/May) and summer (July) which captured child consumption of healthful (e.g., fruit, vegetables, milk) and unhealthful (e.g., soda, fast food, snacks/chips) foods/beverages. Mixed-effects intent-to-treat (ITT) models examined the odds of consuming different foods/beverages during summer, controlling for school year consumption, in the SDC group compared to SAU. Secondary as-treated analyses examined the impact of attending structured summer programming versus not attending on the odds of consuming different food/beverages, regardless of randomization. RESULTS: A total of 2,931 daily diaries were completed for intervention (n = 232) and control (n = 201) children. ITT analyses showed the SDC group had decreased odds of consuming frozen desserts (OR 0.68, 95%CI 0.49–0.94), compared to SAU, during summer weekdays. No other differences were observed. As-treated analyses showed children had increased odds of consuming fruit (1.77, 1.30–2.41), milk (1.97, 1.44–2.69), and chips/snacks (1.49, 1.17–1.90), and decreased odds of consuming soda (0.53, 0.34–0.84), fast food (0.57, 0.45–0.73), and frozen desserts (0.58, 0.45–0.74) on weekdays when they attended structured summer programming, compared to days they did not attend. CONCLUSIONS: Providing free SDC alone did not promote more healthful food/beverage consumption during summer vacation compared to SAU. However, on days children attended a structured program, children experienced more dietary benefits compared to days they did not. Thus, structured environments may positively impact children’s diet during summer; yet, identifying strategies to address barriers beyond cost to improve attendance and enrollment may enhance the impact of summer programming.
Navigating the complexity: a comment on difficulties in conducting systematic reviews to evaluate the effectiveness of behaviour change interventions.
Rhodes S, Abaraogu U
Int J Behav Nutr Phys Act · 2025 Dec · PMID 41408635 · Full text
Behaviour change interventions are widely applied across diverse domains to modify behaviours and improve outcomes, including but not limited to physical activity, sedentary behaviour, and nutrition. Systematic review of...
Behaviour change interventions are widely applied across diverse domains to modify behaviours and improve outcomes, including but not limited to physical activity, sedentary behaviour, and nutrition. Systematic review of trials of behaviour change interventions often aim to determine both their overall effectiveness and the specific components driving behaviour change. The Behaviour Change Technique Taxonomy v1 (BCTTv1) is a useful framework for coding the individual Behaviour Change Techniques (BCTs) within an intervention. This commentary highlights key methodological challenges in conducting a systematic review of behaviour change interventions. It calls for collaboration in developing clear and consistent methodological guidance to enhance the rigor of systematic reviews to optimise behaviour change interventions.
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