The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
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200 papers
Scalable physical activity intervention for youth with disability: Burn 2 Learn adapted cluster randomized controlled trial.
Lubans DR, Shields N, Eather N … +13 more , Smith JJ, Noetel M, Hillman CH, Lonsdale C, Oldmeadow C, Stuart A, Kennedy SG, Boyer J, Comis P, Roche L, Sanders T, Finn T, Leahy AA
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41068928 · Full text
BACKGROUND: Youth with disability are less physically active and more likely to have chronic health conditions than their peers without disability. The aim of our study was to assess the effectiveness of a scalable schoo...
BACKGROUND: Youth with disability are less physically active and more likely to have chronic health conditions than their peers without disability. The aim of our study was to assess the effectiveness of a scalable school-based physical activity intervention for youth with disability on functional capacity and a range of secondary outcomes. METHODS: We conducted a two-arm cluster randomized controlled trial involving adolescents aged 15–19 years with diagnosed disabilities (N = 255) from 28 secondary schools in New South Wales, Australia. Schools were randomized to the Burn 2 Learn adapted (B2La) intervention, or a wait-list control. The B2La intervention included foundational resistance exercises (e.g., push-ups, bodyweight squats), aerobic exercises (e.g., shuttle runs), and sport skills (e.g., catching, kicking), delivered as classroom activity breaks 2–3 times per week by trained special education teachers. The primary outcome was functional capacity assessed using the 6-min walk or push test. Secondary outcomes were muscular fitness, body mass index, physical activity (accelerometers), resistance training motor competence, motivation for physical activity, high-intensity interval training self-efficacy, quality of life, and externalizing behaviors. Assessments were conducted at baseline, 6-months (primary endpoint), and 9-months (follow-up). RESULTS: At 6-months, the intervention group demonstrated a significant improvement in functional capacity, with a group-by-time effect of 20.3 m (95% CI, 3.1–37.1). At 9-months, the effect was 17.8 m (95% CI, 0.0–35.6). The intervention had a small effect on muscular fitness, resistance training motor competence, and high-intensity interval training self-efficacy. No effects were observed for the other outcomes and no adverse events were recorded. CONCLUSIONS: Physical activity breaks delivered by special education teachers during the school day improved functional capacity and a range of secondary outcomes in youth with disability. Activity breaks may need to be longer, more frequent, or more intense to achieve clinically important health effects. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12621000884808; prospectively registered 15th November, 2021.
Association between physical activity energy expenditure and markers of healthspan during prolonged calorie restriction in individuals without obesity: observations from the CALERIE™ phase 2 randomized controlled trial.
Dorling JL, Martin CK, Das SK … +5 more , Racette SB, Redman LM, Huffman KM, Höchsmann C, Kraus WE
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41057847 · Full text
BACKGROUND: It is unclear how physical activity energy expenditure (PAEE) influences calorie restriction (CR)-induced benefits in individuals without obesity. We examined associations between PAEE and healthspan markers...
BACKGROUND: It is unclear how physical activity energy expenditure (PAEE) influences calorie restriction (CR)-induced benefits in individuals without obesity. We examined associations between PAEE and healthspan markers and physical activity (PA) time during prolonged CR. METHODS: In Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE)™ 2, participants without obesity were randomized to 25% CR or ad libitum control. This post-hoc analysis included baseline and 24-month data from participants in both groups who demonstrated CR. PAEE was calculated from total and resting energy expenditure, measured using doubly labelled water and indirect calorimetry, respectively, and adjusted for covariates to obtain a residual value that was used as the primary exposure variable. Outcomes included grip strength, aerobic capacity, glucose, insulin, blood lipids, and self-reported PA time. RESULTS: Overall, 136 participants (97 [71.3%] females; age: 38.6 [7.4] years; BMI: 25.3 [1.7] kg/m²) who showed CR were analyzed. A smaller decrease in PAEE was associated with improved grip strength (estimate = 0.504 [95% CI: 0.023, 0.986] kg), homeostatic model assessment of insulin resistance (estimate: -0.032 [95% CI: -0.062, -0.002]), and high-density lipoprotein-cholesterol (1.011 [95% CI: 0.356, 1.666] mg/dL; P ≤ 0.040). PAEE change was not associated with aerobic capacity, low-density lipoprotein-cholesterol, triglycerides, glucose, or insulin (P ≥ 0.053). A smaller PAEE decline was associated with more PA minutes (P = 0.028). For some blood lipids, change in PAEE interacted with baseline BMI class (P ≤ 0.029): in participants who were overweight, higher PAEE was associated with lower triglyceride and triglyceride: high-density lipoprotein-cholesterol ratio (P ≤ 0.022), whereas in participants who were normal weight, it was related to increased total-cholesterol (P = 0.006). CONCLUSION: A smaller reduction in PAEE during CR was associated with small improvements in several healthspan markers and greater PA time. Maintaining PAEE during CR may enhance healthspan in individuals without obesity. TRIAL REGISTRATION: clinicaltrials.gov registration (NCT00427193).
The effects of different types of leisure-time physical activity on positive mental health among adolescents: a mixed-methods systematic review and meta-analysis.
Lenze L, Benzing V, Schmid J … +3 more , Minder B, Henn RE, Frahsa A
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41057825 · Full text
BACKGROUND: Despite the well-researched general effect of physical activity on mental health, less is known about specific effects, such as qualitative and contextual aspects of physical activity. Thus, this review aimed...
BACKGROUND: Despite the well-researched general effect of physical activity on mental health, less is known about specific effects, such as qualitative and contextual aspects of physical activity. Thus, this review aimed to systematically synthesise evidence on the effects and experiences of different types of leisure-time physical activity (LTPA; e.g., running, fitness, yoga) on distinct positive mental health (PMH) outcomes among adolescents. METHODS: We searched in seven databases (MEDLINE, Embase, PsycINFO, Cochrane, SPORTDiscus, CINAHL, and Web of Science) without language restrictions for records from January 2009 to 16 June 2025. Inclusion criteria were defined according to the PICOS framework: population (adolescents from non-clinical studies); intervention (specific LTPA type); comparisons (with and without comparator); outcomes (measures or experiences of PMH); study designs (longitudinal quantitative and qualitative studies). We appraised included studies using the mixed-methods appraisal tool. RESULTS: 44 articles from initial 8,149 records were included. Following a convergent segregated approach, the meta-analyses for synthesising the quantitative studies showed different effects depending on the LTPA type. Additionally, the effects depend on the PMH outcome in focus. We identified four facilitators to promote PMH outcomes from the synthesis of qualitative studies: social facilitators for all types of LTPA and various configurations of other facilitators (mastery-related, setting-related, affective-related) for specific LTPA types. The mixed-methods synthesis shows the interplay between LTPA and PMH outcomes depending on the LTPA type. CONCLUSIONS: The effects of LTPA on PMH in adolescents depend on the LTPA type and PMH outcome in focus. Perceived facilitators highlight possible explanations for the effects found. By investigating specific LTPA types and different PMH outcomes, ecologically valid implications for specific contexts to foster adolescent mental health may be derived. The limited number of studies per LTPA type, PMH aspect, and study design emphasises the need for more research to derive more specific and robust implications for tailored mental health promotion.
The effectiveness of mobile app-based interventions in facilitating behaviour change towards healthier and more sustainable diets: a systematic review and meta-analysis.
Curtin E, Green R, Brown KA … +7 more , Nájera Espinosa S, Chandrasekar A, Hopkins L, Turner G, Alae-Carew C, Ullian K, Scheelbeek P
Int J Behav Nutr Phys Act · 2025 Sep · PMID 41035009 · Full text
BACKGROUND: Digital health apps have been shown to influence healthy eating, but whether they can promote environmentally friendly diets remains unclear. In countries where diets typically contain a high proportion of ca...
BACKGROUND: Digital health apps have been shown to influence healthy eating, but whether they can promote environmentally friendly diets remains unclear. In countries where diets typically contain a high proportion of carbon-intensive foods (e.g., meat), transitioning to healthier alternatives (e.g., fruit, vegetables, and legumes) can substantially reduce food-related greenhouse gas emissions while also improving public health. Our systematic review and meta-analysis aimed to investigate the effectiveness of mobile apps in facilitating more sustainable and healthier diets among adults from high-income countries. METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health, GreenFILE, Web of Science, Cochrane Trials, and ClinicalTrials.gov from inception until Jan 20, 2025. We included studies that reported the effects of app-based behavioural interventions on the consumption of fruit, vegetables, legumes, nuts, fish, dairy, and/or meat, compared to a control, baseline period, or different intervention. For outcomes measured in at least two studies, we conducted random effects meta-analysis and meta-regression to understand population differences and the role of specific intervention components. RESULTS: Of the 7356 records screened, 21 were included. Nine studies scored ‘high’, 10 scored ‘fair’, and two scored ‘low’ for reporting transparency. Combined, the studies analysed 12,898 participants, interventions lasted from three days to six months, and outcomes were assessed up to 12 months post-intervention. Forty percent of studies targeted populations with at least one health risk factor and 81% of study populations did not meet dietary guidelines at baseline for their primary outcome. Meta-analyses indicated that app use led to increased fruit and vegetable consumption (0.48 portions/day, 95% CI 0.18, 0.78, p = 0.002) and a small decrease in meat consumption (-0.10 portions/day, 95% CI -0.16, -0.03, p = 0.004), with meat-focussed apps showing as more effective than general apps for meat reduction. Meta-regression also revealed that message-based content was particularly effective in promoting meat reduction. There were no pronounced effects on legume or dairy consumption, or differences across populations. CONCLUSION: Our results indicate that apps could be a valuable addition to the multiple interventions required to promote sustainable diets. However, to strengthen the evidence for outcomes beyond fruit and vegetables, we need standardised reporting of populations and intervention components.
Efficiency of time-restricted eating and energy restriction on anthropometrics and body composition in adults: a systematic review and meta-analysis of randomized controlled trials.
Sun Y, Liu Y, Ye W … +4 more , Lebaka VR, Chenji V, Li W, Korivi M
Int J Behav Nutr Phys Act · 2025 Sep · PMID 41034862 · Full text
BACKGROUND: We examined the effect of time-restricted eating (TRE) alone and in combination with energy restriction (ER) on the body composition in adults. METHODS: PubMed, the Cochrane Library, EMBASE, Web of Science, a...
BACKGROUND: We examined the effect of time-restricted eating (TRE) alone and in combination with energy restriction (ER) on the body composition in adults. METHODS: PubMed, the Cochrane Library, EMBASE, Web of Science, and Scopus were systematically searched for articles that evaluated the effects of TRE or TRE + ER on body composition variables. Meta-analysis was performed to explore the overall effect of TRE on body composition. Subgroup analysis was performed to compare the changes in the TRE and TRE + ER trials with those in no restriction (NR) and ER trials. Intervention effects on body composition are expressed as weighted mean differences (WMDs) and 95% confidence intervals (CIs). RESULTS: A total of 20 randomized controlled trials (1242 participants) were included in the systematic review and meta-analysis. Pooled results showed that TRE significantly decreased body weight, fat mass, fat-free mass, body mass index (BMI) and waist circumference (WC). Subgroup analyses revealed that TRE alone (compared to NR) and TRE plus ER (compared to ER) considerably decreased body weight (TRE = WMD:-1.59 kg, 95%CI:-2.02 to -1.15 p < 0.00001; TRE + ER = WMD:-0.94 kg, 95%CI:-1.58 to -0.31, p = 0.004) and fat mass (TRE = WMD:-0.93 kg, 95%CI:-1.22 to -0.63, p < 0.00001; TRE + ER = WMD:-1.13 kg, 95%CI:-1.50 to -0.75, p < 0.00001) but not fat mass percentage. Both TRE and TRE + ER decreased fat-free mass (TRE = WMD:-0.58 kg, 95%CI:-0.81 to -0.36, p < 0.00001; TRE + ER = WMD:-0.56 kg, 95%CI:-0.81 to -0.31, p < 0.0001). TRE independently and combinedly decreased BMI (TRE = WMD:-0.63 kg/m2, 95%CI:-0.95 to -0.30, p = 0.0002; TRE + ER = WMD:-0.42 kg/m2, 95%CI:-0.78 to -0.07, p = 0.02) and WC (TRE = WMD:-2.11 cm, 95%CI:-3.35 to -0.86, p = 0.0009; TRE + ER = WMD:-2.20 cm, 95%CI: -2.64 to -1.75, p < 0.00001). CONCLUSIONS: TRE independently promotes weight loss in adults, and combining of TRE with ER has no additional beneficial effects on weight loss. TRIAL REGISTRATION: This study was registered with PROSPERO: CRD42022370215.
Comment on 'twenty years of behavioural nutrition - a reflection on the road less travelled'.
Alvarenga M
Int J Behav Nutr Phys Act · 2025 Sep · PMID 41029740 · Full text
With great interest, I read the article by Lien et al. "Twenty years of behavioural nutrition - A reflection on the road less travelled". This commentary reflects the long-standing absence of a formal definition for "beh...
With great interest, I read the article by Lien et al. "Twenty years of behavioural nutrition - A reflection on the road less travelled". This commentary reflects the long-standing absence of a formal definition for "behavioral nutrition" (BN) and its implications for scientific and clinical communities. It highlights the Brazilian experience in conceptualizing BN as a scientifically grounded approach to modifying eating behaviors through a biopsychosociocultural perspective, moving beyond the outdated prescriptive role of the dietitian. The commentary also reviews the historical use of BN in publications, noting inconsistencies, conceptual conflation with "eating behavior," and limited clarity on what constitutes a BN intervention. A clearer, theory-driven definition and expanded discourse on behavioral approaches and models are essential to advancing the field.
LIFE-Moms: effects of multicomponent lifestyle randomized control trial on physical activity during pregnancy in women with overweight and obesity.
Cabre HE, Drews KL, Pomeroy J … +21 more , Keadle SK, Arteaga SS, Franks PW, Haire-Joshu D, Knowler WC, Pi-Sunyer X, Van Horn L, Wing RR, Cahill AG, Clifton RG, Couch KA, Gallager D, Josefson JL, Joshipura K, Klein S, Martin CK, Peaceman AM, Phelan S, Thom EA, Redman LM, LIFE-Moms Research Group
Int J Behav Nutr Phys Act · 2025 Sep · PMID 41029405 · Full text
BACKGROUND: This report details the effect of LIFE-Mom's multicomponent lifestyle interventions on physical activity (PA) and inactivity time across pregnancy (2nd and 3rd trimesters) and their effect on gestational weig...
BACKGROUND: This report details the effect of LIFE-Mom's multicomponent lifestyle interventions on physical activity (PA) and inactivity time across pregnancy (2nd and 3rd trimesters) and their effect on gestational weight gain (GWG) and maternal/neonatal outcomes, a pre-specified secondary analysis. METHODS: Pregnant people with BMI ≥ 25 kg/m were randomized to lifestyle interventions with dietary and PA counseling or standard care. PA and inactivity time measured by accelerometry and metabolic and inflammatory biomarkers measured in fasting blood are reported in 522 pregnant people at baseline and end of pregnancy. Generalized linear models with and without covariates were used to evaluate group differences (intervention vs. control) and, separately, time differences (total sample with both groups combined). RESULTS: Although there were statistically significant differences in vigorous activity between the intervention and control group (p = .024), there were no clinically meaningful differences in PA. In the combined sample, moderate to vigorous PA (MVPA) significantly decreased across pregnancy (mean ± SD: 72.9 ± 29.1 min/day vs 63.9 ± 28.1 min/day; p < 0.0001), and inactivity time increased [617.5 min/day (573.5, 659.6) vs 630.4 min/day (56.7, 679.9); p < 0.0001]. Increased inactivity time was associated with a less favorable maternal milieu (biomarker Z-scores) for pro-inflammatory (0.2 ± 0.1; p = 0.003) and cardiometabolic markers (0.1 ± 0.07; p = 0.030). CONCLUSIONS: Physical activity declined over the course of pregnancy, though the intervention group experienced a smaller reduction in activity levels. Our results linked increased inactivity time to maternal metabolic dysregulation and inflammation. Further research is needed to determine if intensive interventions reducing inactivity can improve maternal health and weight outcomes in pregnant people with overweight and obesity. TRIAL REGISTRATION: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, and NCT01812694.
2025 Position statement on active outdoor play.
Lee EY, de Lannoy L, Kim YB … +14 more , Rathod A, James ME, Lopes O, Nasrallah B, Thankarajah A, Adjei-Boadi D, de Barros MIA, Duncan S, Miller RM, Mygind L, Vanderloo LM, Wang PY, Tremblay MS, AOP10 Steering Committee Group
Int J Behav Nutr Phys Act · 2025 Sep · PMID 40999404 · Full text
BACKGROUND: In 2015, the Position Statement on Active Outdoor Play was released in Canada, emphasizing the critical role of active outdoor play-with its risks-in fostering children's healthy development. Building on this...
BACKGROUND: In 2015, the Position Statement on Active Outdoor Play was released in Canada, emphasizing the critical role of active outdoor play-with its risks-in fostering children's healthy development. Building on this foundation, a 10-year update of the Position Statement on Active Outdoor Play (AOP10) was initiated to broaden its scope and impact, by encompassing all age groups and extending its reach conceptually and globally. Here we explain and present the new 2025 Position Statement. METHODS: Development of the 2025 Position Statement was informed by 18 rigorous literature reviews, a series of leadership group meetings, three rounds of draft AOP10 surveys, followed by extensive communication, translation, production, and dissemination activities. RESULTS: The 2025 Position Statement on Active Outdoor Play states: "Active outdoor play promotes holistic health and well-being for people of all ages, communities, and environments, and for our entire planet. It is critical given the multiple global challenges we face today (e.g., social and health inequities, climate change and digital addiction). Together, as a collective of the outdoor play sector, we recommend increasing opportunities for active outdoor play in all settings where people live, learn, work, and play. To achieve this, it is important to collaborate across sectors, settings, and societies to preserve, promote, and value equitable access to active play outdoors and in nature." We also provide key evidence pertaining to the nine core themes that informed the development of the 2025 Position Statement and offer recommendations across sectors, calling for multi-sectoral, multi-level collaborations. Across all three survey rounds, responses indicated strong support for the 2025 Position Statement and its supporting content (Round 3: 93-98%). Comprehensive, proactive knowledge translation and dissemination plans were executed to maximize the reach and impact of the 2025 Position Statement. CONCLUSIONS: The 2025 Position Statement calls for systemic changes that prioritize equitable access to active outdoor play opportunities and aims to create healthier communities. Achieved through international collaboration and consensus, the 2025 Position Statement aspires to connect, advise, inspire, and activate active outdoor play worldwide.
2025 position statement on active outdoor play: process and methodology.
de Lannoy L, Lee EY, Ryu S … +13 more , Lopes O, S Cheruvathur J, Thankarajah A, Adjei Boadi D, de Barros I, Duncan S, James ME, Mygind L, Monro Miller R, Vanderloo LM, Wang PY, Heather L, Tremblay MS
Int J Behav Nutr Phys Act · 2025 Sep · PMID 40999371 · Full text
BACKGROUND: The 2015 Position Statement on Active Outdoor Play highlighted the benefits of active outdoor play for child health and development and had significant impact on public policy, law, philanthropy, and research...
BACKGROUND: The 2015 Position Statement on Active Outdoor Play highlighted the benefits of active outdoor play for child health and development and had significant impact on public policy, law, philanthropy, and research in Canada and internationally. To celebrate its 10th anniversary, we led an update to the Position Statement that is global in scope and inclusive of all human age groups. The goal of this manuscript is to outline the process and methodology involved in developing the 2025 Position Statement on Active Outdoor Play. METHODS: The process involved several key steps: (1) establishing an international leadership group; (2) forming an international steering committee; (3) conducting an environmental scan of historical key events in active outdoor play; (4) using text-mining and linked network analyses to identify core research themes and map relationships among outdoor play organizations; (5) developing a conceptual framework through a consensus-building process; and, (6) using this conceptual framework to guide the completion of a series of reviews used to inform the 2025 Position Statement. RESULTS: The environmental scan identified 136 key events that provided historical context for the evolution of active outdoor play. Text-mining and linked network analyses revealed 10 core research themes and mapped relationships among key organizations and individuals in the field. Informed by these themes and concepts, a draft conceptual framework was developed and circulated to the > 130-person steering committee for review and consensus. The final version of the conceptual framework encompassed 9 key themes, which guided the focus of 18 reviews used to inform the scope and content of the 2025 Position Statement on Active Outdoor Play. CONCLUSIONS: A three-year-long process involving an international leadership group and >130 person steering committee led to the development of an environmental scan, text-mining and linked network analysis, and a conceptual framework including 9 key themes with bidirectional relationships with active outdoor play that guided the development of 18 reviews. Collectively, this work served to inform the updated Position Statement on Active Outdoor Play, which aims to encourage humans of all ages to play, learn, teach, grow, and thrive outdoors and serve as caring stewards of the land, water, air, plants, animals, and each other.
Effectiveness of a multi-component intervention including pictorial warnings to reduce sugar-sweetened beverage consumption - a randomized controlled trial.
Mishra KG, Afreen A, Patnaik N
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40885981 · Full text
INTRODUCTION: Sugar-sweetened beverages (SSBs) are a significant source of added sugars in the Indian diet, contributing to adverse health outcomes such as obesity, type 2 diabetes, and dental caries. Multi-component int...
INTRODUCTION: Sugar-sweetened beverages (SSBs) are a significant source of added sugars in the Indian diet, contributing to adverse health outcomes such as obesity, type 2 diabetes, and dental caries. Multi-component interventions (MCIs) have shown promise in reducing the consumption of harmful products like tobacco. This study assessed the effectiveness of a multi-component intervention-comprising Pictorial Health Warnings (PHWs), educational pamphlets, and targeted counseling-in reducing parental purchases of SSBs for children. METHODS: A randomized stepped-wedge controlled trial was conducted across three urban slum sectors in Hyderabad. A total of 60 parents were recruited, with data collected over ten weeks. MCIs were implemented on SSBs at general stores, and outcomes were measured by comparing SSB purchase frequency, risk perception, and parental attitudes before and after the intervention. RESULTS: The implementation of MCIs led to a significant reduction in SSB purchases, with 25% of parents buying SSBs post-intervention compared to 55% pre-intervention (p = 0.002). Parents also purchased SSBs with fewer calories post-intervention (45 kcal vs. 92 kcal, p < 0.001). Additionally, MCIs increased awareness of SSB-related harms (d = 2.19, p < 0.001) and strengthened negative emotional responses (d = 2.08, p < 0.001). No significant differences were observed in the appeal or perceived tastiness of SSBs (p > 0.05). CONCLUSION: MCIs on SSBs effectively reduced purchase frequency and calorie intake among parents in urban slum settings. The findings support the potential for MCIs to be a feasible public health intervention to reduce SSB consumption in similar socio-economic contexts. TRIAL REGISTRATION: CTRI/2024/08/072220 dated 09/08/2024.
Identifying key determinants influencing the sustainment of physical activity and nutrition programs in Australian primary schools.
Riley-Gibson E, Hall A, Shoesmith A … +10 more , Shelton RC, Lecathelinais C, Hodder RK, Wolfenden L, Pascoe W, Gardner C, O'Brien KM, Pollock E, Sutherland R, Nathan N
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40885977 · Full text
BACKGROUND: To ensure the large number of school-based physical activity and nutrition programs have a lasting positive impact on the health and wellbeing of students, it is essential that such programs are sustained lon...
BACKGROUND: To ensure the large number of school-based physical activity and nutrition programs have a lasting positive impact on the health and wellbeing of students, it is essential that such programs are sustained long-term. However, there is limited research assessing the duration of such programs and the determinants that are related to their sustainment. This study investigates the duration of, and determinants to the sustainment of physical activity and nutrition programs in Australian primary schools. METHODS: A cross-sectional study with 207 Principals (one from each school) from a nationally representative sample of randomly selected Australian primary schools. Principals completed a survey online or via telephone, which included items assessing the determinants of program sustainment categorised based on the domains of the Integrated Sustainability Framework (inner contextual factors; outer contextual factors; characteristics of the intervention; and processes). Schools were randomised to answer survey items relating to either physical activity or nutrition programs. We collected data on the number and type of programs, their duration, and factors influencing the sustainment of one selected program. Descriptive statistics were used to assess the duration and prevalence of programs. Regression analysis was used to assess the association between sustainment determinants and the duration of program delivery. RESULTS: Schools randomised to physical activity programs implemented on average, 5.4 of the nine physical activity programs assessed. Schools randomised to nutrition implemented on average, 2.8 of the seven nutrition programs assessed. Physical activity programs had a mean duration of 6.9 years and nutrition programs had 7.4 years. Nutrition programs had 3.27 times the odds of being sustained longer than physical activity programs (95% CI: 1.57, 6.83; p = 0.002). The only domain from the Integrated Sustainability Framework that was statistically significantly associated with the sustainment for both physical activity and nutrition programs was outer contextual factors. This domain includes the alignment of the program with the priorities of the school, partnerships between the school and external organisations, and the existence of a governing body policy or guideline related to the program. The highest ranked determinant from this domain for both physical activity and nutrition programs was the alignment of the program with the priorities of the school. CONCLUSION: This study highlights the need for targeted strategies to support the sustainment of health programs in schools, particularly focusing on outer contextual factors. Specifically, the alignment of the program with the priorities of the school. Policymakers and practitioners should prioritise targeting these outer contextual determinants to enhance the sustainment of physical activity and nutrition programs, ultimately promoting better long-term population health outcomes.
Using the R = MC heuristic to assess whole-of-school physical activity implementation in elementary schools: a cross-sectional study.
Craig DW, Lanza K, Pfledderer CD … +6 more , Pavlovic A, Onadeko K, Heredia NI, Injil J, DeFina LF, Walker TJ
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40849674 · Full text
BACKGROUND: Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach s...
BACKGROUND: Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach successfully are not well understood. The R = MC heuristic, which defines readiness for implementation as a combination of an organization's motivation and capacity to implement, can enhance our understanding of implementation in the school setting. This study examines associations between constructs from the R = MC heuristic and schools' implementation of a WOS approach. METHODS: We conducted a secondary analysis of cross-sectional data from U.S. elementary schools participating in the NFL PLAY60 FitnessGram Project during the 2022-23 school year. From surveys administered to school staff, we created a WOS index (range = 0-12) comprising six physical activity practices: physical education, recess, before and after-school programs, classroom-based approaches, and active transport. We also assessed how six constructs from the R = MC heuristic (i.e., culture, implementation climate, leadership, priority, resources utilization, resource availability) impact physical activity implementation using a series of questions measured on a 5-point Likert scale. We used linear regression models to determine associations between R = MC constructs (independent variables) and WOS index scores (dependent variable), controlling for school-level characteristics (student enrollment, percentage of race/ethnicity and economically disadvantaged students served) and state-level clustering. RESULTS: The analytic sample consisted of 132 schools across 18 states. On average, school staff rated leadership (mean = 4.1, range = 1.5-5) and organizational culture (mean = 4.0, range = 2.25-5) the highest. The mean WOS index score was 6.1. Partially adjusted models indicated significant positive associations between each R = MC construct and WOS index scores. Fully adjusted regression models revealed priority (b = 0.88; p = 0.010; 95% CI = 0.19-1.56) and implementation climate (b = 0.69; p = 0.047; 95% CI = 0.07-1.32) were positively and significantly associated with WOS index scores. CONCLUSIONS: Our study provides insights into key implementation constructs associated with providing school-based physical activity opportunities. These findings can support the development of resources and implementation strategies which, in turn, can help schools address implementation-related disparities. This will help schools improve the quality and accessibility of opportunities for physical activity provided to students across the United States.
A systematic review of technology-infused physical activity interventions in K-12 school settings: effectiveness, roles, and implementation strategies.
Ha T, Moon J, Yu H … +2 more , Fan X, Paulson L
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40849486 · Full text
BACKGROUND: Rapid technological advancements have rendered many prior reviews of technology-integrated physical activity (PA) interventions in K-12 schools obsolete. A comprehensive analysis examining both the effects of...
BACKGROUND: Rapid technological advancements have rendered many prior reviews of technology-integrated physical activity (PA) interventions in K-12 schools obsolete. A comprehensive analysis examining both the effects of these interventions and the specific roles that technology plays has been notably lacking. This review aimed to systematically examine the effects of technology-infused PA interventions and identify the specific types, roles, and contextual applications of technology within K-12 schools. METHODS: This systematic review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A thorough search across seven electronic databases (CINAHL, ERIC/EBSCOhost, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science) included studies published up to May 20, 2024. Only randomized controlled trials (RCTs), cluster-RCTs, or rigorous quasi-experimental designs with matched/statistically controlled comparisons (N-RCTs) examining technology-infused PA interventions for school-aged children and adolescents were considered. RESULTS: Fifty-eight studies met inclusion criteria. Wearable devices (e.g., accelerometers) were the most used for PA measurement. Other technologies like web-based platforms, mobile applications, and exergaming served as educational tools, communication platforms, or core intervention components. Interventions occurred primarily in classrooms, followed by physical education spaces, and extended to home/online environments, school breaks (e.g., recess), and before-school time. Overall, interventions positively affected PA levels and related outcomes (e.g., PA enjoyment), though effectiveness varied by technology type, design, and context. CONCLUSIONS: Technology holds substantial potential to enhance PA promotion in schools, but its effectiveness hinges on well-designed interventions that consider the specific types and applications of technology.
Reallocation of time between accelerometer-derived movement behaviors, genetic susceptibility, and risk of incident dementia, mortality, and premature death: a longitudinal cohort study.
Zhang W, Pan Y, Dai Y … +8 more , Liang J, Ma J, Liu Y, Gao D, Zhang Y, Ji M, Xie W, Zheng F
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40841675 · Full text
BACKGROUND: It is well established that all types of movement behaviors, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behavior (SB), and sleep, are associat...
BACKGROUND: It is well established that all types of movement behaviors, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behavior (SB), and sleep, are associated with the risk of incident dementia, all-cause mortality, and premature death. However, it remains unclear whether reallocating time from one type to another is associated with these outcomes. In addition, the extent to which genetic susceptibility modifies the association between physical activity and dementia risk still warrants further investigation. METHODS: This study included 94 086 dementia-free participants from the UK Biobank with valid accelerometer and genomic data. Time spent MVPA, LIPA, SB, and sleep were derived from wrist-worn accelerometers. Genetic susceptibility of dementia was assessed by polygenic risk score (PRS) consisting of 82 single nucleotide polymorphisms. The isotemporal substitution model was applied to explore how reallocating time between movement behaviors was associated with incident dementia, mortality, and premature death. RESULTS: Of 94 086 included participants, 52 853 (56.2%) were female, and the mean (standard deviation, SD) age was 62.3 (7.8) years. Reallocating 1 h/day to MVPA from LIPA, SB, and sleep was associated with a 19%, 26%, and 18% lower risk of incident dementia (adjusted hazard ratios [HRs] and 95% confidence intervals [CIs]: 0.81 [0.68, 0.95], 0.74 [0.63, 0.87], and 0.82 [0.69, 0.96], respectively). A 22%, 30%, and 29% reduced risk of mortality were observed when reallocating 1 h/day from LIPA, SB, and sleep to MVPA (0.78 [0.72, 0.84], 0.70 [0.65, 0.75], and 0.71 [0.66, 0.77], respectively). Replacing 1 h/day of SB with MVPA, LIPA, and sleep was associated with a 26%, 8%, and 9% lower risk of incident dementia (0.74 [0.63, 0.87], 0.92 [0.87, 0.97], and 0.91 [0.85, 0.97], respectively), and reallocating 1 h/day from SB to LIPA (0.89 [0.87-0.92]) or MVPA (0.70 [0.65-0.75]) was associated with reduced risk of mortality. Similar results could be seen in premature death. Participants with high levels of MVPA and low genetic risk showed 72% lower risk of dementia comparing to participants with low levels of MVPA and high PRS (0.28 [0.17-0.50]). CONCLUSIONS: Reallocating time to MVPA from any behavior and substituting physical activity of any intensity for SB were associated with decreased risks of incident dementia, mortality, and premature death, suggesting the significance of maintaining a physically active lifestyle among old adults. Moreover, increasing MVPA level could partially attenuate the strength of association between genetic susceptibility and the risk of dementia.
Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention.
Ganakas E, Salmon J, Ma J … +7 more , Lamb KE, Barnett L, Bauman A, Telford A, Ridgers ND, Timperio A, Koorts H
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40820140 · Full text
BACKGROUND: Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implem...
BACKGROUND: Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption across meso- and macro-system levels using data from the 2018-2022 state-wide hybrid effectiveness-implementation trial of TransformUs Primary, a whole-school physical activity intervention. Aims were to: (1) assess differences in contextual characteristics between adopting and non-adopting schools and implications for equity, and (2) assess associations between macro-level events and dissemination events with program adoption over time. METHODS: Descriptive statistics (number and %) and chi-squared tests were used to assess differences in contextual characteristics between adopting and non-adopting schools (Aim 1). A time-series analysis of daily data was used to explore associations between the number of dissemination events promoting program awareness (e.g., media, newsletters), macro-level policy events (e.g., education department policies), COVID-19-related remote/on-site learning periods, school term dates (i.e., during/outside of school term) and program adoption (i.e., the number of TransformUs Primary registrations per day) (Aim 2). RESULTS: No differences in either school type (i.e., primary, combined, or special) or community level socio-educational advantage between adopting (n = 519) and non-adopting schools (n = 1,423) were identified. A higher proportion of adopting schools were located in major cities (71.7% vs. 54.5%; chi-square p < 0.001) and were government (public sector) schools (80.0% vs. 63.1%; chi-square p < 0.001). Time-series analysis results indicated that the likelihood of adopting TransformUs Primary decreased from the date of program launch to the end of the scale-up period (IRR 0.999, 95% CI 0.999-1.000; p < 0.005). Both school term date (IRR 5.95, 95% CI 4.78-7.41; p < 0.001) and dissemination events (IRR 3.30, 95% CI 2.67-4.06; p < 0.001) increased the likelihood of adopting TransformUs Primary. Results provided little evidence of an association between the number of policy events or COVID-19-related remote and on-site learning periods and adoption. CONCLUSIONS: Select meso- and macro-level factors had an impact on TransformUs Primary adoption. Findings inform the need to work with stakeholders in scale-up to prioritize dissemination strategies that have a discernible impact on adoption above others and consider targeted efforts to reach regional/rural and non-government schools.
Adverse changes in close social ties reduce fruit and vegetable intake in aging adults: a prospective gender-sensitive study of the Canadian longitudinal study on aging (CLSA).
Mehranfar S, Ceolin G, Madani Civi R … +4 more , Keller H, Murphy RA, Cohen TR, Conklin AI
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40804679 · Full text
BACKGROUND: Close social ties are known to increase survival, reduce chronic diseases, and promote healthful eating. Little research has explored whether adverse changes in these relationships lead to less healthful eati...
BACKGROUND: Close social ties are known to increase survival, reduce chronic diseases, and promote healthful eating. Little research has explored whether adverse changes in these relationships lead to less healthful eating in older adults, with attention to gender differences. METHODS: Prospective study using 3 waves of the Canadian Longitudinal Study on Aging (CLSA) in a sample of middle-age and older adults (45-85 y) reporting daily intake of fruit or vegetable (F/V) intake (at least one time per day) at baseline using dietary data collected by CLSA's Short Diet Questionnaire. We used multivariable multilevel logistic regression with interaction terms (social tie x gender) to determine whether adverse changes in close social ties (marital status and living arrangement) between baseline (2011-2015) and follow-up 1 (2015-2018) led to developing less healthful eating measured by non-daily intake of F/V at follow-up 2 (2018-2021) (n = 15,672); models adjusted for biological, behavioural, socioeconomic, and socio-political confounders. RESULTS: Distinct transitions by gender precipitated a change from daily F/V intake (healthful eating) to less frequent intakes (unhealthful eating). Compared to women remaining partnered, women remaining non-partnered over 3 years had 21% higher odds of reducing healthful intake of vegetables at 6-year follow-up (OR 1.21 [95% CI: 1.07, 1.38]). Becoming divorced increased the odds of reducing healthful intake of fruits among women (1.76 [1.16, 2.66]) compared to referent. Women remaining lone-living were less likely to reduce healthful fruit intake (0.86 [0.74, 0.99]), compared to remaining co-living. Compared to men remaining partnered, men who became divorced or widowed had 91% greater odds of reducing healthful vegetable intake (1.91 [1.25, 2.92] and 1.91 [1.17, 3.13], respectively). Men who remained non-partnered or became widowed were also more likely to reduce healthful fruit intake (1.20 [1.03, 1.41] and 1.99 [1.26, 3.15], respectively), compared to referent. Finally, men who became lone-living and co-living were more likely to reduce healthful intakes of vegetables (1.42 [1.06, 1.91] and 1.55 [1.04, 2.32]) and fruits (1.48 [1.11, 1.96] and 1.48 [1.00, 2.18]), compared to men remaining co-living. CONCLUSIONS: Findings showed that adverse changes in close social ties led to the development of less healthful eating among aging adults in Canada, and these prospective associations appeared to be gendered. Public health and nutrition interventions should consider the social context as a risk factor to address gender disparities in food intake in the aging population.
Correction: Optimising a multi‑strategy implementation intervention to improve the delivery of a school physical activity policy at scale: findings from a randomised noninferiority trial.
Lane C, Wolfenden L, Hall A … +8 more , Sutherland R, Naylor PJ, Oldmeadow C, Leigh L, Shoesmith A, Bauman A, McCarthy N, Nathan N
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40804389 · Full text
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Global research on 24-hour movement behaviours guidelines in children and adolescents: a systematic review.
Hossian M, Mielke GI, Nisar M … +2 more , Tremblay MS, Khan A
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40781309 · Full text
BACKGROUND: Compliance with 24-hour movement behaviours (24-h MB) guidelines, which encompass moderate-to-vigorous physical activity (MVPA), recreational screen time (ST), and sleep, is associated with various health and...
BACKGROUND: Compliance with 24-hour movement behaviours (24-h MB) guidelines, which encompass moderate-to-vigorous physical activity (MVPA), recreational screen time (ST), and sleep, is associated with various health and developmental outcomes in children and adolescents. Despite growing research interest, a comprehensive synthesis of global research focusing on school-aged youth (5-17 years) is lacking. This systematic review mapped global research on 24-h MB guidelines in youth aged 5-17 years, charted publication trends, geographical spread, and summarised reported outcomes to inform research priorities. METHODS: A systematic search (June 2016-July 2024) across six databases (PubMed, Scopus, Web of Science, SPORTDiscus, APA PsycInfo, Embase) identified 32,832 articles. Overall, 148 articles from 32 countries met inclusion criteria. Extracted data covered publication details, movement behaviours measures, article focus, and headline conclusion. 'Compliance' was defined as simultaneous adherence to all 24-h MB guidelines. Guided by the Behavioural Epidemiology Framework, articles were classified as prevalence, health and well-being, correlates, academic performance, intervention focused. Article quality was assessed with National Institute of Health tools. RESULTS: Global research on 24-h MB guidelines has grown rapidly since 2016 but remains methodologically modest, with 68% articles (n = 132) originated on six high- or upper-middle-income countries. Most articles were cross-sectional (n = 128, 87%) and investigated prevalence (n = 141, 95%) or health and well-being (n = 79, 53%), followed by correlates (n = 40, 27%), academic performance (n = 8, 5%), and interventions (n = 3, 2%). Only 3% of observational and no intervention articles were rated high quality. Globally, compliance rates with 24-h MB guidelines were low (0-53.6%), with 87% (n = 122) articles reporting below 10%. Compliance with 24-h MB guidelines was associated with lower likelihood of obesity, mental health and cardiometabolic problems, and higher physical fitness, academic performance, and cognitive function. Correlates of 24-h MB guidelines compliance included age, gender, weight status, socioeconomic status, environmental pollution, parental support, and in-person schooling. Interventions promoting 24-h MB guidelines showed promising outcomes. CONCLUSIONS: Current research on 24-h MB guidelines is geographically skewed, with only 7% of articles on low- and middle-income countries data. Most evidence was cross-sectional, and no article achieved high methodological quality Future research should focus on under-represented regions, use longitudinal and experimental designs, and assess key outcomes such as academic performance to inform policy and practice for improving youth health and well-being globally.
Correction: Children's Health in London and Luton (CHILL) cohort: a 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children's travel to school.
Xiao C, Scales J, Chavda J … +24 more , Dove RE, Tsocheva I, Wood HE, Kalsi H, Sartori L, Colligan G, Moon J, Lie E, Petrovic K, Day B, Howett C, Keighley A, Mihaylova B, Tofolutti V, Grigg J, Randhawa G, Sheikh A, Fletcher M, Mudway I, Beevers S, Gauderman WJ, Grifths CJ, van Sluijs E, Panter J
Int J Behav Nutr Phys Act · 2025 Aug · PMID 40764566 · Full text
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Considerations in using heart rate-based physical activity estimates from consumer wearables in individuals with varying weight status.
Brown DMY, Wing D, Pfledderer CD … +3 more , Stoepker P, Fairclough SJ, Carlson JA
Int J Behav Nutr Phys Act · 2025 Jul · PMID 40721804 · Full text
Although moderate-to-vigorous physical activity (MVPA) is a widely used construct in physical activity (PA) research, the lack of standardized assessment methods- particularly with the growing use of consumer-grade weara...
Although moderate-to-vigorous physical activity (MVPA) is a widely used construct in physical activity (PA) research, the lack of standardized assessment methods- particularly with the growing use of consumer-grade wearable activity trackers- poses challenges for comparability. Consumer-grade devices tend to rely on heart rate (HR)-based estimation methods to classify PA intensity, which contrasts with traditional research-grade accelerometers that use count- or raw-acceleration metrics. Comparability issues are particularly salient across individuals with varying weight status. In this commentary, we discuss systematic discrepancies between HR-based (relative intensity) and acceleration-based (absolute intensity) classifications of MVPA among individuals with differing weight statuses. Using Fitbit data from the Adolescent Brain Cognitive Development Study, we illustrate how HR-based PA intensity classification may indicate higher MVPA in youth with greater adiposity despite lower step counts and light PA levels. We highlight implications for research design, public health surveillance, messaging, policy, and interventions. We also call for greater transparency, standardized methodologies, and integrative measurement approaches to ensure more accurate assessment of PA behavior.
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