Associations between domains of physical activity, sitting time, and different measures of overweight and obesity.

OBJECTIVE: To describe 1) cross-sectional associations between domain-specific physical activity, sitting time and different measures of overweight/obesity and 2) longitudinal associations between patterns of change in physical activity and overweight/obesity ten years later. METHODS: Cross-sectional and longitudinal analyses based on the first and second follow-up of the Swiss cohort study SAPALDIA (SAP) were conducted (SAP2 in 2002/03, SAP3 in 2010/11). Physical activity was assessed by self-report using the long International Physical Activity Questionnaire (IPAQ) and four short questions regarding moderate and vigorous activities. Overweight/obesity were defined based on body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and percent body fat based on bioelectric impedance analysis (BIA), all measured objectively. Multivariable logistic regression was used for analyses. RESULTS: Cross-sectionally, leisure-time and vigorous physical activity were inversely associated with all obesity parameters. Most consistent associations were found with BIA percent body fat. There were no associations between work-related and domestic activities and overweight/obesity. Sitting time was positively associated with BIA percent body fat, but not with BMI, WHR and WHtR. Longitudinally, remaining inactive from SAP2 to SAP3 was associated with obesity and BIA percent body fat at SAP3 and with weight increase, becoming inactive with BIA percent body fat and weight increase. CONCLUSIONS: The results support associations between physical activity and overweight/obesity cross-sectionally and longitudinally. Most consistent associations were found for BIA percent body fat. For prevention purposes, the results indicate that physical activity can have an important contribution to weight management.

Validation of the long international physical activity questionnaire: Influence of age and language region.

OBJECTIVE: Little is known about the influence of age, gender and language on the measurement properties of the long International Physical Activity Questionnaire (IPAQ). The aim was to validate the long IPAQ in adults aged 18-84 in the German-, French- and Italian-speaking parts of Switzerland, focusing on differences between gender, age groups and language regions. METHODS: This cross-sectional study was conducted in the frame of SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults) in 2011. 346 participants (54.6% women, mean age 54.6 years) wore an Actigraph GT3X accelerometer during 8 days and completed the IPAQ. IPAQ and accelerometer data on total physical activity and on different intensities as well as sitting time were compared using Spearman correlations and Bland-Altman plots. RESULTS: Correlations were highest for vigorous physical activity (r = 0.41) and sitting time (r = 0.42). Significant gender differences were apparent for leisure-time physical activity (men: r = 0.35 versus women: r = 0.57, p = 0.012) and for sitting time (men: r = 0.28 versus women: r = 0.53, p = 0.007). Differences between age groups were present for sitting time (youngest: r = 0.72 versus middle: r = 0.36, p < 0.001; youngest versus oldest: r = 0.34, p = 0.001). Differences between language regions were present for vigorous physical activity (German: r = 0.28 versus Italian: r = 0.53, p = 0.033). IPAQ overestimated physical activity but underestimated sitting time. CONCLUSION: The long IPAQ showed moderate validity similar to other studies when compared to accelerometer data in a diverse sample of individuals. Some sex, age and regional differences were observed but do not seem to limit its applicability in population sub groups.

Physical Activity, Sensation Seeking, and Aggression as Injury Risk Factors in Young Swiss Men: A Population-Based Cohort Study.

BACKGROUND: This study investigates the relationships between physical activity (PA), sports participation and sensation seeking or aggression and injury risk in young men. METHODS: A representative cohort study was conducted with 4686 conscripts for the Swiss army. Risk factors assessed at baseline were PA, the frequency of sports participation, sensation seeking, and aggression. The number of injuries during the past 12 months was reported 16 months after baseline. Exposure to moderate-tovigorous physical activity (MVPA) was estimated based on baseline PA. RESULTS: Among conscripts, 48.5% reported at least 1 injury for the past 12 months. After accounting for exposure to MVPA, the most inactive individuals (reference group) had the highest injury risk and those with high levels of PA and weekly sports participation the lowest (Poisson regression analysis: incidence rate ratio = 0.14 [0.12-0.16]). Independent of activity level, sensation seeking increased cumulative injury incidence significantly (Logistic regression analysis [injured vs. not injured]: odds ratio = 1.29 [1.02-1.63]) and incidence rates marginally. Aggression was marginally associated only with cumulative injury incidence and only in those participating in daily sports. CONCLUSIONS: When accounting for exposure to PA, being inactive is a strong injury risk factor in young men, whereas the roles of the personality variables are less clear.

National physical activity recommendations: systematic overview and analysis of the situation in European countries.

BACKGROUND: Developing national physical activity (PA) recommendations is an essential element of an effective national approach to promote PA. METHODS: Systematic overview and analysis of national PA recommendations across the European Region of the World Health Organization (WHO). The WHO European national information focal points provided information which was complemented through online searches and input from other experts. RESULTS: Information received until summer 2012 from 37 countries was analyzed. Sixteen countries did not have national recommendations while 21 countries did. For 17 countries, the source document was accessible. Seventeen recommendations referred to adults, 14 to young people and 6 to older adults. Most national recommendations for children and young people are quite similar: 12 countries recommend at least 60 minutes of moderate- to vigorous-intensity PA each day, in line with the WHO global recommendation. Three countries recommend longer durations and one a lower one. In some countries, slight variations were found regarding the recommended intensity and minimum bouts. Only one country was fully in line with the WHO recommendations. Two countries have issued separate recommendations for pre-school children. For adults, most countries still follow the 1995 United States recommendations of "at least 30 minutes on 5 days a week". Three countries were fully in line with the WHO recommendations. Four countries give specific recommendations on reducing weight, avoiding weight gain or continuing weight maintenance. The six identified national PA recommendations for older adults are mainly similar to those for adults but underline that particularly for this age group also less activity has important health benefits; four countries also recommend balance training. CONCLUSIONS: About half of the countries for which information was available and likely less than 40% of all 53 countries in the WHO European Region have developed national PA recommendations. Further investment is needed to address this important step towards a comprehensive PA promotion approach. Much remains to be done for the 2010 WHO recommendations to be fully reflected in national documents across all parts of the Region and all age groups. In addition, avoiding extended periods of inactivity and overweight are only addressed by a minority of countries yet.

Injury risk during different physical activity behaviours in children: a systematic review with bias assessment.

INTRODUCTION: The current focus on a physically active lifestyle in children puts children at increased physical activity-related injury risk. OBJECTIVE: To summarise, in a systematic review, the evidence for the injury risk of several physical activity behaviours in 6- to 12-year-old children. METHODS: An electronic search was performed in three databases (Embase, PubMed and SPORTDiscus). Inclusion criteria were: age 6-12 years; report on injuries related to overall physical activity, active commuting, unorganised leisure time physical activity, physical education and/or organised sports; incidence rates expressed as injuries per hours of physical activity; and published after January 1st 2000. Risk of bias was assessed for all studies included. RESULTS: Eight studies were included. The risk of bias assessment resulted in two studies with a score that was higher than 75 %; risk bias of those two studies was considered low. The medically treated, injury incidence rate was reported to be between 0.15 and 0.27 injuries per 1,000 h of physical activity. The absolute number of injuries related to unorganised leisure time physical activity was higher than the absolute number of injuries reported in organised sports. The respective injury incidence rate expressed per 1,000 h exposure was, however, generally lower during unorganised leisure time than during organised sports. Reported injury incidence rates related to active commuting were comparable to those for unorganised leisure time physical activity. Conflicting injury incidence rates were reported for physical education. Subgroup analysis suggested that girls and children with low habitual levels of physical activity are at increased injury risk. A limitation of the review is that no standard bias assessment was available for this specific context. CONCLUSIONS: Children are at an inherent injury risk while participating in physical activities. Most injury prevention efforts have focussed on the sports setting, but our results suggest that many children sustain an injury during unorganised leisure time physical activities.

The combined effect on survival of four main behavioural risk factors for non-communicable diseases.

OBJECTIVE: To quantify and illustrate the combined effects of WHO's four behavioural risk factors for non-communicable diseases (NCDs) on mortality. METHODS: Participants (n=16,721) were part of two Swiss population studies conducted between 1977 and 1993. Smoking status, alcohol consumption, physical activity and diet were assessed at baseline. With record linkage in 2008, up to 31years of follow-up with 3,533 deaths could be recorded. Mortality was assessed with Cox proportional hazard models for each risk factor and their combinations. Ten-year survival probabilities for 65- and 75-year-olds were estimated with Weibull regression models. RESULTS: Hazard ratios for the combination of all four risk factors compared to none were 2.41 (1.99-2.93) in men and 2.46 (1.88-3.22) in women. For 65-year-olds, the probability of surviving the next 10years was 86% for men with no risk factors and 67% for men with four. In women, the respective numbers were 90% and 77%. In 75-year-olds, probabilities were 67% and 35% in men, and 74% and 47% in women. CONCLUSIONS: The combined impact of four behavioural NCD risk factors on survival probability was comparable in size to a 10-year age difference and bigger than the gender effect.

Impact of different domains of physical activity on cause-specific mortality: a longitudinal study.

OBJECTIVE: The aim of this paper is to examine the associations between different domains of physical activity and all-cause, cardiovascular disease (CVD) and cancer mortality. METHODS: Participants (n=17,663, aged 16-92 years) of two general population health studies conducted between 1977 and 1993 in Switzerland were included. Physical activity was assessed at baseline in the domains of commuting to work, work-related physical activity, and leisure-time physical activity (including leisure-time activity level and sport activity). A median follow-up time of 20.2 years was obtained with anonymous record linkage providing 3878 deaths (CVD: 1357; cancer: 1351). Adjusted Cox proportional hazard models were calculated. RESULTS: There were no significant associations between commuting and work-related physical activities, respectively, and mortality. Leisure-time activity level was associated with all-cause mortality in men [adjusted hazard ratio (HR) 0.75, 95% confidence intervals (CI) 0.63-0.89] and women [HR 0.82 (0.74-0.91)], with CVD mortality in women only [HR 0.79 (0.67-0.94)] and with cancer mortality in men only [HR 0.63 (0.47-0.86)]. Sport activity was associated with all-cause, CVD and cancer mortality in men [HR ranged between 0.76 (0.63-0.92) and 0.85 (0.76-0.95)], but not in women. CONCLUSIONS: These results underline the public health relevance of physical activity for the prevention of CVD and cancer, especially regarding leisure-time physical activity.

What physical activity surveillance needs: validity of a single-item questionnaire.

BACKGROUND: Self-report instruments to assess physical activity are still the most feasible option in many population-wide surveys, and often need to be very short owing to resource constraints. The aim of this study was to test the criterion validity of a single-item physical activity measure using accelerometers and to compare its measurement properties by gender, age group (including older adults) and language region. METHODS: A validation study was carried out within the second follow-up of a large Swiss cohort study (Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults, SAPALDIA, n=208) and included an additional convenient sample (n=110). Participants wore an accelerometer over eight consecutive days and then completed the single-item measure. Spearman's rank-order correlations were used to assess the criterion validity. RESULTS: Physical activity levels were higher in men, younger individuals and those from the German-speaking part of Switzerland. Correlation coefficients for the number of days with at least 30 min of moderate-to-vigorous physical activity according to the single item and different accelerometer activity outcomes ranged from 0.40 to 0.54. Correlations were higher for women, younger individuals and participants from the French-speaking and the Italian-speaking parts. CONCLUSIONS: The single-item physical activity measure performed at least as well as other physical activity questionnaires. The differences in criterion validity between sub groups indicate that factors such as gender and age should be taken into account when developing physical activity questionnaires and in future validation studies.

Associations of objectively assessed levels of physical activity, aerobic fitness and motor coordination with injury risk in school children aged 7-9 years: a cross-sectional study.

OBJECTIVES: Physical activity (PA) is important for children's health but entails an inherent risk of injuries. The objective of this study was to assess activity-related correlates of injuries in children of the general population under the age of 10 while accounting for PA behaviour objectively assessed with accelerometers. DESIGN: Cross-sectional. SETTING: Primary schools in Switzerland. PARTICIPANTS: 41 (56.9%) of 72 contacted schools were eligible. 11 (26.9%) of them agreed to participate. 3 more schools were recruited with a snowball system. On the individual level, 83.7% of the parents gave consent. Finally, 249 children with complete data (82.2%) from 20 grade 1-3 classes from 14 schools were analysed (mean age 7.9 years, 49.4% girls). PRIMARY OUTCOME MEASURES: Outcome measures were retrospectively assessed injury incidence rates expressed as the number of injuries per 1000 h of objectively measured moderate-to-vigorous physical activity (MVPA) and injury risk depending on levels of PA, aerobic fitness and motor coordination, derived from logistic regression models. RESULTS: 0.43 injuries/1000 h of MVPA (95% CI 0.28 to 0.58) were reported. After controlling for sociodemographic characteristics and accounting for exposure to PA, children with medium and high levels compared with those with low levels of aerobic fitness assessed with the 20 m shuttle run test were at decreased injury risk (OR=0.37 (95% CI 0.16 to 0.85)/OR=0.29 (0.16 to 0.63)). Children with high motor coordination scores assessed with the "Körperkoordinationstest für Kinder" test were at increased injury risk compared with those in the normal range (2.59 (1.04 to 6.32)). Levels of objectively assessed PA were not associated with injury risk; they were neither expressed as rates nor as cumulative incidence. CONCLUSIONS: This study provides novel data showing that low levels of fitness and high coordinative skills, but not objectively assessed levels of PA, were related to injury risk in children under the age of 10.

Effects of filter choice in GT3X accelerometer assessments of free-living activity.

PURPOSE: ActiGraph accelerometers are widely used devices to objectively assess physical activity. The GT3X version has two filter options to be selected before data assessment (normal and low-frequency extension filter option). It is not clear whether the resulting physical activity levels differ depending on the choice of the filter. The aims were to compare GT3X data collected using the different filter options during free-living activities and to establish correction factors if the results were not comparable. METHODS: Sixty-five participants of the population-based SAPALDIA-cohort (50.8% women, age range = 40-80 yr) wore two GT3X accelerometers with different filter selections simultaneously during 8 d. Spearman correlations, Wilcoxon rank sum tests, McNemar tests, scatter plots, and Bland-Altman plots were used to compare the data. Correction factors were established using linear regression models. RESULTS: Although Spearman correlations were high (r ≥ 0.93), there were significant differences in minutes per day between filter options for nonwearing time and time spent in sedentary, light, and moderate-to-vigorous physical activity (all P < 0.001), with more remarkable differences in the lower range of activity (sedentary and light activities). Mean counts per minute and steps per day were significantly higher using the low-frequency extension filter (P < 0.001). Most differences could be resolved using the correction factors. CONCLUSIONS: The observed differences are especially important when research is focusing on sedentary and light activities. In future studies, it is important to carefully evaluate the suitable filter option and to specify the filter choice in publications. The correction factors can be used to make data assessed using the low-frequency extension filter comparable to data assessed using the normal filter option.

Correlates of physical activity: why are some people physically active and others not?

Physical inactivity is an important contributor to non-communicable diseases in countries of high income, and increasingly so in those of low and middle income. Understanding why people are physically active or inactive contributes to evidence-based planning of public health interventions, because effective programmes will target factors known to cause inactivity. Research into correlates (factors associated with activity) or determinants (those with a causal relationship) has burgeoned in the past two decades, but has mostly focused on individual-level factors in high-income countries. It has shown that age, sex, health status, self-efficacy, and motivation are associated with physical activity. Ecological models take a broad view of health behaviour causation, with the social and physical environment included as contributors to physical inactivity, particularly those outside the health sector, such as urban planning, transportation systems, and parks and trails. New areas of determinants research have identified genetic factors contributing to the propensity to be physically active, and evolutionary factors and obesity that might predispose to inactivity, and have explored the longitudinal tracking of physical activity throughout life. An understanding of correlates and determinants, especially in countries of low and middle income, could reduce the eff ect of future epidemics of inactivity and contribute to effective global prevention of non-communicable diseases.

Active transport, physical activity, and body weight in adults: a systematic review.

CONTEXT: Physical activity has various health benefits. Active transport can contribute to total physical activity and thus affect body weight because of increased energy expenditure. This review summarizes published evidence on associations of active transport, general physical activity, and body weight in adults. EVIDENCE ACQUISITION: A systematic review of the literature was conducted in October 2010 using eight databases. A total of 14,216 references were screened; full texts were retrieved for 95 articles. Forty-six articles (36 unique studies) were included: 20 (17) from Europe; 18 (13) from North America, Australia, and New Zealand; and eight (six) from other countries. Analyses of the retrieved papers were carried out between November 2010 and March 2011. EVIDENCE SYNTHESIS: Of 15 studies assessing active transport and physical activity, five found associations in the expected direction (more active transport associated with more physical activity) for all or most variables studied, nine found some associations, and one reported no associations. Of 30 studies assessing active transport and body weight, 13 reported associations in the expected direction (more active transport associated with lower body weight) for all or most variables studied, 12 found some associations, two presented some associations in the expected and some in the opposite direction, and three reported no associations. CONCLUSIONS: There is limited evidence that active transport is associated with more physical activity as well as lower body weight in adults. However, study heterogeneity, predominantly cross-sectional designs, and crude measures for active transport and physical activity impede quantitative conclusions.

Allez Hop, a nationwide programme for the promotion of physical activity in Switzerland: what is the evidence for a population impact after one decade of implementation?

OBJECTIVES: To present evidence for a population impact of a national physical activity promotion programme after a decade of implementation. METHODS: The programme Allez Hop offered local physical activity courses (mainly walking and Nordic walking) once a week over 12 weeks. Data from a pretest posttest survey in 2005 course participants (N=2157 at baseline (of 4130, 52.2%), 1587 at first follow-up (73.6%); smaller subsample with second follow-up) and from repeated cross-sectional national surveys have been analysed regarding changes in physical activity behaviour. RESULTS: The total number of Allez Hop courses was 18 684 between 1997 and 2008. 89.2% of participants were women, the mean age was 48.5 years. The proportion meeting the physical activity recommendations was 31.7% at baseline, in participants with first follow-up data it increased from 33.1% to 42.3% (p<0.001). On the population level in the main user group of Allez Hop (middle-aged women) the proportion not engaging in any sport decreased from 50.1% (1997) to 47.2% (2002) and to 43.1% (2007) (p<0.01). Walking/hiking was the second most frequently performed sport (33.7%) in 2007, with the most remarkable increase since 2000 (+11.1%). CONCLUSIONS: Allez Hop was successfully implemented for more than a decade, reached middle-aged women and a high proportion of insufficiently active individuals. Changes in participants' physical activity behaviour must be interpreted cautiously because of low response rates and short follow-up. However, indications for behavioural changes were observed at the population level, even though these data do not allow a causal link to Allez Hop.

[Physical activity behavior in the Swiss population: what do we know in 2010?]. / Comportement de la population suisse en matiere d'activité physique: état des lieux en 2010.

Since 1999 Switzerland has physical activity recommendations for adults, since 2006 also for school-age children and adolescents. The best available estimates indicate that 32% of adults meet the recommendations for three endurance-type training sessions and another 9% the minimal recommendations of half an hour moderate intensity physical activity on most days of the week. 13% of adolescents seem to meet the minimal recommendations of one hour on every day of the week, 35% on five days per week. All approaches for physical activity promotion are very important, with the medical care settings having a particular role in reaching inactive individuals.

Comparison of trial participants and open access users of a web-based physical activity intervention regarding adherence, attrition, and repeated participation.

BACKGROUND: Web-based interventions are popular for promoting healthy lifestyles such as physical activity. However, little is known about user characteristics, adherence, attrition, and predictors of repeated participation on open access physical activity websites. OBJECTIVE: The focus of this study was Active-online, a Web-based individually tailored physical activity intervention. The aims were (1) to assess and compare user characteristics and adherence to the website (a) in the open access context over time from 2003 to 2009, and (b) between trial participants and open access users; and (2) to analyze attrition and predictors of repeated use among participants in a randomized controlled trial compared with registered open access users. METHODS: Data routinely recorded in the Active-online user database were used. Adherence was defined as: the number of pages viewed, the proportion of visits during which a tailored module was begun, the proportion of visits during which tailored feedback was received, and the time spent in the tailored modules. Adherence was analyzed according to six one-year periods (2003-2009) and according to the context (trial or open access) based on first visits and longest visits. Attrition and predictors of repeated participation were compared between trial participants and open access users. RESULTS: The number of recorded visits per year on Active-online decreased from 42,626 in 2003-2004 to 8343 in 2008-2009 (each of six one-year time periods ran from April 23 to April 22 of the following year). The mean age of users was between 38.4 and 43.1 years in all time periods and both contexts. The proportion of women increased from 49.5% in 2003-2004 to 61.3% in 2008-2009 (P< .001). There were differences but no consistent time trends in adherence to Active-online. The mean age of trial participants was 43.1 years, and 74.9% were women. Comparing contexts, adherence was highest for registered open access users. For open access users, adherence was similar during the first and the longest visits; for trial participants, adherence was lower during the first visits and higher during the longest visits. Of registered open access users and trial participants, 25.8% and 67.3% respectively visited Active-online repeatedly (P< .001). Predictors of repeated use were male sex (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.04-1.38) and increasing age category in registered open access users, and age 46-60 versus < 30 years (OR = 3.04, 95% CI = 1.25-7.38) and Swiss nationality (OR(nonSwiss)= 0.64, 95% CI = 0.41-1.00) in trial participants. Despite reminder emails, attrition was much higher in registered open access users compared with trial participants, with a median lifetime website usage of 0 days in open access users and 290 days in trial participants. CONCLUSIONS: Adherence, patterns of use, attrition, and repeated participation differed between trial participants and open access users. Reminder emails to encourage repeated participation were effective for trial participants but not for registered open access users. These issues are important when interpreting results of randomized controlled effectiveness trials.

Physical activity levels and determinants of change in young adults: a longitudinal panel study.

BACKGROUND: There is growing concern about physical inactivity in adolescents and young adults. Identifying determinants that are associated with low levels of physical activity and with changes in physical activity levels will help to develop specific prevention strategies. The present study describes the prevalence and potential determinants of physical activity behavior and behavior changes of young adults. The study is based on the Swiss Household Panel (SHP), a longitudinal study assessing social changes in a representative sample of Swiss households since 1999. METHODS: Data is collected yearly using computer-assisted telephone interviews. Information is obtained from each household member over 14 years of age. Participants between 14 and 24 years entering the SHP between 1999 and 2006 were included (N = 3,068). "Inactive" was defined as less than 1 day/week of at least 30 minutes of moderate physical activity, "no sport" as exercising less than once a week. Age, gender, nationality, linguistic region, household income, education, membership in a sport club, reading, and Internet use were included as potential determinants of physical activity behavior and behavior change. RESULTS: In both young men and young women, the prevalence of inactivity, "no sport", and non-membership in a sport club was increasing with age. Women were less active than men of the same age. From one wave to the following, 11.1% of young men and 12.1% of young women became active, and 11.9% of men and 13.7% of women became inactive, respectively (pooled data over all eight waves). Non-membership in a sport club was the strongest predictor for "no sport" (OR(men )6.7 [4.9-8.9]; OR(women )8.1 [5.7-11.4]), but also for being inactive (OR 4.6 [3.5-6.0]; 4.6 [3.3-6.4]). Leaving a sport club (OR 7.8 [4.4-14.0]; 11.9 [5.9-24.1]) and remaining non-member (OR 7.8 [4.7-12.9]; 12.4 [6.4-24.1]) were the strongest predictors of becoming "no sport". Effects for becoming inactive were similar, though smaller (OR 5.9 [3.4-10.5] and 5.1 [2.7-9.6] for leaving a club, OR 5.1 [3.1-8.4] and 6.9 [4.0-11.8] for remaining non-member). CONCLUSIONS: The most important findings were the strong effects of sport club membership on general physical activity. The correlation between sport club membership and exercise was not surprising in its nature, but in its strength.

Physical activity recommendations for health: what should Europe do?

BACKGROUND: Accumulating scientific evidence shows physical activity to have profound health benefits amenable to substantial public health gains. Accordingly, recommendations on how much and what kind of physical activity enhances health have been issued. The 1995 recommendation from the U.S. Centres for Disease Control and Prevention and the American College of Sports Medicine has been adapted worldwide, including Europe. Recently an extensive review of new evidence was undertaken and refined recommendations were issued by the U.S. Department of Health and Human Services. We summarise the development of physical activity recommendations and consider the need and possible ways to update the current European situation. DISCUSSION: The new recommendations include several new elements when compared to the 1995 recommendation, the most notable being the greater emphasis on the contribution of vigorous-intensity activities, and the inclusion of activities for muscle strength and bone health. They also include specific recommendations for young people, middle-aged adults, older adults and some special groups. The existing Pan-European and national physical activity recommendations in Europe are mostly based on the 1995 recommendation and primarily target adults and young people. Thus the degree to which they are compatible with the new recommendations varies. In view of the growing public health importance of physical activity, we discuss the need to review the existing physical activity recommendations at the European level and assess their consistency with the new evidence and the new recommendations. SUMMARY: We argue that a review of the current physical activity recommendations in Europe should be undertaken in view of the most recent research evidence. We recommend that such a task should be taken on by WHO Europe in parallel with the ongoing work by WHO global Headquarters. Following this, each country should develop communication strategies and implementation guidelines that take into account their ethnic and cultural diversity.

Effectiveness of active-online, an individually tailored physical activity intervention, in a real-life setting: randomized controlled trial.

BACKGROUND: Effective interventions are needed to reduce the chronic disease epidemic. The Internet has the potential to provide large populations with individual advice at relatively low cost. OBJECTIVE: The focus of the study was the Web-based tailored physical activity intervention Active-online. The main research questions were (1) How effective is Active-online, compared to a nontailored website, in increasing self-reported and objectively measured physical activity levels in the general population when delivered in a real-life setting? (2) Do respondents recruited for the randomized study differ from spontaneous users of Active-online, and how does effectiveness differ between these groups? (3) What is the impact of frequency and duration of use of Active-online on changes in physical activity behavior? METHODS: Volunteers recruited via different media channels completed a Web-based baseline survey and were randomized to Active-online (intervention group) or a nontailored website (control group). In addition, spontaneous users were recruited directly from the Active-online website. In a subgroup of participants, physical activity was measured objectively using accelerometers. Follow-up assessments took place 6 weeks (FU1), 6 months (FU2), and 13 months (FU3) after baseline. RESULTS: A total of 1531 respondents completed the baseline questionnaire (intervention group n = 681, control group n = 688, spontaneous users n = 162); 133 individuals had valid accelerometer data at baseline. Mean age of the total sample was 43.7 years, and 1146 (74.9%) were women. Mixed linear models (adjusted for sex, age, BMI category, and stage of change) showed a significant increase in self-reported mean minutes spent in moderate- and vigorous-intensity activity from baseline to FU1 (coefficient = 0.14, P = .001) and to FU3 (coefficient = 0.19, P < .001) in all participants with no significant differences between groups. A significant increase in the proportion of individuals meeting the HEPA recommendations (self-reported) was observed in all participants between baseline and FU3 (OR = 1.47, P = .03), with a higher increase in spontaneous users compared to the randomized groups (interaction between FU3 and spontaneous users, OR = 2.95, P = .02). There were no increases in physical activity over time in any group for objectively measured physical activity. A significant relation was found between time spent on the tailored intervention and changes in self-reported physical activity between baseline and FU3 (coefficient = 1.13, P = .03, intervention group and spontaneous users combined). However, this association was no longer significant when adjusting for stage of change. CONCLUSIONS: In a real-life setting, Active-online was not more effective than a nontailored website in increasing physical activity levels in volunteers from the general population. Further research may investigate ways of integrating Web-based physical activity interventions in a wider context, for example, primary care or workplace health promotion.

An evidence-based approach to physical activity promotion and policy development in Europe: contrasting case studies.

Evidence-based public health takes many of the principles of evidence-based medicine and applies them to public health. This is a relatively young discipline however and is not universally applied to public health issues--especially such multidisciplinary topics as physical activity. This paper sets out to provide guidance on this issue by characterising four 'key tasks' that form the basis of a systematic evidence-based approach to promoting physical activity. These tasks are based in part on the physical activity promotion model (Brownson et al.,1999). These are illustrated with examples from work in three contrasting European countries: Finland, England and Switzerland. 'Task one' is concerned with using the evidence for the health benefits of physical activity to 'make the case' and increase action by policy makers. Here, all three countries took a similar approach, conducting academic reviews to draw together the existing evidence of the health benefits of physical activity. 'Task two' is concerned with conducting surveillance to collect evidence on the prevalence of physical activity. Here, Finland and Switzerland were careful to collect trend data and use them for advocacy, while in England continuous changes to questionnaires and survey methodologies have led to poor trend data. 'Task three' is to review evidence on 'what works' in increasing physical activity to influence practice. England appears to be taking a more systematic approach to this task, with a comprehensive approach to reviewing evidence on what works and disseminating this to influence good practice, while the other countries rely mainly on individual evaluation studies. 'Task four' is the evaluation of practice and it is clear that in all three countries this remains a significant challenge--one requiring additional training and dedicated funding. As a result much of current "good practice" is based upon experience (usually unevaluated) and not evidence. This brief analysis shows that there are some common tasks that need to be undertaken as a central part of an evidence-based public health approach. However, cultural and political factors in each country studied have influenced the manner in which these tasks were undertaken, and the importance attached to each component.

Validity of four short physical activity questionnaires in middle-aged persons.

PURPOSE: Self-administered questionnaires continue to be the most widely used type of physical activity assessment in epidemiological studies. However, test-retest reliability and validity of physical activity questionnaires have to be determined. In this study, three short physical activity questionnaires already used in Switzerland and the International Physical Activity Questionnaire (IPAQ) were validated. METHODS: Test-retest reliability was assessed by repeated administration of all questionnaires within 3 wk in 178 volunteers (77 women, 46.1+/-14.8 yr; 101 men 46.8+/-13.2 yr). Validity of categorical and continuous data was studied in a subsample of 35 persons in relation to 7-d accelerometer readings, percent body fat, and cardiorespiratory fitness. RESULTS: Reliability was fair to good with a Spearman correlation coefficient range of 0.43-0.68 for measures of continuous data and moderate to fair with Kappa values between 0.32 and 0.46 for dichotomous measures active/inactive. Total physical activity reported in the IPAQ and the Office in Motion Questionnaire (OIMQ) correlated with accelerometry readings (r=0.39 and 0.44, respectively). In contrast, correlations of self-reported physical data with percent body fat and cardiorespiratory fitness were low (r=-0.26-0.29). Participants categorized as active by the Swiss HEPA Survey 1999 instrument (HEPA99) accumulated significantly more days of the recommended physical activities than their inactive counterparts (4.4 and 2.7 d.wk, respectively, P<0.05). However, compared with accelerometer data, vigorous physical activities were overreported in investigated questionnaires. CONCLUSION: Collecting valid data on physical activity remains a challenging issue for questionnaire surveys. The IPAQ and the three other questionnaires are characterized to inform decisions about their appropriate use.