Beyond health-promoting labels: school factors shape pupils’ leisure-time physical activity

Background: Rates of physical inactivity and obesity among children, including those in Israel, continue to rise. While childhood is recognised as a crucial stage for developing lifelong physical activity (PA) habits, the extent to which the school environment and individual pupil characteristics are associated with leisure-time physical activity (LTPA) is not yet well understood. Objective: This study aimed to explore which characteristics of pupils and elementary schools in Israel were associated with the frequency of pupils’ LTPA. Methods: This cross-sectional survey included 1,398 pupils (aged 10–12 years) and 134 parents across 29 schools. Fourteen of them were Health Promoting Schools (HPS), representing Jewish secular, Jewish religious and Arab populations across Israel. The survey questionnaire examined pupils’ LTPA and potential related factors, including school population group, school climate, school health policies, parental involvement and the integration of PA into school routines. Data were also collected on pupils’ socioeconomic background, gender and school’s recognition as an HPS. Results: LTPA was significantly associated with pupils’ engagement in school sports activities ( p < .001) and a positive school climate ( p < .001). Boys engaged in significantly more LTPA than girls ( p < .001). However, socioeconomic status, school affiliation with the HPS initiative and population group were not significantly associated with LTPA. Conclusion: Integrating sports activities into everyday school routines, fostering positive school climates and considering gender differences are essential factors for enhancing LTPA among elementary school pupils. Furthermore, being an HPS, having high socioeconomic status and implementing health-promotion policies in the school do not necessarily guarantee higher frequency of LTPA among pupils.

The American Heart Association/American College of Cardiology pooled cohort equations (PCEs) are used for predicting 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Pooled cohort equation risk prediction capabilities across self-reported leisure-time physical activity (LTPA) levels and the change in model performance with addition of LTPA to the PCE are unclear. To evaluate PCE risk prediction performance across self-reported LTPA levels and the change in model performance by adding LTPA to the existing PCE model. Individual-level pooling of data from 3 longitudinal cohort studies-Atherosclerosis Risk in Communities, Multi-Ethnic Study of Atherosclerosis, and Cardiovascular Health Study-was performed. A total of 18 824 participants were stratified into 4 groups based on self-reported LTPA levels: inactive (0 metabolic equivalent of task [MET]-min/wk), less than guideline-recommended (<500 MET-min/wk), guideline-recommended (500-1000 MET-min/week), and greater than guideline-recommended (>1000 MET-min/wk). Pooled cohort equation risk discrimination was studied using the C statistic and reclassification capabilities were studied using the Greenwood Nam-D'Agostino χ2 goodness-of-fit test. Change in risk discrimination and reclassification on adding LTPA to PCEs was evaluated using change in C statistic, integrated discrimination index, and categorical net reclassification index. Adjudicated ASCVD events during 10-year follow-up. Among 18 824 participants studied, 10 302 were women (54.7%); mean (SD) age was 57.6 (8.2) years. A total of 5868 participants (31.2%) were inactive, 3849 (20.4%) had less than guideline-recommended LTPA, 3372 (17.9%) had guideline-recommended LTPA, and 5735 (30.5%) had greater than guideline-recommended LTPA level. Higher LTPA levels were associated with a lower risk of ASCVD after adjustment for risk factors (hazard ratio [HR] per 1-SD higher LTPA, 0.91; 95% CI, 0.86-0.96). Across LTPA groups, PCE risk discrimination (C statistic, 0.76-0.78) and risk calibration (all χ2 P > .10) was similar. Addition of LTPA to the PCE model resulted in no significant change in the C statistic (0.0005; 95% CI, -0.0004 to 0.0015; P = .28) and categorical net reclassification index (-0.003; 95% CI, -0.010 to 0.010; P = .95), but a minimal improvement in the integrated discrimination index (0.0008; 95% CI, 0.0002-0.0013; P = .005) was observed. Similar results were noted when cohort-specific coefficients were used for creating the baseline model. Higher self-reported LTPA levels appear to be associated with lower ASCVD risk and increasing LTPA promotes cardiovascular wellness. These findings suggest the American Heart Association/American College of Cardiology PCEs are accurate at estimating the probability of 10-year ASCVD risk regardless of LTPA level. The addition of self-reported LTPA to PCEs does not appear to be associated with improvement in risk prediction model performance.

The longitudinal influence of parental leisure-time physical activity (LTPA) on their offspring's LTPA is poorly understood. This study examined the longitudinal associations between parental LTPA and offspring's LTPA at two-time intervals. Child (offspring) participants (N=3596) were enrolled from the Cardiovascular Risk in Young Finns Study in 1980. Their LTPA was self-rated through nine phases from baseline to 2018 and categorized by year into youth (1980-1986) and adult (1992-2018) LTPA. Parental LTPA was assessed with a single self-reported question at three phases from 1980 to 1986. Latent growth curve modeling stratified by gender was fitted to estimate the potential pathways between parental LTPA and offspring's youth and adult LTPA. Higher initial levels of paternal and maternal LTPA were independently associated with greater initial levels of youth and adult LTPA of offspring in both genders, respectively, except maternal LTPA, which did not associate with male offspring's adult LTPA. The initial levels of paternal LTPA were directly related to changes in male offspring's youth LTPA after adjusting for age, residential place, paternal education and occupation, having siblings, and offspring's body mass index. Our study demonstrates that the initial levels of parental LTPA are directly linked to the initial levels of offspring's LTPA during youth and adulthood, while changes in parental LTPA are unrelated to changes in offspring's youth and adult LTPA for either gender over time. These results imply that higher initial levels of LTPA in parents may serve as a predictor of offspring's LTPA across life stages.

Should workers be physically active after work? Associations of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels—An individual participant data meta-analysis

BACKGROUND/OBJECTIVESAlthough the association of body mass index (BMI) with metabolic syndrome (MetS) is well documented, there is little knowledge on the independent and joint associations of BMI and physical activity with MetS risk based on a continuous scoring system. This study was designed to explore the effect of physical activity on interactions between excess body weight and continuous metabolic syndrome (cMetS) in a nationwide survey of Iranian children and adolescents.SUBJECTS/METHODSData on 5,625 school students between 10 and 18 years of age were analyzed. BMI percentiles, screen time activity (STA), leisure time physical activity (LTPA) levels, and components of cMetS risk score were extracted. Standardized residuals (z-scores) were calculated for MetS components. Linear regression models were used to study the interactions between different combinations of cMetS, LTPA, and BMI percentiles.RESULTSOverall, 984 (17.5%) subjects were underweight, whereas 501 (8.9%) and 451 (8%) participants were overweight and obese, respectively. All standardized values for cMetS components, except fasting blood glucose level, were directly correlated with BMI percentiles in all models (P-trend < 0.001); these associations were independent of STA and LTPA levels. Linear associations were also observed among LTPA and standardized residuals for blood pressure, high-density lipoprotein, and waist circumference (P-trend < 0.01).CONCLUSIONSOur findings suggest that BMI percentiles are associated with cMetS risk score independent of LTPA and STA levels.

The aim of this study is to describe the changes in leisure-time physical activity (LTPA) levels among the Estonian adult population in the years 2013–2015 in order to examine the relationships between LTPA level and socioeconomic status (SES) and health indicators, and also to explore perceived barriers to LTPA. Data from the National Physical Activity Survey were used. The sample consisted of 1009 participants aged 15–69 in 2013 and 1004 respondents in 2015. The proportion of Estonian adults exercising regularly at least four times per week increased from 39% in 2013 to 45% in 2015. Being in the older age groups increased the odds for physical inactivity 2.07–4.74 times compared to the youngest age group (15–24) (p&lt;0.01). Having primary, basic, or secondary education increased the odds of being inactive 2.33–3.14 times compared to respondents with higher education (p &lt; 0.01). The most prevalent barriers to physical activity reported by inactive adults were: 1) the absence of interest or unwillingness to make an effort, 2) tiredness at work, and 3) lack of time. In conclusion, despite a slight positive trend, LTPA levels are low. As the perceived barriers depend on age, public health strategies should involve age-specific solutions, especially for older adults.

Leisure Time, Non-leisure Time, and Occupational Physical Activity in Asian Americans

While headache disorders are linked to low physical activity levels, the impact of depression on this relationship is unclear. To assess how single and comorbid diagnoses of migraine and tension-type headache (TTH) interact with depression and leisure-time physical activity (LTPA) levels in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). In this cross-sectional analysis based on the ELSA-Brasil baseline data, the relationship of migraine, TTH (both assessed with the International Classification of Headache Disorders, Second Edition), and depression (assessed with the Clinical Interview Schedule-Revised) with LTPA levels (International Physical Activity Questionnaire) was investigated by employing linear regression models. Models were adjusted for sociodemographic, lifestyle, and clinical covariates, and interaction terms were created to examine additive effects of comorbid conditions. Among 14,088 participants, 54.4% (7668/14,088) were female, prevalence rates were: TTH = 39.6% (5573/14,088), migraine = 27.0% (3806/14,088), depression = 0.7% (94/14,088), depression + TTH = 1.1% (148/14,088), and depression + migraine = 2.5% (356/14,088). The mean (standard deviation) LTPA levels across the groups were: no headache + no depression = 148.7 (183.0) min/week, TTH = 133.5 (170.1) min/week, migraine = 110.3 (154.8) min/week, depression = 76.5 (146.3) min/week, depression + TTH = 84.5 (127.7) min/week, and depression + migraine = 64.3 (123.2) min/week. Negative associations were found for depression (β = -55.1, 95% confidence interval [CI] -93.6 to -17.0; p = 0.005), migraine (β = -24.7, 95% CI -33.2 to -15.4; p < 0.001), and TTH (β = -15.5, 95% CI -23.1 to -7.6; p < 0.001) with LTPA. No interaction effect was observed for depression + TTH (β = 36.0, 95% CI -12.6 to 84.6; p = 0.147) and depression + migraine (β = 31.7, 95% CI -11.3 to 74.7; p = 0.149), indicating no additive effect of comorbid conditions on LTPA levels. After adjusting for headache attack frequency, only depression + migraine remained negatively associated with LTPA (β = -38.7, 95% CI -71.6 to -5.8; p = 0.021). Headache disorders and depression were independently and inversely associated with LTPA, with the strongest effects seen in depression alone or comorbid with migraine.

Leisure time physical activity and its relation to psychiatric comorbidities in depression. Findings from Finnish Depression and Metabolic Syndrome in Adults (FDMSA) study

Leisure-time physical activity can reduce the risk of Type 2 diabetes, but the potential effect of different types of physical activity is still uncertain. This study is to examine the relationship of occupational, commuting and leisure-time physical activity with the incidence of Type 2 diabetes. We prospectively followed 6898 Finnish men and 7392 women of 35 to 64 years of age without a history of stroke, coronary heart disease, or diabetes at baseline. Hazards ratios of incidence of Type 2 diabetes were estimated by levels of occupational, commuting, and leisure-time physical activity. During a mean follow-up of 12 years, there were 373 incident cases of Type 2 diabetes. In both men and women combined, the hazards ratios of diabetes associated with light, moderate and active work were 1.00, 0.70 and 0.74 (p=0.020 for trend) after adjustment for confounding factors (age, study year, sex, systolic blood pressure, smoking, education, the two other types of physical activity and BMI). The multivariate-adjusted hazards ratios of diabetes with none, 1 to 29, and more than 30 min of walking or cycling to and from work were 1.00, 0.96, and 0.64 (p=0.048 for trend). The multivariate-adjusted hazards ratios of diabetes for low, moderate, high levels of leisure-time physical activity were 1.00, 0.67, and 0.61 (p=0.001 for trend); after additional adjustment for BMI, the hazards ratio was no longer significant. Moderate and high occupational, commuting or leisure-time physical activity independently and significantly reduces risk of Type 2 diabetes among the middle-aged general population.

PurposeAssociations of leisure-time physical activity (LTPA) in three-generational families has not been well studied. This study aimed to examine these associations in a three-generational data including children, and their parents and grandparents.MethodsSelf-reported LTPA data, along with a range of family sociodemographic and health-related variables, were extracted from the ongoing Young Finns Study. The cohort consists of 2501 children aged 7–38 years, their parents, and grandparents in 2018. Structural equation modeling was fitted to estimate the associations of children’s LTPA with parents’ and grandparents’ LTPA in different age and sex groups.ResultsInterrelationships of parental and grandparental LTPA with children’s LTPA varied by age and sex groups. For children aged 7–12 years, mothers’ LTPA was associated with higher LTPA in both boys (r = 0.22, p = 0.017) and girls (r = 0.34, p < 0.001), while fathers’ LTPA was associated with higher LTPA in boys (r = 0.25, p = 0.01). High LTPA level in maternal grandfathers and grandmothers was associated with higher LTPA in grandgirls (r = 0.29, p = 0.024 and r = 0.23, p = 0.039). For adolescents aged 13–18 years, only fathers’ LTPA was associated with higher LTPA in boys (r = 0.20, p = 0.029). For young adults aged >18 years, fathers’ LTPA was associated with higher LTPA in both young males (r = 0.21, p = 0.004) and females (r = 0.20, p = 0.003), while mothers’ LTPA was associated with higher LTPA in young females (r = 0.13, p = 0.009). High LTPA level in maternal grandfathers was associated with higher LTPA in grandboys (r = 0.34, p = 0.003).ConclusionsThe children’s LTPA levels associated independently with parents’ and grandparents’ LTPA depending on the child’s age and sex. Given the primary results available, further research is warranted to fully understand the interrelationships between parents' and grandparents’ LTPA and their children’s LTPA in order to create effective and targeted interventions.

Physical activity (PA) is important for the prevention and management of numerous diseases and may have a positive effect on ability to work. The study aimed to assess the level of occupational and leisure time PA of soldiers during the COVID-19 pandemic and to explore whether there was a relationship between PA and perceived work ability. The study involved 305 men and 68 women who were territorial army soldiers aged 18-55 (M±SD 32.9±9.01). The Seven-Day Physical Activity Recall (SDPAR) and the Work Ability Index (WAI) were used. The level of self-reported PA for the studied soldiers was relatively high; 80% of them met the recommendations of the WHO and were characterized by having a good (60%) or excellent (20%) WAI status. The level of occupational PA of male soldiers was higher than the level of leisure time PA, and they indicated higher levels of occupational PA and leisure time PA during the workweek than the weekend. Current work ability in comparison to the best in life and work ability related to the physical requirements of the work were positively correlated with leisure time PA. Work ability related to physical requirements was also positively correlated with occupational and total PA, and work ability related to mental requirements was positively correlated with total PA. The study supports the relationship between PA and several aspects of work ability. Int J Occup Med Environ Health. 2022;35(3):327-37.

Adults who engage in leisure-time physical activity (LTPA) have a reduced risk of developing heart failure. We hypothesized that high levels of LTPA are associated with diminished adverse age-related changes in cardiac structure and function. We studied 4342 Atherosclerosis Risk in Communities Study participants free of cardiovascular disease who underwent standardized echocardiography. In a cross-sectional analysis, we related LTPA (poor, intermediate, or ideal) to cardiac structure and function. We also related cumulative average LTPA over 24 years and changes in LTPA categories to echocardiographic measures. Cross-sectional analysis demonstrated that ideal LTPA, compared with poor LTPA, was associated with better diastolic function [prevalence of normal diastolic function: 39.8% vs. 31.5%, P < 0.001; mean E/E' ratio (95% CI): 9.8 (9.6, 9.9) vs. 10.4 (10.2, 10.5), P = 0.001] and better systolic function [left-ventricular (LV) longitudinal strain: -18.3 (-18.4, -18.2) vs. -17.9 (-18.0, -17.8), P < 0.001] after adjusting for age, sex, race, and centre. Higher cumulative average LTPA over 24 years or an improvement in LTPA category were also, respectively, related to a more favourable E/E' ratio (P < 0.0001, P = 0.004) and longitudinal LV strain (P = 0.0002, P = 0.002). Ideal LTPA, higher average levels of LTPA over a 24-year period, and an improvement in LTPA even later in life were associated with more favourable indices of LV diastolic and systolic function in older adults. Sustaining higher levels of LTPA, and even increasing physical activity later in life, may be beneficial for older adults in attenuating expected age-related changes in cardiac structure and function.

Results from longitudinal studies suggest that regular leisure time physical activity (LTPA) is associated with reduced risk of dementia or Alzheimer disease. Data on the association between LTPA and brain magnetic resonance imaging (MRI) measures remain scarce and inconsistent. To examine the association of LTPA and MRI-assessed brain aging measures in a multiethnic elderly population. This cross-sectional study included 1443 older (≥65 years) adults without dementia who were participants of the Washington/Hamilton Heights-Inwood Columbia Aging Project study. LTPA, from self-reported questionnaire, was calculated as metabolic equivalent of energy expenditure. Both moderate to vigorous LTPA, assessed as meeting Physical Activity Guidelines for Americans (≥150 minutes/week) or not, and light-intensity LTPA were also examined. LTPA. Primary outcomes included total brain volume (TBV), cortical thickness, and white matter hyperintensity volume, all derived from MRI scans with established methods and adjusted for intracranial volume when necessary. We examined the association of LTPA with these imaging markers using regression models adjusted for demographic, clinical, and vascular risk factors. The 1443 participants of the study had a mean (SD) age of 77.2 (6.4) years; 921 (63.8%) were women; 27.0%, 34.4%, and 36.3% were non-Hispanic White, non-Hispanic African American, and Hispanic individuals, respectively; and 27.3% carried the apolipoprotein E (APOE) ɛ4 allele. Compared with the LTPA of nonactive older adults, those with the most LTPA had larger (in cm3) TBV (β [SE], 13.17 [4.42] cm3; P = .003; P for trend = .006) and greater cortical thickness (β [SE], 0.016 [0.008] mm; P = .05; P for trend = .03). The effect size comparing the highest LTPA level with the nonactive group was equivalent to approximately 3 to 4 years of aging (β for 1 year older, -3.06 and -0.005 for TBV and cortical thickness, respectively). A dose-response association was found and even the lowest LTPA level had benefits (eg, TBV: β [SE], 9.03 [4.26] cm3; P = .03) compared with the nonactive group. Meeting Physical Activity Guidelines for Americans (TBV: β [SE], 18.82 [5.14] cm3; P < .001) and light-intensity LTPA (TBV: β [SE], 9.26 [4.29] cm3; P = .03) were also associated with larger brain measures. The association between LTPA and TBV was moderated by race/ethnicity, sex, and APOE status, but generally existed in all subgroups. The results remained similar after excluding participants with mild cognitive impairment. In this study, more physical activity was associated with larger brain volume in older adults. Longitudinal studies are warranted to explore the potential role of physical activity in brain health among older individuals.

Predictors of decreased physical activity level over time among adults: a longitudinal study.