Exercise Opportunities Research Articles

Life and Stress of Japanese Children and Adolescents During the Prolonged Coronavirus Disease 2019 (COVID-19) Pandemic

This study surveyed adult web monitor enrollees about the lives of and stress experienced by Japanese children and adolescents during the prolonged coronavirus disease 2019 (COVID-19) pandemic. The survey was conducted on February 10, 2022 (after the sixth wave) and August 19, 2022 (during the seventh wave of the COVID-19 pandemic in Japan), with 231 and 217 survey participants, respectively. The questionnaire was designed so that adults could assess the frequency of exercise, and difficulties experienced by children and adolescents around them. Regarding exercise opportunities, 22% of parents of middle and high school children reported that children’s exercise opportunities “stayed the same” or “increased considerably” in the first survey. Whereas, in the second survey, all parents of middle and high school children reported that children’s exercise opportunities “decreased.” Regarding stress, 17% of parents of adolescents 18 years and older responded that the stress experienced was the “same as before” or “a little less than before” in the first survey, but all of these parents responded “quite a bit” to the same question in the second survey. The findings suggest that the life changes caused by the COVID-19 pandemic may have a significant impact on children and adolescents and may increase stress. The long-term effects of the COVID-19 pandemic on children and adolescents should be further investigated.

Construction of traditional national physical education teaching model in medical colleges from the perspective of cultural inheritance

In the context of college education, education in physical in medical schools should focus on cultivating and strengthening students' physical fitness, mobilizing students to actively participate in sports, and improving their comprehensive quality. Therefore, in the process of implementing education in physical, medical schools should fully recognize the importance of education in physical for students, and on this basis, enable students to obtain more sports knowledge and exercise opportunities. However, at present, modern education in physical is generally adopted in China's colleges and universities, and in this process, there is a lack of curriculum teaching combined with traditional national sports. However, for college students, these traditional sports activities are valuable assets for the development of education in physical, and education in physical in the new era should attach importance to and carry forward history and integrate it into education in physical in the new era. At present, the content and elements of traditional national sports courses covered in China's college education in physical courses are relatively small, therefore, from the perspective of cultural inheritance, medical schools should integrate traditional national sports into education in physical, build a relatively complete teaching system, and at the same time, have a certain understanding and mastery of certain traditional national sports in order to design a scientific and reasonable teaching program. In this regard, based on the perspective of cultural inheritance, this paper first analyses the current situation of traditional national education in physical in medical schools, and then focuses on exploring the construction strategy of traditional national education in physical teaching model in medical schools, in order to provide reference for relevant personnel.

Commercial equine production in New Zealand 4: welfare implications of the New Zealand production systems

From racehorses to family pets, equine production and management is primarily pasture-based in New Zealand. Pasture-based equine production systems largely reflect the horse’s ecological niche and have a unique set of management and welfare challenges. This review examines the potential welfare issues related to the management of horses in New Zealand. The economic value of horses varies greatly depending on their usage, which covers a wide spectrum from pest species (e.g. feral horses) to production (e.g. racehorses) and companion animals (e.g. leisure and sport horses). The view of where the horse is positioned on this spectrum may cause differing welfare threats to horses, due to the economic considerations, which drive the majority of welfare and managemental decisions. The organisation, management, racing and wastage metrics of the Thoroughbred racehorse industry are well documented, and the benefits of the pasture-based system have become evident through less stressful weaning practices and opportunity for early exercise (which has been associated with longer careers and fewer musculoskeletal injuries). Identification of equine-welfare research priorities in New Zealand remains challenging, given the lack of vertical integration of many sectors of the equine industry resulting in fragmented and limited availability of data.

Does bike sharing improve public health? A case study in New York City

Bike sharing contributes to public health by providing physical exercise opportunities. Meanwhile, the shift of vehicular travel demand to bike sharing may cut vehicular emissions and severe crashes. However, according to each city’s different composition of travel modes, the net health benefits are not clear and worth studying case by case. In this paper, we focus on the Citi Bike bike-sharing program in New York City. We modify the Integrated Transport Health Impact Model and assess the net health effects by comparing a baseline scenario (with Citi Bike) against a hypothetical scenario (without Citi Bike). For each scenario, we investigate the overall health effects of the Citi Bike program in the unit of Disability Adjusted Life Years (DALYs) in three categories: physical activity, fine inhalable particles (i.e., PM 2.5) exposure, and road traffic injuries. The results indicate that the implementation of Citi Bike plays a positive role in improving public health. It is worth noting that the emission reduction due to the shift from vehicular transport to Citi Bike contributes the most health benefit to the public. Hence we further propose a sensitivity analysis of the Citi Bike market share illustrating the potential benefits of promoting Citi Bike among non-users.

Physical Function of Japanese Preadolescents during the COVID-19 Pandemic.

Children's exercise habits have changed during the COVID-19 pandemic. This study aimed to examine the physical function and physical activity of preadolescent children before and during the COVID-19 pandemic. This cross-sectional study compared time spent in moderate-to-vigorous physical activity (MVPA), grip strength, single-leg standing time, and two-step tests of healthy children aged 10 to 12 years, enrolled from January 2018 to January 2020 (pre-COVID-19 group, n = 177) and from January 2021 to September 2022 (during-COVID-19 group, n = 69). The during-COVID-19 group had weaker grip strength (median: 14.4 vs. 15.8 kg; p = 0.012), worse performance on the two-step test (mean: 1.56 vs. 1.60; p = 0.013), and less MVPA (median: 4 vs. 7 h per week; p = 0.004). Logistic regression showed that the during-COVID-19 group was significantly related to weaker grip strength (odds ratio: 0.904, 95% CI: 0.829-0.986; p = 0.022) and worse performance in the two-step test (odds ratio: 0.976, 95% CI: 0.955-0.997; p = 0.028). The COVID-19 pandemic decreased exercise opportunities for preadolescent children, which may have had a negative impact on muscle strength and balance. It is essential to increase the amount of MVPA among preadolescent children.

A National Implementation Approach for Exercise as Usual Care in Pediatric and Adolescent Oncology: Network ActiveOncoKids.

The diagnosis of cancer as well as accompanying acute and late effects of treatment are influencing physical activity behavior of patients with childhood cancer and survivors. Research has shown that a pediatric cancer diagnosis is associated with impairments of physical performance, and function, as well as reduced physical, and psychosocial, health conditions. From an ethical perspective, lack of knowledge of health care providers, lack of physical activity promotion, and environmental, and structural barriers to physical activity restrict children's right to move and actively engage in physical activities. Network ActiveOncoKids is a German-wide initiative with the main goal of enabling children, adolescents, and young adults with exercise opportunities during and after cancer treatment. Since the network's foundation in 2012, Network ActiveOncoKids focuses on: (1)physical activity support for patients and families, (2)policy change to establish structures and guidelines, and (3)generating evidence through scientific projects. The purpose of this paper is to present an overview of Network ActiveOncoKids structure, aims, and projects. This topical review will highlight the network's structural development, research work, and implementation progress of exercise programs for patients with pediatric cancer and survivors, link international collaborations, and discuss future directions.

Physical Therapy Programs in Older Adults with Coronary Artery Disease: Preferences to Technology-Based Cardiac Physical Therapy Programs.

(1) Background: Assessing preferences in technology-based cardiac physical therapy programs in older adults with coronary artery disease (CAD) is fundamental to promoting adherence to healthy lifestyles and healthy aging. This study aimed at analyzing preferences in technology-based cardiac physical therapy programs in older adults with CAD. Additionally, a comparison by sex was performed. (2) Methods: Cross-sectional study. 70 older adults with CAD (mean age 66.73 ± 0.77, 80% men) were evaluated. Technology use and preferences in technology-based cardiac physical therapy programs (Technology Usage Questionnaire) were assessed. (3) Results: 97.1% of the sample had Smartphones and 81.4% accessed the Internet every day, mostly with their Smartphones (75.5%). A total of 54.3% were interested in receiving rehabilitation via their Smartphone, and most of the sample considered ideas to manage stress (92.9%), healthy meal ideas and recipes (85.7%), exercise ideas (84.3%), exercise prompts (72.9%), setting goals (67.1%), exercise taught by a virtual therapist (65.7%), ideas to overcome cigarette cravings (62.9%), information on local exercise opportunities (60%), ideas to remember to take medications (57.1%), steps to achieve goals (54.3%) and eating tips for takeaways (51.7%) very useful. Additionally, men considered the technology-based advice about exercise prompts, healthy meal ideas and recipes, and ideas to manage stress more useful than women, and had more frequently a Smartphone, less frequently made phone calls, had more regular access to the Internet, and used the Internet more often. (4) Conclusions: Clinicians should encourage older adults to engage in cardiac technology-based physical therapy programs to provide meaningful exercise counselling, promote healthy lifestyle and healthy aging.

Assessing the effect of energy poverty on the mental and physical health in China—Evidence from China family panel studies

Energy poverty is a crucial issue faced by countries all around the world, as the largest developing country in the world, China is also experiencing energy poverty problems. In order to explore the health effect of energy poverty in China, this paper first uses the principal component analysis (PCA) to construct a comprehensive index to measure energy poverty, and then adopts the ordinary least square method (OLS), fixed effect model (FE), instrumental variable two-stage least squares (IV-2SLS) regression to study the impact of energy poverty on the physical and mental health of Chinese people based on China Family Panel Studies 2018 (CFPS 2018). The study discovers that energy poverty significantly hampers the mental and physical health of Chinese people, an increase in energy poverty might cause 28.74%、18.69% decrease in mental and physical health respectively. Moreover, this paper further explores the influencing paths of energy poverty by intermediary effect and regulatory effect. It is revealed that in addition to directly affecting physical and mental health, energy poverty also have a negative impact on physical and mental health by affecting the accessibility of a series of resources, such as water and food, reducing the opportunities for physical exercise and increasing medical expenses. However, the impact is restricted by age and family income. Finally, under the national strategy of China, this paper further discusses how to give consideration to the joint implementation of heath and emission reduction strategies, then gives specific policy suggestions based on the results.

Effectiveness and implementation success of a co-produced physical activity referral scheme in Germany: study protocol of a pragmatic cluster randomised trial

BackgroundWhile effective physical activity referral schemes (PARSs) and related structures for promoting physical activity (PA) already exist in several countries, in Germany, PARSs have not yet been implemented systematically and nationwide. Through a co-production approach with relevant actors in the German healthcare system, a PARS was developed, and an implementation plan was created (e.g. financing). This study protocol aims to evaluate the developed PARS for people with non-communicable diseases (NCDs) in Germany regarding its potential effectiveness and implementation success.MethodsTo evaluate the effectiveness and implementation success of the PARS, we will apply a pragmatic cluster-randomised controlled trial (cRCT) in Hybrid II design by comparing two intervention groups (PARS vs PA advice [PAA]). The trial will take place in the Nürnberg metropolitan region, with 24 physician practices recruiting 567 people with NCDs. Both groups will receive brief PA advice from a physician to initially increase the participants’ motivation to change their activity level. Subsequently, the PARS group will be given individualised support from an exercise professional to increase their PA levels and be transferred to local exercise opportunities. In contrast, participants in the PAA group will receive only the brief PA advice as well as information and an overview of regional PA offerings to become more active at their own initiative. After 12 and 24 weeks, changes in moderate to vigorous PA and in physical activity-related health competence (movement competence, control competence, self-regulation competence) will be measured as primary outcomes. Secondary outcomes will include changes in quality of life. To measure implementation success, we refer to the RE-AIM framework and draw on patient documentation, interviews, focus groups and surveys of the participating actors (physicians, exercise professionals).DiscussionThrough a between-group comparison, we will investigate whether additional individual support by an exercise professional compared to brief PA advice alone leads to higher PA levels in people with NCDs. The acceptance and feasibility of both interventions in routine care in the German healthcare system will also be evaluated.Trial registrationClinicalTrials.gov, NCT04947787. Registered 01 June 2021.

The TROLLEY Study: assessing travel, health, and equity impacts of a new light rail transit investment during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic disrupted life in extraordinary ways impacting health and daily mobility. Public transit provides a strategy to improve individual and population health through increased active travel and reduced vehicle dependency, while ensuring equitable access to jobs, healthcare, education, and mitigating climate change. However, health safety concerns during the COVID-19 pandemic eroded ridership, which could have longstanding negative consequences. Research is needed to understand how mobility and health change as the pandemic recedes and how transit investments impact health and equity outcomes.MethodsThe TROLLEY (TRansit Opportunities for HeaLth, Livability, Exercise and EquitY) study will prospectively investigate a diverse cohort of university employees after the opening of a new light rail transit (LRT) line and the easing of campus COVID-19 restrictions. Participants are current staff who live either < 1 mile, 1–2 miles, or > 2 miles from LRT, with equal distribution across economic and racial/ethnic strata. The primary aim is to assess change in physical activity, travel mode, and vehicle miles travelled using accelerometer and GPS devices. Equity outcomes include household transportation and health-related expenditures. Change in health outcomes, including depressive symptoms, stress, quality of life, body mass index and behavior change constructs related to transit use will be assessed via self-report. Pre-pandemic variables will be retrospectively collected. Participants will be measured at 3 times over 2 years of follow up. Longitudinal changes in outcomes will be assessed using multilevel mixed effects models. Analyses will evaluate whether proximity to LRT, sociodemographic, and environmental factors modify change in outcomes over time.DiscussionThe TROLLEY study will utilize rigorous methods to advance our understanding of health, well-being, and equity-oriented outcomes of new LRT infrastructure through the COVID-19 recovery period, in a sample of demographically diverse adult workers whose employment location is accessed by new transit. Results will inform land use, transportation and health investments, and workplace interventions. Findings have the potential to elevate LRT as a public health priority and provide insight on how to ensure public transit meets the needs of vulnerable users and is more resilient in the face of future health pandemics.Trial registrationThe TROLLEY study was registered at ClinicalTrials.gov (NCT04940481) June 17, 2021, and OSF Registries (https://doi.org/10.17605/OSF.IO/PGEHU) June 24, 2021, prior to participant enrollment.

The role of intermediaries in connecting community-dwelling adults to local physical activity and exercise: A scoping review protocol

Introduction: Physical inactivity is a major global issue affecting health. Promoting, supporting and encouraging physical activity amongst community-dwelling adults is essential. An intermediary is a clinical or non-clinical professional based in primary care, community or voluntary settings. They support individuals referred to them to connect with appropriate community services with the goal of improving health and wellbeing. This may be a promising method to establish a connection to local physical activity and exercise; however the process has been poorly described to date. Objective: The objectives of this scoping review will be to identify and summarise the literature describing the process of connecting community-dwelling adults to an intermediary,the characteristics of these adults,the processes (role, practice and procedure) of an intermediary in connecting these adults to local physical activity and exercise opportunities, and to map these processes of connection to outcomes. Methods: This scoping review will be conducted in accordance with the scoping review methodology of the Joanna Briggs Institute. A comprehensive search strategy will identify relevant studies in Embase, Medline, Web of Science and CINAHL, along with a structured grey literature search. Studies which describe an intermediary connecting community-dwelling adults (aged ≥18 years) to local physical activity and exercise will be included. Data will be charted and narratively summarised. Intermediary processes will be mapped to outcomes related to physical activity, and the PAGER (patterns, advances, gaps, evidence for practice and research recommendations) framework will be used to identify evidence gaps and research recommendations. Conclusions: This scoping review will be the first to describe the process of an intermediary connecting community dwelling adults to local physical activity and exercise. This review will identify, map and summarise the existing research on the processes and outcomes. The results will also identify any evidence gaps and will guide future research.

Asymmetry of max grip force and max rate of grip force development among adolescents with and without intellectual disability

The human body seems symmetrical but functional asymmetry can be observed for many tasks. One of the tasks observed the functional asymmetry is grip force and rate of grip force development (RGFD). To efficiently accomplish many tasks, it is important to measure those parameters in different ages and special groups. Thus, the purpose of the study was to test asymmetry of max grip force and max RGFD among adolescents with and without intellectual disability. 41 adolescents with (IQ between 50 and 70) and 41 adolescents without intellectual disability voluntarily participated to the study. Max grip force and max RGFD was measured using a force transducer with custom-made software. The statistical analysis displayed that adolescents without intellectual disability had higher max grip force and max RGFD with their both hands compared to adolescent with intellectual disability. Interestingly, whereas adolescent without intellectual disability displayed an asymmetry between the hands both for max grip force and max RGFD, adolescents with intellectual disability had asymmetry only for max grip force but not for max RGFD. Thus, adolescents with intellectual disability may have symmetrical neurological pathways. Individuals with intellectual disability should be provided with more physical activity and/or exercise opportunities including the bimanual movements with fast and ballistic actions.

“… Exercise opportunities became very important”: Scottish older adults’ changes in physical activity during Covid19’

BackgroundThe purpose of this study was to explore perceived changes in physical activity (PA) due to Covid19 stay-at-home and social distancing guidance among older adults.MethodsParticipants (n = 1429, 77% female, 84% ≥60 years) living in Scotland completed an online survey in Summer 2020 measuring PA and wellbeing (indexed through loneliness, and health-related quality of life). The survey included open- and closed-ended questions about how these variables changed in response to Covid19 social distancing and ‘shielding’ guidelines.ResultsFrom the International Physical Activity Questionnaire (IPAQ), the majority reported high volumes of PA, indicative of being ‘moderately’ or ‘highly’ active. When asked specifically about strength training, 12% reported engagement on ≥2d/wk. Most participants reported that PA had changed during this time, citing reduced use of exercise facilities, increased active travel, and online PA classes; although only 16% reported engaging in PA online.ConclusionsHigher levels of PA were found to be associated with better health-related quality of life. Additional efforts should be made to support PA engagement in older adults, including strength training and other tailored approaches to support individual needs.

Physical activity promotion at the local government level among the local community

Physical inactivity is a major public health issue. For the prevention and management of noncommunicable diseases (NCDs), such as cardiovascular disease, type-2 diabetes, and a number of malignancies, regular physical activity is a critical protective factor. Along with helping to maintain a healthy weight and overall wellbeing, physical activity has positive effects on mental health, including the avoidance of cognitive decline and the symptoms of despair and anxiety. Local governments all across the world have responded to this problem by launching population-level projects that give locals access to exercise opportunities. Local governments, through the implementation of their own tasks of health promotion and protection, carry out public health tasks as defined by the Law of 11 September 2015 on Public Health. These tasks include activities in the area of physical activity.&#x0D; The aim of the article was to show the role of local government in promoting physical activity among the local community. The article discusses such issues as WHO recommendations for physical activity as well as activities undertaken by local governments in the area of health promotion in the form of health policy programs and activities carried out in cooperation with NGOs.

The role of intermediaries in connecting community-dwelling adults to local physical activity and exercise: A scoping review protocol

Introduction: Physical inactivity is a major global issue affecting health. Promoting, supporting and encouraging physical activity amongst community-dwelling adults is essential. An intermediary is a clinical or non-clinical professional based in primary care, community or voluntary settings. They support individuals referred to them to connect with appropriate community services with the goal of improving health and wellbeing. This may be a promising method to establish a connection to local physical activity and exercise; however the process has been poorly described to date. Objective: The objectives of this scoping review will be to identify and summarise the literature describing the process of connecting community-dwelling adults to an intermediary, the characteristics of these adults, the processes (role, practice and procedure) of an intermediary in connecting these adults to local physical activity and exercise opportunities, and to map these processes of connection to outcomes. Methods: This scoping review will be conducted in accordance with the scoping review methodology of the Joanna Briggs Institute. A comprehensive search strategy will identify relevant studies in Embase, Medline, Web of Science and CINAHL, along with a structured grey literature search. Studies which describe an intermediary connecting community-dwelling adults (aged ≥18 years) to local physical activity and exercise will be included. Data will be charted and narratively summarised. Intermediary processes will be mapped to outcomes related to physical activity, and the PAGER (patterns, advances, gaps, evidence for practice and research recommendations) framework will be used to identify evidence gaps and research recommendations. Conclusions: This scoping review will be the first to describe the process of an intermediary connecting community dwelling adults to local physical activity and exercise. This review will identify, map and summarise the existing research on the processes and outcomes. The results will also identify any evidence gaps and will guide future research.

HIGH SCHOOL FEMALE STUDENTS’ SATISFACTION DEGREE AFTER PRACTICING SPECIFIC AQUAGYM PROGRAMS AS AN EXTRACURRICULAR ACTIVITY

ABSTRACT. Introduction. The aquatic environment offers numerous exercise opportunities with a focus on achieving sports performance, as well as a number of beneficial effects compared to the terrestrial environment. The biological adaptation to aquagym-specific exercises, supported by the physical properties of the aquatic environment, is the response of the body to physical stimuli leading to ameliorative changes in body functions. The novelty of the activity and the relative ease of this form of physical exercise stimulated and motivated the female participants in an aquagym program carried out in the 1st semester of the school year 2021-2022. Objective. Our statement is supported by the results obtained from carrying out a satisfaction survey which aimed to highlight the impact of aquatic recreational activities, namely aquagym, and the effectiveness of the means selected in the operational programs on motor and functional capacity. Materials and Methods. The study included 37 high school female students, aged 16-17, from “Carol I” National College in Craiova. In order to optimize the students’ motor skills, an aquagym-specific program of exercises was developed and carried out along 12 sessions of 50 minutes each. At the end of the program, an opinion questionnaire was administered addressing high school female students’ degree of satisfaction with the content of aquagym sessions. Results. The application of the questionnaire-based satisfaction survey highlighted the advantages of practicing aquagym ranging from bio-motor benefits, such as the increase in flexibility, balance and muscular strength, to aspects outlining the improvement in some components of quality of life. The result of this survey confirms that the aquagym program was appreciated by the students who became aware of the positive effects obtained. Conclusions. Our students’ participation in aquagym-specific programs revealed the need to improve the educational offer of the school subject Physical Education and to harmonize the contents of the classes with students’ options. The analysis of the survey findings shows that the students rated the recreational content higher than the effects on motor skills and, surprisingly, a very small percentage of the students appreciated the effects on body shaping.

Momentum lost or creating new constellations? Insights from an exercise-at-work project during the COVID-19 pandemic - a mixed methods approach.

Exercise-at-work programmes have been identified as venues to decrease inequalities in physical activity and exercise between socioeconomic groups and to improve employees' health and wellbeing. Drawing on a multiple institutional logics perspective and adopting a mixed-methods approach, this paper investigates how employees, exercise-ambassadors and managers at five Danish workplaces experience Covid-19 induced changes to a 1-year exercise-at-work project, and how these changes impacted upon the workplace. Our results suggest that Covid-19 and the altered format of exercise and delivery polarized employees' opportunities for exercise at work. However, the generally positive experiences of exercise-at-work activities and their influence on social environment and collaboration (identified prior to Covid-19 lockdown) remained among those employees who continued with activities. Self-organized adaptions and models of employee exercise which emerged suggest that community logic endured despite the crisis. We show how Covid-19 induced organizational changes led to interplays between institutional logics, with family and state logics becoming more prominent. Specifically, the exercise-at-work programme changed from an aligned model, with complementary logics and minimal conflict, to a model where logics of profession and corporation became dominant at the expense of community logic (exercise-ambassadors activities), but constrained by a state and a family logic.

Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies

Introduction : Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. Areas covered : This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. Expert opinion : Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.

Urban-rural disparities in childhood obesogenic environments in the United States: Application of differing rural definitions.

Research is needed that identifies environmental resourcedisparities and applies multiple rural definitions. Therefore, this study aims to examine urban-rural differences in food and physical activity(PA) environment resource availability by applying several commonly used rural definitions. We also examine differences in resourceavailability within urban-rural categories that are typically aggregated. Six food environment variables (access to grocery/superstores, farmers' markets, fast food, full-service restaurants, convenience stores, and breastfeeding-friendly facilities) and 4 PA environment variables (access to exercise opportunities and schools, walkability, and violent crimes) were included in the childhood obesogenic environment index (COEI). Total COEI, PA environment, and food environment index scores were generated by calculating the average percentile for related variables. US Department of Agriculture Urban Influence Codes, Office of Management and Budget codes, Rural-Urban Continuum Codes, Census Bureau Population Estimates for percent rural, and Rural Urban Commuting Area Codes were used. One-way ANOVA was used to detect urban-rural differences. The greatest urban-rural disparities in COEI (F=310.2, P<.0001) and PA environment (F=562.5, P<.0001) were seen using RUCC codes. For food environments, the greatest urban-rural disparities were seen using Census Bureau percent rural categories (food: F=24.9, P<.0001). Comparing remote rural categories, differences were seen for food environments (F=3.1, P=.0270) and PA environments (F=10.2, P<.0001). Comparing metro-adjacent rural categories, differences were seen for PA environment (F=4.7, P=.0090). Findings inform future research on urban and rural environments by outlining major differences between urban-rural classifications in identifying disparities in access to health-promotingresources.

Transforming Motivation for Exercise in a Safe and Kind Environment-A Qualitative Study of Experiences among Individuals with Type 2 Diabetes.

Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49–88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme ‘The transformation of motivation when exercising in a safe and kind environment’ links the themes together, resembling the participants’ development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.