Health-promoting Physical Activity Research Articles

Rethinking the Vulnerability of Groups Targeted in Health-Promoting Sports and Physical Activity Programs

Vulnerability and related terms are increasingly used to describe the target groups of health-promoting programs involving sports and physical activity. Yet, such terms are often left undefined, creating an image of vulnerability that reinforces the health inequities the programs seek to counter. This article aims to reconceptualize vulnerability to help researchers and program personnel describe and support individuals and groups in vulnerable positions. To do so, we conceptualize vulnerability as a contentious phenomenon, emphasizing the spectrum between individual and community perspectives on vulnerability, along with between experts’ evaluation of (health) risks and lived vulnerability. We illustrate the utility of this elaborate conceptualization of vulnerability through a single case study of a walking program organized by a health promotion unit in a so-called deprived area in Denmark. Interviewing the health professionals, it was not surprising to identify that experts’ evaluations of risks are key to the program. However, employing the conceptual framework in its entirety, we also find indications of lived vulnerability and resistance towards their conditions among the program participants. We conclude that it is relevant for both researchers and program employees to consider the complete spectrum of risks and lived vulnerabilities, along with providing support not only to individuals in need but also to their communities.

Workplace Health Promotion Programs Targeting Smoking, Nutrition, Physical Activity, and Obesity in Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The workplace has been highlighted as a potential setting to deliver health promotion programs to target modifiable health behaviors that contribute to chronic disease. This review evaluated the effectiveness of interventions implemented within the workplace that targeted either smoking, nutrition, alcohol, physical activity, and/or overweight and obesity in men. A review protocol was prospectively registered through PROSPERO (CRD42021293398). Five electronic bibliographic databases were searched for randomized controlled trials conducted in the workplace assessing chronic disease risk factors in men from January 2010 to August 2021. Eleven studies were included, reporting on overweight and obesity n = 8, physical activity n = 7, nutrition n = 4, alcohol n = 3, smoking n = 3, with eight studies assessing multiple outcomes. Results were mixed. Narrative synthesis highlighted studies reporting improvements to snacking frequency, sugar sweetened beverage consumption, and physical activity (METs and Vo2 max). Meta-analysis highlighted pooled mean decrease in body weight of -0.28 kg up to 3 months; -1.38 kg for >3 months, and pooled mean decrease in body mass index 0.06 kg/m2 up to 3 months; -0.27 kg/m2 for >3 months. Despite the encouraging direction of the relationship, results were not statistically significant (p > .05). Findings underscore the potential of workplace health promotion programs targeting certain chronic disease risk factors in men; however, future research should consider long-term study designs to assess the efficacy of workplace health programs as a solution to the growing burden of global disease.

The World Health Organization, physical activity and the contradictions of neoliberal health promotion

ABSTRACT This article constitutes the first holistic exploration of how neoliberalism permeates and manifests in Physical Activity Health Promotion (PAHP). It synthesises a critical analysis of neoliberalism with the sociological concepts of medicalisation and healthism and draws on three distinct phases and methods of data collection, to more adequately understand the development, prominence and largely uncritical acceptance of this domain of global public health. Specifically, it demonstrates how the World Health Organization’s (WHO) initial promotion of PAHP coincided with the organisation’s strategic re-alignment with neoliberal principles within a changing geopolitical landscape. Then, deploying a critical discourse analysis of the recent and globally significant WHO (2020) Guidelines on Physical Activity and Sedentary Behaviour, it shows how the underlying logics of neoliberalism continue to inform not only the intended policy goals but the inclusion and exclusion of certain types of evidence used to justify and evaluate policy. Subsequently, drawing on qualitative interview data and time-series survey data the article details how neoliberalism fosters the ideology of healthism, how this promotes forms of exercise which diverge from health maximising behaviours, and how this extends differences in physical activity uptake across the population, and therefore embeds the health inequalities PAHP is explicitly claimed to address. Outlining why PAHP, in particular, holds appeal for the WHO, we conclude that neoliberalism has both enabled the rapid development and broad political acceptance of PAHP, but concomitantly leads to outcomes which limit and confound the broader policy goals.

Physical Activity for Health Promotion and Disease Prevention in Africa and Cameroon: A Call to Action.

Physical Activity for Health Promotion and Disease Prevention in Africa and Cameroon: A Call to Action.

Physical Activity Intensity Measurement and Health: State of the Art and Future Directions for Scientific Research.

Physical activity guidelines for health recommend any type of unstructured physical activity for health promotion. Adults should perform at least 150-300 min per week of moderate intensity or 75-150 min per week of vigorous intensity activities, or an equivalent combination of the two intensities. However, the relationship between physical activity intensity and longevity remains a debated topic, with conflicting perspectives offered by epidemiologists, clinical exercise physiologists or anthropologists. This paper addresses the current known role of physical activity intensity (in particular vigorous versus moderate intensity) on mortality and the existing problems of measurement. Given the diversity of existing proposals to categorize physical activity intensity, we call for a common methodology. Device-based physical activity measurements (e.g., wrist accelerometers) have been proposed as a valid method to measure physical activity intensity. An appraisal of the results reported in the literature, however, highlights that wrist accelerometers have not yet demonstrated sufficient criterion validity when they are compared to indirect calorimetry. Novel biosensors and wrist accelerometers will help us understand how different metrics of physical activity relates to human health, however, all these technologies are not enough mature to provide personalized applications for healthcare or sports performance.

Feasibility and Acceptability of Chatbots for Nutrition and Physical Activity Health Promotion Among Adolescents: Systematic Scoping Review With Adolescent Consultation.

Reducing lifestyle risk behaviors among adolescents depends on access to age-appropriate health promotion information. Chatbots-computer programs designed to simulate conversations with human users-have the potential to deliver health information to adolescents to improve their lifestyle behaviors and support behavior change, but research on the feasibility and acceptability of chatbots in the adolescent population is unknown. This systematic scoping review aims to evaluate the feasibility and acceptability of chatbots in nutrition and physical activity interventions among adolescents. A secondary aim is to consult adolescents to identify features of chatbots that are acceptable and feasible. We searched 6 electronic databases from March to April 2022 (MEDLINE, Embase, Joanna Briggs Institute, the Cumulative Index to Nursing and Allied Health, the Association for Computing Machinery library, and the IT database Institute of Electrical and Electronics Engineers). Peer-reviewed studies were included that were conducted in the adolescent population (10-19 years old) without any chronic disease, except obesity or type 2 diabetes, and assessed chatbots used nutrition or physical activity interventions or both that encouraged individuals to meet dietary or physical activity guidelines and support positive behavior change. Studies were screened by 2 independent reviewers, with any queries resolved by a third reviewer. Data were extracted into tables and collated in a narrative summary. Gray literature searches were also undertaken. Results of the scoping review were presented to a diverse youth advisory group (N=16, 13-18 years old) to gain insights into this topic beyond what is published in the literature. The search identified 5558 papers, with 5 (0.1%) studies describing 5 chatbots meeting the inclusion criteria. The 5 chatbots were supported by mobile apps using a combination of the following features: personalized feedback, conversational agents, gamification, and monitoring of behavior change. Of the 5 studies, 2 (40.0%) studies focused on nutrition, 2 (40.0%) studies focused on physical activity, and 1 (20.0%) focused on both nutrition and physical activity. Feasibility and acceptability varied across the 5 studies, with usage rates above 50% in 3 (60.0%) studies. In addition, 3 (60.0%) studies reported health-related outcomes, with only 1 (20.0%) study showing promising effects of the intervention. Adolescents presented novel concerns around the use of chatbots in nutrition and physical activity interventions, including ethical concerns and the use of false or misleading information. Limited research is available on chatbots in adolescent nutrition and physical activity interventions, finding insufficient evidence on the acceptability and feasibility of chatbots in the adolescent population. Similarly, adolescent consultation identified issues in the design features that have not been mentioned in the published literature. Therefore, chatbot codesign with adolescents may help ensure that such technology is feasible and acceptable to an adolescent population.

Clustering of physical activity, sedentary behavior, and diet associated with social isolation among brazilian adolescents

BackgoundAlthough obesogenic behaviors have been found to be related to social isolation, evidence-based person-centered approaches are lacking. This study investigated the association between clusters of obesogenic behavior – derived from a data-driven process – and social isolation among Brazilian adolescents.MethodsData from the National Adolescent School-based Health Survey (PeNSE) 2015 were analyzed. A total of 100,794 9th-grade students (51.3% females; 14.3 ± 0.1 years old) enrolled in 3,040 public and private high schools participated in the study. Social isolation was assessed by two outcomes (i.e., perceived loneliness and lack of close friends). A two-step cluster analysis was conducted to identify patterns of obesogenic behaviors with the input of leisure-time physical activity (PA), sitting time as a proxy of sedentary behavior (SB), and the weekly consumption of healthy and unhealthy food. Crude and adjusted binary logistic regression models were applied to evaluate the associations between the clusters of obesogenic behaviors and social isolation variables in adolescents. ResultsThree clusters were identified. Adolescents in the “Health-promoting SB and diet” (32.6%; OR = 0.69; 95% CI = 0.62–0.76) and “Health-promoting PA and diet” (44.9%; OR = 0.73; 95% CI = 0.67–0.79) clusters had lower odds of loneliness compared to those in the “Health-risk” cluster (22.5%). Those belonging to the “Health-promoting PA and diet” cluster were more likely to report having close friends (OR = 1.19; 95% CI = 1.00–1.41) than those in the “Health-risk” cluster.ConclusionAdolescents in clusters where positive behaviors outweighed negative ones were less likely to perceive themselves as lonely and without close connections.

Individual physical activity, neighbourhood active living environment and mental illness hospitalisation among adults with cardiometabolic disease: a Canadian population-based cohort analysis

ObjectivesThis population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition.Design and settingData...

Effectiveness of Comprehensive Physical Activity Health Promotion Program on the Essential Physical Functions of Older Patients With Multiple Diseases and Dementia in Rural Area.

Against the backdrop of aging populations worldwide, physical activity programs aimed at promoting the health of older adults have begun to flourish. However, few studies have focused on elderly residents in rural areas who may have multiple comorbidities. Therefore, the current study aimed to investigate the effects of a 12-week physical activity program on health promotion among rural elderly with multiple diseases. The study included 18 elderly participants, with a mean age of 82.39 years, who had dementia and one or more additional diseases. Among the participants, 89% were female. The results showed that the 12-week physical activity program intervention significantly improved participants' walking speed and range of motion of the arm joints. Based on these findings, it is hoped that this study will provide a reference for future researchers and practitioners targeting rural or elderly populations who may have multiple diseases to develop more comprehensive physical activity programs.

When Moving Is the Only Option: The Role of Necessity Versus Choice for Understanding and Promoting Physical Activity in Low- and Middle-Income Countries.

Given its origins in high-income countries, the field of physical activity and public health research and promotion has broadly followed a choice-based model. However, a substantial amount of the physical activity occurring routinely in many settings, particularly in low- and middle-income countries (LMICs), is the result of economic necessity and is not due to true, free choices. We propose the "necessity- versus choice-based physical activity models" framework as a conceptual tool to ground physical activity and public health research and promotion efforts in LMICs, helping ensurethat these efforts are relevant, ethical, responsive, and respectful to local contexts. Identifying ways to ensure that LMIC populations can maintain high levels of active transport while increasing opportunities for active leisure must be prioritized. To promote equity, physical activity research, programs, and policies in LMICs must focus on improving the conditions under which necessity-driven physical activity occurs for a vast majority of the population.

Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial

BackgroundIn view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only.MethodsA pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data.ResultsThirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention.ConclusionFindings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention.Trial registrationThis study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.

Results from Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth: A call to address inequities in health-promoting activities

Background/ObjectiveThis article reports the methods and findings for Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth indicators, and on inequities within these indicators. MethodsGrades were assigned to indicators using the Active Healthy Kids Global Alliance criteria depending on data availability, and inequities reported based on gender, ethnicity, disability status, area-level socioeconomic deprivation, urbanicity, and school year. Two additional indicators were included in this report card: Sleep, and Physical literacy. ResultsGrades were assigned to indicators as follows: Overall physical activity: C+, Organised sport and physical activity: B-, Physical literacy: B, Active transportation: D, Sedentary behaviours: C-, Sleep: B+, Whānau (family) and peers: D, School: C+, Government: A. Inequities across all socio-demographic variables were observed. An ‘inconclusive’ grade was assigned to the Active play, Physical fitness, and Community and Environment indicators due to insufficient data. ConclusionIt is imperative that targeted, comprehensive, and population-specific approaches are implemented to support health-promoting physical activity behaviours and reduce inequities among children and youth in Aotearoa. There is a need to promote all dimensions of physical activity (overall activity, active play, recreation, organised sport, active transportation) and the reduction of screen time through policy, research, evidence-based social marketing campaigns, and urban design. Regular, nationally representative surveys that enable the consistent and regular measurement of key Report Card indicators are needed.

Ballet after breast cancer: investigating the feasibility and acceptability of a novel 16-week classical ballet intervention for breast cancer survivors

PurposeThe “Ballet after breast cancer” study sought to investigate the feasibility and acceptability of a 16-week classical ballet intervention for breast cancer survivors, delivered face-to-face and/or online.MethodsBreast cancer survivors were recruited to take part in 2 × 1-h ballet classes per week for 16 weeks. Primary outcomes of feasibility and acceptability were assessed according to rates of enrolment and attendance and participant feedback via questionnaire. Secondary outcomes included quality of life (QOL), upper-body disability, shoulder range of motion (ROM), muscular strength, aerobic capacity, and physical activity levels. Associations between rate of attendance and changes in secondary measures were explored.ResultsThirty-one participants (62% of eligible individuals) enrolled in the program. Twenty-nine women commenced the intervention [53.3 ± 10.8 years (Mean ± SD)], attending 77.6% [67.6, 87.5] (Mean [95% CI]) of sessions. Based on these rates of enrolment and attendance, and participant feedback, the program was deemed feasible and acceptable to participants. Significant improvements in shoulder ROM and reductions in sedentary behaviour were achieved. Participants also reported improvements in physical capacity and psychological, social, and cognitive wellbeing.ConclusionsThe “Ballet after breast cancer” program, delivered face-to-face and/or online, was feasible and acceptable to breast cancer survivors. Improvements in shoulder ROM achieved doing ballet were pertinent given the adverse effects of upper-body morbidity on breast cancer survivor QOL. Improvements in physical activity behaviour and perceived benefits to wellbeing also support the use of ballet to mitigate QOL impairment after treatment.Implications for cancer survivorsThe physical demands and the fun, creative, and social characteristics of ballet promote improvement across multiple domains of health and wellbeing. Ballet shows promise as an activity to improve QOL and increase long-term engagement in health-promoting physical activity after breast cancer.

Healthy weight, health behaviours and quality of life among Aboriginal children living in regional Victoria

ObjectiveTo report the prevalence of healthy weight and related behaviours among Victorian Aboriginal and non‐Aboriginal children and explore associations between these factors and health‐related quality of life (HRQoL). MethodsAnalysis of cross‐sectional data from two cluster randomised controlled trials using logistic and linear mixed models. The sample included Aboriginal (n=303) and non‐Aboriginal (n=3,026) children aged 8–13 years. ResultsMore than two‐thirds of Aboriginal children met guidelines for fruit (75.9%), sweetened drinks (66.7%), sleep (73.1%), screen time (67.7%) and objectively measured physical activity (83.6%); and 79.1% reported consuming take‐away foods less than once per week. Aboriginal children were more likely to meet vegetable consumption guidelines (OR=1.42, 95%CI: 1.05, 1.93), but less likely to have a healthy weight (OR=0.66, 95%CI: 0.52, 0.85) than non‐Aboriginal children. Mean HRQoL scores were significantly higher among non‐Aboriginal children and both Aboriginal and non‐Aboriginal children meeting health guidelines. ConclusionsMost Aboriginal children in this study met guidelines for fruit, physical activity, screen time and sleep, and those meeting these guidelines had significantly higher HRQoL. Implications for public healthPromoting nutrition, physical activity and sleep is likely to benefit all children. Aboriginal community‐controlled organisations can use these data to design culturally‐specific programs that may improve disparities in healthy weight and HRQoL.

Health-promoting and health-constraining environmental features and physical activity and sedentary behaviour in adolescence: a geospatial cross-sectional study.

The environment may be an important influence on adolescent behaviour. We combined accelerometry and global positioning system data to investigate how the environment was related to physical activity and sedentary behaviour. Adolescents spent most of their time in very close proximity to a range of both health-promoting and health-constraining features. Several associations were detected between time spent in areas with the greatest access to health-promoting features and reduced sedentary time and less travel time by motor vehicle. The environment may contribute to the variation in adolescent activity behaviour.

Moving from physical literacy to co-existing physical literacies: What is the problem?

This paper explores how various ideological positions or ‘cosmoses’ associated with physical literacy (PL) have come to be and, in doing so, extends scholarship by examining and presenting PL as a multiplicity of physical literacies. Drawing on Stengers’ notion of ‘cosmopolitics’ and Venturini's ‘cartography of controversies’ method, 167 scholarly articles and 23 non-scholarly texts were analysed to observe and describe how PL has been framed over time as a result of dynamic political factors. Findings reveal that three ‘waves’ of PL cosmoses have unfolded over time (PL as health-promoting physical activity, PL as motor competence and PL as phenomenological embodiment). Whilst all three seek to promote engagement in physical activity and have loose ties to ‘health’, each PL cosmos is bound by different objectives, actors and obligations and is orientated towards solving a different problem. Rather than continued confusion and controversy, we propose that PL be understood as a multiverse wherein the three different PL cosmoses are held apart as physical literacies that play co-existing roles based on the problem that each cosmos is trying to solve. While understanding PL as a multiverse is not a solution to the controversy and uncertainty surrounding PL, it provides those who are interested in or tasked with enacting PL an opportunity to become aware of and understand what the different PL cosmoses or physical literacies constitute and thus make possible (or not) on the basis of their ontological differences.

Replacing Sedentary Time with Physically Active Behaviour Predicts Improved Body Composition and Metabolic Health Outcomes.

Background: Discretionary leisure time for health-promoting physical activity (PA) is limited. This study aimed to predict body composition and metabolic health marker changes from PA reallocation using isotemporal substitution analysis. Methods: Healthy New Zealand women (n = 175; 16–45 y) with high BMI (≥25 kg/m2) and high body fat percentage (≥30%) were divided into three groups by ethnicity (Māori n = 37, Pacific n = 54, and New Zealand European n = 84). PA, fat mass, lean mass, and metabolic health were assessed. Isotemporal substitution paradigms reallocated 30 min/day of sedentary behaviour to varying PA intensities. Results: Reallocating sedentary behaviour with moderate intensity, PA predicted Māori women would have improved body fat% (14.83%), android fat% (10.74%), and insulin levels (55.27%) while the model predicted Pacific women would have improved waist-to-hip (6.40%) and android-to-gynoid (19.48%) ratios. Replacing sedentary time with moderate-vigorous PA predicted Māori women to have improved BMI (15.33%), waist circumference (9.98%), body fat% (16.16%), android fat% (12.54%), gynoid fat% (10.04%), insulin (55.58%), and leptin (43.86%) levels; for Pacific women, improvement of waist-to-hip-ratio (5.30%) was predicted. Conclusions: Sedentary behaviour must be substituted with PA of at least moderate intensity to reap benefits. Māori women received the greatest benefits when reallocating PA. PA recommendations to improve health should reflect the needs and current activity levels of specific populations.

Analysis of the Texts Framing the practice of Health-Promoting Physical Activities in Burkina Faso

Physical inactivity and sedentary lifestyle are recognized as risk factors for non-communicable diseases and avoidable mortality. It is in this context that the promotion of physical activity and sport has become a real public health issue and is included in most medical recommendations of learned societies. Multiple determinants affect the adoption of a physically active lifestyle. This situation has led to the development, implementation and coordination of public policy documents that promote the practice of health-promoting physical activities. In this context, the World Health Organization (WHO) has developed the Health Enhancing Physical Activity Policy Analisis Tool (HEPA PAT) to support countries in developing and evaluating strategies and policies that address all the determinants of health-enhancing physical activity. Burkina Faso, like other countries in the world, is confronted with the problem of physical inactivity with its corollaries on health. In order to find palliative solutions to this scourge, the government, through the ministry in charge of sports and leisure, has developed texts to stimulate the practice of physical activities and sports. The objective of this study is to evaluate the policies governing the practice of physical activities and sports in Burkina Faso. To this end, the HEPA PAT tool was used as an analysis model. It was found that the policies governing the practice of physical activity and sport contain only eight of the 17 criteria required to create an appropriate context for the development of health-promoting physical activity and sport. Therefore, it is necessary for the government of Burkina Faso to integrate the nine other criteria without which the expected results cannot be achieved.

The Role of Personality Traits and Lifestyle in Predicting Anxiety and Depression During the Covid-19 Pandemic: A Web-Based Cross-Sectional Study

Background: Social gathering restrictions and quarantine for reducing the spread of coronavirus can reduce social interactions and cause mental health problems such as depression and anxiety. Objective This study aims to investigate the role of personality traits and health-promoting lifestyles in predicting anxiety and depression during the COVID-19 pandemic in Najafabad, Iran Methods: This is a cross-sectional study conducted in April 2021 during the fourth wave of the COVID-19 outbreak. The study population consisted of people aged >18 years old living in Najafabad. Using a convenience sampling method, 225 people were selected and completed questionaries online. Of these, the data of 217 questionnaires were analyzed. Beck Depression Inventory, Corona Disease Anxiety Scale, short form of Big-Five-Factor Inventory, and Walker’s Health Promoting Lifestyle Profile were used to collect data. Data analysis was performed using Multiple Linear Regression and SPSS v. 24 statistical software. Results: The personality traits of neuroticism (r=0.343, r=0.176) and extraversion (r=-0.503, r=-0.375) were positively and negatively correlated with depression and anxiety, respectively, and were the predictive of depression and anxiety (P<0.05). The agreeableness trait (r=0.233) was also negatively correlated with anxiety, and was its significant predictor (P<0.05). Among the health-promoting lifestyle domains, self-fulfillment (r=-0.489) and physical activity (r=-0.348) had a negative correlation with depression, while health responsibility (r=-0.285) had a negative correlation with anxiety; they were the significant predictors of depression and anxiety (P<0.05) during the COVID-19 pandemic. Conclusion: Given the effect of personality traits and health-promoting lifestyles on depression and anxiety during the COVID-19 outbreak, the interventions focused on these components can be effective in improving the mental health of people.

Free-to-use cycle provision schemes have potential to encourage cycling and reduce inequalities

IntroductionCycling is an accessible, cheap way of incorporating health-promoting physical activity into everyday routines. One approach to facilitate engagement is to provide cycles through population-level approaches, such as commercial bike share schemes. However, these may increase health inequalities. An alternative is delivering cycle provision through not-for-profit and targeted schemes. However, there is a lack of peer-reviewed evidence on what comprises successful design and implementation. MethodsAn evaluation of two not-for-profit cycle provision schemes in Norfolk, England, is conducted: The Cycle Loan Scheme (CLS) aimed at the general population, and Welcome Wheels (WW) for refugees/asylum seekers. Quantitative measures assess the extent to which the schemes recruited and engaged groups of need (non-cyclists, women, over 55 years-of-age, living in deprived areas, not White British). Baseline and follow-up surveys established cycling frequency (absolute and change), and motivators, benefits, and barriers to taking part. Responses were compared across groups of need. ResultsAt baseline, 87% of the 613 CLS participants were from a group of need, whilst 100% of WW participants (n = 214) were. At follow-up, CLS participants (n = 413) reported cycling a median of 5.5 h a week (15 reported zero hours), an increase of 3.5 h from baseline. Non-cyclists were less likely to engage than cyclists. WW participants (n = 65) cycled a median five days per week at follow-up (all reported some cycling), an increase for 92%. Females were less likely to engage than males; all non-cyclists increased their cycling compared to 44% existing cyclists. Benefits of and barriers to engagement varied according to group of need. ConclusionsCycle provision schemes have potential to reduce health inequalities by encouraging cycling, particularly when tailored to need and local context, and when interventions are delivered by non-profit, community embedded organisations. ApplicationA novel intervention framework is proposed to guide targeted interventions.