Implications For Public Health Initiatives Research Articles

An in-depth investigation correlating lifestyle choices with cognitive well-being: Public health implications of food packaging trends and memory capacity, an intensive research study

This study presents a multifaceted investigation into the interplay between lifestyle choices, cognitive well-being, and potential health risks associated with food packaging materials. Statistical analyses of memory patterns among diverse population groups, including healthy volunteers, addicted individuals, and those consuming roadside food from street vendors or hawkers, reveal intriguing correlations. The study also conducts a rigorous chemical analysis of newspaper packaging, uncovering significant concerns related to lead contamination. The findings emphasise the need for heightened awareness, further research, and interventions to address potential health risks and ensure the safety of packaging materials. Overall, this research contributes valuable, insightful information that has implications for public health initiatives and packaging industry practices. This is a qualitative study correlating lifestyle choices with cognitive well-being and specific food packaging that impacts the memory and health too. Key findings reveal intriguing correlations between lifestyle habits, the type of food packaging used, and memory capacity. The study’s chemical analysis of newspaper packaging uncovered significant lead contamination, raising serious public health concerns. These findings emphasise the necessity for heightened awareness and targeted interventions to mitigate health risks.

Environmental exposure and element-by-element analysis of pandemic waves at the city level: Exposome algorithm for analysis of short-term temperature drops on surges in COVID-19-associated hospitalizations

Amid the COVID-19 pandemic, it is crucial to understand the complex network of factors that contribute to its pathogenesis and epidemiology in order to be able to prevent, predict, and minimize the consequences of the burden on urban services, particularly the critical surge in hospitalized patients.Based on a hypothesis of compromised airway epithelium, the principle of wave superposition, and mechanistic and causal interface approaches, this study aims to design a concept of element-by-element analysis of pandemic waves to isolate and analyze the impact of short-term drops in ambient temperature (as one important factor) on the spikes in hospitalizations due to the exacerbation of the disease course in SARS-CoV-2 infected individuals during the Omicron-associated wave.A new concept and analysis algorithm were proposed and tested. Results showed that every short-term drop in daily temperature of more than 3 °C led to an increase in the number of hospitalizations due to a worsening of disease progression in infected individuals with a 1–3 day lag. The analysis also revealed an influence with a 7.6-day lag, which may indicate an incubation period in patients at risk, such as the elderly and patients with comorbidities.The findings have implications for public health initiatives and urban planning to prevent overwhelming the healthcare system. Further research is recommended.

The Value of Genetic Data in Predicting Preferences: A Study of Food Taste

The exponential expansion of consumer genetic testing has led to an accumulation of massive genomic data sets owned by governments and firms. The prospect of leveraging genetic data for enhancing consumers' health, well-being, and satisfaction through improved personalization, segmentation, and targeting is promising. Nonetheless, this potential has not been studied empirically to date, and it is unknown whether and when firms should invest resources into incorporating genetic data into strategies and processes. The authors address this gap in a study of taste preferences, important drivers of food and beverage consumption. Using a large U.K.-based sample, they find that with sample sizes currently available, genetic data are expected to significantly improve prediction of taste preferences above traditionally used metrics such as demographics, behavioral variables, and even past consumption, especially for tastes that are uncommon in the local diet (e.g., spicy, sour), as they are less expressed behaviorally. The authors conclude that genetic data show immense promise for prediction-based applications when other data sources are limited or uninformative. These findings could have significant implications for public health initiatives, potentially aiding development of personalized nutrition plans and dietary interventions.

Prospective observational study on clinical profile of congenital anomalies of kidney and urinary tract (CAKUT) in children in central India: A study protocol

Background Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of structural abnormalities affecting these vital organs, frequently leading to chronic kidney disease in children. This study aims to comprehensively understand the clinical profile of CAKUT in children in Central India, an area with unique socio-demographic characteristics and limited prior research on this topic. Methods A prospective observational study will be conducted over three years in the pediatric department of AVBRH, a tertiary healthcare center in Central India. Data were collected through interviews with parents or guardians of children up to 18 admitted to the hospital. Clinical symptoms, prenatal history, physical examinations, and diagnostic investigations were meticulously documented. Expected outcome The study is expected to reveal the prevalence and clinical profile of CAKUT in Central Indian children. Anticipated outcomes include insights into anomalies, clinical symptoms, and potential correlations with factors like prenatal care and consanguineous marriages. Diagnostic investigations will help assess the severity of renal impairment. The results may also uncover regional variations and have implications for public health initiatives aimed at early intervention and improved patient care. However, these are preliminary expectations that are subject to confirmation through the completion of the study.

Composite dietary antioxidant index associated with delayed biological aging: a population-based study.

The objective of this study was to explore the potential correlation between the composite dietary antioxidant index (CDAI) and biological aging, addressing the insufficient epidemiological evidence in this area. Participants meeting eligibility criteria were selected from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2001 and 2018. CDAI was determined based on dietary antioxidants obtained from 24-hour dietary recalls. Biological age was determined using PhenoAge algorithms incorporating various clinical features. Weighted multiple models were employed to investigate and assess the association between CDAI and biological age. Analysis of the CDAI quartile revealed disparities in terms of age, gender, ethnicity, educational level, marital status, poverty, dietary calories intakes, smoking, drinking status, BMI, physical activity, and PhenoAge. After adjusting for potential confounding factors, a significant inverse relationship was found between CDAI and Phenotypic Age, with each standard deviation increase in CDAI score correlating with a 0.18-year decrease in Phenotypic Age. These negative correlations between CDAI and PhenoAge advancement were observed regardless of age, gender, physical activity status, smoking status, and body mass index. Our findings demonstrate a positive relationship between higher CDAI scores and delayed biological aging. These results have significant implications for public health initiatives aimed at promoting healthy aging through dietary interventions.

Modeling and Optimizing Multi-Faceted Strategies for HPV Control: Insights from a Nonlinear Mathematical Approach

This study presents a nonlinear deterministic mathematical model of Human Papillomavirus (HPV) dynamics, emphasizing qualitative analysis through the stability theory of differential equations. Our investigation focuses on validating the existence and stability of disease-free and endemic equilibrium points using the basic reproduction number governing HPV transmission. Notably, the model exhibits a backward bifurcation, prompting a sensitivity analysis. We address the challenge of HPV control by formulating an optimal control problem, applying the Pontryagin maximum principle with three distinct strategies: prevention, treatment, and screening. Numerical simulations reveal that a combined approach involving prevention, screening, and treatment emerges as the most effective strategy for eradicating HPV within the community. In conclusion, this study offers a comprehensive mathematical model for HPV dynamics and underscores the importance of multi-faceted intervention strategies. Our findings have significant implications for public health initiatives aiming to combat HPV infections and reduce their impact on communities.

The association of von willebrand factor and its cleaving protease (ADAMTS13) with health behaviours in young black and white adults: the African-PREDICT study

To reduce cardiovascular risks imposed by Von Willebrand factor (vWF) and ADAMTS13 from young ages, knowledge on health behaviours that may affect their concentrations is essential. We therefore determined whether circulating vWF antigen and ADAMTS13 associate with health behaviours. We included 1196 black and white healthy adults aged 20-30 years and used questionnaires for socio-economic, tobacco and alcohol use data. vWF:Ag was measured from citrated samples and ADAMTS13, cotinine and gamma-glutamyl transferase (GGT) from serum. Salt intake was estimated from 24-hour urine and body mass index (BMI) was calculated. Black adults had higher vWF:Ag and lower ADAMTS13 levels compared to whites (all p < 0.001). In multiple regression analyses in the total group, vWF:Ag associated positively with BMI (p = 0.037), while ADAMTS13 associated negatively with BMI (p = 0.016) and cotinine (p = 0.029); and positively with GGT (p = 0.002). When exploring within each ethnic group, vWF:Ag associated positively with estimated salt intake (p = 0.043) only in blacks. In whites, vWF:Ag associated positively with BMI (p = 0.023) while ADAMTS13 associated positively with GGT (p = 0.003) and negatively with cotinine (p = 0.041). Young black adults may have an increased thrombotic risk due to higher vWF and lower ADAMTS13. The ethnic-specific associations observed may have implications for public health initiatives to improve cardiovascular outcomes.

Childhood memories of food and eating in lower-income families in the United States: a qualitative study

BackgroundChildhood obesity prevention initiatives emphasize healthy eating within the family. However, family-focused initiatives may not benefit children whose families lack economic and/or social resources for home cooking and shared meals. The aim of this paper is to examine how adults talk about and make sense of childhood memories of food and eating, with particular attention to understandings of family life and socioeconomic conditions.MethodsSemi-structured interviews with 49 adults in 16 families (22 parents and 27 grandparents of young children) were conducted in Oregon, United States. Most participants had experienced socioeconomically disadvantaged childhoods. The interviews were analyzed using thematic analysis, with a focus on the participants’ memories of food provision, preparation, and consumption in their childhood homes.ResultsTwo main themes were developed: (1) “Food and cohesion”, with the subthemes “Care and nurturance” and “Virtue transmission through shared meals”, and (2) “Food and adversity”, with the subthemes “Lack and neglect” and “Restriction and dominance”. The first theme captures idealized notions of food in the family, with participants recounting memories of care, nurturance, and culinary pleasure. The second theme captures how participants’ recollections of neglectful or rigidly restrictive feeding, as well as food discipline tipping over into dominance, upend such idealized images. Notably, the participants alternately identified poverty as a source of lack and as an instigator of creative and caring, if not always nutritionally-ideal, feeding. Thus, they remembered food they deemed unhealthy as a symbol of both neglect and care, depending on the context in which it was provided.ConclusionsChildhood memories of food and eating may express both family cohesion and family adversity, and are deeply affected by experiences of socioeconomic disadvantage. The connection between memories of food the participants deemed unhealthy and memories of care suggests that, in the context of socioeconomic disadvantage, unhealthy feeding and eating may become a form of caregiving, with nutrition considered only one aspect of well-being. This has implications for public health initiatives directed at lower-income families.

Evidence for maternal diet-mediated effects on the offspring microbiome and immunity: implications for public health initiatives.

Diets rich in saturated fats have become a staple globally. 50% of women of childbearing age in the US are obese or overweight, with diet being a significant contributor. There is increasing evidence of the impact of maternal high fat diet on the offspring microbiome. Alterations of the neonatal microbiome have been shown to be associated with multiple morbidities, including the development of necrotizing enterocolitis, atopy, asthma, metabolic dysfunction and hypertension among others. This review provides an overview of the recent studies and mechanisms being examined on how maternal diet can alter the immune response and microbiome in offspring and the implications for directed public health initiatives for women of childbearing age.

Characteristics and Motivations of Consumers of Direct Purchasing Channels and the Perceived Barriers to Alternative Food Purchase: A Cross-Sectional Study in the Ecuadorian Andes

Modern food systems generate social inequalities in the access to healthy food, but some families maintain behaviors that provide an alternative to these systems. Agroecological consumers (ACs) and non-agroecological direct market consumers (DMCs) are key actors in alternative food systems. We assessed the characteristics of ACs and DMCs using data from a representative sample of households in Ibarra, Quito and Riobamba (n = 2914). We also deepened the exploration of motivations for adopting these practices through mini-ethnographies with families who were identified as ACs or DMCs (n = 15). We found motivations related to personal health problems, food quality (e.g., taste, freshness), and safety (e.g., avoiding pesticides) to be key. Other motivations were price and community solidarity with farmers. Barriers included inconvenience, lack of awareness, and insecurity of market location. Using Chi-square tests, we found differences between ACs and DMCs on place of residence, education, employment, health, and diet. Controlling for socioeconomic and health variables using logistic regressions, we found DMC dietary habits to be similar to the remainder of the study population, except that they were less likely to eat processed foods less frequently (adjusted odds ratio (AOR) 0.6, 95% confidence interval 0.4–0.9). In contrast, ACs were more likely than the remainder of the study population to control their salt intake (3.2, 1.9–5.2) and have greater knowledge of nutrition labels (2.8, 1.7–4.6). They were more likely to eat traditional foods frequently (1.9, 1.1–3.3), fruit and vegetables daily (1.6, 1.0–2.8), and processed foods less frequently (2.7, 1.5–4.8). Hence, these two types of alternative food provisioning practices (AC and DMC) were adopted by different types of consumers, with heterogenous motivations and food consumption practices. These findings have implications for public health initiatives aiming to scale up the nutrition and ecological potential of alternative food systems.

Dishonesty during a pandemic: The concealment of COVID-19 information.

Honest disclosures of COVID-19 behaviors and symptoms is critical. A sample of adults on MTurk (N = 451, 20-82 years of age) were asked if they have concealed social distancing practices, COVID-19 symptoms, and quarantine instructions, as well as how they evaluated others' COVID-19 concealment. Those who believed they had contracted COVID-19 engaged in greater rates of concealment and evaluated concealment more positively compared to those without the virus. As age and communal orientation increased, COVID-19 concealment behaviors decreased, and evaluations of this concealment were rated more negatively. Implications for public health initiatives and psychological theory on concealing health information is discussed.

Mothers' food choices and consumption of ultra-processed foods in the Brazilian Amazon: A grounded theory study

In recent decades, an increase in consumption of ultra-processed foods (UPF), a type of product frequently associated with diet-related obesity, chronic diseases, decrease of eating traditions and loss of culinary diversity, has been observed in middle-income countries. However, there is lack of information on factors related to choosing UPF. In this study, we aimed to understand the factors promoting UPF choices and consumption among mothers living in an urban context in the Brazilian Amazon, and to present a conceptual model grounded on their experiences that illustrates the dynamics between the observed factors. For this qualitative study, we used a constructive grounded theory approach, with a theoretical sampling of 40 women, to choose mothers with high and low consumption of ultra-processed foods. Data production and the first steps of analysis were performed concomitantly, followed by four steps of coding focused on creating conceptual categories and explaining the interactions between them. Our findings highlighted the importance of context in promoting UPF choice and consumption, particularly the “food environment”, physical and virtual, and the “sociocultural environment”. These contextual aspects interacted with the two main personal aspects influencing participants' UPF consumption, one concerning practices, “cooking behaviors”, and the other concerning preferences, “food tastes”. Factors such as economic and time constraints were also important and competed to shape eating practices through interactions with participants’ health valorization. Findings are discussed in relation to food choice theories, social roles and the food environment. Implications for public health initiatives include the importance of considering environmental changes, sociocultural and economic influences, the reliance on UPF, and the role of women in the home, when promoting healthy diets.

Lifestyle activities in mid-life contribute to cognitive reserve in late-life, independent of education, occupation, and late-life activities.

This study tested the hypothesis that mid-life intellectual, physical, and social activities contribute to cognitive reserve (CR). Two hundred five individuals (196 with magnetic resonance imaging) aged 66-88 years from the Cambridge Centre for Ageing and Neuroscience (www.cam-can.com) were studied, with cognitive ability and structural brain health measured as fluid IQ and total gray matter volume, respectively. Mid-life activities (MAs) were measured using the Lifetime of Experiences Questionnaire. Multivariable linear regression found that MAs made a unique contribution to late-life cognitive ability independent of education, occupation, and late-life activities. Crucially, MAs moderated the relationship between late-life cognitive ability and brain health, with the cognitive ability of people with higher MA less dependent on their brain structure, consistent with the concept of CR. In conclusion, MAs contribute uniquely to CR. The modifiability of these activities has implications for public health initiatives aimed at dementia prevention.

Association between quantity and duration of snowfall and risk of myocardial infarction.

Although aggregate data suggest a link between snowfall and myocardial infarction (MI), individual risk has yet to be assessed. We evaluated the association between quantity and duration of snowfall and the risk of MI using nonaggregated administrative health data. We used a case-crossover study design to investigate the association between snowfall and hospital admission or death due to MI in the province of Quebec, Canada, between November and April during 1981-2014. The main exposure measures were quantity (in centimetres) and duration (in hours) of snowfall by calendar day. We computed odds ratios (ORs) and 95% confidence intervals (CIs) for the association between daily snowfall and MI, adjusted for minimum daily temperatures. In all, 128 073 individual hospital admissions and 68 155 deaths due to MI were included in the analyses. The likelihood of MI was increased the day after a snowfall among men but not among women. Compared with 0 cm, 20 cm of snowfall was associated with an OR of 1.16 for hospital admission (95% CI 1.11-1.21) and 1.34 for death (95% CI 1.26-1.42) due to MI the following day among men. Corresponding ORs among women were 1.01 (95% CI 0.95-1.07) and 1.04 (95% CI 0.96-1.13). Similar but smaller associations were observed for snowfall duration (0 h v. 24 h) and MI. Both the quantity and duration of snowfall were associated with subsequent risk of hospital admission or death due to MI, driven primarily by an effect in men. These data have implications for public health initiatives in regions with snowstorms.

Stroke Awareness Is Worse among the Old and Poorly Educated: A Population-Based Survey

This article surveys a representative sample of adults to assess their knowledge of stroke, its vascular risk factors and warning symptoms, illness perception, and attitude toward strokes. A representative sample of the region population was selected using a double randomization design. Previously trained medical students carried out face-to-face interviews using a structured questionnaire with open- and closed-ended questions. In all, 2411 subjects were interviewed. Seventy-three percent reported at least 1 correct warning sign of stroke, whereas only 12.2% reported 3. The most frequently mentioned were sudden weakness, dizziness, and headache. Only 59.2% named at least 1 correct risk factor for stroke. Smoking and hypertension were mainly named. Forty percent of the respondents demonstrated adequate knowledge of stroke. Tellingly, prevalence of adequate knowledge was significantly lower in subjects with previous stroke (29.3% [95% confidence interval {CI}, 19.7-40.3], P = .049), hypertension (35.0% [95% CI, 31.1-39.1], P = .009), diabetes (31.9% [95% CI, 25.9-38.3], P = .011), hypercholesterolemia (35.8% [95% CI, 31.8-39.9], P = .03), and obesity (28.2% [95% CI, 23.8-33.0], P < .001). Illness perception was generally correct. In the final logistic regression model, younger age, urban area of residence, higher educational level, higher family income, normal pressure, normal weight, and family history of stroke were associated with adequate knowledge of stroke. Basic knowledge of stroke is insufficient among the general population of Extremadura. There is a discrepancy between theoretical stroke knowledge and illness perception. These findings have implications for public health initiatives for stroke.

Benefits of a worksite or home‐based bench stepping intervention for sedentary middle‐aged adults – a pilot study

The aim of this study was to investigate the benefits of a low-volume, vigorous intensity bench stepping programme in sedentary middle-aged adults. Thirty-one healthy but sedentary adults (12 men; 55-64years) took part in the study. Participants accumulated up to 9min per day of stepping exercise on three days per week over the 4-week experimental period. Parameters of cardiorespiratory fitness, body composition and lower limb muscle strength were measured on three occasions: TS1 (baseline test), TS2 (following a 4-week control period) and TS3 (following the 4-week intervention). Data were analysed using a repeated-measures ANOVA. Adherence to the programme was excellent (96%). Relative to the insignificant changes following the control period, parameters of cardiorespiratory fitness were significantly improved following training. No alterations in body composition or lower limb muscle strength were detected. These results show that less than 30min per week of bench step exercise, accumulated in short bouts throughout the day, can improve parameters of cardiorespiratory fitness after only 4weeks in previously sedentary middle-aged adults. Due to its low-cost, time-efficient and discrete aspects, stepping exercise may have important implications for public health initiatives that promote physical activity in a population who commonly report 'lack of time' as a barrier to physical activity.

Future Intentions Regarding Quitting and Reducing Cigarette Use in a Representative Sample of Canadian Daily Smokers: Implications for Public Health Initiatives

Pre-cessation reduction is associated with quitting smoking. However, many smokers reduce the amount consumed but may not quit altogether. Using a representative sample of adult current daily smokers, this project explored future intentions of smokers regarding cigarette consumption. This information is important because it can provide a framework within which to plan tobacco cessation initiatives. A random digit dialing telephone survey was conducted of 889 Canadian current daily smokers, 18 years and older. The response rate was 65% (of households with a smoker in residence, 65% agreed to participate). Analyses focused on the 825 respondents who smoked at least 10 cigarettes per day at some point in their lives. As part of this survey, respondents were asked their future plans about their smoking (maintain, increase, reduce, quit). Of these 825 respondents, the majority of respondents had plans to change their cigarette use, with 55% planning to quit, 18.8% to reduce and 22.5% to maintain the amount they smoked (3.4% did not know and 2 respondents planned to increase). Most smokers who planned to reduce their smoking saw it as a step towards quitting smoking completely. These results present a picture of smokers, the majority of whom appear to be in some form of transition. Many smokers planned to reduce, of which the overwhelming majority saw their reduction as a step towards quitting. Opportunities exist to capitalize on these intentions to change in efforts to promote tobacco cessation.

Frailty and Mortality Among Chinese at Advanced Ages

This study investigates the factors associated with frailty and the association of frailty with mortality in a national sample of adults aged 65-109 in China. Using the 2002 wave of the Chinese Longitudinal Healthy Longevity Survey, we construct a frailty index (FI) based on 39 measures available in the data set. We use ordinal logistic regressions to examine the factors associated with the FI and use Weibull hazard regression to examine the association between frailty and 3-year mortality from 2002 to 2005. Age, sex, ethnicity, urban-rural residence, economic condition, religious involvement, and daily exercise are significantly associated with levels of frailty. Hazard analyses further reveal that the FI is a robust predictor of mortality at advanced ages and that the relationship between frailty and mortality is independent of various covariates. Discussion The measurement and analysis of frailty have broad implications for public health initiatives designed to target individuals with the diminished capacity to effectively compensate for external stressors and to prevent further declines associated with aging and mortality. A key to healthy longevity is the prevention, postponement, and potential recovery from physical and cognitive deficits at advanced ages through enhanced medical interventions and treatments.

Stroke Awareness in Brazil

Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil. The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home. Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (P=0.038, OR=1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (P<0.05, OR=2.0, 95% CI: 1.2 to 3.2) more often than those with lower education. Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies.

The Benefits Of Sandwalking For Improving Strength And Physical Fitness In Elderly Women

Purpose Falls and physical inactivity among older adults is a significant public health burden, with reduced lower limb muscle strength being attributed to a higher risk of falling. Soft sand walking potentially offers many benefits for reducing the risk of falls, as it offers potential for greater improvement in lower limb muscle strength as well as improvement in fitness due to its higher energy cost. This study examined the benefits of soft sand compared to firm surface walking on improving lower limb muscle strength and physical fitness in older females. Methods thirty eight healthy, relatively inactive women, were randomly allocated to either soft sand or firm surface walking groups. Groups walked 3 times per week and progressed from a 25minute self paced walk to a 40 minute walk throughout the 8 week intervention. Pre and post measures were taken for fitness (submaximal VO) and lower limb muscle strength (hip and knee). Blood glucose and cholesterol levels were also analysed. Results Average compliance was 87%, with the sand walking group exercising at a slightly higher intensity (85% HR max) than the firm surface group (74% HR max). A significant main time effect was reported for cholesterol (p=0.002), triglycerides (p=0.001), high density lipoprotein (p=0.036), low density lipoprotein (p=0.002) and coronary risk ratio (p=0.0001) in both groups. The surface interaction effect for HDL approached significance (p=0.052), with a tendency for higher levels in the sand group post intervention (p=0.06). Neither group reported significant differences across time for treadmill walking submaximal oxygen consumption (p=0.223), but heart rate response did change (p=0.0001), with a greater percentage reduction reported in the sand group (p=0.016). Although the sand walking group did not show significantly better improvements in strength measures, there was a greater percentage change in the majority of these measures amongst sand walkers. Conclusions There is a tendency for greater improvements across most measures amongst the sand walking group which may be further enhanced by a longer intervention period. This has implications for public health initiatives as exercising on soft sand may have certain advantages over firm surface walking.