Physical Activity Opportunities Research Articles

Healing Obesity with health-promoting environments – can interventions in Urban Policies bring health benefits?

Abstract Obesity is a complex chronic disease associated with numerous health and social consequences. In 90% of cases, obesity is multifactorial, with a basis in a discrepancy between energy intake and consumption, but also caused by endocrine, psychological factors, environment, improper diet, physical inactivity, and lifestyle. The environment where people live and work must provide opportunity for enough physical activity to prevent obesity. The availability of fitness parks, bike paths, and publicly accessible swimming pools are the many possibilities that a positive and encouraging environment could provide. Urban areas demand publicly accessible places for physical activity. At the same time, it is important to motivate citizens in urban areas to increase their physical activity, because of a predominantly sedentary lifestyle. If the city's urban and health policies promote a healthy lifestyle, for example encouraging cycling and walking by providing infrastructure that will allow for a greater percentage of people to engage daily in physical activity. A healthy-behaviors-promoting environment is important to combat obesity (walkable neighborhood, green space, safe cycling, healthy food availability). A variety of policy strategies are available to create an active and safe environment: 1) increasing green and blue areas in urban settings: to promote recreation and relaxation; 2) promoting cycling and walking as a form of active mobility; 3) reducing or banning of public advertising of unhealthy food, while promoting healthy nutrition and increase of markets with healthy food; 4) encouraging socialization through sport, etc. Providing a healthy and safe environment is necessary to curb the obesity epidemic. Numerous interventions aimed at implementing a plan to change the environment and create a safe and stimulating environment for children and adults are needed.

‘Grunaus moves’ implementation as a best practice in tackling child obesity

Abstract Grunau moves targets children (4-12) and their environmental and living conditions and related actors, focus on deprived district (reduction of health inequalities). It aims at creating health promoting settings, environments to promote physical activity and healthy diet in children and families. This best practice confirmed differences in nutrition and opportunities for physical activity for children between advantaged and disadvantaged districts (health inequity).

7.F. Workshop: Local physical activity policy evaluation: state of the art, tools and methods and future directions

Abstract Insufficient physical activity (PA) is one of the most significant risk factors for chronic diseases and premature mortality worldwide. Public policies are recognized as upstream factors providing system change beyond individual changes. Policies have been recognised as an effective way to increase population PA levels, as they support the development of evidence-based interventions and programs in different domains, that help create a ‘healthy’ PA environment and enhanced PA opportunities. Previous studies have shown an important impact of PA promotion policies at local level (municipalities), but insufficient research and tool development has been realised on PA policies beyond national level. First, the workshop will briefly describe the scientific state of the art on local PA promotion policies evaluation, based on results from a literature review. Second, the panel will present the CAPLA-Santé, a policy evaluation tool designed by a stakeholders’ group in France, based on the Health Enhancing Physical Activity Policy Audit Tool of the World Health Organisation, to comprehensively review local PA policies. The final version of CAPLA-Santé contains 21 items divided into six sections: 1. Overview of HEPA stakeholders in the local government area, 2. Policy documents, 3. Policy contents, 4. Funding and political engagement, 5. Studies and measures relating to physical activity in the local government area, and 6. Progress achieved and future challenges. CAPLA-Santé allows the collection and in-depth analysis of local level policies to assess the progress in promoting PA and intersectoral collaboration as well as identifying successful policy levers and remaining challenges. Third, the panel will illustrate its use in 5 countries worldwide (Finland, France, Germany, Japan and Romania), summarising findings and explaining how such tools allow cross-cultural comparison. Fourth, panellists will discuss the challenges and success in using such tools and provide insights on how these tools can serve as capacity building for policy makers and to draw recommendations, as well as cross-cultural comparisons. Key messages • The workshop will provide key advise on how to monitor local physical activity policies. • The workshop will equip participants with tools to face the challenge of local physical activity policy evaluation. Speakers/Panelists Petru Sandu Cluj School of Public Health, Babes-Bolyai University in Cluj-Napoca, Cluj-Napoca, Romania Anne Vuillemin Université Côte d’Azur, Nice, France François Berdougo Société Française de Santé Publique, Laxou, France Peter Gelius FAU Erlangen-Nürnberg, Erlangen, Germany

Understanding Libraries as Part of the Rural Active Living Environment: Evidence From a Content Analysis of Library Facebook Posts Made in Summer 2022.

As both public health and public libraries continue to evolve, there are opportunities for collaboration focused on building policies, systems, and environments that support communities making healthy choices easy choices. Given the health disparities related to physical inactivity, such as diabetes and heart disease in rural America, public libraries within rural communities are emerging as important settings for health promotion and disease prevention. This study sought to better understand how rural libraries promote physical activity opportunities on Facebook. Based on a content analysis of Facebook posts of a random sample of 118 libraries made during the Summer of 2022, 47 of the 118 had at least one post related to physical activity and 42 had multiple posts. The most frequent offering was events or classes; libraries also supported physical activity by lending equipment and making changes to the built environment. This study provides evidence that some rural libraries are offering physical activity opportunities through community health partnerships, particularly for youth and families. Considering this evidence, public health professionals are encouraged to collaborate with local libraries to promote physical activity and advance rural health equity. Researchers are invited to continue to develop the evidence base around promoting physical activity with rural libraries.

Physical Activity and Mental Health of Youth During the COVID-19 Pandemic

The COVID-19 Pandemic has globally impacted children’s physical activity and mental health outcomes since the transition to remote learning (Štveráková, et al., 2021). Children and adults may encounter negative mental health related consequences, higher stress, and a significant lack of physical activity while in physical and social isolation (Clemente-Suárez, 2022). In particular, school-aged children have experienced a significant reduction in physical activity since transitioning to remote learning and do not have sufficient opportunities to make up for this loss while engaged in remote learning (Štveráková, et al., 2021). Increased physical activity has been consistently correlated with positive mental health outcomes and a reduction of perceived stress in the literature. The purpose of this study, focusing specifically on households participating in remote learning, was to understand the links among access to physical activity opportunities, parental stress, and parent and child mental health outcomes during the Pandemic. In addition, this study will examine how parental stress, mental health and physical activity opportunities may vary depending on the age and socioeconomic status (SES) of the child. Results indicated that most children achieved less than the recommended amount of physical activity and had an increase of at least one mental health concern during remote learning throughout the Pandemic. Parental stress levels were negatively associated with children’s time spent in physical activity, and positively associated with the severity of parents’ mental health concerns and the number of children’s mental health concerns. Implications for school personnel are discussed.

An iSOPARC Case Study of Physical Activity at a Pop-Up Park

ABSTRACT Purpose: Child physical activity (PA) is vital for physical and mental health, yet many children do not meet recommendations. Temporary, place-based programs designed to provide PA opportunities to youth could be a promising approach. This case-study describes familial PA at a suburban pop-up park (PUP) occurring on a weekend during the school year. Methods: iSOPARC (v 1.85) was used with double-rater reliability for a total of four rounds (one round every 30 minutes starting 15 minutes into the event) documenting the PA of individuals in each of the nine target areas at the PUP. PA was dichotomized into physically active (walking or vigorous) and sedentary (sitting or standing). Descriptive statistics were generated. Results: 179 individuals were observed (62% female, 26% children, 28% teens, 45% adults). Overall, 53% (n = 47) of children, 18% of teens (n = 11), and 17% (n = 14) of adults were observed as physically active. Per target area, percentages of physically active individuals were: 93% physically active (n = 14) at the playground, 44% physically active (n = 7) during basketball, 41% physically active (n = 9) during open play, 40% physically active (n = 4) during kickball, 24% physically active (n = 5) at check-in, 20% physically active (n = 6) in the snack area, 11% physically active (n = 2) during reading time, 10% physically active (n = 1) during lawn games, and 6% physically active (n = 2) during boxing. Conclusion: This observational case study provides an example of how PUPs during the school year may be a helpful tool to encourage weekend PA across communities. Future studies should consider the social environment on youth PA.

Associations Between Neighborhood Opportunity and Indicators of Physical Fitness for New York City Public School Youth.

Background: Fewer than 1/4th of US children and adolescents meet physical activity (PA) guidelines, leading to health disparities that track into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to improve fitness attainment and reduce these disparities. We drew data from the Child Opportunity Index to examine associations between neighborhood indicators of opportunity for PA and multiple fitness indicators among New York City public school youth. Methods: Multilevel generalized linear mixed models were used to estimate the overall and sex-stratified associations between neighborhood indicators (green space, healthy food, walkability, commute time) and indicators for physical fitness [curl-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER), sit-and-reach] using the New York City FITNESSGRAM data set. Results: The analytic sample [n = 299,839; median (interquartile range) age = 16 (12-17)] was 50.1% female, 37.5% Hispanic, 26.2% non-Hispanic Black, and most (69.5%) qualified for free/reduced price school meals. Neighborhood indicators were positively associated with higher values of indicators for physical fitness. The strongest associations were observed between walkability and both BMI and PACER, and commute time with BMI, push-ups, and PACER. For example, walkability had the greatest magnitude of effects for BMI and muscular strength and endurance (BMI: β: -0.75, 95% confidence interval, CI: -1.01 to -0.49; PACER: β: 1.98, 95% CI: 1.59 to 2.37), and particularly for girls compared with boys (BMI, girls: β: -0.91, 95% CI: -1.22 to -0.66); BMI, boys: β: -0.56, 95% CI: -0.86 to -0.25); PACER, girls: β: 2.11, 95% CI: 1.68 to 2.54; push-ups, boys: β: 1.71, 95% CI: 1.31 to 2.12). Conclusion: Neighborhood indicators were associated with multiple measures of youth fitness. Continued research on neighborhood opportunity and youth fitness may better inform place-based public health interventions to reduce disparities.

Prevalence of Diagnosed Arthritis - United States, 2019-2021.

Arthritis includes approximately 100 conditions that affect the joints and surrounding tissues. It is a leading cause of activity limitations, disability, and chronic pain, and is associated with dispensed opioid prescriptions, substantially contributing to health care costs. Combined 2019-2021 National Health Interview Survey data were analyzed to update national prevalence estimates of self-reported diagnosed arthritis. An estimated 21.2% (18.7% age-standardized) of U.S. adults aged ≥18 years (53.2 million) had diagnosed arthritis during this time frame. Age-standardized arthritis prevalences were higher among women (20.9%) than men (16.3%), among veterans (24.2%) than nonveterans (18.5%), and among non-Hispanic White (20.1%) than among Hispanic or Latino (14.7%) or non-Hispanic Asian adults (10.3%). Adults aged ≥45 years represent 88.3% of all U.S. adults with arthritis. Unadjusted arthritis prevalence was high among adults with chronic obstructive pulmonary disease (COPD) (57.6%), dementia (55.9%), a disability (54.8%), stroke (52.6%), heart disease (51.5%), diabetes (43.1%), or cancer (43.1%). Approximately one half of adults aged ≥65 years with COPD, dementia, stroke, heart disease, diabetes, or cancer also had a diagnosis of arthritis. These prevalence estimates can be used to guide public health policies and activities to increase equitable access to physical activity opportunities within the built environment and other arthritis-appropriate, evidence-based interventions.

An exploration of parent perceptions of a take-home loose parts play kit intervention during the COVID-19 pandemic.

The restrictions introduced in response to the COVID-19 pandemic affected the regular routines of Canadians, including access to play and physical activity opportunities, while limiting social connections. In response to this, a recreation centre created take-home play kits that contained loose parts with the aim of facilitating unstructured play. Between August 2021 and January 2022, ten parents participated in semi-structured interviews via telephone or videoconferencing platforms that captured their experiences of the take-home play kits. Using Thematic Analysis, we identified themes and subthemes reflecting parent perceptions and experiences of the take-home play kit. Three themes emerged: (1 A forced renaissance of play; (2) Bringing unstructured play home, and; (3) Parenting is child's play. Parents shared how the pandemic resulted in decreased physical activity and social opportunities for their children. The parents described how the take-home play kits supported unstructured play as well as their perspectives on the importance of unstructured play. Parents in our study suggested that a take-home loose parts play kit could be a useful resource to help engage children in unstructured play in both indoor and outdoor environments.

Optimizing Urban Children’s Outdoor Play Spaces: Affordances, Supervision, and Design Dynamics

This research explores how outdoor spaces play a crucial role in providing urban children with opportunities for physical activity and relaxation, together with the supervision of the children’s outdoor activities, particularly in densely populated areas with limited open spaces. Effective design of such spaces is vital for creating functional recreational areas within urban landscapes. Drawing from ecological perceptual psychology’s theory of affordance, this research examines the positive attributes of environmental affordances, specifically in Beijing’s central area. Using a children’s park as a case study, systematic observations are conducted to understand the park’s potential for diverse play opportunities and facilitating social interactions across age groups. However, the results reveal that the children’s park falls short of realizing its affordances fully, restricting available play opportunities. Specific play activities require distinct spatial arrangements influenced by children’s ages. Maternal supervision significantly affects children’s play experiences. The study also highlights grandparent involvement in overseeing children’s outdoor play, revealing differing supervision styles. In conclusion, while fixed play equipment and rubber carpet ground enhance engagement and safety, realizing the complete potential of children’s outdoor play spaces demands more inclusive design. The research underscores the intricate interplay between environmental affordances, adult supervision patterns, and children’s play experiences, paving the way for further exploration of these dynamic relationships, and contribute to build environmentally and socially sustainable urban environments.

Revisiting Recess: A Mixed-Methods Study to Understand Physical Activity During Changing Recess Policies

ABSTRACT Background Recess is an integral part of a comprehensive school physical activity program. Immediately prior to the pandemic, state legislation doubled the amount of required recess, creating an opportunity to better understand how policies and practices influence recess. Purpose To describe changes to recess due to COVID-19 and extended recess legislation and to quantify student physical activity during recess following these changes. Methods This mixed-method study was conducted in Spring 2021 in four elementary schools. Recess physical activity was measured using waist-worn accelerometers, recess was observed, and researchers conducted interviews with teachers and principals. Results Females spent 41.7% (95%CI: 38.2, 44.5) and males spent 47.9% (95%CI: 44.6, 51.2) of recess in accelerometer-measured moderate-to-vigorous physical activity (n = 164). Participants (n = 13) discussed increased supervision, classroom separation on the playground, and benefits of extended recess. Discussion States should consider extending recess requirements but need to consider options for scheduling and indoor recess. Recess continues to be a key physical activity opportunity during school. Translation to Health Education Practice Health Educators considering changes to recess policies and practices may want to consider scheduling of recess including class integration, options for indoor recess, and professional development for recess supervision to help maximize the benefits of recess.

The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice

BackgroundChildren’s physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explored school-based and community-based active clubs after lockdowns, using a unique combination of data sources to highlight implications for policy and practice post-COVID-19.MethodsCross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method.ResultsSchool-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand.ConclusionsFindings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities.

Investigating the Effectiveness of Virtual Physical Activity Education on Students’ Quality of Life of Karaj in 2020

Background: Sedentary lifestyle is regarded as one of the main risk factors for obesity and chronic diseases. As schools provide students with important opportunities for physical activity, their closure, prompted by the COVID-19 pandemic, had a detrimental impact on vulnerable populations, particularly youth and school students. Therefore, this study aimed to investigate the effect of virtual physical education on students’ quality of life during the COVID-19 pandemic. Methods: This community trial was conducted with an experimental and a control group. For this purpose, 300 students aged 13 to 15 years, selected among students of the 1st year of high school, were selected from the four education districts of the urban areas of Karaj city in the year 2020 using a cluster sampling method. The selected students were randomly assigned to the two groups of intervention and control, each with 150 people. There was no difference between the two groups in terms of inclusion criteria and demographic characteristics. Following group assignment, the intervention group received virtual physical education for eight 30-minute sessions, one session each week. All subjects completed the Physical Activity and Quality of Life Questionnaires before and after the training. The data were analyzed with SPSS software version 20, using the chi-square test, paired t-test, and independent t-test. Results: The mean and standard deviation of the scores in almost all areas of quality of life (both physical activity and mental health) in the intervention group had a significant improvement after the training courses (P<0.05). After training, the mean scores of quality of life in the virtual education group were significantly greater than control group (P<0.05). Conclusion: The virtual school-based physical activity intervention had positive effects on children’s psychological and psychological wellbeing. The online educational method could provide customizable physical education learning activities as a suitable step in promoting physical activity engagement for different groups of students.

Social Supports and Barriers for Older Adults Not Participating in Group Physical Activity.

Group physical activity can provide physical and social benefits; however, social barriers or a lack of social support may affect participation. This study examined social-support needs and barriers among older adults who were not participating in group physical activities. Using interpretive description, semistructured interviews were conducted with 38 older adults (M = 70.9years; 81.6% women). Themes were grouped into two categories. Category 1, expectations and initial impressions, consisted ofthe following: (a)Groups cannot meet everyone's expectations or interests, (b)groups are intimidating to join, and (c)the need for inclusive programming. Category 2, social processes within group physical activity, consisted of (a)modeling physical activity behaviors, (b)sharing information and suggestions about physical activity opportunities, and (c)encouragement and genuine interest. Outreach to this population should aim to address these barriers and utilize these supportive behaviors to reduce feelings of intimidation and promote participation among older adults.

Thriving families: The feasibility and preliminary efficacy of a multi-component physical literacy program for children with neurodevelopmental, emotional, or behavioural problems

Children with neurodevelopmental, emotional, or behavioural challenges participate in lower levels of physical activity (PA) and subsequently have poorer physical and mental health outcomes. We sought to determine the feasibility and preliminary efficacy of a multi-component physical literacy program for children with neurodevelopmental, emotional, or behavioural challenges. Thirty children and 28 parents were recruited to participate in the 10-week single-group non-randomised feasibility trial. Thriving Families was designed to promote children's physical literacy through (a) providing programmed opportunities for PA, (b) incorporating parents, (c) supporting motivation and engagement, and (d) utilising behaviour change techniques. Program feasibility was determined using qualitative and quantitative feedback. Preliminary efficacy was determined through pre-and post-intervention assessments of children's physical literacy. Results indicate that the program is acceptable and was well received. Effect size estimates for parent knowledge (d = 0.78) and confidence (d = 0.57) were moderate to large; however, little change was observed for parents' motivation to support PA and children's perceptions of PA support. Moderate or large effects were observed for pre-to-post-program change on children's domains of physical competence. The Thriving Families program appears to be feasible and acceptable for community-based implementation and may provide benefits for physical and psychological outcomes.

Moderate-to-Vigorous Physical Activity in Physical Education: A Review of Reviews

Purpose: This paper aimed to examine moderate-to-vigorous physical activity (MVPA) levels in physical education. Method: A review of reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The screening process, data extraction, assessment of the risk of bias, and analysis of the results were carried out independently by two reviewers. A total of eight systematic reviews from six databases, which included 224 studies, involving more than 80,000 students (elementary, middle, and high school), enrolled in more than 450 schools worldwide were unpacked. Results: Students fail to meet the 50% recommendation of MVPA lesson time, irrespective of country, school stage, gender, or MVPA measures. Physical education-based interventions increased students’ MVPA during lessons (range 14.3%–24%) compared with control groups. Conclusion: Physical education is uniquely positioned to provide physical activity opportunities for students, but teachers must target the provision of adequate MVPA levels, which is not currently happening.

Deep representation learning identifies associations between physical activity and sleep patterns during pregnancy and prematurity

Preterm birth (PTB) is the leading cause of infant mortality globally. Research has focused on developing predictive models for PTB without prioritizing cost-effective interventions. Physical activity and sleep present unique opportunities for interventions in low- and middle-income populations (LMICs). However, objective measurement of physical activity and sleep remains challenging and self-reported metrics suffer from low-resolution and accuracy. In this study, we use physical activity data collected using a wearable device comprising over 181,944 h of data across N = 1083 patients. Using a new state-of-the art deep learning time-series classification architecture, we develop a ‘clock’ of healthy dynamics during pregnancy by using gestational age (GA) as a surrogate for progression of pregnancy. We also develop novel interpretability algorithms that integrate unsupervised clustering, model error analysis, feature attribution, and automated actigraphy analysis, allowing for model interpretation with respect to sleep, activity, and clinical variables. Our model performs significantly better than 7 other machine learning and AI methods for modeling the progression of pregnancy. We found that deviations from a normal ‘clock’ of physical activity and sleep changes during pregnancy are strongly associated with pregnancy outcomes. When our model underestimates GA, there are 0.52 fewer preterm births than expected (P = 1.01e − 67, permutation test) and when our model overestimates GA, there are 1.44 times (P = 2.82e − 39, permutation test) more preterm births than expected. Model error is negatively correlated with interdaily stability (P = 0.043, Spearman’s), indicating that our model assigns a more advanced GA when an individual’s daily rhythms are less precise. Supporting this, our model attributes higher importance to sleep periods in predicting higher-than-actual GA, relative to lower-than-actual GA (P = 1.01e − 21, Mann-Whitney U). Combining prediction and interpretability allows us to signal when activity behaviors alter the likelihood of preterm birth and advocates for the development of clinical decision support through passive monitoring and exercise habit and sleep recommendations, which can be easily implemented in LMICs.

Pedagogical Content Knowledge of Movement Opportunities in Toddler Education: Perceptions of Early Childhood Educators and Student Teachers

AbstractEarly childhood education and care (ECEC) institutions are considered contexts wherein physical activity (PA) can be effectively promoted. Some approaches have been used in the early childhood setting to identify how teachers incorporate movement opportunities into the ECEC curriculum. However, studies are still scarce regarding pedagogical content knowledge (PCK) of structured and non-structured movement possibilities in toddler education (1–3 years old). Taking into account that working with toddlers requires specific training and sensitivity, the aim of the study was to assess ECEC educators’ and student teachers’ perceptions of what they know, how they transmit it, what kind of curricular practices they execute, and the didactic implications of movement opportunities in toddler education. This was an exploratory qualitative research study, in which open-ended, semi-structured qualitative interviews, plus qualitative content analysis of a written questionnaire, were conducted with 14 educators and 20 student teachers. Our results show that educators and students distinguish PCK in the different curricular practices related to movement, identifying differences between structured PA opportunities and free play opportunities. Educators and student teachers identified different sources of knowledge, barriers, and facilitators of structured movement opportunities in the ECEC toddler context, and they recognized that PA is important to young children’s development; however, little knowledge of PA guidelines to promote it was evident. Our findings contribute to understanding educators’ perceptions regarding movement as a curricular practice for children aged 1 to 3 years. Educators and public administration could find structured PA to be a complement to a harmonious development from a young age.

The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia.

Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia.

Examining associations between school-level determinants and the implementation of physical activity opportunities.

School-based physical activity (PA) opportunities can help students engage in greater amounts of daily PA, meet PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This exploratory study examined associations between school-level determinants and the implementation of school-based PA opportunities. We analyzed cross-sectional survey data from schools (n = 46) participating in the Healthy Zone School Program (HZSP) (Dallas, Texas, USA) during 2019-2020. Respondents completed an electronic survey that included measures of school-level determinants (e.g. culture, leadership, priority) and the implementation of school-based PA opportunities. We used linear regression models to examine associations between determinants and implementation outcomes (number of PA opportunities delivered, perceived overall success of each PA program/activity used). After adjusting for campus type (i.e. elementary, middle, high, K-12), student race/ethnicity, and percentage of economically disadvantaged students, no constructs were associated with the number of PA opportunities implemented. Linear regression models suggest access to knowledge and information (β = 0.39, P = .012, 95% CI = 0.24-1.44) and implementation climate (β = 0.34, P = .045, 95% CI = 0.02-1.59) were positively associated with the success of school-based PA opportunities. Our findings provide suggestive evidence that access to knowledge and information and a supportive school climate may improve the overall success of PA opportunities provided to students. Future research should examine additional school-level determinants to understand their importance to implementation and inform the development of strategies to improve schools' capacity for implementing PA opportunities successfully.