Advancing the evidence base for public policies impacting on dietary behaviour, physical activity and sedentary behaviour in Europe: The Policy Evaluation Network promoting a multidisciplinary approach

Abstract Background A pan-European approach to evaluate policy impact on health behaviour requires the employment of a consensus set of established and relevant indicators. Methods As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life, the Policy Evaluation Network PEN identified key indicators of health behaviours and their determinants. These key indicators are already, or have the potential to be, adopted by large European Union surveillance systems for the assessment of policy impact. The iterative selection process included consultations in two rounds via email prior to a 2-days expert workshop. The experts collated a list of dietary behaviour, physical activity and sedentary behaviour indicators for European policy monitoring in young and adult populations based on existing frameworks and literature reviews. The expert panel was composed of researchers, policy makers and representatives of major European surveillance systems and related initiatives, as well as, representatives of organisations providing monitoring data, such as the European Commission and Eurostat. Results The process provided two lists of key indicators including 37 diet ‘policy’ indicators and 35 indicators for dietary behaviour and their ‘determinants’; as well as 32 physical activity ‘policy’ indicators and 35 indicators for physical activity, sedentary behaviour and their ‘determinants’. Conclusion A total of 139 key indicators related to the individual, the setting and the population level, and suitable for the assessment of dietary behaviour, physical activity and sedentary behaviour were prioritised by policy makers and researchers with the ultimate aim to embed policy evaluation measures in existing surveillance systems across the European Union. In a next step, data sources and suitable instruments will be identified to assess these key indicators.

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Is the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findings

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099131 ◽

2018 ◽

Vol 53 (6) ◽

pp. 377-382 ◽

Cited By ~ 85

Author(s):

Emmanuel Stamatakis ◽

Ulf Ekelund ◽

Ding Ding ◽

Mark Hamer ◽

Adrian E Bauman ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Sedentary Behaviour ◽

Disease Risk ◽

Evidence Synthesis ◽

Evidence Base ◽

Narrative Review ◽

Research Progress ◽

Research Paradigms ◽

Sedentary Breaks

Sedentary behaviour (SB) has been proposed as an ‘independent’ risk factor for chronic disease risk, attracting much research and media attention. Many countries have included generic, non-quantitative reductions in SB in their public health guidelines and calls for quantitative SB targets are increasing. The aim of this narrative review is to critically evaluate key evidence areas relating to the development of guidance on sitting for adults. We carried out a non-systematic narrative evidence synthesis across seven key areas: (1) definition of SB, (2) independence of sitting from physical activity, (3) use of television viewing as a proxy of sitting, (4) interpretation of SB evidence, (5) evidence on ‘sedentary breaks’, (6) evidence on objectively measured sedentary SB and mortality and (7) dose response of sitting and mortality/cardiovascular disease. Despite research progress, we still know little about the independent detrimental health effects of sitting, and the possibility that sitting is mostly the inverse of physical activity remains. Unresolved issues include an unclear definition, inconsistencies between mechanistic and epidemiological studies, over-reliance on surrogate outcomes, a very weak epidemiological evidence base to support the inclusion of ‘sedentary breaks’ in guidelines, reliance on self-reported sitting measures, and misinterpretation of data whereby methodologically inconsistent associations are claimed to be strong evidence. In conclusion, public health guidance requires a consistent evidence base but this is lacking for SB. The development of quantitative SB guidance, using an underdeveloped evidence base, is premature; any further recommendations for sedentary behaviour require development of the evidence base and refinement of the research paradigms used in the field.

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Health surveillance indicators: what is available in European data sets for policy evaluation?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.328 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Stanley ◽

A Hebstreit ◽

C Murrin

Keyword(s):

Physical Activity ◽

Sedentary Behaviour ◽

Policy Evaluation ◽

Population Level ◽

Likert Scale ◽

Surveillance Systems ◽

Key Stakeholders ◽

Mapping Process ◽

Key Indicators ◽

The Impact

Abstract Background Policy actions targeting diets and physical activity have been proposed as mechanisms for the prevention and control NCDs in Europe. While these actions have the potential to improve health at a population level, the impact of these policies in Europe is currently unknown. The aim of this study, as part of the wider Policy Evaluation Network, is to catalogue the data available for policy evaluation in Europe to inform the development of surveillance instruments. The catalogues will also provide an opportunity for key stakeholders to view the available EU indicators that can be employed to evaluate policies which influence diet, physical activity and sedentary behaviour. Methods A suite of key indicators was agreed by over 30 EU experts and PEN members in a workshop in September 2019. Variables in existing EU monitoring systems were suggested by workshop participants as measures for each key indicator. The mapping process involved an evaluation of how suitable the suggested variables were as measures for the indicators. This was done using a Likert scale (matched, somewhat matched, less matched, not matched). Results Diet (n = 72) and physical activity and sedentary behaviour (n = 65) related indicators, across all levels of the socio-ecological model were selected for the mapping process. 72% of diet indicators and 86% of physical activity and sedentary behaviour indicators were matched to at least one variable in an existing EU monitoring system. The majority of indicator-measure pairs were categorised as 'matched' on the Likert scale. Conclusions While there are gaps in the measurement of policy level indicators in domains such as inequality, funding and resources and governance, the majority of key policy indicators were mapped to measures in existing systems.Therefore, much of the evidence for evaluation of policies is readily available in Europe. Key messages By mapping the key indicators to variables in existing pan-European monitoring and surveillance systems we aim to document the data currently available for policy evaluation. The catalogue of mapped indicators will provide a tool for key stakeholders to aid in the evaluation and development of policies influencing diets, physical activity and sedentary behaviour in Europe.

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Physical activity and exercise

Oxford Textbook of Rheumatoid Arthritis ◽

10.1093/med/9780198831433.003.0024 ◽

2020 ◽

pp. 285-296

Author(s):

Lindsay M. Bearne ◽

Christina H. Opava

Keyword(s):

Rheumatoid Arthritis ◽

Physical Activity ◽

Clinical Practice ◽

Sedentary Behaviour ◽

Exercise Prescription ◽

Evidence Base ◽

Management Approach ◽

Physical Activity And Exercise ◽

Health Enhancing Physical Activity

This chapter provides an overview of the role of physical activity and exercise in the management of people with rheumatoid arthritis (RA). It defines the concepts of physical activity, exercise, and sedentary behaviour and considers how these are measured objectively and subjectively in research studies and clinical practice. The symptoms and disabilities targeted by appropriately prescribed interventions are discussed and the growing evidence base for the effects of exercise in people with RA is highlighted. The recommendations and guidelines for health-enhancing physical activity and exercise prescription are reviewed and the factors that influence adherence to these are acknowledged. Suggestions of how clinicians may adapt their management approach to facilitate the uptake and maintenance of health-enhancing physical activity and exercise are considered.

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Effects of sedentary behaviour interventions on biomarkers of cardiometabolic risk in adults: systematic review with meta-analyses

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-101154 ◽

2020 ◽

pp. bjsports-2019-101154 ◽

Cited By ~ 6

Author(s):

Nyssa T Hadgraft ◽

Elisabeth Winkler ◽

Rachel E Climie ◽

Megan S Grace ◽

Lorena Romero ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Blood Pressure ◽

Sedentary Behaviour ◽

Vascular Function ◽

Cardiometabolic Risk ◽

Evidence Base ◽

Fat Free Mass ◽

Percentage Body Fat ◽

Meta Analyses

Context/purposeObservational and acute laboratory intervention research has shown that excessive sedentary time is associated adversely with cardiometabolic biomarkers. This systematic review with meta-analyses synthesises results from free living interventions targeting reductions in sedentary behaviour alone or combined with increases in physical activity.MethodsSix electronic databases were searched up to August 2019 for sedentary behaviour interventions in adults lasting for ≥7 days publishing cardiometabolic biomarker outcomes covering body anthropometry, blood pressure, glucose and lipid metabolism, and inflammation (54 studies). The pooled effectiveness of intervention net of control on 15 biomarker outcomes was evaluated using random effects meta-analyses in the studies with control groups not providing other relevant interventions (33 studies; 6–25 interventions analysed).ResultsInterventions between 2 weeks and <6 months in non-clinical populations from North America, Europe and Australia comprised much of the evidence base. Pooled effects revealed small, significant (p<0.05) beneficial effects on weight (≈ −0.6 kg), waist circumference (≈ −0.7 cm), percentage body fat (≈ −0.3 %), systolic blood pressure (≈ −1.1 mm Hg), insulin (≈ −1.4 pM) and high-density lipoprotein cholesterol (≈ 0.04 mM). Pooled effects on the other biomarkers (p>0.05) were also small, and beneficial in direction except for fat-free mass (≈ 0.0 kg). Heterogeneity ranged widely (I2=0.0–72.9).ConclusionsOur review of interventions targeting sedentary behaviour reductions alone, or combined with increases in physical activity, found evidence of effectiveness for improving some cardiometabolic risk biomarkers to a small degree. There was insufficient evidence to evaluate inflammation or vascular function. Key limitations to the underlying evidence base include a paucity of high-quality studies, interventions lasting for ≥12 months, sensitive biomarkers and clinical study populations (eg, type 2 diabetes).PROSPERO trial registration numberCRD42016041742

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Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal

Proceedings of The Nutrition Society ◽

10.1079/pns2003276 ◽

2003 ◽

Vol 62 (3) ◽

pp. 611-619 ◽

Cited By ~ 119

Author(s):

John J. Reilly ◽

Zoe C. McDowell

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Childhood Obesity ◽

Sedentary Behaviour ◽

Critical Appraisal ◽

Meta Analysis ◽

Evidence Base ◽

Rapid Expansion ◽

Paediatric Obesity ◽

Prevention And Treatment

Interventions for prevention and treatment of childhood obesity typically target increases in physical activity and, more recently, reductions in physical inactivity (sedentary behaviour such as television viewing). However, the evidence base for such strategies is extremely limited. The main aim of the present review was to update the systematic review and critical appraisal of evidence in the light of the recent rapid expansion of research in this area. Randomised controlled trials (RCT) that targeted activity or inactivity, that followed up children or adolescents for at least 1 year and that included an objective weight-related outcome measure were included. Trials were appraised using previously published criteria (Harbour & Miller, 2001), and literature search strategies described previously (Reilly et al. 2002) were updated to May 2002. A total of four new RCT, two new systematic reviews and one meta-analysis were identified. The evidence base has increased markedly since the completion of earlier reviews, although high-quality evidence is still lacking. The evidence on childhood obesity prevention is not encouraging, although promising targets for prevention are now clear, notably reduction in sedentary behaviour. There is stronger evidence that targeting activity and/or inactivity might be effective in paediatric obesity treatment, but doubts as to the generalisability of existing interventions, and the clinical relevance of the interventions is unclear. Further research in settings outside the USA is urgently needed, and two ongoing RCT in Scotland are summarised.

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Health Surveillance Indicators: What is Available in European Data Sets for Policy Evaluation?

10.21203/rs.3.rs-58013/v1 ◽

2020 ◽

Author(s):

Isobel Stanley ◽

Agnieszka Neumann-Podczaska ◽

Katarzyna Wieczorowska-Tobis ◽

Gert B.M. Mensink ◽

Lina Garnica Rosas ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behaviour ◽

Policy Evaluation ◽

Population Level ◽

Likert Scale ◽

Data Sets ◽

Mapping Process ◽

Key Indicators ◽

And Control ◽

The Impact

Abstract Background: Policies targeting diets and physical activity have been proposed as mechanisms for the prevention and control non communicable diseases in Europe. While these actions have the potential to improve health at a population level, the impact of these policies in Europe is currently unknown. The aim of this study, as part of the wider Policy Evaluation Network, is to catalogue the data currently available for policy evaluation in Europe to inform the development of surveillance instruments. The catalogues will also provide an opportunity for key stakeholders to view the available EU indicators that can be employed to evaluate policies which influence diet, physical activity and sedentary behaviour. Methods: A suite of key indicators was agreed by PEN members and over 30 EU experts during a workshop in September 2019. Next, variables in existing EU monitoring systems were suggested by workshop participants for the measurement of each key indicator. The mapping process involved an evaluation of how suitable the suggested variables were as measures for the indicators. This was done using a Likert scale (matched, somewhat matched, less matched, not matched). Results: The suite of key indicators included both behaviour outcome indicators and upstream indicators relating to diet (n=72) and physical activity and sedentary behaviour (n=67). 72% of diet indicators and 86% of physical activity and sedentary behaviour indicators were matched to at least one variable in an existing EU monitoring system. The majority of indicator-measure pairs were categorised as ‘matched’ on the Likert scale. Conclusions: While there are gaps in the measurement of policy level indicators in domains such as inequality, funding and resources and governance, the majority of key policy indicators were mapped to measures in existing systems. Therefore, much of the data for evaluation of policies is readily available.

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Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention

Proceedings of The Nutrition Society ◽

10.1017/s0029665108008604 ◽

2008 ◽

Vol 67 (3) ◽

pp. 317-325 ◽

Cited By ~ 122

Author(s):

John J. Reilly

Keyword(s):

Physical Activity ◽

Preschool Children ◽

Energy Balance ◽

Sedentary Behaviour ◽

Dose Response ◽

Evidence Base ◽

Definitive Evidence ◽

Adiposity Rebound ◽

Preschool Period ◽

Increased Risk

Prevalence of obesity in preschool children has increased dramatically in recent years. The preschool years (age 3–6 years) have been regarded as critical for the programming of energy balance, via the concept of early ‘adiposity rebound’. Children who undergo early adiposity rebound are at increased risk of later obesity. Recent evidence suggests that associations between timing of adiposity rebound and later obesity may not reflect programming, but might denote that ‘obesogenic’ growth trajectories are often established by the preschool period. Studies of objectively-measured physical activity and sedentary behaviour in preschool children show that levels of physical activity are typically low and sedentary behaviour high. The review of evidence presented here is supportive of the hypothesis that physical activity is protective against obesity in the preschool period, and that sedentary behaviour, particularly television viewing, is obesogenic. Definitive evidence on dose–response relationships between physical activity, sedentary behaviour and obesity remain unclear. Dose–response evidence could be obtained fairly readily by intervention and longitudinal observational studies that use accelerometry in preschool children. The generalisability of much of the evidence base is limited and there is a need for research on the influence of physical activity and sedentary behaviour in the preschool years in the aetiology of obesity in the developing world.

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