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This editorial is a call for action to make physical activity and sedentary behaviour messages inclusive. It focuses on disability. Numerous definitions of disability and ways of identifying as disabled exist across the globe. For example, some people, cultures, organisations, and governments prefer for certain reasons to use the term 'disabled people', whilst others prefer 'people with disabilities' or 'people with an impairment' [1]. Respecting difference in terminology used around the world [1], we align with the social model and thus use the term 'disabled people' throughout this editorial. Disability refers to people who have long term physical (e.g. spinal cord injury), sensory (e.g. visual impairment), cognitive (e.g. learning difficulties), and/or mental impairments (e.g. depression) which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others [2]. Despite the benefits of physical activity, many disabled people live insufficiently active lifestyles. They are also more likely to be inactive when compared with nondisabled people [2]. Recent UK physical activity guidelines for disabled people recommended doing strength activities on 2 or more days a week and at least 150 min of moderate-intensity aerobic physical activity each week for substantial health gains [2-4]. It was also stressed in the UK guidelines that some physical activity is better than nothing as small amounts bring health benefits and the 150 min message alone can be daunting, especially for disabled adults who are mostly inactive [1-4]. The new World Health Organisation global guidelines for physical activity and disability [5] echoed the UK guidelines, providing support for its recommendations. To maximise the impact of national and global physical activity guidelines, and reduce participation inequalities, inclusive and effective communication is vital [1]. Communicating physical activity recommendations and how to reduce sedentary time often includes simple but compelling messages. When it comes to tackling sedentariness, messages like these have and might be used: "Stand up, sit less", "Sit less, move more", "Move more. Sit less. Sleep better.", "Chairs are killer's", "Time to take a stand against inactivity", "Get Britain standing", "On your Feet Britain", "Now is the time to get up and get moving!", "Breaking up with your Chair", and "Swap sitting for moving" [6, 7]. However, such messages are ableist.

Introduction: Despite the importance of muscle strengthening and balance activities for health, these elements of the physical activity recommendations are often omitted from communication campaigns and national surveillance systems. This paper reviews national physical activity surveillance systems to determine which tools assess muscle strengthening and balance activities. Methods: We reviewed each tool that was used to inform the Global Observatory for Physical Activity (GoPA) country card prevalence estimates. Results: Of the 139 countries with GoPA country cards, 21 countries reported having no physical activity prevalence data. The prevalence estimates for 74 countries came from the World Health Organization 2014 Global Status Report on Non-Communicable Diseases. For the remaining 44 countries, a range of national and international surveys were used. A limited number of tools sought to assess muscle strengthening activities, and even fewer assessed balance and coordination activities. Discussion: Several issues arise from this review, including the need to: verify the strength of the evidence to inform whether muscle strength and balance should be given equal prominence to the aerobic recommendation; establish which activities count towards different aspects of the guidelines; and confirm whether the muscle strengthening and balance components of the guidelines are 'in addition' to the aerobic component.

This study provides a new test of time-use diary methodology, comparing diaries with a pair of objective criterion measures: wearable cameras and accelerometers. A volunteer sample of respondents ( n = 148) completed conventional self-report paper time-use diaries using the standard UK Harmonised European Time Use Study (HETUS) instrument. On the diary day, respondents wore a camera that continuously recorded images of their activities during waking hours (approximately 1,500–2,000 images/day) and also an accelerometer that tracked their physical activity continuously throughout the 24-hour period covered by the diary. Of the initial 148 participants recruited, 131 returned usable diary and camera records, of whom 124 also provided a usable whole-day accelerometer record. The comparison of the diary data with the camera and accelerometer records strongly supports the use of diary methodology at both the aggregate (sample) and individual levels. It provides evidence that time-use data could be used to complement physical activity questionnaires for providing population-level estimates of physical activity. It also implies new opportunities for investigating techniques for calibrating metabolic equivalent of task (MET) attributions to daily activities using large-scale, population-representative time-use diary studies.

BACKGROUND: Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. METHODS: We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. FINDINGS: After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings. INTERPRETATION: Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases. FUNDING: WHO.

Background Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. Methods We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. Findings After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings. Interpretation Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4—reducing premature non-communicable disease mortality by a third by 2030—should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.

Background The after-school period has been described as the 'critical window' for physical activity (PA) participation. However, little is known about the importance of this window compared with the before and during-school period among socioeconomically disadvantaged children, and influence of gender and weight status. Methods 39 out of 156 (RR=25%) invited primary schools across 26 local government areas in Victoria, Australia, consented to participate with 856 children (RR=36%) participating in the wider study. The analysis sample included 298 Grade 4 and Grade 6 children (mean age: 11.2±1.1; 44% male) whom met minimum accelerometry wear-time criteria and had complete height, weight and health-behaviours questionnaire data. Accelerometry measured duration in daily light-intensity PA (LPA), moderate-to-vigorous PA (MVPA) and sedentary time (ST) was calculated for before-school=8–8:59, during-school=9:00–15:29 and after-school=15:30–18:00. Bivariate and multivariable linear regression analyses were conducted. Results During-school represented the greatest accumulation of LPA and MVPA compared with the before and after-school periods. Boys engaged in 102 min/day of LPA (95% CI 98.5 to 104.9) and 62 min/day of MVPA (95% CI 58.9 to 64.7) during-school; girls engaged in 103 min/day of LPA (95% CI 99.7 to 106.5) and 45 min/day of MVPA (95% CI 42.9 to 47.4). Linear regression models indicated that girls with overweight or obesity engaged in significantly less LPA, MVPA and more time in ST during-school. Conclusions This study highlights the importance of in-school PA compared with after-school PA among socioeconomically disadvantage children whom may have fewer resources to participate in after-school PA.

BACKGROUND: The association between poverty and health is highly context-specific; in high-income countries, low socioeconomic status is associated with use of tobacco and alcohol, physical inactivity, and poor diet. We lack good quality epidemiological evidence from developing countries, especially from low and lower middle-income countries (LLMICs). This systematic review sought to fill this gap. METHODS: We conducted a comprehensive literature search for primary research published between Jan 1, 1990, and June 30, 2015, using 13 electronic databases, including Embase and Medline, as well as a grey literature review and hand searching of references. Two reviewers independently screened papers retrieved from 13 databases with a search devised by an experienced medical librarian combining MeSH terms and synonyms for non-communicable diseases, behavioural risk factors, poverty, and the 84 LLMICs defined by the World Bank. We included studies from LLMICs that presented data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. We performed narrative data synthesis. FINDINGS: After review of 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals aged more than 10 years from 39 LLMICs. Most studies found that, compared with high socioeconomic groups, lower status groups had a high prevalence of tobacco and alcohol use (odds ratios up to 18·8 and 3·5, respectively). Most studies also found that lower socioeconomic groups consumed less fruit, vegetables, fish, and fibre (odds ratios negligible to 12·9, depending on context). Higher socioeconomic groups were up to 4·4 times less physically active and consumed more fats, salt, and processed food; however, these dietary studies tended to be smaller with wide confidence intervals. INTERPRETATION: Despite variation in exposure and outcome measures, there is clear evidence that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal 3.4—reducing premature mortality from non-communicable diseases by a third by 2030—should leverage their development budgets to address the poverty–health nexus in these settings. Our findings are also important for health workers serving these populations, and for policymakers tasked with preventing and controlling the rise of non-communicable diseases.

Accepted author manuscript version reprinted, by permission, from Journal of physical activity & health, 15(S2), pp. S347 - S349, https://doi.org/10.1123/jpah.2018-0537 © Human Kinetics, Inc. ; The Active Healthy Kids England 2018 Report Card provides an updated "state of the nation" resource regarding performances on the provision of, and support for, physical activity opportunities for children and young people. Specifically, in this paper we present and discuss key findings from the 2018 Report Card, a release that serves to revise our 2014 and 2016 report cards via the same systematic approach that incorporates best current data. To this end, these data include national surveys, peer-review outputs, and a variety of nonacademic sources including online content and reports from government and nongovernment organizations.

Background: Regular physical activity improves physical and mental health, yet children's physical activity levels were low in England's 2014 Report Card. Within this paper, we update the 2014 Report Card to assess current information for the 9 indicators of physical activity. Methods: A search for nationally representative data on 9 indicators of physical activity was conducted and the data were assessed by an expert panel. The panel assigned grades [ie, A, B, C, D, F, or INC (incomplete)] to each indicator based on whether children across England were achieving specific benchmarks. The 2016 Report Card was produced and disseminated. Results: The following grades were awarded: Overall Physical Activity Levels: D-; Organized Sport Participation: D; Active Play: INC; Active Transportation: C-; Sedentary Behaviors: INC; Family and Peers: INC; School: B+; Community and the Built Environment: B; Government Strategies and Investment: INC. Conclusions: The grades have not improved since the 2014 Report Card and several gaps in the literature are still present. While children's physical activity levels remain low alongside competing sedentary choices, further national plans and investment with local actions are urgently needed to promote physical activity especially via active play, active transport, and family support.

Background: Regular physical activity improves physical and mental health, yet children's physical activity levels were low in England's 2014 Report Card. Within this paper, we update the 2014 Report Card to assess current information for the nine indicators of physical activity. Methods: A search for nationally representative data on nine indicators of physical activity was conducted and the data were assessed by an expert panel. The panel assigned grades (i.e. A, B, C, D, F, or INC (incomplete)) to each indicator based on whether children across England were achieving specific benchmarks. The 2016 Report Card was produced and disseminated. Results: The following grades were awarded: Overall Physical Activity Levels: D-; Organized Sport Participation: D; Active Play: INC; Active Transportation: C-; Sedentary Behaviours: INC; Family and Peers: INC; School: B+; Community and the Built Environment: B; Government Strategies and Investment: INC. Conclusions: The grades have not improved since the 2014 Report Card and several gaps in the literature are still present. While children's physical activity levels remain low alongside competing sedentary choices, further national plans and investment with local actions are urgently needed to promote physical activity especially via active play, active transport, and family support.

BACKGROUND: Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries. METHODS: This study was done within the framework of the EU-funded project 'Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA)', which aims to propose standardised instruments for physical activity and fitness monitoring across Europe. Quantitative studies published from 1990 up to November 2007 were systematically searched in Pubmed, Web of Science, TRIS and Geobase. In addition a survey was conducted among members of the European network for the promotion of Health-Enhancing Physical Activity (HEPA Europe) and European members of the International Physical Activity and Environment Network (IPEN) to identify published or ongoing studies. Studies were included if they were conducted among European general adult population (18+y) and used a questionnaire to assess perceptions of the physical environment. A consensus meeting with an international expert group was organised to discuss the development of a European environmental questionnaire. RESULTS: The literature search resulted in 23 European studies, 15 published and 8 unpublished. In these studies, 13 different environmental questionnaires were used. Most of these studies used adapted versions of questionnaires that were developed outside Europe and that focused only on the walkability construct: The Neighborhood Environment Walkability Scale (NEWS), the abbreviated version of the NEWS (ANEWS) and the Neighborhood Quality of Life Study (NQLS) questionnaire have been most commonly used. Based on the results of the literature review and the output of the meeting with international experts, a European environmental questionnaire with 49 items was developed. CONCLUSION: There is need for a greater degree of standardization in instruments/methods used to assess environmental correlates of physical activity, taking into account the European-specific situation. A first step in this process is taken by the development of a European environmental questionnaire.

The traditional view of translating research to policy is reframed as a complex multidirectional interaction based on international case studies presented at the 2015 Active Living Research conference. The United Kingdom developed a process for reviewing and synthesizing evidence to inform policy, but policy makers were often ahead of the guidance. In Australia, translation of research to policy has been facilitated by brokering the relationship between researchers and policy makers. The best example of dissemination of the evidence for physical activity promotion into a national program comes from Brazil, but implementation has been markedly influenced by community and political factors. In Mexico, "physical activity policy" is being implemented at scale but without much research and with leadership from sectors other than public health. A more flexible understanding of the complex interplay between research and policy will increase the probability that the best available evidence will influence policy and that policy with the potential to increase physical activity will be evaluated.

The health benefits of physically activity (PA) are well documented; therefore, promoting PA and associated guidelines to the population is considered an important task for any government. To support the strategy development for communication of the recently updated PA guidelines, the UK Chief Medical Officers' (CMO) Expert Panel for Communication was created. To help inform this process a rapid review was performed to identify how other nations may be tackling the communication of their PA guidelines and PA more generally. The rapid review used elements of the Health-enhancing physical activity (HEPA) policy audit tool (PAT) created by the World Health Organization (WHO) and investigated all 195 countries. Seventy-seven countries had their own guidelines, 53 used the WHO guidelines (of which 47 used the Regional Office for Africa), and for 65 countries no guidelines could be found. For the communication of PA or PA guidelines, 27 countries used infographics, 56 had government policies/documents, and 11 used a mass media campaign. However only 6 of these communication strategies had been evaluated. Although many countries used infographics, there were no associated evaluations. As such any future communication strategies should incorporate an evaluation of effectiveness. Mass media campaigns had the strongest evidence base, proving to be an effective communication strategy, particularly when incorporating aspects of social marketing. This review provides an insight into what strategies countries worldwide have taken to communicate PA guidelines and PA promotion. These should be carefully considered when deciding how best to communicate and promote PA guidelines.