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      Walking on Water—A Natural Experiment of a Population Health Intervention to Promote Physical Activity after the Winter Holidays

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          Abstract

          Background: Very few experimental studies exist describing the effect of changes to the built environment and opportunities for physical activity (PA). We examined the impact of an urban trail created on a frozen waterway on visitor counts and PA levels. Methods: We studied a natural experiment in Winnipeg, Manitoba, Canada that included 374,204 and 237,362 trail users during the 2017/2018 and 2018/2019 winter seasons. The intervention was a 10 km frozen waterway trail lasting 8–10 weeks. The comparator conditions were the time periods immediately before and after the intervention when ~10 kms of land-based trails were accessible to the public. A convenience sample of 466 participants provided directly measured PA while on the frozen waterway. Results: Most trail users were 35 years or older (73%), Caucasian (77%), and had an annual household income >$50,000 (61%). Mean daily trail network visits increased ~four-fold when the frozen waterway was open (median and interquartile range (IQR) = 710 (239–1839) vs. 2897 (1360–5583) visits/day, p < 0.001), compared with when it was closed. Users achieved medians of 3852 steps (IQR: 2574–5496 steps) and 23 min (IQR: 13–37 min) of moderate to vigorous intensity PA (MVPA) per visit, while 37% of users achieved ≥30 min of MVPA. Conclusion: A winter-specific urban trail network on a frozen waterway substantially increased visits to an existing urban trail network and was associated with a meaningful dose of MVPA. Walking on water could nudge populations living in cold climates towards more activity during winter months.

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          Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women

          Summary Background In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors. Methods We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. Findings During 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98–1·11) for obesity in men and 2 ·17 (2·06–2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38–1·45 for men; 1·34, 1·28–1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21–1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking. Interpretation Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. Funding European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.
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            The effect of season and weather on physical activity: a systematic review.

            This study reviewed previous studies to explore the effect of season, and consequently weather, on levels of physical activity. Thirty-seven primary studies (published 1980-2006) representing a total of 291883 participants (140482 male and 152085 female) from eight different countries are described, and the effect of season on moderate levels of physical activity is considered. Upon review of the evidence, it appears that levels of physical activity vary with seasonality, and the ensuing effect of poor or extreme weather has been identified as a barrier to participation in physical activity among various populations. Therefore, previous studies that did not recognize the effect of weather and season on physical activity may, in fact, be poor representations of this behaviour. Future physical activity interventions should consider how weather promotes or hinders such behaviour. Providing indoor opportunities during the cold and wet months may foster regular physical activity behaviours year round.
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              WHO European review of social determinants of health and the health divide

              The European region has seen remarkable heath gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist. The review reported here, of inequities in health between and within countries across the 53 Member States of the WHO European region, was commissioned to support the development of the new health policy framework for Europe: Health 2020. Much more is understood now about the extent, and social causes, of these inequities, particularly since the publication in 2008 of the report of the Commission on Social Determinants of Health. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed--on the social determinants of health, across the life course, and in wider social and economic spheres--to achieve greater health equity and protect future generations. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                27 September 2019
                October 2019
                : 16
                : 19
                : 3627
                Affiliations
                [1 ]Department of Pediatrics and Child Health, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
                [2 ]Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme at the Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
                [3 ]Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
                [4 ]Winnipeg Trails Association, Winnipeg, MB R3B 0Y6, Canada
                [5 ]The Forks, Winnipeg, MB R3C 4L9, Canada
                [6 ]The Bartlett Centre for Advanced Spatial Analysis, Faculty of the Built Environment, University College London, London WC1E 6BT, UK
                [7 ]Public Health Ontario, 480 University Avenue, Toronto, ON M5G 1V2, Canada
                [8 ]MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
                [9 ]Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
                Author notes
                [* ]Correspondence: jmcgavock@ 123456chrim.ca ; Tel.: +1-204-480-1359
                Author information
                https://orcid.org/0000-0002-3741-5248
                https://orcid.org/0000-0001-6472-0857
                https://orcid.org/0000-0002-8904-0513
                Article
                ijerph-16-03627
                10.3390/ijerph16193627
                6801820
                31569652
                ea11f918-29aa-444d-8880-d08d093b5d73
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 August 2019
                : 23 September 2019
                Categories
                Article

                Public health
                sports and exercise medicine,obesity,epidemiology,public health
                Public health
                sports and exercise medicine, obesity, epidemiology, public health

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