Grant Schofield

Bio: Grant Schofield is an academic researcher from Auckland University of Technology. The author has contributed to research in topics: Overweight & Population. The author has an hindex of 52, co-authored 242 publications receiving 9455 citations.

How many steps/day are enough? for adults

Abstract: Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day.

Physical activity in preschoolers: understanding prevalence and measurement issues.

Abstract: Accurate physical activity quantification in preschoolers is essential to establish physical activity prevalence, dose-response relationships between activity and health outcomes, and intervention effectiveness. To date, best practice approaches for physical activity measurement in preschool-aged children have been relatively understudied. This article provides a review of physical activity measurement tools for preschoolers, an overview of measurement of preschoolers' physical activity, and directions for further research. Electronic and manual literature searches were used to identify 49 studies that measured young children's physical activity, and 32 studies that assessed the validity and/or reliability of physical activity measures with preschool-aged children. While no prevalence data exist, measurement studies indicate that preschool children exhibit low levels of vigorous activity and high levels of inactivity, boys are more active than girls, and activity patterns tend to be sporadic and omnidirectional. As such, measures capable of capturing differing activity intensities in very short timeframes and over multiple planes are likely to have the most utility with this population. Accelerometers are well suited for this purpose, and a number of models have been used to objectively quantify preschoolers' physical activity. Only one model of pedometer has been investigated for validity with preschool-aged children, showing equivocal results. Direct observation of physical activity can provide detailed contextual information on preschoolers' physical activity, but is subjective and impractical for understanding daily physical activity. Proxy-report questionnaires are unlikely to be useful for determining actual physical activity levels of young children, and instead may be useful for identifying potential correlates of activity. Establishing validity is challenging due to the absence of a precise physical activity measure, or 'criterion', for young children. Both energy expenditure (EE) and direct observation have been considered criterion measures in the literature; however, EE is influenced by multiple variables, so its use as a physical activity 'criterion' is not ideal. Also, direct observation is inherently subjective, and coding protocols may result in failure to capture intermittent activity, thereby limiting its utility as a physical activity criterion. Accordingly, these issues must be taken into account where EE or direct observation are used to validate physical activity instruments. A combination of objective monitoring and direct observation may provide the best standard for the assessment of physical activity measurement tools. Ideally, the convergent validity of various physical activity tools should be investigated to determine the level of agreement between currently available measures. The correlational approaches commonly employed in the assessment of physical activity measures do not reveal this relationship, and can conceal potential bias of either measure.

Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing

Abstract: A number of studies find that religious people are happier than non-religious ones. Yet a number of fundamental questions about that relationship remain unanswered. A critical one is the direction of causality: does religion make people happier or are happier people more likely to have faith in something that is beyond their control? We posit that the relationship between religion and wellbeing is mediated by factors ranging from intrinsic purpose, to its social aspects, to its role as an insurance mechanism for people who face great adversity. We explore a number of related questions, using world-wide data from the Gallup World Poll. As these data are cross- section data, we cannot establish causality; we do, however, explore: how or if the relationship between religion and wellbeing varies across the two distinct wellbeing dimensions (hedonic and evaluative); how social externalities mediate the relationship; how the relationship changes as countries and people within them become more prosperous and acquire greater means and agency; and how the relationship between religion and wellbeing varies depending on where respondents are in the wellbeing distribution. We find that the positive relation between religion and evaluative wellbeing is more important for respondents with lower levels of agency, while the positive relation with hedonic wellbeing holds across the board. The social dimension of religion is most important for the least social respondents, while the religiosity component of religion is most important for the happiest respondents, regardless of religious affiliation or service attendance. As such, it seems that the happiest are most likely to seek social purpose in religion, the poorest are most likely to seek social insurance in religion, and the least social are the most likely to seek social time in religion.

Transport, urban design, and physical activity: an evidence-based update

Abstract: The urban environment and modes of transport are increasingly being linked to physical activity participation and population health outcomes. Much of the research has been based on either health or urban design paradigms, rather than from collaborative approaches. Previous health reviews in the urban design area have been constrained to perceptions of the neighborhood or walking behaviors, consequently limiting the understanding of built environment influences on physical activity modalities. This review focuses on existing evidence surrounding various urban design factors and physical activity behaviors. Based on the available evidence, fostering suitable urban environments is critical to sustaining physical activity behaviors. In turn, these environments will provide part of the solution to improving population health outcomes. Key urban design features attributable to transport-related physical activity are density, subdivision age, street connectivity, and mixed land use. Future directions for research include consistent use of transport and health measurement tools, an enhanced understanding of traffic calming measures, and further collaborative work between the health, transport, and urban design sectors. Presenting these findings to transport and urban design audiences may influence future practice, thereby increasing the sustainability of health-related physical activity at the population level.

Travel and the Built Environment

Abstract: Problem: Localities and states are turning to land planning and urban design for help in reducing automobile use and related social and environmental costs. The effects of such strategies on travel demand have not been generalized in recent years from the multitude of available studies. Purpose: We conducted a meta-analysis of the built environment-travel literature existing at the end of 2009 in order to draw generalizable conclusions for practice. We aimed to quantify effect sizes, update earlier work, include additional outcome measures, and address the methodological issue of self-selection. Methods: We computed elasticities for individual studies and pooled them to produce weighted averages. Results and conclusions: Travel variables are generally inelastic with respect to change in measures of the built environment. Of the environmental variables considered here, none has a weighted average travel elasticity of absolute magnitude greater than 0.39, and most are much less. Still, the combined effect o...

Interventions for preventing falls in older people living in the community

Abstract: As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall in a year. Although one in five falls may require medical attention, less than one in 10 results in a fracture. This review looked at the healthcare literature to establish which fall prevention interventions are effective for older people living in the community, and included 159 randomised controlled trials with 79,193 participants. Group and home-based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures. Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined. Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls. Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment. Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure. In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling. The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Interventions for preventing obesity in children

Abstract: The current evidence suggests that many diet and exercise interventions to prevent obesity in children are not effective in preventing weight gain, but can be effective in promoting a healthy diet and increased physical activity levels.Being very overweight (obese) can cause health, psychological and social problems for children. Children who are obese are more likely to have weight and health problems as adults. Programmes designed to prevent obesity focus on modifying one or more of the factors considered to promote obesity.This review included 22 studies that tested a variety of intervention programmes, which involved increased physical activity and dietary changes, singly or in combination. Participants were under 18 and living in Asia, South America, Europe or North America. There is not enough evidence from trials to prove that any one particular programme can prevent obesity in children, although comprehensive strategies to address dietary and physical activity change, together with psycho-social support and environmental change may help. There was a trend for newer interventions to involve their respective communities and to include evaluations.Future research might usefully assess changes made on behalf of entire populations, such as improvements in the types of foods available at schools and in the availability of safe places to run and play, and should assess health effects and costs over several years.The programmes in this review used different strategies to prevent obesity so direct comparisons were difficult. Also, the duration of the studies ranged from 12 weeks to three years, but most lasted less than a year.