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The study purpose was to assess preliminary validity and reliability of the Physical Education and School Sport Environment Inventory (PESSEI), which was designed to audit physical education (PE) and school sport spaces and resources. PE teachers from eight English secondary schools completed the PESSEI. Criterion validity was assessed by researcher observations of schools' spaces and facilities. To measure test–retest reliability, teachers completed the PESSEI twice within 14 days. Pearson's correlations for teacher and researcher observations ranged from r = .8 through .99. Test–retest reliability was also very high (intraclass correlation coefficients = 0.93 through 1.0). Limits of agreement were acceptable for all variables with the exception of indoor spatial area. Results support the potential of the PESSEI as an objective measure of the school physical environment. To confirm these initial findings, further validity and reliability analyses are required in differing school contexts.

Background Schools are repeatedly utilised as a key setting for health interventions. However, the translation of effective research findings to the school setting can be problematic. In order to improve effective translation of future interventions, it is imperative key challenges and facilitators of implementing health interventions be understood from a school's perspective. Methods Nineteen semi-structured interviews were conducted in primary schools (headteachers n = 16, deputy headteacher n = 1, healthy school co-ordinator n = 2). Interviews were transcribed verbatim and analysed using thematic analysis. Results The main challenges for schools in implementing health interventions were; government-led academic priorities, initiative overload, low autonomy for schools, lack of staff support, lack of facilities and resources, litigation risk and parental engagement. Recommendations to increase the application of interventions into the school setting included; better planning and organisation, greater collaboration with schools and external partners and elements addressing sustainability. Child-centred and cross-curricular approaches, inclusive whole school approaches and assurances to be supportive of the school ethos were also favoured for consideration. Conclusions This work explores schools' perspectives regarding the implementation of health interventions and utilises these thoughts to create guidelines for developing future school-based interventions. Recommendations include the need to account for variability between school environments, staff and pupils. Interventions with an element of adaptability were preferred over the delivery of blanket fixed interventions. Involving schools in the developmental stage would add useful insights to ensure the interventions can be tailored to best suit each individual schools' needs and improve implementation.

ObjectivesYouth obesity has increased substantially in recent decades; however, the potential role of the built environment in mitigating these trends is unclear. This study examines whether more walkable neighbourhoods are associated with lower levels of overweight/obesity for adolescents compared to less walkable neighbourhoods, after considering the potential role of socio-economic and lifestyle characteristics.
MethodsWe examine overweight/obesity levels for all singleton 14 years-old children living in Wales, using the UK Millennium Cohort Study. Children are classified as healthy weight, overweight and obese using international age and sex adjusted cut-offs for body mass index (BMI). The built environment is assessed using the active living environments (ALE) index for 2017-2018 classified into 5 categories (1-low walkability and 5 – high walkability). We apply regression analysis and adjust for children characteristics (e.g., physical activity), parental socio-economic circumstances and lifestyle choices (e.g., maternal education, physical activity).
ResultsWe assess the hypothesis that the built environment is associated with adolescents' overweight/obesity levels and examine how much of this association could be modified by parental socioeconomic circumstances and lifestyle choices. The ALE index is higher in urban compared to rural areas. To capture variations in Wales' population, we are conducting a stratified analysis to explore any differences on the association between ALE index and adolescents' overweight/obesity by urban and rural areas. Accounting for the potential role of lifestyle and socio-economic characteristics is key for future research, as understanding the underlying pathways of this association is necessary to design effective interventions.
ConclusionFindings can help us develop a better understanding of associations between the built environment and overweight/obesity status to inform evidence-based planning policy and practice strategies on how to modify the built environment to promote child health in future generations by increasing better opportunities for diet and activity.

ObjectivesIn Wales almost a quarter of adults and 1 in 8 reception age children are obese. Linked data is a key tool to understanding the role of the built environment on obesity rates and is an important part of developing strategies to combat the obesity epidemic in Wales.
ApproachWe set out to develop an analytical platform for generating evidence on key aspects of the built environment which impact child and adult obesity including; walkability, fast food availability, green space size and qualities, active transport routes and school environments. Utilising the Secure Anonymised Information Linkage (SAIL) Databank We linked multi-sectoral data including routine health data, cohort data, administrative data and linked Geographic Information Systems generated metrics at household and school level. The platform will inform policy makers with and facilitate a better understanding of associations between a range of social, health and built environment factors.
ResultsWe have created a range of built environment variables including temporally and age varying walkability indices, viewable greenspace, garden and house size, access to services and parks for 1.5 million households. In the first instance, as part of the BEACHES project, this data has been linked to several health datasets including the Child Measurement Programme (CMP, n=188,800) where initial results have shown that associations between garden size and Body Mass Index in children displays a non-linear negative correlation. We have also created follow-up measures for the CMP using routinely collected general practice data which further enables linking 28,389 height and weight measurements. However, potential bias in these follow-up measures is poorly understood with further work being undertaken to assess usability.
ConclusionThe integrated multi-sectoral data platform approach to linking environmental, administrative, health and cohort data aims to develop insights on a range of public health issues. We are working with a range of stakeholders to develop evidence-based policy initiatives to reduce obesity in Wales.

IntroductionGreen-blue spaces (GBS), such as parks, woodlands, and beaches, may be beneficial for population mental health and wellbeing. However, there are few longitudinal studies on the association between GBS and mental health and wellbeing, and few that incorporate network analysis as opposed to simple Euclidian proximity.
Objectives and ApproachWe are examining the association between the availability of GBS with wellbeing and common mental health disorders. We will use geographic information systems (GIS) to create quarterly household level GBS availability data using digital map and satellite data (2008-2018) for over 1 million homes in Wales, United Kingdom. We will link GBS availability to individual level mental health (1.7 million people with General Practitioner (GP) data) and data from the National Survey for Wales (n = 24,000) on wellbeing (Warwick Edinburgh Mental Wellbeing Scale (WEMWBS)) using the Secure Anonymised Information Linkage (SAIL) databank.
ResultsWe created an historic dataset of GBS availability using road network and path data to create quarterly household level GBS exposures (2008-2018). We tested Residential Anonymised Linking Fields (RALFs) and accurately linked 97\% of individuals and their health data to their home and GBS exposure. The 1.65 million exposure-health data pairs, updated quarterly, will enable a longitudinal panel study to be built. Using GP recorded data on treatments, diagnoses, symptoms and prescriptions for mental health problems we identified 35,000 people had a common mental health disorder in 2016, and 24,000 people answered the National Survey for Wales questions about their wellbeing and use of GBS. We will explore how house moves, and visits to GBS change the association between GBS availability and outcomes.
Conclusion/ImplicationsThis study fills the gap in the evidence base around environmental planning policy to shape living environments to benefit health. It will inform the planning and management of GBS in urban and rural environments and contribute to international work on impacts of the built environment on mental health and wellbeing.

IntroductionA growing evidence base indicates health benefits are associated with access to green-blue spaces (GBS), such as beaches and parks. However, few studies have examined associations with changes in access to GBS over time.
Objectives and ApproachWe have linked cross-sector data collected within Wales, United Kingdom, quarterly from 2008 to 2019, to examine the impact of GBS access on individual-level well-being and common mental health disorders (CMD). We created a longitudinal dataset of GBS access metrics, derived from satellite and administrative data sources, for 1.4 million homes in Wales. These household-level metrics were linked to individuals using the Welsh Demographic Service Dataset within the Secure Anonymised Information Linkage (SAIL) Databank. Linkage to Welsh Longitudinal General Practice data within SAIL enabled us to identify individual-level CMD over time. We also linked individual-level self-reported GBS use and well-being data from the National Survey for Wales (NSW) to routine data for cross-sectional survey participants.
ResultsWe created a longitudinal cohort panel capturing all 2.84 million adults aged 16+ living in Wales between 2008 and 2019 and with a general practitioner (GP) registration. Individual-level health data and household-level environmental metrics were linked for each quarter an individual is in the study. Household addresses were linked to 97% of the cohort, creating 110+ million rows of anonymously linked cross-sector data. The cohort provides an average follow-up period of 8 years, during which 565,168 (20%) adults received at least one CMD diagnosis or symptom.
Conclusion / ImplicationsThis example of multi-sectoral data linkage across multiple environmental and administrative data sources has created a rich data source, which we will use toquantify the impact of changes in GBS access on individual–level CMD and well-being. This evidence will inform policy in the areas of health, planning and the environment.

IntroductionGreen and blue spaces (GBS), such as parks, woodlands, rivers, and beaches, are thought to be important for mental health and wellbeing. Our longitudinal cohort contains objective household-level environment data linked at the invidual level to routinely recorded mental health data, augmented with cross sectional self-reported health behaviours, including leisure visits to the outdoors.
Objectives and ApproachOur overall approach will evaluate if residential proximity to GBS is associated with mental health and wellbeing, and if any associations aremodified by visits to outdoors spaces following individual-level data linkage. Here, we examined cross-sectional survey data on time spent visiting nature outdoors. Wellbeing outcomes were assessed using self-reported scores. Data were analysed using generalised additive models in the SAIL Databank.
ResultsUsing a sample of National Survey for Wales respondents (2016/17, n=3,481), over 40% of adults in Wales reported spending less than 30 minutes outdoors each week. Weekly time outdoors was positively associated with wellbeing (p=0.007) and life satisfaction (p=0.03) having adjusted for potential confounders including, age, rurality, loneliness, employment status. Confidence intervals varied along the fitted GAM model. Models using a second wave of survey data (n≈7,000), anonymously record-linked to residential environment and health data will explore these associations further.
ConclusionA previous study based in England (White et al. 2019) found an upper wellbeing benefit threshold of 2 hours per week for time spent in nature. This was not apparent in our preliminary models, but may be revealed in further analyses. We will next incorporate longitudinal mental health and environmental data for 2 million adults living in Wales, UK. Linking to ambient and accessible residential GBS, while taking into account changes due to migration and actual visits, will allow us to provide valuable guidance to local government, who are often responsible for provisioning and maintaining outdoor facilities.

14/191) and University of Auckland Faculty Research Development Fund. The Cambridge Weight Plan© donated all products for the 8-week LED period. The Danish Agriculture & Food Council. The Danish Meat and Research Institute. National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK). Engineering and Physical Sciences Research Council (EPSRC) (UK). Nutritics (Dublin) donated all dietary analyses software used by UNOTT. Juho Vainio Foundation (FIN), Academy of Finland (grant numbers: 272376, 314383, 266286, 314135), Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, Finnish Diabetes Research Foundation, University of Helsinki, Government Research Funds for Helsinki University Hospital (FIN), Jenny and Antti Wihuri Foundation (FIN), Emil Aaltonen Foundation (FIN). China Scholarship Council. ; Plant-based diets are recommended by dietary guidelines. This secondary analysis aimed to assess longitudinal associations of an overall plant-based diet and specific plant foods with weight-loss maintenance and cardiometabolic risk factors. Longitudinal data on 710 participants (aged 26–70 years) with overweight or obesity and pre-diabetes from the 3-year weight-loss maintenance phase of the PREVIEW intervention were analyzed. Adherence to an overall plant-based diet was evaluated using a novel plant-based diet index, where all plant-based foods received positive scores and all animal-based foods received negative scores. After adjustment for potential confounders, linear mixed models with repeated measures showed that the plant-based diet index was inversely associated with weight regain, but not with cardiometabolic risk factors. Nut intake was inversely associated with regain of weight and fat mass and increments in total cholesterol and LDL cholesterol. Fruit intake was inversely associated with increments in diastolic blood pressure, total cholesterol, and LDL cholesterol. Vegetable intake was inversely associated with an increment in diastolic blood pressure and triglycerides and was positively associated with an increase in HDL cholesterol. All reported associations with cardiometabolic risk factors were independent of weight change. Long-term consumption of nuts, fruits, and vegetables may be beneficial for weight management and cardiometabolic health, whereas an overall plant-based diet may improve weight management only. ; publishersversion ; published

Funding: Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. This research was supported by the EU Seventh Framework Programme (FP7; 2007– 2013) (grant no. 312057); National Health and Medical Research Council (EU Collaborative Grant AUS 8, ID 1067711); Glycemic Diabetologia Index Foundation Australia through royalties to the University of Sydney; Health Research Council of New Zealand (grant no. 14/191) and University of Auckland Faculty Research Development Fund; Cambridge Weight Plan, which donated all products for the 8 week weight loss period; Danish Agriculture & Food Council; Danish Meat Research Institute; National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK); Biotechnology and Biological Sciences Research Council (BBSRC) (UK); Engineering and Physical Sciences Research Council (EPSRC) (UK); Nutritics (Dublin), which donated all dietary analysis software used by the University of Nottingham; Juho Vainio Foundation (Finland); Academy of Finland (grant nos 272376, 314383, 266286 and 314135); Finnish Medical Foundation; Gyllenberg Foundation (Finland); Novo Nordisk Foundation; Finnish Diabetes Research Foundation; University of Helsinki; Government Research Funds for Helsinki University Hospital; Jenny and Antti Wihuri Foundation (Finland); Emil Aaltonen Foundation (Finland); and China Scholarship Council. The funders were not involved in the design of the study, the collection, analysis and interpretation of the data or writing of the report and did not impose any restrictions regarding the publication of the report. ; AIMS/HYPOTHESIS: Lifestyle interventions are the first-line treatment option for body weight and cardiometabolic health management. However, whether age groups or women and men respond differently to lifestyle interventions is under debate. We aimed to examine age- and sex-specific effects of a low-energy diet (LED) followed by a long-term lifestyle intervention on body weight, body composition and ...

14/191) and University of Auckland Faculty Research Development Fund. The Cambridge Weight Plan© donated all products for the 8-weeks LED period. The Danish Agriculture & Food Council. The Danish Meat and Research Institute. National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK). Engineering and Physical Sciences Research Council (EPSRC) (UK). Nutritics (Dublin) donated all dietary analyses software used by UNOTT. Juho Vainio Foundation (FIN), Academy of Finland (grant numbers: 272376, 314383, 266286, 314135), Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, Finnish Diabetes Research Foundation, University of Helsinki, Government Research Funds for Helsinki University Hospital (FIN), Jenny and Antti Wihuri Foundation (FIN), Emil Aaltonen Foundation (FIN). China Scholarship .The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. ; Background: Previous studies have shown an increase in hunger during weight-loss maintenance (WLM) after diet-induced weight loss. Whether a combination of a higher protein, lower glycemic index (GI) diet and physical activity (PA) can counteract this change remains unclear. Aim: To compare the long-term effects of two diets [high protein (HP)-low GI vs. moderate protein (MP)-moderate GI] and two PA programs [high intensity (HI) vs. moderate intensity (MI)] on subjective appetite sensations during WLM after ≥8% weight loss (WL). Methods: Data derived from the 3-years PREVIEW randomized intervention study. An 8-weeks WL phase using a low-energy diet was followed by a 148-weeks randomized WLM phase. For the WLM phase, participants were assigned to one of the four groups: HP-MI, HP-HI, MP-MI, and MP-HI. Available data from 2,223 participants with overweight or obesity (68% women; BMI ≥ 25 kg/m2). Appetite sensations including satiety, hunger, desire to eat, and desire to eat something sweet during the two phases (at 0, 8 weeks and 26, 52, 104, and 156 weeks) were assessed based on the recall of feelings during the previous week using visual analogue scales. Differences in changes in appetite sensations from baseline between the groups were determined using linear mixed models with repeated measures. Results: There was no significant diet × PA interaction. From 52 weeks onwards, decreases in hunger were significantly greater in HP-low GI than MP-moderate GI (Ptime × diet = 0.018, Pdietgroup = 0.021). Although there was no difference in weight regain between the diet groups (Ptime × diet = 0.630), hunger and satiety ratings correlated with changes in body weight at most timepoints. There were no significant differences in appetite sensations between the two PA groups. Decreases in hunger ratings were greater at 52 and 104 weeks in HP-HI vs. MP-HI, and greater at 104 and 156 weeks in HP-HI vs. MP-MI. Conclusions: This is the first long-term, large-scale randomized intervention to report that a HP-low GI diet was superior in preventing an increase in hunger, but not weight regain, during 3-years WLM compared with a MP-moderate GI diet. Similarly, HP-HI outperformed MP-HI in suppressing hunger. The role of exercise intensity requires further investigation. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01777893. ; publishersversion ; published

The Active Healthy Kids Global Alliance organized the concurrent preparation of Report Cards on the physical activity of children and youth in 38 countries from 6 continents (representing 60% of the world's population). Nine common indicators were used (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and the Built Environment, and Government Strategies and Investments), and all Report Cards were generated through a harmonized development process and a standardized grading framework (from A = excellent, to F = failing). The 38 Report Cards were presented at the International Congress on Physical Activity and Public Health in Bangkok, Thailand on November 16, 2016. The consolidated findings are summarized in the form of a Global Matrix demonstrating substantial variation in grades both within and across countries. Countries that lead in certain indicators often lag in others. Average grades for both Overall Physical Activity and Sedentary Behavior around the world are D (low/poor). In contrast, the average grade for indicators related to supports for physical activity was C. Lower-income countries generally had better grades on Overall Physical Activity, Active Transportation, and Sedentary Behaviors compared with higher-income countries, yet worse grades for supports from Family and Peers, Community and the Built Environment, and Government Strategies and Investments. Average grades for all indicators combined were highest (best) in Denmark, Slovenia, and the Netherlands. Many surveillance and research gaps were apparent, especially for the Active Play and Family and Peers indicators. International cooperation and cross-fertilization is encouraged to address existing challenges, understand underlying determinants, conceive innovative solutions, and mitigate the global childhood inactivity crisis. The paradox of higher physical activity and lower sedentary behavior in countries reporting poorer infrastructure, and lower physical activity and higher sedentary behavior in countries reporting better infrastructure, suggests that autonomy to play, travel, or chore requirements and/or fewer attractive sedentary pursuits, rather than infrastructure and structured activities, may facilitate higher levels of physical activity.