5.3.1 Physical activity
Even though in our studies we included many potential confounders as well as aspects of the environment we were not able to explain more than 16 % of the variation in physical activity. This reflects the multidimensional nature of physical activity behaviour.
Partitioning physical activity into smaller parts may additionally enhance our understanding of physical activity behaviour 127. The potential that accelerometry has for overcoming cultural, linguistic and recall limitations of self-reports together with recent technological improvements makes them suitable for use in large scale studies, and they should in the future be employed to a greater extent than they are today. The immense amount of data which they can capture provides better information about physical activity behaviour. Finally, evidence for the relative importance of frequency, independent of the intensity, of physical activity in relation to health is emerging 128, and this should also receive more attention in future studies.
5.3.2 Physical environment
There is a need to further develop valid and reliable methods for assessing the physical environment’s influence on physical activity. Furthermore, there is a need to study the influence of features of the physical environment on particular physical activity behaviours.
The same feature of the environment that supports walking may not necessarily support leisure time physical activity. Finally, the effects of modifications of the physical environment in relation to physical activity need to be studied. Often there is good opportunity to do so since plans to modify the environment are often discussed during a long time period before they are actually implemented. A better multi-disciplinary collaboration between, for example, decision makers, city planners, architects, health professionals and scientists is also warranted.
6 CONCLUDING REMARKS
The findings show that levels of physical activity varied substantially between groups in society. No particular group could be identified as a potential target for physical activity interventions. A broad approach to physical activity promotion may thus be needed.
The test-retest of the Swedish version of the environmental module showed substantial agreement for most variables. The reproducibility was similar between men and women and ranged from fair to substantial. Questions of a more objective nature produced higher reliability values than questions of a subjective nature.
The different associations observed between the neighbourhood environment and walking and the neighbourhood environment and HEPA illustrates the importance of assessing HEPA as well as the partitioning of physical activity. It is possible that associations may differ (in strength and/or direction) depending on which part of physical activity is assessed. It is of great importance to conduct more research in Sweden so that potential opportunities for physical activity promotion can be identified.
During the congestion road tax, an increase in moderate intensity physical activity, a decrease in reported time spent sitting and an increase in HEPA was observed in the exposed group. This is in accordance with ecological model theories in which a major environmental change may influence physical activity behaviour among those exposed.
This is a promising area for public health promotion.
7 ACKNOWLEDGEMENTS
The road to receiving a PhD is not one that I have travelled alone. I would like to acknowledge a few persons without whose help I never would have reached this far.
From the bottom of my heart I would like to express my gratitude to:
Michael Sjöström, main supervisor; for teaching me all about the world of science Maria Hagströmer, co-supervisor; for all the theoretical and practical physical activity sessions
Andrej M Grjibovski, co-supervisor; for teaching me about epidemiology and the practical side of science
Olle Carlsson, my mentor; for always forcing me to think things through by asking:
- What do you want to know?
Anneli Alexander, co-author on my very first scientific article published; thanks!
Adrian Bauman and Jim Sallis, co-authors; it has been an honour to have worked with both of you. Talk about standing on the shoulder of giants...
Anna (Bergman) Stamblewski, my sister-in-arms during the data collection of IPS I.
Christel Bjarnholt and Sanna Sorasto who did a lot of work during the data collection of IPS II. Thanks for making a boring job fun!
Lydia Kwak and especially to Emma Patterson, there are no words that can express how much you have helped me, thank you!
Eric Poortvliet, for all the discussions regarding statistics or the lack thereof and work on computers, networks, printers and servers
All my very nice colleagues at Prevnut (Olle B, Jonatan, Fran, Nico and Julia) and at Pubnut (Agneta, Jenny, Jonna, Bettina, Sanna, Leif and Mohammed), thank you for these five entertaining years.
Anita Hurtig Wennlöf for discussions about life in general and science in particular.
The Department of Biosciences and Nutrition especially to Ingwar Lennerfors and Lennart Nilsson, and to all the girls at the finance department and to the boys at the IT department
Finally to Kajsa you are everything to me and the times they truly are a-changing. I love you!
The work contained in this thesis was supported by grants from the Swedish National Centre for Research in Sports, the EU commission (DG SANCO) via the funding of the ALPHA project, and the Stockholm County Council.
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