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Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

Background Healthy lifestyle behaviours are effective means to reduce the burden of diseases. This study was aimed to fill the knowledge gaps on the distribution, associated factors, and potential health benefits on mortality of four healthy lifestyle behaviours in China. Methods During 2015–2019, participants aged 35–75 years from 31 provinces were recruited by the China PEACE Million Persons Project. Four healthy lifestyle behaviours were investigated in our study, including non-smoking, none or moderate alcohol use, sufficient leisure time physical activity (LTPA), and healthy diet. Results Among 903,499 participants, 74.1% were non-smokers, 96.0% had none or moderate alcohol use, 23.6% had sufficient LTPA, 11.1% had healthy diet, and only 2.8% had all the four healthy lifestyle behaviours. The adherence varied across seven regions; the highest median of county-level adherence to all the four healthy lifestyle behaviours was in North China (3.3%) while the lowest in the Southwest (0.8%) ( p  < 0.05). Participants who were female, elder, non-farmers, urban residents, with higher income or education, hypertensive or diabetic, or with a cardiovascular disease (CVD) history were more likely to adhere to all the four healthy lifestyle behaviours ( p  < 0.001). County-level per capital Gross Domestic Product (GDP) was positively associated with sufficient LTPA ( p  < 0.05 for both rural and urban areas) and healthy diet ( p  < 0.01 for urban areas), while negatively associated with none or moderate alcohol use (p < 0.01 for rural areas). Average annual temperature was negatively associated with none or moderate alcohol use ( p  < 0.05 for rural areas) and healthy diet ( p  < 0.001 for rural areas). Those adhering to all the four healthy lifestyle behaviours had lower risks of all-cause mortality (HR 0.64 [95% CI: 0.52, 0.79]) and cardiovascular mortality (HR 0.53 [0.37, 0.76]) after a median follow-up of 2.4 years. Conclusions Adherence to healthy lifestyle behaviours in China was far from ideal. Targeted health promotion strategies were urgently needed.

Background Research has suggested the positive impact of physical activity on health and wellbeing in older age, yet few studies have investigated the associations between physical activity and heterogeneous trajectories of healthy ageing. We aimed to identify how physical activity can influence healthy ageing trajectories using a harmonised dataset of eight ageing cohorts across the world. Methods Based on a harmonised dataset of eight ageing cohorts in Australia, USA, Mexico, Japan, South Korea, and Europe, comprising 130,521 older adults ( M age  = 62.81, SD age  = 10.06) followed-up up to 10 years ( M follow-up  = 5.47, SD follow-up  = 3.22) , we employed growth mixture modelling to identify latent classes of people with different trajectories of healthy ageing scores, which incorporated 41 items of health and functioning. Multinomial logistic regression modelling was used to investigate the associations between physical activity and different types of trajectories adjusting for sociodemographic characteristics and other lifestyle behaviours. Results Three latent classes of healthy ageing trajectories were identified: two with stable trajectories with high (71.4%) or low (25.2%) starting points and one with a high starting point but a fast decline over time (3.4%). Engagement in any level of physical activity was associated with decreased odds of being in the low stable (OR: 0.18; 95% CI: 0.17, 0.19) and fast decline trajectories groups (OR: 0.44; 95% CI: 0.39, 0.50) compared to the high stable trajectory group. These results were replicated with alternative physical activity operationalisations, as well as in sensitivity analyses using reduced samples. Conclusions Our findings suggest a positive impact of physical activity on healthy ageing, attenuating declines in health and functioning. Physical activity promotion should be a key focus of healthy ageing policies to prevent disability and fast deterioration in health.

Summary Background The COVID‐19 crisis is likely to have had wide‐ranging consequences on lifestyle behaviours and may have affected weight management. The objective of the present study was to examine perceptions of how weight‐related lifestyle changed in social lockdown among UK adults compared with before the emergence of the COVID‐19 crisis. Methods As part of an online cross‐sectional survey conducted during social lockdown in the United Kingdom, 723 UK adults reported on the extent to which their eating (healthiness of diet, frequency of bingeing on food), physical activity, sleep and alcohol consumption had changed since the emergence of the COVID‐19 crisis and completed measures of current psychological well‐being. Results Although both improvements and declines in weight gain protective behaviours were reported, 79% of participants reported a decline in one or more weight gain protective behaviours. Both participants with a diagnosis of psychiatric illness or obesity (body mass index [BMI] ≥ 30) were most likely to report declines in weight gain protective behaviours and show an overall profile of weight management behaviours worsening. Participants experiencing high levels of stress also reported reductions in more weight gain protective behaviours. Conclusions Lifestyle behaviours associated with weight gain are likely to have been affected by the COVID‐19 crisis. Reductions to the perceived frequency by which people engage in behaviours usually associated with successful weight management appear to be common, and people living with obesity and mental health problems may be at increased risk.

Objective:To evaluate nutrition literacy status and its association with adherence to the Mediterranean diet (MD), anthropometric parameters and lifestyle behaviours among early adolescents.Design:This is a cross-sectional study. Nutrition literacy was evaluated using the ‘Adolescent Nutrition Literacy Scale’. Dietary intake was assessed by 24-h food recall. The ‘Mediterranean Diet Quality Index’ was used to evaluate adolescents’ adherence to the MD. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Body weight, height, waist, hip and neck circumference were measured.Setting:Four secondary schools in İzmir, TürkiyeParticipants:The study included 1074 secondary school students.Results:Adolescents’ nutrition literacy was at a moderate level. Nutrition literacy scores were significantly lower in those who skip main meals. Adolescents with high nutrition literacy had higher intakes of fibre, protein, protein, Ca, K, Mg, P, vitamin C, folate and Fe intake than those with low and moderate nutrition literacy (P < 0·05). According to IPAQ, active adolescents had higher nutrition literacy scores than inactive adolescents. There was no significant difference in BMI and anthropometric measurements of the adolescents according to their nutrition literacy level. Linear regression analysis showed that each unit increase in nutrition literacy increased adherence to the MD by 0·286 points (β = 0·286) and decreased total screen time by 0·182 points (β = –0·182).Conclusions:These findings showed that nutrition literacy among early adolescents was not optimal, and a higher nutrition literacy score was significantly associated with higher MD adherence, and healthy eating habits and lifestyle behaviours.

Background Unhealthy lifestyle behaviours are becoming increasingly common and might contribute to the growing burden of mental disorders in adolescence. We examined the associations between a comprehensive set of lifestyle behaviours and depression and anxiety in middle adolescents. Methods School-based survey responses were collected from 24,274 Canadian high school students at baseline and 1-year follow-up (average age 14.8 and 15.8 years, respectively). Using linear mixed-effects models, we examined prospective associations of adherence to recommendations for vegetables and fruit, grains, milk and alternatives, meat and alternatives, sugar-sweetened beverages [SSB], physical activity, screen time, sleep, and no use of tobacco, e-cigarettes, cannabis, and binge drinking at baseline with the depressive and anxiety symptoms (measured by CESD-R-10 and GAD-7 scales, respectively) at follow-up. Results Adherence to recommendations was low overall, particularly for vegetables and fruit (3.9%), grains (4.5%), and screen time (4.9%). Students adhering to individual recommendations, particularly for meat and alternatives, SSB, screen time, sleep, and no cannabis use, at baseline had lower CESD-R-10 and GAD-7 scores at follow-up. Adhering to every additional recommendation was associated with lower CESD-R-10 (β=-0.15, 95% CI -0.18, -0.11) and GAD-7 scores (β=-0.10, 95% CI -0.14, -0.07) at follow-up. Assuming cumulative impact, this might translate into 7.2- and 4.8-point lower CESD-R-10 and GAD-7 scores, respectively, among students adhering to 12 vs. 0 recommendations over four years of high school. Conclusions The results highlight the preventive potential of population-based approaches promoting healthy lifestyle behaviours, particularly those with the lowest prevalence, as a strategy to improve mental health in adolescence.

Background and Purpose Healthy lifestyle behaviour modification may improve health outcomes in people with multiple sclerosis (pwMS), but empirical evidence is needed to confirm prior study findings. We developed an online multimodal lifestyle intervention (Multiple Sclerosis Online Course) to examine the impact of lifestyle modification on health outcomes in pwMS via a randomized control trial (RCT). However, the present study specifically analyses baseline data to assess engagement with healthy lifestyles by RCT participants and cross‐sectional associations with health outcomes. Methods Baseline engagement with six “healthy lifestyle behaviours” of the intervention course (high‐quality, plant‐based diet; ≥5000 IU/day vitamin D; omega‐3 supplementation; ≥30 min physical activity 5 times/week; ≥30 min/week meditation; and nonsmoking) was examined. Associations between individual versus collective behaviours (individual behaviours summated) and health outcomes (quality of life [QoL]/fatigue/disability) were evaluated using multivariate modelling (linear/log‐binomial/multinomial). Results At baseline, 33.7% and 30.0% of participants (n = 857) engaged in one or two healthy behaviours, respectively. In total, engagement with healthy lifestyles by participants was as follows: nonsmoking, 90.7%; omega‐3 supplementation, 34.5%; vitamin D supplementation, 29.8%; physical activity, 29.4%; diet, 10.7%; and meditation, 10.5%. Individual behaviours (nonsmoking/physical activity/diet) were independently associated with better health outcomes. Engagement with multiple behaviours, especially diet and physical activity, was associated with better outcomes; engaging with ≥4 behaviours was associated with a 9.0‐point higher mental QoL and a 9.5‐point higher physical QoL, as well as 23% and 56% lower prevalence of fatigue and moderate disability, respectively. Conclusions Baseline engagement with ≥4 healthy behaviours, including diet and physical activity, was associated with better health outcomes.

Sedentary behaviour is an independent risk factor for cardiovascular disease. In healthy adults, prolonged uninterrupted sitting acutely increases blood pressure (BP) and aortic stiffness; however, these effects can be mitigated with light physical activity interruptions. Whether such mitigation strategies are effective in at‐risk populations remains unclear. This study examined the effects of uninterrupted and interrupted sitting on BP and arterial stiffness, measured by carotid‐femoral pulse wave velocity (cfPWV), and femoral‐ankle PWV in patients with established coronary heart disease (CHD). Using a randomised cross‐over design, 14 CHD patients sat for 2 h uninterrupted (control [CON]), and 2 h interrupted with light physical activity (sit‐to‐stand, calf raises and walking) breaks every 30 min (ACT). Brachial BP and cfPWV were assessed immediately pre‐ and post‐sitting. Time‐by‐condition effects were tested using linear mixed effects models with baseline adjustments. A significant time × condition interaction effect was detected for systolic BP ( P  = 0.037) with an increase in CON (mean difference [MD] = 15 mmHg [95% CI: 8, 23], P  < 0.001) but not ACT (MD = 4 mmHg [95% CI: −4, 11], P  = 0.334). A significant time effect was detected for cfPWV, with an increase across both CON and ACT conditions (MD = 0.76 m/s [95% CI: 0.52, 0.99], P  < 0.001). For CHD patients, light activity breaks every 30 min can attenuate the impact of prolonged sitting on BP but not arterial stiffness; higher frequency or intensity of activity breaks may be required for better preservation of cardiovascular function. What is the central question of this study? Do simple light physical activity interruptions attenuate the detrimental responses to 2 h prolonged sitting on blood pressure and arterial stiffness in a population with established coronary heart disease? What is the main finding and its importance? Light physical activity interruptions appear sufficient to reduce blood pressure in patients with established coronary heart disease. However, higher intensity, more frequent interruptions may be necessary to fully attenuate its impact on arterial stiffness.

Introduction University years represent a crucial period in a student’s life, with mounting pressures on mental health and the formation of lifestyle habits that may endure into adulthood. This study examined the associations between movement and dietary behaviours and mental health among university students. It further explored potential sex-specific differences in these associations. Methods This cross-sectional study used data (2020–2022) from the Health@NUS prospective cohort study. Six behaviours—moderate-to-vigorous physical activity (MVPA), sedentary behaviour, sleep duration, and intake of fruit, vegetables, and unhealthy food—were assessed and categorised as either healthy or unhealthy based on established guidelines. Mental health was measured using the 6-item Kessler Psychological Distress Scale and the 5-item World Health Organisation Well-Being Index. Multivariable linear regression was used to analyse the associations between the behaviours and mental health, and to evaluate effect modification by sex. Results Among 773 students (mean age 22.7 years, 56.8% female), 23.3% engaged in 4–6 healthy behaviours; 14.1% and 37.7% reported high distress and poor well-being, respectively. Compared to students engaging in 0–1 healthy behaviours, those engaging in 2 or more healthy behaviours reported less distress and greater well-being. Students who engaged in 4–6 behaviours reported the lowest distress (females: -1.51, 95% CI -2.75, -0.27; males: -1.72, 95% CI -3.06, -0.39) and the best well-being (females: 10.66, 95% CI 6.04, 15.23; males: 9.98, 95% CI 6.04, 15.23). For individual behaviours, adequate sleep and less intake of unhealthy foods were associated with both less distress and better mental well-being, whereas sufficient MVPA and less sedentary behaviour were associated with better well-being. Additionally, among female students, less sedentary behaviour and unhealthy food intake were associated with better well-being. Conclusions The more healthy movement and dietary behaviours that students engaged in, the better their reported mental health outcomes. The type of behaviour and sex also appear to play a role. These findings highlight the need for interventions addressing both lifestyle behaviours and mental health in university students, potentially using sex-tailored strategies. Clinical trial number NCT05154227 (registered on 16 September 2021; https://www.clinicaltrials.gov/)

BackgroundBased on models of cross-behavioural associations and the role of past behaviour in predicting behaviour, an association was hypothesized between healthy lifestyle behaviours prior to the COVID-19 pandemic and adherence to coronavirus protective behaviours. Self-assessed health was also examined as a potential moderator.MethodsA cross-sectional sample (N = 463) completed online questionnaires during a COVID-19-related lockdown that measured engagement in healthy lifestyle behaviours (e.g., exercising and eating fruits and vegetables), adherence to coronavirus protective behaviours (e.g., wearing a face mask and practicing social distancing), and self-assessed health (subjective evaluation of overall health).ResultsAs predicted, higher engagement in healthy lifestyle behaviours prior to the pandemic was significantly correlated with higher adherence to coronavirus protective behaviours (Pearson r(459) = .308, p < .001). Adherence levels were higher than engagement in healthy lifestyle behaviours, and self-assessed health was related to the latter but not to the former. Moderation was examined using model 1 in PROCESS for SPSS; as expected, the association was stronger among individuals with higher levels of self-assessed health (coefficient 95% CI [.04, .20]).ConclusionsThe findings highlight cross-behavioural facilitating processes, specifically between lifestyle behaviours and adherence to recommended protective behaviours during the pandemic. They also draw attention to the need to address individuals whose poorer evaluations of their general health might prevent them from implementing their behavioural intentions.