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A search for economic evaluations (trial- or model-based) and costing studies of physical activity mass media campaigns was performed in six electronic databases (June/2021). The authors reviewed studies independently. A GRADE style rating was used to assess the overall certainty of each modelled economic evaluation. Results were summarised via narrative synthesis.

Twenty-five studies (five model-based economic evaluations and 20 costing studies) were included, and all were conducted in high-income countries except for one costing study that was conducted in a middle-income country. The methods and assumptions used in the model-based analyses were highly heterogeneous and the results varied, ranging from the intervention being more effective and less costly (dominant) in two models to an incremental cost of US$130,740 (2020 base year) per QALY gained. The level of certainty of the models ranged from very low (n = 2) to low (n = 3). Overall, intervention costs were poorly reported.

There are few economic evaluations of physical activity mass media campaigns available. The level of certainty of the models was judged to be very low to low, indicating that we have very little to little confidence that the results are reliable for decision making. Therefore, it remains unclear to what extent physical activity mass media campaigns offer good value for money. Future economic evaluations should consider selecting appropriate and comprehensive measures of campaign effectiveness, clearly report the assumptions of the models and fully explore the impact of assumptions in the results.

Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).

A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers' scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at - 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD).

The posterior estimate for the between group difference at follow-up was - 2.3 minutes (95% credible interval = - 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of - 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school.

It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.

The Olympic Games represent an opportunity to create a 'physical activity legacy' that promotes physical activity at the population level in the host nations and cities. However, previous studies showed little increase in population-level physical activity following the Olympics. The upsurge of public interest in sports and physical activity participation before the Olympics may diminish rapidly following the Games. We examined the pre-Games effects of the Olympics on Japanese population-level physical activity after the announcement of Tokyo's successful bid for the 2020 Olympic and Paralympic Games in September 2013.

We used publicly available data from serial cross-sectional surveys conducted with nationally or regionally representative samples in Japan seven years before and after the announcement (from 2006-2020). The outcomes were 1) daily step counts and 2) exercise habit prevalence (≥ 30 min/day, ≥ 2 days/week, and over a year) from the National Health and Nutrition Surveys Japan (NHNS-J; 14 time points; aggregated data); and 3) sports participation (at least once a week) from the National Sports-Life Survey conducted every two years (NSLS; eight time points; individual-level data of 18,867 adults) and from the Public Opinion Survey on Sports Participation of Tokyo Residents (POSSP; eight time points; aggregated data). Age- and gender-adjusted regression models were used to estimate changes in the outcomes before and after the announcement.

There were no significant pre-Games effects of the Olympics on national-level physical activity participation among Japanese adults. Sports participation (56.4% and 57.5%, respectively; P = 0.518), daily steps (6,535 and 6,686 steps/day; P = 0.353), and exercise habit (30.7% and 29.1%, P = 0.309) did not change significantly before and after the announcement. Although an increase in sports participation among Tokyo residents was not found in the NSLS (61.5% and 59.3%, P = 0.227), it was observed in the POSSP (49.1% and 57.7%, P = 0.019). Nonetheless, this increase might not be related to the pre-Games effects since the trend diminished following the announcement.

Population-level physical activity did not show significant changes until 2020. Realising the physical activity legacy of an Olympics may require strategic promotion and cross-agency partnership implementation in the pre- and post-event period.

The number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acute illness severity and ongoing symptoms.

One thousand seventy-seven patients with COVID-19 discharged from hospital between March and November 2020 were recruited. Using a 14-day wear protocol, wrist-worn accelerometers were sent to participants after a five-month follow-up assessment. Acute illness severity was assessed by the WHO clinical progression scale, and the severity of ongoing symptoms was assessed using four previously reported data-driven clinical recovery clusters. Two existing control populations of office workers and individuals with type 2 diabetes were comparators.

Valid accelerometer data from 253 women and 462 men were included. Women engaged in a mean ± SD of 14.9 ± 14.7 min/day of moderate-to-vigorous physical activity (MVPA), with 12.1 ± 1.7 h/day spent inactive and 7.2 ± 1.1 h/day asleep. The values for men were 21.0 ± 22.3 and 12.6 ± 1.7 h /day and 6.9 ± 1.1 h/day, respectively. Over 60% of women and men did not have any days containing a 30-min bout of MVPA. Variability in sleep timing was approximately 2 h in men and women. More severe acute illness was associated with lower total activity and MVPA in recovery. The very severe recovery cluster was associated with fewer days/week containing continuous bouts of MVPA, longer total sleep time, and higher variability in sleep timing. Patients post-hospitalisation with COVID-19 had lower levels of physical activity, greater sleep variability, and lower sleep efficiency than a similarly aged cohort of office workers or those with type 2 diabetes.

Those recovering from a hospital admission for COVID-19 have low levels of physical activity and disrupted patterns of sleep several months after discharge. Our comparative cohorts indicate that the long-term impact of COVID-19 on physical behaviours is significant.