Objective . To analyse patients ' self-reported reasons for not adhering to physical activity referrals (PARs). Design and setting . Data on 1358 patients who did not adhere to PARs were collected at 38 primary health care (PHC) centres in Sweden. Intervention . PHC providers issued formal physical activity prescriptions for home-based activities or referrals for facilitybased activities. Subjects . Ordinary PHC patients whom regular staff believed would benefi t from increased physical activity. Main outcome measure: Reasons for non-adherence to PARs: " sickness " , " pain " , " low motivation " , " no time " , " economic factors " , and " other " . Results . Sickness and pain were the most common motives for non-adherence among older patients. The youngest patients blamed economic factors and lack of time more frequently than those in the oldest age group. Economic factors was a more common reason for non-adherence among those referred for facility-based activities compared with those prescribed home-based activities. Low motivation was a more frequent cause of non-adherence among those prescribed home-based activities compared with those referred for facility-based activities. Furthermore, lack of time was a more common reason for non-adherence among patients issued with PARs due to high blood pressure than other patients, while low motivation was a more common reason among patients issued with PARs because of a BMI of Ͼ 25. Conclusion . The reasons for non-adherence differ between patients prescribed home-based activities and referred for facility-based activities, as well as between patients with different specifi c characteristics. The information obtained may be valuable not only for the professionals working in PHC, but also for those who work to develop PARs for use in different contexts.

Background: Despite a strong social gradient in the prevalence of obesity, there is little scientific understanding of obesity in people settled in deprived neighbourhoods. Few studies are actually based on objectively measured data using random sampling of residents in deprived neighbourhoods. In addition, most studies use a crude measure, the body mass index, to estimate obesity. This is of concern because it may cause inaccurate estimations of the true prevalence and give the wrong picture of the factors associated with obesity. The aim of this study was to estimate the prevalence of, and analyse the sociodemographic factors associated with, three indices of obesity in different ethnic groups settled in two deprived neighbourhoods in Sweden.

There is a substantial and growing burden of premature mortality caused by non-communicable diseases (NCDs) globally. This paper evaluates the preventive efforts of the WHO European Healthy Cities Network during its fifth phase (2009-13), specifically for four behavioural risk factors (tobacco use, alcohol abuse, unhealthy diet and physical inactivity). Drawing on case studies, questionnaire responses and other materials, it notes which cities were involved, what worked and did not, the triggers for action, challenges met and lessons learnt. Few cities appeared to have taken comprehensive approaches to NCD prevention across multiple risk factors, or have combined population- and individual-level interventions. Work on healthy food and diet predominantly focused on children in educational or care settings, and few cities appeared to take a comprehensive approach to tackling obesity. Partnerships were a strong feature for all the NCD risk factor work, and were frequently extensive, being most diverse for the Healthy Diet and Food work. There were strong examples of engagement with communities, also involved in co-designing and shaping projects. Equity also featured strongly and there were multiple examples of how attention had been paid to the social determinants of health. There was evidence that cities continue to be significant innovative forces within their countries and drivers of change, and the mutual dependency of the national and local levels was highlighted. Interventions to promote physical activity have shifted focus from specific events and projects to being more integrated with other policy areas and based on intersectoral collaboration.

Local governments in Europe have a vital role in promoting physical activity in the daily life of citizens. However, explicit investment in active living has been limited. One of the four core themes for Phase IV (2003IV ( -2008 of the World Health Organization (WHO) European Healthy Cities Network (WHO-EHCN) was to encourage local governments and their partners to implement programs in favor of active living. This study analyzes the performance of network cities during this period. Responses to a general evaluation questionnaire are analyzed by content according to a checklist, and categorized into themes and dimensions. Most cities viewed "active living" as an important issue for urban planning; to improve visual appeal, enhance social cohesion, create a more sustainable transport system to promote walkability and cyclability and to reduce inequalities in public health. Almost all member cities reported on existing policies that support the promotion of active living. However, only eight (of the 59) responding cities mentioned an integrated framework specific for active living. Many efforts to promote active living are nested in programs to prevent obesity among adults or children. Future challenges include establishing integrated policies specifically for active living, introducing a larger range of actions, as well as increasing funding and capacity to make a difference at the population level.

Background: Despite several health benefits of physical activity, few adults appear to be regularly active. The constructed environment is increasingly being recognized as a main barrier to physical activity, and is therefore important to target to encourage people to adopt a more active lifestyle. Objecti7e: To investigate stairwell and escalator use in a train station in a situation in which the setting was modified during the intervention (one or two ascending escalators) to increase understanding of how physical activity could be promoted in such environment. Design: One hour observation of commuters (n= 1614) in a situation with one (n = 854) or two (n= 760) ascending escalators. Results: With only one ascending escalator, 35.2% of the population decided to climb the stairwell. With two ascending escalators, stairwell use dropped to 18.2% (p= 0.000). The drop in stairwell use between the two conditions was thus nearly 50% and the use of escalators increased by 27%. Conclusions: This brief intervention provided an indication that a modification to the constructed environment influenced the decision to climb the stairwell. However, more experimental research is needed to investigate how people can be encouraged to take the stairs in similar and other settings.