Justin J. Lang

• Public Health Agency of Canada

Background Handgrip strength (HGS) is an important marker of health. Using allometric scaling, we previously identified that adult HGS should be normalized by a cross-sectional or surface area measure of body size, although it is unclear whether scaling youth HGS by the same body size dimension is appropriate. We therefore aimed to (1) identify the...

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global B...

Objective To synthesise data on the associations between cardiorespiratory fitness (CRF) and health in children and adolescents, evaluate the certainty of evidence and identify knowledge gaps. Design An overview of systematic reviews with meta-analyses. Results were pooled using forest plots and certainty of evidence evaluated with GRADE. Data so...

Objectives Greener neighbourhoods may support physical activity; however, it is also important to consider whether greener neighbourhoods are walkable. We assessed whether neighbourhood greenness and walkability were independently and jointly associated with transportational (PATRA) and recreational (PAREC) physical activity among a nationally repr...

Background: Adolescents who engage in physical activity experience positive mental health outcomes. However, the increasing prevalence of physical inactivity combined with high screen time use among adolescents is a growing concern. Parents play an important role in shaping adolescents' physical activity and screen time levels through active parti...

Background Handgrip strength (HGS) is an excellent marker of general strength capacity and health among adults. We aimed to calculate temporal trends in HGS for adults from Shanghai between 2000 and 2020. Methods Adults aged 20–59 years from Shanghai, China, were included. Representative cross-sectional HGS data (n = 127,756) were collected in 200...

Background: Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability. Handgrip strength (HGS) using isometric dynamometry is a convenient, feasible, and widely used method of assessing muscular strength among people of all ages. While adult HGS norms have been published for many coun...

Background Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability. Handgrip strength (HGS) using isometric dynamometry is a convenient, feasible, and widely used method of assessing muscular strength among people of all ages. While adult HGS norms have been published for many count...

Background Physical fitness is an excellent marker of general health and performance. We aimed to calculate trends in physical fitness among Lithuanian adolescents between 1992 and 2022. Methods Using a repeated cross-sectional design, body size and physical fitness data for 17 918 Lithuanian adolescents (50.3% female) aged 11–17 years were collec...

The relationships among neighbourhood greenness, physical activity, and mental health are unclear; therefore, we examined the independent and synergistic associations between neighbourhood greenness and self-rated mental health among a nationally representative sample of urban-dwelling adults in Canada (18-79 years) from the 2007-2019 Canadian Heal...

Objectives: This study investigated the associations between specific sleep health characteristics and indicators of positive mental health among Canadian youth in grades 6-10. Methods: We used cross-sectional data from the Canadian 2017/2018 Health Behaviour in School-aged Children study, a nationally representative sample of Canadian students. Ou...

Background Physical fitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health. However, inconsistencies in tests and protocols limit international monitoring and surveillance. The objective of the study was to seek international consensus on a proposed, evidence-inform...

Introduction Cette étude a évalué l’effet de la pandémie de COVID-19 sur l’évolution des taux d’hospitalisation pour des raisons de santé mentale ou de dépendance chez les jeunes (de 10 à 17 ans) dans les provinces et territoires du Canada (à l’exception du Québec) entre le 1er avril 2018 et le 5 mars 2022. Méthodologie Nous avons effectué une ana...

Introduction This study evaluated the effect of the COVID-19 pandemic on temporal trends in mental health and addiction–related inpatient hospitalization rates among youth (aged 10–17 years) in Canadian provinces and territories (excluding Quebec) from 1 April 2018 to 5 March 2022. Methods We conducted an interrupted time series analysis across th...

Background: Active commuting (AC) to and from work is associated with numerous health benefits, through increased physical activity. This study examined whether occupation types and part-time work, by sex, were associated with AC in a population-based sample of Canadian workers. Data and methods: Cross-sectional public use microdata files from t...

Background Cardiorespiratory fitness (CRF) is a powerful health marker recommended by the American Heart Association as a clinical vital sign. Comparing the predictive validity of objectively measured CRF (the “gold standard”) and estimated CRF is clinically relevant because estimated CRF is more feasible. Our objective was to meta-analyze cohort s...

This chapter provides an overview of health-related physical fitness assessments in school settings, highlighting the importance of evaluating cardiorespiratory fitness, musculoskeletal fitness, flexibility, and body composition in youth, as supported by existing epidemiological evidence. Lab-based fitness measures have been briefly outlined. Speci...

Introduction Les effets de l’utilisation des médias sociaux sur la santé des adolescents soulèvent de plus en plus de préoccupations en matière de santé publique. Nous avons exploré la relation entre cette utilisation et la santé du sommeil chez les adolescents du Canada de 11 à 17 ans. Méthodologie Des données de l’Enquête sur les comportements d...

Introduction Public health concerns over the impact of social media use (SMU) on adolescent health are growing. We investigated the relationship between SMU and sleep health in adolescents in Canada aged 11 to 17 years. Methods Data from the 2017–2018 Health Behaviour in School-aged Children study were available for 12 557 participants (55.2% fema...

Background The purpose of this study was to evaluate the associations of (1) individual absolute and body size normalized weakness cut-points, and (2) the collective weakness classifications on time to diabetes in Americans. Methods We analyzed data from 9577 adults aged at least 50-years from the Health and Retirement Study. Diabetes diagnosis wa...

Background Whilst single chemical exposures are suspected to be obesogenic, the combined role of chemical mixtures in paediatric obesity is not well understood. Objectives We aimed to evaluate the potential associations between chemical mixtures and obesity in a population‐based sample of Canadian children. Methods We ascertained biomonitoring an...

Surveillance of health-related physical fitness can improve decision-making and intervention strategies promoting health for children and adolescents. However, no study has comprehensively analyzed surveillance/monitoring systems for physical fitness globally. This review sought to address this gap by identifying: (1) national-level surveillance/mo...

Background Cardiorespiratory fitness (CRF) is a strong marker of current and future health. The aim of this study was to assess the national temporal trends in CRF for French children and adolescents between 1999 and 2022. Methods CRF data were obtained from several cross‐sectional studies on 15 420 (51.1% boys) French children and adolescents age...

Objective To examine and summarise evidence from meta-analyses of cohort studies that evaluated the predictive associations between baseline cardiorespiratory fitness (CRF) and health outcomes among adults. Design Overview of systematic reviews. Data source Five bibliographic databases were searched from January 2002 to March 2024. Results From...

Background Weakness can be operationalized with several thresholds, which in turn, could impact associations with cognitive impairment when considering obesity status. Objective We examined the associations of absolute, normalized, and collective weakness thresholds on future cognitive impairment by obesity status in older adults. Methods We perf...

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important follow...

Objectives High levels of sedentary time (ST) are associated with poor physical and mental health. Given that Canadians spend a large portion of their days at school and work, they may be important targets for reducing ST. Our objectives are to estimate the daily amount of school and work ST among Canadians, examine differences by subgroups, and de...

Background Cardiorespiratory fitness (CRF) is an important indicator of current and future health. While the impact of habitual physical activity on CRF is well established, the role of sedentary behaviour (SB) remains less understood. Objective We aimed to determine the effect of SB on CRF. Methods Searches were conducted in MEDLINE, Embase, Psy...

Objective The objectives of this study were: (1) to describe burden of rheumatoid arthritis (RA) and trends from 1990 to 2019 using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) data, (2) to describe age and sex differences in RA and (3) to compare Canada’s RA burden to that of other countries. Methods Disease burden indicat...

Decreased muscle strength and physical function often precede disability, nursing home admission, home care use, and mortality in older adults. Normative values for commonly used physical performance-based tests are not widely available for older adults but are required for clinicians and researchers to easily identify individuals with low performa...

Background The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of...

Objectives: The aim of this study was to developed sex- and age-specific normative-referenced percentile values for health-related fitness among 12 to 18 years old Czech youth. Methods: This study included cross-sectional data from 1,173 participants (50.7% boys) collected between 2013 and 2016. Participants were recruited from 32 elementary or sec...

Background Optimizing childhood domain-specific physical activity (PA) and sedentary behavior (SB) for blood lipid profile is not well understood. We aimed to (1) determine the associations between accelerometer-measured PA and SB for each domain (school time and out-of-school time) with blood lipid profile and (2) estimate predicted changes in blo...

Introduction Le Questionnaire sur les points forts et les points faibles (Strengths and Difficulties Questionnaire, ou SDQ), qui permet d’évaluer les difficultés comportementales et émotionnelles, est un outil de dépistage des problèmes de santé mentale utilisé dans plusieurs pays. Notre objectif était de valider les seuils (cut-points) actuels, br...

Introduction The Strengths and Difficulties Questionnaire (SDQ), for assessing behavioural and emotional difficulties, has been used internationally as a screening measure for mental health problems. Our objective was to validate the existing (British) SDQ cut-points in a sample of Canadian children and youth, and develop new Canadian SDQ cut-point...

Background: Strength asymmetries are a type of muscle function impairment that is associated with several health conditions. However, the prevalence of these asymmetries among adults from the United States remains unknown. We sought to estimate the prevalence and trends of handgrip strength (HGS) asymmetry in American adults. Methods: The unweig...

We used a prevalence-based approach to estimate the economic costs associated with low muscle strength, as assessed using handgrip strength, in Canadian adults. We estimated the annual economic burden of low muscle strength at $3.0 billion, representing 2.2% of the 2021 Canadian burden of illness costs. The two most expensive chronic diseases attri...

Introduction Les activités de renforcement des muscles et d’amélioration de l’équilibre sont associées à la prévention des maladies et des blessures. Les Directives canadiennes en matière de mouvement sur 24 heures offrent des recommandations concernant les activités de renforcement de l’appareil locomoteur et d’amélioration de l’équilibre. Entre20...

Introduction Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000–2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22...

Background: decreased muscle strength and physical function often precede disability, nursing home admission, home care use and mortality in older adults. Normative values for commonly used physical performance-based tests are not widely available for older adults but are required for clinicians and researchers to easily identify individuals with...

Objective: To determine the association between social media use (SMU) and physical activity (PA) among Canadian adolescents. Methods: We used data from 12,358 participants in grades 6 to 10 who responded to the Canadian component of the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Social media intensity and problematic SMU...

Objective To estimate health care and health-related productivity costs associated with excessive sedentary behaviour (> 8 h/day and > 9 h/day) in Canadian adults.Methods Three pieces of information were used to estimate costs: (1) the pooled relative risk estimates of adverse health outcomes consistently shown to be associated with excessive seden...

The objective of this study was to estimate health care and health-related productivity costs associated with low cardiorespiratory fitness (CRF) in Canadian adults. We also estimated costs that would be avoided by a 10 percentage point prevalence reduction in low CRF. A prevalence-based approach was used to estimate the economic costs associated w...

Introduction: Associations between physical activity (PA), sedentary behavior (SED), and sleep-24-h movement behaviors (MBs)-and children/youth's mental health (MH) is well-established though often only examined separately. Methods: This scoping review sought to answer the question: What evidence is there on the association between 24-h movement be...

Objective To evaluate current levels of physical activity and sedentary behaviour among pregnant and non-pregnant adults in Canada. Methods We ascertained population-based cross-sectional data from the Canadian Community Health Survey (CCHS), 2015–2019, and from the Canadian Health Measures Survey (CHMS), 2007–2019. We included adults who were ass...

Background: Data on meeting the Canadian 24-Hour Movement Guidelines for adults (24-H Guidelines) and associations with health indicators by body mass index (BMI) class are needed to support public health surveillance. The aim of this study was to describe the proportion of Canadian adults meeting individual and various combinations of the 24-H Gu...

Background: The primary aim was to examine the temporal trends in physical fitness (PF) for Japanese children and adolescents before and during the coronavirus disease (COVID-19) pandemic. The secondary aim was to estimate the concurrent trends in body size (measured as body mass and height) and movement behaviors (exercise, screen, and sleep time...

Introduction: The new Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years and older recommend that adults limit daily sedentary time to eight hours or less, including three hours or less of recreational screen time. The eight-hour recommendation was centred between the evidence from research using self-reported...

Introduction Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods Three bibliographic data...

Background Built environments have been implicated in the development of chronic disease, with physical activity (PA) considered one of the critical mechanisms for this relationship. Substantial growth in research on built environments and PA makes navigating the available evidence challenging. Objective To examine and describe the current state,...

Background The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. Objective This study aimed to produce a list of the top 10 inte...

Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods:...

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.

Background: Recently, the Canadian 24-Hour Movement Guidelines for Adults were released, and included a revised physical activity (PA) recommendation. The recommendation of 150 minutes per week of moderate-to-vigorous intensity PA (MVPA) was revised, from requiring that MVPA be accrued in bouts of 10 minutes or more (bouted) to having no bout requ...

Background Few studies have investigated the optimal anthropometric index associated with potential cardio-metabolic risk. Using direct measures of standing height, body mass, and waist circumference, we sought to identify the optimal index for detecting cardio-metabolic risk associated with diabetes and hypertension in a nationally representative...

Background: Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews. Objective: Examine the current state and quality of research looking at assoc...

Introduction: Handgrip strength (HGS) asymmetry may help identify the functional asymmetries that contribute to mobility limitations. We sought to determine the associations of HGS asymmetry on gait speed and standing balance in older Americans. Materials and Methods: The analytic sample included 8,396 adults aged ≥65-years for the last wave in whi...

Meeting the physical activity (PA) and recreational screen time recommendations for children and young people is associated with several health benefits. The purpose of this study was to compare the odds of meeting PA and recreational screen time recommendations between the Canadian youth living in urban versus rural communities. We analyzed nation...

Handgrip dynamometers are widely used to measure handgrip strength (HGS). HGS is a safe and easy to obtain measure of strength capacity, and a reliable assessment of muscle function. Although HGS provides robust prognostic value and utility, several protocol variants exist for HGS in clinical settings and translational research. This lack of method...

Background Using a nationally representative cohort of Canadian adults, we assessed associations between neighbourhood walkability and cause-specific mortality and investigated whether they differed by socioeconomic status. Methods The study population was drawn from the 2001 Canadian Census Health and Environment Cohort, which contains individual...

Background: The Canadian 24-Hour Movement Guidelines for Adults (18-64 years and 65 years or older) were launched in October 2020 and provide evidence-based recommendations for physical activity, sedentary behaviour and sleep. The purpose of this study was to examine whether meeting the 24-Hour Movement Guidelines overall, and different combinatio...

Regular physical activity prevents several non-communicable chronic conditions and premature mortality. The benefits of physical activity can be achieved through active transport, which refers to non-motorised/active means (e.g. walking, cycling, rollerblading) to move from one place to another. Active transport can be integrated into daily routine...

Background: The fitness levels of Canadian adults declined substantially between 1981 and the years 2007 to 2009, suggesting a reduction in population health. This paper updates the fitness trends of Canadians aged 20 to 69 years by extending the time period to 2017. Data and methods: The Canadian Health Measures Survey is a repeated cross-secti...

Background: Suicide is a leading cause of death, particularly for young adults. Suicide-related behaviours are influenced by a wide-range of personal, social, and cultural factors. Emerging evidence suggests that daily changes in meteorological conditions, including temperature, can increase the risk of suicide. Methods: We conducted a systemati...

Background Cardiorespiratory fitness (CRF), which reflects the overall aerobic capacity of the cardiovascular, respiratory, and muscular systems, is significantly related to health among youth.Objective The aim of this systematic review was to identify health-related criterion-referenced cut-points for CRF among youth aged 5–17 years.MethodsA syste...

Background This study preliminarily examined the relationship between physical activity, sedentary time, and social emotional functioning in children aged 4–6 years. Methods Eighty children attending kindergarden classes in Ottawa, Canada wore Actical accelerometers for 1-week to directly assess their physical activity and sedentary time. Physical...

Introduction: Handgrip strength (HGS) is an important indicator of health. Because HGS is strongly associated with body size, most investigators normalize HGS for some measure of body size as a more sensitive indicator of strength within a population. We aimed to (1) identify the optimal body size dimension to remove (normalize) HGS for difference...

Background Musculoskeletal fitness is an excellent functional measure that is significantly related to health among youth. Objective Our objective was to identify health-related criterion-referenced cut-points for musculoskeletal fitness (MSF) among youth. Methods A systematic search of two electronic databases (MEDLINE and SPORTDiscus) was condu...

Background The standing broad jump (SBJ) is an excellent functional measure of explosive lower-body strength that is significantly related to health among children and adolescents. Objectives The aim of this study was to estimate national (country-level) and international (pooled global data) temporal trends in SBJ performance for children and ado...

Introduction To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Co-operation and Development (OECD) member countries. Methods We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ov...

Background: Physical fitness is an important indicator of current and future health status. This analysis examines the relationships among child-parent dyads in physical fitness measures. Data and methods: The analysis is based on biological child-parent dyads from three cycles of the Canadian Health Measures Survey (Cycle 1: 2007 to 2009, Cycle...

Background: Handgrip strength (HGS) is an excellent marker of functional capability and health in adults, although little is known about temporal trends in adult HGS. Objectives: The aim of this study was to systematically analyze national (country-level) temporal trends in adult HGS, and to examine the relationships between national trends in a...

Summary Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a sta...

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publ...

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardise...