Mediating variable framework in physical activity interventions. How are we doing? How might we do better?

Considering Theory-Based Gamification in the Co-Design and Development of a Virtual Reality Cognitive Remediation Intervention for Depression (bWell-D): Mixed Methods Study

BACKGROUND

In collaboration with clinical domain experts, we developed a prototype of immersive virtual reality (VR) cognitive remediation for major depressive disorder (bWell-D). In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high noncompliance rates. Gamification may play a role in addressing this as it can boost adherence. However, careful consideration is required in its application to promote user motivation intrinsically.

OBJECTIVE

We aimed to address these challenges through an iterative process for development that involves co-design for developing content as well as in the application of gamification while also taking into consideration behavior change theories. This effort followed the methodological framework guidelines outlined by an international working group for development of VR therapies.

METHODS

In previously reported work, we collected qualitative data from patients and care providers to understand end-user perceptions on the use of VR technologies for cognitive remediation, reveal insights on the drivers for behavior change, and obtain suggestions for changes specific to the VR program. In this study, we translated these findings into concrete representative software functionalities or features and evaluated them against behavioral theories to characterize gamification elements in terms of factors that drive behavior change and intrinsic engagement, which is of particular importance in the context of cognitive remediation. The implemented changes were formally evaluated through user trials.

RESULTS

The results indicated that feedback from end users centered on using gamification to add artificial challenges, personalization and customization options, and artificial assistance while focusing on capability as the behavior change driver. It was also found that, in terms of promoting intrinsic engagement, the need to meet competence was most frequently raised. In user trials, bWell-D was well tolerated, and preliminary results suggested an increase in user experience ratings with high engagement reported throughout a 4-week training program.

CONCLUSIONS

In this paper, we present a process for the application of gamification that includes characterizing what was applied in a standardized way and identifying the underlying mechanisms that are targeted. Typical gamification elements such as points and scoring and rewards and prizes target motivation in an extrinsic fashion. In this work, it was found that modifications suggested by end users resulted in the inclusion of gamification elements less commonly observed and that tend to focus more on individual ability. It was found that the incorporation of end-user feedback can lead to the application of gamification in broader ways, with the identification of elements that are potentially better suited for mental health domains.

How does green human resource management foster employees' environmental commitment: A sequential mediation analysis

Drawing on the social identity theory, this study aims to examine the impact of organizational pride and organizational identification as sequential mediators in the association between green HRM and employee environmental commitment. The study extended prior research by incorporating the sequential mediators of organizational pride and organizational identification. The researchers gathered data from 267 employees of telecommunications companies in Pakistan. They used Smart PLS software version 3.0 to carry out partial least squares structural equation modeling to verify the hypotheses. The results indicate that green HRM leads to organizational pride, which, in turn, leads to increased organizational identification and, consequently, enhances environmental commitment. The findings hold significant value to practitioners and HR managers striving to develop HR practices that support sustainability, contribute to a culture of environmental responsibility, and lead to positive green outcomes for employees.

The importance of group factors in the delivery of group-based parenting programmes: a process evaluation of Mellow Babies

Introduction

The role of the group has been largely overlooked within evaluations of group-based parenting programmes. Group contextual factors, including size and level of homogeneity, may impact on essential group processes, such as group identification and cohesion, that are necessary to activate interpersonal change mechanisms and attain programme outcomes. This process evaluation of Mellow Babies, a 14-week attachment-based group parenting programme for mothers of infants aged under 18 months, explores how group context affected mother and practitioner experiences of the programme.

Methods

In-depth interviews were conducted with fourteen mothers and three practitioners from three different Mellow Babies groups. Framework Analysis was employed to analyse data, using groups as cases within the framework matrix while preserving individual participants within each case. This allowed comparisons to be made within and between groups.

Results

Four group contextual factors impacted on the quality of programme delivery: (1) group size; (2) level of group homogeneity; (3) pre-existing relationships; and (4) personalities within the group. These contextual factors affected the hypothesised intervention mechanisms: (1) fluid progression through the stages of group development; (2) a safe, non-judgemental, contained space; (3) social identification with group; (4) group cohesion; and (5) a culture of openness, support and empowerment.

Discussion

Findings have implications for future delivery and implementation of group-based parenting programmes, for example, the importance of considering group composition during programme recruitment. Practitioners may also benefit from a stronger focus on group processes and enabling group dynamics within training, supervision, and the programme manual.

To move or not to move while on campus: Examining the influence of others

OBJECTIVE

To examine the influence of dynamic and trending descriptive norms on increasing physical activity and decreasing the sedentary behaviors of university students while on campus.

PARTICIPANTS

One-hundred fifty-six university students from a Canadian university completed this study.

METHODS

Participants were randomly assigned to receive one of four online messages containing normative information about the on-campus behavior of university students. On-campus physical activity and sedentary behavior were measured pre- and post-message.

RESULTS

The results revealed that students exposed to the trending norm reported a greater decrease in sedentary behavior than students in the control condition, p = .007.

CONCLUSION

Results provide preliminary experimental evidence that trending norm messages may serve to decrease the sedentary behavior of students while on campus.

Effects of active video games on physical activity among overweight and obese college students: a systematic review

Background

The purpose of this study was to critically review the existing literature on the effects of active video games (AVGs) on physical activity in overweight and obese college students to determine whether AVGs can promote and achieve recommended levels of physical activity. The results should provide constructive input for future research.

Methods

A total of five international databases including PubMed, SCOPUS, Web of Science, CINAHL Plus, and EBSCOhost were searched with keywords related to "active video games," "physical activity," and "obese college students" from July 2022. A systematic review was conducted using the PRISMA guidelines and randomised controlled trial (RCT) studies that met the inclusion criteria were included. Furthermore, the quality assessment of the studies was measured using the PEDro scale.

Results

One thousand and twenty-three articles were retrieved, of which eight randomised controlled trial studies met the inclusion criteria. AVGs can reduce sedentary behaviour and positively affect physical activity, time spent on moderate-to-vigorous physical activity (MVPA), positive psychological factors, and game attendance rate. Combining AVGs with other assistive devices (such as mini-trampolines and stationary bikes) can enhance the effects of AVGs and provide greater physiological stimulation. Different types of AVGs and game modes can achieve different emotional responses, physiological stimulation, and physical activity levels.

Conclusion

The research findings prove that AVGs can be a viable intervention to increase physical activity in overweight or obese college students, ultimately reaching the recommended physical activity level(PAL). Physical activity can be further increased by incorporating assistive devices or using features supported by self-determination theory (SDT). As a new modality, AVGs could be a potential alternative to traditional physical activity.Systematic Review Registration:https://www.crd.york.ac.uk/prospero, identifier: CRD42022363993.

Guidelines to conduct research in computer-prompt software studies to decrease sedentary behaviors and increase physical activity in the workplace

BACKGROUND

Computers are ubiquitous in the workplace and facilitate prolonged sitting, which has adverse health consequences. Various computer-prompt software programs are designed to decrease sedentary behaviors and increase physical activity in the workplace. However, specific guidelines that would improve research in this area have not been published.

OBJECTIVE

The objective of this article is to present recommendations for improving computer-prompt software research, to decrease sedentary behaviors and increase physical activity in the workplace.

METHODS

Ten domains were identified based on deficiencies in the current literature combined with quality assessment tools to reduce the risk for bias. The ten domains include composition of the research team, behavioral sciences theoretical frameworks, research design, alert types, outcome measures, confounding factors, intervention duration, carryover effects, racial/ethnic composition, and organizational culture.

RESULTS

Specific recommendations are presented for each domain. The research team should include all stakeholders contributing as copartners in designing the intervention. For theory, a systems science framework was presented. Clustered randomized controlled trials were recommended, rather than randomization at the individual level. Distinct types of alerts (visual, auditory, or both) and frequency of alerts (hourly, randomly generated, or based on prolonged sitting patterns) are described. Outcome measures include average duration of sitting bouts, longest sitting bout, and number of sitting bouts.

CONCLUSION

Prolonged sitting and physical inactivity at work lead to major health problems. Adherence to the recommendations presented here should facilitate high-quality research and improve the health of desk-based workers by decreasing sedentary behaviors and increasing physical activity.

What is the current state of research concerning self-efficacy in exercise behaviour? Protocol for two systematic evidence maps

INTRODUCTION

Knowing about a risk factor is not sufficient to ensure corresponding behaviour as additional psychological factors play a role. Self-efficacy is one of the major factors. This also applies to physical activity and exercise behaviour, which is a major public health topic in both primary and secondary prevention. The amount of research on self-efficacy in exercise behaviour is high yet remains uncharted. This protocol presents the research design for two systematic evidence maps on self-efficacy in exercise behaviour in (1) primary prevention and (2) secondary prevention. These maps will thus provide a comprehensive overview over the current state in published empirical research as a starting point for future researchers.

METHODS AND ANALYSIS

The databases Medline (via PubMed) and PsycINFO (via EbscoHost) will be searched using the search terms 'self-efficacy' and any of the search terms 'sport' and 'exercise' in titles and abstracts. All empirical research studies which have measured self-efficacy in relation to exercise behaviour will be included. The primary prevention systematic evidence map will aggregate all studies on healthy humans and the secondary prevention systematic evidence map will include all studies on humans with a pre-existing condition. We will extract and present the data points authors, title, year, sample size (N), age groups, surveyed sport and method of measuring self-efficacy in both systematic evidence maps. Moreover, we will extract and present the target group in the systematic evidence map on primary prevention and the pre-existing condition in the systematic evidence map on secondary prevention. In addition to a data table, we will create freely accessible evidence maps in the form of graphs.

ETHICS AND DISSEMINATION

Since this is a protocol, an ethics approval is not required for the presented and planned work. The results of the two systematic evidence maps will be disseminated via publication in international peer-reviewed journals. In addition, data will be shared in detail via the Open Science Framework platform.

Mechanisms of an App-Based Physical Activity Intervention and Maintenance in Community-Dwelling Women: Mediation Analyses of a Randomized Controlled Trial

BACKGROUND

Understanding the mechanism of interventions that increase physical activity (PA) is critical to developing robust intervention strategies.

AIMS

This study aims to examine the mediation effects of hypothesized changes in self-efficacy, social support, and barriers on daily changes in accelerometer-measured steps and the duration of moderate to vigorous PA over 3-month intervention and 6-month maintenance periods with a mobile phone-based PA education program.

METHODS

Data were analyzed for a total of 210 physically inactive women who were randomized. The mean (SD) age was 52.4 (11.0) years. The framework of Baron and Kenny and the Sobel test were used to evaluate the proportion of the treatment effect explained by mediation factors.

RESULTS

Postintervention PA changes were mediated by a reduction in self-efficacy and barriers and an increase in social support from friends during the intervention and maintenance periods (P ≤ .05). However, social support from family was significant only during the intervention, but not the maintenance (P = .90). Barriers to PA had the largest mediation effect on the intervention, explaining 13% to 16% of the 3-month intervention effect and 14% to 19% of the 6-month maintenance effect on daily steps and duration of moderate to vigorous PA minutes (P ≤ .05).

CONCLUSIONS

Incorporating strategies for overcoming PA barriers and promoting social support for PA is important for the design of interventions for physically inactive women. However, a reduction in self-efficacy was observed in the intervention group at 3 and 9 months as compared with the control group. This unexpected finding requires further investigation.

Cost-Effectiveness of Prolonged Physical Activity on Prescription in Previously Non-Complying Patients: Impact of Physical Activity Mediators

In Sweden, physical activity on prescription (PAP) is used to support patients in increasing their levels of physical activity (PA). The role of healthcare professionals in supporting PA behavior change requires optimization in terms of knowledge, quality and organization. This study aims to evaluate the cost-effectiveness of support from a physiotherapist (PT) compared to continued PAP at a healthcare center (HCC) for patients who remained insufficiently active after 6-month PAP treatment at the HCC. The PT strategy was constituted by a higher follow-up frequency as well as by aerobic physical fitness tests. The analysis was based on an RCT with a three-year time horizon, including 190 patients aged 27-77 with metabolic risk factors. The cost per QALY for the PT strategy compared to the HCC strategy was USD 16,771 with a societal perspective (including individual PA expenses, production loss and time cost for exercise, as well as healthcare resource use) and USD 33,450 with a healthcare perspective (including only costs related to healthcare resource use). Assuming a willingness-to-pay of USD 57,000 for a QALY, the probability of cost-effectiveness for the PT strategy was 0.5 for the societal perspective and 0.6 for the healthcare perspective. Subgroup analyses on cost-effectiveness based on individual characteristics regarding enjoyment, expectations and confidence indicated potential in identifying cost-effective strategies based on mediating factors. However, this needs to be further explored. In conclusion, both PT and HCC interventions are similar from a cost-effectiveness perspective, indicating that both strategies are equally valuable in healthcare's range of treatments.

A modifiable factors-based model for detecting inactive individuals: are the European assessment tools fit for purpose?

BACKGROUND

The lack of systematic factors affecting physical inactivity (PIA) challenges policymakers to implement evidence-based solutions at a population level. The study utilizes the Eurobarometer to analyse PIA-modifiable variables.

METHODS

Special Eurobarometer 412 physical activity (PA) data were analysed (n = 18 336), including 40 variables along with the International PA Questionnaire. PIA was used as the dependent variable. Variables considered were alternatives to car, places, reasons and barriers to engaging in PA, memberships to clubs and categorical responses about the agreement extent with the area, provision of activities and local governance statements. Logistic regression was used to identify variables contributing to PIA. Beta values (β), standard errors, 95% confidence intervals, the exponentiation for odds ratio and Cox & Snell and Nagelkerke R2 were indicated.

RESULTS

The resulting model correctly identified 10.7% inactives and 96.9% of actives (R2 of Nagelkerke: 0.153). Variables contributing to the detection of PIA were (P ≤ 0.01): having a disability or an illness, not having friends to do sport with, lacking motivation or interest in and being afraid of injury risk. Additionally, totally agreeing, tend to agree and tend to disagree regarding the extent of local providers offering enough opportunities to be more active also contributed to the model.

CONCLUSIONS

The model reported a limited ability to detect modifiable factors affecting PIA, identifying a small percentage of inactive individuals correctly. New questions focused on understanding inactive behaviour are needed to support the European PA public health agenda.

The Impact of Stand-Biased Desks on Afterschool Physical Activity Behaviors of Elementary School Children

The purpose of this secondary analysis was to assess whether students’ use of stand-biased desks during the school day influenced physical activity (PA) and sedentary behaviors (SB) during the afterschool period. By using a crossover design consisting of two 9-week intervention periods, 99 participants from grades 3, 4, and 6 were randomly assigned by their teacher to either a traditional (Group 1; sit−stand) or stand-biased (Group 2; stand−sit) desk in the classroom. The desk type then switched between intervention periods. Afterschool PA and SB were measured by accelerometry at baseline (fall) and following both intervention periods at post I (winter) and post II (spring). Independent sample t-tests and mixed-effects modeling were applied at a significance value of p < 0.05 to detect differences between groups. No significant differences in afterschool SB, light-intensity PA (LPA), or moderate- to vigorous-intensity PA (MVPA) were found between groups. There were also no significant two- or three-way interaction effects detected between desk assignment, time, and afterschool SB, LPA, or MVPA. Stand-biased desks in the classroom were not detrimental to children’s afterschool PA and SB.

Psychosocial factors related to physical activity in frail and prefrail elderly people

BACKGROUND

Increased physical activity (PA) is a very important factor in a healthy aging lifestyle. Psychosocial factors have also a main role in the initiation and maintenance of this behavior, but nowadays its implications for frailty elderly people are unknown, therefore, the aim of this study was to identify the psychosociological variables of behavior change that influence the practice of (PA) in frail and prefrail elderly.

METHODS

A total of 103 frail and pre-frail elderly people (72 females) participated in this cross-sectional study, on the framework of the EXERNET-Elder3.0 project. Age ranged from 68-94 years (mean = 80.4 ± 5.9 years). Individualized face-to-face interviews according to the constructs of the Transtheoretical Model of Change (TTM) [(decisional balance (DB) and self-efficacy (SE)], social support (SS) (family and friends) and outcome expectations (OE) were administered to all participants.

RESULTS

Significant differences were found in DB, perceived benefits (PBn), SE, family-related SS and OE as a function of stages of change (SoC) (p < 0.005), but no significant were found in perceived barriers (PBrr) (p = 0.259) and friends-related SS (p = 0.068). According to the Scheffé post-hoc test, those in advanced SoC (Action-Maintenance), scored higher than those in lower SoC (Precontemplation-Contemplation and Preparation).

CONCLUSION

The scores obtained from the study variables differed according to the SoC, supporting the external validity for the use of the TTM in frailty elderly. Further research is needed to determine the impact of PBrr and friends-related SS on this people, as well as to identify the validity of this model in the long-term in this population.

Compensation or Displacement of Physical Activity in Children and Adolescents: A Systematic Review of Empirical Studies

Regular physical activity during childhood and adolescence is associated with health benefits. Consequently, numerous health promotion programs for children and adolescents emphasize the enhancement of physical activity. However, the ActivityStat hypothesis states that increases in physical activity in one domain are compensated for by decreasing physical activity in another domain. Currently, little is known about how physical activity varies in children and adolescents within intervals of one day or multiple days. This systematic review provides an overview of studies that analyzed changes in (overall) physical activity, which were assessed with objective measurements, or compensatory mechanisms caused by increases or decreases in physical activity in a specific domain in children and adolescents. A systematic search of electronic databases (PubMed, Scopus, Web of Science, SportDiscus) was performed with a priori defined inclusion criteria. Two independent researchers screened the literature and identified and rated the methodological quality of the studies. A total of 77 peer-reviewed articles were included that analyzed changes in overall physical activity with multiple methodological approaches resulting in compensation or displacement. Of 40,829 participants, 16,265 indicated compensation associated with physical activity. Subgroup analyses separated by study design, participants, measurement instrument, physical activity context, and intervention duration also showed mixed results toward an indication of compensation. Quality assessment of the included studies revealed that they were of high quality (mean = 0.866). This review provides inconclusive results about compensation in relation to physical activity. A trend toward increased compensation in interventional studies and in interventions of longer duration have been observed.

Children’s Changes in Perceptions and Body Composition Following a Family-Based Fitness Intervention

Physical fitness is associated with decreased weight in children, which helps improve youth obesity rates. Family programs can provide practical approaches to improving physical fitness for children. The purpose of this study was to assess the influence of a family-based fitness intervention on changes in body composition, fitness status, and perceptions of obese children. Families attended exercise and education sessions for 60–90 min once per week for 10 weeks. Participants consisted of 10 children who participated in semi-structured interviews, body composition, and fitness assessments at pre- and posttest. Following the intervention, results showed that children had a significant increase in sit-ups (p = .03, effect size = 0.79), lean mass (p < .001, Cohen’s d = 1.95), and bone mineral content (p < .001, Cohen’s d = 0.46). Using thematic analysis, four main themes emerged from the pre- and postintervention interviews: an increase in after-school and weekend intentional physical fitness, rules regarding sedentary behavior and screen time, more prevalent physical fitness reinforcements, and a shift in perception of exercise. Results from this study indicate a family-based intervention had an influence on children’s appreciation for and engagement in physical fitness, as well as healthy body composition and fitness outcomes.

Program of Rehabilitative Exercise and Education to Avert Vascular Events After Non-Disabling Stroke or Transient Ischemic Attack (PREVENT Trial): A Randomized Controlled Trial

Background

Non-disabling stroke (NDS) and transient ischemic attack (TIA) herald the possibility of future, more debilitating vascular events. Evidence is conflicting about potency of exercise and education in reducing risk factors for second stroke.

Methods

Three-site, single-blinded, randomized controlled trial with 184 participants <3 months of NDS or TIA (mean age, 65 years; 66% male) randomized to usual care (UC) or UC + 12-week program of exercise and education (PREVENT). Primary (resting systolic blood pressure) and secondary outcomes (diastolic blood pressure [DBPrest], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], TC/HDL, triglycerides, fasting glucose, and body mass index) were assessed at baseline, post-intervention, and 6- and 12-month follow-up. Peak oxygen consumption (VO₂peak) was measured at baseline, post-intervention, 12-month assessments.

Results

Significant between-group differences at post-intervention favored PREVENT group over UC: DBPrest (mean difference [MD]: −3.2 mmHg, 95% confidence interval [CI]: −6.3, −.2, P = .04) and LDL-C (MD: −.31 mmol/L, 95% CI: −.42, −.20, P = .02). Trends of improvement in PREVENT group were noted in several variables between baseline and 6-month follow-up but not sustained at 12-month follow-up. Of note, VO₂ peak did not change over time in either group.

Conclusion

Impact of PREVENT on vascular risk factor reduction was more modest than anticipated, possibly because several outcome variables approximated normative values at baseline and training intensity may have been sub-optimal. Further investigation is warranted to determine when exercise and education programs are viable adjuncts to pharmaceutical management for reduction of risk factors for second stroke.

Clinical Trial Registration-URL:http://www.clinicaltrials.gov. Unique identifier: #NCT00885456

Physical Activity Maintenance: A Critical Narrative Review and Directions for Future Research

A clear rationale can be made for promoting long-term regular physical activity (PA), yet despite some attempts to operationalize "maintenance," no robust definition has been agreed upon, beyond arbitrary time frames of regular PA. This has likely impaired the advancement of theory and practice. The purpose of this critical narrative review was to first overview the conception of maintenance and co-requisite theoretical constructs in theories used in PA research. Our subsequent aims were to engage in a critical analysis of this literature to propose a working definition of PA maintenance followed by recommendations for future research. Relevant behavioral theories were parsed for references to maintenance or maintenance-specific constructs and constructs most likely associated with maintenance were overviewed from a recent systematic review. Based on this information, we suggest PA maintenance be operationalized as a process marked by a shift in the mechanisms of action determining behavioral performance, that engender greater perceived behavioral enactment efficiency. We suggest that maintenance should not be considered an absolute state of behavioral performance (e.g., a stage), as some constructs that were critical to behavioral performance during initiation will still be critical during PA continuation. Based on this definition, we propose a method of falsifiability hypothesis testing of theoretical constructs that may determine the maintenance process. Finally, the review concludes with suggestions for future research using this operationalization of maintenance including measure development, tests of latency to reach the peak maintenance process, validating constructs critical to determining maintenance, exploration of the contextual and individual moderators of maintenance formation, and the development of an omnibus dynamic model of initiation, continuation, and maintenance in PA behavior change.

Exploring intervention components in association with changes in preschool children's vegetable intake: the BRA-study

Objective

The present study aimed to explore kindergarten staffs’ perceived usefulness of intervention components in association with changes in children’s vegetable intake and vegetables served in the kindergarten. Assessment of the perceived usefulness of intervention components consisted of a paper-based questionnaire for the kindergarten staff assessing usefulness of posters, supplementary material and 1-day inspirational course. Children’s vegetable intake in the kindergarten was assessed by direct observation, while vegetables served was assessed by a 5-day weighted vegetable diary.

Results

Seventy-three kindergartens in two counties in Norway participated (response rate 15%) and parental consent was obtained for 633 children 3–5 years of age at baseline (response rate 39%). Mixed effect models indicated a tendency that posters were associated with increased child vegetable intake (P = 0.062). Surprisingly, a low degree of perceived usefulness of supplementary material was associated with the largest increase in child vegetable intake (P = 0.020). No significant associations between perceived usefulness of intervention components and vegetables served in the kindergarten were found. This study indicated a tendency that posters were associated with increased child vegetable intake; however, this may also be due to synergies between multiple intervention components.

Trial registration International Standard Randomized Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05629-1.

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

Multimodality Treatment of Low-Grade Ruptured Brain Arteriovenous Malformations Presenting with Life-Threatening Intracranial Hematoma

Introduction:Acute management of low-grade but life-threatening ruptured arteriovenous malformations (AVM) with simultaneous hematoma evacuation remains controversial. The current report aimed to present a case series of multimodality management of low-grade (Spetzler-Martin I-II) but life-threatening ruptured arteriovenous malformations. Methods:A consecutive case series of six Spetzler-Martin (SM) grade I-II ruptured AVM patients with concurrent life-threatening hematoma initially treated with hematoma removal and, when possible, with simultaneous AVM extirpation is presented. Supplementary treatment was also applied when deemed necessary. Median clinical follow-up was 15.6 months. Neurological assessment was performed on admission (Glasgow coma scale score - GCS) and at final follow-up (modified Rankin scale score - mRS). Results:Intraparenchymal hematoma was evacuated in all six cases, with simultaneous AVM extirpation in three cases. Preoperative embolization was done in one patient, whereas postoperative embolization was performed in three additional patients. Supplementary radiosurgery was applied in one patient. Complete AVM occlusion was achieved in all patients. At the final follow-up (15.6 months), 33.3% of patients were asymptomatic, 50% had a non-significant or slight disability (mRS score 1-2), whereas one patient died. All patients with preoperative GCS score of 8 or higher had a favorable outcome. Conclusion:Acute surgical hemorrhagic clot evacuation as first step, followed by simultaneous AVM extirpation when feasible, may result in favorable clinical outcome in ruptured low-grade (SM I&II) brain AVMs with life-threatening hematoma. Embolization has a supplementary role in the acute phase of treatment either by either securing the bleeding source preoperatively or occluding the residual malformation especially in cases of technically demanding AVM removal.

Predicting Family and Child Physical Activity across Six-Months of a Family-Based Intervention: An Application of Theory of Planned Behaviour, Planning and Habit

Family-based physical activity (PA) interventions have proven effective in modifying PA; yet, the underlying mechanisms are currently unclear. In this study, we follow-up upon prior trial data that showed changes to child moderate-to-vigorous PA (MVPA) as a result of a family education+planning intervention compared to an education-only condition. We examined parents' perceived family PA frequency, family PA social cognitions, and family PA habit over 26 weeks between the two conditions. One hundred and two parents (of children aged 6 to 12 yrs), were recruited through advertisements and randomized to either the planning + education condition (n = 52) or an education-only condition (n = 50). Self-reported family PA, and measures of theory of planned behaviour, planning intention, and habit were completed by the contact parent at baseline, six-week, 13-week, and 26-week time-periods. The education+planning intervention increased planning intention (p <.01) and family PA (p =.06) compared to the© education-only group. The effect of condition on the putative mediators did not explain these changes (all 95% CIs crossed 0), and family PA was associated with child MVPA only at 13 weeks (p <.01). Intervention 20 assignment had a small indirect effect on family PA (favouring©the education+planning group) via Habit. Perceived behavioural©control and habit were consistent predictors of family PA (p <.05), but not PA intention or planning intention (p >.05). The planning+education intervention showed improved family PA and planning intention, yet null mediation results suggest that other variables from the family system (e.g., child motivation, other parent's motivation and plans) are likely needed to fully understand the intervention effects. The promotion of perceived behavioural control and habit to assist in family PA is recommended for future research in this population.

The Use of Theory to Develop Physical Activity Interventions in Urological Cancer Survivors: A Narrative Review

OBJECTIVES

To summarize the current available evidence on the use of behavior change theories to explain and change physical activity behavior in urological cancer survivors.

DATA SOURCES

Five electronic databases including Medline, Web of Science, Embase, Cochrane, and Psych INFO and reference lists of key studies were searched between database inception and November 2020. Peer-reviewed articles on the use of behavior change theories to understand or change physical activity in urological cancer survivors were included.

CONCLUSION

The theory of planned behavior and the social cognitive theory were the most used theories to explain and change physical activity behavior in urological cancers, respectively. However, the use of behavior change theories in physical activity interventions for urological cancers is still low across all urological tumor groups. Planning frameworks such as the intervention mapping approach should be used to enhance the systematic use of behavior change theories during every phase of intervention development. In addition, more research is needed to identity which behavior change techniques are most effective to change physical activity behavior in urological cancer survivors.

IMPLICATIONS FOR NURSING PRACTICE

Nurses play a key role in the urological cancer patients' clinical pathway and should be able to motivate patients to engage in sufficient physical activity levels. Therefore, it is important that nurses understand the underlying reasons why patients (do not) engage in physical activity and which behavior change techniques are most effective in changing a patients' behavior.

Effectiveness of the Fun for Wellness Online Behavioral Intervention to Promote Well-Being Actions in Adults With Obesity or Overweight: A Randomized Controlled Trial

The purpose of this study was to evaluate the effectiveness of the Fun For Wellness (FFW) online intervention to increase well-being actions in adults with obesity in the United States in relatively uncontrolled settings. The FFW intervention is guided by self-efficacy theory. The study design was a large-scale, prospective, double-blind, and parallel-group randomized controlled trial. Data collection occurred at baseline, 30 days after baseline, and 60 days after baseline. Participants (N = 667) who were assigned to the FFW group (nFFW = 331) were provided with 30 days of 24-hr access to FFW. Supportive evidence was provided for the effectiveness of FFW in real-world settings to promote, either directly or indirectly, three dimensions of well-being actions: community, occupational, and psychological. This study shows that theory-based intervention may be effective in promoting well-being actions in adults with obesity in the United States.

Parental and Familial Factors Influencing Physical Activity Levels in Early Adolescence: A Prospective Study

Parental/familial factors are important determinants of the physical activity level (PAL) in children and adolescents, but studies rarely prospectively evaluate their relationships. This study aimed to evaluate the changes in physical activity levels among adolescents from Bosnia and Herzegovina over a two-year period and to determine parental/familial predictors of PAL in early adolescence. A total of 651 participants (50.3% females) were tested at baseline (beginning of high school education; 14 years old on average) and at follow-up (approximately 20 months later). The predictors included sociodemographic characteristics (age, gender) and parental/familial factors (socioeconomic status of the family, maternal and paternal education, conflict with parents, parental absence from home, parental questioning, and parental monitoring). Physical activity levels were evidenced by the Physical Activity Questionnaire for Adolescents (PAQ-A; criterion). Boys were more active than girls, both at baseline (t-test = 3.09, p < 0.001) and at follow-up (t-test = 3.4, p < 0.001). Physical activity level decreased over the observed two-year period (t-test = 16.89, p < 0.001), especially in boys, which is probably a consequence of drop-out from the sport in this period. Logistic regression evidenced parental education as a positive predictor of physical activity level at baseline (OR [95% CI]; 1.38 [1.15–170], 1.35 [1.10–1.65]), and at follow-up (1.35 [1.11–1.69], 1.29 [1.09–1.59], for maternal and paternal education, respectively). Parents with a higher level of education are probably more informed about the importance of physical activity on health status, and thus transfer this information to their children as well. The age from 14 to 16 years is likely a critical period for maintaining physical activity levels in boys, while further studies of a younger age are necessary to evaluate the dynamics of changes in physical activity levels for girls. For maintaining physical activity levels in adolescence, special attention should be paid to children whose parents are less educated, and to inform them of the benefits of an appropriate physical activity level and its necessity for maintaining proper health and growth.

Culinary Education Programs for Children in Low-Income Households: A Scoping Review

Child obesity in the United States is at an all-time high, particularly among underserved populations. Home-cooked meals are associated with lower rates of obesity. Helping children develop culinary skills has been associated with improved nutrition. The purpose of this study is to report results from a scoping review of culinary education interventions with children from low-income families. Three databases and hand searches of relevant articles were examined. Retained articles met inclusionary criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, as appropriate. A data extraction template was developed. Data were independently extracted and verified. Only nine out of 370 articles met the inclusionary criteria and were included in the review. Most interventions were school-based, used a quasi-experimental design, and recruited minority children. Children-only was the primary intervention focus. Primary outcomes were mostly psychosocial from child self-report. Most interventions focused on children only and were guided by Social Cognitive Theory. Most reported stakeholder involvement; however, type and degree varied. All had an in-person component; only one used technology. Few reported training program leaders. Culinary education programs for children from low-income families could benefit from a broader theoretical grounding, program leader training, and greater parental involvement.

Impact of Combined Theory-Based Intervention on Psychological Effects and Physical Activity among Chinese Adolescents

PURPOSE

The current study was intended to assess the effect of a facilitated behavioral intervention based on the extended theory of planned behavior (TPB) on psychological constructs and physical activity among adolescents over a period of eight weeks.

METHODS

Students (n = 51, 12 ± 0.3 years of age) in the seventh grade at a junior middle school in China were randomly assigned to two groups: the intervention group (n = 24) and the control group (n = 27). Both groups were pre- and post-tested with the related psychological constructs of the extended TPB, along with behavioral measures of the Physical Activity Scale and ActiGraph accelerometer (model wGT3X-BT). The intervention group took part in 45 min classes once per week for 8 weeks, including five indoor theoretical courses and three outdoor basketball matches. The control group was not required to make any change to their normal school day. Also, 2 × 2 repeated measures analysis of variance (ANOVA) was conducted to compare the differences between the two groups, and then t-test was employed to compare the independent and paired differences.

RESULTS

Significant increases in pre-post subjective norms (SN) (p = 0.041, Cohen's d = 0.62), perceived behavior control (PBC) (p = 0.023, Cohen's d = 0.72), exercise intention (EI) (p = 0.043, Cohen's d = 0.61), and self-efficacy (SE) (p = 0.035, Cohen's d = 1.36) were observed in the intervention group. In addition, participants in the intervention group increased their exercise frequency (p < 0.001, Cohen's d = 1.25) and intensity (p = 0.028, Cohen's d = 0.68), especially their time spent on light intensity physical activity (light-PA%; p = 0.031, Cohen's d = 0.68), and their percentage of sedentary time (SB%) was also reduced (from 68% ± 10% to 58% ± 7%, p < 0.001, Cohen's d = 1.17). Furthermore, the intervention group showed significantly better performance in PBC (p = 0.032, Cohen's d = 0.62), EI (p < 0.001, Cohen's d = 1.32), SE (p < 0.001, Cohen's d = 1.15), SB% (p < 0.001, Cohen's d = 1.22), light-PA% (p < 0.001, Cohen's d = 1.12), and total physical activity (TPA) (p = 0.015, Cohen's d = 0.72) compared to the control group at the post-test. No significant pre post differences were observed for any psychological or behavioral variables in the control group, except for exercise frequency, but the values were still lower than those in the intervention group after the 8-week intervention (3.70 ± 0.72 versus 3.92 ± 0.83).

CONCLUSION

The combined theory-based intervention was effective at improving psychological constructs and physical activity among seventh-grade adolescents in 8 weeks.

Scoping Review of Pokémon Go: Comprehensive Assessment of Augmented Reality for Physical Activity Change

Pokémon Go™ (PG) is a mobile videogame that requires real-world walking to "catch" augmented reality (AR) virtual creatures. Media attention speculated that extensive physical activity (PA) could result from PG play, which could have public health benefit. Little is known about contextual factors related to PG play and how they may impact play initiation or duration. A systematic search of articles reporting the words PG was conducted with PubMed and Google Scholar. To understand the many possible influences on and outcomes of PG play, a scoping review was conducted by employing a conceptual model to organize the literature. Although large numbers of people started playing PG, these were a relatively small proportion of the relevant populations, but PG may have activated some of those most in need of PA. Diverse factors predicted who initiated PG play, but they tended to emphasize anticipated fun, escapism, nostalgia, social ties, and desire for PA. Environmental factors (e.g., unavailable GPS signals, trespassing laws) limited PG play for some. Diverse factors predicted duration of gameplay, but fun appeared to be prominent. The level of increases in PA from PG among youth and young adults appeared to be small or undetected, and of a relatively short duration (<2 months). Among older adults, however, there were modest increases in PA for up to 7 months post-release. This intensity and duration of increased PA appears to be inadequate to stem the epidemic of obesity but may have mental and social health benefits. Although many adverse outcomes from playing PG were reported, these appear to be low incidence, which should primarily influence PG players to knowingly exercise caution. Many research issues were identified to specify who might play AR games and effective strategies to enhance game design to increase PA.

Behavioral Interventions for Weight Management in Overweight and Obese Adolescents: A Comparison Between a Motivation-based Educational Program and Conventional Dietary Counseling

OBJECTIVES

This study aimed to compare the effects of a three-month motivation-based educational program and conventional dietary counseling on body composition and relevant outcomes among overweight and Obese adolescents.

METHODS

A total of 115 overweight and obese adolescents (46% boys) were randomly assigned to either a motivation-based program or a conventional dietary counseling. The assessments were conducted at baseline and 3, 6, and 12 months after intervention.

RESULTS

Mean age and body mass index (BMI) Z-score were 14.5 ± 1.2 and 2.42 ± 0.62, respectively. Considering time trend analysis, the two groups achieved significant improvements in BMI Z-score, wrist and waist circumferences, body composition indices, and HRQoL total scores after a one-year follow-up. Wrist circumference and the HRQoL reported by parents revealed significant differences between the study groups in favor of the motivation-based program.

CONCLUSIONS

Although both programs could improve anthropometric indices and HRQoL over time, the motivation-based program was more effective in reducing adolescents' wrist circumference and improving HRQoL, as the parents reported.

A Controlled Evaluation of a CBPR Intervention's Effects on Physical Activity and the Related Psychosocial Constructs Among Minority Children in an Underserved Community

BACKGROUND

Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA.

METHODS

Two fifth-grade classes at a school (n = 19 and n = 20) were randomly assigned to an intervention or comparison group. The intervention group participated in a 4-week intervention designed to improve MVPA (wGT3X-BT accelerometer; ActiGraph, Pensacola, FL) and the related psychosocial constructs (written survey). Groups were assessed prior to and immediately following the intervention.

RESULTS

There were no differences at baseline between groups. MVPA (30.0 [4.4] min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P < .05). Knowledge and skills were mediating variables of MVPA.

CONCLUSIONS

Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions.

Analysing facilitating and hindering factors for implementing gender equality interventions in R&I: Structures and processes

This article analyses the facilitating and hindering factors that have affected the implementation of gender equality interventions in research and innovation in Europe. It applies the evaluation framework developed in the EFFORTI project that recognizes the complexity of evaluating gender equality interventions in R&I, the importance of factoring in context to any sound evaluation as well as the need to distinguish between the design and implementation of interventions in evaluations. It is based on the analysis of 19 empirical case studies carried out throughout Europe and focuses on those structural and procedural factors that have either facilitated or hindered the implementation process of these interventions. Findings include how the governance framework; top-management commitment; bottom-up participation; framing synergies with other initiatives, strategies for tackling resistance; resources; sustainability of actions; gender competence, experience and knowledge and transparency, targets, standards and monitoring; and accessible data and information all contributed to the successful implementation of the interventions.

Asthma and Ultra-Processed Food

In the Decade of Nutrition, food must be reconsidered. The main objective of our research was to establish if there are any correlations between ultraprocessed food consumption and increased asthma prevalence or other respiratory outcomes. Meanwhille, it will be an important step to design some lifestyle recommendations with direct benefits for asthma treatment. NOVA system for food classification is a new concept addressing food quality. Ultraprocessed food, made entirely from substances derived from food and additives, that includes other sources of nutrients and energy, is not usually used in culinary preparation. How asthma outcomes are influenced by Western diet that contains a lot of processed food and what benefits could arise from the Mediterranean diet are subjects for interesting studies. Substantial correlations have been established between unhealthy diets, especially Western diet, ultraprocessed foods and food allergies and asthma pathogenesis and control. NOVA clasification of processing foods and dietary inflammatory index are helpful tools in early identifying of correct dietary approach in asthma. More research in nutrition recommendations for asthma patients must be done and practical guidelines in nutritional interventions are future steps.

The Relationships between Physical Activity, Self-Efficacy, and Quality of Life in People with Multiple Sclerosis

Regular physical activity (PA) can enhance the physical and mental health of people with Multiple Sclerosis (MS) because of its impact on muscular strength, mobility, balance, walking, fatigue, pain and health-related quality of life (HRQoL). Previous studies have hypothesized that the relationship between PA and HRQoL is mediated by self-efficacy. The aim of this research is to evaluate whether self-efficacy in goal setting and self-efficacy in the management of symptoms, mediate the relationship between PA and HRQoL, in a similar way to exercise self-efficacy. A sample of 28 participants with MS (18 females) and different levels of physical activity have been recruited and completed the following measures: a) physical activity (GLTEQ); b) health-related quality of life (SF-12); c) self-efficacy in the management of Multiple Sclerosis (SEMS) and, d) exercise self-efficacy (EXSE). The statistical analysis highlighted that self-efficacy in goal setting mediated the relationship between PA and mental health better than exercise self-efficacy. Our findings suggest that self-efficacy in goal setting can contribute to the adoption and maintenance of regular physical activity for long-lasting times, supporting and increasing the mental quality of life of people suffering from MS.

Mediators of Weight Loss Maintenance in the Keep It Off Trial

Background

An important step toward enhancing the efficacy of weight loss maintenance interventions is identifying the pathways through which successful interventions such as the Keep It Off trial have worked.

Purpose

This study aimed to assess the viability of mediated relationships between the Keep It Off Guided intervention, conceptually and empirically grounded potential mediators, and weight. Repeated measurement of mediators and weight enabled documentation of the temporal ordering of intervention delivery and changes in mediators and in weight among participants randomized to the Guided intervention or Self-Directed comparison group.

Methods

Total, direct, and indirect effects of the Guided intervention on weight change were calculated and tested for significance. Indirect effects were comprised of the influence of the intervention on three change scores for each mediator and the relationship between mediator changes and weight changes 6 months later.

Results

Guided intervention participants regained about 2% less weight over 24 months than Self-Directed participants. Starting daily self-weighing accounted for the largest share of this difference, followed by not stopping self-weighing.

Conclusions

Daily self-weighing mediated 24-month weight loss maintenance.

Trial Registration Number

The trial is registered withClinicalTrials.gov (Identifier: NCT00702455www.clinicaltrials.gov/ct2/show/NCT00702455).

Noncomprehensive and Intermittent Obesity-Related School Programs and Policies May Not Work: Evidence from the COMPASS Study

BACKGROUND

The school environment has the potential to influence student body mass index (BMI) through programs and policies. Our objective was to examine the effect of modifying obesity-related school policies and programs on youths' BMI trajectories.

METHODS

Obesity-related school policies and programs related to physical activity and healthy eating were collected from 41 schools across Ontario at baseline (2012-2013) and year 2 (2013-2014) of the COMPASS study. Self-reported height and weight were collected from the 4951 grades 9 and 10 students who attended those schools for 3 years. Linear mixed effects regression models examined the effect of modifying obesity-related school policies and programs on youths' BMI trajectories.

RESULTS

Between Y₁ and Y₂ , 26 of the 41 schools implemented distinct new obesity-related programs or policies related to physical activity or healthy eating. Five of the interventions were associated with BMI trajectories of students attending those schools compared to students attending a pooled sample of control schools, predicting a higher BMI trajectory.

CONCLUSIONS

Isolated programs and policies may not successfully improve youths' BMI trajectories. Further research is required to test the implementation of policies and programs that follow a comprehensive school health (CSH) approach, targeting BMI and associated behaviors.

Associations of neighbourhood safety with leisure-time walking and cycling in population subgroups: The HELIUS study

To create neighbourhood environments that encourage physical activity, it is important to know which neighbourhood characteristics are most influential. We examined the association of neighbourhood safety with leisure-time walking and cycling in the population at large, as well as in some subgroups in terms of sex, age, ethnicity and socio-economic position. We used data of 19,914 participants (18-70 years) from a study in Amsterdam, the Netherlands. Leisure-time walking and cycling in minutes/week were assessed with standard questionnaire. Geographic Information System techniques were used to examine neighbourhood safety (range = 1-10). Multilevel linear regression analyses showed positive associations between safety and walking (B = 7.9, 95% CI = -6.2-21.9) and cycling (B = 14.8, 95% CI = 2.5-27.1), but only the association with cycling was statistically significant. Higher safety levels were significantly associated with more cycling in women and individuals of Turkish and Moroccan origin. Stronger evidence is needed to inform policies to stimulate walking and cycling by improving neighbourhood safety.

Should I sit or stand: likelihood of adherence to messages about reducing sitting time

Background

High population levels of sitting is contributing to high rates of chronic health problems. Therefore, the aim of this study was to identify the sitting time messages with the greatest potential to reduce sitting behaviour, as well as identify how this may differ according to demographic, behavioural and psychosocial characteristics.

Methods

Australian adults (N = 1460) were asked to report the likelihood that they would adhere to seven messages promoting reduced sitting time and two messages promoting increased physical activity (from ‘not at all likely’ to ‘very likely’). Ordinal regression models were used to compare messages on the likelihood of adherence and whether likelihood of adherence differed as a function of demographic, psychosocial and behavioural characteristics.

Results

Likelihood of adherence was highest for the messages, ‘Stand and take a break from sitting as frequently as you can’ (83% respectively) and ‘Avoid sitting for more than 10 hours during the entire day’ (82%) and was significantly lower for the message, ‘Sit as little as possible on all days of the week’ (46%) compared to all other messages.

Conclusions

To increase likelihood of adherence messages should be specific, achievable and promote healthy alternatives to sitting (e.g. standing). Messages promoting standing as a healthy alternative to sitting may be more likely to engage people with high sitting behaviour and messages promoting physical activity may be more likely to engage males and retired adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7189-z) contains supplementary material, which is available to authorized users.

A randomized controlled trial to assess the potential efficacy, feasibility and acceptability of an m-health intervention targeting parents of school aged children to improve the nutritional quality of foods packed in the lunchbox 'SWAP IT'

BACKGROUND

Scalable interventions that improve the nutritional quality of foods in children's lunchboxes have considerable potential to improve child public health nutrition. This study assessed the potential efficacy, feasibility and acceptability of an m-health intervention, 'SWAP IT', to improve the energy and nutritional quality of foods packed in children's lunchboxes.

METHODS

The study employed a 2X2 factorial cluster randomized-controlled trial design. Twelve primary schools in New South Wales, Australia were randomly allocated to one of four groups: (i) no intervention;(ii) physical activity intervention only;(iii) lunchbox intervention only; or(iv) physical activity and lunchbox intervention combined. The two intervention strategies were evaluated separately. This paper focuses on the effects of the lunchbox intervention only. The lunchbox intervention comprised four strategies: 1) school nutrition guidelines; 2) lunchbox lessons; 3) information pushed to parents via a school-communication app and 4) parent resources addressing barriers to packing healthy lunchboxes. Outcome measures were taken at baseline and immediately post-intervention (10 weeks) and included measures of effectiveness (mean energy (kJ) packed in lunchboxes, total energy and percentage energy from recommended foods consistent with Australian Dietary Guidelines), feasibility (of delivering intervention to schools, parent app engagement and behaviour change) and acceptability to school staff and parents. Linear mixed models were used to assess intervention efficacy.

RESULTS

Of the 1915 lunchbox observations, at follow-up there was no significant differences between intervention and control group in mean energy of foods packed within lunchboxes (- 118.39 kJ, CI = -307.08, 70.30, p = 0.22). There was a significant increase favouring the intervention in the secondary outcome of mean lunchbox energy from recommended foods (79.21 kJ, CI = 1.99, 156.43, p = 0.04), and a non-significant increase in percentage of lunchbox energy from recommended foods in intervention schools (4.57%, CI = -0.52, 9.66, p = 0.08). The views of the messages pushed via the app ranged from 387 to 1550 views per week (mean views =1025 per week). A large proportion (71%) of parents reported awareness of the intervention, making healthier swaps in the lunchbox (55%), and pushed content was helpful (84%).

CONCLUSION

The study is the first RCT to assess the potential of a multi-component m-health lunchbox intervention. The intervention was feasible, acceptable and potentially effective in improving the nutritional quality of foods packed within children's lunchboxes.

TRIAL REGISTRATION

Australian Clinical Trials Registry ACTRN: ACTRN12616001228471 .

Which patients benefit from physical activity on prescription (PAP)? A prospective observational analysis of factors that predict increased physical activity

Background

There is robust evidence that regular physical activity (PA) has positive health effects. However, the best PA methods and the most important correlates for promoting PA remain unclear. Physical activity on prescription (PAP) aims to increase the patient’s motivation for and level of PA. This study investigated possible predictive baseline correlates associated with changes in the PA level over a 6-month period of PAP treatment in order to identify the primary care patients most likely to benefit from a PAP intervention.

Methods

The study included 444 patients with metabolic risk factors who were aged 27 to 85 years and physically inactive. The patients received PAP treatment that included individual counseling plus an individually-tailored PA recommendation with a written prescription and individualised structured follow-up for 6 months. Eight baseline correlates of PA were analysed against the PA level at the 6-month follow-up in a predictor analysis.

Results

Five baseline correlates predicted the PA level at the 6-month follow-up: self-efficacy expectations for changing PA; the patient’s preparedness and confidence regarding readiness to change PA; a BMI <  30; and a positive valued physical health. The proportion of patients increasing the PA level and achieving a PA level that was in accordance with public health recommendations was higher with a positive valued baseline correlate. The odds of achieving the recommended PA level increased substantially when 2 to 4 predictive correlates were present. PA levels increased to a greater extent among patients with low PA at baseline than patients with high PA at baseline, especially in combination with 2 to 4 positively-valued correlates (87–95% vs. 62–75%).

Conclusions

This study identified potential predictive correlates of an increased PA level after a 6-month PAP intervention. This contributes to our understanding of PAP and could help individualise PAP support. The proportion of patients with the lowest PA level at baseline increased their PA level in a higher extent (84%) and thus may benefit the most from PAP. These results have clinical implications for behavioural change in those patients having the greatest health gains by increasing their PA level.

Trial registration

ClinicalTrials.gov; NCT03586011. Retrospectively registered on July 17, 2018.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6830-1) contains supplementary material, which is available to authorized users.

The Effects of Multi-Component Exercise Training on Cognitive Functioning and Health-Related Quality of Life in Older Adults

PURPOSE

Exercise has been shown to have various proximal and distal benefits among older adults such as improving physical fitness, cognitive functioning, and health-related quality of life (HR-QOL). Despite this evidence, limited research has investigated pathway change of these outcomes. The primary purpose of this study was to test if older adults who improved in physical fitness measures from engaging in multicomponent exercise training for 12 weeks predicted change in proximal (cognitive functioning) and distal (HR-QOL) outcomes, respectively.

METHODS

Participants (n = 110) were healthy, older adults (M = 72, SD = 7.24) that comprised an exercise-intervention and control group. The intervention consisted of exercising in a supervised laboratory setting for 12 weeks.

RESULTS

Structural equation modeling revealed group type to predict change in physical performance and the maximum walking test with comparable effect sizes. Physical performance in turn predicted improvement in processing speed (β = 0.23, p = 0.013) executive functioning (β = 0.26, p = 0.006), and HR-QOL (β = 0.13, p = 0.031). However, only executive functioning was found to significantly predict HR-QOL (β = 0.49, p < 0.001) over processing speed (p > 0.05).

CONCLUSIONS

Between two fitness measures, the physical performance test demonstrated better predictive validity in proximal and distal health outcomes. In addition to physical fitness, older adults who engage in multi-component exercise sessions regularly can improve their executive functioning, which in turn enhances their HR-QOL.

Generalizability of an adult-validated model for predicting increased physical activity in after-school program children: Effects of treatment formats on fitness indicators

Inappropriately high weight in children is a persistent problem in the United States, and physical activity is often reduced in schools due to academic demands. Effective after-school programs could positively impact both physical activity and overweight/obesity, however previous reviews and meta-analyses have indicated minimal effects. Both 4- and 3-day/week versions of a social cognitive theory-driven physical activity/nutrition after-school program were evaluated against unstructured care to assess effects in children (overall M_age = 10.00 years, SD = .80). For changes over 9 months in body mass index (BMI), effects sizes (Cohen's d) were .68, .40, and .07 in the 4-day (n = 70), 3-day (n = 70), and unstructured (n = 50) groups, respectively. Similar patterns of effects were found for changes in free-time physical activity and cardiovascular endurance. Incorporating a theory-based prediction model previously supported in teens through older adults, with and without medical disorders and health-risk factors, improvements in exercise-related self-regulation and self-efficacy, and mood, significantly predicted increased free-time physical activity (R² = .48). Effects significantly strengthened to R² = .62 when completion/non-completion of the recommended 300 min/week of physical activity was also accounted for. Change in BMI was inversely related to physical activity change, β=-.14, p < .05. The present evaluation process indicated promising effects, and indicated theory-based targets to foster future program improvements.

Differential Programming Needs of College Students Preferring Web-Based Versus In-Person Physical Activity Programs

College students report several barriers to exercise, highlighting a need for university-based programs that address these challenges. In contrast to in-person interventions, several web-based programs have been developed to enhance program engagement by increasing ease of access and lowering the necessary level of commitment to participate. Unfortunately, web-based programs continue to struggle with engagement and less-than-ideal outcomes. One explanation for this discrepancy is that different intervention modalities may attract students with distinctive activity patterns, motivators, barriers, and program needs. However, no studies have formally evaluated intervention modality preference (e.g., web-based or in-person) among college students. The current study sought to examine the relationship between intervention modality preference and physical activity programming needs. Undergraduate students (n = 157) enrolled in psychology courses at an urban university were asked to complete an online survey regarding current activity patterns and physical activity program preferences. Participants preferring web-based physical activity programs exercised less (p = .05), were less confident in their abilities to exercise (p = .01), were less likely to endorse the maintenance stage of change (p < .01) and perceived more barriers to exercising (p < .01) than those who preferred in-person programming. Findings suggest that students preferring web-based programming may require programs that enhance self-efficacy by fostering goal-setting and problem-solving skills. A user-centered design approach may enhance the engagement (and therefore effectiveness) of physical activity promotion programs for college students.

Protective effects of helmets on bicycle-related injuries in elderly individuals

OBJECTIVE

The increasing frequency of bicycle-related injuries is due to the growing elderly population and their increasing physical activity. This study aimed to compare the protective effects of helmets on bicycle-related injuries in elderly individuals compared with those in younger adults.

METHODS

Data from the Korean emergency department-based Injury In-depth Surveillance database from eight emergency departments during 2011-2016 were retrospectively analysed. The subjects sustained injuries while riding bicycles. Cases with unknown clinical outcomes were excluded. Covariates included mechanism, place and time of injury. The primary outcome was traumatic brain injury (TBI) incidence, and the secondary outcomes were in-hospital mortality and severe trauma. The effects of helmets on these outcomes were analysed and differences in effects were determined using logistic regression analysis. Subsequently, the differences in the effects of helmets use between age groups were examined by using interaction analysis RESULTS: Of 7181 adults, 1253 were aged >65 years. The injury incidents showed a bimodal pattern with peaks around ages 20 and 50 years. Meanwhile, the helmet-wearing rate showed a unimodal pattern with its peak at age 35-40 years; it decreased consistently with age. By multivariate analysis, helmet-wearing was associated with a reduced TBI incidence (OR 0.76; 95% CI 0.57 to 0.99) and severe trauma (OR 0.78; 95% CI 0.65 to 0.93). The effects of helmets increased in elderly individuals (TBI (p=0.022) and severe trauma (p=0.024)).

CONCLUSION

The protective effects of helmets on bicycle-related injuries are greater for elderly individuals, thus reducing TBI incidence.

Body dissatisfaction, neuroticism, and female sex as predictors of calorie-tracking app use amongst college students

Objective: This study investigated body dissatisfaction, neuroticism, and sex as potential predictors of calorie-tracking app usage amongst undergraduate college students. Participants: College students (N = 491) were recruited from a large northeastern university in October 2015. Methods: Participants completed an online survey asking about their sex, body dissatisfaction, neuroticism, and use of apps that track calories. Results: Analyses revealed that female sex and body dissatisfaction-but not neuroticism-were direct predictors of calorie-tracking app usage. Analyses also provided support for a causal sequence wherein neuroticism and body dissatisfaction mediate, in serial, the relationship between female sex and calorie-tracking app usage. Conclusions: The results from this study suggest that female college students are more likely to use calorie-tracking apps-a phenomenon which may be attributable to their higher levels of neuroticism and subsequent increased body dissatisfaction.

Behavior change is not one size fits all: psychosocial phenotypes of childhood obesity prevention intervention participants

Variability in individuals' responses to interventions may contribute to small average treatment effects of childhood obesity prevention interventions. But, neither the causes of this individual variability nor the mechanism by which it influences behavior are clear. We used qualitative methods to characterize variability in students' responses to participating in a childhood obesity prevention intervention and psychosocial characteristics related to the behavior change process. We interviewed 18 students participating in a school-based curriculum and policy behavior change intervention. Descriptive coding, summary, and case-ordered descriptive meta-matrices were used to group participants by their psychosocial responses to the intervention and associated behavior changes. Four psychosocial phenotypes of responses emerged: (a) Activated-successful behavior-changers with strong internal supports; (b) Inspired-motivated, but not fully successful behavior-changers with some internal supports, whose taste preferences and food environment overwhelmed their motivation; (c) Reinforced-already practiced target behaviors, were motivated, and had strong family support; and (d) Indifferent-uninterested in behavior change and only did target behaviors if family insisted. Our findings contribute to the field of behavioral medicine by suggesting the presence of specific subgroups of participants who respond differently to behavior change interventions and salient psychosocial characteristics that differentiate among these phenotypes. Future research should examine the utility of prospectively identifying psychosocial phenotypes for improving the tailoring of nutrition behavior change interventions.

Increasing Physical Activity Through Principles of Habit Formation in New Gym Members: a Randomized Controlled Trial

BACKGROUND

The promotion of physical activity (PA) is paramount to public health, yet interventions in the social cognitive tradition have yielded negligible improvements. The limited progression may be due to an overreliance on intention as the proximal determinant of behavior and a lack of consideration of implicit/automatic processes. The purpose of this study was to examine the impact of a habit formation intervention on PA over 8 weeks in a two-arm parallel design, randomized controlled trial.

METHODS

Participants (n = 94) were new gym members with the intention to engage in PA but below international PA guidelines at baseline, who were randomized into a control or habit experimental group. The experimental group attended a workshop (at baseline) and received a follow-up booster phone call at week 4. The primary outcome of the study was minutes of moderate-vigorous intensity PA (MVPA) at week 8. The secondary outcome was a manipulation check to determine if the experimental group effectively incorporated habit-building constructs (cues and practice consistency).

RESULTS

The experimental group showed a significant increase in MVPA after 8 weeks in both accelerometry (d = 0.39, p = .04) and self-report (d = 0.53, p = .01) compared with the control group. The experimental group also showed an increase in use of cues (d = 0.56, p < .001) and practice consistency (d = 0.40, p = .01) at week 8.

CONCLUSION

The results contribute to the initial validity of increasing PA through a focus on preparation cues and practice consistency. Future research should replicate these findings and extend the duration of assessment to evaluate whether PA changes are sustained. Registered Trial Number NCT02785107.

Personal, social, and environmental factors associated with lifejacket wear in adults and children: A systematic literature review

OBJECTIVE

Drowning claims 7% of the global burden of injury-related deaths. Lifejackets are routinely recommended as a drowning prevention strategy; however, a review of related factors regarding lifejacket wear has not previously been investigated.

METHODS

This systematic review examined literature published from inception to December 2016 in English and German languages. The personal, social, and environmental factors associated with lifejacket wear among adults and children were investigated, a quantitative evaluation of the results undertaken, and gaps in the literature identified.

RESULTS

Twenty studies, with sample sizes of studies ranging between 20 and 482,331, were identified. Fifty-five percent were cross-sectional studies. All studies were scored IV or V on the Australian National Health and Medical Research Council (NHMRC) grading system indicating mostly descriptive and cross-sectional levels of evidence. Factors associated with increased wear included age (mostly children), gender (mostly female), boat type (non-motorised), boat size (small boats), role modelling (children influenced by adult lifejacket wear), and activity (water-skiing, fishing). Factors not associated or inconsistent with lifejacket wear included education, household income, ethnicity, boating ability, confidence in lifejackets, waterway type, and weather and water conditions. Factors associated with reduced lifejacket wear included adults, males, discomfort, cost and accessibility, consumption of alcohol, and swimming ability. Three studies evaluated the impact of interventions.

CONCLUSION

This review identified factors associated with both increased and decreased lifejacket wear. Future research should address the motivational factors associated with individuals' decisions to wear or not wear lifejackets. This, combined with further research on the evaluation of interventions designed to increase lifejacket wear, will enhance the evidence base to support future drowning prevention interventions.

Impact of Lifestyle Interventions Targeting Healthy Diet, Physical Activity, and Weight Loss on Asthma in Adults: What Is the Evidence?

Unhealthy lifestyle factors such as poor diet quality, sedentary lifestyle, and obesity are associated with negative health consequences in asthma including poor asthma control, impaired quality of life, and greater health care utilization. Lifestyle modification is the cornerstone of behavioral treatments and has been effective in chronic diseases such as atherothrombotic vascular disease and diabetes. There is a critical need for lifestyle interventions in asthma care that address obesity and its intimately linked risk behaviors in terms of poor diet and physical inactivity. We present in this commentary the promising lifestyle interventions emerging in asthma care that target poor diet, physical inactivity and weight loss, the proposed mechanisms of these lifestyle interventions, and the critical need for guideline-concordant lifestyle interventions in asthma care.