Get the message? A scoping review of physical activity messaging

Cone beam CT in the imaging of musculoskeletal trauma: a scoping review

INTRODUCTION

Cone beam computed tomography (CBCT) is an emerging technology in musculoskeletal (MSK) imaging. The objective of this scoping review was to provide an overview of the research surrounding CBCT utility in bony injury assessment as an alternative to other imaging modalities and investigate any gaps in the current evidence base.

METHODS

MEDLINE, CINAHL, and PubMed were searched up to January 2025 for articles including CBCT studies on human participants following trauma. An online literature review tool was used to manage and streamline the review process.

RESULTS

The search yielded 23 studies. The image quality and diagnostic accuracy of CBCT were high overall, and a number of studies confirmed the radiation dose to be lower than multislice CT. Studies examined CBCT for extremity trauma, with half the studies focused solely on the wrist. The utility appears greatest in the identification of radiographically occult fractures. Limited cost-effectiveness analysis has been undertaken.

CONCLUSIONS

Overall, the literature suggests CBCT can be an effective tool in the diagnosis of bony injuries with greater sensitivity than radiography at a lower radiation dose than multi-slice computed tomography. However, evaluation of wider patient and economic impacts of adopting CBCT in MSK trauma pathways is recommended.

Exercise Communication for Breast Cancer Survivors: A Systematic Scoping Review

Importance

Exercise may offer various clinical benefits to breast cancer survivors. However, exercise participation among survivors is low. Discussions about exercise can increase participation, but details regarding implementation of exercise communication for breast cancer survivors are unclear.

Objective

To examine the development and implementation of explicitly reported exercise communication for breast cancer survivors.

Evidence Review

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews was used. Six databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Communication and Mass Media Complete, and PsycINFO) were searched for articles describing exercise communication for female breast cancer survivors in any geographical location or setting published up to April 2024. Information about study and participant characteristics, exercise communication, and intervention components and effects were extracted.

Findings

Thirty-nine studies were included. Information consistent with exercise guidelines was communicated in 32 studies for aerobic exercise (82.1%) and 7 studies for muscle-strengthening exercise (17.9%). More studies communicated information about exercise benefits (20 [51.3%]) compared with exercise safety (3 [7.7%]). Studies included breast cancer survivors who were predominantly White (median [range], 85.5% [47.4%-98.7%]). Most included breast cancer survivors were educated (median percentage, 50.7% were college graduates) and had completed primary treatment (eg, median percentage, 66.7% had completed chemotherapy). Seventeen individualized (ie, tailored) information based on demographic or clinical characteristics (43.6%), and 5 considered contextual factors, such as the environment (12.8%). Most interventions reported an increase in exercise (19 of 21 [90.4%]). Heterogeneity in intervention design (eg, dietary advice or exercise trackers in addition to exercise information) and evaluation (eg, intervention length and outcomes) prevented quantitative synthesis of intervention effects.

Conclusions and Relevance

In this systematic scoping review of exercise communication for breast cancer survivors, interventions including exercise communication appeared to show a favorable effect. However, data were limited about the development and implementation of these interventions among underrepresented breast cancer survivors. Interest in research involving exercise communication for breast cancer survivors in clinical settings remains strong.

"I Will Exercise to Look Great!": The Impact of Message Frame, Message Focus, and Age Label on Enhancing Older Adults' Physical Activity Intentions

Promoting physical activity (PA) in older adults is a long-standing and crucial aspect of public health. It is essential for improving quality of life and maintaining overall health as people age. This study aims to identify an effective message strategy for enhancing PA intentions in aging population. Using a between subjects, 2 [message frame: gain versus loss] × 2 [message focus: health versus appearance] × 2 [age label: presence versus absence] full factorial survey experiment, this study uncovered a significant main effect for message framing. Gain-framed messages elicited more positive PA attitudes than loss-framed messages among older adults, and this effect of message frame further varied upon different message focuses and age label conditions. Moreover, moderated mediation analyses showed that gain-framed messages exerted a stronger indirect effect on PA intentions through PA attitudes when older adults received appearance-focused messages with age labels than without. The theoretical and practical implications of tailoring health promotion messages targeting older adults were discussed.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

BACKGROUND

Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

METHODS

A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

RESULTS

The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

CONCLUSION

The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

Influences on Physical Activity Participation Among Older Adults: Perspectives of Exercise Professionals and Older Adult Exercise Participants

We compared perceptions of enablers, barriers, and motivators to greater physical activity by older adults in two respondent groups: individuals 55+ years of age participating in a research exercise program and exercise professionals who plan and deliver programming to older adults. We developed and administered a questionnaire on potential factors influencing physical activity participation among older adults. Questionnaire items were transformed into scales and analyzed using independent sample Mann-Whitney U tests and principal component analyses (PCA). Statistically significant differences emerged between the respondent groups. Compared to older adults, exercise professionals rated the influence of physical capabilities (p < 0.001), social (p < 0.001) and physical opportunities (p < 0.001), and reflective motivations on barriers to physical activity (p < 0.001) higher. Older adults rated reflecting on the consequences of physical inactivity (p < 0.05) higher. Respondent groups differed in their perspectives regarding the relative influence of enablers, barriers, and motivators to physical activity participation, and these differences may inform physical activity messaging for older adults.

Moving With the Times: Updating the National Physical Activity Plan's Media and Communication Strategies to Increase Population-Level Physical Activity

In 2022, an interdisciplinary team of subject matter experts was convened to substantially revise the Mass Media sector content of the National Physical Activity Plan. The updated version recognizes the rapid pace at which the media landscape is evolving and includes a new sector name (Media and Communications) and revised strategies and tactics that reflect progress in the development of a national physical activity campaign brand (Move Your Way ®). This commentary summarizes key changes and highlights the importance of ongoing collaboration between physical activity and media professionals to optimize promotion of physical activity through diverse channels.

Communicating physical activity messages with adolescents: what works? A scoping review with stakeholder consultation

BACKGROUND

Global levels of adolescents' physical inactivity are cause for concern, despite the well-documented health benefits of physical activity (PA). Addressing the messaging of PA is one approach to improve PA knowledge. While increased knowledge does not necessarily lead to behavior change, physically active students have better knowledge of the health benefits of PA. Recently, researchers have highlighted the need for an effective communication strategy for PA messages. This review aimed to summarize the state of the available evidence about the operationalization of communicating PA messages, the evaluation, and effectiveness of PA messages.

METHODS

The Levac six steps and Joanna Briggs Institute methodological guidance for scoping reviews were followed. Five databases were searched up until April 8th 2024. Both title and abstract and full-text screening were piloted whereby 10% of the total articles were double-screened and the remainder were completed by CG. Data were extracted and a data-based convergent synthesis design was used following qualitative synthesis methods. Finally, a consultation with key stakeholders was held to confirm the findings concerning practical relevance.

RESULTS

A total of 19,412 articles were identified from searches, 94 full texts were included in the final analysis, corresponding to 80 individual studies. The evidence confirms that there are many factors to consider when communicating PA messages and evaluating their effectiveness. Inconsistencies exist regarding the timing and frequency of message delivery and the evaluation of effective communication. When communicating PA with adolescents, messages commonly focus on the benefits of PA and strategies to overcome barriers and are commonly delivered in the school setting by researchers or school stakeholders i.e. teachers, peers. Messages should be concise, positively framed, support adolescent autonomy, and utilize different messaging platforms and techniques to avoid staleness.

CONCLUSIONS

There is a lack of a standardized approach to communicating PA messages with adolescents making evaluation and comparison challenging. Future research should focus on developing guidance to facilitate the effective communication of PA messages with adolescents.

Sit is not lit: Examining the impact of message framing, modality, and peer influence on attitudes and intentions to reduce sedentary behavior

This study examines the effects of gain-loss framing, messaging modality, peer influence, and individual factors such as social norms and self-efficacy on the attitudes and intentions to reduce sedentary behaviors among university students, specifically through (a) taking breaks and (b) taking 10,000 steps daily. We conducted a two-week health campaign field experiment on Instagram in January 2022, delivering ten posts with tailored messages to 284 university students in Singapore (valid N = 249). The participants were predominantly female (70.16%), ages 21-34 years (M = 24.2, SD = 3.19). This study measured attitudes and intentions to take breaks and 10,000 steps daily as key outcomes. The study yielded three key findings: (1) Gain-loss framing effects were amplified by peer influence, descriptive norms, and injunctive norms, with peer influence amplifying loss framing and both norms amplifying gain framing; (2) Gain framing was more effective than loss framing for motivating the intention to take 10,000 steps; (3) Injunctive norms were associated with attitudes and intentions to take breaks and the intention to take 10,000 steps, while self-efficacy was associated with attitudes toward taking breaks and both attitudes and intentions to take 10,000 steps. This study contributes theoretically by demonstrating how social dynamics amplify framing effects, with peer influence enhancing loss framing on attitude towards taking breaks and norms strengthening gain framing on attitude and intention towards taking 10,000 steps. Practically, it suggests health campaigns can effectively promote behaviors like taking breaks or walking by leveraging norms, peer influence, and self-efficacy.

Smoking Among Healthcare Professionals in Australia: A Scoping Review

Studies showed healthcare professionals who are non-smokers are more likely to deliver smoking cessation advice to their patients than those who are smokers. However, healthcare professionals continue to smoke across the globe. This scoping review assessed the available data on the prevalence and predictors of smoking among healthcare professionals in Australia. Following the PRISMA extension for the Scoping Review checklist, a systematic literature search was conducted on CINAHL, MEDLINE, APA PsycINFO, Scopus, Web of Science, and Cochrane Library in August 2024. Articles published between 1990 and 2024 were considered, and finally, 26 papers met the inclusion and exclusion criteria. Australian healthcare professionals showed varying smoking prevalence. For physicians, it was 10.2% in 1990 to 7.4% in 2013; among dentists, 6% in 1993 to 4.9% in 2004; and among nurses, 21.7% in 1991 and 10.3% during 2014-15. The highest smoking rates were observed among Aboriginal health workers (AHWs): 63.6% in 1995 to 24.6% in 2021. Age was a positive predictor for smoking among nurses, and so was male gender among dentists, physicians, and nurses; other predictors included area of specialty, lower emotional wellbeing, etc. This review highlighted a declining trend in smoking among healthcare professionals in Australia; however, it was not proportionate among the different health specialties.

The longitudinal evaluation of the Canadian 24-Hour Movement Guidelines for Adults: lessons learned and considerations for future research

National movement behaviour guidelines, in isolation, are unlikely to influence practice or policy unless accompanied by robust knowledge mobilization (KMb) strategies. However, without pairing KMb strategies with systematic evaluation, the impact of large-scale dissemination is unknown. The objectives of this study were to (1) systematically assess the dissemination of the Canadian 24-Hour Movement Guidelines for Adults Aged 18-64 Years and Adults Aged 65 Years or Older (24HMG) using the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework and (2) provide recommendations to support the KMb and future impact of national movement behaviour guidelines. Intermediary organizations involved in the development and dissemination of the 24HMG were invited to participate in this study. A combination of methods-including cross-sectional surveys, media monitoring, and website content analysis-were performed at multiple timepoints over a 12-month period to assess the dissemination of the 24HMG. Findings suggest that the multi-pronged dissemination approach used for the 24HMG had a large reach to guideline target audiences (approximately 11.9 million) but resulted in low awareness and knowledge of the 24HMG among adults living in Canada (31.9% and 1.6%, respectively). Dissemination activities performed by intermediary organizations peaked in the first 4-months post-guideline release (76% of responding organizations), trending downwards over time (53% of responding organizations at 12 months). The complexity of disseminating national movement behaviour guidelines presents many challenges to systemic adoption. However, the impact of future national movement behaviour guidelines may be improved by augmenting current dissemination approaches to include coordinated, scalable, and capacity-building strategies.

Barriers and facilitators to the dissemination of national movement behavior guidelines among health-promoting organizations: a qualitative study

Background

National movement behavior guidelines offer evidence-informed recommendations for how to obtain health benefits. However, their impact on practice and policy has been limited. Factors at multiple levels determine the effective mobilization of knowledge into practice. Historically, little attention has been paid to assessing the social, organizational, and economic factors that influence the uptake of national movement behavior guidelines; potentially contributing to their blunted impact on public health outcomes. The purpose of this study was to explore the barriers and facilitators experienced by intermediary organizations to disseminating national movement behavior guidelines.

Methods

Representatives from organizations involved in the development and dissemination of the Canadian 24-Hour Movement Guidelines for Adults 18-64 Years and Adults 65 Years or Older were invited to participate in semi-structured interviews to explore barriers and facilitators to national movement behavior guideline dissemination. Interview guides were informed by the Consolidated Framework for Implementation Research (CFIR). Fourteen interviews were conducted, and transcripts were analyzed using inductive thematic analysis. Identified barriers and facilitators were mapped onto the CFIR.

Results

Participants identified several elements that have the potential to influence the dissemination of national movement behavior guidelines, such as organizational alignment, resources (i.e., time, human, financial), and ownership of the guidelines.

Conclusion

This study provides insight into the breadth of barriers and facilitators to guideline dissemination that may be experienced by intermediary organizations. Findings may be used to inform interventions designed to improve the dissemination and uptake of national movement behavior guidelines among health-promoting organizations.

What's in a Message? Effects of Mental Fatigue and Message Framing on Motivation for Physical Activity

Many adults worldwide do not meet current physical activity (PA) guidelines. Mental fatigue decreases the likelihood of choosing to engage in PA. Message framing may enhance PA motivation when fatigued. We examined the effects of mental fatigue and message framing on PA motivation with additional focus on the messaging "congruency effect." Three hundred and twenty undergraduates completed measures of dispositional motivational orientation and were exposed to either gain-framed or loss-framed messages before completing an effort discounting questionnaire. Results showed lower motivation to engage in PA of higher intensities and longer durations. Direct effects of message framing on PA motivation were not significant. Interaction effects revealed that participants receiving messages congruent with their dominant motivational orientation showed increased motivation for light-intensity PA and decreased motivation for vigorous-intensity PA as mental fatigue increased. Findings suggest that providing messages congruent with one's dominant motivational orientation may increase motivation for engaging in light-intensity PA when fatigued.

"I Don't Believe in Age; I Believe in Staying Enthusiastic": An Exploratory Qualitative Study into Recruitment Strategies Stimulating Middle-Aged and Older Adults to Join Physical Activity Interventions

Many middle-aged and older adults (MAOAs) do not engage in sufficient physical activity (PA), despite its well-documented benefits for healthy aging. Existing PA interventions often fail to reach or engage the target population effectively. This study investigates MAOAs' preferences for recruitment strategies to optimize the reach and uptake of PA interventions, thereby enhancing their impact on healthy aging and public health. Qualitative interviews were conducted with 39 MAOA participants (69% female, mean age = 69.46, SD = 7.07), guided by McGuire's Theory on Persuasive Communication. Factors related to the source, message content, channel, receiver characteristics and target behavior of recruitment strategies were analyzed. Our findings suggest a preference for trustworthy sources (e.g., healthcare professionals over commercial entities) and positive, non-ageist messaging. MAOAs vary in their channel preferences but emphasize the importance of personalization. Despite heterogeneity, MAOAs commonly perceive themselves as sufficiently active, indicating a need for improved knowledge on what constitutes sufficient PA, as well as easy enrollment or trying out interventions. Tailoring recruitment strategies to diverse MAOA segments based on age seems crucial for effective engagement. Future research could explore quantitative research into how communication factors relate to various target population characteristics.

Reframing Communication about Fall Prevention Programs to Increase Older Adults' Intentions to Participate

INTRODUCTION

Falls and fall-related injuries in community-dwelling older adults are a growing global health concern. Despite effective exercise-based fall prevention programs (FPPs), low enrollment rates persist due to negative connotations associated with falls and aging. This study aimed to investigate whether positive framing in communication leads to a higher intention to participate in an FPP among community-dwelling older adults.

METHODS

We conducted a two-sequence randomized crossover study. We designed two flyers, a standard flyer containing standard terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity by reframing 'fall prevention' as an 'exercise program' and 'old' as 'over 65 years'. With a Mann-Whitney U test, we investigated group differences regarding the intention to participate between the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative thematic analysis on open-ended answers to gain a deeper understanding of participants' intention to participate.

RESULTS

In total, we included 133 participants. Findings indicated a significantly higher intention to participate in the reframed flyer (median = 4; interquartile range = 1-6) compared to the standard flyer (median = 2; interquartile range = 1-4) (p = 0.038). Participants favored more general terms such as 'over 65 years' over 'older adults'. Older adults who were female, not at high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging showed greater receptivity to positively-framed communications in the reframed flyer. Additionally, already being engaged in physical activities and a lack of practical information about the FPP appeared to discourage participation intentions.

DISCUSSION

The results in favor of the reframed flyer provide practical insights for designing and implementing effective (mass-)media campaigns on both (inter)national and local levels, as well as for interacting with this population on an individual basis. Aging-related terminology in promotional materials hinders engagement, underscoring the need for more positive messaging and leaving out terms such as 'older'. Tailored positively framed messages and involving diverse older adults in message development are essential for promoting participation in FPPs across various population subgroups to promote participation in FPPs among community-dwelling older adults.

The association between morning pleasant anticipation and daily positive incidental affect on adults' daily steps: An ecological momentary assessment study

OBJECTIVE

This study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry.

METHODS

A total of 152 adults in Taiwan (female = 67.1 %, age range = 18-59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February-July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates' potential effects on the study outcomes.

RESULTS

The study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p = .03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p < .01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation.

CONCLUSION

On days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the "anticipatory" affective processes on movement behaviors with the goal of promoting physical activity in daily life.

Assessing the impact of message relevance and frequency on physical activity change: A secondary data analysis from the random AIM trial

Text messages are widely used to deliver intervention content; however, sending more intensive messages may not always improve behavioral outcomes. This study investigated whether message frequency was associated with daily physical activity, either by itself or in interaction with message content relevance. Healthy but insufficiently active young adults (aged 18-29 years) wore Fitbit activity trackers and received text messages for 180 days. Message frequencies varied daily at random, and messages were sent from three content libraries (40% Move More, 40% Sit Less, 20% Inspirational Quotes). Contrary to expectations, the results revealed a null association between total daily text message frequency and physical activity, both for daily step counts and moderate-to-vigorous physical activity (MVPA) duration. Additional analyses revealed that the daily frequency of messages with relevant content (i.e. Move More, Sit Less) was not associated with physical activity, but the daily frequency of messages with irrelevant content (i.e. Inspirational Quotes) was negatively associated with physical activity. We concluded that the effectiveness of text messages in promoting physical activity is impacted by the combination of content relevance and frequency, with frequent irrelevant messages potentially decreasing activity levels. This study suggests that irrelevant message frequency can negatively impact physical activity, highlighting the risks of delivering irrelevant content in digital health interventions.

Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity

BACKGROUND

A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice.

METHODS

Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice.

RESULTS

When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms.

CONCLUSIONS

To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts.

Promoting physical activity and a healthy active lifestyle in community-dwelling older adults: a design thinking approach for the development of a mobile health application

Background

Physical activity (PA) has wide-ranging, and well documented benefits for older adults, encompassing physical, cognitive, and mental well-being. The World Health Organization advocates for a minimum of 150-300 min of moderate intensity PA per week, supplemented by muscle-strengthening exercises. However, the rates of PA among older adults remain a concern. While portable technologies hold promises in promoting PA, sustaining long-term engagement continues to be a challenge.

Objective

The aims of this study are to identify barriers and facilitators to PA in older adults, to develop an mHealth app promoting PA and an active healthy lifestyle in collaboration with community-dwelling older adults guided by the design thinking process, and to test it.

Methods

A co-creative process was used, employing design thinking. Interviews were conducted to understand the needs of the target population and identify the problem of insufficient PA. Two cocreation sessions involving older adults and experts were conducted to generate innovative ideas. Participants were selected based on age (≥65 years), no severe illness, Dutch language proficiency, and active participation ability. Results were qualitatively analyzed and coded. Finally a prototype was developed and tested.

Results

Interviews with older adults highlighted diverse perceptions of PA but unanimous agreement on its importance. They recognized health benefits such as improved mobility, balance, and reduced fall risk, while emphasizing the social and mental aspects. Barriers included poor health, time constraints, weather conditions and fear of falling. Cocreation sessions identified key topics: perception of a healthy lifestyle, coping strategies, mHealth App features, screen visualization, and tailored notifications, which led to the development of a mobile app promoting PA and an active lifestyle. The app was stepwise prototyped.

Conclusion

This study emphasizes the importance of promoting PA among older adults through a collaborative design thinking approach. However, the implementation of mHealth apps faces obstacles due to the digital divide, necessitating personalized solutions to bridge the gap. Moreover, it calls for further research to investigate the long-term impact of such interventions and explore behavior change patterns in this population.

Does messaging matter? A registered report on appearance-versus health-based message framing in exercise appeals targeted towards women

OBJECTIVE

Prospect theory proposes that message framing differentially impacts the likelihood of engaging in health-related behaviors. Specifically, gain-framed messages that highlight the benefits of engaging in a behavior are more effective at promoting preventative behaviors than loss-framed messages highlighting the costs associated with a lack of engagement. Research suggests that gain-framed messages may more successfully reduce psychological reactance compared to loss-framed messages, which in turn, may promote behavioral change. However, reactance as a mechanism has been largely overlooked in the literature and support for this hypothesis is mixed. These conflicting results may be due to additional factors, such as outcomes of the targeted behavior (health vs. appearance) and goal orientation. Therefore, the present study examined whether message framing (gain-vs. loss-framing) and the fit between a health message's outcomes of focus (i.e., health vs. appearance) and an individual's goal orientation predict psychological reactance, and in turn, cognitive and behavioral outcomes related to exercise.

DESIGN

This study employed a randomized trial with four experimental groups composed of insufficiently active women. Specifically, participants were randomized to view a loss- or gain-framed video emphasizing either health- or appearance-related outcomes.

RESULTS

Counter to expectations, there were no between-group differences on exercise-related attitudes and intentions immediately post-intervention, or self-reported behavior at one-week post intervention. However, when health outcomes were emphasized, loss-framed messages generally elicited more reactivity than gain-framed messages. This finding was not replicated for the appearance conditions. Appearance messages also generally elicited more reactance than health messages. Meanwhile, reactance did not predict changes in exercise-related attitudes, intentions, or self-reported behavior, and the relationship between messaging content and reactance was generally not moderated by goal orientation.

CONCLUSION

For young inactive women, receiving messages geared towards appearance-related risks of inactivity (e.g., weight gain) tended to produce more reactivity than messages geared towards health-related risks of inactivity (e.g., weakened immune system). However, this did not change exercise-related attitudes, intentions, or self-reported behaviors. Health gain-framed education regarding exercise may be an important part of a comprehensive intervention toolkit, but is likely not enough in and of itself to support or hinder exercise engagement, regardless of framing or emphasized outcomes.

Testing the Effects of App-Based Motivational Messages on Physical Activity and Resting Heart Rate Through Smartphone App Compliance in Patients With Vulnerable Coronary Artery Plaques: Protocol for a Microrandomized Trial

BACKGROUND

Achieving the weekly physical activity recommendations of at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long term.

OBJECTIVE

The Messages Improving Resting Heart Health (MIRTH) study aims to determine if (1) sending daily motivational messages through a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart disease randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training.

METHODS

We will conduct a single-center, microrandomized trial. Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (phase 1: months 4-6) and at the end (phase 2: months 10-12) of the Lifestyle Vulnerable Plaque Study. Wrist-worn devices (Fitbit Inspire 2) and Bluetooth pairing with smartphones will be used to passively collect data for proximal (ie, physical activity duration, steps walked, and heart rate within 180 minutes of receiving messages) and distal (ie, change values for resting heart rate and total steps walked within and across both phases 1 and 2 of the trial) outcomes. Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and the Royal Prince Alfred Hospital Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre Royal Prince Alfred clinic. Individuals aged 18-80 years (n=58) with stable coronary heart disease who have low attenuation plaques based on a coronary computed tomography angiography within the past 3 months and have been randomized to an intensive lifestyle intervention program will be included in MIRTH.

RESULTS

The Lifestyle Vulnerable Plaque Study was funded in 2020 and started enrolling participants in February 2022. Recruitment for MIRTH commenced in November 2022. As of September 2023, 2 participants were enrolled in the MIRTH study and provided baseline data.

CONCLUSIONS

This MIRTH microrandomized trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention delivered through a customized mobile health app on smart devices on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12622000731796; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382861.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46082.

Association between the use of weight management strategies and weight change among Australian adults over 12 months: an observational study

BACKGROUND

Obesity is a growing, global public health issue. This study aimed to describe the weight management strategies used by a sample of Australian adults; examine the socio-demographic characteristics of using each strategy; and examine whether use of each strategy was associated with 12-month weight change.

METHODS

This observational study involved a community-based sample of 375 healthy adults (mean age: 40.1 ± 5.8 years, 56.8% female). Participants wore a Fitbit activity monitor, weighed themselves daily, and completed eight online surveys on socio-demographic characteristics. Participants also recalled their use of weight management strategies over the past month, at 8 timepoints during the 12-month study period.

RESULTS

Most participants (81%) reported using at least one weight management strategy, with exercise/physical activity being the most common strategy at each timepoint (40-54%). Those who accepted their current bodyweight were less likely to use at least one weight management strategy (Odds ratio = 0.38, 95% CI = 0.22-0.64, p < 0.01) and those who reported being physically active for weight maintenance had a greater reduction in bodyweight, than those who did not (between group difference: -1.2 kg, p < 0.01). The use of supplements and fasting were associated with poorer mental health and quality of life outcomes (p < 0.01).

CONCLUSIONS

The use of weight management strategies appears to be common. Being physically active was associated with greater weight loss. Individuals who accepted their current body weight were less likely to use weight management strategies. Fasting and the use of supplements were associated with poorer mental health. Promoting physical activity as a weight management strategy appears important, particularly considering its multiple health benefits.

Public health guidelines for physical activity during pregnancy from around the world: a scoping review

BACKGROUND AND OBJECTIVE

Despite the known health benefits of physical activity (PA), pregnancy is a time of marked decline in PA levels. To provide women with reliable and trustworthy information, and to encourage greater participation in PA during pregnancy, many governments have developed guidelines for PA during pregnancy. Our aim was to synthesise the most recent public health guidelines on PA during pregnancy from different countries in order to understand the nature and extent of advice that is available.

DESIGN

Scoping review.

DATA SOURCES

Search of the grey literature, direct contact with international experts, screening of relevant academic literature and citation searching.

ELIGIBILITY CRITERIA

Public health guidelines developed or endorsed by government departments published since 2010.

RESULTS

Our search located 30 eligible guidelines, published in 11 different languages. There is remarkable concordance in the advice offered. For women with uncomplicated pregnancy, guidelines recommend: 150-300 min/week of moderate intensity aerobic activity; pelvic floor and muscle strengthening exercises; modification of some exercises (eg, supine position); and provide lists of warning signs to cease activity (eg, persistent dizziness, vaginal bleeding) and activities that should be avoided (eg, if high risk of falling/collision). Few guidelines offer specific advice for highly active women (eg, athletes), or trimester-specific or culturally specific considerations.

CONCLUSIONS

This review provides a summary of public health recommendations for PA during pregnancy around the world. The challenge is now to ensure that all who provide healthcare for women understand the guidelines and encourage safe participation in PA during pregnancy.

Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom

BACKGROUND

The physician-patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions.

METHODS

A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1-research questions specified; Stage 2-relevant studies identified by searching five electronic databases and manual screening of references; Stage 3-studies screened using Covidence™; Stage 4-study data extracted and charted; and Stage 5-findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion.

RESULTS

In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance.

CONCLUSION

This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients.

Beyond the big city: using a systems approach to cultivate a cycling culture in small cities and towns in Ireland

Urban mobility and how people move in our towns and cities is garnering more attention, as solutions are sought to multiple challenges faced by residents; health and physical inactivity, climate change, air quality, urbanisation and accessibility. Traditional, siloed approaches limit impact and collaborative, systems approaches hold promise. However, systems approaches often remain theoretical and few practical applications of their added value have been demonstrated. This study illustrates how a systems approach can be used to underpin the development of a 9-step process to generate solutions for action on active mobility. The development of a systems map and a theory of change framework are key outputs of this 9-step process. The purpose of this paper is to describe how a systems map was developed in an Irish town utilising broad stakeholder engagement to map the variables that influence cycling in the town and to identify the leverage points for transformational interventions.

"Where was this when I was in Physical Education?" Physical literacy enriched pedagogy in a quality physical education context

Introduction

In recent years, there has been a call to restructure physical education (PE) practices and outcomes. A physical literacy enriched pedagogy approach would support this change by more intentional design of lesson planning that includes concurrent development of competence & confidence and inclusion of students of all levels of ability, leading to holistic development of the student. Despite this potential, there is little research to date that outlines PE pedagogical practices with physical literacy as a foundation. The purpose was to explore pedagogical practices and perspectives from elementary PE teachers through a physical literacy enriched pedagogy lens in a high-quality PE context.

Methods

One-on-one semi-structured interviews were conducted with a convenience sample of elementary PE teachers within one school division. Interviews with all participants focused on questions related to PE and physical literacy. Thematic analysis was used to analyze the data collected from the audio-recorded interviews.

Results

Four themes were generated based on the semi-structured interviews from six elementary PE teachers from one school division. The results identified key physical literacy enriched pedagogical practices based on four themes: supporting a holistic PE experience based upon physical literacy as an outcome; movement within and beyond PE; inclusive and individualized experiences; and physical literacy practices bringing the school community together. The findings were then connected to the physical literacy cycle and UNESCO components of quality PE.

Conclusions

All participants spoke to how their pedagogy focused on the holistic development and inclusion of their students based upon activation of various feedback pathways of the physical literacy cycle. The themes that emerged and subsequent insight gained from teachers went beyond existing physical literacy cycles, in particular by discussing development of students from cognitive, affective, social and creative (problem solving) perspectives, supporting an expansion to the existing physical literacy cycle as presented.

Could the Hybridization of the SE/TGfU Pedagogical Models Be an Alternative for Learning Sports and Promoting Health? School Context Study

The present study aims to analyze the influence of the Sport Education (SE)/Teaching for understanding (TGfU) hybrid unit on enjoyment, perceived competence, intention to be physically active, skill execution, decision making, performance and game involvement. A short-term (12-lesson) pre-test/post-test quasi-experimental design was conducted in two groups: control (technical approach: 70 students; age = 14.43 ± 0.693; n = 32 female) and experimental (hybrid unit SE-TGfU: 67 students; age = 13.91 ± 0.900; n = 30 female). The coding instrument was based on the Game performance Assessment Instrument. The Enjoyment and Perceived Competence Scale and the Measure of Intentionality to be Physically Active questionnaire were also used. The results of pairwise comparisons between the groups showed higher post-test scores for most dependent variables for boys and girls using the hybrid SE/TGfU unit. Lower post-test scores were found in pairwise comparisons for several dependent variables in both boys and girls. The present study showed that the application of hybrid models SE/TGfU could increase and help facilitate students' game involvement and game performance, enjoyment, perceived competence and intention to be physically active, in both boys and girls. In future studies, it would be necessary to analyze psychological variables in the educational context for a deeper assessment.

Extraordinary claims in the literature on high-intensity interval training (HIIT): III. Critical analysis of four foundational arguments from an interdisciplinary lens

Kinesiology aspires to be an integrated, interdisciplinary field that studies human movement from multiple perspectives. However, the main societal deliverables of the field, namely exercise prescriptions and physical activity recommendations, still reflect fragmentation, placing more emphasis on physiological outcomes than on behavioral and other considerations. Recently, researchers have called for the introduction of High-Intensity Interval Training (HIIT) to the domain of public health, based on the argument that HIIT can maximize fitness and health benefits for a fraction of the time recommended by the prevailing model of physical activity in public-health guidelines. Here, we show that an unintended side-effect of arguments underpinning the implementation of HIIT in the domain of public health might have been the exacerbation of segmentation. To highlight the value of interdisciplinarity, four foundational claims in support of HIIT are critiqued by tapping into cognate literatures: (1) the primary reason people do not exercise is lack of time, (2) HIIT is relevant to public health, (3) HIIT is being proposed as merely another option, so there is no basis for controversy, and (4) HIIT is safe and well tolerated. These claims are contradicted by credible lines of evidence. To improve the accuracy and effectiveness of its public claims, kinesiology should remain committed to the ideals of integration and interdisciplinarity.

Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents

Obesogenic behaviors have been individually associated with bullying during adolescence. However, physical activity, sedentary behavior, and diet manifest themselves in synergy and even behavioral profiles in which positive and negative behaviors coexist can be more positively associated with psychosocial outcomes. The present study aimed to analyze the association between clusters of obesogenic behaviors and different bullying roles in Brazilian adolescents. This cross-sectional study used data from the Brazilian School-based Health Survey-PENSE, 2015. A total of 100,794 male and female adolescents of the ninth-grade elementary school participated in the study. Students responded to an electronic questionnaire. Clusters of obesogenic behavior consisted of physical activity, exposure to sedentary behavior, and diet, and the different roles in bullying were: participant, victim, bully, and bully-victim. Binary logistic regression with 95% confidence intervals (CI) was used for data analysis (p < .05). Multiple adjustments and complex sampling procedures were employed. Adolescents in the cluster "Health-promoting sedentary behavior and Diet" had reduced chances of participating in bullying (odds ration [OR] = 0.70; 95% CI [0.64, 0.76]), of being a victim (OR = 0.87; 95% CI = 0.76-0.99), and being the bully (OR = 0.65; 95% CI [0.59, 0.71]); and those from the cluster "Health-promoting physical activity and Diet" had reduced chances of participating (OR = 0.81; 95% CI [0.76, 0.87]), being a victim of bullying (OR = 0.86; 95% CI [0.76, 0.98]), being the bully (OR = 0.79; 95% CI [0.72, 0.85]), and being a bully-victim (OR = 0.74; 95% CI [0.61, 0.90]), when compared to those from the "health-risk" cluster in the adjusted analysis. Clusters of obesogenic behavior may reduce adolescent bullying: victim, bully, and bully-victim benefit when exposed to healthier behavioral profiles. The school setting must recognize bullying as a problem and therefore simultaneously promote multi-component interventions to tackle physical activity, sedentary behavior, and eating behavior. Outcomes other than obesity should be acknowledged when promoting obesogenic behaviors.

Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis

BACKGROUND

Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions.

OBJECTIVE

The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques.

METHODS

We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively.

RESULTS

Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages.

CONCLUSIONS

No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type.

Public Health Messaging to Address Indoor Tanning: A Scoping Review

Indoor tanning (IT) is an avoidable skin cancer risk. Although numerous communication interventions have been assessed for IT deterrence, less attention has been paid to the persuasive messages within these interventions. This scoping review summarizes the current peer-reviewed literature on persuasive messages for IT. Overall, 20 articles (21 studies) were included. Most were experimental or quasi-experimental and conducted in the US. Participants were mostly young women who had tanned indoors before. Few studies evaluated persuasive theme; in those that did, health and appearance themes were effective. Narrative and statistical evidence formats were also effective. The included studies also supported normative messages, loss-framed messages, and images. Improved reporting on message design and evaluation would be beneficial for future evidence synthesis. Our understanding of persuasive messages for IT has expanded in recent years, but more research is needed to optimize them.

Does health literacy moderate the psychological pathways of physical activity from guideline awareness to behavior? A multi-group structural equation modeling

BACKGROUND

Awareness, knowledge, beliefs, and behavioral intentions of physical activity (PA) guidelines may be important mediating factors for promoting PA. However, these pathways of the psychological process to PA behavior have not been examined. These pathways may differ depending on health literacy levels. This study investigated the pathways to PA, from guideline awareness to behavior, and further examined whether they differed by health literacy.

METHODS

A cross-sectional study was conducted with 7,000 Japanese participants aged 20-69 years. The participants were registered with an Internet survey company. Participants' awareness, knowledge, beliefs, and behavioral intentions regarding the PA guidelines of Japan, the volume of moderate-to-vigorous intensity PA, activity level, and health literacy were examined through a questionnaire. The PA pathways, from guideline awareness to behavior, were examined by structural equation modeling (SEM), with PA behavior as the dependent variable. Multi-group SEM was conducted to examine the moderating effect of health literacy on PA pathways. Health literacy scores were dichotomized into high and low groups in multi-group modeling by the median split.

RESULTS

SEM revealed that PA guideline awareness directly affects PA behavior and has certain indirect effects through the mediation of knowledge, beliefs, and behavioral intentions. Furthermore, the multi-group SEM showed that the proportion of indirect effects (path coefficient [PC]: 0.11, 95% confidence interval [CI]: 0.10-0.13) was higher than direct effects (PC: 0.07, 95%CI: 0.03-0.11) in the high-health literacy group. In contrast, the proportion of direct effects (PC: 0.22, 95%CI: 0.15-0.30) was higher than indirect effects (PC: 0.06, 95%CI: 0.05-0.07) in the low-health literacy group.

CONCLUSIONS

PA guideline awareness is both directly and indirectly associated with PA behavior, mediated by psychological pathways of knowledge, beliefs, and behavioral intentions, and influenced by health literacy. These results suggest that health literacy should be considered when implementing PA guideline-based interventions.

Identification of physical activity and sedentary behaviour dimensions that predict mortality risk in older adults: Development of a machine learning model in the Whitehall II accelerometer sub-study and external validation in the CoLaus study

BACKGROUND

Identification of new physical activity (PA) and sedentary behaviour (SB) features relevant for health at older age is important to diversify PA targets in guidelines, as older adults rarely adhere to current recommendations focusing on total duration. We aimed to identify accelerometer-derived dimensions of movement behaviours that predict mortality risk in older populations.

METHODS

We used data on 21 accelerometer-derived features of daily movement behaviours in 3991 participants of the UK-based Whitehall II accelerometer sub-study (25.8% women, 60-83 years, follow-up: 2012-2013 to 2021, mean = 8.3 years). A machine-learning procedure was used to identify core PA and SB features predicting mortality risk and derive a composite score. We estimated the added predictive value of the score compared to traditional sociodemographic, behavioural, and health-related risk factors. External validation in the Switzerland-based CoLaus study (N = 1329, 56.7% women, 60-86 years, follow-up: 2014-2017 to 2021, mean = 3.8 years) was conducted.

FINDINGS

In total, 11 features related to overall activity level, intensity distribution, bouts duration, frequency, and total duration of PA and SB, were identified as predictors of mortality in older adults and included in a composite score. Both in the derivation and validation cohorts, the score was associated with mortality (hazard ratio = 1.10 (95% confidence interval = 1.05-1.15) and 1.18 (1.10-1.26), respectively) and improved the predictive value of a model including traditional risk factors (increase in C-index = 0.007 (0.002-0.014) and 0.029 (0.002-0.055), respectively).

INTERPRETATION

The identified accelerometer-derived PA and SB features, beyond the currently recommended total duration, might be useful for screening of older adults at higher mortality risk and for diversifying PA and SB targets in older populations whose adherence to current guidelines is low.

FUNDING

National Institute on Aging; UK Medical Research Council; British Heart Foundation; Wellcome Trust; French National Research Agency; GlaxoSmithKline; Lausanne Faculty of Biology and Medicine; Swiss National Science Foundation.

Older adults as designers of behavior change strategies to increase physical activity-Report of a participatory design process

Background

Despite the significant value of physical activity for the health of older adults, this population often fails to achieve recommended activity levels. Digital interventions show promise in providing support for self-managed physical activity. However, more information is needed about older adults' preferences for digital support to change physical activity behaviors as well as the process of designing them. The aim of this paper was to describe the participatory design process in which older adults were involved in the co-creation of digitally supported behavioral change strategies to support self-managed physical activity, and how the results were integrated in a prototype.

Methods

The participatory design process involved with nine older adults and two researchers. The participants were divided in two groups, and each group participated in three workshops and completed home tasks in between workshops. Following an iterative design process influenced by theories of behavior change, the workshops and home tasks were continuously analyzed, and the content and process were developed between groups and the next set of workshops. Prototypes of a mobile health (mHealth) solution for fall preventive exercise for older adults were developed in which the conceptualized strategies were integrated. To support coherence in reporting and evaluation, the developed techniques were mapped to the Behavior Change Technique Taxonomy v1 and the basic human psychosocial needs according to the Self-determination Theory.

Results

The results highlight different preferences of older adults for feedback on physical activity performance, as well as the importance of transparency regarding the identification of the sender of feedback. Preferences for content and wording of feedback varied greatly. Subsequently, the design process resulted in a virtual health coach with three different motivational profiles and tools for goal setting and self-monitoring. These behavior change strategies were integrated in the exercise application Safe Step v1. The conformity of the design concepts with the needs of Self-determination Theory and Behavior Change Technique Taxonomy v1 are presented.

Conclusion

The participatory design process exemplifies how older adults successfully contributed to the design of theory-based digital behavior change support, from idea to finished solution. Tailoring feedback with a transparent sender is important to support and not undermine motivation.

A Call for Action on Chronic Respiratory Diseases within Physical Activity Policies, Guidelines and Action Plans: Let's Move!

Global policy documents for the promotion of physical activity (PA) play an important role in the measurement, evaluation, and monitoring of population PA levels. The World Health Organisation (WHO) guidelines include, for the first time, recommendations for specific populations, including individuals living with a range of non-communicable diseases. Of note, is the absence of any chronic respiratory diseases (CRDs) within the recommendations. Globally, CRDs are highly prevalent, are attributable to significant individual and societal burdens, and are characterised by low PA. As a community, there is a need to come together to understand how to increase CRD representation within global PA policy documents, including where the evidence gaps are and how we can align with PA research in other contexts. In this commentary, the potential for synergy between evidence into the relationships between PA in CRDs globally and the relevance to current policies, guidelines and action plans on population levels of PA are discussed. Furthermore, actions and considerations for future research, including the need to harmonize and promote PA assessment (particularly in low- and middle-income countries) and encompass the synergistic influences of PA, sedentary behaviour and sleep on health outcomes in CRD populations are presented.

Evaluation of the communication strategy for promoting physical activity in a cross-company network in Germany: A mixed-methods analysis

Introduction

The workplace is considered a promising setting for reaching physically inactive adults, but participation quotes in workplace health promotion (WHP) remain low. Regarding the low participation in WHP, the question emerges concerning the importance of health communication strategies. This paper presents the results from the evaluation of the communication strategy of a cross-company network for promoting physical activity and derives findings for the successful communication of measures.

Materials and methods

Quantitative and qualitative data sources were used to evaluate the communication strategy. The methods applied included individual semi-structured interviews (n = 14) and the monitoring of the usage of digital communication channels.

Results

The analysis revealed that the usage of the digital communication channels within this study was subjected to major fluctuations and a variety of factors must be considered when communicating physical activity measures in a cross-company network. It is important to engage in appropriate communication management that explicitly takes the interpersonal communication and the organizational circumstances into account.

Conclusion

This study revealed which factors may have an influence on the successful communication of physical activity measures in the context of WHP in cross-company networks. Thus, it makes an important contribution to the transfer of science and practice as it captured relevant questions from the field of WHP.

Trial registration

German Clinical Trials Register (DRKS)-ID: DRKS00020956; Date of registration: 18 June 2020, https://drks.de/search/de/trial/DRKS00020956.

Characterising trusted spokespeople in noncommunicable disease prevention: A systematic scoping review

Noncommunicable diseases (NCD) are an increasing global threat. Utilising public policy to address NCDs can reduce incidence and prevalence. However, NCD-relevant public policy action is minimal in many countries as changing public policy is difficult and multifactorial. Two factors that may influence this process is the message people receive and the messenger delivering it. To date, much health communication research has focused on message content, with limited research on messengers that are trusted by policymakers and the public to communicate NCD matters. We aimed to review the literature to characterise who the public and policymakers consider to be trustworthy and/or credible for NCD messaging, and why this might be the case. Arksey and O'Malley's scoping review methodology guided the review. A systematic search of three databases up to June 2021 combined with hand searching of review reference lists was undertaken. Nineteen articles were included. Data extraction focused on study design, issue being influenced, spokesperson studied, and measures of trust. Results showed health professionals were the most-frequently trusted sources of information. Other spokespeople, such as government sources or religious leaders, were only trustworthy in some contexts, and even distrusted in others. Reasons why spokespeople were trusted included technical expertise, strategic engagement with stakeholders, and reputation. However, we also found the nature of trust and credibility of spokespeople is dependent on the studied population and context. Overall, characteristics of influential messengers were nonspecific. Thus, trusted messengers and their characteristics in NCD-messaging must be better understood to develop and maintain the trust of the public and policymakers.

Likeability and perceived effectiveness of messages designed to encourage physical activity participation among older adults

ISSUE ADDRESSED

Older adults are significantly less likely than their younger counterparts to engage in physical activity. Comprehensive policies to support healthy ageing thus need to include components encouraging greater participation in physical activity in later life. This study tested potential messages for use in health communication campaigns aimed at increasing physical activity among older adults.

METHODS

Twelve written messages designed to encourage older adults to increase their levels of physical activity were rated by Australians aged 60-92 years (n = 369; 54% female) on the variables of likeability and perceived effectiveness.

RESULTS

Ratings for all the tested messages were high across both outcome variables. The message Move more, live longer scored most favourably, with large majorities of participants liking this message (87%) and considering it effective (81%). Messages featuring rhyming or alliteration were rated significantly higher on both outcomes than messages without these attributes (all Ps < .001).

CONCLUSIONS

Results provide insights into the types of messages that are likely to be accepted by older adults. Statements that use the phonological patterns of rhyming or alliteration are likely to be especially well received. SO WHAT?: Increasing participation in physical activity among older adults is critical to promoting the sustainability of health care systems and enhancing quality of life. The specific messaging attributes identified in the present study as being effective could be used by public health practitioners to inform their approach to physical activity messaging to older adults and incorporated into future health communication campaigns to increase their potential effectiveness with this target group.

Impact of having a child on physical activity in the UK: a scoping review protocol

INTRODUCTION

Throughout the life course, there are major life transitions that are associated with reduced physical activity, which may have further implications for health and well-being. Having a child is one such transition that has been identified as a critical transformative experience and window for intervention. We will conduct a scoping review of available evidence exploring the impact of having a child on physical activity in the UK.

METHODS AND ANALYSIS

We will use best-practice methodological frameworks to map key concepts and available evidence, summarise and disseminate findings to stakeholders, and identify knowledge gaps. A three-step search strategy will identify primary research studies, including reviews, from published and grey literature, exploring the impact of having a child on physical activity in the UK, from the preconception period, throughout pregnancy, the postpartum period, and into parenthood. An initial limited search will identify relevant reviews, from which keywords and index terms will be extracted. We will conduct searches of CINAHL, Embase, Medline, PsycINFO and Web of Science to identify relevant articles written in English from inception to February 2022. Two reviewers will independently screen titles and abstracts of identified studies for inclusion and chart data, with a third reviewer resolving any conflicts. Backwards citation tracking will identify any additional studies. We will conduct numerical and thematic analysis to map data in tabular and diagrammatic format and provide a description of findings by theme.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review. We will disseminate findings to stakeholders through publications, conferences, social media platforms and in-person communications. Consultations with key stakeholders, with their unique expertise and perspectives, will provide greater insight. We will establish the main priorities for future research to inform the research questions of subsequent studies.

SCOPING REVIEW REGISTRATION

Open Science Framework (https://osf.io/gtqa4/) DOI 10.17605/OSF.IO/GTQA4.

Affective components in promoting physical activity: A randomized controlled trial of message framing

Although the study of the affective components involved in predicting physical activity is spreading faster and faster, there is a lack of studies testing their role when promoting physical activity through message interventions. In the present study, we considered these components by focusing on how anticipated affective reactions and emotional processing of the messages influence receivers’ affective attitude toward physical activity, concurrent behavior, and future intention. A sample of 250 participants was involved in an intervention relying on prefactual (i.e., “If … then…”) messages promoting physical activity. All messages were sent through a research app and were focused on the expected consequences of exercising (or not exercising). Four experimental conditions involving messages differing as to their outcome sensitivity framing (i.e., gain, non-loss, non-gain, and loss) were compared to a control condition. Results showed that reading gain and non-gain messages enhanced the positive affective attitude toward physical activity, compared to control. Enhanced affective attitude after the intervention increased, in turn, self-reported physical activity and future intention. Interestingly, gain messages were even more persuasive for people with a low level of positive anticipated affective reactions. Furthermore, their effectiveness was especially attributable to the elicitation of hope in receivers. Discussion focuses on the advantages of considering affective components and their implications when promoting physical activity.

Designing a programme to train social workers on how to promote physical activity for disabled people: A Delphi study in the UK

Recently, social workers have been identified as a key messenger group for promoting physical activity (PA) to disabled people. Also identified is the need to train social workers in PA promotion. In response, the purpose of this article is to inform the design of a training programme prototype aiming to support social workers to become active PA messengers. We conducted a three-round Delphi study to identify the essential contents and teaching methods for the programme, as well as the challenges that may jeopardise its success. Qualified experts on physical activity and health, social work, and/or disability working in the UK were invited to partake in the study. The response rates were 55% (33/60) in the first round, 79% (26/33) in the second and 77% (20/26) in the third rounds. Following the last questionnaire round, the experts reached consensus on 8 contents, 7 teaching methods and 10 challenges to success. The top three most important contents were: benefits of PA (1.05 ± 0.22), what PA means to disabled people (1.15 ± 0.36) and person-centred PA planning (1.35 ± 0.57). The most relevant teaching methods were interactive activities and discussions (1.20 ± 0.51) and case studies (1.25 ± 0.43). Blended learning (1.85 ± 0.57) was preferred to e-learning (2.20 ± 0.60) and face-to-face learning (2.10 ± 0.70). Lack of time (1.30 ± 0.46) and confidence (1.45 ± 0.59) were deemed vital challenges. However, consensus around other potential barriers such as lack of interest and commitment (1.30 ± 0.46), lack of buy in from employers (1.75 ± 0.70) and professional inertia (2.05 ± 0.67) suggest that a major challenge for long-term impact is to convince key people that social work and PA promotion make a good match. The results of this study provide a valuable starting point evidence base for PA curriculum development. Future research will delve into expert opinions using in-depth qualitative interviews. Participatory approaches including knowledge cafés will also be used to add more views of stakeholders with experiential knowledge.

Communicating Physical Activity with Adolescents: What works? A scoping review protocol

Background: Worldwide, adolescents are not meeting the minimum recommended physical activity (PA) guidelines to achieve health benefits. Awareness of the guidelines among adolescents is low, only 3.6% can report them correctly. The school is an ideal PA promotion setting, no other institute has the same reach or influence on the adolescent population. There is a need for an effective communication strategy for PA messages for adolescents. The purpose of this review is to explore how, when, who, where and what i.e. the content, context and mode of delivery of PA messages to communicate with adolescents to improve their awareness and understanding of PA that will potentially lead to an increase in PA levels. Methods: A scoping review was selected as the most appropriate methodology due to the broad nature of the research question. The PCC mnemonic (Population, concept, context), recommended by the Joanna Briggs Institute, was used to develop the search strategy and research question. This review will follow the scoping review framework developed by Arksey and O'Malley (2005) which was later updated by Levac et al (2010) to ensure the methods are systematic. It will also follow the PRISMA extension for scoping reviews checklist. Sources include databases (CINAHL, Education Source, Scopus, PubMED), grey literature from the World Health Organisation, Global Index Medicus and the reference lists of extracted articles will be checked from the year 1995 onwards. Results: A PRISMA flow diagram will demonstrate the final articles included and results will be presented and summarised as recurring themes. The results will be discussed in relation to existing literature and future implications for research, policy and practice. Conclusion: This will be the first review to explore the PA messaging context among adolescents and the findings will help inform a strategy for communicating PA to adolescents.

Dissemination and implementation strategies for physical activity guidelines among adults with disability, chronic conditions, and pregnancy: a systematic scoping review

BACKGROUND

Physical activity guidelines for adults with disability, chronic conditions, and pregnancy (i.e., specific populations) have been developed to provide guidance for engaging in physical activity. However, specific populations remain considerably less physically active compared to the general population, presenting a knowledge-practice gap.

PURPOSE

The purpose of this systematic scoping review was to identify and evaluate strategies for disseminating and implementing physical activity guidelines among specific populations and/or stakeholders (e.g., healthcare professionals) in Canada.

METHODS

Five search approaches (peer-reviewed literature databases, grey literature database, custom Google search engines, targeted web-based searches, and content expert consultation) identified records documenting and/or evaluating strategies that had been used to disseminate or implement guidelines from a predetermined list. Systematic and scoping review protocols were followed. Risk of bias assessments were conducted for all studies that evaluated strategies.

RESULTS

Eighty-one records reported dissemination strategies (n = 42), implementation strategies (n = 28), or both (n = 11). Twenty-two studies reporting on 29 evaluated strategies were deemed "serious" or "high" risk of bias. Common guideline dissemination and implementation strategies are deliberated and recommendations for future practice are made.

CONCLUSIONS

Findings may inform future dissemination and implementation efforts for physical activity guidelines in Canada or similar countries.

A Personalized Smartphone-Delivered Just-in-time Adaptive Intervention (JitaBug) to Increase Physical Activity in Older Adults: Mixed Methods Feasibility Study

BACKGROUND

Just-in-time adaptive interventions (JITAIs) provide real time in-the-moment behavior change support to people when they need it most. JITAIs could be a viable way to provide personalized physical activity (PA) support to older adults in the community. However, it is unclear how feasible it is to remotely deliver a PA intervention through a smartphone to older adults or how acceptable they would find a JITAI targeting PA in everyday life.

OBJECTIVE

The aims of this study are to describe the development of JitaBug, a personalized smartphone-delivered JITAI designed to support older adults to increase or maintain their PA level, assess the feasibility of conducting an effectiveness trial of the JitaBug intervention, and explore the acceptability of JitaBug among older adults in a free-living setting.

METHODS

The intervention was developed using the Behavior Change Wheel and consisted of a wearable activity tracker (Fitbit) and a companion smartphone app (JitaBug) that delivered goal-setting, planning, reminders, and JITAI messages to encourage achievement of personalized PA goals. Message delivery was tailored based on time of day, real time PA tracker data, and weather conditions. We tested the feasibility of remotely delivering the intervention with older adults in a 6-week trial. Data collection involved assessment of PA through accelerometery and activity tracker, self-reported mood and mental well-being through ecological momentary assessment, and contextual information on PA through voice memos. Feasibility outcomes included recruitment capability and adherence to the intervention, intervention delivery in the wild, appropriateness of data collection methodology, adverse events, and participant satisfaction.

RESULTS

Of the 46 recruited older adults (aged 56-72 years), 31 (67%) completed the intervention. The intervention was successfully delivered as intended; 87% (27/31) of the participants completed the intervention independently; 94% (2247/2390) of the PA messages were successfully delivered; 99% (2239/2261) of the Fitbit and 100% (2261/2261) of the weather data calls were successful. Valid and usable wrist-worn accelerometer data were obtained from 90% (28/31) of the participants at baseline and follow-up. On average, the participants recorded 50% (7.9/16, SD 7.3) of the voice memos, 38% (3.3/8, SD 4.2) of the mood assessments, and 50% (2.1/4, SD 1.6) of the well-being assessments through the app. Overall acceptability of the intervention was very good (23/30, 77% expressed satisfaction). Participant feedback suggested that more diverse and tailored PA messages, app use reminders, technical refinements, and an improved user interface could improve the intervention and make it more appealing.

CONCLUSIONS

This study suggests that a smartphone-delivered JITAI is an acceptable way to support PA in older adults in the community. Overall, the intervention is feasible; however, based on user feedback, the JitaBug app requires further technical refinements that may enhance use, engagement, and user satisfaction before moving to effectiveness trials.

Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study

Background

Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into office workers' perspectives on physical activity and sedentary behaviour.

Methods

Sixteen Dutch office workers (50% female) from different professions participated in semi-structured face-to-face interviews in March 2019. To facilitate the interviews, participants received a sensitizing booklet one week before the interview. The booklet aimed to trigger them to reflect on their physical activity and sedentary behaviour and on their values in life. All interviews were audiotaped, transcribed verbatim and coded following codebook thematic analysis.

Results

Six themes were identified: 1) beliefs about health effects are specific regarding physical activity, but superficial regarding sedentary behaviour; 2) in addition to ‘health’ as a value, other values are also given priority; 3) motivations to engage in physical activity mainly stem from prioritizing the value ‘health’, reflected by a desire to both achieve positive short/mid-term outcomes and to prevent long-term negative outcomes; 4) attitudes towards physical inactivity and sedentary behaviour are diverse and depend on individual values and previous experiences; 5) perceived barriers depend on internal and external factors; 6) supporting factors are related to support and information in the social and physical environment.

Conclusions

The great value that office workers attach to health is reflected in their motivations and attitudes regarding physical activity. Increasing office workers' knowledge of the health risks of prolonged sitting may therefore increase their motivation to sit less. Although ‘health’ is considered important, other values, including social and work-related values, are sometimes prioritized. We conclude that interventions that aim to reduce sedentary behaviour and increase physical activity among office workers could be improved by informing about health effects of sedentary behaviour and short/mid-term benefits of physical activity, including mental health benefits. Moreover, interventions could frame physical activity as congruent with values and support value-congruent choices. Finally, the work environment could support physical activity and interruption of sedentary behaviour.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13024-z.

Sleep Health in Male-dominated Workplaces: A Qualitative Study Examining the Perspectives of Male Employees

OBJECTIVE

The purpose of this qualitative study was to explore working men's perspectives about sleep health and the intersecting influences of gender and work, describing participant's views on current and potential programming and organizational support to promote sleep health.

METHODS

Twenty men employed in male-dominated industries in the north-central region of Alberta, Canada, participated in 4 consultation group discussions addressing motivators, facilitators and barriers to sleep health.

RESULTS

Participants reported sleeping an average of 6.36 (SD ±1.1) hours per night, and the majority worked more than 40 hours per week. Data were analyzed using an inductive approach. The findings provided important insights. In normalizing sleep deprivation and prioritizing the need to "just keep going" on six or less hours of sleep, the men subscribed to masculine ideals related to workplace perseverance, stamina and resilience. Workplace cultures and practices were implicated including normative dimensions of overtime and high productivity and output, amid masculine cultures constraining emotions and conversations about sleep, the sum of which muted avenues for discussing, let alone promoting sleep. Challenges to good sleep were primarily constructed around time constraints, and worry about meeting work and home responsibilities. Men's preferences for workplace support included providing and incentivizing the use of sleep health resources, designing work for sleep health (e.g., shift schedules, overtime policies) and getting advice from experienced coworkers and experts external to the workplace organization.

CONCLUSION

These findings hold potential for informing future gender-sensitive programming and organizational practices to support sleep health among working men.

Creating a social movement to engage communities in physical activity: A mixed methods study of motivations to engagement

Throughout the world social isolation and loneliness are common and both have several adverse impacts on health and wellbeing. We are designed to live in close-knit communities and we thrive in close co-operation, however, modern life isolates us from others. To reduce the burden of loneliness and social isolation we need to find strategies to reconnect people to each other, their place and provide a common purpose. Social movements aim to create healthier communities by connecting people to each other and giving people a common purpose. Interventions which create a social movement appear to be effective at engaging substantial portions of a community, however, it remains unclear why individuals are attracted to these initiatives, and if such reasons differ by sociodemographic characteristics. This study combined qualitative and quantitative methods to understand what motivated (different) people to take part in a social movement based intervention. This study suggests that it is not one but a combination of reasons people engage in interventions of this nature. This diversity needs to be acknowledged when promoting and communicating these interventions to potential participants to maximise engagement. Promoting an end reward or health/fitness may not be the most effective way to promote interventions to a large proportion of people. Instead, communications should be centred around what people value (i.e., being with their friends, doing what they enjoy and are good at).

Opportunities to engage health system leaders in whole systems approaches to physical activity in England

Background

Physical activity plays an important role in maintaining good health and wellbeing, non-communicable disease prevention and can improve healthcare outcomes. Some progress is being made on incorporating physical activity into routine care, but less on engaging health system leaders in the ‘whole systems’ approaches which are increasingly recognised as important for addressing complex public health challenges such as physical inactivity. This commentary builds upon the findings of a recent study and aims to identify opportunities for engaging National Health Service (NHS) systems leaders in whole systems approaches to physical activity.

Opportunities for action in England

Pockets of good practice exist from which lessons can be learned, but there are systemic issues that discourage and create barriers, and a need for meaningful engagement, leadership and action at national, regional and local levels. National and regional actors like Sport England, NHS England, health professional bodies, Active Partnerships, the Local Government Association and the Office for Health Improvement and Disparities can encourage and support government and the NHS to change policy drivers, culture and practices. Emerging opportunities include the 2021 White Paper Integration and Innovation, development of local integrated care systems, leadership from health charities and investment in non-clinical interventions (‘social prescribing’). At local level, public health and physical activity specialists and other organisations have a key role as champions and facilitators of local whole systems approaches and engagement of local NHS leaderships. Finally, although whole systems action is about collaborative leadership, individual champions of physical activity can make a difference in influencing NHS leaders at every level towards whole systems working.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12602-5.

Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study

Background

The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings.

Objective

To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program.

Methods

A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior.

Results

Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors.

Conclusions

Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change.