Adoption Of Healthy Lifestyle Behaviors Research Articles

Cardiac Rehabilitation for Prediabetes and Metabolic Syndrome Remission: Impact of Ultraprocessed Food–Intake Reduction and Time-Restricted Eating in the DIABEPIC-1 Study

BackgroundCardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVDs) and metabolic comorbidities, including metabolic syndrome and prediabetes. However, strategies to reverse these conditions remain to be explored. The DIABEPIC-1 study aimed to assess the feasibility of an enhanced 6-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and metabolic syndrome remission. MethodsThe study combined exercise training with a comprehensive nutritional intervention, emphasizing reduction in intake of ultraprocessed foods, adoption of a Mediterranean diet, and implementation of time-restricted eating. Baseline, 3-month, and 6-month assessments included segmental body-composition measurements, blood analysis, maximal exercise testing, nutritional diaries recorded with the Keenoa AI app, and lifestyle questionnaires. Remission criteria included a return to an HbA1c level of < 5.7%, and < 3 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) criteria for prediabetes and metabolic syndrome, respectively. ResultsA total of 36 participants were recruited. The study demonstrated completion rates of 94.4% at 3 months, and 88.9% at 6 months, and a mean compliance rate of 92.5% for planned clinical appointments. Significant reductions in waist circumference (–9.2 cm, P < 0.001) and weight (–8.0 kg, P < 0.001) were observed. Improvement in glycemic and lipid profiles, insulin-resistance marker levels, and liver health were noted. Participants enhanced their cardiorespiratory fitness, reduced their consumption of ultraprocessed food, and increased their adherence to the Mediterranean diet and time-restricted eating. Notably, 50% achieved prediabetes remission, and 70% with metabolic syndrome at baseline achieved remission. ConclusionsThe study demonstrates the possibility of enhancing cardiac rehabilitation with an intensive nutritional intervention, yielding clinically significant outcomes, including remission of key risk factors in a substantial number of ASCVD patients. Clinical Trial RegistrationClinicalTrials.gov, NCT05459987.

Healthy lifestyles and better periodontal health: Results from two large population-based surveys.

To ascertain whether healthy lifestyles are associated with periodontal diseases in two large-scale surveys in the US (National Health and Nutrition Examination Survey - NHANES) and the UK Biobank. 9854 US adults and 111 679 UK adults were included in the analyses. A healthy lifestyle score (HLS), ranging between 0 and 5, was calculated based on the reported number of healthy behaviours, including never smoking, no heavy alcohol consumption, top third of leisure-time physical activity, higher dietary quality, and ideal sleep duration. The prevalence of periodontal diseases was the primary outcome in both surveys. In the NHANES, periodontal status was assessed through a full-mouth periodontal examination, while in the UKB, only self-reported periodontal status was available. Multiple regression analyses confirmed that the presence of at least 2-3 healthy behaviours (vs. 0-1) was associated with lower odds of overall and severe periodontitis (ORs 0.5, 0.4-0.6; p < .001 and 0.5, 0.3-0.8; p = .003, respectively) in the NHANES, and of bleeding gums (OR = 0.9, 0.8-1.0; p = .092) and loose teeth (OR = 0.6, 0.5-0.7; p < .001) in UKB. This association increased when considering prevalence of 4-5 healthy behaviours (vs. 0-1) in both the NHANES (periodontitis: OR = 0.3, 0.2-0.4; p < .001; severe periodontitis: OR = 0.1, 0.01-0.2; p < .001) and the UKB (bleeding gums: OR = 0.8, 0.7-0.9; p < .001; loose teeth: OR = 0.5, 0.4-0.6; p < .001). Mediation analyses revealed how these protective associations could be partially mediated (1-14%) by differences in biomarkers of systemic inflammation (white blood cells and neutrophils count as well as C-reactive protein). Adoption of healthy lifestyle behaviours is associated with a lower prevalence of periodontal diseases within two large population-based samples. This relationship exhibits a dose-response pattern, implying that greater adherence to healthy habits leads to a more significant protective effect against the odds of periodontal diseases. Additionally, our findings suggest that this protective effect is, in part, mediated by reductions in systemic inflammation.

Frequency of sleep disorders among patients with type 2 diabetes and contributing factors

IntroductionSleep disorders represent a significant health concern among individuals diagnosed with type 2 diabetes. Identifying the prevalence and underlying factors contributing to these disorders is crucial for devising effective interventions to mitigate or resolve this issue. MethodsThis cross-sectional study was undertaken, involving 320 patients diagnosed with type 2 diabetes, who were attendees of the Hamadan Diabetes Clinic in 2023. Data collection was done using the demographic information checklist and the Pittsburgh Sleep Quality Index. Furthermore, the study examined the associations between sleep quality and demographic parameters, hemoglobin A1C levels, body mass index, and duration of diabetes by the t-test, chi-square test and logistic regression analysis. Poor sleep quality was defined as a sleep quality score exceeding 5. Results70.3 % of participants exhibited poor sleep quality. Female gender, hemoglobin A1c levels exceeding 7.5 %, a body mass index exceeding 30 kg/m2, and advancing age were associated with an increased likelihood of poor sleep quality. Higher levels of education were correlated with a decreased likelihood of poor sleep quality (P < 0.001). Female patients had significantly higher body mass index (P = 0.003), higher hemoglobin A1c (P = 0.006) and lower education (P = 0.001). ConclusionThe results of this study underscore the significance of enhancing sleep quality among individuals diagnosed with type 2 diabetes. Accordingly, healthcare providers are recommended to prioritize interventions targeting factors influencing sleep quality and imparting blood sugar management education. Addressing these factors comprehensively can manage diabetes-related complications, resolve sleep disorders, and facilitate the adoption of healthy lifestyle behaviors among patients.

Effects of Mindfulness-Based Practices in the Perinatal and Postpartum Periods on Women's Health: A Systematic Review

The aim of this systematic review was to evaluate the effects of mindfulness interventions on women's mental health in the perinatal and postpartum period. In the study, randomized controlled studies published in the last five years, from January 2018 to September 2023, were searched in CINAHL, PubMed, Cochrane Library, Science Direct, and Springer Link databases. The keywords "Pregnancy", "Pregnant", "Prenatal", "Perinatal", "Postpartum", "Mindfulness", "Meditation", "Self-compassion" and "Randomized controlled trial" were used while searching the databases. The assessed articles were subjected to quality assessment using the PRISMA checklist and the Joanna Briggs Institute's Critical Appraisal Checklist for Randomized Controlled Trials. As a result of the search, 26 studies were found. The studies revealed that the most commonly applied mindfulness intervention among intervention groups was self-help programs in an online setting. Mindfulness-based practices significantly impacted women's mental health, reducing fear of childbirth, depression, anxiety, and stress levels, while enhancing psychological well-being, self-efficacy, self-compassion, and mindfulness. Furthermore, these practices also benefited women’s physical health, contributing to higher rates of normal vaginal births and increased maternal-fetal attachment. They were found to lessen birth pain, reduce the need for medication or anesthesia, and support the adoption of healthy lifestyle behaviors. These findings suggest that mindfulness interventions, which positively influence the mental health of both mothers and infants, should be widely applied to women, and the results of this study should be disseminated.

Abstract P233: Leveraging Community-Engaged Research Methods to Improve Recruitment and Retention of Midlife Black Women in Cardiovascular Research

Introduction: Midlife Black women (ages 45-64) are more likely to die of a cardiovascular disease (CVD)-related cause compared to White women of the same age and less likely to be optimally controlled for upstream chronic conditions like hypertension or dyslipidemia. Black women are also 58% less likely than White women to identify heart disease as their greatest health risk. Recruitment and retention of Black women in research trials has been historically difficult, contributing to the paucity of interventions designed to address the unique sociocultural factors that contribute to the existing health disparities. The Midlife Black Women’s Stress Reduction and Wellness intervention (B-SWELL) was created to lower stress and increase CVD awareness and adoption of healthy lifestyle behaviors to lower CVD risk in midlife Black women. Hypothesis We hypothesized that a theoretically based intervention co-developed with midlife Black women from the community would yield a culturally appropriate and appealing intervention, resulting in high retention, low attrition, and high satisfaction. Methods: Mixed methods and community-engaged methods were used in the preliminary research that supported the B-SWELL feasibility trial. Each step (i.e., conceptualization, development, intervention design and delivery) was viewed through a Black Feminist lens, giving voice to midlife Black women. The B-SWELL materials and content were co-developed with an existing community research advisory board (C-RAB) and midlife Black women from the community to produce a culturally tailored and targeted product that was rated highly by experts. A randomized feasibility study was conducted. Recruitment was led by the C-RAB and other community partners. Satisfaction was measured using a 9-item tool ranging from 1 (strongly disagree) to 5 (strongly agree) and a maximum score of 45. Narrative feedback responses were also obtained. Results: Recruitment (N=52) was completed within 30 days and attrition was low (8%). Four participants withdrew prior to the start of the feasibility trial. The remaining 48 participants completed the trial, and none were lost to follow up. Participant satisfaction ratings were high with a mean of 41. Narrative feedback responses were positive. Participant responses indicated an increase in CVD awareness and motivation to adopt healthier behaviors: “Sisterhood is very important to Black women's health." “Never too late in your life to make changes and better choices.” “I need to be a cheerleader and I need to be checked on as well". Conclusions: Theoretically based interventions that employ community-engaged methods have potential to increase recruitment and retention of midlife Black women in research studies. We recommend integration of community-engaged methods at each level of development and for delivery of interventions targeted to at-risk subpopulations like midlife Black women.

Mediterranean diet and time-restricted eating as a cardiac rehabilitation approach for patients with coronary heart disease and pre-diabetes: the DIABEPIC-1 protocol of a feasibility trial

IntroductionDespite proven programmes, implementing lifestyle interventions for pre-diabetes and type 2 diabetes is challenging. Cardiac rehabilitation, provide a valuable opportunity to promote the adoption of healthy lifestyle behaviours for patients...

Household Polluting Fuel Use and Frailty among Older Adults in Rural China: The Moderating Role of Healthy Lifestyle Behaviors.

This study worked to investigate the effect of household polluting fuel use (HPFU), as an indicator of household air pollution exposure, on frailty among older adults in rural China. Additionally, this study aimed to examine the moderating effect of healthy lifestyle behaviors on the aforementioned association. This study employed cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, which conducted nationally representative sampling of older adults from 23 provinces in mainland China. The frailty index was calculated using 38 baseline variables that assessed health deficits through questionnaire surveys and health examinations. A total of 4535 older adults aged 65 years and above were included in our study, among whom, 1780 reported using polluting fuels as their primary household cooking fuel. The results of regression analyses and multiple robustness checks indicated a significant increase in the frailty index due to HPFU. This environmental health threat was more profound among women, illiterate individuals, and low-economic-status groups. Moreover, healthy dietary and social activities had significant moderating effects on the association between HPFU and frailty. HPFU can be regarded as a risk factor for frailty among older adults in rural China, with its effects exhibiting socio-economic disparities. The adoption of healthy lifestyle behaviors can alleviate the frailty associated with HPFU. Our findings underscore the significance of using clean fuels and improving household air quality for healthy aging in rural China.

Adolescents' reports of chaos within the family home environment: Investigating associations with lifestyle behaviours and obesity.

Disorganised and chaotic home environments may hinder the adoption of healthy lifestyle behaviours and contribute to excessive weight gain among adolescents. We examined whether self-reported level of chaos within the family home environment is associated with lifestyle behaviours and obesity in adolescent girls and boys. Cross-sectional data from the 3rd wave of the Québec Adipose and Lifestyle Investigation in Youth (QUALITY) study were analyzed. The sample consisted of n = 377 White adolescents with a history of parental obesity. Home environment chaos was measured using the Confusion, Hubbub, and Order Scale (CHAOS) analyzed both continuously and dichotomized as high vs. low chaos. Body Mass Index z-scores (zBMI) were computed using WHO standards from measured weight and height. Physical activity (7-day accelerometry), vegetable and fruit intake (three 24-hour diet recalls), and leisure screen time and sleep duration (questionnaire) were assessed. Sex-specific linear regression models were used to estimate associations between level of family home environment chaos, lifestyle behaviours and zBMI. The overall level of chaos was low in our study sample, with higher reported levels among girls compared to boys. Among girls, high (vs low) chaos was associated with shorter sleep duration (hours/day) (B = - 0.44, 95% CI: -0.75, -0.14). No associations were observed for other lifestyle behaviours or for zBMI. In this sample of adolescents with a parental history of obesity, higher household chaos was not associated with obesity or lifestyle behaviours, except for sleep duration among girls. Replication of findings in more diverse samples is indicated.

Implementation of SWEET: A postpartum patient navigation program for diabetes prevention after gestational diabetes

Given the challenges patients experience establishing diabetes-prevention behaviors after a pregnancy complicated by gestational diabetes (GDM), we developed a GDM-focused postpartum patient navigation intervention to improve factors supporting health after GDM, such as screening, primary care transition, and adoption of healthy lifestyle behaviors. This analysis evaluates the implementation of this program within a randomized controlled trial (RCT) designed to assess feasibility of the intervention.

Aile Sağlığı Merkezi’ne kayıtlı gebelerde sosyodemografik özelliklerin sağlıklı yaşam biçimi davranışları üzerine etkisi

The Introduction: Pregnancy is a critical period in which women experience many physical, psychological and social changes. Studies reveal that the lifestyle adopted during pregnancy has a long-term effect on the health and quality of life of the child, mother and even the whole family. It is known that sociodemographic characteristics determine the health of individuals. Aim: The aim of this study is to reveal the effect of sociodemographic characteristics of pregnant women on healthy lifestyle behaviors. Method: This is a cross-sectional analytical study. 105 volunteer pregnant women who applied for any reason and/or were invited to participate in the study by phone call between March and April 2022 were recruited. Sociodemographic characteristics were questioned with a questionnaire prepared by the researchers. The Health Promoting Lifestyle Profile II (HPLP-II) was used to evaluate the lifestyles of pregnant women. The data obtained were evaluated with the independent t-test and ANOVA tests in the SPSS 20.0 program. Results: A total of 105 pregnant women between the ages of 19-42 were included in the study. The mean age was 29.23 ± 4.8 years, and 77% (n=81) had a high school or higher education. 56.2% (n=59) of the participants have a monthly income of 8000 TL or less. 11.4% (n=12) of the pregnants were in the first trimester, 50.5% (n=53) in the second, and 38.1% (n=40) in the third trimester. The mean scale score of the participants was calculated as 133.9±22.5 and 2.6±0.4 out of four. Although the total scale mean score of the groups with high education and income levels and working pregnant women was higher, no statistically significant difference was found between the total scale score of education level, income level, and employment status (p=0.281, p=0.192, p=0.804, respectively). The mean total scale score of the pregnant women who used regular medication was found to be higher than those who did not use drugs (p=0.017). Conclusion: It has been observed that pregnant women who use regular medication adopt a healthier lifestyle. Education level, income level, employment status and the presence of social security were not found to have a significant effect on the adoption of healthy lifestyle behaviors by pregnant women.

A CROSS SECTIONAL STUDY OF CLINICAL PROFILE, MANAGEMENT AND LEVELS OF AWARENESS IN YOUNG HYPERTENSIVES AT A TERTIARY CARE HOSPITAL IN CHENGALPET

Introduction: Hypertension is a condition in which the force of blood against the arterial walls is excessive.Our study aims to describe the clinical profile and management of young hypertensives and to assess the levels of awareness of health care facilities. Material and Methods: This cross sectional study is conducted on young adult hypertensives 20-40 years of age attending the Out Patient Department of General Medicine,KarpagaVinayaga Institute of Medical Sciences and Research Centre, Chinnakolambakkam. Study duration is about 6 months. Young adults (males as well as females) in the age group of 20 to 40 years,who are diagnosed as hypertensives based on with/without comorbidities, visiting the General medicine out patient department who were willing to be a part of the study were included after obtaining an informed consent. Based on this reference and assuming a 95% confidence interval, 5% the minimum required sample size were 112 ~ 120.Data were collected and entered in Microsoft excel 2007. According to the data collected, appropriate statistical tests like Chi-square test was used. Results: In our study mean age of the study participants were 38.56±12.34 years. There were about 63.3% males and 36.7% females. About 62.8% were from rural areas and 37.2% from urban areas.Females comparatively had more awareness, treatment and control of hypertension than males. Urban areas and rural areas had around same percentage of awareness, treatment and control of hypertension.Knowledge about risk factors awareness present among 25.9% of the study participants. Around 58.7% checked blood pressure at least once in the past year among the study participants. Conclusion: Headaches were the most common symptom that young people with hypertension presented with when they were diagnosed. Enhanced awareness would assist in the adoption of healthy lifestyle behaviors and highlight the significance of maintaining adherence to medication.

Families' expectations of an eHealth family-based cardiovascular disease-risk reduction programme.

Research has shown that families' participation in a cardiovascular disease (CVD) prevention programme could boost early adoption of healthy lifestyle behaviours in families. Behaviour-based, eHealth interventions are a potential means of achieving this. This study aimed to explore expectations of families-parents and children-at risk of CVD towards the design and functionality of an eHealth family-based CVD-risk reduction programme 'Health-e-Hearts'. Three online focus groups were conducted with six families comprising at least one parent at risk of CVD and at least one child aged 5-17 years. The focus groups were video and audio recorded and transcribed. Content analysis was used to synthesize and identify key categories and subcategories regarding development of and engagement with an eHealth programme. Three categories emerged: experiences of health apps and devices; eHealth application needs of family members; and motivators for using an eHealth programme. Experiences included using health apps individually and inconsistently. Needs included personalization, free and easy-to-use, time efficient, and multiple content formats. Motivators for engaging with the programme included goal setting, rewards, and competition. Families' expectations of an eHealth family-based CVD-risk reduction programme include the incorporation of personalized, easy-to-use design features and motivators for engaging with the programme. Family involvement in the development of an eHealth programme such as 'Health-e-Hearts' has the potential to boost early adoption of healthy lifestyle behaviours among all family members.

Factors Associated with Risk of Perinatal Depressive Symptoms Among Puerto Rican Women with Hyperglycemia.

Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may reduce a woman's ability to engage in lifestyle changes that could reduce their subsequent diabetes risk. We conducted a secondary analysis using data from Estudio Parto to evaluate sociodemographic, behavioral, psychosocial, and medical factors associated with perinatal depressive symptoms. Estudio Parto was a randomized controlled trial conducted in Western Massachusetts from 2013 to 17. Eligible participants had pregnancy hyperglycemia. The Edinburgh Postnatal Depression Scale (EPDS) was administered at 24-28weeks gestation and at 6weeks, 6months, and 12months postpartum. An EPDS cutpoint of 10 or greater defined the presence of depressive symptoms. In this sample of Puerto Rican women with pregnancy hyperglycemia, 32% and 27% showed prenatal and postpartum depressive symptoms, respectively. Among participants, 35.5% were diagnosed with GDM, 44.3% with isolated hyperglycemia, and 20.2% with impaired glucose tolerance. In multivariable models, being unmarried (OR 3.87; 95% CI 1.51-9.94), prenatal substance use (smoking or alcohol consumption; OR 2.96; 95% CI 1.41-6.18), and maternal age (1.11 for each year; 95% CI 1.04-1.18) were associated with higher odds of prenatal depressive symptoms. None of the risk factors were associated with subsequent postpartum depression in adjusted analyses. Identifying factors associated with prenatal and postpartum depression in Puerto Rican women with pregnancy hyperglycemia can inform targeted lifestyle interventions in this at-risk group, increase the likely adoption of healthy lifestyle behaviors, and thereby work to address health disparities. gov NCT01679210; date of registration 08/07/2012.

Behavior Change Interventions for Health Promotion in Physical Therapist Research and Practice: An Integrative Approach.

There is an increasing focus on health promotion in physical therapist research and practice. A clinical model (Health-Focused Physical Therapy Model) was developed for identifying major steps in the delivery of health promotion focusing on adoption of healthy lifestyle behaviors. One of the primary steps within this model is the design and delivery of behavior change interventions. Such interventions involve coordinated sets of activities that target change in a specific pattern of unhealthy behavior (eg, physical inactivity, smoking). This Perspective contends that the science and practice of behavior change interventions can be significantly advanced in the field of physical therapy (implementation science) through the integration of behavior change frameworks and techniques within the context of an experimental medicine approach for health behavior change. This perspective presents the integration of the Theoretical Domains Framework, the Behavior Change Wheel, including the Capability Opportunity Motivation-Behavior core system, and the Behavior Change Technique Taxonomy as a comprehensive approach for designing and delivering behavior change interventions in physical therapy. An experimental medicine approach is described, outlining a 4-step process in the design, delivery, and evaluation of behavior change interventions that can be applied to health promotion in physical therapist research and practice. The proposed integrative approach can advance public health and health promotion through healthy lifestyle behavior change in the field of physical therapy.

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The association of sleep problem, dietary habits and physical activity with weight status of adolescents in Nepal

BackgroundOverweight/obesity among adolescents is an emerging public health issue worldwide. However, the evidence on the determinants of body weight status and lifestyle behaviors among Nepalese adolescents is limited. This study aims to explore the sleep characteristics, dietary habits, and physical activity and its association with body mass index (BMI) among Nepalese adolescents.MethodsA cross-sectional study was conducted between July and November 2019 among 627 randomly selected adolescents from eight schools located in Kathmandu Metropolitan City, Nepal. A self-administrated structure questionnaire was used to collect the data. Anthropometric measurements (adolescent’s BMI), sleep characteristics, dietary habits, and physical activity were assessed using validated tools. Multinomial logistic regression analyses assessed the association between covariates and BMI categories. The statistical significance was considered at p-value < 0.05 and 95% confidence intervals (CIs).ResultsThe overall prevalence of underweight and overweight/obesity among adolescents was 9.1% (95% CI: 7.1–11.6) and 23.7% (95% CI: 20.6–27.7) respectively. In multinomial logistic regression, adolescents who reported sleep problem compared to those with no such problem (Relative risk ratio (RRR) = 13.37, 95% CI: 7.14–25.05), adolescents who had obstructive sleep apnea (OSA) symptoms (RRR = 3.21, 95% CI:1.31–7.86), who consumed soft drink ≥1 time/day in past 1 months (RRR = 5.44, 95% CI: 2.93–10.10), consumed high-fat dietary ≥2 times/day (RRR = 2.17, 95% CI: 1.18–3.99), and had a habit of junk food consumptions (RRR = 5.71, 95% CI:2.55–12.82), adolescents who had 5–6 h/day sedentary behavior (RRR = 3.21, 95% CI: 1.14–9.09), adolescents from Terai/Madhesi castes (RRR = 2.81, 95% CI: 1.19–6.64) and adolescents whose father was employed (RRR = 2.04, 95% CI: 1.04–3.98) were at increased risk of being overweight/obesity. In contrast, adolescents aged 14–16 years had 71% lower (RRR = 0.29, 95% CI: 0.16–0.52), and adolescents who consumed less than five food groups had 45% lower (RRR = 0.55, 95% CI: 0.31–0.97) risk of being overweight/obesity compared to 12–14 years age groups and consumed more than five food groups respectively.ConclusionsThe findings of this study warrant immediate interventions to improve the lifestyle to reduce overweight/obesity among Nepalese adolescents. Creating a conducive environment, both at school and home is essential to encourage adolescents for the adoption of healthy lifestyle behaviors.

Evaluating the implementation of the SWITCH\xae school wellness intervention and capacity-building process through multiple methods

BackgroundSchool wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming.MethodsAs part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR).ResultsPaired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy.ConclusionsThe results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.

24-hour activity for children with cerebral palsy: a clinical practice guide.

The association between physical activity and health has been clearly established, and the promotion of physical activity should be viewed as a cost‐effective approach that is universally prescribed as a first‐line treatment for nearly every chronic disease. Health care providers involved in the care for individuals with cerebral palsy (CP) are encouraged to take an active role in promoting their health and well‐being. Balancing activity behaviours across the whole day, with improved physical activity, reduced sedentary time, and healthy sleep behaviours, can set up infants, preschool‐, and school‐aged children with CP for a healthy trajectory across their lifetime. However, most clinicians do not apply a systematic surveillance, assessment, and management approach to detect problems with physical activity or sleep in children with CP. Consequently, many children with CP miss out on an important first line of treatment. This article presents an evidence‐informed clinical practice guide with practical pointers to help practitioners in detecting 24‐hour activity problems as a critical step towards adoption of healthy lifestyle behaviours for children with CP that provide long‐term health benefits.

Conversation Cards for Adolescents ©: a patient-centered communication and behavior change tool for adolescents with obesity and health care providers

ABSTRACT Background: Health care providers (HCPs) report barriers to effective communication with adolescents with obesity when discussing lifestyle behavior change and may benefit from tailored health communication tools to use during consultations with this uniquely challenging group of patients. Our purpose was to describe the content, design, production, dissemination, and application of Conversation Cards for Adolescents © (CCAs), a patient-centered, bilingual (English and French) tool intended to facilitate adolescent-HCP communication as well as lifestyle and behavior changes among adolescents with obesity. Methods: Our multiple mixed-methods, cross-language, and patient-oriented research included three interrelated steps and was conducted in 2018–19 with 19 adolescents with obesity, 3 HCPs, and profit and non-profit organizations. These included data prioritization activities (Step 1), semi-structured telephone interviews (Step 2), and production and dissemination in collaboration with Obesity Canada (Step 3). Results: In Step 1, adolescents prioritized 153 barriers, enablers, and recommendations related to the adoption of healthy lifestyle behaviors among adolescents with obesity. In Step 2, adolescents, HCPs, and researchers co-designed CCAs, which resulted in creating a hard copy deck of 45 cards organized into seven suits that were equally distributed across three categories (barriers, enablers, recommendations). In Step 3, 500 English and 200 French copies of CCAs were refined, produced and disseminated online. Conclusions: Our research generated a practical, patient-centered, bilingual tool for HCPs that was designed to optimize clinical communication and tailored messaging for lifestyle behavior change among adolescents with obesity.

A randomized controlled trial examining an exam room poster to prompt communication about weight.

Recognition of childhood weight status is important to the adoption of healthy lifestyle behaviours. We assessed whether an exam room educational poster addressing weight and healthy lifestyle behaviours was acceptable to parents, prompted parent-provider communication or improved parental weight perception accuracy. In this multi-site randomized controlled trial, exam rooms were randomized to display the posters (English and Spanish) or not. Children ages 3 to 8 years (N = 965) attending well visits were weighed and roomed per usual clinic protocol. After the visit, parents completed a questionnaire assessing demographics, child weight status perceptions and whether they discussed weight status with provider or were shown growth charts. We used separate logistic regression analyses to examine associations between intervention status and: asking provider about child weight, being shown growth charts, and accuracy of weight perception, adjusting for covariates and clustering by exam room. Of the parents who saw the poster, 97% liked seeing it and reported greater understanding of weight status visualization (96%) and healthy lifestyle behaviours (94%). Parents who saw the poster were more likely to report being shown a growth chart (OR 1.87, 95% 1.06, 3.30) but were not more likely to ask about their child's weight status nor accurately report their child's weight status. An educational exam room poster about healthy weight was well-received by parents and prompted providers to show the child's growth chart but did not prompt parent-initiated conversations about weight status nor improve parental weight perception accuracy.