American College Of Sports Medicine Research Articles

Development and validation of a Tai chi intervention protocol for managing the fatigue-sleep disturbance-depression symptom cluster in female breast cancer patients

ObjectiveTo develop an evidence-based tai chi intervention protocol for managing the fatigue-sleep disturbance-depression symptom cluster (FSDSC) in breast cancer (BC) patients. MethodsThe Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions (the MRC framework) was utilized to guide the study design. This study focused on Phase І of the MRC framework—the development of the intervention—to develop an evidence-based tai chi intervention protocol for managing the FSDSC in BC patients based on existing research evidence, theories, practice standards/guidelines, and experts’ consensus. An extensive literature search was performed to identify current systematic reviews, theories, and practice standards/guidelines that can be utilized to inform the intervention dosage and techniques of tai chi and practice instructions. Content validity assessment was also conducted to assess the content validity of the tai chi protocol through expert panel consensus. The content validity index (CVI) was calculated to identify whether the intervention required further refinement. ResultsThe components of the tai chi protocol were identified by current research evidence and relevant practice standards/guidelines, including the selection of an appropriate tai chi modality and intensity and the duration of the intervention. The Easy 8 form Yang-style tai chi was selected based on the guidelines of the National Comprehensive Cancer Network, the American College of Sports Medicine, and China’s State Commission for Physical Culture and Sports. The intensity and duration of the tai chi intervention were scheduled, respectively, twice per week, with each session lasting about one hour, for eight weeks based on the current systematic review evidence on traditional Chinese exercise for the alleviation of cancer-related symptoms. The practise techniques of tai chi were identified from practise standards released by the State Sport General Administration of China. All the items in the tai chi protocol were determined to be content valid after the first round of rating, with all item-level CVIs at 1.00. The scale-level CVI for the tai chi protocol was also identified as excellent, at 1.00. ConclusionAn evidence-based tai chi program for managing the FSDSC in BC patients was developed by following the MRC framework. The results provided a clear specification of the tai chi intervention protocol for healthcare professionals and researchers in the next phase of the study—pilot testing the tai chi intervention protocol for FSDSC management through a preliminary randomized controlled trial.

The prevalence of uninvestigated dyspepsia and the association of physical exercise with quality of life of uninvestigated dyspepsia patients in Indonesia: An internet-based survey.

Epidemiological data on the prevalence of uninvestigated dyspepsia (UD) and its impact on the health-related quality of life (HRQOL) in Indonesian population are still lacking. There is no study investigating the association between exercise and the HRQOL in UD patients. We aimed to investigate the prevalence of UD and its association with physical exercise, and its impact on HRQOL in Indonesian patients with UD. This was a population-based, cross-sectional study, conducted using an internet-based questionnaire which was randomly distributed throughout Indonesia using the social media. The questionnaire contained socio-demographic details, exercise levels, Rome III criteria for dyspepsia, and SF-NDI (Short Form-Nepean Dyspepsia Index). The frequency, duration, the intensity of exercise, and the classification of exercise according to ACSM (American College of Sports Medicine) were included in the assessment. The screening for UD was conducted using the Rome III criteria and the SF-NDI score was calculated to assess the HRQOL in patients with UD. A total of 2725 valid responses were collected. The overall prevalence of UD in the study was 49.75%. Multiple logistic regression analysis showed that gender (female) and lack of exercise were independently associated with UD (OR 2.07, 95% CI 1.74-2.47, p < 0.001 and OR 1.72, 95% CI 1.42-2.07, p <0.001). The median SF-NDI score among 1295 UD subjects in non-exercising and exercising groups was 21.00 and 18.00 (p <0.001), respectively. This study demonstrated the prevalence of UD and the association between exercise and HRQOL among UD patients in Indonesia.

Encuesta Nacional de Tendencias de Fitness en España para 2021 (National Survey of Fitness Trends in Spain for 2021)

Desde 2017 se realizan anualmente las Encuestas Nacionales de Tendencias de Fitness en España, reproduciendo la metodología de las encuestas internacionales promovidas por el Colegio Americano de Medicina del Deporte (ACSM). El objetivo del presente estudio es presentar los resultados de la quinta encuesta española e identificar las principales tendencias en el sector del fitness español para el año 2021, así como comparar sus resultados con los obtenidos en las encuestas nacional e internacional para el año 2020. Dado que la presente edición se realiza en una situación sanitaria excepcional debido a la COVID-19, se trató de identificar su posible influencia en los resultados. La encuesta fue enviada a 6230 profesionales del sector del fitness recogiéndose un total de 503 respuestas (tasa de respuesta de 8.1%). Las tendencias más relevantes para 2021 fueron: “ejercicio y pérdida de peso”, “contratación de profesionales certificados”, “entrenamiento personal”, “entrenamiento personal en pequeños grupos" y “entrenamiento funcional”. Las tendencias en el top-20 en España para el año 2021 resultaron muy similares a las obtenidas para el año 2020 (17 coincidencias), si bien con algunos cambios reseñables en cuanto a su posición que podrían ser explicables por los efectos de la COVID-19. Las diferencias son mayores cuando se comparan con la encuesta internacional (solo 12 coincidencias) con relevantes diferencias en las posiciones ocupadas. Estos hallazgos confirman los encontrados en ediciones anteriores, mostrando bastante estabilidad de las tendencias en el sector del fitness español y una progresiva divergencia con las tendencias internacionales. &#x0D; Abstract. Since 2017 the National Surveys of Fitness Trends in Spain are yearly carried out, reproducing the methodology of the worldwide surveys endorsed by the American College of Sport Medicine (ACSM). The objective of the current study is to show the findings of the fifth Spanish survey of fitness trends and identified the main trends in Spanish fitness sector for year 2021, as well as to compare its results with those got in the national and international surveys for 2020. Because of the current edition of the survey was carried out in an exceptional health situation by COVID-19, it was tried to identify its possible influence in its results. The survey was sent to 6230 professionals of the fitness sector and a total of 503 responses were collected (response rate 8.1 %). The more relevant trends for 2021year were: “exercise and weight loss”, “employing certificate fitness professional”, “personal training”, “personal training in small groups” and “functional training”. The top-20 trends in Spain for year 2021were very similar to those for year 2020 (17 coinciding trends), however with some remarkable changes in their positions, that could be explained by the COVID-19 effect. Differences are greater when trends are compared with worldwide survey (just 12 coinciding trends) with relevant differences in their positions. These findings confirm those ones found in previous editions showing rather stability in the trends in Spanish fitness sector and a progressive divergency with worldwide trends.

Beneficial Effects of Exercise on Depression and Anxiety During the Covid-19 Pandemic: A Narrative Review.

First reported in Dec 2019, the on-going COVID-19 pandemic has become a public health emergency of international concern (PHEIC). The isolation and quarantine during the COVID-19 pandemic limited the physical and social activities of the population, which contributed to the increased prevalence of mental disorder. Depression and anxiety are the most common mental illnesses conferring a serious impact on individuals' life quality. This review summarizes the mental health consequences of COVID-19, especially for depression and anxiety. Exercise as an intervention for anxiety and depression has been demonstrated in both of the animal studies and human clinical trials. The underlying mechanism including the regulation on the production of brain-derived neurotrophic factor (BDNF), D-β-hydroxybutyrate, synaptic transmission, hypothalamic pituitary adrenal (HPA) axis, tryptophan hydroxylase, GSK3β/β-catenin pathway, neuroinflammation, oxidative stress and PGC-1α1-PPAR axis. In addition, we summarized the exercise strategies to fight against anxiety and depression according to the information from American College of Sports Medicine (ACSM), World Health Organization and recent literatures about physical exercise during COVID-19.

Comparison of Energy and Nutrient Intake vs. Estimated Needs in Warfighters: an Update.

Active members of the military must perform optimally under conditions of thermal stress and/or energy deficiency. Military dietary reference intakes (MDRIs) provide guidelines for energy and nutrient intakes but is based studies largely conducted in Army. Needs may vary by service branch and/or position. New protein recommendations have emerged, which are not reflected in MDRIs. PURPOSE OF REVIEW: Compare reported dietary intake in active duty members to MDRIs and 2016 American College of Sports Medicine (ACSM) sports nutrition guidelines. RECENT FINDINGS: Active duty members are not meeting their energy and carbohydrate needs with low-to-adequate protein intake and adequate-to-high fat intake. Other nutrients of concern are vitamin D, calcium, iron, B-vitamins, and fiber. Thermal stress increases energy needs and suppresses appetite and thus increase risk for energy and nutrition deficiencies. Energy and nutrients needs can vary by branch of armed service, job responsibility, and external stressors.

Development of a Novel Clinical Decision Support System for Exercise Prescription Among Patients With Multiple Cardiovascular Disease Risk Factors.

Cardiovascular disease (CVD) risk factors cluster in an individual. Exercise is universally recommended to prevent and treat CVD. Yet, clinicians lack guidance on how to design an exercise prescription (ExRx) for patients with multiple CVD risk factors. To address this unmet need, we developed a novel clinical decision support system to prescribe exercise (prioritize personalize prescribe exercise [P3-EX]) for patients with multiple CVD risk factors founded upon the evidenced-based recommendations of the American College of Sports Medicine (ACSM) and American Heart Association. To develop P3-EX, we integrated (1) the ACSM exercise preparticipation health screening recommendations; (2) an adapted American Heart Association Life’s Simple 7 cardiovascular health scoring system; (3) adapted ACSM strategies for designing an ExRx for people with multiple CVD risk factors; and (4) the ACSM frequency, intensity, time, and time principle of ExRx. We have tested the clinical utility of P3-EX within a university-based online graduate program in ExRx among students that includes physicians, physical therapists, registered dietitians, exercise physiologists, kinesiologists, fitness industry professionals, and kinesiology educators in higher education. The support system P3-EX has proven to be an easy-to-use, guided, and time-efficient evidence-based approach to ExRx for patients with multiple CVD risk factors that has applicability to other chronic diseases and health conditions. Further evaluation is needed to better establish its feasibility, acceptability, and clinical utility as an ExRx tool.

Interrater Reliability Across 7 Established Risk Stratification Protocols in Cardiac Rehabilitation

ObjectiveTo analyze the interrater agreement among physiotherapists in using 7 risk stratification (RS) protocols to evaluate participants of cardiac rehabilitation (CR) and the main factors associated with disagreements that emerged during the RS process. DesignCross-sectional observational study. SettingOutpatient rehabilitation center. ParticipantsPatients (N=72) enrolled in CR with a diagnosis of cardiovascular disease or cardiovascular risk factors. Mean age was 65.62±12.14 y, and mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 29.18±4.56. InterventionsNot applicable. Main Outcome MeasuresThe main outcome was to the agreement between 2 physiotherapists in the patients’ RS process, using 7 protocols established in the literature for use in CR: American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Sports Medicine, American Heart Association, Sociedade Brasileira de Cardiologia, Sociedad Española de Cardiología, and Société Française de Cardiologie. In addition, the main disagreement factors were assessed. ResultsInterrater agreement was classified as moderate-to-good in the 7 included RS protocols (kappa index between 0.53-0.76). The most important aspects that led to disagreement between physiotherapists were reported in 5 categories. The protocol with the greater agreement index was the American College of Sports Medicine (93.10%; n=67), and the one with the greater disagreement was the American Association of Cardiovascular and Pulmonary Rehabilitation (27.80%; n=20). ConclusionsModerate-to-good interrater agreement among physiotherapists in using 7 RS protocols was observed. Major disagreements were the definition of abnormal hemodynamic responses, rhythm disorders, left ventricular dysfunction, and interpretation of the patient’s clinical characteristics.

Effects of Therapeutic Weight Loss Exercises on Obese Indivduals with Genu Valgum Deformity

Introduction: Obesity is a major factor, increasing susceptibility for MSDs, specifically thereof lower backand lower extremities. An increase in Q angle beyond the normal range is known as genu valgum (knockknees) and considered as extensor mechanism misalignment, and it has been associated with knee jointhypermobility, patellar instability and patellofemoral pain syndrome. the association with increased BMIand genu valgum and found that the severity of tibia vara was high obesity.Material and Methods : The interventional study was conducted in a Physiotherapy centre with 50overweight and obese males with increased Q-angle between the age group of 25-40 years. Recent fractures,open wounds, and other congenital anomalies in the lower extremities were excluded. Therapeutic weightloss exercises were given based on the American college of sports medicine (ACSM) and the observationswere done.Results: Pre and post intervention results showed a significant (p &lt; 0.005) that the treatment given waseffective.Conclusion : In conclusion, the severity of the genu valgum is directly associated with increase in BMI,sedentary lifestyle and physical inactivity plays a major etiological role for obesity in the development andprogression of genu valgum. Essentially, early detection and intervention with guidance of physical therapistcan correct the deformity with limited surgical morbidity.Introduction: Obesity is a major factor, increasing susceptibility for MSDs, specifically thereof lower backand lower extremities. An increase in Q angle beyond the normal range is known as genu valgum (knockknees) and considered as extensor mechanism misalignment, and it has been associated with knee jointhypermobility, patellar instability and patellofemoral pain syndrome. the association with increased BMIand genu valgum and found that the severity of tibia vara was high obesity.Material and Methods : The interventional study was conducted in a Physiotherapy centre with 50overweight and obese males with increased Q-angle between the age group of 25-40 years. Recent fractures,open wounds, and other congenital anomalies in the lower extremities were excluded. Therapeutic weightloss exercises were given based on the American college of sports medicine (ACSM) and the observationswere done.Results: Pre and post intervention results showed a significant (p &lt; 0.005) that the treatment given waseffective.Conclusion : In conclusion, the severity of the genu valgum is directly associated with increase in BMI,sedentary lifestyle and physical inactivity plays a major etiological role for obesity in the development andprogression of genu valgum. Essentially, early detection and intervention with guidance of physical therapistcan correct the deformity with limited surgical morbidity.

Physical activity and health-related quality of life among postmenopausal women with breast cancer treated with aromatase inhibitors.

Breast cancer is the most common non-cutaneous cancer in women with an estimated 268,600 new cases diagnosed in 2019, joining the over 3 million women living with the disease. To reduce cancer recurrence, postmenopausal women (highest incidence and prevalence of breast cancer) who test positive for hormone receptors in their tumors are candidates for adjuvant endocrine therapy (i.e., aromatase inhibitors [AIs]). Despite the benefits of AIs in the treatment for breast cancer, many women remain at risk for complications, including osteoporosis and fractures, all of which can adversely affect health-related quality of life (HRQoL). Increased attention is being paid to the role physical activity (PA) may have in improving health outcomes in survivors of breast cancer, but few studies focus on postmenopausal women. We sought to examine (1) the percentage of women in our sample meeting (or not meeting) the American College of Sports Medicine (ACSM) PA recommendations, (2) the relationship between AI use and three types of PA (leisure time, strength training, and walking), and (3) the relationship between PA and HRQoL by AI use, controlling for covariates. Postmenopausal women with breast cancer (n = 170), ages 50-95 years (M = 68.7), diagnosed with stage 1-3 disease, 45% on AIs, were recruited. Demographic, HRQoL, and PA data were collected via patient self-report, while clinical data (AI use) were abstracted from patient medical records. To address study aims, we utilized descriptive statistics, chi-square analyses, and multiple linear regressions, respectively. Half of the sample met the ACSM recommendations for total leisure-time PA (vigorous and moderate intensity combined), and 65.3% (n = 111) weekly walking. With regard to strength training, 36.5% of the women met these ACSM recommendations. Generally, there were positive relationships between AI use and most HRQoL domains. There were no statistically significant relationships between PA (meeting recommendations or not) and HRQoL by AI use. The proportion of women meeting guidelines for walking activity was encouraging. It is imperative that healthcare professionals providing care to breast cancer survivors follow up regarding symptoms, side effects, and physical activity in tandem to fully understand their relationship on an individual level.

The Effect of the ERVE Smartphone App on Physical Activity, Quality of Life, Self-Efficacy, and Exercise Motivation for Inactive People: A Randomized Controlled Trial

IntroductionPhysical inactivity has a major negative health effect worldwide. Mobile health apps may help promote active living. This study aimed to examine the effects of a smartphone app based on the American College of Sports Medicine (ACSM) guidelines and a theory called exercise prescription and education (ERVE as abbreviated in the original Turkish) on physical activity, quality of life, self-efficacy, and exercise motivation for inactive people. MethodsThe study was conducted as a randomized controlled trial (RCT). The 128 participants were randomly allocated to either the experimental group or control group in a 1:1 ratio. Participants in the experimental group received the ERVE smartphone app. No intervention was applied to the participants in the control group. The primary outcomes included self-efficacy, health-related quality of life, and motivational orientation for exercise. Secondary outcomes were body mass index (BMI) and levels of physical activity. ResultsThe per-protocol analysis revealed that participants in the experimental group reported an increase in behavior initiation, physical functioning, vitality, mental health, general health perception, and intrinsic regulation compared to the control group. Also, the app showed efficacy in reducing the BMI of the participants in the experimental group (p < .05). ConclusionsThe ERVE smartphone-based app seems to be a promising tool to promote physical activity, improve the quality of life, increase self-efficacy beliefs in the initiation of behaviors, and provide intrinsic motivation in sedentary individuals, at least in the short-term.

Professional Doctorate in Clinical Exercise Physiology

Professional Doctorate in Clinical Exercise Physiology

Finding The Clinical Exercise Physiologist's Collective Voice During the COVID-19 Pandemic

Finding The Clinical Exercise Physiologist's Collective Voice During the COVID-19 Pandemic

Association between favourable changes in objectively measured physical activity and telomere length after a lifestyle intervention in pediatric patients with abdominal obesity.

The purpose of this study was to assess the effect of physical activity (PA) changes, measured by accelerometry, on telomere length (TL) in pediatric patients with abdominal obesity after a lifestyle intervention. One hundred and twenty-one children (7-16 years old) with abdominal obesity were randomized to the intervention (a moderately hypocaloric Mediterranean diet) or the usual care group (standard pediatric recommendations) for 22 months (a 2 month intensive phase and a subsequent 20 month follow-up). Both groups were encouraged to accumulate an extra 200 min/week of PA. TL was measured by MMqPCR. Data were analyzed in 102 subjects after 2 months and 64 subjects at the first 10 months of follow-up. Light PA level decreased in both groups after 12 months of intervention. At month 2, moderate to vigorous PA (MVPA) increased in the intervention group (+5.4 min/day, p = 0.035) and so did sedentary time in the usual care group (+49.7 min/day, p = 0.010). TL changes were positively associated (p < 0.050) with metabolic equivalents (METs), MVPA level, and number of steps, and were inversely associated with sedentary and light PA levels in the intervention group after the intensive phase. In conclusion, favourable changes in PA levels in the intensive phase of a lifestyle intervention could contribute to TL maintenance in a pediatric population with abdominal obesity. Novelty Changes in physical activity levels had a direct effect on telomere length, a biomarker of cellular aging and oxidative stress. PA advice based on The American College of Sports Medicine included in this intervention is easy to implement in primary care.

Professional Doctorate in Clinical Exercise Physiology

Professional Doctorate in Clinical Exercise Physiology

Revisiting vitamin D and home-based exercises for patients with sleep apnea facing the COVID-19 quarantine.

Citation:Ekiz T, Kara M, Ozcakar L. Revisiting vitamin D and home-based exercises for patients with sleep apnea facing the COVID-19 quarantine. J Clin Sleep Med. 2020;16(8):1409–1410.

Recommended adequate exercise for diabetic patients in response to new lifestyle manner with corona era for Global health

Crucial problems of Coronavirus disease 2019 (COVID-19) are found worldwide. Elderly people and diabetic patients tend to show less activity or exercise. “Exercise is Medicine” has been known by American College of Sports Medicine (ACSM). From 24 articles with 10948 COVID-19 cases, the prevalence (odds ratio, OR) showed diabetes in 10.0% (2.61), Cardiovascular disease (CVD) in 8.0% (4.81), hypertension in 20.0% (2.84), chronic pulmonary disease in 3.0% (3.83). Out of 7337 cases of COVID-19, there were 952 Type 2 Diabetes Mellitus (T2DM) patients. The mortality of diabetes vs non-diabetes was 7.8% vs 2.7%, respectively (HR 1.49). Regarding these diabetics, cases with max glucose below 180mg/dL showed 1.1% of mortality, whereas case with above 180mg/dL showed 11.0%. People's lifestyles are changing due to corona infections, and this article is expected to become useful reference for adequate exercise leading to global health.

Effective Practice Using Pole Exercise Would Contribute for The Situation of “Exercise is Medicine”

The presence of the sports can historically contribute international understanding and cooperation. Olympic and Paralympic Games in Tokyo will be scheduled, and “Exercise is Medicine” has been known widely by American College of Sports Medicine (ACSM). Authors et al. have continued clinical practice and research on pole exercise for years. The methods include various movements in frontal, horizontal and sagittal planes. The pole consists of aluminum with 60-160 cm in length. Moriyasu pole training would be clinically effective, which can simultaneously increase the flexibility of thorax, vertebrae and pelvis, and the functioning ability of joint movement and posture control.

COVID-19 — Is It Time for Exercise Clinicians to Prehabilitate “High Risk” Respiratory Patients?

COVID-19 — Is It Time for Exercise Clinicians to Prehabilitate “High Risk” Respiratory Patients?

Exercise is Medicine&lt;SUP&gt;®&lt;/SUP&gt; on Campus: Effectiveness of an Employee Circuit Training Class

Exercise is Medicine® on Campus (EIM-OC) is a global health initiative lead by the American College of Sports Medicine (ACSM) to integrate physical activity (PA) into university campus culture and establish PA as a vital sign. There is limited research on the EIM-OC, especially studies which include university employees. Therefore, the purpose of this study was to evaluate the effectiveness of an EIM-OC sponsored employee circuit training class at increasing PA and reducing perceived stress in participants. Out of 20 class participants, 12 females volunteered to take part in the study. Data was collected with an online questionnaire that included the Godin Leisure-Time Exercise Questionnaire (LTEQ) and Cohen’s Perceived Stress Scale. Paired-samples t-tests were performed for LTEQ score, PA days, and perceived stress score. Physical activity score significantly increased (p=.05) from pre-to post-training. Moderate days of PA significantly increased from pre-to post-training, but strenuous and light days of PA were not statistically significant. Perceived stress scores improved significantly (p<.001) from pre-to post-training. These results demonstrate that EIM-OC employee exercises classes can be an effective program offering to increase PA and improve perceived stress among university employees.

Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis.

BackgroundRheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA.ObjectiveThis study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise.MethodsA systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14).ResultsA total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified.ConclusionsThis review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation.