Physical Activity Behavior Change Research Articles

Randomized controlled trials of self-monitoring interventions with or without incentives for diet and exercise among individuals with overweight or obesity: Psychological and behavioural effects.

To test the effects of three behavioural interventions (daily monetary incentives+self-monitoring, delayed lump sum monetary incentives+self-monitoring, and self-monitoring only) on psychological constructs and fruit and vegetable consumption or physical activity behaviour change among a sample of adults with overweight or obesity. A pair of 3-arm longitudinal randomized controlled trials compared daily monetary incentives+self-monitoring, delayed lump sum monetary incentives+self-monitoring, and self-monitoring only interventions for either fruit and vegetable consumption or physical activity. Individuals reporting elevated weight status and insufficient engagement in one of the target behaviours were randomly assigned to one of three 3-week interventions. All three interventions involved daily self-monitoring of the behaviour, and two provided monetary incentives contingent upon reported behaviour. Participants completed measures of psychological constructs and reported behaviour at baseline, the end of the intervention, and two and four weeks post-intervention. Participants across all three intervention conditions demonstrated increased engagement in the target behaviour from pre- to post-intervention and reported behaviour remained above baseline levels at both follow-up time points. Increases in reported behaviour during the intervention were associated with increases in self-efficacy, and this enhanced self-efficacy prospectively predicted sustained reported behaviour at follow-up. However, contrary to hypotheses, the incentive interventions including self-monitoring were not more efficacious than self-monitoring alone, and increased reported behaviour was not associated with enhancements in attitudes. Self-monitoring interventions can aid behaviour change efforts, and behavioural practice during these interventions can increase self-efficacy. However, among adults with overweight or obesity who are seeking behaviour change interventions, incentive-based self-monitoring approaches may not be superior to self-monitoring alone in driving behaviour change and maintenance.

Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis.

BackgroundPhysical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity.ObjectiveThe aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women.MethodsA systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified.ResultsNineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality.ConclusionsOur findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women.

Development and Feasibility of an Obesity Prevention Intervention for Adolescent African American Daughters and Their Mothers

African American (AA) girls and women having disproportionately higher rates of obesity than their racial/ethnic counterparts. There is an urgent need to address overweight and obesity in AA girls through preventive interventions that enhance lifestyle physical activity (PA) and improve dietary behaviors in middle adolescence. Middle adolescence represents a unique and important opportunity to strengthen the daughter/mother bond and improve healthy behaviors such as PA and dietary intake. Because of the developmental and cultural complexities of adolescence, it is essential to include mothers, however, this approach is understudied in the literature. This pre-pilot study--- Black Girls Move was conducted using a 12-week pre-post within-subjects design to assess a) feasibility of conducting the study b) feasibility of delivering the intervention and c) program satisfaction by AA 9th and 10th grade daughters and their mothers. Twenty-two dyads were recruited, 14 dyads completed baseline assessments, however, only eight daughters and their mothers attended the first session and were retained for the entire study. All dyads had valid objective and self-reported PA data, however, two of eight daughters and one mother provided self-reported dietary data that were considered invalid. All individual sessions were rated highly. Excellent attendance, retention, and satisfaction among participants suggest that we succeeded in conveying the importance of healthy PA and dietary behavior change. This lifestyle intervention would be strengthened by modifications to recruitment and retention as well as incorporation of a computerized dietary assessment tool, a tailored dietary app for self-monitoring, and increased photo-based and group homework activities.

Predicting Physical Activity Behavior Change Among Individuals Living With Severe Mental Illness

Individuals living with a severe mental illness (SMI) have an increased risk of comorbid health conditions, many of which can be attributed to unhealthy lifestyle habits and medication side effects. The purpose of the present study is to examine health behavior theories including the social cognitive theory, self-determination theory, and theory of planned behavior in an effort to predict individuals living with SMI's stage of change (SOC) relating to physical activity (PA). Each theory focuses on important theoretical behavior changing components, such as self-efficacy, autonomy, and intention. The sample of this study includes 60 people with SMI from an assertive community treatment (ACT) program in a large Midwestern city. The results indicated that individual outcome expectations may be the proximal predictor of SOC, although significant relationships were found between SOC, self-efficacy, autonomy, and intentions as well. Future research should focus on the value of positive beliefs about the benefits of PA as that was found to be significant predictor regarding individuals with SMI and their readiness to engage in PA.

Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial.

BackgroundIn 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population.ObjectiveThis study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center’s (UMMC) pediatric weight management clinic.MethodsThis single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi–enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC’s pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change.ResultsRecruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC’s Institutional Review Board (#2020V0249).ConclusionsThe proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations.International Registered Report Identifier (IRRID)PRR1-10.2196/25699

A study on prospective associations between adiposity and 7-year changes in movement behaviors among older women based on compositional data analysis

IntroductionIt is unclear whether adiposity leads to changes in movement behaviors, and there is a lack of compositional analyses of longitudinal data which focus on these associations. Using a compositional approach, this study aimed to examine the associations between baseline adiposity and 7-year changes in physical activity (PA) and sedentary behavior (SB) among elderly women. We also explored the longitudinal associations between change in adiposity and change in movement-behavior composition.MethodsThis longitudinal study included 176 older women (mean baseline age 62.8 (4.1) years) from Central Europe. Movement behavior was assessed by accelerometers and adiposity was measured by bioelectrical impedance analysis at baseline and follow-up. A set of multivariate least-squares regression analyses was used to examine the associations of baseline adiposity and longitudinal changes in adiposity as explanatory variables with longitudinal changes in a 3-part movement-behavior composition consisting of SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) as outcome variables.ResultsNo significant associations were found between baseline adiposity and longitudinal changes in the movement-behavior composition (p > 0.05). We found significant associations of changes in body mass index (BMI) and fat mass percentage (FM%) with changes in the movement-behavior composition. An increase in BMI was associated with an increase of SB at the expense of LPA and MVPA (β = 0.042, p = 0.009) and with a decrease of MVPA in favor of SB and LPA (β = − 0.059, p = 0.037). An increase in FM% was significantly associated only with an increase of SB at the expense of LPA and MVPA (β = 0.019, p = 0.031).ConclusionsThis study did not support the assumption that baseline adiposity is associated with longitudinal changes in movement behaviors among elderly women, but we found evidence for change-to-change associations, suggesting that a 7-year increase in adiposity is associated with a concurrent increase of SB at the expense of LPA and MVPA and with a concurrent decrease of MVPA in favor of LPA and SB. Public health interventions are needed to simultaneously prevent weight gain and promote physically active lifestyle among elderly women.

Adherence to a lower versus higher intensity physical activity intervention in the Breast Cancer & Physical Activity Level (BC-PAL) Trial.

The first aim is to examine adherence to a lower versus higher intensity physical activity (PA) prescription in breast cancer survivors in the Breast Cancer & Physical Activity Level (BC-PAL) Trial. The second aim is to assess associations between baseline characteristics with mean PA adherence in both intervention groups combined. Forty-five participants were randomized to a 12-week, home-based lower (300 min/week, 40-59% heart rate reserve (HRR)) or higher (150 min/week, 60-80% HRR) intensity PA intervention, or no intervention/control. Both intervention groups received Polar A360® trackers and were included in this analysis (n=30). Study outcomes assessed on a weekly basis with the Polar A360® activity tracker throughout the intervention included relative adherence to the prescribed PA interventions (% of PA prescription goal met), and the absolute amount of PA time ≥40% of HRR. Baseline predictors of adherence included demographic characteristics, cardiorespiratory fitness, habitual PA and sedentary time, quality of life measures, and motivational variables from the Theory of Planned Behavior. For our primary aim, a linear mixed model was used to assess the effects of randomization group, time (intervention weeks 1-12), and the interaction of these factors on the natural logarithm of PA adherence. For our secondary aim, the association between each baseline predictor with the natural logarithm of mean weekly PA adherence was assessed, with randomization group added as a covariate. Higher relative time within the prescribed HRR zone was noted in the lower versus higher intensity PA groups (eβ=3.12, 95% CI=1.97, 4.95). No differences in adherence across time were noted. Social support was inversely associated with relative PA time within the prescribed HRR zone (eβ=0.83, 95% CI=0.72, 0.97) and absolute PA time ≥40% of HRR (eβ= 0.82, 95% CI: 0.71, 0.93). Baseline VO2max was inversely associated with relative PA adherence (eβ=0.98, 95% CI=0.95, 0.99). No other baseline measures were associated with PA adherence. There were no significant changes in absolute PA time ≥40% of HRR across time or between groups. However, the lower intensity PA group averaged over 3 times the relative amount of PA within the prescribed HRR zone compared to the higher intensity PA group. Finally, lower peer support and cardiorespiratory fitness at baseline were associated with higher PA adherence. The recent rise in popularity of commercially available activity trackers provides new opportunities to promote PA participation remotely, and these devices can be used to continuously and objectively measure PA levels as an indicator of intervention adherence. Future studies are needed to explore baseline predictors, facilitators, and barriers to sustained activity tracker use to promote PA behavior change and intervention adherence in cancer survivors. This study was registered at www. gov (No. NCT03564899) on June 21, 2018.

Exacerbations and Changes in Physical Activity and Sedentary Behaviour in Patients with Bronchiectasis after 1 Year.

Background: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic characteristics related to a change in physical activity and sedentary behaviour in patients with bronchiectasis after one year. Methods: This was a prospective observational study during which physical activity measurements were recorded using a SenseWear Armband for one week at baseline and at one year. At each assessment point, patients were classified as active or inactive (measured as steps per day) and as sedentary or not sedentary (measured as sedentary time). Results: 53 patients with bronchiectasis were analysed, and after one year, 18 (34%) had worse activity and sedentary levels. Specifically, 10 patients became inactive and sedentary. Multivariable analysis showed that the number of exacerbations during the follow-up period was the only outcome independently associated with change to higher inactivity and sedentary behaviour (odds ratio (OR), 2.19; 95% CI, 1.12 to 4.28). Conclusions: The number of exacerbations in patients with bronchiectasis was associated with changes in physical activity and sedentary behaviour. Exacerbation prevention may appear as a key factor in relation to physical activity and sedentary behaviour in patients with bronchiectasis.

Effect of Dissemination of Resources and Information Method for Overnutrition Prevention Behavior on Primary School Children in Makassar

The prevalence of overnutrition among primary school aged children, which ranges from the risk of obesityglobally including Indonesia, is currently increasing. This study aimed to assess the difference in behaviorchange in physical activity and habit of soft drinks consumptions before and after the intervention withthe dissemination method of resources and information. The research was conducted at primary schools inMakassar City. This research used a Quasy Experiment approach with a pretest and post-test examinationthrough control group design. The study was conducted for 3 months by providing health information relatedto overnutrition and obesity while monthlyvisit or monitoring of children was carried out using a 24 hourfood recall. The sampling technique was carried out by means of proportional random sampling. Data wereanalyzed by univariate, bivariate, and multivariate analysis. The results showed that there was an effect ofdissemination of resources and information on physical activity (p = 0.000) and soft drink consumptionhabits (p = 0.000) before and after the intervention. The conclusion is that the application of the method ofdissemination of resources and information is effective in changing the behavior of preventing overnutritionin primary school children. It is expected that efforts in schools such as the method of dissemination ofresources and information with peer education will become a reference in efforts to prevent more nutritionin improving students’ healthy eating patterns through dissemination of resources and information.

Applying the Transtheoretical Model of Behavioral Change to Establish Physical Activity Habits

The Transtheoretical Model is an integrative model of behavior change developed in response to increasing theoretical diversity within psychotherapy. Since its conception, the model has been applied to a variety of behavior change contexts such as substance abuse, diet, and exercise. PURPOSE: to review and summarize the literature relative to applications of the Transtheoretical Model in exercise interventions, and to provide considerations for health professionals while using the Transtheoretical Model in their practice. METHODS: The components of the Transtheoretical Model of behavior change are parsed and analyzed to review their function and role in the model. In addition, the model is reviewed to determine the effectiveness of applying the Transtheoretical Model in conjunction to interventions aimed at increasing physical activity behavior. RESULTS: In general, results support the application of Transtheoretical Model for physical activity behavioral change, but not unconditionally. Beyond highlighting results of studies applying the Transtheoretical Model, implications and considerations for interventions using the models are also detailed. CONCLUSION: When acknowledging the multidimensional nature of the model, it is important to demonstrate a good understanding of how the various dimensions relate to one another and recognize how these relationships will influence intervention development.

Examining Device-Assessed Physical Activity During the Transition Into Emerging Adulthood: Results From the MovingU Study

PurposeThe purpose of the present study was to conduct the first longitudinal investigation using accelerometers to assess physical activity behavior change during individuals' acute transition out of high school. MethodsParticipants in the current investigation were a part of a prospective cohort study called the MovingU Study. Participants were 163 adolescents (Mage = 16.9 ± .5; n = 88 females) recruited at the beginning of their final year at high school, with follow-up at 6 and 18 months. Participants wore the ActiGraph Link for 7 days at each assessment period. ResultsResults from the mixed-effects models found no significant differences in moderate-to-vigorous physical activity or total physical activity between baseline and follow-up at 6 months (Estimates = 1.91 and −2.26, p's > .05), respectively; however, significant differences in both moderate-to-vigorous physical activity and total physical activity between baseline and follow-up at 18 months after the transition out of highschool (Estimate = −123.62 and −15.38, p's < .01). ConclusionsCurrent findings provide additional compelling data to show precipitous declines in physical activity as adolescents transition out of high school and into emerging adulthood. Continued efforts to maintain or increase physical activity during adolescence and the prevention of physical activity declines as they enter emerging adulthood could have important public health benefits.

Effectiveness of interventions and behaviour change techniques for improving physical activity in young adults: A systematic review and meta-analysis

ABSTRACT Physical activity (PA) participation declines from adolescence to young adulthood. This review evaluates the effectiveness of interventions aiming to improve PA among healthy young adults (17–35 years), and the effectiveness of the behaviour change techniques (BCTs) used. Six electronic databases were searched up to December 2019, for randomized controlled trials aiming to achieve PA behaviour change among young adults. In total, 66 RCTs were included. Meta-analyses for moderate-vigorous PA (n = 11 studies), steps (n = 5 studies) and total PA (MET min/week, n = 11 studies) identified that intervention participants compared with control significantly increased PA at time points up to 3 months and >3 months. Narrative synthesis identified that 34 RCTs (52%) reported significant between group differences favouring the intervention for one or more PA outcome. BCTs with the highest effectiveness were material reward, valued self-identity and habit formation. However, the overall test of significance demonstrated no significant relationship between type or number of BCTs and effectiveness. This review identified interventions that improve steps, moderate-vigorous and total PA in young adults in the shorter-term, and BCTs associated with greater effectiveness. Further research is needed to determine strategies to achieve longer-term effectiveness of PA interventions in young adults.

Stress, physical activity, and screen-related sedentary behaviour within the first month of the COVID-19 pandemic.

This study investigated how stress, physical activity and sedentary behaviours, of a small sample of Canadians, changed within the first month (i.e. March/April) of the COVID‐19 pandemic and the reasons/barriers associated with such changes. Individuals who regularly wear activity trackers were recruited via social media. Participants (N = 121) completed fillable calendars (March/April 2020) with their step counts and answered an online survey. Separate paired‐sample t‐tests, one‐way ANOVAs and bivariate chi‐squares were conducted, in addition to qualitative analysis. Daily (p <.001) and work (p =.003) stress increased, physical activity (measured by step count) decreased (p =.0014), and screen‐related sedentary behaviour increased (p <.001) as a result of COVID‐19. A decrease in physical activity, as a result of the pandemic, was also associated with a larger increase in work stress, compared with those who self‐reported their physical activity to have been maintained or increased (p =.005). The most common reasons/barriers to changes in physical activity behaviours were access/equipment, time and motivation. Findings provide initial evidence of the impact of the COVID‐19 pandemic on the health of some Canadians and highlight the need for continued monitoring of the health of Canadians throughout the pandemic.

Everyday Physical Activity and Sedentary Behavior After Total Joint Arthroplasty: Do Patients and Partners Develop an Active Lifestyle?

BackgroundOsteoarthritis (OA) is a frequent cause of pain and disability, affecting half of the world’s population aged 65 years or older. Due to experienced pain and limitations, OA patients generally spend most of their waking hours sedentary and fail to adhere to physical activity (PA) recommendations. As a result of living together with OA patients, their partners might adopt a sedentary lifestyle. This study investigates the change in habitual PA and sedentary behavior (SB) in patients and their partners one year after the patients’ total joint replacement (arthroplasty) and inpatient rehabilitation.MethodsThis is a follow-up of a prospective cohort study including 24 older couples (69.3±7.8 years, gender ratio 11:13) consisting of OA patients (17 hip OA, 7 knee OA) and their partners. The participants’ habitual PA and SB were assessed by means of synchronous accelerometry (16h per day, 4–7 days) and additional self-report.ResultsAlthough the partners (~6300 steps per day) were significantly more active than the patients (~4800 steps per day) before arthroplasty, their lifestyle was still classified “low active”. Irrespective of the method used, the PA and SB parameters of patients and partners were significantly correlated before arthroplasty (accelerometry: r≥0.333, p≤0.001; self-report: r≥0.569, p≤0.004). Following the patients’ arthroplasty, no improvement in PA or SB was observed either in the patients or their partners. A detailed evaluation of accelerometric data on hourly basis revealed no change in behavior for both groups. Furthermore, their everyday activities remained correlated (accelerometry: r≥0.418, p≤0.001; questionnaire: r≥0.554, p≤0.005).ConclusionOne year post-arthroplasty and inpatient rehabilitation neither the OA patients nor their partners had changed their PA or SB. Their everyday physical activity was still strongly intertwined. Further research is needed to determine why behavior change does not occur even though the prerequisites are in place.

Using Fitbit as an mHealth Intervention Tool to Promote Physical Activity: Potential Challenges and Solutions.

Consumer-based physical activity (PA) trackers, also known as wearables, are increasingly being used in research studies as intervention or measurement tools. One of the most popular and widely used brands of PA trackers is Fitbit. Since the release of the first Fitbit in 2009, hundreds of experimental studies have used Fitbit devices to facilitate PA self-monitoring and behavior change via goal setting and feedback tools. Fitbit’s ability to capture large volumes of PA and physiological data in real time creates enormous opportunities for researchers. At the same time, however, it introduces a number of challenges (eg, technological, operational, logistical), most of which are not sufficiently described in study publications. Currently, there are no technical reports, guidelines, nor other types of publications discussing some of these challenges and offering guidance to researchers on how to best incorporate Fitbit devices in their study design and intervention to achieve their research goals. As a result, researchers are often left alone to discover and address some of these issues during the study through “trial and error.” This paper aims to address this gap. Drawing on our cumulative experience of conducting multiple studies with various Fitbit PA trackers over the years, we present and discuss various key challenges associated with the use of Fitbit PA trackers in research studies. Difficulties with the use of Fitbit PA trackers are encountered throughout the entire research process. Challenges and solutions are categorized in 4 main categories: study preparation, intervention delivery, data collection and analysis, and study closeout. Subsequently, we describe a number of empirically tested strategies used in 4 of our interventional studies involving participants from a broad range of demographic characteristics, racial/ethnic backgrounds, and literacy levels. Researchers should be prepared to address challenges and issues in a timely fashion to ensure that the Fitbit effectively assists participants and researchers in achieving research and outcome goals.

Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance

ObjectivesPeople with progressive multiple sclerosis (PwPMS) report that they recognise the benefits of activity on their physical and psychological health but need support to achieve their physical activity goals. We...

Changes in physical activity behavior and development of cardiovascular risk in children.

The study aimed to investigate the association of changes in physical activity, screen time, and cardiorespiratory fitness (CRF) with development of body mass index (BMI), blood pressure (BP), and retinal microvascular health in children over four years. In 2014, 391 children aged 6-8years were screened, and thereof 262 children were reexamined after four years following standardized protocols. Retinal arteriolar (CRAE) and venular diameters were measured by a retinal vessel analyzer. CRF was objectively assessed by a 20m shuttle run, physical activity, and screen time by use of a questionnaire. Children who achieved higher CRF levels reduced their BMI (β [95% CI] -0.35 [-0.46 to -0.25] kg/m2 per stage, P≤.001) and thereby developed wider CRAE (β [95% CI] 0.25 [0.24 to 0.48] µm per stage, P=.03) at follow-up. Moreover, children with elevated or high systolic BP at baseline, but lower levels of screen time during the observation period, had wider CRAE at follow-up (β [95% CI] -0.37 [-0.66 to -0.08] µm per 10min/d, P=.013). Change in CRF was not directly associated with better microvascular health at follow-up. However, an increase of CRF over four years was associated with a reduced BMI and consequently wider retinal arterioles at follow-up. In children with elevated or high systolic BP, a reduction of screen time significantly improved retinal microvascular health as a primary prevention strategy to promote childhood health and combat development of manifest CV disease later in life.

Development of a behaviour change workplace-based intervention to improve nurses\u2019 eating and physical activity

BackgroundThere is a critical need for an intervention to improve nurses’ eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses.MethodsThe intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques.ResultsData from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention.ConclusionsAn evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

Maintaining physical activity following myocardial infarction: a qualitative study

BackgroundOutcomes following myocardial infarction (MI) are improved by uptake and maintenance of physical activity (PA), but little is understood regarding patients experience of maintaining an active lifestyle once immediate support, such as cardiac-rehabilitation (CR), has ended.AimThe purpose of this study was to investigate MI survivors’ attitude and appraisal towards PA and the perceived barriers, motivators and facilitators for maintaining PA long-term.MethodsSemi-structured interviews were carried out with 18 adults (mean age 60.5, range 37–73 years) from England and Scotland, who were a minimum of 5 months post-MI (mean 29 months, range 5–122 months). There were comparatively more male participants (n = 13, 72 %) than female (n = 5, 28 %). Overall 12 (67 %) participants had attended CR. The interviews were transcribed verbatim and thematic analysis was performed using qualitative data analysis software NVivo.ResultsData analysis indicated that the following four core themes influenced MI survivors’ behaviour and attitude towards PA: (1) MI as a teachable moment for behaviour change, (2) affective response to MI: enjoyment versus fear, (3) cognitive response to MI: self-perception, attitude and self-efficacy, and (4) access to support and resources, including PA facilities and social support. Participants highlighted a lack of available guidance on maintaining PA behaviour change following CR and that advice on the frequency and intensity of exercise to follow was often unclear and confusing. Feelings of vulnerability and fear of overexertion were apparent, affecting participants self-efficacy to exercise.ConclusionsCurrent CR programmes fail to address PA belief systems and perceptions of self-efficacy to exercise. Interventions that address feelings of vulnerability and fear of overexertion may be beneficial. Providing ongoing PA advice and access to social support may facilitate patients to maintain changes in PA.

Feasibility and efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: Results of a pilot randomized controlled trial

BackgroundThis pilot randomized controlled trial examined the feasibility and efficacy of a physical activity behavior change intervention for improving restless legs syndrome (RLS) severity and secondary sleep outcomes among a sample of adults with multiple sclerosis (MS). MethodsParticipants with MS(N=15) were randomly assigned into intervention(n=8) or waitlist control(n=7) conditions. The physical activity intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions. ResultsThere was a significant, positive effect of the intervention on overall RLS severity (p=.01;ηρ2=.43), severity during the night(p=.03,ηρ2=.35), severity during the day while resting(p=.01,ηρ2=.44), and severity during the day while active(p<.01,ηρ2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,ηρ2=.09). There were significant positive effects on sleep satisfaction(p<.01,ηρ2=.49) and non-significant improvements in self-reported global sleep quality(p=.35,ηρ2=.08). There was a significant intervention effect on self-reported time in bed(p=.03,ηρ2=.37) and total sleep time(p=.03,ηρ2=.36), and non-significant improvements in self-reported sleep latency (p=.08,ηρ2=.25), sleep efficiency(p=.27,ηρ2=.11), and daytime sleepiness (p=.52,ηρ2=.04;p=.35,ηρ2=.08;p=.51,ηρ2=.04). There was no significant effect of the intervention on device-measured sleep quality. ConclusionsWe provide preliminary evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and potentially improving self-reported sleep outcomes in adults with MS. ClinicalTrials.gov Identification NumberNCT04061681