Physical Activity Interventions Research Articles

Impact of ‘10,000 Steps Duesseldorf’ after one year: Results of a controlled intervention study

Abstract Background Despite marked decreases in physical activity (PA) in Germany due to the pandemic, population-based intervention strategies to tackle this public health problem remain sparse. The 12-month PA intervention ‘10,000 Steps Duesseldorf’ was composed of multiple components: at individual level, website to self-monitor steps; organizational level, step count competitions; environmental level, city-wide media campaign to increase awareness regarding benefits of PA and street signage indicating walking routes. This study aimed to replicate a research trial from Belgium addressing two questions: (1) Do individuals located in the city that the intervention is implemented in (Duesseldorf) engage in more PA compared to individuals located in the control city (Wuppertal) after one year? (2) Is the proportion of those reaching 10,000 steps/day higher in the intervention than in the control city after the intervention? Methods To investigate intervention effects, PA was assessed via pedometers in two representative samples of adults aged 25-75 years in the cities of Duesseldorf (intervention) and Wuppertal (control) at baseline (April 2021 - March 2022) and one-year follow-up (May-November 2023). Baseline differences in socio-demographic and health-related variables between intervention and control were adjusted for in a propensity score model with matching weights. Results 627 adults participated in the study at baseline and 553 at follow-up (60% female, 60% intervention). The results of the propensity score analyses revealed that intervention participants walked 462 steps more (95% confidence interval: -146 to 1070) than controls at follow-up. However, the proportion of residents reaching 10,000 steps/day was comparable between intervention and control city after the intervention (26%, both cities). Conclusions Our results suggest an intervention effect on daily steps taken in Duesseldorf experiencing intervention activities compared to the control city after one year. Key messages • The complex PA intervention from Belgium was successfully adapted and implemented in Germany resulting in a higher level of daily steps taken in the intervention city (compared to control). • A limitation of the study is that the recruitment process was hampered by the ongoing pandemic, resulting in selection bias, i.e. already active individuals were more likely to enrol in the study.

Non-health-targeted promotions and step counts of smartphone-based mall walking program users

Abstract Background The COVID-19 pandemic changed lifestyles and raised concerns regarding physical inactivity among adults. Mobile health interventions for physical activity may be a potential solution. However, the effects may diminish over time. This study investigated whether incorporating non-health-targeted promotions into an existing mobile health-walking program could stimulate users to walk. Methods We used nationwide cohort data of smartphone users participating in a shopping mall walking program in Japan. We focused on existing users registered in the program until October 31, 2022. A Japanese anime tie-in promotion was conducted by the shopping mall company from December 3 to 25, 2022, offering additional rewards alongside the regular program. We collected step count records of existing users 1 month before and after (November 1 to December 2, 2022, and December 26, 2022 to January 31, 2023, respectively), and during the promotion period. Propensity score matching was applied to ensure balance in the baseline characteristics of existing users in terms of gender, age, and pre-promotion program participation frequency. Next, we analyzed the association between participation in the promotion program and the average daily step counts during and after the promotional period using mixed effects models for repeated measures, while adjusting for the same covariates. Results Among the 18,156 users included in the study, 13,386 (73.7%) were women, with a mean (SD) age of 45.2 (12.7) years, and a mean (SD) pre-promotion program participation frequency of 9.7 (9.6) per month. During the promotion period, the participants walked 87 (95% CI: 50-125) more steps per day than non-participants, after adjusting for covariates. No clear association was observed 1 month post-promotion. Conclusions These findings indicate that non-health-targeted promotions may be short-term motivators for existing app users to walk. Ongoing monitoring is necessary to assess the long-term impact. Key messages • Mobile health intervention effects may diminish over time. • A non-health-related promotion could stimulate existing mall walking program app users to increase their daily step count temporarily.

Is being a physically active parent related to having a physically active son/daughter?

Abstract Background Engaging in physical activity (PA) during childhood and adolescence can promote lifelong healthy habits and improve overall health. Physically active parents could play a key role in influencing the sons’ and daughters’ PA. The study aimed to evaluate the levels of PA among children and adolescents and to investigate the possible relationship with PA levels of parents. Methods This cross-sectional study involved a random sample of parents of a son/daughter aged 5 to 17 years in the Southern part of Italy. Data were collected through an anonymous self-administered questionnaire designed to retrieve i) sociodemographic characteristics and anthropometric data, ii) parent’s knowledge about the World Health Organization’s (WHO) guidelines (GL) about PA, iii) levels of PA of son/daughter and parent. Results Preliminary findings refer to a sample of 230 parents, of whom, 52.2% were women with a mean age of 38.6 (SD ± 6.8) years. The vast majority of the sample was employed (79.6%) and married (89.1%). Less than half (48.7%) were knowledgeable about WHO’s GLs for PA both in adults (52.6%) and children/adolescents (74.8%). Almost two-thirds (63%) of parents practised PA according to WHO’s GLs. Among sons/daughters, 44.4% practised PA according to WHO’s GLs. The results of the multivariate analysis showed that sons/daughters of physically active parents had higher odds of practising PA according to WHO’s GLs (OR:6.48, 95%CI:3.29-12.79). Similarly, those with parents knowledgeable about WHO’s GLs for PA (OR:3.19, 95%CI:1.75-5.83) were more likely to practise PA according to WHO’s GLs. Conclusions Preliminary results reveal a lack of compliance with WHO’s GL on PA, especially among children and adolescents. This is of concern since it is linked to negative health outcomes in the future. The figure that sons/daughters of active parents had a higher likelihood of being active highlights that public health organizations should prioritise family-based interventions for PA. Key messages • Almost one-third of adults and more than half of the children and adolescents in the sample did not comply with WHO’s recommendations for physical activity. • Sons and daughters of physically active parents are more likely to be active, prompting the need for family-based public health intervention to promote physical activity.

Evaluating the feasibility of an Adapted Physical Activity intervention among breast cancer patients

Abstract Adapted physical activity (PA) programs have shown promising results to reduce physical, psychological and social side effects associated with breast cancer (BC), but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime), an innovative intervention focused on improving the quality of life (QoL) of BC surgery patients through fencing. A convergent mixed-methods pilot study was conducted to evaluate the RE-AIM dimensions of RIPOSTE. 24 participants who have just undergone surgery for invasive BC were randomly allocated either in the “RIPOSTE” group (starting immediately after their inclusion), or the “Delayed RIPOSTE” group (starting at 3 months following their inclusion). They answered to questionnaires at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and PA. Interviews were conducted with 10 participants, 3 sports physicians and 1 fencing master. RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of health indicators, even without any significant differences between the two groups. The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during vacations were the main barriers. Maintenance analyses showed that most participants continued to practice PA after the program. RIPOSTE is an acceptable and effective program for involving BC survivors in PA, that needs to be tested at larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide. Key messages • These results would help to enrich the literature on how to best intervene to enhance treatment and recovery among patients and facilitate transfer from a research program to a field daily practice. • By highlighting complexities of RIPOSTE effectiveness and implementation, this study could lead to a more complete program that addresses issues related to improving external and internal validity.

Trajectories of physical activity among participants of six-month mobile app-based disease management program for cardiovascular risk: a group-based trajectory modelling approach

Abstract Background Mobile app-based health promotion is an emerging preventive intervention for cardiovascular disease that allows for the frequent and longitudinal monitoring of physical activity (PA). Previous studies exploring PA trajectories categorized participants in a limited number of follow-up assessments and did not consider dynamic nature with changes that occur over the intervention period. Purpose This study explored the trajectories of PA during mobile app-based disease management programs in adults with cardiovascular risk using group-based trajectory modelling (GBTM). Methods Participants who completed a six-month disease management program using a mobile app were enrolled. The program promoted behavioural changes for the management of cardiovascular risk factors in individuals with one or more of hypertension, diabetes, or dyslipidaemia. Daily step count was measured using a wrist-worn activity tracker (Fitbit devices). Each participant was encouraged to wear a tracker for the monitoring of exercise and physical activity. To analyse relatively physically inactive participants, we included those with baseline step count <8,000 steps/day. GBTM was conducted to identify distinct patterns of longitudinal step count changes of baseline, 3-22 weeks, and 24 weeks. Participants with PA measurements <4 time points were excluded. The baseline characteristics and indicators related to mobile app usage during the first two weeks were compared among the trajectory groups. Results A total of 1,760 participants were included in the analysis (age: median 55 years; 83.8% men; body mass index (BMI): median 27.0 kg/m²; baseline step count: median 6,118 steps/day). GBTM identified four step count trajectory groups: rapid increase (T1, rapid increase in the first three months; 5%), gradual increase (T2, gradual increase in the first three months; 24%), moderate activity (T3, maintained at around 7,000 steps/day; 45%), and physically inactive (T4, around 4,500 steps/day throughout the program; 26%) (Figure 1). The trajectory groups that showed increasing PA patterns were older (T1: median 57 years; T2: 55 years; T3: 55 years; T4: 54 years; p=0.040) with a lower baseline BMI (T1: median 26.6 kg/m²; T2: 26.4 kg/m²; T3: 27.0 kg/m²; T4: 27.7 kg/m²; p<0.001) and were predominantly men (T1: 89.5%; T2: 87.4%; T3: 82.8%; T4: 81.1%; p=0.028). PA increasing patterns were associated with a longer time of mobile app use (T1: median 8.5 min/day; T2: 5.5 min/day; T3: 5.5 min/day; T4: 4.9 min/day; p=0.012) and more login times (T1: median of daily average 3.9/day; T2: 3.0/day; T3: 3.1/day; T4: 2.9/day; p=0.003) during the first two weeks of the program. Conclusions GBTM showed that 30% of participants in the mobile app-based intervention showed significant PA improvement during the first 12 weeks. Results of this study suggest that the response to PA intervention may be associated with lifestyle prior to the program and willingness to use the mobile app.Figure 1.Step count trajectories

Population-based physical activity promotion with a focus on health equity: evidence challenges

Abstract Issue Physical activity (PA) approaches that target the entire population hold great promise for public health particularly in terms of health equity due to their broad reach. During the process of developing national recommendations for PA and PA promotion in Germany, followed by a partial update, it became evident that there is limited evidence regarding population-based PA interventions with a focus on health equity. Our objective was to present an overview of the underlying reasons for this scarcity of evidence. Methods The methodology used in the development of the German recommendations to identify evidence for population-based health equity interventions was applied. Five scientific databases were searched for reviews published between 2015-2021. References of the included reviews were checked for additional reviews. Publications without any focus on health equity were not considered. The identified evidence was summarized narratively, followed by a description of existing challenges in evaluating. Results Our search yielded 4,411 reviews, of which 79 met the inclusion criteria but 75 were excluded because approaches did not focus on the whole population, or did not address health equity. Two reviews were found in the search for gray literature. Thus, the result is a total of 6 articles. None of these reviews reported the application of a theory. The consideration of quality criteria used before, during and after the practical implementation of interventions is not common. The complexity of population-based approaches proved to be a challenge. Conclusions Overall, there is a need for more emphasis on health equity in the implementation and evaluation of population-based PA approaches. The consideration of a theoretical underpinning of such complex approaches in complex systems and the application of standardised quality criteria are an important prerequisite for the generation of evidence. Key messages • There is little evidence of population-based PA approaches aimed at health equity. • A standardized and comprehensive evaluation assessment that is accepted by all public health stakeholders is needed.

Digital, Social Micro-Interventions to Promote Physical Activity Among Midlife Adults With Elevated Cardiovascular Risk: An Ambulatory Feasibility Study With Momentary Randomization.

Although regular physical activity (PA) mitigates the risk for cardiovascular disease (CVD) during midlife, existing PA interventions are minimally effective. Harnessing social influences in daily life shows promise: digital micro-interventions could effectively engage these influences on PA and require testing. This feasibility study employed ecological momentary assessment with embedded micro-randomization to activate two types of social influences (i.e., comparison, support; NCT04711512). Midlife adults (N = 30, MAge = 51, MBMI = 31.5kg/m2, 43% racial/ethnic minority) with ≥1 CVD risk conditions completed four mobile surveys per day for 7 days while wearing PA monitors. After 3 days of observation, participants were randomized at each survey to receive 1 of 3 comparison micro-interventions (days 4-5) or 1 of 3 support micro-interventions (days 6-7). Outcomes were indicators of feasibility (e.g., completion rate), acceptability (e.g., narrative feedback), and potential micro-intervention effects (on motivation and steps within-person). Feasibility and acceptability targets were met (e.g., 93% completion); ratings of micro-intervention helpfulness varied by intervention type and predicted PA motivation and behavior within-person (srs=0.16, 0.27). Participants liked the approach and were open to ongoing micro-intervention exposure. Within-person, PA motivation and behavior increased from baseline in response to specific micro-interventions (srs=0.23, 0.13), though responses were variable. Experimental manipulation of social influences in daily life is feasible and acceptable to midlife adults and shows potential effects on PA motivation and behavior. Findings support larger-scale testing of this approach to inform a digital, socially focused PA intervention for midlife adults.

Investigating the Feasibility and Acceptability of a Facebook Delivered, Parent Mediated, Physical Activity Intervention for Children with Developmental Coordination Disorder

ABSTRACT Objective Children with Developmental Coordination Disorder (DCD) experience difficulties performing fundamental movement skills, resulting in reduced physical activity (PA). Given low PA can impact mental and physical health, improving PA in DCD appears imperative. This study investigates the feasibility of a Facebook delivered, parent mediated, PA intervention for children with DCD. Methods Parents of children with DCD (n=31; 5-11 years), were invited to private Facebook groups where physical activity resources and questionnaires were provided over 12 weeks. Parents and their children wore activity trackers during the intervention period. Feasibility and acceptability of the intervention was considered with reference to (1) Facebook engagement, (2) adherence intervention components, and (3) parent perspectives. Results Facebook engagement was high, with 78.03% (SD=23.06) of all intervention posts being viewed by parents on average. Activity trackers were worn correctly for 92.45% of intervention days and 95.61% of intervention weeks. Weekly questionnaires were completed, on average, 84.37% of the time. Parent perspectives were positive, with 80.77% somewhat or strongly agreeing that the intervention was useful for themselves and their child. Conclusions Given the results described, Facebook appears to be a feasible platform through which parent mediated physical activity interventions can be provided to children with DCD.

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial.

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the "design thinking" framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND - Let's get moving (physical activity intervention) and i-REBOUND - Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND - Let's get moving and i-REBOUND - Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

The effectiveness and acceptability of physical activity interventions amongst older adults with lower socioeconomic status: a mixed methods systematic review.

Older adults with lower socioeconomic status are less likely to be physically active than those with higher socioeconomic status. To inform future intervention development, this review explored: [i] how effective are physical activity interventions at increasing levels of physical activity amongst older adults with lower socioeconomic status?; [ii] what factors are associated with the acceptability of physical activity interventions amongst older adults with lower socioeconomic status?; [iii] what are the implications for developing physical activity interventions for older adults with lower socioeconomic status? This mixed methods systematic review followed PRISMA guidelines. MEDLINE, CENTRAL, Embase, Scopus, Web of Science, PsycINFO, CINAHL, ASSIA and Sports Medicine and Education Index were searched up to May 2023, to identify quantitative, qualitative and mixed methods primary research studies measuring the effectiveness of and/or experiences of physical activity interventions for older adults (aged ≥ 65 years) with lower socioeconomic status. No limits on country were applied. Included studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. Results were synthesised using a results-based convergent synthesis approach with narrative synthesis of quantitative findings and thematic synthesis of qualitative findings. Thirty studies were included. Mixed effects were found for the effectiveness of physical activity interventions, with positive effects for increases in utilitarian walking (i.e. for transport) but not for leisure, mixed effects for objectively measured physical activity and no effects for self-reported total physical activity or muscle strengthening and flexibility activities. Engaging in physical activity interventions was perceived as offering many benefits, social familiarity was important to intervention acceptability and interventions were seen as more acceptable when they were compatible with the lifestyles of older adults with lower socioeconomic status. Future development of physical activity interventions for older adults with lower socioeconomic status should foster social connections, emphasise health benefits of physical activity, hold interventions in locations that are accessible and familiar to older adults with lower socioeconomic status, minimise costs to participants, employ individuals who share participant characteristics to lead interventions, and combine physical activity with other activities older adults with lower socioeconomic status already do to make more efficient use of time. PROSPERO CRD42023417312; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=417312 .

Telehealth-delivered physical activity interventions provided by maternal healthcare services influence postpartum women’s engagement in physical activity: a systematic review

The benefits of physical activity in the postpartum population are well documented, and regarded as being vitally important to the recovery process. Psychological health, musculoskeletal conditions, cardiorespiratory fitness and weight retention are among the postpartum health issues that physical activity can positively influence. Although international guidelines for physical activity postpartum have been published, there is a lack of current research into the effectiveness of, and patient compliance with, physical activity programmes in this population. Physiotherapists are well placed to deliver physical activity interventions for these women because of the multidisciplinary maternal healthcare services that are provided for them. The focus of this paper is to examine the available evidence regarding how the delivery and accessibility of physical activity programmes have changed with the exponential growth of telehealth. A detailed systematic literature search limited to randomized controlled trials published in English was performed for the period from 2014 to 2022. Four relevant publications were identified that utilized an element of telehealth physical activity in the postpartum population, although the timescale and definition of postpartum was not standardized across the papers. The findings of this literature review indicate that there is tentative support for the use of remote intervention as a means of improving physical activity in postpartum patients. The literature does not provide a consensus on the most appropriate length, type or duration of telehealth-delivered postpartum physical activity intervention for this population. There is a need for future high-quality research to investigate the effect of remote physical activity delivery on cost-effectiveness and patient satisfaction.

Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study.

Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Data from 957 cancer survivors from the Health Information National Trends Survey-Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion.

What do older women want from a physical activity program? Stakeholder consultation to optimise design and recruitment for the Active Women over 50 trial

BackgroundEffective recruitment and retention of participants are prerequisites for high quality physical activity intervention programs and evaluation trials, but this is underreported in the literature making it difficult to identify the most promising strategies. Incorporating stakeholder feedback in the design of program components and recruitment materials can optimise recruitment reach and the engagement of participants throughout programs and trials.MethodsThe Active Women over 50 randomised controlled trial is testing a program designed to support women aged 50 + to be more physically active. To optimise program design and recruitment flyers, we conducted one focus group and 17 interviews with diverse purposively sampled women aged 50 + living in New South Wales, Australia. Women were asked to review recruitment flyers and the four proposed program components: (1) health coaching, (2) dedicated website with resources, (3) private Facebook group and (4) motivational email and SMS messages. Data analysis incorporated framework methods, deductive analysis using the Adapted Mobile App Rating Scale for evaluating websites and abductive analysis to critique the underlying program theory.ResultsFive themes were identified in relation to recruitment: I want to see (women like) myself, Keep it real, Readability is for everyone, Why should I do it? and Find us where we live. The four program components were strongly supported as a package, but were valued differently for their relative importance. Results were used to refine the health coaching scheduling; website appearance and content; promotion and moderation of the Facebook group; and the structure, appearance and content of messages. Not all suggestions were actionable due to technological and time constraints, and the desire to keep program costs low enough for delivery at scale during the study and beyond. The program theory was expanded to encompass two emergent concepts.ConclusionsThis consultation resulted in substantial refinements to recruitment flyers and strategies, and all four program components. We anticipate that these refinements will increase the reach and appeal of the trial and optimise future scale-up. Consultation feedback, while specific to this program, may have wider transferability for recruitment and the design of programs with similar components targeting women aged 50+.

Physical activity interventions to prevent and manage type 2 diabetes in Aboriginal and Torres Strait Islander people: a systematic review.

To review evidence regarding the impact of physical activity interventions for preventing and managing type 2 diabetes in Aboriginal and Torres Strait Islander Australians. We searched for published reports of physical activity interventions for preventing and managing type 2 diabetes in Indigenous adults (18 years or older). There were no exclusion criteria regarding study type or duration, frequency, length, or intensity of physical activity, except that short term interventions were excluded. We assessed the quality of each study using the Joanna Briggs Institute (JBI) critical appraisal tools and the ethical and methodological quality of studies from an Indigenous Australian perspective with the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) Critical Appraisal Tool. MEDLINE; Scopus, Embase (Elsevier); Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sports Discus, PsycINFO (EBSCO); Informit Complete; ProQuest Dissertations and Theses, and ProQuest Health and Medicine; each from their inception to 30 October 2022. The database searches identified 703 potentially relevant records; after removing duplicates and initial screening, the full text of 27 articles was assessed for eligibility. Nine studies met our inclusion criteria: two randomised controlled trials, five cohort studies, one quasi-experimental study, and one repeated cross-sectional study. Eight studies were rated as being of low or medium quality (median JBI score, 54%; interquartile range [IQR], 36-64%); seven studies were rated as being of low to medium ethical and methodological quality from the Indigenous perspective (median CREATE score, 50%; IQR, 36-64%). Six studies reported changes in glycated haemoglobin (HbA1c) levels, of which two (both cohort studies) reported significantly lower mean HbA1c levels after the intervention, but only one publication provided detailed results. No randomised controlled trials that investigated the effect of a combination of physical activity and dietary change for Indigenous Australians diagnosed with type 2 diabetes were identified. Differences in study design, outcome variables, and the small number of studies precluded meta-analysis. Quality research into the impact of physical activity interventions on type 2 diabetes in Indigenous people is sparse. To improve research translation, studies that involve Indigenous community members at all levels of the research process are needed. PROSPERO CRD42021247496 (prospective).

Incorporating Therapeutic Education and Exercise in Migraine Management: A Biobehavioral Approach.

The main objective was to perform a description of the potential biobehavioral factors that influence disability in patients with migraines and develop a multimodal physiotherapy treatment proposal incorporating therapeutic education and exercise prescription, applying a biobehavioral approach. This manuscript highlights the complex interplay between migraines and physical activity, with many migraine sufferers performing reduced physical activity, even during headache-free intervals. The kinesiophobia present in a significant portion of patients with migraine exacerbates functional disability and compromises quality of life. Psychological elements, especially pain catastrophizing, depression, and self-efficacy, further compound migraine-related disability. Addressing these issues requires a multidisciplinary approach that integrates physical activity and behavioral interventions. We propose a therapeutic education model of motor behavior that emphasizes the enhancement of therapeutic exercise outcomes. This model consists of the four following phases: (1) biobehavioral analysis of movement; (2) goal setting; (3) education about exercise benefits; and (4) movement education. A notable feature is the incorporation of motivational interviewing, a communication strategy that amplifies intrinsic motivation for change. Recent clinical guidelines have advocated for specific exercise modalities to ameliorate migraine symptoms. However, we highlight the importance of a tailored exercise prescription to maximize the benefits of exercise and reduce the possible adverse effects. The integration of exercise with other lifestyle recommendations, such as maintaining consistent sleep patterns and employing stress management techniques, is pivotal for improving outcomes in patients with migraine. Although evidence supports the benefits of these interventions in various painful conditions, further research is needed to establish their efficacy specifically for migraine management.

Promoting physical activity among cancer survivors through general practice: a realist review.

Multiple studies have shown that physical activity improves cancer survivorship, by decreasing risk of second primary cancers and chronic conditions. However, cancer survivor physical activity levels remain low. General practice presents more opportunities for lifestyle interventions, such as increasing physical activity. We conducted a realist review of physical activity interventions relevant to general practice. A total of 9728 studies were obtained from a systematic search of the CINAHL, Embase, PsycINFO, PubMed, and SPORTDiscus databases from the inception of the electronic database to 21 June 2024. We focussed on intervention studies that improved physical activity among cancer survivors and were relevant to general practice. Data extraction focussed on: what makes physical activity interventions effective for cancer survivors (what works) and what factors promote physical activity for cancer survivors (for whom it works). Thirty-seven studies were used to generate themes on the components of physical activity interventions that are likely to work and for whom; these studies facilitated goal setting, action planning, self-monitoring, social support, and shaping of knowledge; through delivering tailored motivational support, evoking a teachable moment, and promoting the use of self-monitoring tools. Interventions that were cost-effective and easily implementable improved sustainability, deployability, and uptake by cancer survivors. Cancer survivor psychological and physical factors, such as baseline motivational levels and post-treatment symptoms, influenced the uptake of physical activity interventions. Our realist review has highlighted opportunities for general practices to promote physical activity among cancer survivors through collaborative goal setting, action planning, self-monitoring, social support, and shaping of knowledge.

Assessing the factors associated with body image perception and quality of life of Palestinian women undergoing breast cancer treatment: a cross-sectional study

BackgroundWorldwide, breast cancer has replaced lung cancer and has become the most commonly diagnosed malignancy. Breast cancer poses a significant burden on the health and quality of life of women and can lead to substantial physical burdens and significant psychological problems, including distress, anxiety, depression, and sexuality-related issues, including negative body image. This study was conducted to assess how women diagnosed with, treated, and/or receiving treatment for breast cancer perceived their body image.MethodsA cross-sectional study design was used to assess body image perceptions among Palestinian women diagnosed with breast cancer. The study was conducted in four different hospitals located in the West Bank of Palestine where women with breast cancer received their treatments or visited for follow-up care in the period between November 2023 and March 2024. An interviewer-administered questionnaire was used to collect the data. Body perception was assessed using the body image self-rating questionnaire for breast cancer (BISQ-BC).ResultsIn this study, 376 women with breast cancer completed the interviewer-administered questionnaire (response rate = 75.2%. The mean age of the women was 44.0 ± 5.3 years. Of the women, 74.7% agreed or strongly agreed that they cared about their body image. On the other hand, 43.1% of the women were not satisfied with their body image and 58.8% did not think that their body image was attractive. Multiple linear regression showed that younger age, employment status, living in cities, marital status, educational level, presence of comorbidities, and longer time passes since diagnosis with breast cancer were associated with the different aspects of body image perception and behavior.ConclusionThe findings of this study indicated that Palestinian women with breast cancer were concerned about their body image. The findings also indicated that breast cancer and its treatment posed a significant burden on the physical and psychosocial well-being of the affected women and impacted the different dimensions of their lives, including their perceptions of their body image. Patients with significant physical and body image changes might benefit from reconstructive surgeries, psychosocial support, cognitive behavioral therapy, and nutritional, and physical activity interventions.

Heart Failure Symptoms Improve With More Intense Physical Activity.

Little is known about how changes in physical activity (PA) over time may influence symptoms in people with heart failure (HF). A secondary analysis was conducted with data from an RCT of an exercise intervention in patients with ICDs (implantable cardioverter defibrillator) and a HF diagnosis (n = 96). Data were collected at baseline and 2months of PA intervention. Physical activity (PA Steps = mean steps/day; PA Intensity = mean steps/min for most intense 30minutes/day) were measured over 5days at each timepoint. Physical symptoms were measured using the Patient Concerns Assessment, the SF-36 Vitality, and Bodily Pain subscales for fatigue and pain. Psychological symptoms were assessed using the Patient Health Questionnaire-9, and the State-Trait Anxiety Index. Associations between PA and physical and psychological symptoms were analyzed with multivariate regression. Patients (n = 96) were predominately male (83%) and Caucasian (79%), aged 55.8 ± 12.3years, BMI of 29.7 ± 5.1, with heart failure with reduced ejection fraction (HFrEF; 30.9 ± 9.9%). An increase in PA Steps was associated with improvement in anxiety (β = -1.178, p = .048). An increase in PA Intensity was associated with significant reductions in depression (β = -0.127, p = .021), anxiety (β = -0.234, p = .037), and fatigue (β = 0.528, p = .022). Decreases in PA Steps and PA Intensity were not associated with changes in any symptoms. For HF patients with an ICD, more intense PA over 2months was associated with improved psychological symptoms and reduced fatigue. Decreases in PA (total and intensity) were not associated with changes in symptoms. Interventions promoting increasing the intensity of PA over time may be an effective approach to reduce some HF symptoms.

Navigating the body’s double nature in a sedentary environment: Swedish primary school children’s use of physical activity during the school day

ABSTRACT The structuring of time and space in schools influences when children’s bodies should be active and when they should be still. The growing interest in physical activity interventions in schools today highlights a pattern where schools act as sites meant to regulate and educate children’s bodies according to adult-centric interests. Drawing on existential phenomenology, particularly the dual nature of the body as both object and subject, this article examines how children themselves use physical activity in school. Sixty-three children aged 8 – 13 in Sweden participated in semi-structured focus groups where they discussed the significance of movement for them in the school environment. Reflexive thematic analysis in an ‘experiential mode’ was used to understand how the children related to their bodies in terms of objectivity and subjectivity, creating different types of incentives for movement. This is illustrated through two themes: ‘Physical activity for a healthy body (The body as object)’, which shows how children use physical activity based on instrumental motives, and ‘The sentient body (The body as subject)’, where the feeling body is presented in two states: both as trapped and as liberated. The children used movement as a way to balance the structuring of time and place imposed by their school environment, which generated various subjective corporeal states. Thus, the analysis shows that the school environment produces subjective bodies that children understand in objective terms influenced by contemporary health discourses, which in turn shapes their use of movement.

Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial.

While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511. DERR1-10.2196/60270.