Physical Activity Interventions Research Articles

School Poverty Level Moderates the Effectiveness of a Physical Activity Intervention.

To explore whether school poverty level and funding modified the effectiveness of an evidence-based Comprehensive School Physical Activity Program called Health Empowers You! implemented in elementary schools in Georgia. Secondary data analysis of a multi-level, cluster-randomized controlled trial. 40 elementary schools in Georgia in 2018-2019. 4th grade students in Georgia. Intervention schools implemented the Health Empowers You! program to increase school-day physical activity. The outcome was average daily moderate-to-vigorous physical activity, school free-reduced price lunch (FRPL) percentage and per pupil expenditures were effect modifiers. Separate linear mixed regression models estimated the effect of the intervention on average daily moderate-to-vigorous physical activity, with interaction terms between intervention status and (1) school FRPL percentage or (2) per pupil expenditures. The effect of the intervention was significantly higher in schools with higher FRPL percentage (intervention*school % FRPL β (95% CI): .06 (.01, .12)), and was modestly, but not statistically significantly, higher in schools with lower per pupil expenditures. Findings support the use of the Health Empowers You! intervention, which was effective in lower income schools, and may potentially reduce disparities in students' physical activity levels.

A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression-the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial.

Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)-an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696. DERR1-10.2196/56882.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants’ physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p < 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p < 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80–89% HRmax) and an increase in the percentage of muscle mass (70–79% and 80–89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

Systematic review and meta-analysis on the effects of physical activity-based interventions on frailty status and clinical outcomes in adults with long-term cardiac conditions

Abstract Introduction Frailty is common in patients with long-term cardiac conditions and is associated with poor clinical outcomes, but limited treatment options are available. Previous studies investigating interventions for frailty have shown positive results with physical activity interventions, however, these studies were largely based on general elderly populations. Aim To assess the impact of physical activity-based interventions on frailty and clinical outcomes in frail patients with long-term cardiac conditions. Methods A systematic review and meta-analysis was conducted based on the PRISMA guideline, using Medline, Embase, CENTRAL, PEDro, CINAHL electronic databases for articles published between 2000 and 2023. Studies which recruited adults >18 years with long-term cardiac conditions (including angina, acute coronary syndrome (ACS), valve disease, heart failure (HF), atrial fibrillation, cardiac surgery and congenital heart disease) who underwent physical activity-based interventions were included. The primary outcome was change in frailty (measured using a validated tool) post intervention. We also assessed the effect of interventions on mortality and hospitalisation. Results We screened 2697 records and reviewed 91 full-text articles; 12 studies (14 articles) were included, involving 1394 patients. Median age of participants ranged from 64 to 82 years. Five studies recruited participants with HF, 3 evaluated participants post transaortic valve implantation, 3 recruited cardiac surgical patients and 1 study evaluated participants post ACS. Physical activity-based interventions were multi-domain, including a mixture of aerobic, strength, balance, endurance and respiratory muscle training; the majority (N=10) had individualised exercise prescription. Meta-analysis of 8 randomised controlled trials (RCTs) showed statistically significant improvement in frailty associated with physical activity-based interventions compared to controls [pooled standardised mean difference (95% CI) = -0.34 (-0.59 to -0.08), p = 0.01, I2 = 48%]. Seven RCTs evaluated change in frailty by short physical performance battery (SPPB). Meta-analysis of these studies showed a statistically significant improvement in SPPB associated with physical activity-based interventions compared to controls [pooled mean difference (95% CI) = 0.83 (0.31-1.34), p = 0.002, I2 = 49%]. (Figure) The magnitude of improvement in SPPB exceeded the minimally clinically significant improvement of 0.5. Three studies evaluated the effect of physical activity-based intervention on clinical outcomes, all of which showed neutral effect on mortality and hospitalisation. Conclusion Physical activity-based interventions in patients with frailty and long-term cardiac conditions were associated with significant improvement in frailty status, with neutral effect on mortality and hospitalisation. Figure: Meta-analysis of 7 RCTs assessing effect of physical activity-based interventions on SPPB

Physical Activity-Related Health Services in Germany: Relevance and Necessary Framework Conditions - a Position Paper of the DNVF Working Group Physical Activity-Related Health Services Research

Based on the relevance of an established and broad foundation of physical activity in healthcare, this position paper of the DNVF working group Physical Activity-Related Health Services research presents current conceptual approaches to physical activity-related health services in Germany and highlights the need for interprofessional and interdisciplinary approaches. Three central positions are outlined and elaborated in order to integrate the evidence on health benefits of physical activity and exercise more strongly into healthcare and to show that, against the background of the challenges in the German healthcare system, physical activity-related health services can make a cost-effective and high-quality contribution to improve healthcare. These three positions include 1) the integration of all professional groups involved in healthcare into physical activity-related health services, 2) the greater integration of physical activity professions and physical activity interventions into all healthcare contexts and 3) the systematic consideration of physical activity- and exercise-related expertise in clinical guidelines.

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.