Physical Activity Plan Research Articles

Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention in people with inflammatory arthritis: study protocol of the Physiotherapy WORKs trial

BackgroundAlthough reduced work ability is a substantial problem among people with inflammatory arthritis (IA), work ability is an underexposed area in clinical practice. Evidence on vocational interventions in IA is limited, but favourable results of delivery by a physiotherapist (PT) warrant the need for further research. Therefore, we aim to evaluate the (cost-)effectiveness of a multimodal, PT-led, vocational intervention in (self-)employed people with IA compared to usual care.MethodsThis randomized controlled trial will include 140 people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) who are (self-)employed and have reduced work ability (Work Ability Index – Single Item Scale (WAS) ≤ 7/10) and/or RA/axSpA related sick leave (≤ 6 months). Participants will be randomized 1:1 to the intervention or control condition (usual care). The intervention, delivered by primary care PTs, will be personalized to each patient, consisting of 10 to 21 sessions over 12 months. The intervention will be multimodal, comprising of 1) exercise therapy and a physical activity plan, 2) education/self-management support, 3) work-roadmap to guide participants in finding relevant other care, with optionally 4) online self-management course and 5) workplace examination. Assessments will be performed at baseline and after 3, 6, and 12 months. The primary outcome measure of effectiveness is work ability, as measured with the WAS at 12 months. For the cost-effectiveness analysis, the EuroQol (EQ-5D-5L), self-reported healthcare use, sick leave and productivity while at work will be used to estimate the trial based cost-utility from a societal perspective. A process evaluation, including assessments of adherence and treatment fidelity, will be undertaken using the registrations of the PTs and semi-structured interviews at 12 months follow-up in a random sample of the intervention group.DiscussionThe results of this study will provide insights in the (cost-)effectiveness of a multimodal, PT-led, vocational intervention in people with IA and a reduced work ability.Trial registrationThis study is registered in the International Clinical Trial Registry Platform (ICTRP) under number NL9343.

O.6.1-4 A whole school, systems-based approach to health enhancing physical activity (WSA HEPA)- challenges and lessons learnt from an ERASMUS+ Collaborative Partnership project

Abstract Purpose Health-enhancing physical activity (HEPA) is an ongoing concern for all countries and in particular for young people, who are the future adults in our society. Global physical inactivity levels remain static (Guthold et al., 2018) and as a consequence there is an international goal to reduce physical inactivity by 10% by 2025 and by 15% by 2030 (WHO, 2018). To support the achievement of physical activity goals, the World Health Organisation designed a Global Action Plan for Physical Activity (GAPPA) (WHO, 2018). Using the GAPPA, the aim of the WSA HEPA project was to co-produce resource materials that promote the GAPPA objectives and adopt a whole-systems approach to addressing HEPA in schools for young people. In summary, this presentation will present the WSA HEPA project, explain the material development and how to access them (here) and conclude with challenges and lessons learnt. Description The presentation will include (i) an overview of the project including the co-production approach to the material (module) development and EU wide mixed method needs analysis undertaken to inform their development; (ii) an explanation of the six modules and conclude with (iii) challenges and lessons learnt from the project. Conclusion Participants attending the presentation will gain an understanding of how a whole school, whole systems-based approach for health enhancing physical activity can be implemented. They will also have access to the resources to enable this from the project and be cognisant of the challenges and benefits to such an approach. They should have sufficient knowledge and access to resources to be able to implement this in their home countries.

S8-5 INTERACT capacity building framework for sport for all among sports federations

Abstract Purpose International Sports Organisations (ISOs) have increasing interest in investing on sport for all and have been called by policy-makers through different policies (e.g. WHO Global Action Plan for physical activity, UN Sustainable Development Goals) to leverage their health and physical activity potential towards the society. This presentation showcase a training (in-person, informal education workshop) that aims to empower the staff and volunteers of ISOs promote Sport for All and physical activity and act as multipliers to train their national federations and grassroot sport organisations. Project The INTERACT Capacity-Building Framework which was designed by INTERACT Erasmus+ project partners (TAFISA and 8 International Sports Organisation) through different meetings and a co-construction approach, addresses key elements, identified as part of the INTERACT project, to support ISOs and continental/national sport federations in developing their own Sport for All and physical activity initiatives and engage with their members in the field. It provides exchange of knowledge and training to empower ISOs, their staff and volunteers in Sport for All and place physical activity promotion at the core of their activities. This will in turn increase participation in sport and physical activity. By using different sensory channels (e.g. visual, acoustic, tactile), our approach satisfies the participant’s different learning types and primary ways of absorbing and processing information. Composed of three steps (advocacy, diagnostic, training), it alternates theory and practice as well as tension and relaxation, movement and rest. Participant-oriented educational work includes the conscious handling of diversity and diversity of people (e.g. in relation to sex/gender, nationality, ethnicity, religious belief, disability, sexual orientation etc.). A first pilot has been launched among 12 ISOs, and evaluation framework will be created this spring, based on a litterature review. Conclusion The INTERACT Capacity-building programme is developed to become a full-fetched service that is offered in the coming years to any ISO willing to step up its promotion of Sport for All activity.

Validation and Psychometric Properties of the Visual Analogical Fitness Perception Scale for Adolescents

Physical fitness (PF) is considered a highly relevant indicator for the healthy growth and development of children and adolescents, crucial stages where lifestyles and behaviors are established. Self-perceived fitness scales are quick and easy to use tools, allowing students to know and monitor fitness. The aim of the study was to show the factor structure and validity of the Visual Analogical Fitness Perception Scale for Adolescents (FP VAS A), a scale aimed at assessing self-perception of PF in adolescents. Reliability tests were used, as well as exploratory and confirmatory factor analyses. The results show a single-factor structure for the scale with high reliability (Cronbach's alpha = 0.80-0.90) and good and exceptional goodness-of-fit indices, composed of 4 items, eliminating the item of self-perception of flexibility for not meeting the criteria of factor loading (>0.60) and communality (>0.30). In conclusion, a cheap, simple and fast tool is shown. Applicable to the educational field in relation to Physical Education (PE), for the self-monitoring of PF by students and to encourage self-elaboration of physical activity (PA) plans. Keywords: physical fitness; physical activity; FP VAS A; validation; reliability; adolescents; physical education.

Nutrition, frailty assessment, and interventions for the liver transplant candidate.

Nutrition, frailty assessment, and interventions for the liver transplant candidate.

An Assessment of State-Level Planning for Physical Activity Promotion in the United States.

The prevalence and attributable risk of disease due to physical inactivity require it to be made a public health priority. Public health planning allows for prioritization and resource allocation, particularly at the state and local levels. The extent to which state planning efforts for physical activity exist in the United States is unknown. The purpose of this paper is to describe the scope in which physical activity is incorporated in state-level public health plans in the United States, with an emphasis on alignment with the national guidelines and the National Physical Activity Plan. A standardized internet search audit was developed and conducted for each of 50 US states and the District of Columbia between May 2017 and January 2018 to determine the prevalence and characteristics of health planning documents that include physical activity. Data abstracted for analysis used a standardized search protocol that included the components of the Physical Activity Guidelines for Americans and the US National Physical Activity Plan. Results found that most states had between 4 and 6 chronic disease prevention and control plans that mention physical activity; however, it was inconsistently aligned with recommendations from both the Guidelines and the National Plan. Only 2 states had stand-alone public health planning documents explicitly dedicated to physical activity promotion. No state planning documents addressed children and adolescents, adults, and older adults simultaneously. To be maximally effective, state public health planning for physical activity should be made a priority and these efforts should align as much as possible with current guidance from the Physical Activity Guidelines for Americans and the US National Physical Activity Plan.

Stakeholder perspectives on promoting health enhancing sport through the Rwanda Sports Policy

ABSTRACT Sport is an adaptable channel for change. It has been widely used to enhance health and wellbeing, foster social cohesion, and engender peace and development in different societies. The government of Rwanda developed a Sports Development Policy (SDP) to advance sports within the spectrum of its development agendas. However, the extent to which health constructs are integrated and implemented within the tenets of this policy remain unexplored, despite their pivotal role in population wellbeing and in contributing to the country’s overarching development goals. This study sought to understand if and how the Rwanda SDP promotes sports for health from the stakeholders’ perspectives. In-depth semi structured interviews were used for thirteen purposively sampled stakeholders of the SDP. Thematic and narrative analysis were used to examine and report the findings. Themes highlighted a progressive awareness of the Sports Policy pertaining to health outcomes, less involvement of stakeholders in sport policy formulation which affected its implementation, disproportionate efforts between sports policies for health, competitive, and mass sports activities. Stakeholders further underscored cultural beliefs, attitudes, and contextual environmental factors as the key constraints to bridge the policy theory and practice of sports. Finally, findings emphasise the integral role stakeholders play in the life course of a policy. Further, the SDP does not primarily promote sports for health, but rather elite sports, on the premise that health benefits are automatically achieved through participation in sports activities. Thus, reinforcements are still needed to clearly define the national physical activity plan either through the SDP or other national physical activity guidelines.

Associations of postoperative delirium with activities of daily living in older people after major surgery: A prospective cohort study.

To assess the association of postoperative delirium developed in the post-anaesthetic care unit (PACU) with older patients' ability to perform activities of daily living (ADL) during the first five postoperative days. Previous studies have focused on the association between postoperative delirium and long-term function decline, however the association between postoperative delirium and the ability to perform ADL, particularly in the immediate postoperative period, needs further investigation. A prospective cohort study. A total of 271 older patients who underwent elective or emergency surgery at a tertiary care hospital in Victoria, Australia, participated in the study. Data were collected between July 2021 and December 2021. Delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The Katz Index of Independence in Activities of Daily Living (KATZ ADL) scale was used to measure ADL. ADL was assessed preoperatively and daily during the first five postoperative days. The STROBE checklist was used to report this study. Results showed that 44 (16.2%) patients developed new episode of delirium. Postoperative delirium was independently associated with decline in ADL (RR = 2.83, 95% CI = 2.71-2.97; p < 0.001). Postoperative delirium was associated with a decline in ADL among older people during the first five postoperative days. Screening for delirium in the PACU is essential to identify delirium during the early stages of postoperative period and implement a timely comprehensive plan. Delirium assessment of older patients in the PACU, and for at least the first five postoperative days, is strongly recommended. We also recommend engagement of patients in a focused physical and cognitive daily activity plan, particularly for older patients undergoing major surgery. Patients and nurses helped in data collection at a tertiary care hospital.

Interprofessional Approach to Educate Health Care Students About Intellectual and Developmental Disabilities: Adaptive Communication and Physical Activity Planning.

People with intellectual and/or developmental disabilities (IDD) are a historically marginalized population and often require complex team-based health care services. Health care students receive little, if any, training about caring for this population. Improving training at the student level can improve health care quality for this population. We developed a two-part interprofessional seminar series to increase students' knowledge, attitudes, and skills regarding caring for patients with IDD. The seminars were taught over Zoom and utilized presentation slides, prerecorded mock video interviews, and breakout room discussions focused on adaptive communication and developing adaptive physical activity plans for people with IDD. Participants comprised undergraduate and graduate students from various health care professional programs, including occupational therapy, medicine, and nursing. Part 1 had 208 participants, and part 2 had 107 participants. Both seminars were assessed using pre- and postsurveys that demonstrated increased participant comfort and confidence with the respective subjects. Competence of learned skills was not assessed. Participants in both seminars felt they would benefit from more direct interaction with people with IDD to practice learned skills. The results are encouraging for continued implementation at Quinnipiac University, with potential for use in other programs. Further iterations may include people with IDD serving as seminar cofacilitators, opportunities for students to directly interact with people with IDD, and use of an assessment approach evaluating learned skills competence. Curriculum expansion should cover the unique health care inequities faced by people with IDD who also belong to other marginalized groups.

Campus environmental quality and streetscape features related to walking activity

ABSTRACT Many college students have adopted sedentary and physically inactive lifestyles, leading to obesity, diabetes, and other epidemics. Improving campus walkability can promote students’ walking activities and health conditions. This study aims to explore the influence of street-level environmental walkability attributes on campus pedestrian activity in a developing country, and thus present physical activity and health promotion campus planning and design strategies. Based on the Urban Design Quality theory, we use field audit to measure five environmental qualities and 23 types of streetscape features at eight Chinese university campuses. Several negative binomial regression models, without spatial autocorrelation, are fitted to analyze the effect of campus micro-scale walkability environmental attributes on pedestrian volume in different types of campuses. We found that environmental qualities and street space part streetscape features significantly affect pedestrian volume. Pedestrian-oriented campus planning strategies are presented based on the results.

The influence of nondrug methods on cognitive and emotional-affective disorders in patients with mild vascular cognitive impairment

Emotional-affective disorders often accompany vascular cognitive impairment. Currently, there is insufficient data on the impact of non-drug treatment of cognitive impairment on the emotional sphere. The aim of the study was to evaluate the effect of non-drug methods (meal planning, exercise, cognitive training) on anxiety and depression in patients with mild cognitive impairment of vascular etiology. Material and methods. The study included 60 patients aged 45 to 88 years (mean age 63.9 ± 9.7, 26 males and 34 females) with mild cognitive impairment of vascular etiology. 30 patients (study group, 18 women, 12 men, mean age 63.7 ± 8.8 years, Montreal Cognitive Assessment (MoCA) score 22.5 ± 2.4) received a set of non-drug methods for 1 month, including cognitive training, detailed recommendations on physical activity and meal planning. Patients in the control group (n = 30, 16 women, 14 men, mean age — 64.2 ± 10.7 years, MoCA score — 21.7 ± 2.4 points) were once informed by the attending physician about the expediency of a physically and cognitively active lifestyle and the basic principles diets, however, systematic training with them was not carried out. Anxiety and depression were assessed at the stage of inclusion in the study, after 1 month, after 6 months, and one year after the start of observation using the Beck Depression Scale, the Spielberger–Khanin Anxiety Scale. Results. 1 month after the start of the study, along with a significant (p &lt; 0.05) improvement in cognitive functions according MoCA, a significant decrease in the severity of anxiety was noted in the study group (p &lt; 0.05). In patients with mild and moderate depression (n = 13), a significant (p &lt; 0.05) regression in the severity of depression was recorded after a month of using non-drug methods. However, in the process of long-term follow-up (1 year), the differences with the initial visit for these indicators lost statistical significance. In the control group, a month after the start of the study, there were no significant differences in the MoCA test (p &gt; 0.05), while the indicators of anxiety and depression worsened throughout the entire observation period. The study group significantly (p &lt; 0.05) outperformed the control group in the MoCA test immediately after treatment and after 6 months. Differences of anxiety level were significant only immediately after treatment. Conclusion. A complex of non-drug methods is effective in the treatment of vascular MCI and reduces anxiety in patients. In patients with mild and moderate depression decrease of depression symptoms was observed also. However the effect of the monthly course was not stable.

Promoting Physical Activity in a Primary Care Practice in People Living with Dementia and Their Family Caregivers.

People living with dementia (PLWD) and their family caregivers report higher rates of having a sedentary lifestyle than their non-disabled peers do. This study analyzed the effectiveness of an intervention designed to increase physical activity among PLWD and their family caregivers in primary health care settings. A cluster-randomized multicenter clinical trial was conducted. Participants from four health centers were randomly assigned to the intervention group (IG) or the control group (CG) in a 1:1 ratio using Epidat software. After a seven-day period with a digital pedometer (Omron Hj-321 lay-UPS), participants were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ-SF). PLWD and caregivers allocated to the IG were given brief advice, educational materials and an additional 15 min appointment to prescribe an individualized physical activity plan. Seventy PLWD and 80 caregivers were assigned to the CG and 70 PLWD and 96 caregivers were assigned to the IG. Results of the pedometer assessment show that in PLWD, the IG's activity increased by 52.89 aerobic steps at 6 months and the CG's activity decreased by 615.93 aerobic steps, showing a net increase in the IG of 668.82 (95% CI: -444.27 to 1781.91; p = 0.227). For caregivers in the IG, activity increased by 356.91 aerobic steps and in the CG it decreased by 12.95 aerobic steps, showing a net increase in favor of the IG of 369.86 (95%CI: -659.33 to 1399.05; p = 0.476). The effectiveness of interventions to increase physical activity in this group of people with dementia and their caregivers did not achieved positive results overall but may have provided suggestions for family physicians and physical therapists to improve physical activity among people with dementia and their families.

A Forced Shift: Effects and Outcomes of Online Higher Education Physical Activity Courses

ABSTRACT Higher education institutions often provide physical education activity courses designed to meet learning outcomes associated with physical activity. However, these activity courses were shifted online during the COVID-19 pandemic. This study investigated the impact of an online learning environment on educational outcomes of physical activity courses. Final reflection assignments from a variety of 7-week activity courses were analyzed. Students reflected on the execution of a personal fitness plan, goals, goal progress, barriers, and personal impact on purposeful physical activity. Qualitative document analysis was used to determine themes and to identify patterns. Four major categories emerged across the reflections: physical activity plan, motivation, barriers, and future plans. Students discussed creating and modifying individual physical activity plans. Motivating factors for physical activity were both internal and external, including class accountability and available time and locations to be active. A variety of barriers were identified, including illness and injury and psychosocial factors. Finally, students indicated a desire to continue to be active beyond the class environment. Overall, our results suggest students still met learning outcomes even in online learning environments. In fact, students were able to retain the well-being benefits typically associated with physical activity. Additionally, these courses provided a sense of accountability and students felt the instructors played a key role in their overall enjoyment.

Construct validity of the physical activity neighborhood environment scale-Oman.

This study aims to examine the construct validity of Physical Activity Neighborhoods Environment Scales, Oman (PANES-O), and compare the subjective perceptions with objective measures in Muscat, the capital area of Oman. Walkability index scores using GIS maps were calculated for 35 study areas in Muscat based on which five low and 5 high walkable study areas were randomly selected. A community survey was then conducted in November 2020 in each study area using the 16-item PANES-O instrument to measure the participants' perception of neighborhood density, land use mix, infrastructure, safety, aesthetics, and street connectivity. Due to pandemic restrictions, a social media-based purposive sampling strategy was utilized to reach community-based networks and complete digital data collection. Significant differences between the low and high walkablehigh-walkable neighborhoods were observed for 2 of 3 macroenvironment subscales, density and land use. Respondents in high walkable neighborhoods perceived their areas as having more twin villas (P = 0.001) and apartment buildings (P < 0.001), greater access to destinations (like more shops, and places to go within walking distance; P < 0.001), easy access to public transport (P < 0.001), and more places to be active (P < 0.001); than their counterparts in low walkable neighborhoods. In terms of microenvironmental attributes, respondents in high walkablehigh-walkable neighborhoods perceived their areas to have better infrastructure, better aesthetic qualities, and better social environment than their counterparts in low walkablelow-walkable neighborhoods. Significant differences in perceptions across 12 of the 16-item PANES tool confirmed that 6 of the 7 subscales were significantly sensitive to built environment attributes between the low and high walkable study areas. Respondents in high walkable neighborhoods perceived their areas as having greater access to destinations (like more shops, places to go within walking distance; P ≤ 0.001), easy access to public transport (P ≤ 0.001), more places to be active (P ≤ 0.001), better infrastructure (like more sidewalks, facilities to bicycle; P ≤ 0.001), and better aesthetic qualities (P ≤ 0.001). PANES-O also was able to rate high walkable neighborhoods to be higher in residential density and land-use mix compared to the low walkable neighborhoods demonstrating its sensitivity to the GIS maps' objective measures. These results provide preliminary strong support for the construct validity of PANES-O, suggestingconfirming that it is a promising tool for assessing macroenvironmental perceptions related to physical activity in Oman. Further research using objective measures of microenvironments and device-based physical activity scores is needed to confirm the criterion validity of the 10 micro-environmental attributes of PANES-O using objective measures for the microenvironment. PANES-O could be used to generate and develop the needed evidence on the most appropriate approaches to improving the built environment to promote physical activity and urban planning in Omanthe country.

Staying physically active during the COVID-19 pandemic: Assessing the roles of motivation, basic psychological needs, goal orientation and anticipatory sport persistence.

Nationwide barriers to public and private sport institutions were implemented during COVID-19 lockdowns. Autonomous motivation, perceived fulfillment of basic psychological needs (competence, autonomy, and relatedness) and goal orientation coincide with higher persistence rates in physical activity. The aim of this study is to investigate which factors are related to anticipatory sport persistence, a specific form of sport persistence. We conducted an online survey with N = 208 (74% female) participants. Correlation analyses showed that higher anticipatory sport persistence coincides with autonomous motivation (r = 0.314, p < 0.01), basic psychological needs (competence r = 0.528, autonomy r = 0.446, relatedness r = 0.315; all p < 0.01), and goal orientation (intrinsic r = 450, extrinsic r = 0.146; all p < 0.01). Furthermore, multiple regression analysis showed that anticipatory sport persistence can be predicted through intrinsic goal orientation (B = 0.465, p < 0.01) and the need for competence (B = 0.418, p < 0.01). The importance of anticipatory sport persistence when expecting external barriers to physical activity, its relationship toward sport persistence and possible implications for the planning and perseverance of physical activity plans are being discussed.

Efficacy of a combination of non-drug therapies in patients with non-dementia vascular cognitive impairment

Objective : to study the effectiveness of a combination of non-drug methods in the treatment of non-dementia cognitive impairment of vascular etiology. Material and methods . The study involved 60 patients with moderate cognitive impairment of vascular etiology. The patients were divided into two groups: group 1 (n=30, mean age 63.7±8.8 years) received a combination of non-drug methods in the form of cognitive training, physical activity and meal planning for 1 month; patients of the 2nd group (n=30, mean age 64.2±10.7 years) were once informed about the advisability of a healthy diet and maintenance of mental and physical activity. Neuropsychological testing was done at the inclusion stage of the study, immediately after 1 month course of treatment, 6 months and a year after the start of the study. There were no significant differences between the groups in terms of cognitive functions at baseline. Results . After a month of treatment, in the 1st group the results of neuropsychological testing significantly (p&lt;0.05) improved compared to the first visit: Montreal Cognitive Function Assessment Scale (MoCA-test) – from 22.5±2.4 to 23.7±2.8, Trail making test part A – from 56.9±20.1, up to 49.3±21.7; Trail making test part B – from 116.8±47.8 to 93.5±36.3; the Digit Symbol Substitution test (DSST) scores increased from 26.6±9.0 to 28.8±9.0. Categorical and literal fluency increased from 14.9±4.1 to 16.5±4.6 and from 10.0±1.7 to 11.6±1.9, respectively. In the 2nd group, 1 month after the start of the study, there were no significant differences from the baseline in neuropsychological tests. Differences between the groups at the second visit were statistically significant (p&lt;0.05) according to the MoCA test, Trail making tests (parts A, B), DSST, and association tests. Significant differences between groups persisted during the first 6 months, but disappeared after 12 months of follow-up. Conclusion . Multimodal non-drug therapy in patients with moderate cognitive impairment of vascular etiology improves the main cognitive parameters.

An Evaluation of Policies Promoting Physical Activity among Filipino Youth

Government is key to promoting physical activity at the population level through policy. The government was one of the physical activity indicators graded for the 2022 Philippine Physical Activity Report Card based on ten physical activity-related policies. This study aimed to evaluate the scope of the policies and to update these policies. Philippine government databases were searched for policies using physical activity-related key terms. Policies found were evaluated using the Wales Active Healthy Kids scoring rubric. The overall grade was converted to a letter grade based on the Global Matrix 4.0 grading system. The authors analyzed the policies' scope and implications to practice and policy. Seven additional policies were found. Considering all 17 policies, the government indicator grade is now A- from the preliminary grade of B. The scope covers promoting physical activity mainly through sports participation and active transport among students, student-athletes, persons with disabilities, and the general population in school and community settings. The gap between government and overall physical activity (F) scores suggests the need for a comprehensive physical activity plan promoting various forms of physical activity and reducing sedentary behavior among all Filipino youth and across various settings. Crucial to achieving change is a well-coordinated, whole-of-systems approach to promoting active healthy lifestyles.

Future Directions for Transforming Kinesiology Implementation Science Into Society

Physical activity policy can play a crucial role in ensuring that individuals, communities, and societies can obtain the wide range of health benefits associated with regular physical activity participation. Policies such as Title IX, the Americans With Disabilities Act, and state physical education laws have all increased opportunities for millions of Americans to participate in physical activity. With that said, how policies are developed and implemented vary considerably. The purpose of this manuscript is to contrast an academic conceptual framework with a pragmatic approach for policy implementation. In an ideal world, polices would be developed from foundational knowledge, scaled up to community-level interventions, and implemented in a sequential fashion. However, policy implementation is a disorderly process that requires a practical methodology. The National Physical Activity Plan encompasses strategies and tactics across 10 key societal sectors—and highlights the disorderly process of policy implementation across the various sectors.

Automatic Detection of Aerobic Threshold through Recurrence Quantification Analysis of Heart Rate Time Series.

During exercise with increasing intensity, the human body transforms energy with mechanisms dependent upon actual requirements. Three phases of the body's energy utilization are recognized, characterized by different metabolic processes, and separated by two threshold points, called aerobic (AerT) and anaerobic threshold (AnT). These thresholds occur at determined values of exercise intensity(workload) and can change among individuals. They are considered indicators of exercise capacities and are useful in the personalization of physical activity plans. They are usually detected by ventilatory or metabolic variables and require expensive equipment and invasive measurements. Recently, particular attention has focused on AerT, which is a parameter especially useful in the overweight and obese population to determine the best amount of exercise intensity for weight loss and increasing physical fitness. The aim of study is to propose a new procedure to automatically identify AerT using the analysis of recurrences (RQA) relying only on Heart rate time series, acquired from a cohort of young athletes during a sub-maximal incremental exercise test (Cardiopulmonary Exercise Test, CPET) on a cycle ergometer. We found that the minima of determinism, an RQA feature calculated from the Recurrence Quantification by Epochs (RQE) approach, identify the time points where generic metabolic transitions occur. Among these transitions, a criterion based on the maximum convexity of the determinism minima allows to detect the first metabolic threshold. The ordinary least products regression analysis shows that values of the oxygen consumption VO2, heart rate (HR), and Workload correspondent to the AerT estimated by RQA are strongly correlated with the one estimated by CPET (r > 0.64). Mean percentage differences are <2% for both HR and VO2 and <11% for Workload. The Technical Error for HR at AerT is <8%; intraclass correlation coefficients values are moderate (≥0.66) for all variables at AerT. This system thus represents a useful method to detect AerT relying only on heart rate time series, and once validated for different activities, in future, can be easily implemented in applications acquiring data from portable heart rate monitors.

Attitudes of women with gestational diabetes toward diet and exercise: a qualitative study

Objective Gestational diabetes (GDM) refers to glucose intolerance of varying severity first occurring in pregnancy. Following a diagnosis of GDM, exercise and dietary modification has a positive effect on improving glycemic control. Lifestyle changes affected in pregnancies affected by GDM have beneficial effects on long-term health if continued following birth. In addition, the psychological impact of a diagnosis of GDM should not be overlooked. Reports of maternal stress, anxiety, and fear are commonly reported issues in the literature. Support, both socially and from health care professionals, is also linked with higher rates of success in GDM management. Research to date had focused on women’s reaction to a diagnosis of GDM, their mood and quality of life following a diagnosis, and their knowledge or opinions on the management of GDM. This qualitative study explored the attitudes of women with GDM toward these lifestyle changes, specifically diet and exercise. Women were also asked to identify advice that would be useful for other women newly diagnosed with GDM. Methods With ethical approval a qualitative study was conducted using semi-structured interviews which were examined using Thematic Analysis. Patients were invited to participate and gave written consent after a discussion with a study researcher. The question plan for semi-structured interviews was designed with the advice of patient advocates. Recurrent themes were developed until the saturation of data. Results Thirty-two women took part in the study. Time, convenience, and lack of educational awareness were common barriers to healthy eating and physical activity plans. Enablers for change included meal planning and organization. Women regarded their diets pre-diagnosis as healthy, with small “tweaks” (such as portion control) required to comply with recommendations. Another significant facilitator to change was support from the woman’s partner. This also set a benchmark for plans of diet maintenance within the family structure after pregnancy. Unlike dietary changes, a consistent theme was that exercise was considered a “chore” in managing GDM and was unlikely to be continued in the long term. Practical advice offered by participants for other women with GDM included organization, realistic approaches, and lack of self-blame. Conclusion Women reported that changes in diet would be more achievable in the long term than changes in exercise patterns. Partners and the clinical team were significant sources of support. Women’s views are crucial to providing clinicians with a comprehensive and holistic understanding of disease management. Involving women in self-care decisions and empowering women to manage their own health are key contributors to long-term behavior change as well as service provision and policy implementation