Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving

Development of a Framework for Scaling Up Community-Based Health Promotion: A Best Fit Framework Synthesis

Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this qualitative review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion. First, we conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework. From 80 articles, a total of 12 frameworks were eligible, and 5 were included for data extraction. The analysis yielded 10 a priori defined key components: “innovation characteristics”; “clarify and coordinate roles and responsibilities”; “build up skills, knowledge, and capacity”; “mobilize and sustain resources”; “initiate and maintain regular communication”; “plan, conduct, and apply assessment, monitoring, and evaluation”; “develop political commitment and advocacy”; “build and foster collaboration”; “encourage participation and ownership”; and “plan and follow strategic approaches”. We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework. We further identified “encourage participation and ownership” as a crucial component regarding health equity.

COVID-19 patients require multi-disciplinary rehabilitation approaches to address persisting symptom profiles and restore pre-COVID quality of life

BACKGROUND

Long-COVID diagnosis is prominent, and our attention must support those experiencing debilitating and long-standing symptoms. To establish patient pathways, we must consider the societal and economic impacts of sustained COVID-19. Accordingly, we sought to determine the pertinent areas impacting quality of life (QoL) following a COVID-19 infection.

RESEARCH METHODS

Three hundred and eighty-one participants completed a web-based survey (83% female, 17% male) consisting of 70 questions across 7 sections (demographics, COVID-19 symptoms; QoL; sleep quality; breathlessness; physical activity and mental health). Mean age, height, body mass and body mass index (BMI) were 42 ± 12 years, 167.6 ± 10.4 cm, 81.2 ± 22.2 kg, and 29.1 ± 8.4 kg.m², respectively.

RESULTS

Participant health was reduced because of COVID-19 symptoms ("Good health" to "Poor health" [P<0.001]). Survey respondents who work reported ongoing issues with performing moderate (83%) and vigorous (79%) work-related activities.

CONCLUSIONS

COVID-19 patients report reduced capacity to participate in activities associated with daily life, including employment activities. Bespoke COVID-19 support pathways must consider multi-disciplinary approaches that address the holistic needs of patients to restore pre-pandemic quality of life and address experienced health and wellbeing challenges.

Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers

INTRODUCTION

Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception.

METHODS AND ANALYSIS

A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T₀), mid-intervention (T₁; 6 months post baseline), at intervention conclusion (T₂; 12 months post baseline) and 1-year post intervention (T₃; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted.

ETHICS AND DISSEMINATION

The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media.

TRIAL REGISTRATION NUMBER

ACTRN12620001280998; U1111-1252-0599.

A systematic review of adaptations and effectiveness of scaled-up nutrition interventions

CONTEXT

Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings.

OBJECTIVES

The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process.

DATA SOURCES

Six electronic databases were searched and field experts contacted.

STUDY SELECTION

An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial ("prescale") in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition.

DATA EXTRACTION

Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model.

RESULTS

Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from -32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions.

CONCLUSION

The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no.CRD42020149267.

Ecological Predictors of Older Adults' Participation and Retention in a Physical Activity Intervention

Research is still lacking regarding the question as to how programs to promote healthy ageing should be organized in order to increase acceptance and thus effectiveness. For older adults, ecological factors, such as the physical distance to program sites, might predict participation and retention. Thus, the key aim of this analysis was to examine these factors in a physical activity intervention trial. Adults (N = 8299) aged 65 to 75 years were invited to participate and n = 589 participants were randomly assigned to one of two intervention groups with 10 weeks of physical activity home practice and exercise classes or a wait-list control group. Response, participation, and dropout data were compared regarding ecological, individual, and study-related variables. Kaplan-Meier curves and Cox regression models were used to determine predictors of dropout. In total, 405 participants completed the study. Weekly class attendance rates were examined regarding significant weather conditions and holiday periods. The highest rates of nonresponse were observed in districts with very high neighborhood levels of socioeconomic status. In this study, ecological factors did not appear to be significant predictors of dropout, whereas certain individual and study-related variables were predictive. Future studies should consider these factors during program planning to mobilize and keep subjects in the program.

An Investigation into the Physical Activity Experiences of People Living with and beyond Cancer during the COVID-19 Pandemic

This study investigated the physical activity experiences of people living with and beyond cancer (PLWBC) during the COVID-19 pandemic. Participants attended the cancer and rehabilitation exercise (CARE) programme delivered by a football community trust. Staff (n = 2) and participants (n = 9) attended semi-structured interviews investigating the PA participation and experiences of attending/delivering different modes of CARE, including exercise classes delivered outdoors and delivered online. Interviews also investigated participant aspirations for returning to CARE sessions delivered in person indoors. The findings show that the COVID-19 pandemic and government restrictions impacted on PA participation, yet exercise sessions provided via CARE offered participants an important opportunity to arrest their inactivity, keep active and maintain their fitness and functionality. Barriers to participation of CARE online included access to IT infrastructure, internet connectivity and IT skills and comfort using IT. Regarding CARE outdoors, the weather, range of equipment, variety of exercises and the lack of toilets and seats were barriers. In the different CARE modes, the skills of delivery staff who were sensitive to the needs of participants, social support, and the need for participants to maintain good mental and social health were important facilitators for engagement and are considerations for programme delivery. CARE helped PLWBC to keep physically active.

Association of public physical activity facilities and participation in community programs with leisure-time physical activity: does the association differ according to educational level and income?

Background

Our aim was to analyze the association of the presence of public physical activity (PA) facilities and participation in public PA programs with leisure-time PA, with an emphasis on the moderating role of educational level and income.

Methods

We used data of 88,531 adults (46,869 women), with a mean age of 47.2 ± 17.1y, from the 2019 Brazilian National Health Survey. Leisure-time PA (dichotomized considering 150 min/week), the presence of a public PA facility near the household (yes or no), participation in public PA programs (yes or no), educational level (divided into quintiles) and per capita income (divided into quintiles) were all self-reported through interviews. Adjusted logistic regression models were used for the analyses.

Results

The presence of public PA facilities near the household and the participation in public PA programs were associated with higher leisure-time PA among all quintiles of income and educational level. However, multiplicative interactions revealed that participating in PA programs [Quintile (Q)1: OR: 13.99; 95%CI: 6.89–28.38 vs. Q5: OR: 3.48; 95%CI: 2.41–5.01] and the presence of public PA facilities near the household (Q1: OR: 3.07; 95%CI: 2.35–4.01 vs. Q5: OR: 1.38; 95%CI: 1.22–1.55) were more associated with higher odds of being active in the leisure-time among the lowest quintile of educational level.

Conclusions

The presence of public PA facilities and participation in public PA programs are environmental correlates that may be relevant for designing effective public health interventions to reduce social inequalities in leisure-time PA among adults in low-income areas.

Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income, Predominantly Latino Urban Residents: An Agent-Based Model

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)−(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.

Modeling the Development of Local Health-Enhancing Physical Activity Policies from Empirical Data and Policy Science Theories

Physical inactivity is considered a pandemic, requiring strong policy responses to address this major health issue. However, research on the development of Health-Enhancing Physical Activity policies (HEPA) remains scarce, particularly at the local level. There is a need to produce evidence to better understand the process to develop local HEPA policies. This study aims to model the development of HEPA policy promotion in French municipalities from empirical data and policy science theories. This research was undertaken in three steps: (1) assess the level of development of HEPA policies from 10 French municipalities using a local HEPA analysis tool, (2) provide a brief overview of core political science theories applied in health promotion, and (3) from these empirical and theoretical perspectives, model a conceptual framework to better understand the development of HEPA policy promotion in French municipalities. Based on empirical data and the Multiple Streams, policy cycles and Institutional Rational Choice theories, a conceptual framework of the development of municipal HEPA policy promotion was modeled. This conceptual framework is comprised of five stages describing the development of municipal HEPA policies. This paper contributes to a better understanding of the development of municipal HEPA policies.

Planning implementation and scale-up of physical activity interventions for people with walking difficulties: study protocol for the process evaluation of the ComeBACK trial

Background

There is currently little evidence of planning for real-world implementation of physical activity interventions. We are undertaking the ComeBACK (Coaching and Exercise for Better Walking) study, a 3-arm hybrid Type 1 randomised controlled trial evaluating a health coaching intervention and a text messaging intervention. We used an implementation planning framework, the PRACTical planning for Implementation and Scale-up (PRACTIS), to guide the process evaluation for the trial. The aim of this paper is to describe the protocol for the process evaluation of the ComeBACK trial using the framework of the PRACTIS guide.

Methods

A mixed methods process evaluation protocol was developed informed by the Medical Research Council (MRC) guidance on process evaluations for complex interventions and the PRACTIS guide. Quantitative data, including participant questionnaires, health coach and administrative logbooks, and website and text message usage data, is being collected over the trial period. Semi-structured interviews and focus groups with trial participants, health coaches and health service stakeholders will explore expectations, factors influencing the delivery of the ComeBACK interventions and potential scalability within existing health services. These data will be mapped against the steps of the PRACTIS guide, with reporting at the level of the individual, provider, organisational and community/systems. Quantitative and qualitative data will elicit potential contextual barriers and facilitators to implementation and scale-up. Quantitative data will be reported descriptively, and qualitative data analysed thematically.

Discussion

This process evaluation integrates an evaluation of prospective implementation and scale-up. It is envisaged this will inform barriers and enablers to future delivery, implementation and scale-up of physical activity interventions. To our knowledge, this is the first paper to describe the application of PRACTIS to guide the process evaluation of physical activity interventions.

Trial registration

Australian and New Zealand Clinical Trials Registry (ANZCTR) Registration date: 10/12/2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05990-3.

Barriers to initiating and maintaining participation in parkrun

Interventions that increase population physical activity are required to promote health and wellbeing. parkrun delivers community-based, 5 km events worldwide yet 43% who register never participate in a parkrun event. This research had two objectives; i) explore the demographics of people who register for parkrun in United Kingdom, Australia, Ireland, and don't initiate or maintain participation ii) understand the barriers to participating in parkrun amongst these people. Mandatory data at parkrun registration provided demographic characteristics of parkrun registrants. A bespoke online survey distributed across the three countries captured the reasons for not participating or only participating once. Of 680,255 parkrun registrants between 2017 and 19, 293,542 (43%) did not participate in any parkrun events and 147,148 (22%) only participated in one parkrun event. Females, 16-34 years and physically inactive were more likely to not participate or not return to parkrun. Inconvenient start time was the most frequently reported barrier to participating, with females more likely than males to report the psychological barrier of feeling too unfit to participate. Co-creating strategies with and for people living with a chronic disease, women, young adults, and physically inactive people, could increase physical activity participation within parkrun.

Effects of Olympic Combat Sports on Health-Related Quality of Life in Middle-Aged and Older People: A Systematic Review

Olympic combat sports are unconventional physical activity strategies to train middle-aged and older people with and without health problems. This systematic review aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports interventions (boxing, fencing, judo, karate, taekwondo, wrestling) on health-related quality of life in adults aged 45 and older. The search was carried out in five generic databases until July 2021 and the protocol was registered in PROSPERO (code: CRD42021244161). The PRISMA guidelines were followed and the Downs and Black checklist was used to assessed the methodological quality of the studies. After reviewing 1,151 records, only seven studies met the inclusion criteria, adding 212 participants (43.4% female) with a mean age of 63.7 years. Six studies (two with middle-aged participants and four with older people) provided data to calculate the effect size (ES) in the Olympic combat sports groups (No research that used taekwondo or wrestling as an intervention modality was found). Three studies reported beneficial changes with a small ES for the total score (d < 0.40) of the health-related quality of life. Two studies reported a beneficial change with a small ES (d = 0.49) and strong ES (d = 4.45) for physical health. One study reported improvements with a small ES for emotional (d = 0.23) and functional (d = 0.26) well-being. In conclusion, interventions based on Olympic combat sports produce beneficial effects with a small and moderate ES on health-related quality of life in male and female aged 45 and older who are healthy participants, participants with Parkinson's disease, and participants with breast cancer. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO: CRD42021244161.

Associations Between Physical Activity and Gross Motor Skills in Parent–Child Dyads

This study examines the associations of physical activity and gross motor skills in parent–child dyads. Parent–child dyads (N = 61, 84% mothers, children aged 8–11 years) participated in this study. Anthropometrics were self-reported through Qualtrics. Physical activity was assessed using accelerometers. Motor skills were measured through four skills: catch, kick, throw, and jump. These skills were assessed using process (i.e., performance criteria of the Test of Gross Motor Development-3) and product (i.e., catch percentage and jump distance) measures. A complete motor skill score was computed by standardizing both process and product scores and summing them. Correlation coefficients and ordinary least square regressions were computed to examine the associations of physical activity and motor skills. Parents’ and children’s moderate to vigorous physical activity were significantly associated (β = 0.30 ± 0.11; p = .008). Parents’ and children’s motor skills were significantly associated (β = 0.46 ± 0.18; p = .012). Understanding parent determinants can support effective interventions targeting children’s low physical activity levels and improving motor competence. Our results highlight the importance of parents’ physical activity and motor skills, which are significantly associated with those of their children. These parent factors may be a key consideration for effective family-based physical activity interventions.

Time trends of physical activity for leisure and transportation in the Brazilian adult population: results from Vigitel, 2010-2019

This time-series study examined a 10-year historical series of the physical activity prevalence for leisure and transportation in the Brazilian adult population. Information from 512,969 adults interviewed from the Vigitel between 2010 and 2019 was analyzed. Individuals who reported practicing at least 150 minutes/week of moderate-intensity physical activity or at least 75 minutes/week of vigorous-intensity physical activity were considered active during leisure time. Individuals who reported walking or cycling to/from work, course, or school at least 30 minutes/day, equivalent to at least 150 minutes/week of moderate-intensity physical activity, were considered active during transportation. The prevalence of physical activity for leisure and transportation was calculated annually and stratified by sex, age group, schooling, and race/skin color. The segmented regression model was applied to analyze the time series. Annual percent change and average annual percent change were calculated. Over time, the prevalence of physical activity for leisure increased, and the prevalence of physical activity for transportation decreased. The highest prevalence of physical activity for leisure was observed among males, young individuals, and those with high education. Older adults, those with high education, and white people presented the lowest prevalence of active transport. Policymakers should propose strategies that encourage and facilitate physical activity for leisure in women, individuals aged ≥ 35 years, and those with less education (< 12 years), and physical activity for transportation among older adults (≥ 60 years), those with high education (≥ 12 years), and white people.

Differences in Park Walking, Comparing the Physically Inactive and Active Groups: Data from mHealth Monitoring System in Seoul

Despite the overall increase in physical activities and park uses, the discrepancies between physically inactive and active people have increasing widened in recent times. This paper aims to empirically measure the differences in walking activity in urban parks between the physically inactive and active. As for the dataset, 22,744 peoples' 550,234 walking bouts were collected from the mHealth system of the Seoul government, using the smartphone healthcare app, WalkOn, from September to November 2019, in Seocho-gu district, Seoul, Korea. We classified the physically inactive and active sample groups, based on their regular walking (≥150 min of moderate-to-vigorous walking activity a week), and analyzed their park walking activities. We found that while there was no significant difference in walking measures of non-park walking between the sample groups, the difference did exist in park walking. The park walking average in the physically active group had more steps (p = 0.021), longer time (p = 0.008), and higher intensity (p < 0.001) of walking than that in the inactive group. Each park also revealed differences in its on-site park walking quantity and quality, based on which we could draw the list of 'well-walked parks', which held more bouts and more moderate-to-vigorous physical activities (MVPAs) than other parks in Seocho-gu district. This paper addresses how park walking of physically inactive and active people is associated with multiple differences in everyday urban walking.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model

OBJECTIVES

Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling.

DESIGN

Cross-sectional survey by probability sampling.

SETTING

Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students.

PARTICIPANTS

2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame.

PRIMARY OUTCOME MEASURES

Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour.

RESULTS

Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ²=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05).

CONCLUSIONS

This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

E-&mHealth interventions targeting nutrition, physical activity, sedentary behavior, and/or obesity among children: A scoping review of systematic reviews and meta-analyses

Childhood obesity is a public health concern. Electronic and mobile health (e-&mHealth) approaches can facilitate the delivery of interventions for obesity prevention and treatment. Synthesizing reviews of e-&mHealth interventions to improve weight and weight-related behaviors (physical activity, sedentary behavior, and diet) is useful to characterize the current scope of the literature and identify opportunities for future reviews and studies. Using a scoping review methodology, we aimed to evaluate the breadth and methodological quality of systematic reviews and meta-analyses of e-&mHealth interventions targeting weight and weight-related behaviors in children and adolescents aged <19 years. A systematic search of seven databases was conducted, including reviews published between 2000 and 2019. Review characteristics were extracted, and methodological quality was assessed using the AMSTAR 2 tool. Forty-five systematic reviews and meta-analyses were included. All reviews evaluated intervention efficacy (100%), but few assessed other aspects (20% in total) such as cost-effectiveness. Smartphone applications (47%), text messages (44%), and websites (35%) were the main modalities. Weight (60%), physical activity (51%), and diet (44%) were frequently assessed, unlike sedentary behavior (8%). Most reviews were rated as having critically low or low methodological quality (97%). Reviews that identify the effective active ingredients of interventions and explore metrics beyond efficacy are recommended.

Juggling with theory, evidence, practice, and real-world circumstances: Development of a complex community intervention to increase physical activity in inactive adults aged 50 years and older - The Move for Life Study

Despite well-known benefits of physical activity, in Ireland only 38 % of older adults are sufficiently active. Behavioural interventions are rarely developed systematically and, when reported, inadequate description often becomes a barrier for subsequent replication and scalability. In this article, we describe the development and characteristics of Move for Life, an intervention to reach and help inactive adults aged 50 years and older increase their physical activity. It was designed to fit within existing group-based structured physical activity programmes run by Local Sports Partnerships, thus maximising the likelihood of translation into policy and practice. Constructs from social cognitive theory, self-determination theory, and the conceptual model of group cohesion in exercise informed the conceptual model and the development of behavioural skills, social support, and group cohesion intervention strategies. Physical activity instructors supported by peer mentors, who also contributed to sustaining the intervention, implemented these strategies. Moving away from accounts of intervention development as a relatively simple linear process, we illustrate the complex interplay of theory, evidence, practice, and real-world contextual circumstances that shaped the development of Move for Life. Against this backdrop, we discuss issues relevant to the planning and reporting of behavioural and physical activity interventions in public health.

Virtual Reality in Health Care: Bibliometric Analysis

BACKGROUND

Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with.

OBJECTIVE

We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords.

METHODS

Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer.

RESULTS

The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than "virtual" and "reality" are "training," "trial," and "patients." The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames.

CONCLUSIONS

The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability.

Using self-determination theory to understand and improve recruitment for the Coaching for Healthy Ageing (CHAnGE) trial

BACKGROUND

Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches.

METHODS

We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data.

RESULTS

Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively.

CONCLUSIONS

Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.

Measurement of Physical Activity Self-Efficacy in Adults With Obesity: A Latent Variable Approach to Explore Dimensionality, Temporal Invariance, and External Validity

The objective of this study was to improve the measurement of physical activity self-efficacy (PASE) in adults with obesity. To accomplish this objective, a latent variable approach was used to explore dimensionality, temporal invariance, and external validity of responses to a newly developed battery of PASE scales. Data (Nbaseline = 461 and N30 days postbaseline = 427) from the Well-Being and Physical Activity Study (ClinicalTrials.gov, identifier: NCT03194854), which deployed the Fun For Wellness intervention, were analyzed. A two-dimensional factor structure explained responses to each PASE scale at baseline. There was strong evidence for at least partial temporal measurement invariance for this two-dimensional structure in each PASE scale. There was mixed evidence that the effectiveness of the Fun For Wellness intervention exerted a direct effect on latent PASE in adults with obesity at 30 days postbaseline (i.e., external validity) of this two-dimensional structure.

Examining 24-Hour Activity and Sleep Behaviors and Related Determinants in Latino Adolescents and Young Adults With Obesity

Background. Few studies have examined 24-hour activity and sleep behaviors and their contribution to type 2 diabetes (T2D) in Latino adolescents and young adults with obesity. Aim. This study included quantitative data on T2D risk and 24-hour activity and sleep behaviors and qualitative data on individual, social, and environmental behavioral determinants. Method. A 7 day, 24-hour, wrist-worn accelerometer protocol assessed moderate-to-vigorous physical activity (PA), sedentary behaviors (SB), sleep, and sleep regularity, in adolescents (N = 38; 12-16 years) and young adults (N = 22; 18-22 years). T2D-related outcomes included adiposity (BMI, BF%, waist circumference), fasting, and 2-hour glucose. A subsample of participants (N = 16 adolescents, N = 15 young adults) completed interviews to identify behavioral determinants. Results. High levels of PA were observed among adolescents (M = 103.8 ± 67.5 minutes/day) and young adults (M = 96.8 ± 78.8 minutes/day) as well as high levels of SB across both age groups (≥10 hours/day). Sleep regularity was negatively associated with adiposity (all ps < .05) in both age groups as well as fasting and 2-hour glucose in young adults (all ps < .05). Social support was associated with PA in both age groups as well as SB in younger youth. Auditory noises, lights, and safety inhibited sleep in both age groups. Conclusion. PA is critical for disease reduction, yet reducing SB and improving sleep are also important targets for reducing T2D risk in Hispanic adolescents and young adults. Future health promotion and disease prevention strategies should leverage qualitative findings regarding behavioral determinants.

Scaling Up Public Health Interventions: Engaging Partners Across Multiple Levels

Advancing the science of intervention scale-up is essential to increasing the impact of effective interventions at the regional and national levels. In contrast with work in high-income countries (HICs), where scale-up research has been limited, researchers in low- and middle-income countries (LMICs) have conducted numerous studies on the regional and national scale-up of interventions. In this article, we review the state of the science on intervention scale-up in both HICs and LMICs. We provide an introduction to the elements of scale-up followed by a description of the scale-up process, with an illustrative case study from our own research. We then present findings from a scoping review comparing scale-up studies in LMIC and HIC settings. We conclude with lessons learned and recommendations for improving scale-up research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Investigating the delivery of health improvement interventions through professional football club community trusts-strengths and challenges

Objectives

This study audits health improvement provision delivered in/by English professional Football Club Community Trusts and reports the strengths and challenges around the implementation of interventions.

Study design

Multi-methods design: Data were collected through (i) a review of trust websites (n ​= ​72), (ii) an online survey (n ​= ​34/47.2%) and (iii) semi-structured interviews (n ​= ​11/32.3%) with a sub-sample of trust managers.

Results

The review of websites confirms all trusts provided physical activity-led interventions. The online survey showed most managers were male (n ​= ​23/67.7%) and white British (n ​= ​30/88.2%). Two thirds held management roles, (n ​= ​23/67.6%) and represented Championship (n ​= ​12/35.2%), League 1 (n ​= ​13/38.2%) and League 2 clubs (n ​= ​9/26.5%). Trusts provided physical activity and most provided diet (n ​= ​31/91.2%) as well as smoking (n ​= ​20/58.8%) and alcohol (n ​= ​19/55.9%) interventions. Weight management, (n ​= ​25/73.5%), mental health interventions (n ​= ​28/82.4%) were offered. Trusts provided male-specific (n ​= ​20/58.8%), with fewer providing female-specific interventions (n ​= ​15/44.1%). Most trusts (n ​= ​30/88.2%) evaluated interventions. 80.8% (n ​= ​21/26) used public health guidance for programme design, 69.2% (n ​= ​18/26) delivery, 57.7% (n ​= ​15/26) needs assessment and 50% (n ​= ​13/26) evaluation. Interviews and qualitative reports identified strengths including, using football, the 'club brand', 'meeting health needs' and 'working as a strategic collaboration with partners'. Challenges included 'short-term funding staffing, mainstreaming, and evaluating interventions'.

Conclusion

Football Community Trusts deliver interventions, but challenges were encountered when implementing these programmes.

A Critique of National Physical Activity Policy in Oman Using 3 Established Policy Frameworks

BACKGROUND

This paper aimed to assess the development process, content, and early implementation of Oman's national physical activity plan of action to identify strengths and areas for improvement.

METHODS

Data were extracted from 4 documents: national noncommunicable diseases policy, physical activity plan of action, and 2 World Health Organization Mission Reports. Three policy frameworks and approaches (physical activity content analysis grid, health-enhancing physical activity policy audit tool, and policy cube approach for diet-related noncommunicable diseases) were used.

RESULTS

The findings demonstrated that policymakers engaged a broad range of sectors in developing a national plan. It aligned with many of the elements from the 3 policy frameworks (ie, multisectoral approach, political commitment/leadership, identification of national goals and targets, time frame for implementation). The main gaps included the lack of a specified sustainable funding mechanism, systems for monitoring progress, and an emphasis on general interventions, with limited focus on specific target groups.

CONCLUSION

A range of sectors were engaged in the development of Oman's national physical activity plan of action, with strong political commitment and using global guidance and local evidence. Establishing a strong accountability framework, including a clear financing mechanism, is critical for Oman to meet its target for a 10% relative reduction in physical inactivity by 2025.

Impact of Outdoor Gyms on Adults' Participation in Physical Activity: A Natural Experiment in Chile

BACKGROUND

Although low levels of physical activity have slightly decreased globally, the need to reverse the physical inactivity remains urgent. One approach has been the installation of outdoor gyms (OGs).

METHOD

A natural experiment arose from the installation of OGs in different neighborhoods of the city of Temuco, Chile. Baseline measurements were collected between 2006 and 2017 in a cohort of adults participating in the Prospective Urban & Rural Epidemiology study. Physical activity was assessed with the short version of the International Physical Activity Questionnaire, and time-varying covariates was assessed every 3 years. The multistage hierarchical, nested sampling process and the follow-up assessments led to data correlated at different levels, thus the authors analyzed the data using a logistic multilevel model.

RESULT

2463 urban adults from 16 neighborhoods, with an average age of 51.7 (9.8) years (67% female), were included. Having an adequate number of OGs improved the odds of complying with the World Health Organization's recommendations (adjusted odds ratio = 4.64, 3.95-5.45). In addition, being male (odds ratio = 1.53, 1.32-1.77) and under the age of 60 years (odds ratio = 0.83, 0.71-0.97) were associated with being physically active.

CONCLUSION

The presence of more OGs can have a positive impact on physical activity recommendations.

Physical activity as a health resource: a cross-sectional survey applying a salutogenic approach to what older adults consider meaningful in organised physical activity initiatives

Objectives

Examine health resources that physically active older adults consider meaningful when participating in physical activity initiatives. Health resources are protective factors, including attitudes, knowledge, material factors or social support, that potentially enable people to understand and make sense of their lives or to cope with life stressors.

Design and main outcome measures

A cross-sectional quantitative study was conducted with two questionnaires used to serve as a compiled ‘ageing well’ survey: the Salutogenic Physical Activity Health Resources Questionnaire (SPAHRQ) and the short form of the Sense of Coherence questionnaire, SOC-13.

Results

The study included 372 participants ranging from 60 to 96 years of age (mean age: 74.4 ± 7 years; 60% women). Social relations, positive energy, the habit of exercising and embodied satisfaction were considered important by more than 70% of the participants. Social relations were the most meaningful health resource for both men and women (89%). Women rated positive energy as a significantly more important consequence of their participation in physical activity than men (W 88%, M 72%; p = .001). The three health resources that were considered less important were capability in and about physical activity, self-worth and identity as an exercising person. Those who were more physically active considered social relations, self-worth and the habit of exercising to a higher extent. Participants with higher sense of coherence consider the habit of exercising to a greater extent to be important.

Conclusions

Findings that social relations, positive energy, the habit of exercising and embodied satisfaction were considered important by more than 70% of the participants, can contribute to a wider understanding of health resources that older adults consider meaningful in their participation in organised physical activity initiatives.

Mixed Methods Process Evaluation of a National Peer-Led Training Program to Increase Brief Advice on Physical Activity Given By Health Care Professionals

INTRODUCTION

Health care professionals are well-positioned to encourage physical activity. The Clinical Champions Physical Activity Training Program (CCTP) aimed to increase population-level physical activity across England. This study aimed to (1) evaluate CCTP uptake and utilization; (2) explore CCTP fidelity, barriers, facilitators, and satisfaction; and (3) provide recommendations for program improvement.

METHODS

Physical Activity Clinical Champions were recruited and trained to deliver training to other health care professionals about physical activity. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to conduct a process evaluation using data collected from CCTP training sessions delivered (often at hospitals and General Practitioner surgeries) between February and December 2018.

RESULTS

About 509 training sessions were delivered, with 89% of sessions delivered by doctor/physician and nurse Clinical Champions; 8917 health care professionals attended a training session. Sessions lasted on average 1 hour 28 minutes and core slide sets were used in 65% of sessions. Barriers related to arranging the sessions and time available to deliver sessions.

CONCLUSION

The process evaluation demonstrated a national peer-led training program can reach all geographical regions of England; however, barriers need to be addressed. Recommendations include providing more administrative support to the Clinical Champions, improving communication and advertising to raise awareness of the CCTP, and standardizing training session duration and content.

Implementation of the EIRA 3 Intervention by Targeting Primary Health Care Practitioners: Effectiveness in Increasing Physical Activity

The World Health Organization (WHO) estimated that physical inactivity (PI) is responsible for 20 to 30% of all non-communicable diseases. We aimed to analyze the effectiveness of a multiple health behavior change (MHBC) intervention to increase physical activity (PA) in patients 45 to 75 years old who had at least 2 of 3 unhealthy behaviors (tobacco use, reduced fruit and vegetable consumption, and insufficient PA). The MHBC intervention is based on the Transtheoretical Model and the conceptual framework of the "5 A's" and includes an individually tailored intervention, group sessions, and the use of community resources. We included 3062 participants, 1481 in the intervention group and 1581 in the control group. After 12 months, there were no differences in PA intensity measured by metabolic_equivalent_of_task_minutes/week (adjusted mean difference: 284.093, 95% CI: -298.24, 866.42) nor in the proportion of participants who increased PA levels to moderate or high (OR: 1.02, 95% CI: 0.85, 1.23; p = 0.822), and no differences in blood pressure, weight loss, or waist circumference. We found an increased proportion of patients in the intervention group who followed the WHO recommendations for PA (OR: 1.29; 95% CI: 1.04, 1.60; p = 0.02). We concluded that the intervention did not lead to a significant increase in PA.

Tai Chi for cancer survivors: A systematic review toward consensus-based guidelines

To manage acute, long‐term, and late effects of cancer, current guidelines recommend moderate‐to‐vigorous intensity aerobic and resistance exercise. Unfortunately, not all cancer survivors are able or willing to perform higher intensity exercise during difficult cancer treatments or because of other existing health conditions. Tai Chi is an equipment‐free, multicomponent mind–body exercise performed at light‐to‐moderate intensity that may provide a more feasible alternative to traditional exercise programs for some cancer survivors. This systematic review evaluated the therapeutic efficacy of Tai Chi across the cancer care continuum. We searched MEDLINE/PubMed, Embase, SCOPUS, and CINAHL databases for interventional studies from inception to 18 September 2020. Controlled trials of the effects of Tai Chi training on patient‐reported and objectively measured outcomes in cancer survivors were included. Study quality was determined by the RoB 2 tool, and effect estimates were evaluated using the Best Evidence Synthesis approach. Twenty‐six reports from 14 trials (one non‐randomized controlled trial) conducted during (n = 5) and after treatment (after surgery: n = 2; after other treatments: n = 7) were included. Low‐level evidence emerged to support the benefits of 40–60 min of thrice‐weekly supervised Tai Chi for 8–12 weeks to improve fatigue and sleep quality in cancer survivors. These findings need to be confirmed in larger trials and tested for scaling‐up potential. Insufficient evidence was available to evaluate the effects of Tai Chi on other cancer‐related outcomes. Future research should examine whether Tai Chi training can improve a broader range of cancer outcomes including during the pre‐treatment and end of life phases.

Using social networks to scale up and sustain community-based programmes to improve physical activity and diet in low-income and middle-income countries: a scoping review protocol

INTRODUCTION

The World Health Organisation endorses community-based programmes as a cost-effective, feasible and a 'best buy' in the prevention and management of non-communicable diseases (NCDs). These programmes are particularly successful when the community actively participates in its design, implementation and evaluation. However, they may be only useful insofar as they can be scaled up and sustained in some meaningful way. Social network research may serve as an important tool for determining the underlying mechanisms that contribute to this process. The aim of this planned scoping review is to map and collate literature on the role of social networks in scaling-up and sustaining community-based physical activity and diet programmes in low-income and middle-income countries.

METHODS AND ANALYSIS

This scoping review protocol has been planned around the Arksey and O'Malley framework and its enhancement. Inclusion criteria are peer-reviewed articles and grey literature exploring the role of social networks in the scale-up and/or sustainability of NCD prevention community-based programmes in adult populations. Studies must have been published since 2000, in English, and be based in a low-income or middle-income country. The following databases will be used for this review: PubMed, Cochrane, Scopus, Web of Science, CINAHL, SocIndex, the International Bibliography of the Social Sciences, Google and Google Scholar. Books, conference abstracts and research focused only on children will be excluded. Two reviewers will independently select and extract eligible studies. Included publications will be thematically analysed using the Framework Approach.

ETHICS AND DISSEMINATION

Ethical approval will not be sought for this review as no individual-level data or human participants will be involved. This protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/KG7TX). The findings from the review will be published in an accredited journal. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist will be used to support transparency and guide translation of the review.

Evaluating the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens program

BACKGROUND

Physical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program.

METHODS

Data were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained in schools.

RESULTS

The estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers' adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop.

CONCLUSIONS

The RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1^st February 2021.

Scaling Up a Community-Based Exercise Program for Women in Difficult Life Situations in Germany-The BIG Project as a Case-Study

Scaling up community-based participatory research (CBPR) remains challenging. This case-study reports on how, and under which conditions, a CBPR project aiming at promoting exercise among socially disadvantaged women (BIG) scaled up at four project sites. As part of BIG, researchers support city administrations in implementing a participatory project to reach socially disadvantaged women for exercise. The case study was conducted in winter 2020 in southern Germany and is based on a co-creative process involving city administrators and researchers. Following Kohl and Cooley's scaling up dimensions, scaling up BIG was investigated at the four sites using a mixed-method approach. Course registrations and offers were analysed, and qualitative interviews (n = 4) with administrative staff members were conducted and analysed using content analysis. The geographical coverage of exercise classes, the addressed groups, and the utilisation of participatory methods by city administrations are described. All four sites managed to scale-up project activities. Three of the four sites reported that further growth of the project was no longer possible due to limited resources. All sites attempted to reach a larger number of, and more diverse, women. One site managed to scale-up the use of participatory methods within the city administration. The following important facilitators for scaling up CBPR projects were reported: advertisements tailored to the needs of the addressed women, utilising participatory approaches, and equipping project coordinators with sufficient resources.

Barriers and facilitators to implementing community-based physical activity interventions: a qualitative systematic review

Background

Over the past decade several physical activity (PA) interventions have been shown to be efficacious in a controlled research setting, however there is a continued lack of evidence for how to successfully implement these PA interventions in real-world settings such as the community. This review aims to explore the barriers and facilitators that affect the implementation of community-based PA interventions and make recommendations to improve implementation from the included studies.

Methods

A systematic literature search of EBSCOhost, Scopus, PUBMED and Web of Science was conducted to identify articles that reported qualitative data on the implementation factors of community-based interventions where PA was a primary outcome. Data were extracted using the Consolidated Framework for Implementation Research (CFIR) as a guide. Implementation factors and recommendations were then mapped onto the 5 domains of the CFIR and synthesised thematically.

Results

From 495 articles, a total of 13 eligible studies were identified, with 6 studies using a mixed methods approach, and 7 reporting qualitative methods only. There were 82 implementation factors identified, including 37 barriers and 45 facilitators, and a further 26 recommendations from the papers across all 5 domains of the CFIR. More barriers than facilitators were identified within the CFIR domain inner setting, in contrast to all other domains where facilitator numbers outweighed barriers.

Conclusions

This review identified many facilitators and barriers of implementing physical activity interventions in the community. A key finding of this review was the impact of implementation strategies on successful implementation of community PA interventions. From the evidence, it was clear that many barriers to implementation could have been negated or reduced by an implementation plan in which several strategies are embedded. The findings of this review also suggest more attention to individual’ skills and involvement is needed to improve self-efficacy and knowledge. The role of individuals across all organisational levels, from providers to leaders, can impact on the implementation of an intervention and its success.

Trial registration

PROSPERO - CRD42020153821.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01177-w.

Participation and Physical Activity in Recreovia of Bucaramanga, Colombia

BACKGROUND

Open Streets initiatives have allowed for physical activity (PA) in cities worldwide. However, few studies have evaluated the use of small Open Streets in low- and middle-income countries, such as those in Latin America. Thus, this study aimed to describe participation and PA level of users in the Recreovia program in Bucaramanga, Colombia.

METHODS

A cross-sectional study was conducted during 5 Sundays from September to November 2017. Recreovia use was evaluated at 4 strategic points according to street accessibility (2 points) and aerobics class areas (2 points), using the System for Observing Play and Recreation in Communities.

RESULTS

A total of 38,577 observations were made (34,969 on streets and 3608 in aerobics class areas). Men (63%) and adults (62%), with moderate to vigorous PA (MVPA) (98%) were observed on streets. The most common PAs were biking (50%), walking/dog walking (36%), and jogging (9%). In aerobics class areas, the most common groups were female (65%) and adults (89%). Participants were engaged in moderate to vigorous PA (91%).

CONCLUSION

Measurement of number of participants at moderate to vigorous levels of PA was high. A difference between sexes and age in these street and aerobic class area groups was also observed.

Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design

Background

As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.

Objectives

To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.

Data sources

Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.

Design

Realist evidence synthesis and co-design for primary care service innovation.

Setting

Primary care in Wales and England.

Participants

Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.

Methods

The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.

Results

Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.

Limitations

Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.

Conclusions

We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.

Future work

A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.

Study registration

This study is registered as PROSPERO CRD42018103027.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.

Smart Wearable Device Users' Behavior Is Essential for Physical Activity Improvement

BACKGROUNDS

This study aimed to explore the effect on physical activity and sedentary behavior of users of wearable devices, and understand the association between physical activity and behavior.

METHODS

This study conducted a three-arm, randomized controlled trial for 12 weeks. Healthy adults without experience of using a wearable device were recruited and were randomly assigned to a control group with a mobile app and two experimental groups with different smart wearable devices. Data were collected through questionnaires.

RESULTS

No significant effect of group, time, or group-by-time interaction among groups for physical activity, sedentary time, or sleep quality was found. Wearing duration significantly positively predicted changes in low-intensity and total physical activity. The number of times the device was checked negatively predicted a change in sedentary time.

CONCLUSIONS

The behavior of wearable device users is an essential factor for successfully increasing physical activity and decreasing sedentary time.

Pragmatic Evaluation of Older Adults' Physical Activity in Scale-Up Studies: Is the Single-Item Measure a Reasonable Option?

Convergent validity and responsiveness to change of the single-item physical activity measure were assessed in adults aged 60 years and older, at baseline (n = 205) and 6 months (n = 177) of a health promotion program, Choose to Move. Spearman correlations were used to examine associations between physical activity as measured by the single-item measure and the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and for 6-month change in all participants and for sex and age (60-74 years, and ≥75 years) subgroups. Effect size assessed responsiveness to change in physical activity for both tools. Baseline physical activity by the single-item measure correlated moderately with physical activity by the CHAMPS questionnaire in all participants and subgroups. Correlations were weaker for change in physical activity. Effect size for physical activity change was larger for the single-item measure than for the CHAMPS questionnaire. The single-item measure is a valid, pragmatic tool for use in intervention and scale-up studies with older adults.

Feasibility and Provisional Efficacy of Embedding High-Intensity Interval Training Into Physical Education Lessons: A Pilot Cluster-Randomized Controlled Trial

PURPOSE

The aim of this study was to determine the feasibility of generalist school teachers delivering curriculum connected high-intensity interval training in a school's physical education class time.

METHOD

Two schools volunteered to participate. A total of 84 students (11.9 [0.5] y, M = 64 and F = 19) volunteered to participate. Four classes from 2 schools were randomized to either intervention (n = 53) or control (n = 31) for one school term (8 wk). Intervention class teachers participated in a 1-day workshop instructing them how to deliver twice weekly, high-intensity interval training sessions. The control classes continued with their usual physical education curriculum. Recruitment, intervention fidelity, and program satisfaction were assessed. Preliminary efficacy (primary outcome cardiorespiratory fitness) was quantified using generalized linear mixed models, expressed as effect size. A range of secondary outcomes was also assessed.

RESULTS

The recruitment rate was 88%. About 84% of the sessions were delivered. The heart rate peak over all sessions was 89.6% (13%) of the predicted maximum. The intervention teachers reported high levels of satisfaction. Almost all student participants were positive about participating. No adverse events occurred. The adjusted between-group difference for cardiorespiratory fitness was trivial (effect size 0.02).

CONCLUSIONS

This teacher-delivered high-intensity interval training program was feasible and acceptable to both teachers and student participants. It is therefore potentially scalable.

An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity

Pre-Olympic Games predictions commonly include an increase in population-based physical activity in the host city, as often stated in the bid, but the post-Olympic Games effects on physical activity have not been summarised. In this Series paper, we aim to do the following: examine mentions of a physical activity legacy in pre-Olympic bid documentation; analyse existing physical activity surveillance data collected before, during, and after the Olympic Games in hosting areas around the world; and evaluate Google Trends data surrounding the London 2012 Olympic Games as a case study of community interest in the topic of exercise during the time of the Olympic Games. Before 2007, little mention of physical activity was made in pre-Olympic Games documentation, but, after that, most documents had targets for population physical activity or sports participation. The synthesis of available surveillance data indicates that there was no change in the prevalence of physical activity or sports participation, except for the 2008 Summer Olympics in Beijing and the 1998 Winter Olympics in Nagano; although, the increase in participation in Nagano might not be attributable to the Olympic Games since there was no change in participation in winter sports. The Google Trends data showed an acute spike in searches with the term "Olympic" immediately associated with the London Olympic Games period and showed a sustained peri-Olympic increase in searches with the term "exercise". By themselves, the Olympic Games have not improved population-wide physical activity but might be an important missed public health opportunity. Such a legacy will require strategic planning and partnerships across the International Olympic Committee and the Olympic, sport, and public health agencies and a thorough evaluation framework implemented throughout the pre-Olympic Games and post-Olympic Games period in the host country.

Physical activity promotion in German vocational education: does capacity building work?

Apprentices in many sectors are exposed to increased health risks and show low levels of physical activity (PA). Environmental and policy approaches seem to be promising tools for PA promotion as they can positively influence the context in which PA occurs. This article reports results from a German research project (2015–2018) that developed and implemented measures for PA promotion in the field of vocational education (VE). A participatory approach—cooperative planning (COP)—involving researchers as well as stakeholders from policy and practice was used in two VE settings—nursing care and automotive mechatronics. We assessed the extent to which new capacities for PA promotion were created by conducting semi-structured interviews with stakeholders from both sectors (n = 12) and one group interview with nursing students (n = 4). Transcripts were analysed using qualitative content analysis. Findings show that new capacities were created mainly in the form of resources and opportunities and that several measures for PA promotion (e.g. a regular lesson on the issue of PA and health and a tutoring system) were successfully integrated into VE routines. However, establishing new organizational goals and obligations appeared to be challenging. Moreover, the article presents influencing factors, such as the participation of the main actors that strongly supported the process of capacity building within their organization. We conclude that COP seems promising in creating new capacities for PA promotion in the field of VE, and therefore has the potential to promote a physically active lifestyle among apprentices.

Perceptions of outdoor gymnasiums in National Capital Region, India: creating active environments for health promotion

The prevalence of physical inactivity in India is estimated to be at 34%, the highest among South Asian nations. Interventions, such as outdoor gymnasiums/gyms, aiming to promote physical activity, are becoming popular worldwide, including in India. This paper presents the first empirical evidence on outdoor gyms in India from a qualitative perspective. Semi-structured, in-depth interviews of 56 outdoor gym stakeholders-40 users, 10 non-users, 4 healthcare providers and 2 outdoor gym implementing municipality authorities were conducted in the National Capital Region of India. The interviews were transcribed and analyzed through the Framework Method. The qualitative findings present the perceived benefits, barriers/challenges to using and provide insights for further improving and scaling up outdoor gyms in India. Health enhancement in the form of improved general fitness, body weight control and diversification of physical exercise routines, social connectivity, easy accessibility, affordability, green outdoor surroundings, and a place of intrigue and attraction in respective parks were the major reported benefits of outdoor gyms. Low gym equipment to user ratio was one of the major challenges to gym use across the user group. Healthcare providers and non-users were majorly concerned about the potentially incorrect and unsupervised use of outdoor gym equipment. Major suggestions for improvement were increasing the number of equipment installed, regular equipment maintenance, and the presence of an on-site physical exercise trainer. Outdoor gymnasiums present as a viable option for promoting physical activity and should be scaled up systematically to improve the health of the populations across India and other similar nations.