The effects of a theory-informed intervention on physical activity behaviour, motivation and well-being of frontline aged care workers: A pilot study with 6-month follow-up

ISSUE ADDRESSED

Due to the nature of their jobs, frontline aged care workers may be a population at risk of poor health and lifestyle habits. Support of their well-being through the workplace is likely to be complex. The objective of this study was to assess the effectiveness of a need-supportive program for changing physical activity and psychological well-being via the motivational processes of behavioural regulations and perceived need satisfaction.

METHODS

Frontline aged care workers (n = 25) participated in a single cohort, pre-post pilot trial. The program included a Motivational Interviewing style appointment, education on goal setting and self-management, the use of affect, exertion and self-pacing for regulating physical activity intensity and practical support activities. Outcomes (7-day accelerometery, 6-min walk, K10 and AQoL-8D), and motivational processes (BREQ-3 and PNSE) were measured at baseline, 3 and 9 months, and analysed using linear mixed models for repeated measures.

RESULTS

There were significant increases in perceived autonomy at 3 months (Δ .43 ± SE: .20; p = .03) and 6-min walk distance at 9 months (Δ 29.11 m ± SE: 13.75; p = .04), which appeared to be driven by the relative autonomy index (behavioural regulations in exercise questionnaire [BREQ-3]). Amotivation increased at 3 months (Δ .23 ± SE:.12; p = .05); which may have been due to low scores at baseline. No other changes were demonstrated at any timepoint. SO WHAT?: Participants demonstrated positive changes in motivational processes and physical function, however, due to the low levels of participation in the program, the program had a negligible impact at the organisational level. Future researchers and aged care organisations should aim to address factors impacting participation in well-being initiatives.

Process evaluation of the Invictus Pathways Program

INTRODUCTION

UniSA's Invictus Pathways Program (IPP), a service program, was originally developed to assist veterans to train for and participate in the Invictus Games. More recently, the scope of the IPP has widened to support and improve wellbeing and facilitate post traumatic growth and recovery among participants who are living with physical and mental health injuries and conditions. This paper describes the components of the IPP and reports its process evaluation.

METHODS

Underpinned by a pragmatic approach, data related to participant and student involvement in the IPP, the number of participant training sessions, session attendance, program activities and events, and program fidelity were compiled from process documentation that had been collected between 2017 and 2020, inclusive. Following ethics approval, semi-structured interviews were conducted with participants of the IPP, members of their family support network, and university staff to understand the operations of the IPP and satisfaction with the program.

FINDINGS

There was high fidelity for the student-led exercise training aspects of IPP; however, data collection relevant to participants' psychological outcomes, and non-training IPP events and activities did not always occur as intended. Between 2017 and 2020, 53 veterans had participated in or were still participating in the IPP, and 63 allied health students had completed placements as student trainers. Fifty-three individual training sessions were delivered in 2017, increasing to 1,024 in 2020. Seventy-one interviews were completed with key IPP stakeholders. The qualitative analysis identified four higher order themes: Implementation and fidelity of the IPP, Satisfaction with the IPP, Areas of the IPP requiring improvement and suggestions for change, and Sustainability of the IPP. Satisfaction was generally high for the IPP, although there were factors that negatively impacted the experience for some participants and their family support network. Suggestions for improvement to program components and delivery aspects were made during the interviews, and the precariousness of IPP funding and sustainability was raised as an ongoing concern.

CONCLUSION

This process evaluation has demonstrated that the physical activity training components of the IPP were delivered with high levels of fidelity, and that satisfaction with the IPP is mostly high, although there are areas that could be improved. There is a need for a more structured approach to the ongoing evaluation of the IPP. This includes ensuring that program staff have a shared understanding of the purpose of evaluation activities and that these activities occur as intended. Beyond this is the need to secure funding to support the sustainability of the IPP, so that it can continue to contribute to the wellbeing of veterans living with physical and mental health conditions, and their families.

The physical, psychological, and social impacts of participation in the Invictus Pathways Program: A qualitative analysis of veterans' perceptions and experiences

INTRODUCTION

UniSA's Invictus Pathways Program (IPP) is motivated by the spirit of the Invictus Games to mobilise the benefits of sport to aid physical, psychological, and social wellbeing. Originally developed to assist veterans to train for and participate in the Invictus Games, the program has extended its scope to promote recovery and wellbeing for all veterans through physical activity. This paper describes the expectations and experiences of the IPP from the perspective of program participants.

METHODS

Objective measures of physical and psychological wellbeing were collected by survey, to enable description of the participating veterans' wellbeing status. Semi-structured interviews were conducted with 15 participants of the IPP who had not participated in an Invictus Games or Warrior Games. Reflexive thematic analysis was used to analyse the interview data. Coding and themes were developed through a mixture of inductive and deductive approaches to analysis. Initial themes related to previous life experience, expectations of participation, and outcomes of participation were preconceived, but the analysis provided scope for an inductive approach to formulate additional themes.

FINDINGS

Five of the participants had very high K10 scores, and scores above the norm for PCL-C, whilst one would be classified with an alcohol disorder. The qualitative analysis identified five higher order themes: Life experiences prior to participation in the IPP, Making a choice to participate in the IPP, Expectations of participation in the IPP, Impact of participation in the IPP, and Future Plans. There were perceptions that the IPP was beneficial for the participating veterans, irrespective of their physical and psychological health status. Participants described the positive impact of the IPP on their physical fitness, their social engagement, and their sense of belonging within the IPP and the university. Participants perceived the IPP to be an opportunity for them to 'give back' by contributing to the education of the students delivering the IPP. Participants reported the intention to continue being physically active. For some, this meant selection in an Invictus Games team, for others, this meant getting involved in community sporting organisations.

CONCLUSION

The Invictus Pathways Program has been shown to have a positive impact on the physical and psychological wellbeing of the veterans who participated in its initial stages. As the program evolves, the longitudinal impact of participation, for veterans and their families, will be assessed.

What I see and what I feel: the influence of deceptive visual cues and interoceptive accuracy on affective valence and sense of effort during virtual reality cycling

Background

How we feel during exercise is influenced by exteroceptive (e.g., vision) and interoceptive (i.e., internal body signals) sensory information, and by our prior experiences and expectations. Deceptive visual cues about one's performance during exercise can increase work rate, without negatively impacting affective valence (good/bad responses) or perceived exertion. However, what is less understood is whether the perception of the exercise experience itself can be shifted, if work rate is held constant. Here we aimed to investigate whether deceptive vision-via illusory hills in a virtual reality (VR) cycling experience-alters affective valence and perceived exertion when physical effort is controlled. We also evaluated whether the accuracy with which one detects interoceptive cues influences the extent to which deceptive visual information can shift exercise experiences.

Methods

A total of 20 participants (10 female; 30.2 ± 11.2 yrs) completed three VR cycling conditions each of 10-min duration, in a randomised, counterbalanced order. Pedal resistance/cadence were individualised (to exercise intensity around ventilatory threshold) and held constant across conditions; only visual cues varied. Two conditions provided deceptive visual cues about the terrain (illusory uphill, illusory downhill; resistance did not change); one condition provided accurate visual cues (flat terrain). Ratings of affective valence (Feeling Scale) and of perceived exertion (Borg's RPE) were obtained at standardised timepoints in each VR condition. Interoceptive accuracy was measured via a heartbeat detection test.

Results

Linear mixed effects models revealed that deceptive visual cues altered affective valence (f2 = 0.0198). Relative to flat terrain, illusory downhill reduced affective valence (Est = -0.21, p = 0.003), but illusory uphill did not significantly improve affective valence (Est = 0.107, p = 0.14). Deceptive visual cues altered perceived exertion, and this was moderated by the level of interoceptive accuracy (Condition-Interoception interaction, p = 0.00000024, f2 = 0.0307). Higher levels of interoceptive accuracy resulted in higher perceived exertion in the illusory downhill condition (vs flat), while lower interoceptive accuracy resulted in lower perceived exertion in both illusory hill conditions (vs flat) and shifts of greater magnitude.

Conclusions

Deceptive visual cues influence perceptual responses during exercise when physical effort does not vary, and for perceived exertion, the weighting given to visual exteroceptive cues is determined by accuracy with which interoceptive cues are detected. Contrary to our hypotheses, deceptive visual cues did not improve affective valence. Our findings suggest that those with lower levels of interoceptive accuracy experience most benefit from deceptive visual cues, providing preliminary insight into individualised exercise prescription to promote positive (and avoid negative) exercise experiences.

Correlation of frailty assessment metrics in one-year follow-up of aged care residents: a sub-study of a randomised controlled trial

INTRODUCTION

Frailty is increasingly recognised as a dynamic syndrome, with multiple causes, dimensions and consequences. There is little understanding of how those frailty assessment metrics interact over time. The aim of this study was to describe the longitudinal correlation between five frailty metrics, namely multimorbidity, muscular strength, mood alterations, cognitive capacity, and functional capacity in a cohort study of aged care (nursing home) residents.

METHODS

248 aged care residents with Frailty Index at baseline of < 0.4 and no dementia were followed for 12 months. A multimorbidity score and an activity of daily living limitation score were created using individual items of the Frailty Index. Muscular strength was measured by grip strength. Cognitive capacity was measured using the Montreal Cognitive Assessment (MoCA) test. Mood alterations were measured using the anxiety/depression screening question from EQ-5D. We analysed the inter-individual correlation at baseline, association between baseline and future change, and within-individual correlation at baseline, 6 and 12 months.

RESULTS

Population analysis shows that metrics were not associated at baseline. All of the studied metrics at baseline were associated with change in 12 months, with the exception of anxiety/depression scores. Pairwise within-individual correlation was strong between MoCA and grip strength (0.13, p = 0.02) and activity of daily living (- 0.48, p < 0.001), and between activities of daily living and multimorbidity index (0.28, p < 0.001). No within-individual correlation was found between anxiety depression score and other metrics.

CONCLUSION

The results suggest an interdependence between comorbidities, physical capacity, cognition and activities of daily living in aged care residents. Comprehensive measurement of frailty-related metrics may provide improved understanding of frailty progression at later life stages.

Using wrist-worn accelerometers to identify the impact of medicines with anticholinergic or sedative properties on sedentary time: A 12-month prospective analysis

INTRODUCTION

Studies have shown that use of medicines with sedative or anticholinergic properties is associated with a decline in physical function; however, the effects have not been quantified, and it is not known how and which specific physical movements are affected. This prospective study quantified the impact of a change in sedative or anticholinergic load over time on 24-hour activity composition.

METHODS

This study used data collected from a randomised trial assessing an ongoing pharmacist service in residential aged care. The 24-hour activity composition of sleep, sedentary behaviour, light-intensity physical activity, and moderate to vigorous physical activity was derived from 24-hour accelerometry bands. Mixed effect linear models were used to regress the multivariate outcome of 24-hour activity composition on medication load at baseline and at 12 months. A fixed effect interaction between trial stage and medication load was included to test for differing sedative or anticholinergic load effects at the two trial stages.

RESULTS

Data for 183 and 85 participants were available at baseline and 12 months respectively. There was a statistically significant interaction between medication load and time point on the multivariate outcome of 24-hour activity composition (sedative F = 7.2, p < 0.001 and anticholinergic F = 3.2, p = 0.02). A sedative load increase from 2 to 4 over the 12-month period was associated with an average increase in daily sedentary behaviour by an estimated 24 min.

CONCLUSION

As sedative or anticholinergic load increased, there was an increase in sedentary time. Our findings suggest wearable accelerometry bands are a possible tool for monitoring the effects on physical function of sedative and anticholinergic medicines.

TRIAL REGISTRATION

The ReMInDAR trial was registered on the Australian and New Zealand Trials Registry ACTRN12618000766213.

Ratings of perceived exertion from a submaximal 20-m shuttle run test predict peak oxygen uptake in children and the test feels better

PURPOSE

To determine the validity and test-retest reliability of using ratings of perceived exertion (RPE) elicited during a submaximal 20-m Shuttle Run Test (20mSRT) to predict VO_2peak in children and investigate acute affective responses.

METHODS

Twenty-five children (14 boys; age, 12.8 ± 0.7 years; height, 162.0 ± 9.3 cm; mass, 49.9 ± 7.7 kg) completed four exercise tests (GXT, 2 submaximal 20mSRT, maximal 20mSRT). The Eston-Parfitt RPE scale was used, and affect was measured with the Feeling Scale. Submaximal 20mSRT were terminated upon participants reporting RPE7. The speed-RPE relationship from the submaximal 20mSRTs was extrapolated to RPE9 and 10 to predict peak speed and then used to estimate VO_2peak.

RESULTS

Repeated measures ANOVA to examine the validity of using submaximal RPE to predict VO_2peak resulted in a Gender main effect (boys = 46.7 ± 5.1 mL kg^-1 min^-1; girls = 42.0 ± 5.1 mL kg^-1 min^-1) and Method main effect (p < 0.01). There were significant differences between measured and estimated VO_2peak from the maximal 20mSRT, but not between measured and estimated VO_2peak at RPE9 and RPE10. Intraclass correlation analysis revealed excellent reliability (~ 0.9) between the two submaximal 20mSRTs. Significant differences (p < 0.05) in end-test affect were reported between submaximal and maximal trials in girls, but not in boys, with girls feeling less negative at the end of the submaximal trials.

CONCLUSIONS

The results of this study provide evidence that RPE reported during a submaximal 20mSRT can be used to predict VO_2peak accurately and reliably. In this study, the submaximal 20mSRT ending at RPE7, provided better predictions of VO_2peak while minimising aversive end-point affect, especially in girls.

Wrist accelerometer temporal analysis as a prognostic tool for aged care residents: A sub‐study of the ReMInDAR trial

BACKGROUND

Objective measures for screening, prioritizing, and planning care for frail individuals are essential for appropriate aged care provision. This study evaluates metrics derived from actigraphy measures (captured by wrist accelerometer) as a digital biomarker to identify frail individuals at risk of adverse outcomes, including death, hospitalization, and cognitive decline.

METHODS

This was a secondary study using data from a randomized controlled trial assessing the effectiveness of an ongoing pharmacist service in residential aged care facilities. Three metrics are studied and compared: the Frailty Index, the daily time spent in light time activity, and the temporal correlation of the actigraphy signal, measured by detrended fluctuation analysis. The association between actigraphy-derived metrics at baseline and adverse events within 12 months (death, cognitive decline, and hospitalizations) was assessed using logistic regression.

RESULTS

Actigraphy records were available for 213 participants living in aged-care, median age of 85 years. Individuals with higher temporal correlation (activity is less random) were at lower risk of death (Standardized OR: 0.49; 95% CI 0.34, 0.7, p < 0.001) and hospitalization (Standardized OR: 0.57; 95% CI 0.42, 0.77, p < 0.001) in 12 months, but there was no difference in cognitive decline (Standardized OR: 1; 95% CI 0.74, 1.35, p = 0.98). The predictive model that included temporal correlation had an area under the curve of 0.70 (CI 0.60-0.80) for death and 0.64 (CI 0.54-0.72) for hospitalization.

CONCLUSION

Temporal correlation of the actigraphy signal from aged care residents was strongly associated with death and hospitalization, but not cognitive decline. Digital biomarkers may have a place as an objective, accurate, and low-cost patient metric to support risk stratification and clinical planning.

Caring for carers: Understanding the physical and psychological well-being of carers of veterans in Australia

Carers of veterans tend to put their own physical and psychological well-being needs behind the needs of the person they are caring for and often do not seek assistance for their own physical and psychological well-being. Combined, these factors lead to increased risk of acute and chronic illness and mental health issues. It is acknowledged that physical activity independently contributes to improved physical and mental health and may be a driver for mental well-being in carers. The aim of this pilot research was to understand how movement behaviour and health behaviours of carers of veterans in Australia relate to carers' physical and psychological well-being. Assessment occurred between February and July 2019 and included objective, validated measures to examine physical and psychological well-being. To assess the association between physical and psychological factors, correlational analyses were performed. Twenty-eight carers participated in the pilot study (96% female, mean age 61.6 years). Exercise capacity varied, and 84% of carers met the recommended 150 min of physical activity per week, with carers spending 8.6% of their time in moderate-to-vigorous physical activity; and 37.9% of the day sedentary. Psychological health outcomes reflect a population with high distress levels and lower than average mental well-being, but with normal resilience scores. Carers with higher levels of resilience had greater exercise capacity, covering further distance in the 6-min walk test, and as resilience increased, number of sedentary bouts decreased. This research demonstrates that there is a relationship between health behaviours and psychological well-being in carers of veterans and serving personnel. Based on the findings of this pilot study, programmes to support family carers should include information about physical activity, reducing sedentary time, and increasing resilience. Interventions designed to improve physical and psychological well-being should be trialled and evaluated for effectiveness.

Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial)

Objective

To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions.

Design and setting

Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities.

Participants

Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine.

Intervention

Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months.

Comparator

Usual care (Residential Medication Management Review) provided by accredited pharmacists.

Outcomes

Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life.

Results

248 persons (median age 87 years) completed the study; 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: −0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength.

Conclusions

The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.

What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review

INTRODUCTION

Recreational scuba diving has existed for over 70 years with organisations emerging that teach individuals with disabilities to dive. It is unclear what the physical and psychosocial effects of scuba interventions might be. This systematic review explores evidence for the effects of scuba diving in individuals with neurological disability, intellectual disability and autism.

METHODS

The databases Medline, EMBASE, Ovid Emcare, and SportDiscus were searched. Included papers described a scuba-based intervention for clients with a neurological disability, intellectual disability and autism, with physical or psychosocial outcomes explored in the paper. Quality of the included papers was assessed using the McMaster Appraisal Tools, with descriptive data synthesis completed to explore the physical and psychosocial effects of the interventions.

RESULTS

Four papers met the inclusion criteria: a cross-sectional investigation, a phenomenological study, a case-control study and a multiple case study. The quality of the papers was low to moderate. Papers addressed the psychosocial effects of scuba diving, including motivation to participate, participant experiences, the effect on cognition and physical self-concept. One study reported an increase in self-concept for the majority of participants. An increase in understanding instructions and in visual attention was reported in another. Enjoyment of the activity was reported and motivators to be involved in scuba diving for people with disabilities included fun and excitement. No papers addressed functional outcomes.

CONCLUSIONS

Whilst scuba diving interventions appear to enhance physical self-concept and are enjoyable, conclusive evidence regarding effectiveness could not be determined. Research in this area is extremely limited.

Exercisers' Affective and Enjoyment Responses: A Meta-Analytic and Meta-Regression Review

Affective responses and enjoyment of exercise mediate exercise adherence, but previous research findings have failed to examine nuances that may moderate this relationship. We examined the effects of exercise on affective and enjoyment responses during and post exercise through a systematic literature review and meta-regression analysis. We searched major databases up to July 9, 2020 for studies evaluating healthy adults' acute and chronic responses to exercise, using either of The Feeling Scale or Physical Activity Enjoyment Scales. We calculated effect size (ES) values of 20 unique studies (397 participants; 40% females) as standardized differences in the means and expressed them as Hedges' g, together with the 95% confidence interval (95%CI). Among acute studies examining affective responses, we found a greater positive effect post exercise for continuous training (CT) compared to high intensity interval training (HIIT) (g = -0.61; 95%CI = -1.11, -0.10; p < .018), but there was no significant difference between these modes for effects during exercise. Subgroup analyses revealed that moderate, and not high intensity, CT, compared to HIIT, resulted in significantly greater positive affective responses (g = -1.09; 95%CI = -1.88, -0.30; p < .006). In contrast, enjoyment was greater for HIIT, compared to CT (g = 0.75; 95%CI = 0.17, -1.13; p = .010), but CT intensity did not influence this result. Among chronic studies, there was greater enjoyment following HIIT compared to CT, but these studies were too few to permit meta-analysis. We concluded that an acute bout of moderate intensity CT is more pleasurable, when measured post exercise than HIIT, but enjoyment is greater following HIIT, perhaps due to an interaction between effort, discomfort, time efficiency and constantly changing stimuli.

Physical Activity Intensity Cut-Points for Wrist-Worn GENEActiv in Older Adults

Purpose: This study aims to (1) establish GENEActiv intensity cutpoints in older adults and (2) compare the classification accuracy between dominant (D) or non-dominant (ND) wrist, using both laboratory and free-living data.

Methods: Thirty-one older adults participated in the study. They wore a GENEActiv Original on each wrist and performed nine activities of daily living. A portable gas analyzer was used to measure energy expenditure for each task. Testing was performed on two occasions separated by at least 8 days. Some of the same participants (n = 13) also wore one device on each wrist during 3 days of free-living. Receiver operating characteristic analysis was performed to establish the optimal cutpoints.

Results: For sedentary time, both dominant and non-dominant wrist had excellent classification accuracy (sensitivity 0.99 and 0.97, respectively; specificity 0.91 and 0.86, respectively). For Moderate to Vigorous Physical Activity (MVPA), the non-dominant wrist device had better accuracy (ND sensitivity: 0.90, specificity 0.79; D sensitivity: 0.90, specificity 0.64). The corresponding cutpoints for sedentary-to-light were 255 and 375 g · min (epoch independent: 42.5 and 62.5 mg), and those for the light-to-moderate were 588 and 555 g · min (epoch-independent: 98.0 and 92.5 mg) for the non-dominant and dominant wrist, respectively. For free-living data, the dominant wrist device resulted in significantly more sedentary time and significantly less light and MVPA time compared to the non-dominant wrist.

The Use of Ratings of Perceived Exertion in Children and Adolescents: A Scoping Review

In adults, ratings of perceived exertion (RPE) can be used to predict maximal oxygen uptake, estimate time to exhaustion, assess internal training load and regulate exercise intensity. However, the utility of RPE in children is less researched and therefore, warrants investigation. The purpose of this scoping review is to map out the literature around the application of RPE specifically during aerobic exercise in paediatric populations. Seven bibliographic databases were systematically searched. Grey literature searching and pearling of references were also conducted. To be included for the review, studies were required to comply with the following: (1) participants aged ≤ 18 years asymptomatic of any injuries, disabilities or illnesses; (2) applied RPE in aerobic exercise, testing and/or training; (3) included at least one measure of exercise intensity; and (4) be available in English. The search identified 22 eligible studies that examined the application of RPE in children. These studies involved a total of 718 participants across ten different countries. Nine different types of RPE scales were employed. Overall, the application of RPE in paediatric populations can be classified into three distinct themes: prediction of cardiorespiratory fitness/performance, monitoring internal training loads, and regulation of exercise intensity. The utility of RPE in paediatric populations remains unclear due to the small body of available research and inconsistencies between studies. However, findings from the included studies in this scoping review may show promise. Further research focussing on child-specific RPE scales across various sports, subgroups, and in field-based settings is needed.

Some gain for a small investment: An economic evaluation of an exercise program for people living in residential aged care

OBJECTIVE

To evaluate the cost-effectiveness of a 12-week Exercise Physiology (EP) program for people living in a residential aged care facility.

METHODS

A within-study pre- and postintervention design to calculate incremental cost-effectiveness ratios per quality-adjusted life years gained. A health service provider perspective was used.

RESULTS

Fifty-nine participants enrolled in a 12-week program. The program cost was A$514.30 per resident. At a willingness-to-pay threshold of A$64 000, the likelihood of being cost-effective of the program is approximately 60%, due to a small increase in participants' quality of life, as reported by care staff. The model showed great variance, depending on who rated the participants' quality of life outcomes.

CONCLUSION

It is uncertain that a 12-week EP program is cost-effective based on the evidence of the current trial. However, it appears that a low-cost program can produce small improvements for residents in care facilities.

Feasibility and Process Evaluation of a Need-Supportive Physical Activity Program in Aged Care Workers: The Activity for Well-Being Project

The need to undertake pilot testing and evaluation of novel health promotion programs has become increasingly apparent for the purpose of understanding the true effects of complex interventions and for testing and refining behavioral theories that these interventions are informed by. A mixed-methods process evaluation and feasibility study was undertaken for a need-supportive physical activity program that was piloted in a single-group pre–post study. The piloted program was designed to support participant needs of autonomy, competence, and relatedness through evidence-based and theory-informed behavior change strategies including a motivational interviewing style appointment, education on self-management tools (i.e., pedometers, goal setting, action and coping planning, a customized website for goal setting and self-monitoring), and self-determined methods of regulating physical activity intensity [affect, rating of perceived exertion (RPE), and self-pacing]. The program aimed to positively impact physical activity behavior, psychological well-being, and associated motivational processes. Reach, adoption, fidelity, context, change and performance objectives, and feasibility of the program were evaluated using information from survey respondents from the target population (n = 118) and implementing staff (n = 6); questionnaires from pilot study participants (n = 21); and individual semi-structured interviews with a combination of pilot study participants, non-participants, and implementing staff (n = 19). Process evaluation of the Activity for Well-Being program found that the reach of the program was moderate but adoption was low. The use of self-management tools and self-determined methods of regulating physical activity intensity appeared to be feasible. The website had mixed responses and low engagement. The element of having a support person elicited a strong positive response in the program participant interviews. Involving local implementing staff more directly into the delivery of the intervention could have potentially improved reach, adoption, and feasibility of the program.

Exploring the social conditions of physical activity participation amongst rural South Australian women: A qualitative study

ISSUE ADDRESSED

Australian women are less likely to participate in recommended levels of weekly physical activity compared with men. Physical activity participation rates decrease with geographical remoteness. Research suggests that a lack of social support mechanisms within the home environment may act as a barrier for rural women to engage in physical activity, along with discomfort experienced within exercise environments. The purpose of this study was to explore the social conditions that facilitate or inhibit physical activity participation amongst women from two rural South Australian communities.

METHODS

A qualitative descriptive approach underpinned by a phenomenological methodological orientation was applied. Participants were recruited using a purposive sampling strategy before semi-structured interviews (N = 16) were conducted and prepared for thematic analysis.

RESULTS

Four inter-related themes were identified: support from others, time, expectations and available opportunities. Further contextual analysis revealed interwoven notions of physical activity spaces, time and social context within the themes.

CONCLUSIONS

Multiple types of regulators interact to shape the motivational pattern of an individual. The themes identified align with self-determination, transactional and structuration theory, suggesting a need to consider human behaviour both pragmatically and conceptually. SO WHAT?: Results provide insight into social barriers and facilitators for physical activity participation and concomitantly provide the initial development of a framework for local strategic planning of health-promoting activities, and individual reflection to increase physical activity participation amongst rural women.

A cross-sectional assessment of the relationship between sedative medication and anticholinergic medication use and the movement behaviour of older adults living in residential aged care

Objectives

Medications with anticholinergic or sedative effects are frequently used by older people but can increase risk of falls and adverse events; however, less is known about their effect on movement behaviour. Here we examine the cross-sectional association between medication use and movement behaviour in older adults living in residential aged care.

Materials and Methods

Twenty-eight older adults living in residential aged care in metropolitan Australia participated. Medication data were collected from participants’ medical charts and sedative load and anticholinergic burden were determined. Seven-day movement behaviour was objectively assessed by a wrist-worn triaxial accelerometer. Raw accelerations were converted to sleep, sedentary time, and time in light, moderate, and moderate-to-vigorous physical activity. To explore the relationship between medication and movement behaviour, Spearman’s Rho correlations were conducted, as the data were not normally distributed.

Results

Analyses indicated that while anticholinergic burden was not associated with movement behaviour, sedative load was negatively correlated with a number of variables, accounting for 14% variance in moderate-to-vigorous physical activity (MVPA), and 17% in the bout length of MVPA (p < .02).

Conclusion

The findings of this study showed a negative association between sedative load, due to medicines, and an individual’s movement behaviour. The impact of this could be a reduction in the ability of this population to maintain or improve their functional mobility, which may overshadow any benefits of the medicine in some circumstances.

Reducing medicine-induced deterioration and adverse reactions (ReMInDAR) trial: study protocol for a randomised controlled trial in residential aged-care facilities assessing frailty as the primary outcome

INTRODUCTION

Many medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as medicine-induced deterioration, may reduce the risk of developing frailty. The aim of this trial is to determine the effectiveness of a 12-month pharmacist service compared with usual care in reducing medicine-induced deterioration, frailty and adverse reactions in older people living in aged-care facilities in Australia.

METHODS AND ANALYSIS

The reducing medicine-induced deterioration and adverse reactions trial is a multicentre, open-label randomised controlled trial. Participants will be recruited from 39 facilities in South Australia and Tasmania. Residents will be included if they are using four or more medicines at the time of recruitment, or taking more than one medicine with anticholinergic or sedative properties. The intervention group will receive a pharmacist assessment which occurs every 8 weeks. The pharmacists will liaise with the participants' general practitioners when medicine-induced deterioration is evident or adverse events are considered serious. The primary outcome is a reduction in medicine-induced deterioration from baseline to 6 and 12 months, as measured by change in frailty index. The secondary outcomes are changes in cognition scores, 24-hour movement behaviour, grip strength, weight, percentage robust, pre-frail and frail classification, rate of adverse medicine events, health-related quality of life and health resource use. The statistical analysis will use mixed-models adjusted for baseline to account for repeated outcome measures. A health economic evaluation will be conducted following trial completion using data collected during the trial.

ETHICS AND DISSEMINATION

Ethics approvals have been obtained from the Human Research Ethics Committee of University of South Australia (ID:0000036440) and University of Tasmania (ID:H0017022). A copy of the final report will be provided to the Australian Government Department of Health.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Trials Registry ACTRN12618000766213.

Challenges associated with physical assessments for people living with dementia: Modifying standard assessment protocols

Objectives:

Regular physical activity for older adults as they age is important for maintaining not only physical function but also independence and self-worth. To be able to monitor changes in physical function, appropriate validated measures are required. Reliability of measures such as the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk has been demonstrated; however, the appropriateness of such measures in a population of adults living with dementia, who may be unable to follow instructions or have diminished physical capacity, is not as well quantified. This study sought to test modified standard protocols for these measures.

Methods:

Modification to the standard protocols of the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk was trialled. This occurred through modification of procedural components of the assessment, such as encouraging participants to use their hands to raise themselves from a seated position, or the incorporation of staged verbal cueing, demonstration, or physical guidance where required. The test–retest reliability of the modified protocols was assessed using Pearson’s correlation, and performance variances were assessed using the %coefficient of variation. Intraclass correlations were included for comparisons to previous research and to examine measurement consistency within three trials.

Results:

At least 64% of the population were able to complete all measures. Good test–retest reliability was indicated for the modified measures (timed-up-and-go = 0.87; five-repetition sit-to-stand = 0.75; handgrip strength = 0.94; two-minute walk = 0.87; the 30-second sit-to-stand = 0.93; and the four-metre walk = 0.83), and the %coefficient of variation (7.2%–14.8%) and intraclass correlation (0.77–0.98) were acceptable to good.

Conclusion:

This article describes the methodology of the modified assessments, presents the test–retest statistics, and reports how modification of the current protocols for common measures of physical function enabled more older adults living with dementia in a residential aged care facility to participate in assessments, with high reliability demonstrated for the measures.

Efficacy of theory-informed workplace physical activity interventions: a systematic literature review with meta-analyses

This review aimed to assess the efficacy of workplace physical activity interventions; compare the efficacy of those that were and were not informed by behaviour change theory, and outline the effectiveness of different intervention components. A search was undertaken in Medline, Embase, PsycINFO, Ovid Emcare (previously CINAHL) and SportDiscus. Randomised, non-randomised and cluster-controlled trials with objectively measured physical activity and/or measured or predicted maximal oxygen uptake (VO_2max) as outcomes were included in the review (83 papers from 79 trials). Random-effects meta-analyses of mean differences were undertaken. Workplace physical activity programmes demonstrated positive overall intervention effects for daily step counts (814.01 steps/day; CI: 446.36, 1181.67; p < 0.01; i² = 88%) and measured VO_2max (2.53 ml kg^-1 min^-1; CI: 1.69, 3.36; p < 0.01; i² = 0%) with no sub-group differences between theory- and non-theory informed interventions. Significant sub-group differences were present for predicted VO_2max (p < 0.01), with a positive intervention effect for non-theory informed studies (2.11 ml.kg^-1 min^-1; CI: 1.20, 3.02; p < 0.01; i² = 78%) but not theory-informed studies (-0.63 ml kg^-1 min^-1; CI: -1.55, 0.30; p = 0.18; i² = 0%). Longer-term follow-ups ranged from 24 weeks to 13 years, with significant positive effects for measured VO_2max (2.84 ml kg^-1 min^-1; CI: 1.41, 4.27; p < 0.01; i² = 0%). Effective intervention components included the combination of self-monitoring with a goal, and exercise sessions onsite or nearby. The findings of this review were limited by the number and quality of theory-informed studies presenting some outcomes, and confounding issues in complex interventions. Future researchers should consider rigorous testing of outcomes of theory-informed workplace physical activity interventions and incorporate longer follow-ups.

Physiological and Perceived Exertion Responses during Exercise: Effect of β-blockade

PURPOSE

This study investigated the effect of β-blockade on physiological and perceived exertion (RPE) responses during incremental treadmill exercise.

METHODS

Sixteen healthy participants (n = 8 men; age, 25.3 ± 4.6 yr) performed a maximal treadmill exercise test after ingestion of 100 mg metoprolol or placebo, with a double-blind, randomized, and counterbalanced design. Heart rate (HR), ventilatory, and gas exchange variables were measured continuously, and participants reported RPE at the end of each minute. Physiological and RPE responses during each condition were compared at the ventilatory threshold (VT), respiratory compensation point, and at maximal exercise using repeated-measures ANOVA. Linear regression modeled relationships between perceived exertion and physiological variables.

RESULTS

The HR and V˙O2 at the VT, respiratory compensation point, and maximal exercise were all significantly lower after β-blockade (P < 0.05). However, when standardized to within condition peak values, differences were no longer significant. The RPE associated with VT was higher after β-blockade (12.9 ± 1.0 vs 12.3 ± 1.2, P < 0.05) but lower at maximal exercise (19.1 ± 0.6 vs 19.4 ± 0.5, P < 0.05). Increases in RPE relative to HR were greater after β-blockade and remained significant when expressed relative to peak HR. There was no difference in the growth of the relationship between RPE and V˙O2 across conditions, although the origin of the relationship was higher with β-blockade.

CONCLUSIONS

Although β-blockade resulted in a significant reduction in exercising HR and V˙O2, the RPE for a given relative intensity remained unchanged. The relationship between RPE and V˙O2 was not affected by β-blockade. The results provide evidence that RPE is a useful and reliable measure for exercise testing and prescription in patients prescribed β-blockade therapy.

A Case Study of Exercise Adherence during Stereotactic Ablative Radiotherapy Treatment in a Previously Active Male with Metastatic Renal Cell Carcinoma

Stereotactic Ablative Radiotherapy (SABR) is increasingly replacing thoracotomy for resection of lung cancers and oligometastatic lung lesions but it is not known whether exercise can be maintained during SABR, the major side-effect of which is fatigue. This case study describes a 57-year-old male who exercised regularly (above American College of Sports Medicine minimum weekly exercise guidelines) and continued to exercise during SABR for a renal cell metastasis in his left lung. His exercise program included 5x60-minute moderate intensity aerobic exercise sessions and 3x45-minute resistance exercise sessions per week for 12 weeks post-treatment. Cardiorespiratory fitness and strength, as well as self-reported fatigue, depression, anxiety, physical wellbeing and sleep quality were assessed at baseline and fortnightly. Exercise adherence was 98% and no adverse events occurred. Fatigue was elevated from Weeks 2-8, which adversely impacted exercise intensity perception. Minimal changes were observed in cardiorespiratory fitness, depression, anxiety and sleep quality, but strength decreased, and physical wellbeing was improved above baseline levels. This is the first reported clinical case of exercise during SABR for a lung carcinoma. The data suggest that exercise may be feasible for patients undergoing SABR and may improve physical wellbeing. Larger controlled studies are needed to confirm these findings.

Perceived Facilitators and Barriers in Response to a Walking Intervention in Rural Cancer Survivors: A Qualitative Exploration

Physical activity has numerous associated benefits for cancer survivors. Compared to their urban counterparts, rural and remote Australians experience a health disadvantage, including poorer survival rate after the diagnosis of cancer. The purpose of this qualitative study was to (a) investigate factors that motivated or inhibited walking in rural participants during a 12-week intervention and (b) to investigate factors that motivated or inhibited physical activity behavior change three months post-intervention. Ten cancer survivors living in rural areas of South Australia participated in a 12-week computer-delivered walking-based intervention during which they reported daily steps, daily affect, and ratings of perceived exertion. Based on this information, individualized daily step goals were sent to them to increase walking. Following the intervention, participants engaged in face-to-face semi-structured interviews. Interviews were recorded, transcribed and coded using thematic analysis. Participants identified a range of physical, psychological, social, environmental, and organizational motivators and barriers. Participants appreciated the monitoring and support from the research team, but some voiced a need for better transition to post-program and many desired ongoing support to maintain their motivation. Future studies should incorporate strategies to help walking behavior to become more intrinsically motivated and therefore sustained.

Exercise physiology in aged care: Perceptions and acceptability from the perspectives of family members and care staff in the residential aged care environment

As we age, maintaining physical functionality is important with respect to wellbeing and healthy ageing. For older adults with dementia this may be difficult, particularly in the residential aged care environment. This article reports the qualitative examination of an Exercise Physiologist-delivered exercise programme for residents with dementia. Perspectives related to the perceived impact and acceptability of the programme, as well as barriers to implementation, and delivery of exercise to residents, were sought from family members and care staff through semi-structured interviews. Benefits related to physical and social factors were identified, and perceptions related to who might benefit from exercise were changed as a result of observing residents participate in the programme. These findings support the notion that an Exercise Physiologist-delivered exercise programme, with a person-centred approach, can contribute to improved functionality for residents with dementia

Development of a Self-Determination Theory-Based Physical Activity Intervention for Aged Care Workers: Protocol for the Activity for Well-being Program

Despite the well-established benefits of regular participation in physical activity, many Australians still fail to maintain sufficient levels. More self-determined types of motivation and more positive affect during activity have been found to be associated with the maintenance of physical activity behaviour over time. Need-supportive approaches to physical activity behaviour change have previously been shown to improve quality of motivation and psychological well-being. This paper outlines the development of a need-supportive, person-centred physical activity program for frontline aged-care workers. The program emphasises the use of self-determined methods of regulating activity intensity (affect, rating of perceived exertion and self-pacing) and is aimed at increasing physical activity behaviour and psychological well-being. The development process was undertaken in six steps using guidance from the Intervention Mapping framework: (i) an in-depth needs assessment (including qualitative interviews where information was gathered from members of the target population); (ii) formation of change objectives; (iii) selecting theory-informed and evidence-based intervention methods and planning their practical application; (iv) producing program components and materials; (v) planning program adoption and implementation, and (vi) planning for evaluation. The program is based in Self-Determination Theory (SDT) and provides tools and elements to support autonomy (the use of a collaboratively developed activity plan and participant choice in activity types), competence (action/coping planning, goal-setting and pedometers), and relatedness (the use of a motivational interviewing-inspired appointment and ongoing support in activity).

Predicting Engagement With Online Walking Promotion Among Metropolitan and Rural Cancer Survivors

BACKGROUND

Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer.

OBJECTIVE

The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change.

METHODS

This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program.

RESULTS

An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy.

CONCLUSIONS

The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention.

IMPLICATIONS FOR PRACTICE

Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.

Effect of a 12-Week Online Walking Intervention on Health and Quality of Life in Cancer Survivors: A Quasi-Randomized Controlled Trial

Cancer survivors are at an increased risk of experiencing physical and psychological ill-effects following cancer treatment. Rural cancer survivors are at a greater risk of future health problems following a cancer diagnosis compared to their urban counterparts. Physical activity has been targeted as a health promotion priority in cancer survivors. Research indicates that a large portion of cancer survivors do not meet physical activity recommendations. The purpose of this quasi-randomized controlled trial was to test the effectiveness of an online 12-week walking intervention designed for cancer survivors, and to explore its impact on physical health indicators and quality of life outcomes. Steps Toward Improving Diet and Exercise among cancer survivors (STRIDE) is an online resource designed according to Social Cognitive Theory and Self Determination Theory, based on individualized step goal setting. Measures of physiology, physical fitness, and quality of life were taken at the baseline, post-intervention, and three-month follow-up in an Intervention group (n = 46) and active Control group (n = 45). The Control group was provided with a pedometer but did not have access to the online program. Three-factor repeated measures ANOVAs indicated that there were improvements in physical fitness (p < 0.01), systolic blood pressure (p < 0.01), diastolic blood pressure (p < 0.01), waist girth (p < 0.01), mental health (p < 0.05), social functioning (p < 0.01), and general health (p < 0.01), but an increase in bodily pain (p < 0.01), from the baseline to week 12 and the three-month follow-up, irrespective of group allocation. Pedometer interventions, delivered with or without online support and step goal setting, show promise for improving the overall health of cancer survivors, at least in the short term.

What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis

OBJECTIVE

Assess the role of exercise intensity on changes in cardiorespiratory fitness (CRF) in patients with cardiac conditions attending exercise-based cardiac rehabilitation.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO and Web of Science.

ELIGIBILITY CRITERIA FOR SELECTION

Studies assessing change in CRF (reported as peak oxygen uptake; V̇O_2peak) in patients post myocardial infarction and revascularisation, following exercise-based cardiac rehabilitation. Studies establishing V̇O_2peak via symptom-limited exercise test with ventilatory gas analysis and reported intensity of exercise during rehabilitation were included. Studies with mean ejection fraction <40% were excluded.

RESULTS

128 studies including 13 220 patients were included. Interventions were classified as moderate, moderate-to-vigorous or vigorous intensity based on published recommendations. Moderate and moderate-to-vigorous-intensity interventions were associated with a moderate increase in relative V̇O_2peak (standardised mean difference±95% CI=0.94±0.30 and 0.93±0.17, respectively), and vigorous-intensity exercise with a large increase (1.10±0.25). Moderate and vigorous-intensity interventions were associated with moderate improvements in absoluteV̇O_2peak (0.63±0.34 and 0.93±0.20, respectively), whereas moderate-to-vigorous-intensity interventions elicited a large effect (1.27±0.75). Large heterogeneity among studies was observed for all analyses. Subgroup analyses yielded statistically significant, but inconsistent, improvements in CRF.

CONCLUSION

Engagement in exercise-based cardiac rehabilitation was associated with significant improvements in both absolute and relative V̇O_2peak. Although exercise of vigorous intensity produced the greatest pooled effect for change in relative V̇O_2peak, differences in pooled effects between intensities could not be considered clinically meaningful.

REGISTRATION

Prospero CRD42016035638.

Comparison of two low-fat diets, differing in protein and carbohydrate, on psychological wellbeing in adults with obesity and type 2 diabetes: a randomised clinical trial

Background

Although higher-protein diets (HP) can assist with weight loss and glycemic control, their effect on psychological wellbeing has not been established. The objective of this study was to compare the effects of a HP and a higher-carbohydrate diet (HC), combined with regular exercise, on psychological wellbeing both during weight loss (WL) and weight maintenance phases (WM).

Methods

In a parallel RCT, 61 adults with T2D (mean ± SD: BMI 34.3 ± 5.1 kg/m², aged 55 ± 8 years) consumed a HP diet (29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%), with moderate intensity exercise, for 12 weeks of WL and 12 weeks of WM. Secondary data evaluating psychological wellbeing was assessed using: Problems Areas in Diabetes (PAID); Diabetes-39 Quality of Life (D-39); Short Form Health Survey (SF-36); Perceived Stress Scale-10 (PSS-10) and the Leeds Sleep Evaluation Questionnaire (LSEQ) at Weeks 0, 12 and 24 and evaluated with mixed models analysis.

Results

Independent of diet, improvements for PAID; D-39 diabetes control; D-39 severity of diabetes; SF-36 physical functioning and SF-36 general health were found following WL (d = 0.30 to 0.69, P ≤ 0.04 for all) which remained after 12 weeks of WM. SF-36 vitality improved more in the HP group (group x time interaction P = 0.03). Associations were seen between HbA1c and D-39 severity of diabetes rating (r = 0.30, P = 0.01) and SF-36 mental health (r = − 0.32, P = 0.003) and between weight loss and PAID (r = 0.30, P = 0.01).

Conclusion

Several improvements in diabetes-related and general psychological wellbeing were seen similarly for both diets following weight loss and a reduction in HbA1c with most of these improvements remaining when weight loss was sustained for 12 weeks. A HP diet may provide additional increases in vitality.

Trial registration

The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000008729) on 4 January 2013.

Reductions in food cravings are similar with low-fat weight loss diets differing in protein and carbohydrate in overweight and obese adults with type 2 diabetes: A randomized clinical trial

Food cravings are common in type 2 diabetes (T2D). Higher-protein diets are effective in improving satiety but their effect on cravings is unclear. It was hypothesized that a high protein (HP) diet would provide greater reductions in cravings than an isocaloric higher-carbohydrate diet (HC). In a randomized controlled trial, 61 adults (54% males) with T2D (means ± SD: BMI 34.3 ± 5.1 kg/m²; aged 55 ± 8 years) consumed either a HP diet (mean across study: 29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%) for 12-weeks each of weight loss (WL) and weight maintenance (WM). The Food Craving Inventory (FCI), measuring types of foods craved and the General Food Craving Questionnaires measuring traits (G-FCQ-T) and states (G-FCQ-S) were assessed at Weeks 0, 12 and 24. Weight changes were similar between groups (means ± SEM: WL: -7.8 ± 0.6 kg, WM: -0.6 ± 0.4 kg). No group effects or group x time interactions were found for any outcome (P ≥ .07). Independent of group, all food cravings (except carbohydrates) and G-FCQ-T subscales decreased over the 24-week study (P ≤ .04) with sweets and fast food cravings, loss of control and emotional cravings reducing following WL (P ≤ .03). Obsessive preoccupation with food decreased following both phases (WL: P = .03; WM: P = .001). Weight was associated with several FCI subscales (r ≥ 0.24, P ≤ .04). In conclusion, both the HP and HC diets provided significant reductions in food cravings after similar weight losses which were maintained when weight was stabilized.

Associations of physical activity and sedentary behaviour with metabolic syndrome in rural Australian adults

OBJECTIVES

Associations between objectively measured sedentary behaviour, physical activity (PA) and metabolic syndrome (MetS)-classified using three different definitions were investigated in an inactive sample of rural Australian adults.

DESIGN

Quantitative, cross-sectional.

METHODS

171 adults (50.7±12.4years) from two rural South Australian regions underwent seven-day accelerometer activity monitoring and MetS classification using the National Cholesterol Education Program, the International Diabetes Federation and the Harmonized definitions. Associations between sedentary and activity variables and MetS (adjusted for age, sex, diet and smoking status) were modelled using logistic regression. In secondary modelling, associations of sedentary and activity outcomes for each MetS definition were assessed, adjusting for other activity and sedentary variables. Prediction differences across the definitions of MetS were directly compared using Akaike's Information Criterion.

RESULTS

Sedentary behaviour increased MetS risk, whereas light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) reduced MetS risk, irrespective of definition. In secondary models, LPA predicted MetS independently of MVPA and total sedentary time. Time spent in sedentary bouts (>30min) predicted MetS independently of MVPA and the number of sedentary bouts predicted MetS independently of LPA and MVPA. Prediction differences for MetS definitions failed to reach the critical threshold for difference (>10).

CONCLUSIONS

This study highlights the importance of sedentary behaviour and LPA on the prevalence of MetS in an inactive sample of rural Australian adults. Studies assessing the efficacy of increasing LPA on MetS in this population are needed. Minimal predictive differences across the three MetS definitions suggest evidence from previous studies can be considered cumulative.

Converting between estimates of moderate-to-vigorous physical activity derived from raw accelerations measured at the wrist and from ActiGraph counts measured at the hip: the Rosetta Stone

The ability to compare published group-level estimates of objectively measured moderate-to-vigorous physical activity (MVPA) across studies continues to increase in difficulty. The objective of this study was to develop conversion equations and demonstrate their utility to compare estimates of MVPA derived from the wrist and hip. Three studies of youth (N = 232, 9-12yrs, 50% boys) concurrently wore a hip-worn ActiGraph and a wrist-worn GENEActiv for 7-days. ActiGraph hip count data were reduced using four established cutpoints. Wrist accelerations were reduced using the Hildebrand MVPA 200 mg threshold. Conversion equations were developed on a randomly selected subsample of 132 youth. Equations were cross-validated and absolute error, absolute percent error, and modified Bland-Altman plots were evaluated for conversion accuracy. Across equations R²_adj was 0.51-0.56 with individual-level absolute error in minutes ranging from 7 (wrist-to-hip Puyau) to 14.5 minutes (wrist-to-hip Freedson 3MET) and absolute percent differences ranging from 13.9%-24.5%. Group-level cross-validation to convert hip-to-wrist MVPA resulted in average absolute percent errors ranging from 3.1%-4.9%. Conversion of wrist-to-hip MVPA resulted in average absolute percent errors ranging from 3.0%-10.0%. We recommend the use of these equations to compare published estimates of MVPA between the wear-site cut-point combinations presented.

Exergaming: Feels good despite working harder

Strategies to encourage exercise have led to research on cycle ergometer ‘exergaming’, as a means of enhancing exercise enjoyment. This research has typically prescribed the exercise intensity and used one exercise mode. The aim of this study was to compare self-selected exercise intensity on a cycle ergometer with and without exergaming modes activated. A total of 20 participants aged between 18–40 years (M = 24.2 ± 5.9) completed a sub-maximal exercise test. Participants returned two days later to complete one 45 minute session of self-selected exercise with 15 minutes in each of ‘control’ (standard ergometer), ‘track’, and ‘game’ modes, with order randomized. Heart rate, work rate, perceived exertion, and affective valence were recorded during exercise. Dissociation and enjoyment were recorded in the rest interval between each mode. Participants exercised above ventilatory threshold (VT) in all three modes (track, M = 9.5 ± 12%; game, M = 6.2 ± 12%; and control, M = 4.4 ± 14% above VT) and at higher work rates (P < 0.05) exergaming (track, M = 94.5 ± 27.9; game, M = 96.2 ± 32.8 watts) than control (M = 86.6 ± 26.5 watts). Despite exercising at a higher intensity, participants perceived exercise during the exergaming modes to be most pleasant (P < 0.01), with greater enjoyment (P < 0.01) and dissociation (P < 0.01) in the game than track mode, and both modes higher on these variables than the control mode. Findings support the use of exergaming as a strategy to encourage individuals to exercise, with participants choosing to work harder physiologically, but reporting more positive psychological responses during and following the exercise.

Moving Forward with Backward Compatibility: Translating Wrist Accelerometer Data

PURPOSE

This study aimed to provide a means for calibrating raw acceleration data from wrist-worn accelerometers in relation to past estimates of children's moderate-to-vigorous physical activity (MVPA) from a range of cut points applied to hip-worn ActiGraph data.

METHODS

This is a secondary analysis of three studies with concurrent 7-d accelerometer wear at the wrist (GENEActiv) and hip (ActiGraph) in 238 children age 9-12 yr. The time spent above acceleration (ENMO) thresholds of 100, 150, 200, 250, 300, 350, and 400 mg from wrist acceleration data (≤5-s epoch) was calculated for comparison with MVPA estimated from widely used children's hip-worn ActiGraph MVPA cut points (Freedson/Trost, 1100 counts per minute; Pate, 1680 counts per minute; Evenson, 2296 counts per minute; Puyau, 3200 counts per minute) with epochs of ≤5, 15, and 60 s.

RESULTS

The optimal ENMO thresholds for alignment with MVPA estimates from ActiGraph cut points determined from 70% of the sample and cross validated with the remaining 30% were as follows: Freedson/Trost = ENMO 150+ mg, irrespective of ActiGraph epoch (intraclass correlation [ICC] ≥ 0.65); Pate = ENMO 200+ mg, irrespective of ActiGraph epoch (ICC ≥ 0.67); Evenson = ENMO 250+ mg for ≤5- and 15-s epochs (ICC ≥ 0.69) and ENMO 300+ mg for 60-s epochs (ICC = 0.73); Puyau = ENMO 300+ mg for ≤5-s epochs (ICC = 0.73), ENMO 350+ mg for 15-s epochs (ICC = 0.73), and ENMO 400+ mg for 60-s epochs (ICC = 0.65). Agreement was robust with cross-validation ICC = 0.62-0.71 and means within ∣7.8∣% ± 4.9% of MVPA estimates from ActiGraph cut points, except Puyau 60-s epochs (ICC = 0.42).

CONCLUSION

Incremental ENMO thresholds enable children's acceleration data measured at the wrist to be simply and directly compared, at a group level, with past estimates of MVPA from hip-worn ActiGraphs across a range of cut points.

Inter- and Intra-rater Reliability of the Athletic Ability Assessment in Subelite Australian Rules Football Players

Rogers, DK, McKeown, I, Parfitt, G, Burgess, D, and Eston, RG. Inter- and intra-rater reliability of the athletic ability assessment in subelite Australian rules football players. J Strength Cond Res 33(1): 125-138, 2019-The aim of this study was to determine the inter- and intra-rater rater reliability of the Athletic Ability Assessment (AAA) in subelite Australian Rules football (ARF) players. Eighteen male ARF players completed the AAA movement assessment (overhead squat, double lunge [left and right], single-leg Romanian deadlift [left and right], chin-up and push-up), on 2 occasions separated by 1 week. During the first movement assessment, players were filmed in the frontal and sagittal planes. Ten raters took part in the study (1 experienced rater and 9 novices) and were assigned in a quasirandom manner, to complete either (a) real-time assessment on 2 occasions, (b) real-time assessment on 1 occasion, or (c) video-based assessment on 2 occasions. When assessed in real-time, of the 7 component movements of the AAA, raters registered moderate or greater intrarater agreement on between 2 and 5 occasions. Intraclass correlation coefficients (ICCs) of between 0.50 and 0.61 for the AAA total score indicated poor real-time intrarater reliability for this variable. When assessed by video-recording, raters registered moderate or greater intrarater agreement on between 6 and 7 occasions. The ICC for total score ranged between 0.60 and 0.93. Overall poor interrater reliability was evident for AAA component movements regardless of whether it was assessed in real-time or from video. Findings suggest the AAA is most reliably used when assessed through video. It is recommended that if comparison between multiple raters is desired, a stringent training process be applied so that the interpretation of AAA scoring criteria is standardized across raters.

Prefrontal oxygenation and the acoustic startle eyeblink response during exercise: A test of the dual-mode model

The interplay between the prefrontal cortex and amygdala is proposed to explain the regulation of affective responses (pleasure/displeasure) during exercise as outlined in the dual-mode model. However, due to methodological limitations the dual-mode model has not been fully tested. In this study, prefrontal oxygenation (using near-infrared spectroscopy) and amygdala activity (reflected by eyeblink amplitude using acoustic startle methodology) were recorded during exercise standardized to metabolic processes: 80% of ventilatory threshold (below VT), at the VT, and at the respiratory compensation point (RCP). Self-reported tolerance of the intensity of exercise was assessed prior to, and affective responses recorded during exercise. The results revealed that, as the intensity of exercise became more challenging (from below VT to RCP), prefrontal oxygenation was larger and eyeblink amplitude and affective responses were reduced. Below VT and at VT, larger prefrontal oxygenation was associated with larger eyeblink amplitude. At the RCP, prefrontal oxygenation was greater in the left than right hemisphere, and eyeblink amplitude explained significant variance in affective responses (with prefrontal oxygenation) and self-reported tolerance. These findings highlight the role of the prefrontal cortex and potentially the amygdala in the regulation of affective (particularly negative) responses during exercise at physiologically challenging intensities (above VT). In addition, a psychophysiological basis of self-reported tolerance is indicated. This study provides some support of the dual-mode model and insight into the neural basis of affective responses during exercise.

Validity of a perceptually-regulated step test protocol for assessing cardiorespiratory fitness in healthy adults

PURPOSE

To determine whether maximal oxygen uptake (VO₂max) could be predicted accurately and reliably from a 2-step, perceptually-regulated exercise test (PRET) in healthy adults.

METHODS

Sixteen participants (31.7 ± 11.3 years, 3 females) completed three PRETs (separated by 24-72 h) and one maximal, perceptually-regulated, graded exercise test (PRETmax) on a motorized treadmill. Oxygen uptake (VO₂) and heart rate (HR) were recorded during each test. VO₂ values for RPE range 9-15 were extrapolated to RPE 20 and age-predicted maximal HR (HRmax) using individual linear regression analysis to predict VO₂max values compared to measured VO₂max.

RESULTS

VO₂ and HR values were consistent between each of four RPE levels of the PRET. ICC values ranged between 0.76 and 0.85. Predicted VO₂max from both methods were lower than measured VO₂max (p < 0.01). Limits of agreement (LoA) for measured (41.4 ± 5.3 ml kg^-1 min^-1) versus predicted VO₂max from each of the three PRETs using RPE20 were -1.2 ± 15.6, -1.0 ± 7.2 and -2.1 ± 5.5 and for HRmax were -1.8 ± 4.2; -2.6 ± 4.2 and -2.4 ± 4.4 ml kg^-1 min^-1 for PRET 1, 2 and 3, respectively.

CONCLUSIONS

The step PRET elicited significant and reliable increases in VO₂ across the four RPE levels, but under-estimated treadmill VO₂max. However, there was better agreement between measured and predicted VO₂max when extrapolated to HRmax. As evidence indicates the underestimation of VO₂max is explained by the difference in the mode of exercise, the step PRET provides a simple and convenient test of cardiorespiratory fitness.

The Effect of Prescribed and Preferred Intensity Exercise on Psychological Affect and the Influence of Baseline Measures of Affect

This study compared the effects of 20 minutes of treadmill exercise at a prescribed intensity exercise (65% VO2max) and a preferred intensity exercise on psychological affect and exercise enjoyment in aerobically fit individuals. Affect was measured before exercise, at 5-minute intervals during exercise and 5 minutes post-exercise. Heart rate, ratings of perceived exertion (RPE) and enjoyment were also measured during each session. Results indicated that there was no difference in psychological affect or enjoyment between the two exercise sessions, although work rate was higher in the preferred condition. However, pre-exercise values of affect played an influential role in the affective response to exercise. These results suggest that allowing fit individuals to select their own exercise intensity may be more beneficial physiologically and psychologically.

Accelerometer wear-site detection: When one site does not suit all, all of the time

OBJECTIVES

Choice of accelerometer wear-site may facilitate greater compliance in research studies. We aimed to test whether a simple method could automatically discriminate whether an accelerometer was worn on the hip or wrist from free-living data.

DESIGN

Cross-sectional.

METHODS

Twenty-two 10-12y old children wore a GENEActiv at the wrist and at the hip for 7-days. The angle between the forearm and the total acceleration vector for the wrist-worn monitor and between the pelvis and the total acceleration vector for the hip-worn monitor (i.e. the angle between the Y-axis component of the acceleration and the total acceleration vector) was calculated for each 5s epoch. The standard deviation of this angle (SDangle) was calculated over time for the wrist-worn and hip-worn monitor for windows of varying lengths. We hypothesised that the wrist angle would be more variable than the hip angle.

RESULTS

Wear site could be discriminated based on SDangle; the shorter the time window the lower the optimal threshold and Area under the Receiver-Operating-Characteristic curve (AUROC) for discrimination of wear-site (AUROC=0.833 (1min) - 0.952 (12h)). Classification accuracy was good for windows of 8min (sensitivity=90%, specificity=87%, AUROC=0.92) and plateaued for windows of ≥60min (sensitivity and specificity >90%, AUROC=0.95-0.96).

CONCLUSIONS

We have presented a robust, computationally simple method that detects whether an accelerometer is being worn on the hip or wrist from 8 to 60min of data. This facilitates the use of wear-site specific algorithms to analyse accelerometer data.

Effects of Low-Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors during Weight Loss and Weight Maintenance in Obese Adults with Type 2 Diabetes

Despite evidence for the benefits of higher-protein (HP) diets in weight loss, their role in type 2 diabetes mellitus (T2DM) management and weight maintenance is not clear. This randomised study compared the effects of a HP diet (38% carbohydrate, 30% protein, 29% fat) to a isocaloric higher-carbohydrate diet (HC: 53%:21%:23%) on cardiometabolic risk factors for 12 weeks in energy restriction (~30% reduction) followed by 12 weeks of energy balance whilst performing regular exercise. Outcomes were measured at baseline and the end of each phase. Sixty-one overweight/obese adults (BMI (body mass index) 34.3 ± 5.1 kg/m², aged 55 ± 8 years) with T2DM who commenced the study were included in the intention-to-treat analysis including the 17 participants (HP n = 9, HC n = 8) who withdrew. Following weight loss (M ± SEM: −7.8 ± 0.6 kg), there were significant reductions in HbA1c (−1.4% ± 0.1%, p < 0.001) and several cardiometabolic health risk factors. Improvements were sustained for 12 weeks when weight was stabilised and weight loss maintained. Both the HP and HC dietary patterns with concurrent exercise may be effective strategies for weight loss and weight maintenance in T2DM although further studies are needed to determine the longer term effects of weight maintenance.

A comparison of head motion and prefrontal haemodynamics during upright and recumbent cycling exercise

The aim of this observational study was to compare head motion and prefrontal haemodynamics during exercise using three commercial cycling ergometers. Participants (n = 12) completed an incremental exercise test to exhaustion during upright, recumbent and semi-recumbent cycling. Head motion (using accelerometry), physiological data (oxygen uptake, end-tidal carbon dioxide [P_ET CO₂ ] and heart rate) and changes in prefrontal haemodynamics (oxygenation, deoxygenation and blood volume using near infrared spectroscopy [NIRS]) were recorded. Despite no difference in oxygen uptake and heart rate, head motion was higher and P_ET CO₂ was lower during upright cycling at maximal exercise (P<0·05). Analyses of covariance (covariates: head motion P>0·05; P_ET CO₂ , P<0·01) revealed that prefrontal oxygenation was higher during semi-recumbent than recumbent cycling and deoxygenation and blood volume were higher during upright than recumbent and semi-recumbent cycling (respectively; P<0·05). This work highlights the robustness of the utility of NIRS to head motion and describes the potential postural effects upon the prefrontal haemodynamic response during upright and recumbent cycling exercise.