Community-based exercise enhanced by a self-management programme to promote independent living in older adults: a pragmatic randomised controlled trial.

BACKGROUND: older adults face several modifiable barriers for engaging in physical activity (PA) programmes such as incontinence, loneliness and fear of falling. Enhancing PA programmes with behavioural components to support self-management of such barriers may increase the effectiveness to preserve functional capacity and independent living. OBJECTIVE: this study aimed at assessing the effects of a complex active lifestyle intervention (CALSTI) on objective and self-report measures of functional capacity and disability in community-dwelling older adults. SUBJECTS AND METHODS: about 215 older adults (79.9 ± 0.4 years) at increased risk of functional decline were randomly allocated to (i) CALSTI consisting of 12-weeks progressive explosive resistance training (24 sessions) enhanced by a 24-week multi-factorial self-management programme (8 sessions), or (ii) an extended version of the self-management intervention (SEMAI; 12 sessions) to reflect a reinforcement of usual care. The interventions were embedded in a nationally regulated preventive care pathway. Blinded assessors collected primary (the Short Physical Performance Battery; SPPB) and secondary outcome data (self-reported difficulty in activities of daily living, the short version of the Late-Life Function and Disability Index, and the EQ-health VAS scale) at baseline and after 12 and 24 weeks. RESULTS: after 24 weeks, CALSTI led to a clinically superior increase in SPPB compared with SEMAI (+0.77 points, P < 0.01), and the CALSTI group also demonstrated improvements in selected self-reported outcomes. CONCLUSIONS: a novel complex exercise and multi-factorial self-management intervention embedded in preventive care practice had large and clinically meaningful effects on a key measure of functional capacity and predictor of disability.

Implementing community-based health promotion in socio-economically disadvantaged areas: a qualitative study.

BACKGROUND: There is a gradient relationship between socio-economic status and health. We investigated the views and perceptions of health promotion service providers regarding factors that affect lack of engagement in public health initiatives by residents in socio-economically disadvantaged (SED) communities. METHODS: We conducted semi-structured interviews with a purposive sample of key providers (n = 15) of community-based health promotion services to elicit their views about engagement-related factors and their experiences of the provision, delivery and impact of health promotion in SED areas. Interviews were analysed using thematic analysis. RESULTS: Failure to (i) recognise within SED communities, socio-cultural norms of health-related behaviour and (ii) communicate to local residents an understanding of complex lifestyle influences appeared to affect adversely service engagement and contribute to the development of negative attitudes towards health promotion. Engagement is more likely when services are delivered within familiar settings, peer support is available, initiatives are organized within existing groups, external incentives are offered and there are options regarding times and locations. Collaborative working between providers and communities facilitates efficient, context-sensitive service delivery. CONCLUSIONS: Knowledge of a local community and its socio-environmental context alongside a collaborative, facilitative and tailored approach to delivery are required to ensure successful engagement of SED communities in health promotion.

Interventions promoting active transport to school in children: A systematic review and meta-analysis.

The systematic review investigated the effectiveness of active travel (AT) interventions on physical activity and fitness in primary school children. The review assessed intervention effectiveness, design, complexity, and study quality. Searches were conducted in five databases on 30/08/2018. Studies with an AT intervention compared to an inactive control, in 4 to 11 year olds, measuring AT or fitness outcomes were included. Two-stage screening identified relevant studies. Relevant data were extracted using Cochrane Extraction Form, Quality Assessment Tool for Quantitative Studies, Active Living by Design model, and intervention Complexity Assessment Tool for Systematic Reviews. Meta-analysis and Cohen's D effect size assessed effectiveness. Seventeen eligible studies were included. Effectiveness assessment found a statistically significant standardised mean difference (SMD) in AT outcomes in favour of the intervention (continuous AT - SMD 0.78 (CI 0.11-1.46); frequency AT - SMD 1.87 (CI 0.88-2.86)). Cohen's D calculation concurred with this finding. Fifteen studies had SMD favouring the intervention - two studies had SMD favouring the control. Sixteen studies received a weak quality rating - one study rated moderate. Active travel shows promise in increasing physical activity in primary school children. The review found walking school buses and educational strategies most effective for increasing relevant outcomes, although overall study quality was weak. Effect size did not associate with the complexity of an intervention, therefore supporting efforts to promote active travel through interventions may be easier to scale. Further intervention studies of greater methodological quality are necessary to confirm these findings due to the limited evidence available.

Addressing inequalities in physical activity participation: implications for public health policy and practice.

OBJECTIVE: To investigate the characteristics of those doing no moderate-vigorous physical activity (MVPA) (0 days/week), some MVPA (1-4 days/week) and sufficient MVPA (≥ 5 days/week) to meet the guidelines in order to effectively develop and target PA interventions to address inequalities in participation. METHOD: A population survey (2010/2011) of 4653 UK adults provided data on PA and socio-demographic characteristics. An ordered logit model investigated the covariates of 1) participating in no PA, 2) participating in some PA, and 3) meeting the PA guidelines. Model predictions were derived for stereotypical subgroups to highlight important policy and practice implications. RESULTS: Mean age of participants was 45 years old (95% CI 44.51, 45.58) and 42% were male. Probability forecasting showed that males older than 55 years of age (probability=0.20; 95% CI 0.11, 0.28), and both males (probability=0.31; 95% CI 0.17, 0.45) and females (probability=0.38; 95% CI 0.27, 0.50) who report poor health are significantly more likely to do no PA. CONCLUSIONS: Understanding the characteristics of those doing no MVPA and some MVPA could help develop population-level interventions targeting those most in need. Findings suggest that interventions are needed to target older adults, particularly males, and those who report poor health.

Unclean Cooking Fuel Use and Health Outcomes in Older Adults: Potential Mechanisms, Public Health Implications, and Future Directions.

BACKGROUND: Unclean cooking fuels (ie, polluting fuels including kerosene/paraffin, and solid fuels) are a major contributor to diseases and mortality, specifically in low- and middle-income countries. METHODS: This review aimed to identify potential mechanisms, public health implications, and future directions of unclean cooking fuel use and health outcomes in older adults. RESULTS: There is an expanding body of literature to demonstrate associations between unclean cooking fuel use and multiple mental and physical health outcomes in older adults. Two key mechanisms likely driving such associations include inflammation and oxidative stress. CONCLUSIONS: Considering that inflammation and oxidative stress have been implicated in multiple other health conditions (eg, arthritis and osteoporosis) in addition to those investigated to date on this topic it would be prudent to continue investigation of unclean cooking fuel use and with yet to be studied health outcomes. Moreover, future research is indeed now required to identify pathways to eliminating unclean cooking fuel globally to better the health of an aging global population and to support the implementation of Sustainable Development Goal 7.

Functional management of ankle sprains: what volume and intensity of walking is undertaken in the first week postinjury.

BACKGROUND: Acute ankle sprains are usually managed functionally, with advice to undertake progressive weight-bearing and walking. Mechanical loading is an important modular of tissue repair; therefore, the clinical effectiveness of walking after ankle sprain may be dose dependent. The intensity, magnitude and duration of load associated with current functional treatments for ankle sprain are unclear. AIM: To describe physical activity (PA) in the first week after ankle sprain and to compare results with a healthy control group. METHODS: Participants (16-65 years) with an acute ankle sprain were randomised into two groups (standard or exercise). Both groups were advised to apply ice and compression, and walk within the limits of pain. The exercise group undertook additional therapeutic exercises. PA was measured using an activPAL accelerometer, worn for 7 days after injury. Comparisons were made with a non-injured control group. RESULTS: The standard group were significantly less active (1.2 ± 0.4 h activity/day; 5621 ± 2294 steps/day) than the exercise (1.7 ± 0 .7 h/day, p=0.04; 7886 ± 3075 steps/day, p=0.03) and non-injured control groups (1.7 ± 0.4 h/day, p=0.02; 8844 ± 2185 steps/day, p=0.002). Also, compared with the non-injured control group, the standard and exercise groups spent less time in moderate (38.3 ± 12.7 min/day vs 14.5 ± 11.4 min/day, p=0.001 and 22.5 ± 15.9 min/day, p=0.003) and high-intensity activity (4.1 ± 6.9 min/day vs 0.1 ± 0.1 min/day, p=0.001 and 0.62 ± 1.0 min/day p=0.005). CONCLUSION: PA patterns are reduced in the first week after ankle sprain, which is partly ameliorated with addition of therapeutic exercises. This study represents the first step towards developing evidence-based walking prescription after acute ankle sprain.

GPs' perspectives regarding their sedentary behaviour and physical activity: a qualitative interview study.

BACKGROUND: General practice is a highly sedentary occupation, with many GPs spending more than 10.5 hours sitting each workday. This excessive sedentary behaviour and lack of physical activity (PA) is potentially detrimental to the health of GPs, as well as their ability to counsel patients regarding sedentary behaviour and PA. There is a lack of prior research examining the perspectives of GPs regarding their sedentary behaviour and PA. AIM: To explore GPs' perspectives regarding their sedentary behaviour and PA. DESIGN & SETTING: A qualitative interview study of GPs in Northern Ireland. METHOD: Semi-structured interviews were conducted with a purposive sample of 13 GPs who had previously taken part in a study to objectively measure their levels of sedentary behaviour and PA. Interview transcripts were analysed using deductive thematic analysis. The Theoretical Domains Framework (TDF) was used to facilitate identification of barriers and enablers affecting the ability of GPs to increase their PA. RESULTS: Key themes were categorised within six theoretical domains (environmental context and resources, social professional role and identity, goals, social influences, knowledge, and intentions) with sub-themes within each domain. CONCLUSION: Most GPs are unhappy with their current levels of sedentary behaviour and PA, and are concerned with how this is affecting their health. Numerous barriers and facilitators were identified affecting the ability of GPs to increase their PA, including working environment, and personal and professional responsibilities, among others. Addressing these could improve the health of GPs and their ability to counsel patients regarding sedentary behaviour and PA.

Exploration of sedentary behaviour among GPs: a cross-sectional study.

BACKGROUND: Sedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality. AIM: To explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs). DESIGN & SETTING: Sequential, cross-sectional design (initial online sedentary behaviour questionnaire and subsequent thigh-worn accelerometer substudy) of GPs and GPSTs in Northern Ireland. METHOD: Self-reported questionnaire data were aggregated and compared with device-measured accelerometry data. RESULTS: Data from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 hours, SD 2.97) than those in secondary care (7.9 hours, SD 3.43 [mean difference {MD} 2.43 hours; P<0.001]). An active workstation (for example, sit-stand desk), was used by 5.6% of participants in general practice, while 86.0% of those without one would consider using one in future. Active workstation users self-reported lower workday sedentary time (7.88 hours, SD 3.2) than non-users (10.47 hours, SD 2.88 [MD -2.58 hours, P = 0.001]). Accelerometer substudy participants underestimated their workday sedentary time by 0.17 hours (95% confidence interval [CI] = -1.86 to 2.20; P = 0.865), and non-workday sedentary time by 2.67 hours (95% CI = 0.99 to 4.35; P = 0.003). Most GPs (80.7%) reported increased workday sitting time compared to prior to the COVID-19 pandemic, while 87.0% would prefer less workday sitting time. CONCLUSION: GPs have high levels of workday sedentary time, which may be detrimental to their health. It is imperative to develop methods to address sedentary behaviour among GPs on workdays, both for their own health and the health of their patients.

How many steps/day are enough? For adults.

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day.

How many steps/day are enough? For older adults and special populations.

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities.

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults' use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.

The effect of different COVID-19 public health restrictions on mobility: A systematic review.

BACKGROUND: In response to the COVID-19 pandemic, most countries have introduced non-pharmaceutical interventions, such as stay-at-home orders, to reduce person-to-person contact and break trains of transmission. The aim of this systematic review was to assess the effect of different public health restrictions on mobility across different countries and cultures. The University of Bern COVID-19 Living Evidence database of COVID-19 and SARS-COV-2 publications was searched for retrospective or prospective studies evaluating the impact of COVID-19 public health restrictions on Google Mobility. Titles and abstracts were independently screened by two authors. Information from included studies was extracted by one researcher and double checked by another. Risk of bias of included articles was assessed using the Newcastle Ottowa Scale. Given the heterogeneous nature of the designs used, a narrative synthesis was undertaken. From the search, 1672 references were identified, of which 14 were included in the narrative synthesis. All studies reported data from the first wave of the pandemic, with Google Mobility Scores included from January to August 2020, with most studies analysing data during the first two months of the pandemic. Seven studies were assessed as having a moderate risk of bias and seven as a low risk of bias. Countries that introduced more stringent public health restrictions experienced greater reductions in mobility, through increased time at home and reductions in visits to shops, workplaces and use of public transport. Stay-at-home orders were the most effective of the individual strategies, whereas mask mandates had little effect of mobility. CONCLUSIONS: Public health restrictions, particularly stay-at-home orders have significantly impacted on transmission prevention behaviours. Further research is required to understand how to effectively address pandemic fatigue and to support the safe return back to normal day-to-day behaviours.

The Effect of Chair-Based Exercise on Physical Function in Older Adults: A Systematic Review and Meta-Analysis.

Physical activity is an important determinant of health in later life. The public health restrictions in response to COVID-19 have interrupted habitual physical activity behaviours in older adults. In response, numerous exercise programmes have been developed for older adults, many involving chair-based exercise. The aim of this systematic review was to synthesise the effects of chair-based exercise on the health of older adults. Ovid Medline, EMBASE, CINAHL, AMED, PyscInfo and SPORTDiscus databases were searched from inception to 1 April 2020. Chair-based exercise programmes in adults ≥50 years, lasting for at least 2 weeks and measuring the impact on physical function were included. Risk of bias of included studies were assessed using Cochrane risk of bias tool v2. Intervention content was described using TiDieR Criteria. Where sufficient studies (≥3 studies) reported data on an outcome, a random effects meta-analysis was performed. In total, 25 studies were included, with 19 studies in the meta-analyses. Seventeen studies had a low risk of bias and five had a high risk of bias. In this systematic review including 1388 participants, results demonstrated that chair-based exercise programmes improve upper extremity (handgrip strength: MD = 2.10; 95% CI = 0.76, 3.43 and 30 s arm curl test: MD = 2.82; 95% CI = 1.34, 4.31) and lower extremity function (30 s chair stand: MD 2.25; 95% CI = 0.64, 3.86). The findings suggest that chair-based exercises are effective and should be promoted as simple and easily implemented activities to maintain and develop strength for older adults.

Changes in physical activity predict changes in a comprehensive model of balance in older community-dwelling adults. A longitudinal analysis of the TILDA study.

OBJECTIVE: Falls due to poor balance can cause injury, disability, and death in older adults. The relationship between free-living physical activity (PA) and balance over time is poorly understood. The aim of this study is to explore the association between PA and balance in older adults over time. METHODS: Using two waves of data from the TILDA study (n=8,504 participants) a structural equation model was used to identify a composite measure of balance that incorporated measures of Timed Up and Go; handgrip strength; Mini Mental State Exam; vision; hearing; and steadiness. The patterns of change in PA and balance were then compared over time (controlling for covariates). RESULTS: The results showed that one extra metabolic equivalent of task (MET) minute of PA improves balance by 4% over one week (Est=-0.10, SE=0.12), and by 5% cumulatively over two years (Est=-0.13, SE=0.02). Medication, alcohol consumption, sex, age, fear of falling, education, pain, and problems performing activities of daily living (ADL) were risk factors for balance. CONCLUSION: This study provides a novel and robust model that should guide comprehensive balance assessment. PA promotion should engage older adults in more free-living PA that may be more relevant to them.

Same old song and dance: an exploratory study of portrayal of physical activity in television programmes aimed at young adolescents.

OBJECTIVE: Exposure to health-related behaviours on television has been shown to influence smoking and drinking in young people, but little research has been conducted on the portrayal physical activity. The aim of the current project was to explore the portrayal of physical activity in television programmes aimed specifically at adolescent females. Content analysis of 120 episodes of four popular adolescent television programmes was performed. Information on the type and context of physical activity, motivating factors and characters involved was recorded. RESULTS: Physical activity was portrayed 122 times, for a duration of 1 h and 31 min (3.2% of total viewing time). Physical activity was mainly portrayed as part of an informal activity as part of a group activity. Over half (53.2%) of scenes portrayed activity been carried out by teenagers. The types of activities portrayed were mostly of vigorous intensity (76.2%), for recreational purposes (78.7%) such as dancing (54.1%) and running (11.5%), and motivated by enjoyment. This study highlights that physical activity is portrayed infrequently, and often with a skewed representation of type of activity. There may be an opportunity to influence physical activity in young adolescents through the positioning of positive images of an active lifestyle in the media.

Shared decision-making (SHARE-D) for healthy behaviour change: a feasibility study in general practice.

BACKGROUND: Effective interventions are needed to support health behaviour change for cardiovascular disease (CVD) prevention. Decision tools encourage behaviour change but their effectiveness when used in shared decision-making with health professionals (HPs) is unknown. AIM: To test the feasibility of using a novel, paper-based tool for shared decision-making in initiating behaviour change. DESIGN & SETTING: A feasibility study in five general practices in Northern Ireland. METHOD: Adults with, or at high risk of, CVD were invited to discuss their diet and physical activity (PA) with an HP. Using a paper-based decision aid in shared decision-making about behaviour change, their capabilities, opportunities, and motivation were considered. Diet and PA were assessed at baseline, 1, and 3 months using the Dietary Instrument for Nutritional Education (DINE) and the Recent Physical Activity Questionnaire (RPAQ); accelerometers measured PA at baseline and 3 months. Semi-structured interviews, analysed thematically, explored participants' and HPs' views of the process. RESULTS: The positive response rate to study invitation was 28% (45/162); 23 were recruited (aged 43-74 years; 50% male; <40% met diet or PA recommendations); and 87% (20/23) completed the study. All interviewees valued the tool's structure, succinct content, and facilitation of discussion. HPs' sharing of relevant personal experience encouraged behaviour change; social responsibilities, health conditions, and beliefs restricted change. HPs' workloads prohibited the tool's routine use. CONCLUSION: Recruitment and completion rates suggest that using a novel, paper-based tool in shared decision-making for behaviour change is feasible. HPs' workloads constrain its use in practice, but qualitative findings indicate its potential value. Cross-sector collaborative exploration of sustainable models to promote behaviour change is needed.

Walk with Me: a protocol for a pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults.

BACKGROUND: Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those from lower socio-economic position, are also the most inactive. Increasing physical activity levels, particularly among those most inactive, is a public health priority. Peer-led physical activity interventions may offer a model to increase physical activity in the older adult population. This study aims to test the feasibility of a peer-led, multicomponent physical activity intervention in socio-economically disadvantaged community dwelling older adults. METHODS: The Medical Research Council framework for developing and evaluating complex interventions will be used to design and test the feasibility of a randomised controlled trial (RCT) of a multicomponent peer-led physical activity intervention. Data will be collected at baseline, immediately after the intervention (12 weeks) and 6 months after baseline measures. The pilot RCT will provide information on recruitment of peer mentors and participants and attrition rates, intervention fidelity, and data on the variability of the primary outcome (minutes of moderate to vigorous physical activity measured with an accelerometer). The pilot trail will also assess the acceptability of the intervention and identify potential resources needed to undertake a definitive study. Data analyses will be descriptive and include an evaluation of eligibility, recruitment, and retention rates. The findings will be used to estimate the sample size required for a definitive trial. A detailed process evaluation using qualitative and quantitative methods will be conducted with a variety of stakeholders to identify areas of success and necessary improvements. DISCUSSION: This paper describes the protocol for the 'Walk with Me' pilot RCT which will provide the information necessary to inform the design and delivery of a fully powered trial should the Walk with Me intervention prove feasible. TRIAL REGISTRATION: ISRCTN Number ISRCTN23051918. Date of registration, November 18, 2015.

"They should stay at their desk until the work's done": a qualitative study examining perceptions of sedentary behaviour in a desk-based occupational setting.

BACKGROUND: Workplace sedentary behaviour is a priority target for health promotion. However, little is known about how to effect change. We aimed to explore desk-based office workers' perceptions of factors that influenced sedentary behaviour at work and to explore the feasibility of using a novel mobile phone application to track their behaviours. METHODS: We invited office employees (n = 12) and managers (n = 2) in a software engineering company to participate in semi-structured interviews to explore perceived barriers and facilitators affecting workplace sedentary behaviour. We assessed participants' sedentary behaviours using an accelerometer before and after they used a mobile phone application to record their activities at self-selected time intervals daily for 2 weeks. Interviews were analysed using a thematic framework. RESULTS: Software engineers (5 employees; 2 managers) were interviewed; 13 tested the mobile phone application; 8 returned feedback. Major barriers to reducing workplace sedentary behaviour included the pressure of 'getting the job done', the nature of their work requiring sitting at a computer, personal preferences for the use of time at and after work, and a lack of facilities, such as a canteen, to encourage moving from their desks. Facilitators for reduced sedentariness included having a definite reason to leave their desks, social interaction and relief of physical and mental symptoms of prolonged sitting. The findings were similar for participants with different levels of overall physical activity. Valid accelerometer data were tracked for four participants: all reduced their sedentary behaviour. Participants stated that recording data using the phone application added to their day's work but the extent to which individuals perceived this as a burden varied and was counter-balanced by its perceived value in increasing awareness of sedentary behaviour. Individuals expressed a wish for flexibility in its configuration. CONCLUSIONS: These findings indicate that employers' and employees' perceptions of the cultural context and physical environment of their work, as well as personal factors, must be considered in attempting to effect changes that reduce workplace sedentary behaviour. Further research should investigate appropriate individually tailored approaches to this challenge, using a framework of behaviour change theory which takes account of specific work practices, preferences and settings.