Barriers and enablers of vigorous intermittent lifestyle physical activity (VILPA) in physically inactive adults: a focus group study.

BACKGROUND: Vigorous Intermittent Lifestyle Physical Activity (VILPA) refers to brief bouts of vigorous intensity physical activity performed as part of daily living. VILPA has been proposed as a novel concept to expand physical activity options among the least active. As a nascent area of research, factors which impede or encourage VILPA in physically inactive adults are yet to be explored. Such information is pertinent in the design of future interventions. We examined the barriers and enablers of VILPA among physically inactive adults using the Capability, Opportunity, Motivation, Behavior (COM-B) model as a conceptual framework. METHODS: We recruited a sample of self-identified physically inactive middle-aged and older adults (N = 78) based in Australia to take part in 19 online focus groups across three age groups: young-middle (age 35-44), middle (age 45-59) and old (age 60-76). We analyzed interviews using a critical realist approach to thematic analysis. Identified barriers and enablers were subsequently mapped onto the COM-B model components. RESULTS: The data generated 6 barriers and 10 enablers of VILPA that corresponded to COM-B concepts. Barriers included physical limitations (physical capability), perceptions of aging, need for knowledge (psychological capability), environmental constraints (physical opportunity), perceptions of effort and energy, and fear (automatic motivation). Enablers included convenience, reframing physical activity as purposeful movement, use of prompts and reminders (physical opportunity), normalization of taking the active option, gamification (social opportunity), sense of achievement, health improvements, personally salient rewards (reflective motivation), identity fit, and changing from effortful deliberation to habitual action (automatic motivation). CONCLUSION: The barriers and enablers of VILPA span capability, opportunity, and motivation beliefs. Promoting the time-efficient nature and simplicity of VILPA requiring no equipment or special gym sessions, the use of prompts and reminders at opportune times, and habit formation strategies could capitalize on the enablers. Addressing the suitability of the small bouts, the development of specific guidelines, addressing safety concerns, and explicating the potential benefits of, and opportunities to do, VILPA could ameliorate some of the barriers identified. Future VILPA interventions may require limited age customization, speaking to the potential for such interventions to be delivered at scale.

Feasibility of 'parkrun' for people with knee osteoarthritis: A mixed methods pilot study.

Objective: To investigate the feasibility of 'parkrun' for people with knee osteoarthritis (OA) and examine its potential to improve symptoms and increase physical activity. Design: This uncontrolled mixed methods pilot study enrolled people with knee OA not meeting physical activity guidelines. Participants were asked to walk in four consecutive parkrun events supervised by an exercise physiologist/physiotherapist. Feasibility was assessed by recruitment data (numbers screened and time to enrol 15 participants), adherence to the protocol, acceptability (measured by confidence, enjoyment, difficulty ratings and qualitative interviews), and safety (adverse events). Secondary measures were changes in knee pain, function, stiffness, and physical activity levels. Results: Participants (n â€‹= â€‹17) were enrolled over 11 months and recruitment was slower than anticipated. Fourteen participants attended all four parkruns and three of these participants shortened the 5 â€‹km course to ∼3 â€‹km. Across all four parkruns, 75% of participants reported high confidence that they could complete the upcoming parkrun and the majority (87%) enjoyed participating. Most participants rated parkrun either "slightly difficult" (38.5%) or "moderately difficult" (35%) and two mild adverse events were reported. Participants showed improvements in knee pain, function, stiffness, and physical activity levels. Conclusions: This pilot study demonstrates parkrun's feasibility, acceptability, safety and, its potential to improve knee OA symptoms and physical activity levels. Participating in parkrun was acceptable and enjoyable for some, but not all participants. The scalability, accessibility and wide appeal of parkrun supports the development of larger programs of research to evaluate the use of parkrun for people with knee OA.

Experiences of using very low energy diets for weight loss by people with overweight or obesity: a review of qualitative research.

Although very low energy diets (VLEDs) are the most successful non-surgical, non-pharmacological treatment for obesity, they are underutilized, and little is known about experiences of people using VLEDs for weight loss. This systematic review synthesizes qualitative studies investigating participants' experiences of undertaking a VLED composed of total meal replacement products to lose weight. Of the 4,911 articles screened, three studies met criteria for inclusion. Thematic synthesis was used to analyse the study findings. Health and appearance were the main motivators to use a VLED for weight loss. Adherence was facilitated by group support meetings, rapid weight loss and ease of use of the diet. Being part of a clinical trial gave a sense of accountability and further reason to adhere to a VLED, and the VLED itself was well accepted by users. Barriers to adherence, such as temptations and social occasions, were overcome by avoidance and distraction strategies. In conclusion, this qualitative synthesis of users' experiences of VLEDs shows that VLEDs are well accepted and positively viewed by users. More in-depth research could facilitate understanding of how this weight loss strategy influences the weight maintenance period, in order to facilitate better long-term results.

Assessing junk food consumption among Australian children: trends and associated characteristics from a cross-sectional study.

BACKGROUND: The ubiquitous supply of junk foods in our food environment has been partly blamed for the increased rates in overweight and obesity. However, consumption of these foods has generally been examined individually perhaps obscuring the true extent of their combined consumption and impact on health. An overall measure of children's junk food consumption may prove useful in the development of child obesity prevention strategies. We describe the development of a children's Junk Food Intake Measure (JFIM) to summarise temporal change in junk food consumption and examine the association between the JFIM and health-related behaviours. METHODS: Cross-sectional population surveillance survey of Australian children age 5-16 years collected in 2010 and 2015. Data were collected by questionnaire with parent's proxy reporting for children in years K, 2 and 4 and children in years 6, 8 and 10 by self-report. Information on diet, screen-time and physical activity was collected using validated questionnaires. The JFIM comprised consumption of fried potato products, potato crisps/salty snacks, sweet and savoury biscuits/cakes/doughnuts, confectionary and, ice cream/ice blocks. RESULTS: A total of 7565 (missing = 493, 6.1%) and 6944 (missing n = 611, 8.1%) children had complete data on consumption of junk foods, in 2010 and 2015, respectively. The 2015 survey data showed that among students from high socio-economic status neighbourhoods, there were fewer high junk food consumers than low junk food consumers. Children from Middle Eastern cultural backgrounds had higher junk food consumption. High junk food consumers were more likely to consume take-away ≥3/week, eat dinner in front of the television, receive sweet rewards, be allowed to consume snacks anytime, have soft drinks available at home and a TV in their bedroom. There was a lower proportion of high junk food consumers in 2015 compared to 2010. CONCLUSION: This is the first study to provide and examine a summary measure of overall junk food consumption among Australian children. The results indicate that junk food consumption among Australian children is lower in 2015, compared with 2010. Still, the public health workforce must continue their efforts as levels of junk food consumption remain of concern among Australian children.

Nutritional adequacy of diets for adolescents with overweight and obesity: considerations for dietetic practice.

BACKGROUND/OBJECTIVES: Adolescents have unique nutrient requirements due to rapid growth and development. High rates of obesity in adolescents require a variety of diet interventions to achieve weight loss under clinical supervision. The aim of this study is to examine the nutritional adequacy of energy-restricted diets for adolescents. SUBJECTS/METHODS: Three popular diets were modelled for 7 days and assessed by comparing the nutrient profile to the Australian Nutrient Reference Values. Three diets were: (1) a standard energy restricted diet based on current dietary guidelines; (2) a modified carbohydrate diet; and (3) a modified alternate day fasting diet. RESULTS: Initial modelling revealed limiting nutrients (that is, not meeting the recommended intakes) across the diets. Subsequent modelling was required to achieve nutritional adequacy for all three diets. The dietary guidelines diet design met most nutrient targets except essential fatty acids before subsequent modelling, however this diet also provided the highest energy (8.8 vs 8.0 MJ and 6.8 MJ for the modified carbohydrate and modified alternate day fasting diet, respectively). CONCLUSIONS: Energy-restricted diets need careful consideration to meet nutritional requirements of adolescents. A variety of eating patterns can be adapted to achieve nutritional adequacy and energy restriction, however health practitioners need to consider adequacy when prescribing diet interventions for weight loss during adolescence.

Evaluating the effectiveness of an Australian obesity mass-media campaign: how did the 'Measure-Up' campaign measure up in New South Wales?

In 2008, the Australian Government launched a mass-media campaign 'Measure-Up' to reduce lifestyle-related chronic disease risk. Innovative campaign messages linked waist circumference and chronic disease risk. Communication channels for the campaign included television, press, radio and outdoor advertising and local community activities. This analysis examines the impact of the campaign in the state of New South Wales, Australia. Cross-sectional telephone surveys (n = 1006 adults pre- and post-campaign) covered self-reported diet and physical activity, campaign awareness, knowledge about waist circumference, personal relevance of the message, perceived confidence to make lifestyle changes and waist-measuring behaviours. The campaign achieved high unprompted (38%) and prompted (89%) awareness. From pre- to post-campaign, knowledge and personal relevance of the link between waist circumference and chronic disease and waist measuring behaviour increased, although there were no significant changes in reported fruit and vegetable intake nor in physical activity. Knowledge of the correct waist measurement threshold for chronic disease risk increased over 5-fold, adjusted for demographic characteristics. 'Measure-Up' was successful at communicating the new campaign messages. Continued long-term investment in campaigns such as 'Measure-Up', supplemented with community-based health promotion, may contribute to population risk factor understanding and behaviour change to reduce chronic disease.

Age at first intercourse in an Australian national sample of technical college students.

OBJECTIVE: This study aims to broaden the current body of knowledge regarding the sexual behaviour of young Australians by examining the age and correlates of age of first intercourse in a national sample of Technical and Further Education apprentices. METHOD: In 1995, students at randomly selected technical colleges in Australia were surveyed on HIV-related issues. Questionnaires were administered to a stratified cluster sample of automotive, hairdressing and commercial cookery apprentices. Respondents were asked the age at which they first had heterosexual vaginal or anal intercourse. RESULTS: Of 4,055 respondents aged 15-24 years, 3,848 answered the question; 3,195 (83%) had had intercourse. Males and females did not differ significantly. Median age at first intercourse was 16 (range 12-23). In multivariate analysis, older age at first intercourse was associated with: greater age at interview; higher school education; church attendance; and State of residence. The model, however, accounted for only 14% of the variance in age at first intercourse. CONCLUSIONS AND IMPLICATIONS: In this sample, those apprentices who completed secondary school became sexually active later on average than those who left before the end of Year 10. For sex education to occur before sexual initiation, it needs to be offered in primary schools and the first year of high school (aged 11-13 years). Further, as technical college students are likely to initiate sex earlier than their age mates still at school, colleges may be in a position to take responsibility for the continuing sexual education of this group, especially for those students entering college at 15 or 16 years of age.

Sexuality education and young people's sexual behavior: a review of studies.

PIP: Sexuality education for children and young adults is one of the most heavily debated issues facing policy-makers, national AIDS program planners, and educators, provoking arguments over how explicit education materials should be, how much of it there should be, how often it should be given, and at what age instruction should commence. In this context, the World Health Organization's Global Program on AIDS' Office of Intervention Development and Support commissioned a comprehensive literature review to assess the effects of HIV/AIDS and sexuality education upon young people's sexual behavior. 52 reports culled from a search of 12 literature databases were reviewed. The main purpose of the review is to inform policy-makers, program planners, and educators about the impact of HIV and/or sexuality education upon the sexual behavior of youth as described in the published literature. Of 47 studies which evaluated interventions, 25 reported that HIV/AIDS and sexuality education neither increased nor decreased sexual activity and attendant rates of pregnancy and sexually transmitted diseases (STDs). 17 reported that HIV and/or sexuality education delayed the onset of sexual activity, reduced the number of sex partners, or reduced unplanned pregnancy and STD rates Only 3 studies found increases in sexual behavior associated with sexuality education. Inadequacies in study design, analytic techniques, outcome indicators, and the reporting of statistics are discussed.^ieng

Neuropsychological function in asymptomatic HIV-1 infection: methodological issues.

There have been conflicting reports as to whether significant neuropsychological deterioration occurs in asymptomatic HIV-1 infection. Comparisons among studies have been hindered by substantial variations in sample size, statistical methods, definitions of neuropsychological abnormality, and attention to potential confounding factors. In this study, the neuropsychological performance of 44 subjects with asymptomatic HIV-1 infection and 41 seronegative (SN) controls was compared using analysis of variance models. Rates of abnormality were also determined using commonly employed impairment criteria. The seropositive (SP) subjects performed comparably to SN controls once differences in full scale IQ were taken into account. Rates of abnormality for HIV-1 SP subjects were estimated at 10%, 17.5%, and 67.5% by three different criteria, and were not significantly different from the rates of the control group. The findings indicated that both premorbid characteristics, and the validity and biases of definitions of impairment should be examined and incorporated into the interpretation of study findings.

Young people and sex/HIV education: the debate continues....

The legal age of consent for heterosexual sex is 16 years. Large numbers of young people at school are sexually active. Indicators, such as sexually transmitted diseases, show that in spite of education programmes a large proportion of sexually active young people are practising unsafe sex. Access to anonymous sources of condoms such as vending machines would encourage and enable safe sex practices amongst youth.

Anxiety, depression and HIV related symptomatology across the spectrum of HIV disease.

Levels of anxiety and depression were assessed for 207 HIV seropositive homosexual/bisexual men (AIDS = 34, ARC = 72, asymptomatic HIV infection = 101), and 36 seronegative controls. Lymphocyte subset enumeration, history of opportunistic infections, and occurrence of HIV-related symptoms were recorded at the time of assessment. No differences between groups were found on age, educational level, state/trait anxiety or depression scores. Neither the number of symptoms reported, their duration, severity, frequency of occurrence, nor the proportion of patients who reported a specific symptom was different between the three HIV seropositive groups. Severity of anxiety and depression was related to the magnitude of symptomatology, but not associated with either degree of immunodeficiency, number of opportunistic infections or diagnostic group. Principal component analysis extracted five symptom factors (cognitive, affective, psychosocial, neurological and physical), none of which predicted state anxiety scores. However, affective and psychosocial symptom factors predicted trait anxiety and depression scores. The results indicate that ratings of anxiety and depression are independent of stage of HIV infection, may be in part mediated by constitutional and physical symptoms of HIV disease, but are primarily associated with the presence of psychological and psychosocial symptoms.

Changes in neuropsychological performance of AIDS-related complex patients who progress to AIDS.

OBJECTIVE: To investigate the changes in neuropsychological performance associated with progression from AIDS-related complex (ARC) to AIDS. DESIGN: A repeated measures design was used to compare three groups: ARC patients who progressed to AIDS (n = 15), those who did not (n = 19) and seronegative controls (n = 16). METHODS: The three groups were compared on tests of memory, information processing, motor performance, attention and conceptual flexibility. Clinical and immunological characteristics were recorded. Rates of neuropsychological impairment among the three groups were calculated and compared. RESULTS: The only significant difference between the groups at baseline was for one measure of motor performance. Repeated measures analysis indicated that there was a differential rate of change for the three subject groups for tasks of motor performance and attention. ARC patients who progressed to AIDS did not differ significantly from the non-progressors, although both groups showed significant deterioration over time compared with seronegative controls. Although there was a tendency for the progressors to have a higher rate of impairment, there were no consistent significant differences between visits. CONCLUSION: There were no significant changes in performance exclusively associated with progression to AIDS.