Effectiveness of physical activity interventions on undergraduate students' mental health: systematic review and meta-analysis.

This systematic review and meta-analysis assessed the effectiveness of physical activity interventions on undergraduate students' mental health. Seven databases were searched and a total of 59 studies were included. Studies with a comparable control group were meta-analysed, and remaining studies were narratively synthesized. The included studies scored very low GRADE and had a high risk of bias. Meta-analyses indicated physical activity interventions are effective in reducing symptoms of anxiety (n = 20, standardized mean difference (SMD) = -0.88, 95% CI [-1.23, -0.52]), depression (n = 14, SMD = -0.73, 95% CI [-1.00, -0.47]) and stress (n = 10, SMD = -0.61, 95% CI [-0.94, -0.28]); however, there was considerable heterogeneity (anxiety, I2 = 90.29%; depression I2 = 49.66%; stress I2 = 86.97%). The narrative synthesis had mixed findings. Only five studies reported being informed by a behavioural change theory and only 30 reported intervention fidelity. Our review provides evidence supporting the potential of physical activity interventions in enhancing the mental health of undergraduate students. More robust intervention design and implementation are required to better understand the effectiveness of PA interventions on mental health outcomes.

Sitting less and moving more for improved metabolic and brain health in type 2 diabetes: 'OPTIMISE your health' trial protocol.

BACKGROUND: Clinical practice guidelines recommend that adults with type 2 diabetes (T2D) sit less and move more throughout the day. The 18-month OPTIMISE Your Health Clinical Trial was developed to support desk-based workers with T2D achieve these recommendations. The two-arm protocol consists of an intervention and control arms. The intervention arm receives 6 months health coaching, a sit-stand desktop workstation and an activity tracker, followed by 6 months of text message support, then 6 months maintenance. The control arm receives a delayed modified intervention after 12 months of usual care. This paper describes the methods of a randomised controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of the intervention, compared to a delayed intervention control. METHODS: This is a two-arm RCT being conducted in Melbourne, Australia. Desk-based workers (≥0.8 full-time equivalent) aged 35-65 years, ambulatory, and with T2D and managed glycaemic control (6.5-10.0% HbA1c), are randomised to the multicomponent intervention (target n = 125) or delayed-intervention control (target n = 125) conditions. All intervention participants receive 6 months of tailored health coaching assisting them to "sit less" and "move more" at work and throughout the day, supported by a sit-stand desktop workstation and an activity tracker (Fitbit). Participants receive text message-based extended care for a further 6-months (6-12 months) followed by 6-months of non-contact (12-18 months: maintenance). Delayed intervention occurs at 12-18 months for the control arm. Assessments are undertaken at baseline, 3, 6, 12, 15 and 18-months. Primary outcomes are activPAL-measured sitting time (h/16 h day), glycosylated haemoglobin (HbA1c; %, mmol/mol) and, cognitive function measures (visual learning and new memory; Paired Associates Learning Total Errors [adjusted]). Secondary, exploratory, and process outcomes will also be collected throughout the trial. DISCUSSION: The OPTIMISE Your Health trial will provide unique insights into the benefits of an intervention aimed at sitting less and moving more in desk-bound office workers with T2D, with outcomes relevant to glycaemic control, and to cardiometabolic and brain health. Findings will contribute new insights to add to the evidence base on initiating and maintaining behaviour change with clinical populations and inform practice in diabetes management. TRIAL REGISTRATION: ANZCTRN12618001159246 .

Association of Accelerometer-Measured Sedentary Accumulation Patterns With Incident Cardiovascular Disease, Cancer, and All-Cause Mortality.

Background Emerging evidence suggests accruing sedentary behavior (SB) in relatively more prolonged periods may convey additional cardiometabolic risks, but few studies have examined prospective outcomes. We examined the association of SB accumulation patterns with incident cardiovascular disease (CVD), cancer, and all-cause mortality (ACM). Methods and Results Data were from 7671 EPIC-Norfolk (European Prospective Investigation Into Cancer and Nutrition-Norfolk) cohort middle- to older-aged adults who wore accelerometers on the right hip for 4 to 7 days. Cox proportional hazards regression modeled associations between 2 measures of SB accumulation and incident CVD, cancer, and ACM. These were usual SB bout duration (the midpoint of each individual's SB accumulation curve, fitted using nonlinear regression) and alpha (hybrid measure of bout frequency and duration, with higher values indicating relatively shorter bouts and fewer long bouts). Models were adjusted for potential confounders, then further for 24-hour time-use compositions. During mean follow-up time of 6.4 years, 339 ACM, 1106 CVD, and 516 cancer events occurred. Elevated rates of incident cancer and ACM were seen with more prolonged SB accumulation (lower alpha, higher usual SB bout duration) but not CVD. For usual SB bout duration and alpha, respectively, the confounder-adjusted hazard ratios per SD of the exposure were 1.12 (95% CI, 1.02-1.23) and 0.88 (95% CI, 0.79-0.98) with incident cancer and 1.16 (95% CI, 1.07-1.26) and 0.80 (95% CI, 0.72-0.89) with ACM (all P<0.05). Further adjustment for 24-hour time use weakened associations with ACM for usual bout duration (hazard ratio, 1.06; 95% CI, 0.97-1.16; P=0.209) and partially for alpha (hazard ratio, 0.87; 95% CI, 0.77-0.99; P=0.029). Conclusions Accruing SB in longer bout durations was associated with higher rates of incident cancer and ACM but not with incident CVD, with some evidence of direct SB accumulation effects independent of 24-hour time use. Findings provide some support for considering SB accumulation as an adjunct target of messaging to "sit less and move more."

Dietary and Physical Activity Changes and Adherence to WCRF/AICR Cancer Prevention Recommendations following a Remotely Delivered Weight Loss Intervention for Female Breast Cancer Survivors: The Living Well after Breast Cancer Randomized Controlled Trial.

BACKGROUND: Diet, exercise, and weight management are key in improving outcomes for breast cancer survivors, with international recommendations for cancer survivors relating to these behaviors. However, few behavioral interventions have reported outcomes aligned specifically with these recommendations. OBJECTIVE: To evaluate a remotely delivered weight loss intervention vs usual care for female breast cancer survivors, on changes in multiple diet and physical activity behaviors. DESIGN: A randomized controlled trial with assessments at study baseline, 6-, 12-, and 18 months (ie, mid-intervention, post-intervention, and non-contact follow-up). PARTICIPANTS/SETTING: Participants were recruited between October 2012 and December 2014 through hospitals in Brisbane, Australia, and the state-based cancer registry. Eligible participants (women aged 18 to 75 years with body mass index 25 to 45 kg/m2 who were diagnosed with stage I through III breast cancer during previous 2 years) were randomly allocated to intervention (n = 79) or usual care (n = 80). INTERVENTION: Participants randomized to the intervention group received 22 counseling telephone calls targeting diet and physical activity aimed at achieving 5% to 10% weight loss, and optional text messages, over 12 months. Usual care participants received their standard medical care and brief feedback following each assessment, which was similar to that provided to intervention participants with the exception that usual care participants' results were not compared with national and study recommendations. MAIN OUTCOME MEASURES: Dietary intake (24-hour recalls), physical activity (hip-worn GT3X+ accelerometer [Actigraph]), sitting time (thigh-worn activPAL3 [PAL Technologies Limited), and adherence to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations for cancer survivors (0 to 7 score) were measured at each assessment, with data collected between November 2012 and October 2016. STATISTICAL ANALYSES PERFORMED: Intervention effects were assessed by linear mixed models, accounting for repeated measures and baseline values. Significance was set at P < 0.05. RESULTS: At baseline, participants were aged 55 ± 9 years, with a body mass index of 31.4 ± 5.0 kg/m2, 10.7 ± 5.0 months postdiagnosis, and primarily non-minority. At baseline, only 8% (n = 12) of participants met ≥5 out of seven WCRF/AICR recommendations (WCRF/AICR adherence score = 3.8 ± 1.0). At 12 months, significant intervention effects were observed in walking/running (+21 minutes/week; 95% CI 4 to 38) and WCRF/AICR adherence scores (+0.3 points; 95% CI 0.0 to 0.6) only. At 18 months, significant intervention effects were observed for energy intake (-229 kcal/day energy; 95% CI -373 to -84), total fat (-10 g/day; 95% CI -18 to -2), and saturated fat (-5 g/day; 95% CI -9 to -1), and were sustained for WCRF/AICR adherence scores (+0.5 points; 95% CI 0.2 to 0.8). CONCLUSIONS: This remotely delivered weight loss intervention led to sustained improvements in WCRF/AICR adherence scores, and some improvements in diet and physical activity. These findings provide support for the health benefit of programs targeting lifestyle behaviors in line with cancer survivor recommendations, and the potential for dissemination of such programs for women following treatment for early-stage breast cancer.

Using compositional data analysis to explore accumulation of sedentary behavior, physical activity and youth health.

PURPOSE: The study aimed to describe youth time-use compositions, focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity (PA), and to examine associations of these time-use compositions with cardiometabolic biomarkers. METHODS: Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7-13 years old were pooled (complete cases with accelerometry and adiposity marker data, n = 782). A 9-component time-use composition was formed using compositional data analysis: time in shorter and longer bouts of sedentary behavior; time in shorter and longer bouts of light-, moderate-, or vigorous-intensity PA; and "other time" (i.e., non-wear/sleep). Shorter and longer bouts of sedentary time were defined as <5 min and ≥5 min, respectively. Shorter bouts of light-, moderate-, and vigorous-intensity PA were defined as <1 min; longer bouts were defined as ≥1 min. Regression models examined associations between overall time-use composition and cardiometabolic biomarkers. Then, associations were derived between ratios of longer activity patterns relative to shorter activity patterns, and of each intensity level relative to the other intensity levels and "other time", and cardiometabolic biomarkers. RESULTS: Confounder-adjusted models showed that the overall time-use composition was associated with adiposity, blood pressure, lipids, and the summary score. Specifically, more time in longer bouts of light-intensity PA relative to shorter bouts of light-intensity PA was significantly associated with greater body mass index z-score (zBMI) (ß = 1.79; SE = 0.68) and waist circumference (ß = 18.35, SE = 4.78). When each activity intensity was considered relative to all higher intensities and "other time", more time in light- and vigorous-intensity PA, and less time in sedentary behavior and moderate-intensity PA, were associated with lower waist circumference. CONCLUSION: Accumulating PA, particularly light-intensity PA, in frequent short bursts may be more beneficial for limiting adiposity compared to accumulating the same amount of PA at these intensities in longer bouts.

Using touchscreen mobile devices-when, where and how: a one-week field study.

This cross-sectional study explored the objectively measured Touchscreen Mobile Device (TSMD) use in free-living conditions. Data on TSMD use, gross body posture (lying, sitting, standing, stepping), and location of use (workplace, home, other) were collected over seven consecutive days from 54 adults (mean ± SD, 38 ± 10 years). The average duration of TSMD use was 152 ± 91 min/day, with a TSMD engagement of 51 ± 35 times/day. Participants under 30 years spent significantly more time on their TSMD, averaging 230 ± 108 min/day. By location, 54 ± 17% of use occurred at home and 24 ± 15% at work. The most common posture adopted during any TSMD use was sitting (77 ± 5 2 min/day), with participants also spending considerable time lying down in the home environment (39 ± 49 min/day). These findings provide valuable insights into how adults are using TSMDs, including the postures and locations of use. Further research is needed on the health and wellbeing implications of these usage patterns. Practitioner summary: This study explored Touchscreen Mobile Device (TSMD) use in free-living conditions among 54 adults (mean ± standard deviation, 38 ± 10 years). Participants under 30 years spent significantly more time on their devices. More than half of the time spent using TSMD occurred at home while sitting and lying down.Abbreviations: TSMD: touchscreen mobile device; SD: standard deviation; MSD: musculoskeletal disorder; HDR: higher degree by research; SEES: School of Earth and Environmental Sciences; UK: The United Kingdom; USA: United States of America; SAS: statistical analysis system; ANOVA: analysis of variance; SPSS: statistical package for the social sciences; h: hour; min/d: minutes per day; d: day; ICC: intraclass correlation; CI: confidence interval; min: minute; GPS: global positioning systemsHighlightsTouchscreen mobile device use and gross body posture were quantified objectively.The most common postures for touchscreen mobile device use were lying and sitting.Touchscreen mobile devices were used around twice as much at home than at work.Use at home, with a predominance of the lying posture, needs further investigation.

CHAP-Adult: A Reliable and Valid Algorithm to Classify Sitting and Measure Sitting Patterns Using Data From Hip-Worn Accelerometers in Adults Aged 35.

Background: Hip-worn accelerometers are commonly used, but data processed using the 100 counts per minute cut point do not accurately measure sitting patterns. We developed and validated a model to accurately classify sitting and sitting patterns using hip-worn accelerometer data from a wide age range of older adults. Methods: Deep learning models were trained with 30-Hz triaxial hip-worn accelerometer data as inputs and activPAL sitting/nonsitting events as ground truth. Data from 981 adults aged 35-99 years from cohorts in two continents were used to train the model, which we call CHAP-Adult (Convolutional Neural Network Hip Accelerometer Posture-Adult). Validation was conducted among 419 randomly selected adults not included in model training. Results: Mean errors (activPAL - CHAP-Adult) and 95% limits of agreement were: sedentary time -10.5 (-63.0, 42.0) min/day, breaks in sedentary time 1.9 (-9.2, 12.9) breaks/day, mean bout duration -0.6 (-4.0, 2.7) min, usual bout duration -1.4 (-8.3, 5.4) min, alpha .00 (-.04, .04), and time in ≥30-min bouts -15.1 (-84.3, 54.1) min/day. Respective mean (and absolute) percent errors were: -2.0% (4.0%), -4.7% (12.2%), 4.1% (11.6%), -4.4% (9.6%), 0.0% (1.4%), and 5.4% (9.6%). Pearson's correlations were: .96, .92, .86, .92, .78, and .96. Error was generally consistent across age, gender, and body mass index groups with the largest deviations observed for those with body mass index ≥30 kg/m2. Conclusions: Overall, these strong validation results indicate CHAP-Adult represents a significant advancement in the ambulatory measurement of sitting and sitting patterns using hip-worn accelerometers. Pending external validation, it could be widely applied to data from around the world to extend understanding of the epidemiology and health consequences of sitting.

Effect of a Remotely Delivered Weight Loss Intervention in Early-Stage Breast Cancer: Randomized Controlled Trial.

Limited evidence exists on the effects of weight loss on chronic disease risk and patient-reported outcomes in breast cancer survivors. Breast cancer survivors (stage I-III; body mass index 25-45 kg/m2) were randomized to a 12-month, remotely delivered (22 telephone calls, mailed material, optional text messages) weight loss (diet and physical activity) intervention (n = 79) or usual care (n = 80). Weight loss (primary outcome), body composition, metabolic syndrome risk score and components, quality of life, fatigue, musculoskeletal pain, menopausal symptoms, fear of recurrence, and body image were assessed at baseline, 6 months, 12 months (primary endpoint), and 18 months. Participants were 55 ± 9 years and 10.7 ± 5.0 months post-diagnosis; retention was 81.8% (12 months) and 80.5% (18 months). At 12-months, intervention participants had significantly greater improvements in weight (-4.5% [95%CI: -6.5, -2.5]; p < 0.001), fat mass (-3.3 kg [-4.8, -1.9]; p < 0.001), metabolic syndrome risk score (-0.19 [-0.32, -0.05]; p = 0.006), waist circumference (-3.2 cm [-5.5, -0.9]; p = 0.007), fasting plasma glucose (-0.23 mmol/L [-0.44, -0.02]; p = 0.032), physical quality of life (2.7 [0.7, 4.6]; p = 0.007; Cohen's effect size (d) = 0.40), musculoskeletal pain (-0.5 [-0.8, -0.2]; p = 0.003; d = 0.49), and body image (-0.2 [-0.4, -0.0]; p = 0.030; d = 0.31) than usual care. At 18 months, effects on weight, adiposity, and metabolic syndrome risk scores were sustained; however, significant reductions in lean mass were observed (-1.1 kg [-1.7, -0.4]; p < 0.001). This intervention led to sustained improvements in adiposity and metabolic syndrome risk.

A RE-AIM evaluation in early adopters to iteratively improve the online BeUpstanding™ program supporting workers to sit less and move more.

BACKGROUND: The web-based BeUpstanding program supports desk workers to sit less and move more. Successfully translated from a research-delivered intervention, BeUpstanding has gone through iterative development and evaluation phases in preparation for wide-scale implementation. In the third planned "early-adopters" phase (01/09/2017-11/06/2019), the program was made freely-available online. An integrated delivery and evaluation platform was also developed to enable workplace champions to run and evaluate the intervention within their work team independent of researcher support. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, this study reports on the extent to which the program and processes were "fit-for-purpose" for a national implementation trial across the indicators of uptake (reach and adoption), implementation and engagement, and effectiveness for behaviour change. METHODS: Data were collected via the online surveys embedded in the program and through program access analytics. Descriptive data (with linearized variance for the clustered staff-level data) and results from mixed models (repeated data and clustering for pre-post changes) are reported. RESULTS: Despite purposeful limited promotion, uptake was good, with 182 Australian users initially registering (208 total) and 135 (from 113 organisations) then completing the sign-up process. Recruitment reached users across Australia and in 16 of 19 Australian industries. Implementation was inconsistent and limited, with signed-up users completing 0 to 14 of the program's 14 steps and only 7 (5.2%) completing all seven core steps. Many champions (n = 69, 51.1%) had low engagement (1 day toolkit usage) and few (n = 30, 22%) were highly engaged (> 1 day toolkit usage and surveyed staff). Although only 18 users (7 organisations) performed the pre- and post-program staff evaluations (337 and 167 staff, respectively), pre-post changes showed the program effectively reduced workplace sitting by - 9.0% (95% CI -12.0, - 5.9%). DISCUSSION: The program had uptake across industries and across Australia, but implementation and engagement varied widely. Few workplaces completed the evaluation components. In those that did, the program was effective for the primary outcome (workplace sitting). Conducting a planned early adopters phase and a comprehensive evaluation according to RE-AIM helped highlight necessary program improvements to make it more suitable for wide-scale implementation and evaluation. TRIAL REGISTRATION: Australian and New Zealand Clinic Trials Registry ACTRN12617000682347 . Date registered: 12/05/2017.

Alternatives for Measuring Sitting Accumulation in Workplace Surveys.

OBJECTIVES: To develop and assess the measurement properties of self-report measures of accumulation of sitting time. METHODS: Seven candidate measures were collected in 51 workers from three office environments (79% women) via online questionnaire administered immediately before and after 7-day monitoring periods (activPAL3 24-hour protocol with diary recorded work hours). RESULTS: Three measures had some validity (P < 0.05 vs activPAL): % of sitting in long bouts more than or equal to 30 minutes, sitting strategy frequency (0 to 100), and interruption rate (n/h sitting). Agreement was limited. Some reliability (intraclass correlation or kappa P < 0.05) was seen for these measures, strategy variety (0 to 100), typical day (five categories), and making a conscious effort to sit less (yes/no). CONCLUSIONS: Two brief and one longer option may suit workplace studies requiring self-report measures of sitting accumulation. Validity was weaker for sitting accumulation than sitting time.

Dose and engagement during an extended contact physical activity and dietary behavior change intervention delivered via tailored text messaging: exploring relationships with behavioral outcomes.

BACKGROUND: Extended contact interventions delivered via text messaging are a low-cost option for promoting the long-term continuation of behavior change. This secondary analysis of a text message-delivered extended contact intervention ('Get Healthy, Stay Healthy' (GHSH)) explores the extent to which changes in physical activity, dietary behaviors and body weight were associated with the frequency of text messages (dose) and contact between the health coach and participant (engagement). METHODS: Following a telephone coaching program, participants were randomised to receive extended contact via tailored text messages (GHSH, n = 114) or no additional contact (n = 114) over a 6-month period. Message dose, timing, and content were based on participant preferences, ascertained during two tailoring telephone calls. All incoming and outgoing messages were recorded. At baseline and 6 months, participants self-reported body weight and dietary behaviors (fruit and vegetable servings/day). Moderate-vigorous physical activity (MVPA) was assessed via accelerometry. RESULTS: Median dose (25th, 75th percentile) was 53 (33, 72) text messages in total across six months. Mean fortnightly dose in weeks 1-2 was 5.5 (95 % CI: 4.3, 6.6) text messages, and remained stable (with the exception of planned decreases in weeks involving additional intervention contacts). Offset against the average fortnightly dose of goal checks (1.6, 95 % CI: 1.3, 2.0 and 1.5, 95 % CI: 1.2, 1.8, for physical activity and diet respectively), mean replies to goal checks were highest in weeks 1-2 (1.4, 95 % CI: 1.4, 1.5 and 1.3, 95 % CI: 1.2, 1.4, respectively) and tended to become lower in most weeks thereafter. Greater weight loss was positively associated with text message dose (P = 0.022), with a difference of 1.9 kg between participants receiving the most and fewest texts. There was no association between engagement and changes in outcome measures. CONCLUSIONS: A fixed dose of texts does not seem suitable to meet participants' individual preferences. Higher self-selected text doses predicted better weight outcomes. However, greater participant engagement through text replies does not predict more favourable outcomes, despite being a suggested facilitator of successful behavior change maintenance. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number: ACTRN12613000949785. Date registered: 27 August 2013. Retrospectively registered. http://www.anzctr.org.au/ .

Descriptive Epidemiology of Interruptions to Free-Living Sitting Time in Middle-Age and Older Adults.

PURPOSE: To describe the frequency and characteristics (i.e., duration, stepping time, and estimated intensity) of all interruptions and physically active interruptions to adults' free-living sitting time (i.e., transitions from sitting to upright posture) across segments of the population. METHODS: Australian Diabetes, Obesity and Lifestyle study participants (321 men; 406 women; mean ± standard deviation, 58.0 ± 10.3 yr) wore the activPAL3™ for ≥1 valid day. The characteristics of interruptions from laboratory studies demonstrating health benefits were selected to define active interruptions (≥5 min upright and/or ≥2 min stepping) and ambulatory interruptions (≥2 min stepping). The frequency and characteristics of all, active, and ambulatory interruptions were described and compared by age, sex, diabetes status, and body mass index. RESULTS: Adults averaged 55.0 ± 21.8 interruptions per day, but only 20.3 ± 6.7 were active and 14.0 ± 5.4 were ambulatory. Median (25th, 75th percentile) duration was 2.6 min (0.9, 7.8 min), stepping time was 0.8 min (0.3, 2.0 min), and estimated energy expenditure was 4.3 metabolic equivalents (MET)·min-1 (1.4, 12.5 MET·min-1). Those who were older, had obesity, or had diabetes had significantly (P < 0.05) fewer interruptions of all types and less stepping time during active interruptions than their counterparts (Cohen's d < 0.2). CONCLUSIONS: Free-living interruptions were often less active than interruptions performed in effective acute laboratory studies and their content varied widely between population groups. Monitoring all interruptions, as well as those that are more active, is advisable to provide a comprehensive understanding of free-living sedentary behavior.

Sedentary time in people with obstructive airway diseases.

Sedentary time (ST) and light-intensity physical activity (LIPA) are movement behaviours associated with important health outcomes, but are not widely explored in respiratory diseases. We aimed to describe their volume and/or accumulation patterns in moderate-severe COPD, bronchiectasis and severe asthma using the accurate postural-based accelerometer activPAL, contrasting these values with a non-respiratory population. We also sought to test the cross-sectional associations of these behaviours with disease characteristics by diagnostic group, and as a combined label-free disease group. RESULTS: Adults with COPD (n = 64), bronchiectasis (n = 61), severe asthma (n = 27), and controls (n = 61) underwent cross-sectional measurements of volume and/or accumulation patterns of ST and LIPA. The prevalence and characteristics, and associations with exercise capacity, health-status, airflow-limitation, dyspnoea, systemic inflammation and exacerbations were analysed. ST volumes in COPD were higher than that of bronchiectasis and severe asthma. Values in bronchiectasis and severe asthma were similar to each other and controls (≈8.9 h/day). Their accumulation patterns were also significantly better than in COPD, but similar if not worse compared to controls. LIPA volumes in bronchiectasis and severe asthma were also higher than those of COPD (p < 0.05) and controls. In bronchiectasis and COPD, lower levels/better patterns of ST accumulation, as well as higher LIPA volume were associated with better clinical characteristics. These associations may be mediated by airflow limitation. CONCLUSIONS: The discordance between engagement in ST volume versus ST patterns highlights the importance of accounting for both these different yet complementary metrics. ST and LIPA are low-intensity activities associated with important clinical characteristics in people with chronic respiratory diseases. TRIAL REGISTRATION: Not applicable.

Effects of sedentary behaviour interventions on biomarkers of cardiometabolic risk in adults: systematic review with meta-analyses.

CONTEXT/PURPOSE: Observational and acute laboratory intervention research has shown that excessive sedentary time is associated adversely with cardiometabolic biomarkers. This systematic review with meta-analyses synthesises results from free living interventions targeting reductions in sedentary behaviour alone or combined with increases in physical activity. METHODS: Six electronic databases were searched up to August 2019 for sedentary behaviour interventions in adults lasting for ≥7 days publishing cardiometabolic biomarker outcomes covering body anthropometry, blood pressure, glucose and lipid metabolism, and inflammation (54 studies). The pooled effectiveness of intervention net of control on 15 biomarker outcomes was evaluated using random effects meta-analyses in the studies with control groups not providing other relevant interventions (33 studies; 6-25 interventions analysed). RESULTS: Interventions between 2 weeks and <6 months in non-clinical populations from North America, Europe and Australia comprised much of the evidence base. Pooled effects revealed small, significant (p<0.05) beneficial effects on weight (≈ -0.6 kg), waist circumference (≈ -0.7 cm), percentage body fat (≈ -0.3 %), systolic blood pressure (≈ -1.1 mm Hg), insulin (≈ -1.4 pM) and high-density lipoprotein cholesterol (≈ 0.04 mM). Pooled effects on the other biomarkers (p>0.05) were also small, and beneficial in direction except for fat-free mass (≈ 0.0 kg). Heterogeneity ranged widely (I2=0.0-72.9). CONCLUSIONS: Our review of interventions targeting sedentary behaviour reductions alone, or combined with increases in physical activity, found evidence of effectiveness for improving some cardiometabolic risk biomarkers to a small degree. There was insufficient evidence to evaluate inflammation or vascular function. Key limitations to the underlying evidence base include a paucity of high-quality studies, interventions lasting for ≥12 months, sensitive biomarkers and clinical study populations (eg, type 2 diabetes). PROSPERO TRIAL REGISTRATION NUMBER: CRD42016041742.

How supportive are workplace environments for sitting less and moving more? A descriptive study of Australian workplaces participating in the BeUpstanding program.

Desk-based workers are highly sedentary; this has been identified as an emerging work health and safety issue. To reduce workplace sitting time and promote physical activity it is important to understand what factors are already present within workplaces to inform future interventions. This cross-sectional study examined the prevalence of supportive environmental factors, prior to workplaces taking part in a 'sit less, move more' initiative (BeUpstanding). Participants were 291 Australian-based workplace champions (representing 230 organisations) who unlocked the BeUpstanding program's online toolkit between September 2017 and mid-November 2020, and who completed surveys relating to champion characteristics, organisation and workplace characteristics, and the availability of environmental factors to support sitting less and moving more. Factors were characterized using descriptive statistics and compared across key sectors and factor categories (spatial; resources/initiatives; policy/cultural) using mixed logistic regression models. Of the 42 factors measured, only 11 were present in > 50% of workplaces. Spatial design factors were more likely to be present than resources/initiatives or policy/cultural factors. Centralised printers were the most commonly reported attribute (94%), while prompts to encourage stair use were the least common (4%). Most workplace factors with < 50% prevalence were modifiable and/or were considered modifiable with low cost. Organisations that were public sector, not small/medium, not regional/remote, and not blue-collar had higher odds of having supportive factors than their counterparts; however, workplaces varied considerably in the number of factors present. These findings can assist with developing and targeting initiatives and promoting feasible strategies for desk-based workers to sit less and move more.

Translating research into practice: outcomes from the Healthy Living after Cancer partnership project.

BACKGROUND: Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. METHODS: In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. RESULTS: Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. CONCLUSIONS: This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Device-measured sedentary behavior and physical activity in older adults differ by demographic and health-related factors.

BACKGROUND: Our aim was to describe and explore older adults' device-measured sedentary behavior and physical activity (PA) pattern by sex, age, education, marital status, body mass index, and physical function; and to assess agreement regarding fulfillment of PA recommendations, i.e. 150 min/week of moderate-to-vigorous intensity PA (MVPA), between device-measured and self-reported PA. METHOD: We included 656 older adults (64% women), aged 66, 81-87 or ≥ 90 years from a Swedish population-based cohort study. The activPAL3 accelerometer provided information on sedentary behavior (sedentary time, sedentary bouts, sit-to-stand transitions) and PA. Stepping ≥100 steps/min was considered MVPA; standing and stepping < 100 steps/min were considered light-intensity PA (LPA). Self-reported PA was compared with min/week in MVPA and steps/day. RESULTS: On average, 60% of wear time was spent sedentary, 36% in LPA, and 4% in MVPA. Relative to men, women, had significantly (p < 0.05) more sit-to-stand transitions, spent 33 min/day less sedentary and 27 min/day more in LPA, and were more likely to report meeting PA recommendations, but showed no difference in steps/day, MVPA, or sedentary bout duration. Older age was associated with more sedentary time, lower MVPA and fewer steps/day. The prevalence of meeting PA recommendations was 59% device-measured and 88% by self-report with limited agreement between methods (Cohen's Kappa = 0.21, Spearman's rho = 0.28). Age differences were much more pronounced with objective measures than by self-report. CONCLUSIONS: We found significant sex differences in sedentary behavior and time in LPA in older adults, but not in MVPA, in contrast to previous findings. Sedentary time increased with age, with small differences in accumulation pattern. MVPA time was lower with older age, obesity, and poor physical function. A majority of the participants > 80 years did not meet the PA recommendations. Given the strong relationships between sedentary behavior, PA and health in older adults, programs are needed to address these behaviors. Agreement between device-measured and self-reported fulfillment of PA recommendations was limited. Device-based measurement adds value to PA studies, providing richer and different data than self-report.

Impact of dopamine-related genetic variants on physical activity in old age - a cohort study.

OBJECTIVES: The beneficial effects of a physically active lifestyle in aging are well documented. Understanding the factors of importance for physical activity in older adults are therefore essential. Informed by animal and human data linking the dopamine system to motivation and reward processes, we investigated the associations between variations in dopamine genes and objectively measured physical activity and sedentary behaviour. Further, we aimed to verify whether higher age may exacerbate the impact of dopamine genes on physical activity. METHODS: We analyzed data from 504 older adults, 66-87 years, from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Physical activity was measured with activPAL accelerometers and DNA was extracted from blood samples for genotyping. We assessed the effects of three dopamine relevant genetic variations (DRD1, DRD2, and DRD3) on daily time in sedentary behavior, light-intensity physical activity and moderate-to-vigorous physical activity using analyses of covariance, adjusting for sex, age and physical function. RESULTS: Higher dopamine receptor efficacy was related to moderate-to-vigorous physical activity, but not to light-intensity physical activity or sedentary time. DRD1 explained 2.7% of variance in moderate-to-vigorous physical activity, with more pronounced effect in people aged ≥80 years, about 10% of explained variance. CONCLUSION: Stronger genetic effects in older adults are in line with the well-established nonlinear effects of dopamine signaling on performance, expected to be exacerbated with aging. Individuals over 80 years, genetically predisposed to lower dopamine receptor efficacy, engaged on average 100 min/week in moderate-to-high physical activity, below the recommended levels beneficial for healthy aging. Our findings highlight that some individuals might need extra support to maintain a physically active lifestyle.

Supporting Workers to Sit Less and Move More Through the Web-Based BeUpstanding Program: Protocol for a Single-Arm, Repeated Measures Implementation Study.

BACKGROUND: The web-based BeUpstanding Champion Toolkit was developed to support work teams in addressing the emergent work health and safety issue of excessive sitting. It provides a step-by-step guide and associated resources that equip a workplace representative-the champion-to adopt and deliver the 8-week intervention program (BeUpstanding) to their work team. The evidence-informed program is designed to raise awareness of the benefits of sitting less and moving more, build a supportive culture for change, and encourage staff to take action to achieve this change. Work teams collectively choose the strategies they want to implement and promote to stand up, sit less, and move more, with this bespoke and participative approach ensuring the strategies are aligned with the team's needs and existing culture. BeUpstanding has been iteratively developed and optimized through a multiphase process to ensure that it is fit for purpose for wide-scale implementation. OBJECTIVE: The study aimed to describe the current version of BeUpstanding, and the methods and protocol for a national implementation trial. METHODS: The trial will be conducted in collaboration with five Australian workplace health and safety policy and practice partners. Desk-based work teams from a variety of industries will be recruited from across Australia via partner-led referral pathways. Recruitment will target sectors (small business, rural or regional, call center, blue collar, and government) that are of priority to the policy and practice partners. A minimum of 50 work teams will be recruited per priority sector with a minimum of 10,000 employees exposed to the program. A single-arm, repeated-measures design will assess the short-term (end of program) and long-term (9 months postprogram) impacts. Data will be collected on the web via surveys and toolkit analytics and by the research team via telephone calls with champions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework will guide the evaluation, with assessment of the adoption/reach of the program (the number and characteristics of work teams and participating staff), program implementation (completion by the champion of core program components), effectiveness (on workplace sitting, standing, and moving), and maintenance (sustainability of changes). There will be an economic evaluation of the costs and outcomes of scaling up to national implementation, including intervention affordability and sustainability. RESULTS: The study received funding in June 2018 and the original protocol was approved by institutional review board on January 9, 2017, with national implementation trial consent and protocol amendment approved March 12, 2019. The trial started on June 12, 2019, with 48 teams recruited as of December 2019. CONCLUSIONS: The implementation and multimethod evaluation of BeUpstanding will provide the practice-based evidence needed for informing the potential broader dissemination of the program. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000682347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372843&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15756.