Intercellular viral spread and intracellular transposition of Drosophila gypsy.

It has become increasingly clear that retrotransposons (RTEs) are more widely expressed in somatic tissues than previously appreciated. RTE expression has been implicated in a myriad of biological processes ranging from normal development and aging, to age related diseases such as cancer and neurodegeneration. Long Terminal Repeat (LTR)-RTEs are evolutionary ancestors to, and share many features with, exogenous retroviruses. In fact, many organisms contain endogenous retroviruses (ERVs) derived from exogenous retroviruses that integrated into the germ line. These ERVs are inherited in Mendelian fashion like RTEs, and some retain the ability to transmit between cells like viruses, while others develop the ability to act as RTEs. The process of evolutionary transition between LTR-RTE and retroviruses is thought to involve multiple steps by which the element loses or gains the ability to transmit copies between cells versus the ability to replicate intracellularly. But, typically, these two modes of transmission are incompatible because they require assembly in different sub-cellular compartments. Like murine IAP/IAP-E elements, the gypsy family of retroelements in arthropods appear to sit along this evolutionary transition. Indeed, there is some evidence that gypsy may exhibit retroviral properties. Given that gypsy elements have been found to actively mobilize in neurons and glial cells during normal aging and in models of neurodegeneration, this raises the question of whether gypsy replication in somatic cells occurs via intracellular retrotransposition, intercellular viral spread, or some combination of the two. These modes of replication in somatic tissues would have quite different biological implications. Here, we demonstrate that Drosophila gypsy is capable of both cell-associated and cell-free viral transmission between cultured S2 cells of somatic origin. Further, we demonstrate that the ability of gypsy to move between cells is dependent upon a functional copy of its viral envelope protein. This argues that the gypsy element has transitioned from an RTE into a functional endogenous retrovirus with the acquisition of its envelope gene. On the other hand, we also find that intracellular retrotransposition of the same genomic copy of gypsy can occur in the absence of the Env protein. Thus, gypsy exhibits both intracellular retrotransposition and intercellular viral transmission as modes of replicating its genome.

Bowler and coach experiential knowledge of new ball swing bowling in elite cricket.

Swing bowling can influence the outcome of cricket matches, but technique characteristics and coaching practices have not been investigated at an elite level. This study aimed to provide insight into the perceived technique parameters, coaching practices and variables contributing to conventional new ball swing bowling in elite cricket. Six Australian Test match fast bowlers and six Australian international and national-level coaches were interviewed. A reflexive thematic analysis of interview transcripts generated themes associated with swing bowling. Most bowlers reported their technique allows them to naturally create either inswing or outswing, with technique variations used to create swing in the opposite direction. To increase delivery effectiveness, bowlers and coaches recommended pitching the ball closer to the batter in length and varying release positions along the crease. Coaches recommended making individualised technique adjustments, but suggested all bowlers could benefit from maintaining balance and forward momentum to create a consistent release position in repeated deliveries. This study could inform training strategies to alter techniques and improve swing bowling performance. Future research should investigate the physical qualities of fast bowlers and use biomechanical analyses to provide a deeper understanding of swing bowling.

Development, explanation, and presentation of the Physical Literacy Interventions Reporting Template (PLIRT).

BACKGROUND: The physical literacy (PL) concept integrates different personal (e.g., physical, cognitive, psychological/affective, social) determinants of physical activity and has received growing attention recently. Although practical efforts increasingly adopt PL as a guiding concept, latest evidence has shown that PL interventions often lack specification of important theoretical foundations and basic delivery information. Therefore, the goal of the present study was to develop an expert-based template that supports researchers and practitioners in planning and reporting PL interventions. METHODS: The development process was informed by Moher et al.'s guidance for the development of research reporting guidelines. We composed a group of ten distinguished experts on PL. In two face-to-face meetings, the group first discussed a literature-driven draft of reporting items. In the second stage, the experts anonymously voted and commented on the items in two rounds (each leading to revisions) until consensus was reached. RESULTS: The panel recommended that stakeholders of PL initiatives should tightly interlock interventional aspects with PL theory while ensuring consistency throughout all stages of intervention development. The Physical Literacy Interventions Reporting Template (PLIRT) encompasses a total of 14 items (two additional items for mixed-methods studies) in six different sections: title (one item), background and definition (three items), assessment (one item each for quantitative and qualitative studies), design and content (five items), evaluation (one item plus one item each for quantitative and qualitative studies), discussion and conclusion (two items). CONCLUSION: The PLIRT was designed to facilitate improved transparency and interpretability in reports on PL interventions. The template has the potential to close gaps between theory and practice, thereby contributing to more holistic interventions for the fields of physical education, sport, and health.

Cellular labeling of endogenous retrovirus replication (CLEVR) reveals de novo insertions of the gypsy retrotransposable element in cell culture and in both neurons and glial cells of aging fruit flies.

Evidence is rapidly mounting that transposable element (TE) expression and replication may impact biology more widely than previously thought. This includes potential effects on normal physiology of somatic tissues and dysfunctional impacts in diseases associated with aging, such as cancer and neurodegeneration. Investigation of the biological impact of mobile elements in somatic cells will be greatly facilitated by the use of donor elements that are engineered to report de novo events in vivo. In multicellular organisms, reporter constructs demonstrating engineered long interspersed nuclear element (LINE-1; L1) mobilization have been in use for quite some time, and strategies similar to L1 retrotransposition reporter assays have been developed to report replication of Ty1 elements in yeast and mouse intracisternal A particle (IAP) long terminal repeat (LTR) retrotransposons in cultivated cells. We describe a novel approach termed cellular labeling of endogenous retrovirus replication (CLEVR), which reports replication of the gypsy element within specific cells in vivo in Drosophila. The gypsy-CLEVR reporter reveals gypsy replication both in cell culture and in individual neurons and glial cells of the aging adult fly. We also demonstrate that the gypsy-CLEVR replication rate is increased when the short interfering RNA (siRNA) silencing system is genetically disrupted. This CLEVR strategy makes use of universally conserved features of retroviruses and should be widely applicable to other LTR retrotransposons, endogenous retroviruses (ERVs), and exogenous retroviruses.

Behaviour change techniques in cardiovascular disease smartphone apps to improve physical activity and sedentary behaviour: Systematic review and meta-regression.

BACKGROUND: Smartphone apps are increasingly used to deliver physical activity and sedentary behaviour interventions for people with cardiovascular disease. However, the active components of these interventions which aim to change behaviours are unclear. AIMS: To identify behaviour change techniques used in smartphone app interventions for improving physical activity and sedentary behaviour in people with cardiovascular disease. Secondly, to investigate the association of the identified techniques on improving these behaviours. METHODS: Six databases (Medline, CINAHL Plus, Cochrane Library, SCOPUS, Sports Discus, EMBASE) were searched from 2007 to October 2020. Eligible studies used a smartphone app intervention for people with cardiovascular disease and reported a physical activity and/or sedentary behaviour outcome. The behaviour change techniques used within the apps for physical activity and/or sedentary behaviour were coded using the Behaviour Change Technique Taxonomy (v1). The association of behaviour change techniques on physical activity outcomes were explored through meta-regression. RESULTS: Forty behaviour change techniques were identified across the 19 included app-based interventions. Only two studies reported the behaviour change techniques used to target sedentary behaviour change. The most frequently used techniques for sedentary behaviour and physical activity were habit reversal and self-monitoring of behaviour respectively. In univariable analyses, action planning (ß =0.42, 90%CrI 0.07-0.78) and graded tasks (ß =0.33, 90%CrI -0.04-0.67) each had medium positive associations with increasing physical activity. Participants in interventions that used either self-monitoring outcome(s) of behaviour (i.e. outcomes other than physical activity) (ß = - 0.47, 90%CrI -0.79--0.16), biofeedback (ß = - 0.47, 90%CrI -0.81--0.15) and information about health consequences (ß = - 0.42, 90%CrI -0.74--0.07) as behaviour change techniques, appeared to do less physical activity. In the multivariable model, these predictors were not clearly removed from zero. CONCLUSION: The behaviour change techniques action planning and graded tasks are good candidates for causal testing in future experimental smartphone app designs.

The Impact of Cognitive, Physical, and Psychological Stressors on Subsequent Cognitive Performance.

OBJECTIVE: To quantify the impact of performing challenging cognitive, physical and psychological tasks on subsequent cognitive performance, and whether differences in performance are predicted by psychological variables. BACKGROUND: Successful performance in many occupations depends on resilient cognition: the degree to which cognitive functions can withstand, or are resilient to, the effects of stress. Several studies have examined the effect of individual stressors on cognition; however, the capacity to compare different types of stress across studies is limited. METHOD: Fifty-eight participants completed cognitive, physical, psychological and control interventions, immediately preceded, and followed, by a battery of cognitive tasks. Self-efficacy and cognitive appraisal were reported at baseline. Perceived stress was recorded post-intervention. Subjective workload was recorded for each cognitive battery and intervention. RESULTS: Cognitive performance was impaired by the cognitive, physical and psychological interventions, with the greatest effect following the cognitive intervention. The subjective workload reported for the post-intervention cognitive battery was higher following the cognitive and physical interventions. Neither self-efficacy, cognitive appraisal, perceived stress nor subjective workload of the intervention strongly predicted post-intervention performance. CONCLUSION: Given the differences among interventions and cognitive domains, it appears that challenges to resilient cognition are broad and varied, and the mechanism(s) by which impairment occurs is complex. APPLICATION: Considering the increase in subjective workload for the post-intervention cognitive battery, a combination of subjective and objective measures of cognitive performance monitoring should be considered.

Quality-of-Life in Achilles Tendinopathy: An Exploratory Study.

OBJECTIVE: This research aimed to explore the quality-of-life and experiences of people with Achilles tendinopathy. DESIGN: This mixed-methods research used the 8-dimension Assessment of Quality-of-Life (AQoL-8D), focus groups and grounded theory analysis. AQoL-8D scores were compared with population normative scores. In focus groups, participants discussed their experiences with Achilles tendinopathy. SETTING: An online survey was completed, followed by focus groups and interviews held at the University of Canberra. PARTICIPANTS: Adults with Achilles tendon pain were eligible to participate in the online survey, which was distributed through email and social media. RESULTS: Complete survey responses were obtained from 92 individuals, and 11 individuals participated in focus groups and interviews. AQoL-8D scores were significantly lower in those with Achilles tendinopathy (79 ± 11 vs 81 ± 13). AQoL-8Ds of mental health, pain, senses, and the physical "super dimension" were also significantly lower. The difference exceeded the AQoL-8D minimum clinically important difference of 6% only for the pain dimension. Themes identified included adapting lifestyles, living with the condition, changes in mental and social well-being, conflict with identity, frustration, and individual experiences. CONCLUSIONS: Achilles tendinopathy is associated with a lower quality-of-life score, but on average, the difference does not exceed the minimum clinically important difference. In focus groups, some individuals described profound impacts on their life. This discrepancy likely reflects the variability of the impact across individuals. For some people, the effect is minimal, yet for those who tie their identity and social activities to fitness and physical activity, the effect can be profound.

The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review.

The green tea amino acid, L-theanine (L-THE) is associated with several health benefits, including improvements in mood, cognition and a reduction of stress and anxiety-like symptoms. This systematic review evaluated the effect of pure L-THE intake, in the form of orally administered nutritional supplements, on stress responses and anxiety levels in human randomised controlled trials. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, 9 peer-reviewed journal articles were identified where L-THE as a supplement was compared to a control. Our findings suggest that supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety in people exposed to stressful conditions. Despite this finding, longer-term and larger cohort clinical studies, including those where L-THE is incorporated into the diet regularly, are needed to clinically justify the use of L-THE as a therapeutic agent to reduce stress and anxiety in people exposed to stressful conditions.

Toward a better assessment of perceived social influence: The relative role of significant others on young athletes.

The purpose of this three-study paper was to develop and validate the Perceived Social Influence in Sport Scale-2 (PSISS-2) that aimed to resolve the limitations of PSISS-1 in assessing the relative social influence of significant others in youth sport. In Study 1, a pool of 60 items generated from revisiting a qualitative dataset about significant others of young athletes were examined by two expert panel reviews in terms of content validity, clarity, coverage, and age-appropriateness, leading to the development of 16 items of the PSISS-2. In Study 2, multi-group exploratory structural equation model for PSISS-2 was conducted among 904 young athletes, and the results supported a model comprising positive influence (ie, conditional and unconditional positive influence combined), punishment (ie, conditional negative influence), and dysfunction (ie, unconditional negative influence) as three factors. The goodness of fit of the three-factor model was acceptable and invariant across the coach-, father-, mother-, and teammates-versions of PSISS-2. In support of the criterion validity of PSISS-2, the three factors explained substantial variance of young athletes' perceived competence, effort, enjoyment, and trait anxiety in sport. Study 3 examined the relationship between PSISS-2 factors, psychological need support, and controlling behaviors in a subsample of 452 young athletes, and the findings supported the concurrent validity and discriminant validity of the scale. In conclusion, the data are supportive of PSISS-2. The three factors of the scale (ie, positive influence, punishment, and dysfunction) may form a new framework for understanding and comparing the relative role of significant others in youth sport.

The Impact of Environmental Stress on Cognitive Performance: A Systematic Review.

OBJECTIVE: In this review, we detail the impact of environmental stress on cognitive and military task performance and highlight any individual characteristics or interventions which may mitigate any negative effect. BACKGROUND: Military personnel are often deployed in regions markedly different from their own, experiencing hot days, cold nights, and trips both above and below sea level. In spite of these stressors, high-level cognitive and operational performance must be maintained. METHOD: A systematic review of the electronic databases Medline (PubMed), EMBASE (Scopus), PsycINFO, and Web of Science was conducted from inception up to September 2018. Eligibility criteria included a healthy human cohort, an outcome of cognition or military task performance and assessment of an environmental condition. RESULTS: The search returned 113,850 records, of which 124 were included in the systematic review. Thirty-one studies examined the impact of heat stress on cognition; 20 of cold stress; 59 of altitude exposure; and 18 of being below sea level. CONCLUSION: The severity and duration of exposure to the environmental stressor affects the degree to which cognitive performance can be impaired, as does the complexity of the cognitive task and the skill or familiarity of the individual performing the task. APPLICATION: Strategies to improve cognitive performance in extreme environmental conditions should focus on reducing the magnitude of the physiological and perceptual disturbance caused by the stressor. Strategies may include acclimatization and habituation, being well skilled on the task, and reducing sensations of thermal stress with approaches such as head and neck cooling.

Are Individuals Who Engage in More Frequent Self-Regulation Less Susceptible to Mental Fatigue?

The aim of this study was to investigate whether individuals who engage in more frequent self-regulation are less susceptible to mental fatigue. Occupational cognitive demand and participation in sports or exercise were quantified as activities requiring self-regulation. Cardiorespiratory fitness was also assessed. On separate occasions, participants either completed 90 min of an incongruent Stroop task (mental exertion condition) or watched a 90-min documentary (control condition). Participants then completed a cycling time-to-exhaustion (physical endurance) test. There was no difference in the mean time to exhaustion between conditions, although individual responses varied. Occupational cognitive demand, participation in sports or exercise, and cardiorespiratory fitness predicted the change in endurance performance (p = .026, adjusted R2 = .279). Only cognitive demand added significantly to the prediction (p = .024). Participants who reported higher levels of occupational cognitive demand better maintained endurance performance following mental exertion.

Performing under pressure: Exploring the psychological state underlying clutch performance in sport.

Clutch performance is improved performance under pressure. However, little research has examined the psychological state experienced by athletes in these situations. Therefore, this study qualitatively examined the subjective experience underlying clutch performance across a range of sports (e.g., team, individual) and standards (Olympic to recreational athletes). Sixteen athletes (Mage = 27.08 years; SD = 6.48) took part in in-depth, semi-structured interviews primarily after an exceptional performance (M = 4.38 days later; SD = 3.14). Data were analysed inductively and thematically. Clutch states involved 12 characteristics, including heightened and deliberate concentration, intense effort, and heightened awareness, which distinguished the experience of clutch from other optimal psychological states such as flow. Other characteristics, such as perceptions of control, were also reported and supported previous experimental research on clutch. These findings present in-depth qualitative insights into the psychological state underlying clutch performance, and are discussed in relation to the existing literature on optimal psychological states in sport.

Auditing the socio-environmental determinants of motivation towards physical activity or sedentariness in work-aged adults: a qualitative study.

BACKGROUND: There is a lack of understanding of work aged adults' (30-60 years old) perspectives on the motivation of physical activity versus sedentariness. This study aims to: (1) identify which socio-environmental factors motivate physical activity and/or sedentary behavior, in adults aged 30-60 years; and (2) explore how these motivators interact and combine. METHOD: Fifteen work-aged adults who, were able to engage in physical activity (Mean age = 43.9 years; SD 9.6, range 31-59), participated in semi-structured interviews. Inductive content analysis was used to generate an inventory of socio-environmental factors and their specific influences on motivation towards physical activity or sedentariness. RESULTS: Key socio-environmental agents found to influence motivation included: Spouse/partner, parents, children, siblings, whole family, grandchildren, friends, work-mates, neighbors, strangers, team-mates and class-mates, instructors, health care professionals, employers, gyms and health companies, governments, media and social media, cultural norms, and the physical environment. Mechanisms fell into five broad themes of socio-environmental motivation for both physical activity and sedentariness: (1) competence and progress; (2) informational influences, (3) emotional influences, (4) pragmatics and logistics, and (5) relationships. Similar socio-environmental factors were frequently reported as able to motivate both activity and sedentariness. Likewise, individual categories of influence could also motivate both behaviors, depending on context. CONCLUSION: The findings of this paper 'unpack' theoretical concepts into specific and targeted behavioral recommendations. The data suggested no simple solutions for promoting physical activity or reducing sedentariness, but rather complex and interacting systems surrounding work-aged adults. Findings also suggest that health professionals should be encouraged to support adults' health by examining the socio-environmental motivational influences, or 'motivational atmosphere'.

Mental fatigue does not affect maximal anaerobic exercise performance.

PURPOSE: Mental fatigue can negatively impact on submaximal endurance exercise and has been attributed to changes in perceived exertion rather than changes in physiological variables. The impact of mental fatigue on maximal anaerobic performance is, however, unclear. Therefore, the aim of the present study was to induce a state of mental fatigue to examine the effects on performance, physiological and perceptual variables from subsequent tests of power, strength and anaerobic capacity. METHODS: Twelve participants took part in the single-blind, randomised, crossover design study. Mental fatigue was induced by 90 min of the computer-based Continuous Performance Task AX version. Control treatment consisted of 90 min of watching emotionally neutral documentaries. Participants consequently completed countermovement jump, isometric leg extension and a 3-min all-out cycling tests. RESULTS: Results of repeated measures analysis of variance and paired t tests revealed no difference in any performance or physiological variable. Rating of perceived exertion tended to be greater when mentally fatigued (mental fatigue = 19 ± 1 vs control = 18 ± 1, p = 0.096, [Formula: see text] = .232) and intrinsic motivation reduced (mental fatigue = 11 ± 4 vs control = 13 ± 6, p = 0.063, d = 0.597) in the mental fatigue condition. CONCLUSIONS: Near identical responses in performance and physiological parameters between mental fatigue and control conditions suggest that peripheral mechanisms primarily regulate maximal anaerobic exercise. Whereas mental fatigue can negatively impact submaximal endurance exercise, it appears that explosive power, voluntary maximal strength and anaerobic work capacity are unaffected.

The Relationship Between Pain and Interoception: A Systematic Review and Meta-Analysis.

Interoception refers to the ability to sense internal bodily sensations. Research suggests that dysfunctions in interoception may be implicated in the transition to chronic pain, however, little work has examined interoceptive ability in pain states. Therefore, this systematic review aimed to assess whether interoception is altered in individuals experiencing pain. Following a systematic search of 4 electronic databases from inception to February 2023, 28 studies were included. Outcomes of interoceptive accuracy, interoceptive sensibility, and interoceptive awareness were meta-analysed. The risk of bias was assessed, and the certainty of the evidence was evaluated. Meta-analyses indicated that those with chronic pain display reduced interoceptive accuracy and increased interoceptive sensibility. Subgroup analyses indicated that the change in interoceptive sensibility is dependent on the measure used, with those with chronic pain scoring higher on measures focusing on attention to bodily sensations, while also scoring lower on emotional reactivity. No difference in interoceptive awareness was observed between individuals with chronic pain and pain-free controls. Only one study was found that measured interoception in those experiencing acute pain, while another study recruited those experiencing recurrent pain. These findings suggest that while those with chronic pain self-report as more interoceptively aware, they are less accurate at detecting internal bodily signals. Further research investigating domains of interoception in those experiencing acute and recurrent pain is needed. Data should be interpreted with caution as the certainty of evidence was very low for all completed analyses. This review was registered on the PROSPERO International Prospective Register of Systematic Reviews (Registration ID = CRD42022318843). PERSPECTIVE: This review considered the relationship between interoception and pain and found that an individual's ability to accurately sense internal signals is decreased in those with chronic pain, despite them reporting being more aware of internal sensations. However, there remains little research examining interoception in non-chronic pain states.

Gender and socioecological level differences in stakeholders' perceptions of athlete attrition factors in an Australian high-performance pathway system.

OBJECTIVES: This study aimed to build on previous work by the authors. It examines how socioecological level and gender influence high-performance sport system (HPSS) stakeholders' perspectives of the relative importance and feasibility to address athlete attrition factors within an Australian high-performance pathway system (HPPS). DESIGN: Mixed methods. METHODS: Sub-analysis was conducted of rating data from 30 participants who had contributed to identifying 83 statements in 13 clusters in a previous Concept Mapping study. The 13 clusters were statistically analysed in 'R' using cumulative link mixed models (CLMMs) to determine differences in perceived importance and feasibility between 1) socioecological levels, and 2) genders. RESULTS: Mean ratings for 11 and three of the 13 clusters were statistically significantly different between at least two of the five socioecological levels, for importance and feasibility, respectively. Athletes had the largest variation in mean ratings from the most (athlete health 4.59), to least (performance potential 2.83) important cluster, when compared to the other four socioecological levels. There were statistically significant differences between the ratings between genders (Men/Women) for two clusters for each rating scale: Importance: 'athlete health' (M3.33:W3.84 [p 0.012]); 'performance potential' (M3.35:W2.57; [p 0.001]), Feasibility: 'abuse and mismanagement of health' (M2.97:W3.68; [p 0.000]) and 'athlete health' (M2.54:W3.33; [p 0.000]). CONCLUSIONS: This study highlights the need to implement more robust athlete attrition monitoring protocols. It also highlights the importance of listening to youth athletes' voices, and enabling equal gender representation to ensure holistically tailored environments are created to retain talented athletes in high-performance pathway programmes.

Cognition in soccer and futsal: evidence of validity of a 4-instrument protocol to assess executive functioning among women athletes.

Evidence suggests that success in sports, especially soccer and futsal are linked to higher levels of executive functioning. Still, the literature does not present a homogeneous set of instruments to measure executive functions, which leads to large variability in results. In this paper, we assembled four already recognised measures to propose a valid 4-instrument protocol to assess executive functions among soccer and futsal athletes. We conducted two studies to validate the proposed protocol. We addressed known-groups validity and latent structure in Study 1 for data collected on 105 female soccer and futsal athletes from elite and lower-division clubs. Findings pointed to partial validity of the protocol - with working memory and inhibition showing the best results. For Study 2, we used performance data from 51 elite female soccer players collected throughout a season of the first division league to assess predictive validity. Our protocol was able to partially replicate previous findings and added new insights on how working memory, processing speed and higher-level executive functions might play different roles for goalscoring and assist-making skills. Specifically, study 1 did not find a significant difference between elite and lower-division athletes in higher-order executive functions as in previous studies, but it did find on visual working memory and inhibitory control which weights towards higher demands of core executive functions. On the other hand, study 2 yielded significant results for processing speed and visual working memory to predict assists among elite soccer players, but not inhibitory control as previous findings suggested. Regardless, the proposed 4-instrument protocol showed adequate criterion and structural validity in both studies.

Contextualising flexible nonlinear periodization as a person-adaptive behavioral model for exercise maintenance.

There is a growing focus on developing person-adaptive strategies to support sustained exercise behaviour, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodisation (FNLP) - a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning - that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behaviour evidence and theory to propose a modified FNLP model and to show hypothesised pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation.

Very brief intervention for physical activity behaviour change in cardiac rehabilitation: protocol for the 'Measure It!' effectiveness-implementation hybrid trial.

INTRODUCTION: Physical inactivity is a risk factor for repeat cardiac events and all-cause mortality in coronary heart disease (CHD). Cardiac rehabilitation, a secondary prevention programme, aims to increase physical activity levels in this population from a reported low baseline. This trial will investigate the effectiveness and implementation of a very brief physical activity intervention, comparing different frequencies of physical activity measurement by cardiac rehabilitation clinicians. The Measure It! intervention (<5 min) includes a self-report and objective measure of physical activity (steps) plus very brief physical activity advice. METHODS AND ANALYSIS: This type 1 hybrid effectiveness-implementation study will use a two-arm multicentre assessor-blind randomised trial design. Insufficiently active (<150 min of moderate-to-vigorous physical activity per week) cardiac rehabilitation attendees with CHD (18+ years) will be recruited from five phase II cardiac rehabilitation centres (n=190). Patients will be randomised (1:1) to five physical activity measurements or two physical activity measurements in total over 24 weeks. The primary effectiveness outcome is accelerometer daily minutes of moderate-to-vigorous intensity physical activity at 24 weeks. Secondary effectiveness outcomes include body mass index, waist circumference and quality-of-life. An understanding of multilevel contextual factors that influence implementation, and antecedent outcomes to implementation of the intervention (eg, feasibility and acceptability), will be obtained using semistructured interviews and other data sources. Linear mixed-effects models will be used to analyse effectiveness outcomes. Qualitative data will be thematically analysed inductively and deductively using framework analysis, with the framework guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. ETHICS AND DISSEMINATION: The study has ethical approval (University of Canberra (ID 11836), Calvary Bruce Public Hospital (ID 14-2022) and the Greater Western Area (ID 2022/ETH01381) Human Research Ethics Committees). Results will be disseminated in multiple formats for consumer, public and clinical audiences. TRIAL REGISTRATION NUMBER: ACTRN12622001187730p.

Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial.

BACKGROUND: People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. OBJECTIVE: We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. METHODS: A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI -22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (ß=1.62; P=.05), waist circumference (ß=5.81; P=.01), waist-to-hip ratio (ß=.03, P=.03), and quality of life (ß=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. CONCLUSIONS: The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2020-040479.