Factors relating to sustainability and scalability of the 'Food, Move, Sleep (FOMOS) for Postnatal Mental Health' program: Qualitative perspectives from key stakeholders across Australia.

ISSUE ADDRESSED: Supporting healthy behaviours (quality diet, physical activity, sleep) through home-based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale-up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research-practice translation. METHODS: Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi-structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale-up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale-up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. RESULTS: Individual-level: Targeting multiple systems (primary, tertiary, community-based care) and entry points (early, mid-postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at-risk women, was suggested. Provider-level: Stakeholders identified strategies to enhance future roll-out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems-level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. CONCLUSIONS: For sustainable implementation and potential scalability of a home-based multi-behaviour postnatal intervention, multi-level implementation and scale-up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. SO WHAT?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future.

Meal kits in the family setting: Impacts on family dynamics, nutrition, social and mental health.

Families face many barriers in providing nutritious home-cooked family meals. Meal kit subscription services are increasingly popular among families and may address obstacles to cooking at home and facilitate shared family meals. This study aimed to understand why families use meal kits and what they perceived to be the main impacts on family dynamics, nutrition, social and mental health. Sixteen primary meal providers with at least one child 18 years and under living at home, were recruited via social media (e.g., Facebook, Twitter) to participate in a semi-structured interview using Zoom videoconferencing. Interviews were conducted with participants who currently purchased and used commercially available meal kits in Australia (e.g., HelloFresh, Marley Spoon). Thematic analysis of interview transcripts revealed that women, as the primary carers responsible for family meals, primarily reported the role that meal kits played in reducing their mental load through reduced food-related decision making, enhanced family participation in meal preparation, and opportunities for food literacy. Additionally, meal kits were reported to reduce food eaten away-from-home with the majority of participants perceiving meal kits to provide nutritionally dense meals and appropriate portion sizes aligned with National dietary guidelines. This study provides important insights into the potential physical, mental and social health benefits of meal kits in supporting families to cook and eat meals together at home. While meal kits have the capacity to positively influence population health and wellbeing, it is necessary that meal kit subscription services address the nutritional quality of their meals and provide evidence-based nutrition messaging to facilitate improvements in food literacy and nutritional intake.

Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study.

BACKGROUND: Physical activity (PA) is a modifiable risk factor for postnatal depression (PND) and programs are needed to enhance PA amongst women at risk of PND. Key stakeholder involvement in informing development and implementation of such programs is vital. However, little research demonstrates key stakeholder insights to inform the design and delivery of PA programs for improving PND. The aim of this study was to explore key stakeholder perspectives on the design and delivery of a home-based PA program for mothers with PND symptoms to inform future real-world implementation and scale-up. METHODS: A descriptive qualitative study was undertaken whereby semi-structured interviews were conducted with representatives from various key stakeholder organisations involved in postnatal PA and/or mental health, public health and policy in Australia (n = 11). Interviews were conducted between September to November 2019 and explored stakeholder perceptions on the design and delivery of a home-based PA program for mothers with PND symptoms. The interview schedule was informed by both the Consolidated Framework for Implementation Research (CFIR) and the PRACTical planning for Implementation and Scale-up (PRACTIS) guide. Data were analysed thematically using both deductive and inductive coding. RESULTS: The relative priority of PND and PA was high for most organisations involved, although none implemented PA programs supporting women at risk of PND. Most stakeholders perceived the program as appealing due to addressing barriers to postnatal PA, although identified some feasibility issues regarding funding and delivery mechanisms. Suggestions for program adaptations included an equity focus (e.g. providing socioeconomically disadvantaged women with a greater program dose; translating web-app based content into various languages). Planned components of the program were suggested to align (i.e. relative advantage) with existing initiatives (e.g. equipment hire for nurseries scheme) and screening systems for PND (timing of referral). Perceived barriers to scale-up included logistics/cost of equipment, organisational capacity demands and safety risks/liability. Perceived enablers to scale-up included linking the program with 'adjunct' programs and services. CONCLUSIONS: While the program was appealing and most organisations could see a role in endorsing and/or referring to the program, funding and delivery mechanisms still need to be identified.

The impact of maternal post-partum depressive symptoms on child diet at 18 months.

Post-partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post-partum (baseline) on child diet at 18 months of age (follow-up). This study used longitudinal data from 263 first-time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Women self-reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale [CES-D]) and child diet (fruits, vegetables and discretionary foods). Multiple linear regression analyses were used to explore the relationship between maternal depressive symptoms at baseline and child fruit and vegetable intake and discretionary food intake (g day-1 ) at follow-up. Baseline maternal depressive symptoms were associated with higher childhood consumption of discretionary foods at 18 months of age (ß = 0.45, 95% confidence interval [CI] 0.03 to 0.87, P = 0.034 [adjusted]). There was no evidence of association for maternal depressive symptoms and child intake of fruits and vegetables. Further longitudinal studies are warranted to confirm these findings, with the hope of translating this knowledge into optimal clinic care and improved physical and mental health for mother and child.

Adherence to the Australian dietary guidelines and development of depressive symptoms at 5 years follow-up amongst women in the READI cohort study.

BACKGROUND: Depression is the single largest contributor to global disability. There is growing evidence that a healthy diet is associated with reduced depression risk. However, beyond the Mediterranean diet, few longitudinal studies have explored the relationship between adherence to national dietary guidelines and depression. Hence, this study investigates the relationship between adherence to Australian Dietary Guidelines and depressive symptoms. METHODS: Data was drawn from the READI longitudinal study, a prospective cohort study of socioeconomically disadvantaged Australian women. This analysis includes a sub-sample of 837 women. A generalized linear model was used to explore whether baseline diet (assessed using the Dietary Guideline Index (DGI-2013; score range 0 to 85)) was associated with risk of developing depressive symptoms (measured by the Centre for Epidemiologic Studies Depression (CES-D)) at 5 years follow-up, whilst adjusting for potential confounders. A fixed-effects model was used to assess associations between concurrent changes in diet quality and depressive symptoms from baseline to 5 years follow-up. RESULTS: An association between baseline diet quality and risk of developing depressive symptoms at follow-up was observed, where a 10 unit increase in DGI-2013 score was associated with an estimated 12% lower risk of developing heightened depressive symptoms (RR = 0.875, 95%CI 0.784 to 0.978, p = 0.018). The fixed-effects model indicated that an increase in DGI score over 5 years follow-up was associated with a lower (improved) CES-D score (B = -0.044, 95% CI - 0.08 to - 0.01, p = 0.024). CONCLUSIONS: Our results provide evidence that better adherence to the Australian Dietary Guidelines may result in improved depressive symptoms. The growing high-quality evidence regarding the diet-depression relationship provides us with a rationale for developing strategies for supporting dietary behaviour change programs to lower depression rates.

How and why does discretionary food consumption change when we promote fruit and vegetables? Results from the ShopSmart randomised controlled trial.

OBJECTIVE: The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption. DESIGN: Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes' PROCESS macro for SPSS. SETTING: Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia. PARTICIPANTS: Analyses included 225 women (116 intervention and 109 control). RESULTS: Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = -0·194, 95 % CI -0·378, -0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects. CONCLUSIONS: The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.

Maternal Postpartum Diet and Postpartum Depression: A Systematic Review.

OBJECTIVES: Compelling evidence from observational studies shows that dietary patterns play a role in the development of depression and depressive symptoms in the general population. However, few studies have specifically sought to explore the association between maternal diet in the postpartum period and PPD. The purpose of this literature review was to synthesise data from existing published studies, examining the association between maternal postpartum diet and PPD symptoms. METHODS: Relevant studies were identified by systematic search from the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PsycInfo databases for articles published between 1835 and April 2020. RESULTS: Of the 931 articles identified, six met eligibility criteria and were included. Four were cross-sectional and two were a cohort design. All but one study showed at least one inverse association, such that greater adherence to a healthy diet in the postpartum period was associated with fewer PPD symptoms. Specifically, if confirmed in further longitudinal and intervention studies, a balanced maternal diet with an emphasis on fruits, vegetables, fish, grains, legumes, and herbs could be a potential option for helping reduce the incidence of PPD. CONCLUSIONS: This review provides evidence that the postnatal diet could have an effect on PPD symptoms, although further longitudinal and intervention research is warranted.

Fruit and vegetable consumption and psychological distress in Australian pregnant and breastfeeding women.

BACKGROUND AND OBJECTIVES: Mental health disorders amongst pregnant and postpartum women are an increasing public health concern. Our aim was to determine the association between fruit and vegetable intake and psychological distress in a nationally representative sample of Australian pregnant and breastfeeding women. METHODS AND STUDY DESIGN: This study used cross-sectional data collected by the Australian Bureau of Statistics in the 2014 to 2015 Australian National Health Survey. Participants included 166 pregnant and 207 breastfeeding women >18 years old. Number of serves of fruit and vegetables usually consumed each day was reported. The Kessler Psychological Distress Scale (K10) measured levels of global non-specific psychological distress. The association between fruit and vegetable intake and psychological distress was investigated using linear regression adjusted for available known covariates (age, education, physical activity). RESULTS: Mean±SD fruit intake was greater in pregnant compared to breastfeeding women (2.0±1.0 versus 1.7±1.0, p<0.05). The mean K10 score for both the pregnant and breastfeeding women was in the 10-15 'little or no psychological distress" range. In pregnant women, combined fruit and vegetable intake was inversely associated with psychological distress in the fully adjusted model (ß=-0.37, 95% CI -0.72, -0.02). There was no association between fruit and vegetable intake and psychological distress in breastfeeding women. CONCLUSIONS: A higher intake of combined fruit and vegetables was found to be associated with less psychological distress in pregnant women. Further research, including longitudinal and intervention studies, are required to determine causality between fruit and vegetable intake and psychological distress in this population group.

A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial.

BACKGROUND: The SMILES trial was the first randomized controlled trial (RCT) explicitly designed to evaluate a dietary intervention, conducted by qualified dietitians, for reducing depressive symptomatology in adults with clinical depression. OBJECTIVES: Here we detail the development of the prescribed diet (modified Mediterranean diet (ModiMedDiet)) for individuals with major depressive disorders (MDDs) that was designed specifically for the SMILES trial. We also present data demonstrating the extent to which this intervention achieved improvements in diet quality. METHODS: The ModiMedDiet was designed using a combination of existing dietary guidelines and scientific evidence from the emerging field of nutritional psychiatric epidemiology. Sixty-seven community dwelling individuals (Melbourne, Australia) aged 18 years or over, with current poor quality diets, and MDDs were enrolled into the SMILES trial. A retention rate of 93.9 and 73.5% was observed for the dietary intervention and social support control group, respectively. The dietary intervention (ModiMedDiet) consisted of seven individual nutrition counselling sessions delivered by a qualified dietitian. The control condition comprised a social support protocol matched to the same visit schedule and length. RESULTS: This manuscript details the first prescriptive individualized dietary intervention delivered by dietitians for adults with major depression. Significant improvements in dietary quality were observed among individuals randomized to the ModiMedDiet group. These dietary improvements were also found to be associated with changes in depressive symptoms. DISCUSSION/CONCLUSION: The ModiMedDiet, a novel and individually tailored intervention designed specifically for adults with major depression, can be effectively implemented in clinical practice to manage this highly prevalent and debilitating condition. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000251820. Registered 29 February 2012.

A behavioural nutrition intervention for obese pregnant women: Effects on diet quality, weight gain and the incidence of gestational diabetes.

BACKGROUND: Obese pregnant women have an increased risk of antenatal, intra- and post-partum complications. At present, there is limited evidence to support specific nutritional management of obese women in pregnancy, and guidelines are infrequently translated into practice. AIMS: To implement an individually tailored nutrition program for obese pregnant women to reduce the rates of gestational diabetes mellitus (GDM), improve diet quality, achieve weight gain targets, limit gestational weight gain (GWG) and reduce complications for mother and child. METHODS: A prospective dietary intervention study was conducted at a hospital in Melbourne, Australia, using a parallel control group from the Birthing Outcomes System (BOS) database. Obese pregnant women were included if they were ≤21 weeks gestation and aged ≥18 years. The intervention group received one face-to-face dietitian-delivered consultation, with reviews conducted over the phone. RESULTS: A total of 92 and 125 obese pregnant women were enrolled into the dietary intervention group and BOS control group, respectively. The diet quality of intervention participants improved, without significant differences in GWG across groups. In the control group, 19.3% of women developed GDM, compared to 6.5% in the diet group (P 0.013). However, after adjusting for ethnicity and body mass index, the association between the diet group and GDM incidence was no longer significant. CONCLUSIONS: This study demonstrates that a behavioural nutrition intervention, individually tailored for obese pregnant women can improve diet quality. A larger randomised controlled trial targeted at obese pregnant women, with comparable groups at baseline, is required to observe the effects of dietary improvement on GDM incidence, and other maternal and neonatal outcomes.

The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials.

OBJECTIVE: Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success. DESIGN: A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014. RESULTS: Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47%) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet. CONCLUSIONS: Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.

Preventing mental health problems in offspring by targeting dietary intake of pregnant women.

BACKGROUND: The concept of 'early life programming' considers the importance of very early environmental exposures throughout the gestational period on the subsequent health outcomes of offspring. The role of maternal dietary intake, specifically, has been highlighted after recent studies have shown maternal diet quality to predict mental health problems in offspring. Even in the pre-conception period, maternal nutrition can have permanent and sustained phenotypic consequences for offspring. DISCUSSION: Here, we consider these findings in the context of the primary prevention of mental disorders and argue that interventions that target maternal diet could be of significant value. SUMMARY: It is clear that, in order to reduce the burden of mental health issues across the lifespan, urgent action is required, particularly in the field of prevention. We thus call for the application and evaluation of targeted, primary prevention strategies that focus on dietary intake with the view to improve mental health outcomes of mothers and offspring during the postnatal period and beyond.

Clinical trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome.

BACKGROUND: Diet is fundamental to the care of irritable bowel syndrome (IBS). However, some approaches are not appropriate for individuals experiencing psychological symptoms. AIMS: To assess feasibility of a Mediterranean diet in IBS and its impact on gastrointestinal and psychological symptoms. METHODS: We recruited adults with Rome IV IBS and mild or moderate anxiety and/or depressive symptoms to an unblinded 6-week randomised controlled trial. Patients were randomised to Mediterranean diet counselling or habitual diet. We collected gastrointestinal and psychological symptom data, dietary data and stool samples for metagenomic sequencing. RESULTS: We randomised 59 individuals (29 Mediterranean diet, 30 control); 48 completed the study. The Mediterranean Diet Adherence Screener score was higher in the Mediterranean diet group than controls at week 6 (7.5 [95% CI: 6.9-8.0] vs. 5.7 [5.2-6.3], p < 0.001), and there was a greater score increase than controls (2.1 [95% CI: 1.3-2.9] vs. 0.5 [95% CI: 0.1-1.0], p = 0.004), demonstrating Mediterranean diet feasibility. There was a greater proportion of gastrointestinal symptom responders in the Mediterranean diet group than controls (24/29, 83% vs. 11/30, 37%, p < 0.001) and depression responders (15/29, 52% vs. 6/30 20%, p = 0.015). There was no difference in FODMAP intake at week 6 (p = 0.51). Gastrointestinal adverse events were similar (p = 0.588). There were no differences in change in microbiome parameters between groups. CONCLUSIONS: A Mediterranean diet is feasible in IBS and leads to improvement in gastrointestinal and psychological symptoms. Although this study was unblinded, these findings together with the broader benefits of the Mediterranean diet, provide strong impetus for future research in IBS. Australia New Zealand Clinical Trials Registry: ACTRN12620001362987.

Evaluating a multi-behavioural home-based intervention for reducing depressive symptoms in postnatal women : The food, move, sleep (FOMOS) for postnatal mental health randomised controlled trial protocol.

BACKGROUND: Postnatal depression (PND) is a leading cause of illness and death among women following childbirth. Physical inactivity, sedentary behaviour, poor sleep, and sub-optimal diet quality are behavioural risk factors for PND. A feasible, sustainable, and scalable intervention to improve healthy behaviours and reduce PND symptoms among women at postpartum is needed. This study aims to examine the effectiveness of a multi-behavioural home-based program Food, Move, Sleep (FOMOS) for Postnatal Mental Health designed to improve PND symptoms in women at postpartum. METHODS: This randomised clinical trial will recruit 220 Australian women (2-12 months postpartum) experiencing heightened PND symptoms (Edinburgh Postnatal Depression Scale score ≥ 10). Participants will be randomised to FOMOS or wait-list control receiving standard clinical care. FOMOS is a 6-month mobile health (mHealth) intervention targeting diet quality, physical activity, sedentary behaviour, sleep, and mental health. The intervention, informed by the Social Cognitive Theory and incorporating behaviour change techniques defined in the CALO-RE taxonomy and Cognitive Behavioural Treatment of Insomnia, provides exercise equipment, and educational/motivational material and social support via mHealth and social media. Data collection pre-intervention and at 3, 6 and 12 months will assess the primary outcome of PND symptoms and secondary outcomes (diet quality, physical activity, sitting time, sleep quality) using self-report and device measures. Process evaluation will explore acceptability, appropriateness, cost-effectiveness, feasibility, and sustainability via analytic tools, record keeping, interviews, and surveys. DISCUSSION: If effective, FOMOS could be a feasible and potentially scalable management strategy to support improvement of health behaviours and mental health for women with PND symptoms. TRIAL REGISTRATION: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001079730p.

Effects of a high-prebiotic diet versus probiotic supplements versus synbiotics on adult mental health: The "Gut Feelings" randomised controlled trial.

Background: Preliminary evidence supports the use of dietary interventions and gut microbiota-targeted interventions such as probiotic or prebiotic supplementation for improving mental health. We report on the first randomised controlled trial (RCT) to examine the effects of a high-prebiotic dietary intervention and probiotic supplements on mental health. Methods: "Gut Feelings" was an 8-week, 2 × 2 factorial RCT of 119 adults with moderate psychological distress and low prebiotic food intake. Treatment arms: (1) probiotic supplement and diet-as-usual (probiotic group); (2) high-prebiotic diet and placebo supplement (prebiotic diet group); (3) probiotic supplement and high-prebiotic diet (synbiotic group); and (4) placebo supplement and diet-as-usual (placebo group). The primary outcome was assessment of total mood disturbance (TMD; Profile of Mood States Short Form) from baseline to 8 weeks. Secondary outcomes included anxiety, depression, stress, sleep, and wellbeing measures. Results: A modified intention-to-treat analysis using linear mixed effects models revealed that the prebiotic diet reduced TMD relative to placebo at 8 weeks [Cohen's d = -0.60, 95% confidence interval (CI) = -1.18, -0.03; p = 0.039]. There was no evidence of symptom improvement from the probiotic (d = -0.19, 95% CI = -0.75, 0.38; p = 0.51) or synbiotic treatments (d = -0.03, 95% CI = -0.59, 0.53; p = 0.92). Improved anxiety, stress, and sleep were noted in response to the prebiotic diet while the probiotic tentatively improved wellbeing, relative to placebo. No benefit was found in response to the synbiotic intervention. All treatments were well tolerated with few adverse events. Conclusion: A high-prebiotic dietary intervention may improve mood, anxiety, stress, and sleep in adults with moderate psychological distress and low prebiotic intake. A synbiotic combination of high-prebiotic diet and probiotic supplement does not appear to have a beneficial effect on mental health outcomes, though further evidence is required. Results are limited by the relatively small sample size. Clinical trial registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372753, identifier ACTRN12617000795392.

Designing Lifestyle Interventions for Common Mental Disorders: What Can We Learn from Diabetes Prevention Programs?

Lifestyle factors including diet, sleep, physical activity, and substance use cessation, are recognised as treatment targets for common mental disorders (CMDs). As the field of lifestyle-based mental health care evolves towards effectiveness trials and real-world translation, it is timely to consider how such innovations can be integrated into clinical practice. This paper discusses the utility and scale-up of lifestyle interventions for CMDs and draws on diabetes prevention literature to identify enablers and barriers to translation efforts. We discuss the extent to which lifestyle interventions aimed at managing CMDs and preventing diabetes share commonalities (program content, theoretical underpinnings, program structures, interventionists, frameworks promoting fidelity, quality, sustainability). Specific considerations when utilising these programs for mental health include personalising content with respect to symptoms and trajectories of depression and anxiety, medication regimen and genetic risk profile. As this field moves from efficacy to effectiveness and implementation, it is important to ensure issues in implementation science, including "voltage drop", "program drift", logistics, funding, and resourcing, are in line with evidence-based models that are effective in research settings. Ongoing considerations includes who is best placed to deliver this care and the need for models to support implementation including long-term financing, workforce training, supervision, stakeholder and organisational support.

Mums on the Move: A pilot randomised controlled trial of a home-based physical activity intervention for mothers at risk of postnatal depression.

BACKGROUND: Postnatal women are commonly physically inactive, and, when coupled with depressive symptoms, barriers to physical activity can be heightened. This study aimed to 1) examine the feasibility and acceptability of a multi-component home-based physical activity intervention delivered to mothers at risk of postnatal depression, and 2) examine changes in health behaviours (physical activity, sedentary behaviour, sleep, diet) and indicators of mental health. METHODS: Sixty-two mothers (3 - 9 months postpartum) who at baseline were insufficiently active and experiencing heightened depressive symptoms were recruited into a 12-week randomised controlled trial in 2018. Participants were randomised into either a) Intervention group (receiving a theoretically underpinned multi-component program including free exercise equipment at home, access to smartphone web-app, and an online forum); or b) Control group (usual routine). Primary outcomes were program feasibility and acceptability. Secondary outcomes included self-reported and accelerometer-assessed physical activity and sedentary behavior, sleep, diet, determinants of physical activity, and mental health (depressive and anxiety symptoms), measured at baseline and follow-up (12-weeks), with self-reported physical activity, sedentary behaviour and depressive symptoms also measured at weeks 4 and 8. Qualitative data was analysed following inductive content analysis, and quantitative data using linear mixed models. RESULTS: Exercise equipment use in the home was shown to be a feasible strategy to re-engage postnatal women in physical activity. Other components of the program (e.g. web-app, online forum) had low compliance. The program had high acceptability, predominately due to its accessibility, flexibility and ability to overcome key barriers to physical activity. The program resulted in improvements in short-term self-reported physical activity (increased 162min/week at 4 weeks, 95% CI: 37.7, 286.2), behavioural skills (B=0.4, 95% CI: 0.0, 0.8) and perceived barriers to physical activity. However, accelerometer measured physical activity decreased in the intervention group, compared to control group at week 12 (B=-1.3, 95% CI:-2.5, -0.1). There were no changes in other outcomes. CONCLUSIONS: A home-based physical activity program involving free exercise equipment is acceptable and feasible amongst women experiencing heightened postnatal depressive symptoms. Such programs may be effective in increasing engagement in physical activity, yet additional strategies may be needed to enhance maintenance of physical activity and improvements in mental health.

Pilot-Testing of "Healthy Body Healthy Mind": An Integrative Lifestyle Program for Patients With a Mental Illness and Co-morbid Metabolic Syndrome.

Background: Metabolic syndrome and co-morbid physical health conditions are highly prevalent in people with a mental illness. Modifiable lifestyle factors have been targeted to improve health outcomes. Healthy Body Healthy Mind (HBHM) program was developed to provide an integrated evidence-based program incorporating practical diet and exercise instruction; alongside meditation and mindfulness strategies, and comprehensive psychoeducation, to improve the physical and mental health of those with a mental illness. Methods: We report on two data points: (1) Qualitative data derived from the first HBHM program (version 1) exploring its utility and acceptance according to patient feedback; (2) Biometric and mental health data collected on the modified and enhanced 12-week HBHM program (version 2) involving a pilot of 10 participants. Mental and physical health outcomes, weight, abdominal circumference, fasting glucose, cholesterol, and triglycerides were measured at program entry and completion. Results: Qualitative data from HBHM version 1 provided valuable feedback to redevelop and enhance the program. At the end of the HBHM (version 2) 12-week program, a significant mean weight loss of 2 kg was achieved, p = 0.023. There was also a significant reduction in abdominal circumference (mean = 2.55 cm) and a decrease in BMI of almost one point (mean = 0.96 kg/m2), p = 0.046 and p = 0.019, respectively. There were no significant changes in mental health measures or on any other biometrics. Conclusion: Pilot data from the HBHM program found significant reductions in weight and abdominal obesity. The HBHM program could benefit from further modifications, and study replication is required using a controlled design in a larger sample.

Efficacy and Effectiveness of Carnitine Supplementation for Cancer-Related Fatigue: A Systematic Literature Review and Meta-Analysis.

BACKGROUND: Carnitine deficiency has been implicated as a potential pathway for cancer-related fatigue that could be treated with carnitine supplementation. The aim of this systematic literature review and meta-analysis was to evaluate the literature regarding the use of supplemental carnitine as a treatment for cancer-related fatigue. METHODS: Using the PRISMA guidelines, an electronic search of the Cochrane Library, MEDLINE, Embase, CINAHL and reference lists was conducted. Data were extracted and independently assessed for quality using the Academy of Nutrition and Dietetics evidence analysis by two reviewers. In studies with positive quality ratings, a meta-analysis was performed using the random-effects model on Carnitine and cancer-related fatigue. RESULTS: Twelve studies were included for review with eight reporting improvement in measures of fatigue, while four reported no benefit. However, many studies were non-randomized, open-label and/or used inappropriate dose or comparators. Meta-analysis was performed in three studies with sufficient data. Carnitine did not significantly reduce cancer-related fatigue with a standardized mean difference (SMD) of 0.06 points ((95% CI -0.09, 0.21); p = 0.45). CONCLUSION: Results from studies with lower risk of bias do not support the use of carnitine supplementation for cancer-related fatigue.

A nutrition strategy to reduce the burden of diet related disease: access to dietician services must complement population health approaches.

Poor diet quality is implicated in almost every disease and health issue. And yet, in most advanced market economies diet quality is poor, with a minority meeting guidelines for healthy eating. Poor diet is thus responsible for substantial disease burden. Societies have at their disposal a range of strategies to influence diet behaviors. These can be classified into: (i) population level socio-educational approaches to enhance diet knowledge; (ii) pricing incentives (subsidies on healthy foods, punitive taxes on unhealthy foods); (iii) regulations to modify the food environment, and (iv) the provision of clinical dietetic services. There is little evidence that societies are active in implementing the available strategies. Advertising of "junk foods" is largely unchecked, contrasting with strict controls on advertising tobacco products, which also attract punitive taxes. Access to dieticians is restricted in most countries, even in the context of universal health care. In Australia in 2011 there were just 2,969 practicing dieticians/nutritionists or 1.3 clinicians per 10,000 persons, compared with 5.8 physiotherapists per 10,000 persons, 14.8 general practitioners (family physicians) per 10,000 persons or 75 nurses per 10,000 persons. It is time to implement comprehensive national nutrition strategies capable of effecting change. Such strategies need to be multi-component, incorporating both public health approaches and expanded publicly funded dietetic services. Access to individualized dietetic services is needed by those at risk, or with current chronic conditions, given the complexity of the diet message, the need for professional support for behavior change and to reflect individual circumstances. The adoption of a comprehensive nutrition strategy offers the promise of substantial improvement in diet quality, better health and wellbeing and lower health care costs.