Can the delivery of behavioural support be improved in the NHS England Low-Calorie Diet Programme? An observational study of behaviour change techniques.

BACKGROUND: Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the design of the pilot NHS England Low-Calorie Diet (NHS-LCD) Programme. This study evaluated a subsequent domain of fidelity, intervention delivery. Two research questions were addressed: (1) To what extent were BCTs delivered with fidelity to providers programme plans? (2) What were the observed barriers and facilitators to delivery? METHODS: A mixed-methods sequential explanatory design was employed. Remote delivery of one-to-one and group-based programmes were observed. A BCT checklist was developed using the BCT Taxonomy v1; BCTs were coded as present, partially delivered, or absent during live sessions. Relational content analysis of field notes identified observed barriers and facilitators to fidelity. RESULTS: Observations of 122 sessions across eight samples and two service providers were completed. Delivery of the complete NHS-LCD was observed for five samples. Fidelity ranged from 33% to 70% across samples and was higher for group-based delivery models (64%) compared with one-to-one models (46%). Barriers and facilitators included alignment with the programme's target behaviours and outcomes, session content, time availability and management, group-based remote delivery, and deviation from the session plan. CONCLUSIONS: Overall, BCTs were delivered with low-to-moderate fidelity. Findings indicate a dilution in fidelity during the delivery of the NHS-LCD and variation in the fidelity of programmes delivered across England. Staff training could provide opportunities to practice the delivery of BCTs. Programme-level changes such as structured activities supported by participant materials and with sufficient allocated time, might improve the delivery of BCTs targeting self-regulation.

Providing recovery support to wounded, injured, and sick UK military personnel throughout the COVID-19 pandemic.

Health precautions implemented by the United Kingdom (UK) government to limit the spread of the Coronavirus Disease 2019 (COVID-19) led to the closure of many well-being support services in 2020. This created a need to re-think how impactful recovery support courses can be provided. One such service was that of the five-day Multi Activity Course (MAC) which was redesigned in accordance with national health guidelines to allow continued access for Wounded, Injured and Sick (WIS) military personnel to the service; the positive impacts of which are well established. This study investigated the influence of the newly developed Reduced numbers MAC (R-MAC) on the WIS participants lives during and for 12 months after attending. The R-MAC led to comparable impacts for participants well-being, at a time in which people's mental well-being was often being adversely affected. The positive mental well-being of the 261 participants improved by 33% throughout the course and remained 14% higher for the 37 participants who provided data six months after attending. Key facets of the experience that were most impactful for the participants were (i) shared experience with other veterans, (ii) discussing issues in a safe environment while receiving support from the staff and (iii) developing knowledge around self-help/personal development. Adapting to the challenging circumstances and developing the R-MAC mitigated against the already adverse impact of the COVID-19 pandemic for the WIS participants.

A Narrative Review of Non-Pharmacological Strategies for Managing Sarcopenia in Older Adults with Cardiovascular and Metabolic Diseases.

This narrative review examines the mechanisms underlying the development of cardiovascular disease (CVD) and metabolic diseases (MDs), along with their association with sarcopenia. Furthermore, non-pharmacological interventions to address sarcopenia in patients with these conditions are suggested. The significance of combined training in managing metabolic disease and secondary sarcopenia in type II diabetes mellitus is emphasized. Additionally, the potential benefits of resistance and aerobic training are explored. This review emphasises the role of nutrition in addressing sarcopenia in patients with CVD or MDs, focusing on strategies such as optimising protein intake, promoting plant-based protein sources, incorporating antioxidant-rich foods and omega-3 fatty acids and ensuring sufficient vitamin D levels. Moreover, the potential benefits of targeting gut microbiota through probiotics and prebiotic fibres in sarcopenic individuals are considered. Multidisciplinary approaches that integrate behavioural science are explored to enhance the uptake and sustainability of behaviour-based sarcopenia interventions. Future research should prioritise high-quality randomized controlled trials to refine exercise and nutritional interventions and investigate the incorporation of behavioural science into routine practices. Ultimately, a comprehensive and multifaceted approach is essential to improve health outcomes, well-being and quality of life in older adults with sarcopenia and coexisting cardiovascular and metabolic diseases.

The role of microRNAs in regulating inflammation and exercise-induced adaptations in rheumatoid arthritis.

MicroRNAs (miRNAs) are endogenously generated single-stranded RNAs that play crucial roles in numerous biological processes, such as cell development, proliferation, differentiation, metabolism and apoptosis. They negatively regulate target gene expression by repressing translation of messenger RNA into a functional protein. Several miRNAs have been implicated in the development and progression of RA. They are involved in inflammatory and immune processes and are associated with susceptibility to RA and disease activity. They are also considered to be potential markers of disease activity or even therapeutic targets. Likewise, several miRNAs are affected acutely by exercise and regulate exercise-related adaptations in the skeletal muscle and cardiovascular system and aerobic fitness. Interestingly, some miRNAs affected by exercise are also important in the context of RA. Investigating these might increase our understanding of the effects of exercise in RA and improve exercise prescription and, potentially, disease management. In this review, we focus on the miRNAs that are associated with both RA and exercise and discuss their roles in (and potential interactions between) RA and exercise-induced adaptations.

Physical activity promotion interventions in chronic airways disease: a systematic review and meta-analysis.

Physical inactivity is common in people with chronic airways disease (pwCAD) and associated with worse clinical outcomes and impaired quality of life. We conducted a systematic review and meta-analysis to characterise and evaluate the effectiveness of interventions promoting step-based physical activity (PA) in pwCAD. We searched for studies that included a form of PA promotion and step-count outcome measure. A random-effects model was used to determine the overall effect size using post-intervention values. 38 studies (n=32 COPD; n=5 asthma; n=1 bronchiectasis; study population: n=3777) were included. Overall, implementing a form of PA promotion resulted in a significant increase in step-count: median (IQR) 705 (183-1210) when compared with usual standard care: -64 (-597-229), standardised mean difference (SMD) 0.24 (95% CI: 0.12-0.36), p<0.01. To explore the impact of specific interventions, studies were stratified into subgroups: PA promotion+wearable activity monitor-based interventions (n=17) (SMD 0.37, p<0.01); PA promotion+step-count as an outcome measure (n=9) (SMD 0.18, p=0.09); technology-based interventions (n=12) (SMD 0.16, p=0.01). Interventions promoting PA, particularly those that incorporate wearable activity monitors, result in a significant and clinically meaningful improvement in daily step-count in pwCAD.

How patients with diabetes experience physical activity promotion during nursing consultations in the Spanish context.

OBJECTIVE: Although physical activity (PA) is a key behaviour for controlling Type 2 Diabetes, problematic adoption and/or adherence continues to impair disease management. This study aims to understand how patients with T2D live and experience nurses PA promotion during consultations in Spanish context. METHOD: The present study is a qualitative research. In 2019-2020, pre-COVID-19, Twenty-two people living with T2D from Barcelona province contributed either to focus groups (n = 5) or to semi-structured interviews (n = 4). All interviews were recorded, transcribed, and analysed using conventional content analysis approach through constant comparative method. RESULTS: Data analysis revealed two major themes with sixteen subthemes. The two major themes include: "Intra-personal conscious PA adoption processes" and "Structural unconscious PA (non)adherence processes". CONCLUSION: Patients' experiences reflect two concurrent and interconnected issues. First, most patients readily adopted new PA after encouragement from nurses, who were the main proponents of PA. Indeed, adoption seemed to be most nurses' PA priority and it was effective for most patients. Second, few nurses discussed adherence, making it an almost universal problem and source of disappointment. For adherence, patients experience that nurses' attention needs to focus on activating processes and skills that support continued involvement in already-adopted PA.

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial.

BACKGROUND: Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals' (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs' opinion regarding its applicability within the Spanish healthcare system. METHODS: A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs' walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures. A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis. DISCUSSION: Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients' Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

From Secondary School to University: Associations Between Domain-Specific Sedentary Behaviors and Lifestyle Risk Behaviors.

This study examined associations between changes in domain-specific sedentary behaviors and changes in health-related lifestyles of Spanish secondary school students (n = 113) to their first year of university. During the transitions from the end of high school to the beginning of university, engagement in sedentary behaviors have emerged as potential additional behavioral risk factors. Understanding how sedentary behaviors interconnect with other (un)healthy behaviors will inform interventions on multiple risk behaviors across this critical life period. A 3-year longitudinal survey assessed associations between domain-specific sedentary behaviors and leisure time physical activity (IPAQ), alcohol and tobacco consumption, and fruit and vegetable intake (24-h dietary recall), using Generalized Estimating Equations. Spending time on sedentary transportation was associated with a greater likelihood of smoking, whereas sedentary weekend homework was associated with a reduced likelihood of consuming alcohol. The lowest and highest tertiles for sedentary screen use and leisure-time PA were also less likely not to meet the recommendations for fruit and vegetable consumption. For specific sedentary behaviors, associations were gender-based or affected by leisure time physical activity. From secondary school to university, specific sedentary behaviors are linked to lifestyle risk factors. Over this transitional period, public health interventions targeting reduced sedentary behaviors may bring multiple benefits by also preventing other harmful behaviors.

Acute effects of exercise on pain symptoms, clinical inflammatory markers and inflammatory cytokines in people with rheumatoid arthritis: a systematic literature review.

Background: Exercise is advocated in the treatment of rheumatoid arthritis (RA). However, uncertainty around the acute effects of exercise on pain and inflammation may be stopping people with RA from exercising more regularly. Objectives: To determine the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cytokines in RA. Design: A systematic review of the literature. Data sources and methods: Five databases were searched (PubMed, Cochrane Library, CINAHL, Scopus and SPORTDiscus); inclusion criteria were studies with acute exercise, a definite diagnosis of RA and disease characteristics assessed by clinical function (i.e., disease activity score, health assessment questionnaire and self-reported pain), clinical markers associated with inflammation (i.e., c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), and inflammatory cytokines (i.e., interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α)). Results: From a total of 1544 articles, initial screening and full text assessment left 11 studies meeting the inclusion criteria. A total of 274 people were included in the studies (RA = 186; control = 88). Acute bouts of aerobic, resistance, and combined aerobic and resistance exercise did not appear to exacerbate pain symptoms in people with RA. Conclusion: Post-exercise responses for pain, clinical inflammatory markers and inflammatory cytokines were not different between people with or without RA. Exercise prescription was variable between studies, which limited between-study comparisons. Therefore, future investigations in people with RA are warranted, which combine different exercise modes and intensities to examine acute effects on pain symptoms and inflammatory markers. Registration: The PROSPERO international prospective register of systematic reviews - CRD42018091155.

Mission Himalaya: Exploring the Impact of a Supported High-Altitude Mountaineering Expedition on the Well-Being and Personal Development of UK Military Veterans.

Meaningful, positive, emotional and challenging adventurous activities may generate personal growth or recovery from ill health or injury. In this study, we used a distinctive longitudinal and immersive research approach to explore the psychological impact of a high-altitude expedition to the Nepalese Himalaya on 10 (9 males) UK military veterans with longstanding well-being concerns. In the 12 months prior to the expedition, participants took part in three training weekends in the UK mountains. During the expedition, instructors-who were all experienced health coaches-facilitated reflective practices with the beneficiaries throughout, focusing on experiential transfer to day-to-day lives after the expedition. Follow-up interviews, conducted up to 18-months post-expedition, identified that the most desirable changes aligned with the three innate psychological needs of self-determination theory: autonomy, competence and relatedness. The routines established during the preparation stage and during the expedition itself activated a renewed energy for personal improvement. At 18 months post-expedition, the key changes reflected altered perspective, employment skills and work-life balance, increased physical activity and enhanced personal awareness and mindfulness. Importantly, supported by regular health coaching and focused on the transfer of learning, expeditions can activate meaningful long-term changes to the well-being and personal development of military veterans.

Looking Back and Looking Around: How Athletes, Parents and Coaches See Psychosocial Development in Adolescent Performance Sport.

Sport has the potential to support psychosocial development in young people. However, extant studies have tended to evaluate purpose-built interventions, leaving regular organised sport relatively overlooked. Moreover, previous work has tended to concentrated on a narrow range of outcomes. To address these gaps, we conducted a season-long ethnography of a youth performance sport club based on a novel Realist Evaluation approach. We construed the club as a social intervention within a complex system of agents and structures. The results are published in this special issue as a two-part series. In this first paper, we detail the perceptions of former and current club parents, players and coaches, using them to build a set of programme theories. The resulting network of outcomes (i.e., self, emotional, social, moral and cognitive) and generative mechanisms (i.e., the attention factory, the greenhouse for growth, the personal boost and the real-life simulator), spanning across multiple contextual layers, provides a nuanced understanding of stakeholders' views and experiences. This textured perspective of the multi-faceted process of development provides new insights for administrators, coaches and parents to maximise the developmental properties of youth sport, and signposts new avenues for research in this area.

Roots to Grow and Wings to Fly: An Ethnography of Psychosocial Development in Adolescent Performance Sport.

This study aimed to explore the potential for sport to support psychosocial development in young people in a youth performance setting using a novel realistic evaluation approach. Part 1 of this two-paper series published in this Special Issue identified the programme theories-how the programme is supposed to work. A wide and deep network of context, generative mechanisms and outcomes responsible for psychosocial development in this youth performance basketball club emerged. The first paper also concluded that the outcomes and the experience are highly contextual and individualised. In this second part, the stakeholder's programme theories were tested during a full-season ethnography of the same club. Immersion in the day-to-day environment generated a fine-grain analysis of the processes involved, including: (i) sustained attentional focus; (ii) structured and unstructured skill-building activities; (iii) deliberate and incidental support; and (iv) feelings indicating personal growth. Personal development in and through sport is thus shown to be conditional, multi-faceted, time-sensitive and idiosyncratic. The findings of this two-part study are considered to propose a model of psychosocial development in and through sport. This heuristic tool is presented to support sport psychologists, coaches, club administrators and parents to deliberately create and optimise developmental environments.

Smartphone pedometers in adults with asthma: a practical approach to physical activity assessment? A pilot validation study.

OBJECTIVE: The aim of this pilot validation study was to determine the accuracy of a smartphone (iPhone®) pedometer in adults with and without asthma. METHODS: Ten adults with asthma and ten healthy controls underwent clinical assessment prior to completing two separate trials. Phase 1. standardized treadmill and self-paced walking tests. Total steps were recorded via: (i) Yamax Digiwalker™ SW800 pedometer positioned on the waistband, (ii) iPhone® pedometer positioned on the upper body, (iii) iPhone® pedometer positioned on the lower body and evaluated against a video-verified manual step-count. Phase 2. step-count was evaluated over seven-days during habitual free-living conditions via Yamax Digiwalker™ SW800 and iPhone® pedometers. RESULTS: During treadmill walking, the iPhone® positioned on the lower body correlated strongly (r = 0.96) and produced the highest level of agreement (mean bias: -11 steps, LOA: -43 to 21 steps) in comparison to video-verified manual step-count. During self-paced walking, all devices provided an excellent step-count estimate. During free-living conditions, no difference was observed between the Yamax Digiwalker™ SW800 pedometer and iPhone® (P = 0.10) and a strong correlation (r = 0.94) and acceptable agreement (mean bias: -343, LOA: -1963 to 1276 steps) was observed. CONCLUSION: Our findings indicate that an in-built iPhone® pedometer offers a practical approach to physical activity assessment in adults with and without asthma. Future research is now required to further validate the precision of this approach and evaluate the efficacy and effectiveness of smartphone pedometers to monitor and promote physical activity when employed during medical consultation and/or clinical research trials.

Participation in physical activity decreased more in people with rheumatoid arthritis than the general population during the COVID-19 lockdown: a cross-sectional study.

The COVID-19 pandemic and social distancing restrictions have significantly reduced population-wide physical activity (PA) levels. However, the impact of the pandemic and relevant restrictions on PA participation, and any potential barriers to it, in people with rheumatoid arthritis (RA) are not clear. Furthermore, we are unsure if any such PA changes have affected their body weight, mental wellbeing, and/or quality of life (QoL). Thus, the aim of this study was to examine the impact of the lockdown on PA participation in people with RA, versus people without RA. Participants (n = 128; RA = 27, non-RA = 101) completed a self-administered online survey, which included questions on PA, body weight, mental wellbeing and QoL. PA participation during lockdown was significantly lower among RA versus non-RA participants (p < 0.001). Additionally, a similar profile of results was found where more RA participants vs non-RA participants reported reduced habitual PA (59% vs 33%) and increased body weight (59% vs 35%). Mental wellbeing scores were similarly low in both groups during lockdown (RA: 20.8 ± 4.2; non-RA: 22.2 ± 3.4, p = 0.080). Matched group comparisons identified similar trends to full sample analyses. In the first months of the lockdown, more people with RA reported decreased PA participation and increased body weight than their non-RA counterparts. Access to exercise equipment and facilities appears to be the main cause for these results. Looking beyond COVID-19, specific PA promotion for people with RA will be required to prevent a pandemic of inactivity.

The enduring well-being impacts of attending the Battle Back Multi Activity Course for the lives of recovering UK armed forces personnel.

Few adventurous training courses have been formally designed to assist military personnel in their recovery and/or transition into civilian life by supporting psychological health and well-being. This study examines, for the first time, the longitudinal effects of a five-day Multi Activity Course (MAC) on the mental well-being of serving but wounded, injured, and/or sick (WIS) UK armed forces personnel. The MAC is delivered using a participant-centered approach to encourage engagement in adaptive sports, adventurous activities, and personal development coaching sessions. This work extends previous research showing powerful short-term well-being benefits. Measures of positive well-being and psychological need satisfaction were provided by participants before and after attending the course, as well as two weeks, three months, six months and 12 months later. Self-reported well-being measures of psychological need satisfaction and positive mental well-being improved significantly throughout the course. These remained significantly higher at six and 12 months after the course, respectively.

A whole system approach to increasing children's physical activity in a multi-ethnic UK city: a process evaluation protocol.

BACKGROUND: Engaging in regular physical activity requires continued complex decision-making in varied and dynamic individual, social and structural contexts. Widespread shortfalls of physical activity interventions suggests the complex underlying mechanisms of change are not yet fully understood. More insightful process evaluations are needed to design and implement more effective approaches. This paper describes the protocol for a process evaluation of the JU:MP programme, a whole systems approach to increasing physical activity in children and young people aged 5-14 years in North Bradford, UK. METHODS: This process evaluation, underpinned by realist philosophy, aims to understand the development and implementation of the JU:MP programme and the mechanisms by which JU:MP influences physical activity in children and young people. It also aims to explore behaviour change across wider policy, strategy and neighbourhood systems. A mixed method data collection approach will include semi-structured interview, observation, documentary analysis, surveys, and participatory evaluation methods including reflections and ripple effect mapping. DISCUSSION: This protocol offers an innovative approach on the use of process evaluation feeding into an iterative programme intended to generate evidence-based practice and deliver practice-based evidence. This paper advances knowledge regarding the development of process evaluations for evaluating systems interventions, and emphasises the importance of process evaluation.

Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial.

BACKGROUND: A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans. OBJECTIVE: This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans' Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA. METHODS: The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans' Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences. RESULTS: Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so. CONCLUSIONS: Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/21911.

Moderate-to-Vigorous Physical Activity in Primary School Children: Inactive Lessons Are Dominated by Maths and English.

BACKGROUND: A large majority of primary school pupils fail to achieve 30-min of daily, in-school moderate-to-vigorous physical activity (MVPA). The aim of this study was to investigate MVPA accumulation and subject frequency during academic lesson segments and the broader segmented school day. METHODS: 122 children (42.6% boys; 9.9 ± 0.3 years) from six primary schools in North East England, wore uniaxial accelerometers for eight consecutive days. Subject frequency was assessed by teacher diaries. Multilevel models (children nested within schools) examined significant predictors of MVPA across each school-day segment (lesson one, break, lesson two, lunch, lesson three). RESULTS: Pupils averaged 18.33 ± 8.34 min of in-school MVPA, and 90.2% failed to achieve the in-school 30-min MVPA threshold. Across all school-day segments, MVPA accumulation was typically influenced at the individual level. Lessons one and two-dominated by maths and English-were less active than lesson three. Break and lunch were the most active segments. CONCLUSION: This study breaks new ground, revealing that MVPA accumulation and subject frequency varies greatly during different academic lessons. Morning lessons were dominated by the inactive delivery of maths and English, whereas afternoon lessons involved a greater array of subject delivery that resulted in marginally higher levels of MVPA.