Barriers and Facilitators to Participating in an Exercise Referral Scheme among Women Living in a Low Socioeconomic Area in Australia: A Qualitative Investigation Using the COM-B and Theoretical Domains Framework.

INTRODUCTION: Despite the health benefits of regular physical activity, women experiencing socioeconomic disadvantage are at high risk of inactivity. Reasons are multifactorial but likely include broad structural and contextual factors, e.g., lack of access to physical activity programs, as well as individual and interpersonal factors, e.g., lack of motivation and childcaring responsibilities. Few studies among women of low socioeconomic position (SEP) have explored these factors in-depth, yet an understanding of these factors can help inform the development and improve the uptake of exercise referral schemes. The Theoretical Domains Framework (TDF) and COM-B model (capability, opportunity, motivation and behaviour) were employed to understand behaviours for intervention development. Therefore, using these behaviour change models, this study aimed to explore the barriers and facilitators influencing the use of an exercise referral scheme among women living in a socioeconomically disadvantaged area. METHODS: Semi-structured interviews were conducted with women who had registered with a free exercise referral scheme (Live Life Get Active) and living in a low socioeconomic neighbourhood in Sydney, Australia. Reflexive thematic analysis and framework analysis were used to allow naturally identified themes to be determined and then allocated to theoretically driven domains. RESULTS: Nine women were interviewed (aged 30-69 years). Eighteen themes were identified and mapped directly on to the six COM-B constructs. The most reported barriers to using the physical activity referral scheme related to the opportunity construct of the COM-B model, specifically childcare responsibilities, work commitments and environmental barriers. Key facilitators were enjoyment (motivation), no cost (opportunity), instructor led (opportunity) and social support (opportunity). CONCLUSION: Future exercise referral schemes targeting women living in low-SEP neighbourhoods should ensure programs are designed and delivered to overcome barriers aligned with the constructs of the COM-B model, particularly opportunity-related constructors.

Reliability and Convergent Validity of Self-Reported Physical Activity Questionnaires for People With Mental Disorders: A Systematic Review and Meta-Analysis.

PURPOSE: To examine the reliability and convergent validity of self-reported questionnaires (SRQs) to measure physical activity (PA). METHODS: Systematic review with meta-analysis. The validity and reliability of SRQs to assess PA in people with mental disorders (January 20, 2020). Random-effects meta-analyses were performed pooling (1) test-retest correlations or (2) the convergent validity between the SRQs and objective measures (eg, accelerometry). Associations were provided in r values with the 95% confidence interval. Methodological quality was assessed. RESULTS: A total of 9 unique studies (N = 1344; 40.5% females) were included. The authors found a moderate correlation test-retest reliability for PA SRQs in the assessment of vigorous PA (r = .69 [.38 to .85]; P = .001), moderate to vigorous PA (r = .63 [.25 to .84]; P = .003), moderate PA (r = .63 [.39 to .79]; P = .001), and good correlation total PA (r = .75 [.37 to .92]; P = .001). The SRQs have moderate correlations with objective measures for moderate to vigorous PA (r = .25 [.18 to .32]; P = .0001) and total PA (r = .47 [.28 to .62]; P = .005), a poor correlation for moderate PA (r = .18 [.03 to .36]; P = .047), and no correlation with vigorous PA (r = .06 [-.10 to .22]; P = .440). CONCLUSION: Current evidence indicates that SRQs are reliable over time to assess moderate, vigorous, and total PA levels and valid when assessing moderate PA.

Temporal trends in exercise physiology services in Australia-Implications for rural and remote service provision.

OBJECTIVE: To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. DESIGN AND PARTICIPANTS: Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017. MAIN OUTCOME MEASURE(S): Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953. RESULTS: Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations. CONCLUSION: Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession.

Is the link between movement and mental health a two-way street? Prospective associations between physical activity, sedentary behaviour and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods.

This study aimed to investigate the bi-directional relationship between different domains of physical activity (PA), sedentary behaviour (SB) and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods in Victoria, Australia. Women (n=1033), aged 18-46years at Wave 1 (2007/08), completed self-report measures of PA (leisure-time, transport, occupational, domestic), SB (TV viewing, computer use, overall sitting time) and depressive symptoms (CES-D 10) at each study time-point (Wave 2: 2010/11, Wave 3: 2012/13). Separate linear mixed models were fitted to examine if change in depressive symptoms differed dependent on each of the baseline PA or SB measures. Similarly, baseline depressive symptoms were used as a predictor of change in PA and SB. In secondary analyses, associations between baseline PA or SB and odds of becoming 'at risk' of depression among those not 'at risk' at baseline were examined using logistic regression. There was no evidence that change in depressive symptoms differed depending on PA or SB at baseline. In general, there was also no evidence that change in PA or SB differed depending on baseline depressive symptoms. One exception was change in leisure-time PA, which declined more among those with heightened depressive symptoms at baseline (Interaction: ß=-0.003, 95% CI=-0.007, -0.0003). Transport-related PA (adjusted OR=1.06, 95% CI=1.013, 1.101) and domestic PA (adjusted OR=1.02, 95% CI=1.003, 1.040) were associated with greater odds of becoming at risk of depression at wave 3. There was limited evidence of a bi-directional relationship between PA, SB and depressive symptoms in women living in socioeconomically disadvantaged neighbourhoods.