A systematic review of culturally adapted physical activity interventions for culturally and linguistically diverse children and adolescents.

OBJECTIVE: Limited evidence shows culturally and linguistically diverse (CALD) children and adolescents are less active, compared to the general population. It is unclear, how physical activity interventions have been adapted for CALD children and adolescents to enhance engagement. This study aimed to review culturally adapted physical activity interventions targeting CALD children and adolescents. METHODS: All studies recruited children and adolescents (i.e., aged ≥5 to <18 years old) from CALD backgrounds, targeted physical activity, and included cultural adaptations. Cultural adaptations were defined as surface structures (i.e., observable characteristics of a targeted population) or deep structures (i.e., rooted in core ethnic values derived from individual cultures. RESULTS: Twenty studies were included. Ten studies used a combination of surface and deep structure adaptations. Of these 10 studies, 3 found a significant between-group difference in physical activity favouring the intervention group. Among studies (n = 6) that used surface structure adaptations (e.g., language adjustments to information sheets, consent forms, and resources), 1 found a significant intervention effect on physical activity. With studies (n = 4) that used deep structure adaptations (e.g., incorporating traditional songs and dances relevant to cultural groups), 1 study found a significant intervention effect on physical activity. CONCLUSION: A small number of studies found significant changes to increase physical activity levels. We found there is a lack of consistent evidence indicating that incorporating surface and/or deep structure adaptations result in significant changes in physical activity. Future research should focus on establishing higher quality methodology when developing culturally adapted interventions for CALD populations.

A systematic review and meta-analysis of randomized controlled trials to reduce burden, stress, and strain in informal stroke caregivers.

OBJECTIVES: To understand the nature and effectiveness of interventions aimed at improving informal stroke caregiver burden, stress, and strain. DATA SOURCES: In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of CENTRAL, CINAHL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted in May 2022. REVIEW METHODS: Studies were eligible if they included an intervention designed for informal stroke caregivers, reported on caregiver burden, strain, or stress, were published in English, and used a randomized controlled trial design. An updated search was conducted in June 2024. The methodological quality of studies was appraised using the Cochrane risk-of-bias tool for randomized trials. The data were pooled, and a meta-analysis was completed for caregiver burden and strain outcomes. RESULTS: Nineteen studies met inclusion criteria and were meta-analyzed. Interventions ranged from 4 days to 12 months. Most studies incorporated educational and/or support components. Meta-analyses revealed nonsignificant effects on caregiver burden or strain. Significant between-group differences for caregiver strain and burden were, however, found in seven studies. CONCLUSION: Limited studies, small sample sizes, and conflicting results made definitive conclusions on the most effective intervention characteristics for improving caregiver outcomes difficult. Of the 19 studies, seven found significant between-group differences for caregiver outcomes postintervention, and these tended to incorporate educational components and comprised between seven and nine sessions. Further high-quality research is required to identify optimal format, duration, and frequency for improving caregiver outcomes.

Participation in physical activity and sport in adolescent girls from Middle Eastern backgrounds.

OBJECTIVES: This study investigated the barriers and facilitators to physical activity and sport participation among adolescent girls from Middle Eastern backgrounds. These factors were explored through the perspectives of both adolescent girls and parents of adolescent girls, living in Australia. DESIGN: A qualitative study design was used to understand perceived barriers and facilitators to physical activity and sport in adolescent girls. Participants were 18 adolescent girls and 9 parents of adolescent girls, all of Middle Eastern backgrounds, living in Western Sydney, Australia. Data were collected through five focus groups and four one-on-one interviews, separated for girls and parents. Data were analysed using an inductive approach and thematic analysis. RESULTS: Three main themes (family, social support, religion and culture) and nine subthemes were identified. The main facilitators for physical activity and sport included the values and presence of an active family role model, religion to encourage lifelong physical activity skills, and promotion of physical activity from peers, school, and social media. The predominant barriers to physical activity and sport included established cultural norms and traditional gender roles, which were often influenced by religion and culture, and extended time using technology. CONCLUSION: The findings of the current study show the complex relationships between family, religion, and culture when promoting physical and sport participation. Such factors highlight the need to develop culturally tailored physical activity interventions that consider the perceived barriers and facilitators for adolescent girls' participation from Middle Eastern backgrounds.

Physical activity interventions among culturally and linguistically diverse populations: a systematic review.

OBJECTIVES: To systematically review physical activity interventions among culturally and linguistically diverse (CALD) populations and explore the strategies used to recruit CALD populations, the cultural adaptations made in these interventions, and the cultural adaptations used among successful interventions. DESIGN: Four electronic databases (Embase, MEDLINE, CENTRAL, and CINAHL) was searched in March 2017 and re-run in January 2018. Manual screening of the reference lists of the included studies was also conducted. Eligibility criteria for inclusion in the systematic review were: intervention studies (e.g. controlled and non-controlled studies), physical activity as primary outcome and as the only health behaviour targeted, culturally and linguistically diverse population of interest, published in English, and targeted adult populations (i.e. aged ≥18). RESULTS: A total of 19 articles were included in this review, comprising 15 unique studies. Most studies targeted Latino populations, published in the United States, and targeted women. An array of recruitment strategies were used, such as recruiting from religious establishments or religious and cultural events, and community organisations and events. The majority of studies made cultural adaptations to their intervention to suit the CALD population of interest, however, the level of detail of reported adjustments was limited. Successful interventions were those that generally included community consultation to inform their intervention, language adjustments, community health workers/bilingual/bicultural personnel for intervention delivery, recruitment, and data-collection, and using culturally-relevant intervention material. CONCLUSIONS: Although many studies included in this review reported increases in physical activity at follow-up, the results need to be interpreted with caution due to the lower level of methodological quality and reporting on study methodology. Future interventions designed for CALD populations should be of greater methodological quality and also provide a greater level of transparency in terms of the cultural adaptations that have been made to the intervention.

A systematic review of qualitative studies exploring the factors influencing the physical activity levels of Arab migrants.

BACKGROUND: Evidence suggests that Arab migrant populations engage in low levels of physical activity. To our knowledge, there are no reviews that explore the perspectives of Arab migrant populations on the factors influencing physical activity. The aim of this systematic review was to thematically synthesise qualitative literature on the factors influencing physical activity among Arab migrant populations. METHODS: Five electronic databases (CINAHL, SPORTDiscus, PsychoInfo, MEDLINE, Embase) were searched in July 2018 and searched again in April 2020. A manual search in Google Scholar was also performed using keywords and the reference lists of included studies were also screened to identify further articles. The eligibility criteria for inclusion were studies that sampled adult (≥18 years) Arab migrant populations, used qualitative methodology, explored the factors influencing physical activity as a primary aim, and were published in English. The 10-item Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological quality of individual studies. The results of the studies were thematically synthesised using the qualitative software Quirkos v1.6. RESULTS: A total of 15 studies were included, with the largest proportion of studies conducted in Australia, followed by the United States, Netherlands, Sweden, and then Canada. Five studies exclusively sampled Arab migrant populations in their study. A total of 7 major themes influencing physical activity among Arab migrants emerged from the synthesis: culture and religion, competing commitments and time, social factors, health-related influences, accessibility issues, outdoor environment, and the migratory experience. CONCLUSIONS: The findings of this review highlighted the various factors influencing the physical activity levels of Arab migrant adults. While many of the factors influencing physical activity are shared with those experienced by other populations (e.g., time constraints), for Arab migrant populations there are other more unique factors closely associated with culture and religion that appear to influence their levels of physical activity. The findings of this review could be used to inform the design of physical activity interventions targeting Arab migrant populations.

Feasibility and acceptability of a culturally tailored physical activity intervention for Arab-Australian women.

BACKGROUND: Despite being one of the largest migrant groups in Australia, few physical activity interventions exist for Arab-Australians. The primary aim of this study was to test the feasibility and acceptability of a 12-week culturally tailored physical activity intervention for Arab-Australian women. METHODS: This study used a single-group pretest-posttest design, and was informed by extensive formative research and consultation involving the Arab-Australian community. Participants were insufficiently active Arab-Australian women aged 35-64 with no current illness or injury that would limit physical activity participation. The intervention comprised 6 face-to-face physical activity and education sessions over 12 weeks. The intervention was conducted at 2 separate intervention sites in Western Sydney, Australia. Feasibility outcomes included recruitment, session attendance, and retention. The acceptability of the intervention was assessed through a process evaluation questionnaire completed post-intervention. Accelerometers and the short-form International Physical Activity Questionnaire were used to measure physical activity at baseline and post-intervention. Descriptive statistics were used for feasibility and acceptability outcomes, and changes in physical activity were examined using Wilcoxon signed-rank tests. RESULTS: Of the 53 women who were contacted or expressed interest, 22 were eligible and enrolled in the study. Participants were primarily recruited through direct contact by Arab-Australian community workers and by word-of-mouth. Average session attendance was 63% and the retention rate post-intervention was 68%. The culturally-related intervention components, such as the appropriateness of content, and women-only setting, were rated highly favourably (4.33 to 4.87/5). General intervention elements, such as the face-to-face delivery, knowledge and approachability of facilitators, and session structure, were also rated favourably (4.33 to 4.93/5), and the lowest scored item was the intervention session frequency (3.2/5). There were no statistically significant changes in physical activity post-intervention. CONCLUSIONS: The findings from this study highlighted factors related to recruitment and delivery that need to be considered when developing physical activity interventions for Arab-Australian women. Further research is required using a larger sample and a randomised controlled trial design to examine the longer-term impact on physical activity, and to also examine ways of increasing intervention engagement and retention among Arab-Australian women. TRIAL REGISTRATION: ANZCTR, ACTRN12618001392257. Registered 20 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375636 .

The perceptions, barriers and enablers to physical activity and minimising sedentary behaviour among Arab-Australian adults aged 35-64 years.

ISSUES ADDRESSED: The objective of this study was to explore the perceptions, barriers and enablers to physical activity (PA) and minimising sedentary behaviour among Arab-Australians, a group who have lower levels of PA and higher rates of certain chronic diseases when compared with the general Australian population. METHODS: A total of 28 Arab-Australians aged 35-64 years participated in one of five focus groups conducted in Western Sydney during 2017-2018, a culturally diverse region in New South Wales, Australia. Focus group duration ranged from 35-90 minutes with 4-7 participants in each group. Focus group data were recorded and transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Participants had a general understanding of PA and the associated health benefits. Fewer participants were aware of the independent health effects associated with prolonged sitting. A lack of time and motivation due to work, familial duties, domestic roles and lack of effort reportedly influenced PA participation. Health was perceived to be both a barrier and an enabler to PA. Barriers related to health included pain and existing conditions and enablers included preventive and reactive measures. Social support and accessibility, such as a lack of support networks, the availability of services and costs were also discussed. Cultural and religious influences, such as traditional gender roles and the importance of gender-exclusive settings, were also important factors influencing the PA behaviours of participants. CONCLUSIONS: This study highlighted the factors that influence the PA levels and sedentary behaviour of Arab-Australian adults aged 35-64 years. SO WHAT?: The findings of this study could help inform the design and development of culturally tailored PA interventions for Arab-Australian adults.

Systematic review of randomised control trial health promotion intervention studies in the fire services: study characteristics, intervention design and impacts on health.

The objective of this study was to systematically review health promotion interventions in the fire services. Four databases were searched for articles reporting on health promotion interventions for firefighters evaluated in randomised controlled trials (RCT) and measuring efficacy on health or lifestyle behaviour outcomes. Data were extracted to create a narrative synthesis regarding study design, intervention characteristics and impact on outcomes. Risk of bias was assessed using a 13-item tool. Of 448 papers identified, after removal of duplicates, 209 were excluded based on title/abstract screening. A further 60 papers were excluded, mostly due to studies not being RCTs, not including a lifestyle behaviour intervention, or not focusing on health or lifestyle behaviour outcomes. Ten studies (reported in 11 papers) were eligible for inclusion. Six studies compared an intervention to usual practice, one compared a full intervention to a minimal intervention, one compared two exercise programmes and two compared two interventions to usual practice. Four studies evaluated structured physical activity interventions. Five studies evaluated physical activity and diet-focused behaviour change programmes, and one study included a mindfulness programme. When assessing risk of bias, three studies had low risk ratings for >8/13 items, leaving seven studies with high-risk ratings for ≥5/13 items. Eight of the 10 studies reported improvements in at least 1 outcome from baseline to final follow-up in the intervention group over a comparison group. The majority of lifestyle behaviour interventions targeted physical activity and/or diet. Findings from included studies suggest that programmes for firefighters initiated in the workplace can improve some health outcomes.

Psychological distress among carers and the moderating effects of social support.

BACKGROUND: Carers provide both practical and emotional support and often play an important role in coordination of care for recipients. The demands of caring may lead to increased levels of stress for the carer, which can affect mental health and quality of life. This study examined the relationship between being a carer and psychological distress (assessed using the Kessler Psychological Distress Scale [K10]), and explored the moderating effect of social support in that relationship using a large sample. METHODS: The study used data from the 45 and Up study, a large cohort study of individuals aged 45 years and over in New South Wales, Australia, and applied multiple regression methods and moderation analysis. The sample for the current study comprised 267,041 participants drawn from the baseline dataset, with valid data on the primary outcome (carer status). RESULTS: The mean age of participants was 62.73 (±11.18) years, and 4.23% and 7.13% were identified as full-time and part-time carers, respectively. Compared to non-carers, full-time carers had K10 scores that were on average, higher by 1.87, while part-time carers' K10 scores were on average higher by 1.60 points. A perception of social support reduced the strength of the relationship between carer status and psychological distress by 40% for full-time carers and 60% for part-time carers. CONCLUSIONS: The findings have important implications, for both prevention and treatment of psychological problems among carers. In terms of prevention, they suggest that public health campaigns focused on increasing awareness regarding the psychological burden faced by carers would be useful. In terms of intervention, potential treatments that focus on improving social support networks may be helpful. The results are particularly important in the current context of an ageing population in Australian and other developed countries, where caregiving is likely to play an increasing role in the care and support services.

"We need a one-stop-shop": co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers.

BACKGROUND: Timely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers. METHODS: Data collection comprised semi-structured interviews (N = 98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos. RESULTS: GPs' attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs. CONCLUSION: This study demonstrates the importance of working with stakeholders to co-design models of care for people with dementia that take into account the local communities' needs. Findings pave the way for the development of a potential new "gold standard" memory clinic model of care and operationalise new national clinical guidelines.

Co-participation in physical activity: perspectives from Australian parents of pre-schoolers.

Co-participation in physical activity may be important for helping families with young children meet physical activity recommendations. Yet, little is known about what families perceive to be the benefits, barriers and facilitators of co-participation. This study explored (i) parents' perceptions about physical activity and possible benefits of family-based co-participation in physical activity, (ii) their perceived facilitators and barriers to co-participation and (iii) their recommendations for improving co-participation within their community. Fifteen parents (14 mothers, 1 father) of 2- to 4-year-old children residing in Western Sydney, Australia, participated in one-on-one interviews between September 2016 and January 2017. Interviews were audio-recorded and transcribed verbatim. Four main themes and seven sub-themes emerged from the thematic analysis of the interview data. When parents were asked to reflect on their understanding of physical activity, they discussed a range of well-known activities (e.g. active play, active transport) and also reported 'anything but screen time'. The major benefits parents reported about co-participation were spending quality time together, improving children's general health and well-being and the development of physical skills. Social (e.g. social networks, negative stereotypes) and environmental (e.g. home space, neighbourhood design, shading) facilitators and barriers were identified, yet their impact on co-participation often varied depending on the presence (or lack thereof) of other factors in the physical or social environment. Key recommendations suggested by parents included improvements to home outdoor spaces, neighbourhood design and play spaces and community services.

A systematic review of health promotion intervention studies in the police force: study characteristics, intervention design and impacts on health.

To systematically review studies of health promotion intervention in the police force. Four databases were searched for articles reporting on prepost single and multigroup studies in police officers and trainees. Data were extracted and bias assessed to evaluate study characteristics, intervention design and the impact of interventions on health. Database searching identified 25 articles reporting on 21 studies relevant to the aims of this review. Few studies (n=3) were of long duration (≥6 months). Nine of 21 studies evaluated structured physical activity and/or diet programmes only, 5 studies used education and behaviour change support-only interventions, 5 combined structured programmes with education and behaviour change support, and 2 studies used computer prompts to minimise sedentary behaviour. A wide array of lifestyle behaviour and health outcomes was measured, with 11/13 multigroup and 8/8 single-group studies reporting beneficial impacts on outcomes. High risk of bias was evident across most studies. In those with the lowest risk of bias (n=2), a large effect on blood pressure and small effects on diet, sleep quality, stress and tobacco use, were reported. Health promotion interventions can impact beneficially on health of the police force, particularly blood pressure, diet, sleep, stress and tobacco use. Limited reporting made comparison of findings challenging. Combined structured programmes with education and behaviour change support and programmes including peer support resulted in the most impact on health-related outcomes.

Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study.

BACKGROUND: The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males' physical activity and dietary practices. OBJECTIVE: This study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention. METHODS: Participants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants' physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months. RESULTS: A total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(ß)=1.45, 95% CI 1.09-1.95; exp(ß)=1.61, 95% CI 1.17-2.22) and 9 months (exp(ß)=1.55, 95% CI 1.14-2.10; exp(ß)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(ß)=1.07, 95% CI 1.03-1.11) and 9 months (exp(ß)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(ß)=2.25, 95% CI 1.29-3.92; exp(ß)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(ß)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(ß)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. CONCLUSIONS: The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

Determining priority areas for health promotion amongst Australian professional sporting organisations.

OBJECTIVES: Professional sporting organisations (PSOs) are well-positioned to promote health through their reach and standing within communities. However, the health promotion (HP) priority areas of interest of PSOs are unknown. The objectives of this study were to: identify HP priority areas amongst Australian PSOs and explore the development, implementation, and evaluation of HP programming within the identified priority areas. DESIGN: Delphi procedure with qualitative interviews. METHODS: Participants were community-focussed employees from PSOs across Australia. To identify HP priory areas, three rounds of surveys were used in a Delphi procedure. Participants were then invited to participate in semi-structured interviews focussed on the development, implementation, and evaluation of HP programmes. RESULTS: Of the 103 community employees invited to participate in the Delphi, 28 participated in at least one round and 16 completed all rounds. Overall, HP priorities fell under five main areas: access/participation in sport; general HP; physical activity promotion; community, culture, and inclusion; and support for HP initiatives. Eleven interviews were conducted, and central themes included needing support with programme design and evaluation, and the need to build employee capacity and greater inter-organisational collaboration. CONCLUSIONS: This study determined HP priority areas amongst PSOs using a consensus-generating approach. Interview findings demonstrated that community-focussed employees are committed to delivering HP programmes, but encounter difficulty with funding, employee capacity, and programme design and evaluation expertise. The findings from these interviews reveal potential avenues of collaboration between organisations that can provide expertise in design and evaluation and sporting organisations for HP programming.

The impact of caregiving on the roles and valued activities of stroke carers: A systematic review of qualitative studies.

OBJECTIVE: To understand the experiences of informal carers and the impact of role and activity changes on their health and wellbeing. METHODS: A systematic search of CINHAL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted. Studies were eligible if they included informal stroke carers (≥18 years), used a qualitative methodology, explored the roles and valued activities of stroke carers, and were published in English. The 10-item Critical Appraisal Skills Programme checklist for qualitative studies was used to assess methodological quality. The results of the included studies were thematically synthesised. RESULTS: A total of 36 qualitative studies were included and four overarching themes were identified: (1) Life adjustment; (2) Changing role and identity; (3) Changing activities: From meaningful to purposeful; and (4) Understanding and supporting carers. CONCLUSION: The sudden nature of stroke requires major readjustment in the carers life that has implications on their relationships, roles, and activities, subsequently impacting on their health and wellbeing. Health professionals and researchers should collaborate with stroke carers to identify their valued activities and implement realistic strategies to maintain these activities. Future interventions designed for carers should implement education about the importance of participating in valued activities and strategies to maintain these activities.

Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study.

BACKGROUND: Compared to females, males experience a range of health inequities including higher rates of diabetes and cardiovascular disease. Although sitting time is emerging as a distinct risk factor for chronic disease, research on the association of sitting time and chronic disease in middle-aged Australian males is limited. METHODS: A sample of 63,048 males aged 45-64 years was drawn from the baseline dataset of the 45 and Up Study - a longitudinal cohort study on healthy ageing with 267,153 participants from across New South Wales, Australia's most populous state. Baseline data on self-reported chronic disease (heart disease, cancer, diabetes, high blood pressure, combined chronic diseases), sitting time, physical activity (Active Australia Survey), and a range of covariates were used for cross-sectional analyses. Crude (OR), partially and fully adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using binary logistic regression. RESULTS: Compared to those sitting <4 hours/day, participants reporting 4 to <6, 6 to <8, and ≥8 hours were significantly more likely to report ever having any chronic disease (AOR 1.06, 95% CI 1.00 - 1.12, p = 0.050; AOR 1.10, 95% CI 1.03 - 1.16, p = 0.003; AOR 1.09, 95% CI 1.03 - 1.15, p = 0.002, respectively). Participants who reported 6 to <8 hours and ≥8 hours of sitting were also significantly more likely to report ever having diabetes than those reporting <4 hours/day (AOR 1.15, 95% CI 1.03 - 1.28, p = 0.016; AOR 1.21, 95% CI 1.09 - 1.33, p <0.001, respectively). CONCLUSIONS: Our findings suggest that higher volumes of sitting time are significantly associated with diabetes and overall chronic disease, independent of physical activity and other potentially confounding factors. Prospective studies using valid and reliable measures into domain-specific sitting time in middle-aged males are required to understand and explain the direction of these relationships.

A review of the nature and effectiveness of nutrition interventions in adult males--a guide for intervention strategies.

BACKGROUND: Energy excess, low fruit and vegetable intake and other suboptimal dietary habits contribute to an increased poor health and the burden of disease in males. However the best way to engage males into nutrition programs remains unclear. This review provides a critical evaluation of the nature and effectiveness of nutrition interventions that target the adult male population. METHODS: A search for full-text publications was conducted using The Cochrane Library; Web of Science; SCOPUS; MEDLINE and CINAHL. Studies were included if 1) published from January 1990 to August 2011 and 2) male only studies (≥18 years) or 3) where males contributed to >90% of the active cohort. A study must have described, (i) a significant change (p<0.05) over time in an objective measure of body weight, expressed in kilograms (kg) OR Body Mass Index (BMI) OR (ii) at least one significant change (p<0.05) in a dietary intake measure to qualify as effective. To identify emerging patterns within the research a descriptive process was used. RESULTS: Nine studies were included. Sample sizes ranged from 53 to 5042 male participants, with study durations ranging from 12 weeks to 24 months. Overlap was seen with eight of the nine studies including a weight management component whilst six studies focused on achieving changes in dietary intake patterns relating to modifications of fruit, vegetable, dairy and total fat intakes and three studies primarily focused on achieving weight loss through caloric restriction. Intervention effectiveness was identified for seven of the nine studies. Five studies reported significant positive changes in weight (kg) and/or BMI (kg/m2) changes (p≤0.05). Four studies had effective interventions (p<0.05) targeting determinants of dietary intake and dietary behaviours and/or nutritional intake.Intervention features, which appeared to be associated with better outcomes, include the delivery of quantitative information on diet and the use of self-monitoring and tailored feedback. CONCLUSION: Uncertainty remains as to the features of successful nutrition interventions for males due to limited details provided for nutrition intervention protocols, variability in mode of delivery and comparisons between delivery modes as well as content of information provided to participants between studies. This review offers knowledge to guide researchers in making informed decisions on how to best utilise resources in interventions to engage adult males while highlighting the need for improved reporting of intervention protocols.

What kinds of website and mobile phone-delivered physical activity and nutrition interventions do middle-aged men want?

Within a health context, men in Western societies are a hard-to-reach population who experience higher rates of chronic disease compared with women. Innovative technology-based interventions that specifically target men are needed; however, little is known about how these should be developed for this group. This study aimed to examine opinions and perceptions regarding the use of Internet and mobile phones to improve physical activity and nutrition behaviors for middle-aged men. The authors conducted 6 focus groups (n = 30) in Queensland, Australia. Their analyses identified 6 themes: (a) Internet experience, (b) website characteristics, (c) Web 2.0 applications, (d) website features, (e) self-monitoring, and (f) mobile phones as delivery method. The outcomes indicate that men support the use of the Internet to improve and self-monitor physical activity and dietary behaviors on the condition that the website-delivered interventions are quick and easy to use, because commitment levels to engage in online tasks are low. Participants also indicated that they were reluctant to use normal mobile phones to change health behaviors, although smartphones were perceived to be more acceptable. This pilot study suggests that there are viable avenues to engage middle-aged men in Internet- or in mobile-delivered health interventions. This study also suggests that to be successful, these interventions need to be tailor-made especially for men, with an emphasis on usability and convenience. A wider quantitative study would bring further support to these findings.

Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: trial protocol and baseline findings of the ManUp Study.

BACKGROUND: Compared to females, males experience higher rates of chronic disease and mortality, yet few health promotion initiatives are specifically aimed at men. Therefore, the aim of the ManUp Study is to examine the effectiveness of an IT-based intervention to increase the physical activity and nutrition behaviour and literacy in middle-aged males (aged 35-54 years). METHOD/DESIGN: The study design was a two-arm randomised controlled trial, having an IT-based (applying website and mobile phones) and a print-based intervention arm, to deliver intervention materials and to promote self-monitoring of physical activity and nutrition behaviours. Participants (n = 317) were randomised on a 2:1 ratio in favour of the IT-based intervention arm. Both intervention arms completed assessments at baseline, 3, and 9 months. All participants completed self-report assessments of physical activity, sitting time, nutrition behaviours, physical activity and nutrition literacy, perceived health status and socio-demographic characteristics. A randomly selected sub-sample in the IT-based (n = 61) and print-based (n = 30) intervention arms completed objective measures of height, weight, waist circumference, and physical activity as measured by accelerometer (Actigraph GT3X). The average age of participants in the IT-based and print-based intervention arm was 44.2 and 43.8 years respectively. The majority of participants were employed in professional occupations (IT-based 57.6%, Print-based 54.2%) and were overweight or obese (IT-based 90.8%, Print-based 87.3%). At baseline a lower proportion of participants in the IT-based (70.2%) group agreed that 30 minutes of physical activity each day is enough to improve health compared to the print-based (82.3%) group (p = .026). The IT-based group consumed a significantly lower number of serves of red meat in the previous week, compared to the print-based group (p = .017). No other significant between-group differences were observed at baseline. DISCUSSION: The ManUp Study will examine the effectiveness of an IT-based approach to improve physical activity and nutrition behaviour and literacy. Study outcomes will provide much needed information on the efficacy of this approach in middle aged males, which is important due to the large proportions of males at risk, and the potential reach of IT-based interventions. TRIAL REGISTRATION: ACTRN12611000081910.

Physical activity and psychological distress in older men: findings from the New South Wales 45 and up study.

Physical activity is an important factor in healthy aging and has been shown to reduce depressive symptoms. This association, however, is relatively understudied in older men. This study was a cross-sectional analysis of the association between physical activity (Active Australia Survey) and psychological distress (Kessler-10). Participants were a sample of 17,689 men age ≥ 65 yr drawn from a large-scale Australian cohort study of people age 45 years and over (The 45 and Up Study). The likelihood of reporting high or very high levels of psychological distress decreased with increasing weekly sessions of physical activity. Compared with participants reporting no sessions of physical activity, the fully adjusted odds ratio for high or very high psychological distress was .66 (95% CI .51-.85) for men who undertook 1-6 sessions of physical activity per week and decreased to .57 (95% CI, .43-.79) for men who reported 16 or more weekly sessions. The cross-sectional findings show that older men who are more active are less likely to report psychological distress, regardless of their level of functional limitation. Further research, informed by these findings, is required to investigate causal pathways and the temporal sequence of events.