Awareness of having hypertension, diabetes and dyslipidaemia among US adults: The 2011-2018 NHANES data.

AIM: This study aimed to investigate awareness of having hypertension, diabetes and dyslipidaemia and their associated factors among US adults. METHODS: Data from the National Health and Nutrition Examination Survey, including 21,399 adults aged ⩾20 years (pregnant women excluded) collected between 2011 and 2018, were used. Blood pressure was measured using a Baumanometer calibrated mercury true gravity wall model sphygmomanometer. Serum total cholesterol levels were measured using enzymatic assays. The percentage of haemoglobin A1C (HbA1c), which reflects long-term blood glucose levels, was measured and used to identify diabetes. Participants self-reported whether they were told by a doctor that they have hypertension, dyslipidaemia and diabetes. Awareness was defined as alignment between objective and self-reported measures for having the conditions. Sampling weights and the Taylor series linearisation variance estimation method were used in the analyses. RESULTS: The findings showed that 64.06% of people with hypertension, 54.71% of those with dyslipidaemia and 78.40% of those with diabetes were aware of having the respective condition. Age, sex and health insurance were associated with awareness of having all three conditions, but marital status was not associated with any outcome. Weight status was associated with awareness of having hypertension and dyslipidaemia, whereas ethnicity was associated with awareness of having hypertension and diabetes. Relative family income was only associated with awareness of having hypertension. CONCLUSIONS: Large proportions of US adults with hypertension, dyslipidaemia and diabetes are not aware of having the conditions. Interventions targeting groups at higher risk of being unaware of these conditions are needed.

Engagement, acceptability, usability and satisfaction with Active for Life, a computer-tailored web-based physical activity intervention using Fitbits in older adults.

BACKGROUND: Preliminary evidence suggests that web-based physical activity interventions with tailored advice and Fitbit integration are effective and may be well suited to older adults. Therefore, this study aimed to examine the engagement, acceptability, usability, and satisfaction with 'Active for Life,' a web-based physical activity intervention providing computer-tailored physical activity advice to older adults. METHODS: Inactive older adults (n = 243) were randomly assigned into 3 groups: 1) tailoring + Fitbit, 2) tailoring only, or 3) a wait-list control. The tailoring + Fitbit group and the tailoring-only group received 6 modules of computer-tailored physical activity advice over 12 weeks. The advice was informed by objective Fitbit data in the tailoring + Fitbit group and self-reported physical activity in the tailoring-only group. This study examined the engagement, acceptability, usability, and satisfaction of Active for Life in intervention participants (tailoring + Fitbit n = 78, tailoring only n = 96). Wait-list participants were not included. Engagement (Module completion, time on site) were objectively recorded through the intervention website. Acceptability (7-point Likert scale), usability (System Usability Scale), and satisfaction (open-ended questions) were assessed using an online survey at post intervention. ANOVA and Chi square analyses were conducted to compare outcomes between intervention groups and content analysis was used to analyse program satisfaction. RESULTS: At post-intervention (week 12), study attrition was 28% (22/78) in the Fitbit + tailoring group and 39% (37/96) in the tailoring-only group. Engagement and acceptability were good in both groups, however there were no group differences (module completions: tailoring + Fitbit: 4.72 ± 2.04, Tailoring-only: 4.23 ± 2.25 out of 6 modules, p = .14, time on site: tailoring + Fitbit: 103.46 ± 70.63, Tailoring-only: 96.90 ± 76.37 min in total, p = .56, and acceptability of the advice: tailoring + Fitbit: 5.62 ± 0.89, Tailoring-only: 5.75 ± 0.75 out of 7, p = .41). Intervention usability was modest but significantly higher in the tailoring + Fitbit group (tailoring + Fitbit: 64.55 ± 13.59, Tailoring-only: 57.04 ± 2.58 out of 100, p = .003). Participants reported that Active for Life helped motivate them, held them accountable, improved their awareness of how active they were and helped them to become more active. Conversely, many participants felt as though they would prefer personal contact, more detailed tailoring and more survey response options. CONCLUSIONS: This study supports web-based physical activity interventions with computer-tailored advice and Fitbit integration as engaging and acceptable in older adults. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12618000646246. Registered April 23 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374901.

A mixed-methods exploration of attitudes towards pregnant Facebook fitness influencers.

BACKGROUND: Exercise during pregnancy is associated with various health benefits for both mother and child. Despite these benefits, most pregnant women do not meet physical activity recommendations. A known barrier to engaging in exercise during pregnancy is a lack of knowledge about appropriate and safe exercise. In our current era of social media, many pregnant women are turning to online information sources for guidance, including social media influencers. Little is known about attitudes towards pregnancy exercise information provided by influencers on social media platforms. This study aimed to explore attitudes towards exercise during pregnancy depicted by social media influencers on Facebook, and user engagement with posted content. METHODS: A mixed-methods approach was used to analyse data from 10 Facebook video posts of social media influencers exercising during pregnancy. Quantitative descriptive analyses were used to report the number of views, shares, comments and emotive reactions. Qualitative analysis of user comments was achieved using an inductive thematic approach. RESULTS: The 10 video posts analysed were viewed a total of 12,117,200 times, shared on 11,181 occasions, included 13,455 user comments and 128,804 emotive icon reactions, with the most frequently used icon being 'like' (81.48%). The thematic analysis identified three themes associated with attitudes including [1] exercise during pregnancy [2] influencers and [3] type of exercise. A fourth theme of community was also identified. Most user comments were associated with positive attitudes towards exercise during pregnancy and the influencer. However, attitudes towards the types of exercise the influencer performed were mixed (aerobic and body weight exercises were positive; resistance-based exercise with weights were negative). Finally, the online community perceived by users was mostly positive and recognised for offering social support and guidance. CONCLUSIONS: User comments imply resistance-based exercise with weights as unsafe and unnecessary when pregnant, a perception that does not align with current best practice guidelines. Collectively, the findings from this study highlight the need for continued education regarding exercise during pregnancy and the potential for social media influencers to disseminate evidence-based material to pregnant women who are highly receptive to, and in need of reliable health information.

Comparison of multicenter MRI protocols for visualizing the spinal cord gray matter.

PURPOSE: Spinal cord gray-matter imaging is valuable for a number of applications, but remains challenging. The purpose of this work was to compare various MRI protocols at 1.5 T, 3 T, and 7 T for visualizing the gray matter. METHODS: In vivo data of the cervical spinal cord were collected from nine different imaging centers. Data processing consisted of automatically segmenting the spinal cord and its gray matter and co-registering back-to-back scans. We computed the SNR using two methods (SNR_single using a single scan and SNR_diff using the difference between back-to-back scans) and the white/gray matter contrast-to-noise ratio per unit time. Synthetic phantom data were generated to evaluate the metrics performance. Experienced radiologists qualitatively scored the images. We ran the same processing on an open-access multicenter data set of the spinal cord MRI (N = 267 participants). RESULTS: Qualitative assessments indicated comparable image quality for 3T and 7T scans. Spatial resolution was higher at higher field strength, and image quality at 1.5 T was found to be moderate to low. The proposed quantitative metrics were found to be robust to underlying changes to the SNR and contrast; however, the SNR_single method lacked accuracy when there were excessive partial-volume effects. CONCLUSION: We propose quality assessment criteria and metrics for gray-matter visualization and apply them to different protocols. The proposed criteria and metrics, the analyzed protocols, and our open-source code can serve as a benchmark for future optimization of spinal cord gray-matter imaging protocols.

The association of resilience with depression, anxiety, stress and physical activity during the COVID-19 pandemic.

BACKGROUND: COVID-19 has resulted in substantial global upheaval. Resilience is important in protecting wellbeing, however few studies have investigated changes in resilience over time, and associations between resilience with depression, anxiety, stress, and physical activity during the COVID-19 pandemic. METHODS: Online surveys were conducted to collect both longitudinal and cross-sectional data at three time points during 2020. Australian adults aged 18 years and over were invited to complete the online surveys. Measures include the six-item Brief Resilience Scale, the 21-item Depression, Anxiety and Stress Scale, and the Active Australia Survey which have eight items identifying the duration and frequency of walking, and moderate and vigorous physical activities (MVPA), over the past 7 days. General linear mixed models and general linear models were used in the analysis. RESULTS: In the longitudinal sample, adjusted differences (aDif) in resilience scores did not significantly change over time (time 2 vs. time 1 [aDif = - 0.02, 95% CI = - 0.08, 0.03], and time 3 vs. time 1 [aDif = < 0.01, 95% CI = - 0.07, 0.06]). On average, those engaging in at least 150 min of MVPA per week (aDif = 0.10, 95% CI = 0.04, 0.16), and having depression (aDif = 0.40, 95% CI = 0.33), anxiety (aDif = 0.34, 95% CI = 0.26, 0.41), and stress scores (aDif = 0.30, 95% CI = 0.23, 0.37) within the normal range had significantly higher resilience scores. The association between resilience and physical activity was independent of depression, anxiety, and stress levels. All results were similar for the cross-sectional sample. CONCLUSIONS: Resilience scores did not change significantly during the COVID-19 pandemic. However, there were significant associations between resilience with physical activity and psychological distress. This research helps inform future interventions to enhance or nurture resilience, particularly targeted at people identified as at risk of psychological distress.

The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial.

BACKGROUND: Physical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. OBJECTIVE: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. METHODS: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants' Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)-measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. RESULTS: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI -24% to 40%) or the tailoring-only group (-4%, 95% CI -24% to 30%); however, a significant decline was seen in the control group (-35%, 95% CI -52% to -11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). CONCLUSIONS: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246.

Are web-based personally tailored physical activity videos more effective than personally tailored text-based interventions? Results from the three-arm randomised controlled TaylorActive trial.

OBJECTIVES: Some online, personally tailored, text-based physical activity interventions have proven effective. However, people tend to 'skim' and 'scan' web-based text rather than thoroughly read their contents. In contrast, online videos are more engaging and popular. We examined whether web-based personally tailored physical activity videos were more effective in promoting physical activity than personally tailored text and generic information. METHODS: 501 adults were randomised into a video-tailored intervention, text-tailored intervention or control. Over a 3-month period, intervention groups received access to eight sessions of web-based personally tailored physical activity advice. Only the delivery method differed between intervention groups: tailored video versus tailored text. The primary outcome was 7-day ActiGraph-GT3X+ measured moderate-to-vigorous physical activity (MVPA) assessed at 0, 3 and 9 months. Secondary outcomes included self-reported MVPA and website engagement. Differences were examined using generalised linear mixed models with intention-to-treat and multiple imputation. RESULTS: Accelerometer-assessed MVPA increased 23% in the control (1.23 (1.06, 1.43)), 12% in the text-tailored (1.12 (0.95, 1.32)) and 28% in the video-tailored (1.28 (1.06, 1.53)) groups at the 3-month follow-up only, though there were no significant between-group differences. Both text-tailored (1.77 (1.37, 2.28]) and video-tailored (1.37 (1.04, 1.79)) groups significantly increased self-reported MVPA more than the control group at 3 months only, but there were no differences between video-tailored and text-tailored groups. The video-tailored group spent significantly more time on the website compared with text-tailored participants (90 vs 77 min, p=0.02). CONCLUSIONS: The personally tailored videos were not more effective than personally tailored text in increasing MVPA. The findings from this study conflict with pilot study outcomes and previous literature. Process evaluation and mediation analyses will provide further insights. TRIAL REGISTRATION NUMBER: ACTRN12615000057583.

Sedentary behaviour research in adults: A scoping review of systematic reviews and meta-analyses.

Sedentary behaviour research is rapidly growing. Scoping reviews are important to inform policy and practice.The aim of this scoping a review was to map the available evidence from systematic reviews and meta-analyses of sedentary behaviour research on adults (≥18 years), within the phases of the behavioural epidemiology framework, and to identify bibliometric parameters of studies included in this review. Nine bibliographic databases were searched. Studies were screened and relevant information (e.g., general information, inclusion criteria, findings and reporting quality) was extracted independently by two authors. In total, 108 systematic reviews and/or meta-analyses of sedentary behaviour research in adults (≥18 years) were included. Most papers (91.7%) were published between 2010 and 2020. Studies on the relationship of sedentary behaviour with health (53.7%) and interventions to reduce sedentary behaviour (25.9%) were most common. Forty-five (41.7%) studies reported quality assessment with categorization, and 887 out of 1268 (70%) included primary studies were categorized having moderate-to-high quality. Sedentary behaviour research on adults (≥18 years) has grown exponentially in the last decade and demonstrates strength in several stages of the behavioural epidemiology framework. However, more research should focus on the measurement, prevalence/epidemiology and determinants of sedentary behaviour, to better inform policy development.

Should I sit or stand: likelihood of adherence to messages about reducing sitting time.

BACKGROUND: High population levels of sitting is contributing to high rates of chronic health problems. Therefore, the aim of this study was to identify the sitting time messages with the greatest potential to reduce sitting behaviour, as well as identify how this may differ according to demographic, behavioural and psychosocial characteristics. METHODS: Australian adults (N = 1460) were asked to report the likelihood that they would adhere to seven messages promoting reduced sitting time and two messages promoting increased physical activity (from 'not at all likely' to 'very likely'). Ordinal regression models were used to compare messages on the likelihood of adherence and whether likelihood of adherence differed as a function of demographic, psychosocial and behavioural characteristics. RESULTS: Likelihood of adherence was highest for the messages, 'Stand and take a break from sitting as frequently as you can' (83% respectively) and 'Avoid sitting for more than 10 hours during the entire day' (82%) and was significantly lower for the message, 'Sit as little as possible on all days of the week' (46%) compared to all other messages. CONCLUSIONS: To increase likelihood of adherence messages should be specific, achievable and promote healthy alternatives to sitting (e.g. standing). Messages promoting standing as a healthy alternative to sitting may be more likely to engage people with high sitting behaviour and messages promoting physical activity may be more likely to engage males and retired adults.

Physical Activity Attitudes, Preferences, and Experiences of Regionally-Based Australia Adults Aged 65 Years and Older.

An understanding of physical activity attitudes, preferences, and experiences in older adults is important for informing interventions. Focus groups were conducted with 46 regionally-based Australian adults aged 65 years and older, who were not currently meeting activity recommendations. Content analysis revealed that participants mainly engaged in incidental activities such as gardening and household chores rather than planned exercise; however, leisure-time walking was also mentioned frequently. Although participants valued the physical and mental health benefits of physical activity, they reported being restricted by poor physical health, extreme weather, and fear of injury. Participants were interested in exercise groups and physical activity programs tailored to their existing physical health. The majority of participants reported preferring to be active with others. The findings from this study are useful in for informing future interventions specifically tailored to the needs of older adults in Australia.

The effectiveness of a web 2.0 physical activity intervention in older adults - a randomised controlled trial.

BACKGROUND: Interactive web-based physical activity interventions using Web 2.0 features (e.g., social networking) have the potential to improve engagement and effectiveness compared to static Web 1.0 interventions. However, older adults may engage with Web 2.0 interventions differently than younger adults. The aims of this study were to determine whether an interaction between intervention (Web 2.0 and Web 1.0) and age group (<55y and ≥55y) exists for website usage and to determine whether an interaction between intervention (Web 2.0, Web 1.0 and logbook) and age group (<55y and ≥55y) exists for intervention effectiveness (changes in physical activity). METHODS: As part of the WALK 2.0 trial, 504 Australian adults were randomly assigned to receive either a paper logbook (n = 171), a Web 1.0 (n = 165) or a Web 2.0 (n = 168) physical activity intervention. Moderate to vigorous physical activity was measured using ActiGraph monitors at baseline 3, 12 and 18 months. Website usage statistics including time on site, number of log-ins and number of step entries were also recorded. Generalised linear and intention-to-treat linear mixed models were used to test interactions between intervention and age groups (<55y and ≥55y) for website usage and moderate to vigorous physical activity changes. RESULTS: Time on site was higher for the Web 2.0 compared to the Web 1.0 intervention from baseline to 3 months, and this difference was significantly greater in the older group (OR = 1.47, 95%CI = 1.01-2.14, p = .047). Participants in the Web 2.0 group increased their activity more than the logbook group at 3 months, and this difference was significantly greater in the older group (moderate to vigorous physical activity adjusted mean difference = 13.74, 95%CI = 1.08-26.40 min per day, p = .03). No intervention by age interactions were observed for Web 1.0 and logbook groups. CONCLUSIONS: Results partially support the use of Web 2.0 features to improve adults over 55 s' engagement in and behaviour changes from web-based physical activity interventions. TRIAL REGISTRATION: ACTRN ACTRN12611000157976 , Registered 7 March 2011.

Age differences in physical activity intentions and implementation intention preferences.

This study aimed to examine older adults' physical activity intentions and preferred implementation intentions, and how intentions and preferred implementation intentions differ between older, middle aged and younger adults. A cross-sectional Australian wide telephone survey of 1217 respondents was conducted in 2016. Multiple and ordinal regression analyses were conducted to compare intentions and preferred implementation intentions between older (65 +), middle aged (45-64) and younger adults (< 45). A higher percentage of older adults had no intentions to engage in regular physical activity within the next 6 months (60%) compared to younger adults (25%). Older adults' most popular preferences included being active at least once a day and for 30 min or less and were more likely to prefer more frequent and shorter sessions compared to younger adults. Both older and middle aged adults were more likely to prefer slower paced physical activity compared to younger adults who preferred fast paced physical activity. Physical activity interventions for older adults should address the high percentage of older adults with no intentions and public health campaigns for older adults should promote 30 min daily sessions of slow paced activity.

The Effectiveness of a Web-Based Computer-Tailored Physical Activity Intervention Using Fitbit Activity Trackers: Randomized Trial.

BACKGROUND: Web-based interventions that provide personalized physical activity advice have demonstrated good effectiveness but rely on self-reported measures of physical activity, which are prone to overreporting, potentially reducing the accuracy and effectiveness of the advice provided. OBJECTIVE: This study aimed to examine whether the effectiveness of a Web-based computer-tailored intervention could be improved by integrating Fitbit activity trackers. METHODS: Participants received the 3-month TaylorActive intervention, which included 8 modules of theory-based, personally tailored physical activity advice and action planning. Participants were randomized to receive the same intervention either with or without Fitbit tracker integration. All intervention materials were delivered on the Web, and there was no face-to-face contact at any time point. Changes in physical activity (Active Australia Survey), sitting time (Workforce Sitting Questionnaire), and body mass index (BMI) were assessed 1 and 3 months post baseline. Advice acceptability, website usability, and module completion were also assessed. RESULTS: A total of 243 Australian adults participated. Linear mixed model analyses showed a significant increase in total weekly physical activity (adjusted mean increase=163.2; 95% CI 52.0-274.5; P=.004) and moderate-to-vigorous physical activity (adjusted mean increase=78.6; 95% CI 24.4-131.9; P=.004) in the Fitbit group compared with the non-Fitbit group at the 3-month follow-up. The sitting time and BMI decreased more in the Fitbit group, but no significant group × time interaction effects were found. The physical activity advice acceptability and the website usability were consistently rated higher by participants in the Fitbit group. Non-Fitbit group participants completed 2.9 (SD 2.5) modules, and Fitbit group participants completed 4.4 (SD 3.1) modules. CONCLUSIONS: Integrating physical activity trackers into a Web-based computer-tailored intervention significantly increased intervention effectiveness. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001555448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371793 (Archived by WebCite at http://www.webcitation.org/73ioTxQX2).

Sitting Time in Adults 65 Years and Over: Behavior, Knowledge, and Intentions to Change.

This study examined sitting time, knowledge, and intentions to change sitting time in older adults. An online survey was completed by 494 Australians aged 65+. Average daily sitting was high (9.0 hr). Daily sitting time was the highest during TV (3.3 hr), computer (2.1 hr), and leisure (1.7 hr). A regression analysis demonstrated that women were more knowledgeable about the health risks of sitting compared to men. The percentage of older adults intending to sit less were the highest for TV (24%), leisure (24%), and computer (19%) sitting time. Regression analyses demonstrated that intentions varied by gender (for TV sitting), education (leisure and work sitting), body mass index (computer, leisure, and transport sitting), and physical activity (TV, computer, and leisure sitting). Interventions should target older adults' TV, computer, and leisure time sitting, with a focus on intentions in older males and older adults with low education, those who are active, and those with a normal weight.

Osteoporosis and low bone mineral density (osteopenia) in rural and remote Queensland.

OBJECTIVE: To report that prevalence rates of osteoporosis and osteopenia differ according to different levels of remoteness in Queensland, Australia. DESIGN: Retrospective analysis of bone mineral density scans undertaken between April 2015 and April 2016. SETTING: Mobile laboratory housing a dual energy X-ray absorptiometry in rural and remote Queensland. PARTICIPANTS: Four-thousand-four-hundred-and-twenty-seven referred individuals 70 years of age or older. MAIN OUTCOME MEASURES: Bone mineral density (g cm-2 ) at two sites was used to measure the level of bone health as per the World Health Organization criteria for osteoporosis. RESULTS: A slightly higher percentage of women was screened and the percentage screened in both men and women decreased as levels of remoteness increased. Women in outer regional areas had significantly higher odds of having osteopenia over normal bone mineral density, compared to women in an urban setting. CONCLUSION: As the level of remoteness increased, there was a decrease in the percentage of men and women being screened to determine their risk of osteoporosis. Furthermore, the current data suggest that women in more remote areas have significantly lower bone density, compared to an urban female population. Finally, men and women have similar levels of osteopenia across Queensland, Australia.

Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: a review of quality, features and behaviour change techniques.

BACKGROUND: The number of commercial apps to improve health behaviours in children is growing rapidly. While this provides opportunities for promoting health, the content and quality of apps targeting children and adolescents is largely unexplored. This review systematically evaluated the content and quality of apps to improve diet, physical activity and sedentary behaviour in children and adolescents, and examined relationships of app quality ratings with number of app features and behaviour change techniques (BCTs) used. METHODS: Systematic literature searches were conducted in iTunes and Google Play stores between May-November 2016. Apps were included if they targeted children or adolescents, focused on improving diet, physical activity and/or sedentary behaviour, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. App inclusion, downloading and user-testing for quality assessment and content analysis were conducted independently by two reviewers. Spearman correlations were used to examine relationships between app quality, and number of technical app features and BCTs included. RESULTS: Twenty-five apps were included targeting diet (n = 12), physical activity (n = 18) and sedentary behaviour (n = 7). On a 5-point Mobile App Rating Scale (MARS), overall app quality was moderate (total MARS score: 3.6). Functionality was the highest scoring domain (mean: 4.1, SD: 0.6), followed by aesthetics (mean: 3.8, SD: 0.8), and lower scoring for engagement (mean: 3.6, SD: 0.7) and information quality (mean: 2.8, SD: 0.8). On average, 6 BCTs were identified per app (range: 1-14); the most frequently used BCTs were providing 'instructions' (n = 19), 'general encouragement' (n = 18), 'contingent rewards' (n = 17), and 'feedback on performance' (n = 13). App quality ratings correlated positively with numbers of technical app features (rho = 0.42, p < 0.05) and BCTs included (rho = 0.54, p < 0.01). CONCLUSIONS: Popular commercial apps to improve diet, physical activity and sedentary behaviour in children and adolescents had moderate quality overall, scored higher in terms of functionality. Most apps incorporated some BCTs and higher quality apps included more app features and BCTs. Future app development should identify factors that promote users' app engagement, be tailored to specific population groups, and be informed by health behaviour theories.

Feasibility, acceptability and efficacy of a web-based computer-tailored physical activity intervention for pregnant women - the Fit4Two randomised controlled trial.

BACKGROUND: Physical activity (PA) during pregnancy is associated with a variety of health benefits including a reduced risk of pregnancy related conditions such as pre-eclampsia and pregnancy-induced hypertension and leads to greater control over gestational weight gain. Despite these associated health benefits, very few pregnant women are sufficiently active. In an attempt to increase health outcomes, it is important to explore innovative ways to increase PA among pregnant women. Therefore, the aim of this study was to assess the feasibility, acceptability and efficacy of a four week web-based computer-tailored PA intervention among pregnant women. METHODS: Seventy-seven participants were randomised into either: (1) an intervention group that received tailored PA advice and access to a resource library of articles relating to PA during pregnancy; or (2) a standard information group that only received access to the resources library. Objective moderate-to-vigorous physical activity (MVPA) was assessed at baseline and immediately post-intervention. Recruitment, attrition, intervention adherence, and website engagement were assessed. Questions on usability and satisfaction were administered post-intervention. RESULTS: Feasibility was demonstrated through acceptable recruitment (8.5 participants recruited and randomised/month), and attrition (25%). Acceptability among intervention group participants was positive with high intervention adherence (96% of 4 modules completed). High website engagement (participants logged in 1.6 times/week although only required to log in once per week), usability (75/100), and satisfaction outcomes were reported in both groups. However, participants in the intervention group viewed significantly more pages on the website (p < 0.05), reported that the website felt more personally relevant (p < 0.05), and significantly increased their MVPA from baseline to post-intervention (mean difference = 35.87 min), compared to the control group (mean difference = 9.83 min) (p < 0.05), suggesting efficacy. CONCLUSIONS: The delivery of a computer-tailored web-based intervention designed to increase PA in pregnant women is feasible, well accepted and associated with increases in short-term MVPA. Findings suggest the use of computer-tailored information leads to greater website engagement, satisfaction and greater PA levels among pregnant women compared to a generic information only website. TRIAL REGISTRATION: The trial was 'retrospectively registered' with the Australian New Zealand Clinical Trials Registry ( ACTRN12614001105639 ) on 17th October, 2014.

Impact of increasing social media use on sitting time and body mass index.

Issue addressed Sedentary behaviours, in particular sitting, increases the risk of cardiovascular disease, type 2 diabetes, obesity and poorer mental health status. In Australia, 70% of adults sit for more than 8h per day. The use of social media applications (e.g. Facebook, Twitter, and Instagram) is on the rise; however, no studies have explored the association of social media use with sitting time and body mass index (BMI). Methods Cross-sectional self-report data on demographics, BMI and sitting time were collected from 1140 participants in the 2013 Queensland Social Survey. Generalised linear models were used to estimate associations of a social media score calculated from social media use, perceived importance of social media, and number of social media contacts with sitting time and BMI. Results Participants with a high social media score had significantly greater sitting times while using a computer in leisure time and significantly greater total sitting time on non-workdays. However, no associations were found between social media score and sitting to view TV, use motorised transport, work or participate in other leisure activities; or total workday, total sitting time or BMI. Conclusions These results indicate that social media use is associated with increased sitting time while using a computer, and total sitting time on non-workdays. So what? The rise in social media use may have a negative impact on health by contributing to computer sitting and total sitting time on non-workdays. Future longitudinal research with a representative sample and objective sitting measures is needed to confirm findings.

The effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries: A systematic review.

BACKGROUND: Promoting physical activity and healthy eating is important to combat the unprecedented rise in NCDs in many developing countries. Using modern information-and communication technologies to deliver physical activity and diet interventions is particularly promising considering the increased proliferation of such technologies in many developing countries. The objective of this systematic review is to investigate the effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries. METHODS: Major databases and grey literature sources were searched to retrieve studies that quantitatively examined the effectiveness of e-& mHealth interventions on physical activity and diet outcomes in developing countries. Additional studies were retrieved through citation alerts and scientific social media allowing study inclusion until August 2016. The CONSORT checklist was used to assess the risk of bias of the included studies. RESULTS: A total of 15 studies conducted in 13 developing countries in Europe, Africa, Latin-and South America and Asia were included in the review. The majority of studies enrolled adults who were healthy or at risk of diabetes or hypertension. The average intervention length was 6.4 months, and text messages and the Internet were the most frequently used intervention delivery channels. Risk of bias across the studies was moderate (55.7 % of the criteria fulfilled). Eleven studies reported significant positive effects of an e-& mHealth intervention on physical activity and/or diet behaviour. Respectively, 50 % and 70 % of the interventions were effective in promoting physical activity and healthy diets. CONCLUSIONS: The majority of studies demonstrated that e-& mHealth interventions were effective in promoting physical activity and healthy diets in developing countries. Future interventions should use more rigorous study designs, investigate the cost-effectiveness and reach of interventions, and focus on emerging technologies, such as smart phone apps and wearable activity trackers. TRIAL REGISTRATION: The review protocol can be retrieved from the PROSPERO database (Registration ID: CRD42015029240 ).

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review.

BACKGROUND: Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. METHODS: Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers. RESULTS: Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes. CONCLUSIONS: This review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than stand-alone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy.