Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION): Study protocol for a randomized controlled trial of a web-based platform integrating nutrition, physical activity, and mindfulness for individuals with obesity.

Excess body weight, suboptimal diet, physical inactivity, alcohol consumption, sleep disruption, and elevated stress are modifiable risk factors associated with the development of chronic diseases. Digital behavioural interventions targeting these factors have shown promise in improving health and reducing chronic disease risk. The Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION) study is a parallel group, two-arm, randomized controlled trial evaluating the effects of adding healthcare professional guidance and peer support via group-based sessions to a web-based wellness platform (experimental group, n = 90) compared to a self-guided use of the platform (active control group, n = 90) among individuals with a body mass index (BMI) of 30 to <35 kg/m2 and aged 40-65 years. Obesity is defined by a high BMI. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which holistically integrates nutrition, physical activity, and mindfulness programs. Over 16 weeks, the experimental group uses the web-based wellness platform daily and engages in weekly online support group sessions. The active control group exclusively uses the web-based wellness platform daily. Assessments are conducted at baseline and weeks 8 and 16. The primary outcome is between-group difference in weight loss (kg) at week 16, and secondary outcomes are BMI, percent weight change, proportion of participants achieving 5% or more weight loss, dietary intake, physical activity, alcohol consumption, sleep, and stress across the study. A web-based wellness platform may be a scalable approach to promote behavioural changes that positively impact health. This study will inform the development and implementation of interventions using web-based wellness platforms and personalized digital interventions to improve health outcomes and reduce chronic disease risk among individuals with obesity.

Sleep Health in Male-dominated Workplaces: A Qualitative Study Examining the Perspectives of Male Employees.

OBJECTIVE: The purpose of this qualitative study was to explore working men's perspectives about sleep health and the intersecting influences of gender and work, describing participant's views on current and potential programming and organizational support to promote sleep health. METHODS: Twenty men employed in male-dominated industries in the north-central region of Alberta, Canada, participated in 4 consultation group discussions addressing motivators, facilitators and barriers to sleep health. RESULTS: Participants reported sleeping an average of 6.36 (SD ±1.1) hours per night, and the majority worked more than 40 hours per week. Data were analyzed using an inductive approach. The findings provided important insights. In normalizing sleep deprivation and prioritizing the need to "just keep going" on six or less hours of sleep, the men subscribed to masculine ideals related to workplace perseverance, stamina and resilience. Workplace cultures and practices were implicated including normative dimensions of overtime and high productivity and output, amid masculine cultures constraining emotions and conversations about sleep, the sum of which muted avenues for discussing, let alone promoting sleep. Challenges to good sleep were primarily constructed around time constraints, and worry about meeting work and home responsibilities. Men's preferences for workplace support included providing and incentivizing the use of sleep health resources, designing work for sleep health (e.g., shift schedules, overtime policies) and getting advice from experienced coworkers and experts external to the workplace organization. CONCLUSION: These findings hold potential for informing future gender-sensitive programming and organizational practices to support sleep health among working men.

Health Literacy Among Canadian Men Experiencing Prostate Cancer.

The objective was to describe the health literacy of a sample of Canadian men with prostate cancer and explore whether sociodemographic and health factors were related to men's health literacy scores. A sample of 213 Canadian men (M age = 68.71 years, SD = 7.44) diagnosed with prostate cancer were recruited from an online prostate cancer support website. The men completed the Health Literacy Questionnaire along with demographic, comorbidity, and prostate cancer treatment-related questions online. Of the 5-point scales, men's health literacy scores were highest for "Understanding health information enough to know what to do" (M = 4.04, SD = 0.48) and lowest for "Navigating the health care system" (M = 3.80, SD = 0.58). Of the 4-point scales, men's scores were highest for "Feeling understood and supported by health care professionals" (M = 3.20, SD = 0.52) and lowest for "Having sufficient information to manage my health" (M = 2.97, SD = 0.46). Regression analyses indicated that level of education was positively associated with health literacy scores, and men without comorbidities had higher health literacy scores. Age and years since diagnosis were unrelated to health literacy. Support in health system navigation and self-management of health may be important targets for intervention.

Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?

Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

Demographic and clinical correlates of accelerometer assessed physical activity and sedentary time in lung cancer survivors.

OBJECTIVE: To determine demographic and clinical correlates of accelerometer assessed physical activity and sedentary time among a population-based sample of lung cancer survivors. METHODS: Lung cancer survivors in Southern Alberta, Canada (N = 527) were invited to complete a mailed survey assessing socio-demographics and wear an Actigraph® GT3X+ accelerometer for 7 days. Average daily minutes of physical activity and sedentary time were derived from the accelerometer data. Accelerometer data were processed using standard Freedson cutpoints, and correlates of physical activity and sedentary time were determined with linear regression. RESULTS: A total of 127 lung cancer survivors participated (mean age = 71 years), for a 24% response rate. Moderate-to-vigorous physical activity was negatively associated with being >60 years of age (ß = -7.4, CI: -14.7, -0.10). Moderate-to-vigorous physical activity accumulated in 10-minute bouts was associated with receiving surgery and adjuvant chemotherapy (ß = 9.1, CI: 2.1, 16.1). Sedentary time was associated with being >60 years of age (ß = 32.4, CI: 3.1, 61.7), smoking (ß = 63.9, CI: 22.5, 105.4), and being overweight/obese (ß = 28.6, CI: 6.4, 50.1). CONCLUSION: Age, smoking history, and body mass index emerged as correlates of accelerometer assessed light, moderate, and vigorous physical activity, and sedentary time among lung cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Identifying correlates of physical activity and sedentary time may aid in the development of targeted behavioral interventions for this population.

Examining Lifestyle Information Sources, Needs, and Preferences among Breast Cancer Survivors in Northern British Columbia.

PURPOSE: Little is known about the lifestyle (e.g., physical activity, nutrition) information needs among breast cancer survivors living in nonurban settings. This study determined lifestyle information sources, needs, and preferences among breast cancer survivors in Northern British Columbia (BC), Canada. METHODS: A cross-sectional, paper-based survey was distributed to a random sample of breast cancer survivors (n = 300) in Northern BC, which was generated through the BC Cancer Registry. RESULTS: A total of 132 breast cancer survivors responded (true response rate = 49%; 132/270 received surveys). Two-thirds lived in rural and remote locations. The most commonly reported need was diet and physical activity (58%) to decrease risk of recurrence or improve survival. The most frequently identified sources of lifestyle information included physicians, family or friends, the internet, and magazines. A majority of breast cancer survivors (64%) preferred face-to-face interactions when considering potential lifestyle-related programs or services; distance-based formats (e.g., videoconferencing) were least preferred (11%). CONCLUSIONS: There is strong interest in information about lifestyle behaviours among breast cancer survivors in nonurban settings such as Northern BC. Future research is needed to investigate how best to deliver evidence-based lifestyle-related information to breast cancer survivors residing in nonurban settings.

Examining Diet-Related Care Practices Among Adults with Type 2 Diabetes: A Focus on Glycemic Index Choices.

We examined self-care dietary practices and usual intakes among adults with Type 2 diabetes in Alberta, Canada, using data from the Healthy Eating and Active Living for Diabetes study. Participants completed a modified Fat/Sugar/Fruit/Vegetable Screener and answered questions about the number of days per week they followed specific diabetes self-care dietary recommendations. Capillary blood samples were collected to assess glycemic control measured by hemoglobin A1c (HbA1c). ANOVA was used to examine differences in dietary self-care, intakes, and glycemic control across categories of days/week of practicing recommended dietary behaviour. Participants (n = 196) were 51% women, mean ± SD age 59.6 ± 8.5 years, with BMI 33.6 ± 6.5 kg/m2, and diabetes duration of 5.1 ± 6.3 years. Sixteen percent of participants were unfamiliar with low-GI eating and 28% did not include low-GI foods in their diet. Overall, lower mean intake of saturated fat, trans fat, added sugars, higher fibre, and greater GI were each associated with meeting diabetes-related dietary behaviours including: eating ≥5 servings of vegetables and fruit; avoiding processed high fat foods; and replacing high with low-GI foods (P < 0.05). No clear pattern was observed for low-GI eating and HbA1c.

"I'm Still Here": Personhood and the Early-Onset Dementia Experience.

Early-onset dementia (EOD) occurs before age 65. The current study examined the lived experience from the point of view of four adults younger than 65 with dementia, particularly how they perceive their personhood. Using interpretative phenomenological analysis as the research approach, findings revealed that the EOD experience can be incorporated into six themes: (a) A Personal Journey, (b) Navigating the System, (c) The Stigma of Dementia, (d) Connecting to the World, (e) A Story Worth Telling, and (f) I'm Still Here. Participants' stories, as presented via these six thematic threads, reveal that individuals with EOD can have a strong sense of personhood. Findings are discussed and situated within the current EOD body of knowledge, and new knowledge is presented. Implications for practice and recommendations for future research are discussed. [Journal of Gerontological Nursing, 43 (5), 12-17.].

Health Literacy, Pedometer, and Self-Reported Walking Among Older Adults.

OBJECTIVES: We examined the association of health literacy with physical activity and physical activity guideline adherence in older adults. METHODS: We used cross-sectional data from a 2012 population-based study in Alberta, Canada, assessing health literacy, and deriving moderate-to-vigorous physical activity (MVPA) and metabolic equivalent of task (MET) minutes per week from the Godin Leisure-Time Exercise Questionnaire, and steps per day via a pedometer. RESULTS: Mean age of participants (n = 1296) was 66.4 (SD = 8.2) years, 57% were female, and 94% were White. Nine percent had inadequate health literacy, and 46% met guidelines for self-reported physical activity and 18% for steps per day. Participants with inadequate health literacy had nonsignificant adjusted decrements of 58 MVPA minutes and 218 MET minutes per week and were less likely to meet physical activity guidelines (MVPA: odds ratio = 0.63; 95% confidence interval [CI] = 0.41, 0.97; P = .037; MET: odds ratio = 0.65; 95% CI = 0.42, 1.01; P = .057) compared with their health-literate counterparts. Such differences were nonsignificant for steps per day. CONCLUSIONS: Inadequate health literacy was associated with less likelihood of meeting MVPA guidelines based on self-reported physical activity, but not based on an objective measure of steps per day.

A qualitative study examining healthcare managers and providers' perspectives on participating in primary care implementation research.

BACKGROUND: Primary care reforms should be supported by high-quality evidence across the entire life cycle of research. Front-line healthcare providers play an increasing role in implementation research. We recently evaluated two interventions for people with type 2 diabetes (T2D) in partnership with four Primary Care Networks (PCNs) in Alberta, Canada. Here, we report healthcare professionals perspectives on participating in primary care implementation research. METHODS: Guided by the RE-AIM framework, we collected qualitative data before, during, and after both interventions. We conducted 34 in-person or telephone interviews with 17 individual PCN professionals. We used content analysis to identify emerging codes and concepts. RESULTS: Two major themes emerged from the data. First, healthcare managers were eager to conduct implementation research in a primary care setting. Second, regardless of willingness to conduct research, there were challenges to implementing experimental study designs for both interventions. PCN professionals presumed the interventions were better than usual care, expressed role conflict, and reported administrative burdens related to research participation. Perceptions of patient vulnerability and an obligation to intervene exacerbated these issues. CONCLUSIONS: Healthcare professionals with limited practical research experience might not foresee the challenges in implementing experimental study designs in primary care settings to generate high-quality evidence. These issues are intensified when healthcare professionals perceive target patient populations as vulnerable and in need of intervention based on the presenting illness. Possible solutions include further research training, involving healthcare professionals in study design development, and using non-clinical staff to conduct research activities, particularly among acutely unwell patient populations.

Testing social-cognitive mediators for objective estimates of physical activity from the Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN) study.

OBJECTIVE: More evidence from prospective studies is needed to determine 'if' and 'how' social cognitive constructs mediate behaviour change. In a longitudinal study, we aimed to examine potential social cognitive mediators of objectively measured physical activity (PA) behaviour among people with type 2 diabetes (T2D) who participated in a six-month PA intervention. METHODS: All participants from the proven effective Healthy Eating and Active Living for Diabetes in Primary Care Networks trial were included for this secondary analysis. Change in pedometer-derived daily step counts (baseline to six months) was the outcome of interest. Primary constructs of interest were from Social Cognitive Theory, however constructs from and Theory of Planned Behaviour were also tested in a mediating variable framework using a product-of-coefficients test. RESULTS: The sample (N = 198) had a mean age of 59.5 (SD 8.3) years, haemoglobin A1c 6.8% (SD 1.1), 50% women, BMI 33.6 kg/m(2) (SD 6.5), systolic pressure 125.6 mmHg (SD 16.2) and average daily steps were 5879 (SD 3130). Daily pedometer-determined steps increased for the intervention group compared to usual care control at six-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p = .002). There was a significant action theory test effect for 'planning' (A = .21, SE = .10, p = .037), and significant conceptual theory test results for 'subjective norms' (B = 657, SE = 312, p = .037) and 'cons' (B = -664, SE = 270, p = .015). None of the constructs satisfied the criteria for mediation. CONCLUSIONS: We were unable to account for the effect of a pedometer-based PA intervention for people with T2D through our examination of mediators. Our findings are inconsistent with some literature concerning PA interventions in diabetes; this may be due to variability in measures used or in study populations.

Health Behaviours and Awareness of Canada's Food Guide: A Population-based Study.

PURPOSE: Lifestyle behaviours among adults reporting awareness of Canada's Food Guide (CFG) are described. METHODS: Data from a cross-sectional survey of adults from Alberta were used to estimate the prevalence of reported health behaviours among respondents aware of the CFG. RESULTS: Respondents (n = 1044) reported general awareness of CFG (mean age 50.3 years; 54.2% female) of whom 82.2% reported awareness of specific CFG recommendations. Respondents reported frequently reading food labels (>58.0%), reading the number of calories (45.5%), the amount of sodium (49.5%), the amount of fat (46.7%), and the type of fat (45.5%) on the food label. Most respondents (90.0%) reported frequently selecting foods to promote health. Approximately one-third of the respondents (35.8%) reported frequently consuming ≥5 portions of vegetables and fruit per day and regularly participating in physical activity (55.3%). Body weight was perceived as healthy by 63.4% of the respondents. Most engaged in 2 health behaviours frequently. Adjusting for important socio-demographic characteristics, those who reported frequently consuming ≥5 portions of vegetables and fruit per day were more likely to engage in a second health behaviour outlined in CGF (OR: 23.6, 95% CI (16.2-34.4)). CONCLUSION: Awareness of CFG did not translate to positive health behaviours. More proactive population level strategies to support specific health behaviours as outlined in CFG might be warranted.

Osteoarthritis prevalence and modifiable factors: a population study.

BACKGROUND: This study's objectives were to investigate the prevalence of self-reported knee and hip osteoarthritis (OA) stratified by age and sex and to examine the association of modifiable factors with knee and hip OA prevalence. The study was conducted using randomly sampled data gathered from four communities in the province of Alberta, Canada. METHODS: A large adult population sample (N = 4733) of individuals ≥18 years were selected. Health-related information was collected through telephone interviews and community measurement clinics for which a sub-sample (N = 1808) attended. Participants self-reported OA during telephone interviews. Clinic interviews further assessed if the diagnosis was made by a health care professional. Statistical analyses compared prevalence of OA between sexes and across age categories. Associations between modifiable factors for OA and the prevalence of knee and hip OA were assessed using binary logistic regression modelling. RESULTS: Overall prevalence of self-reported OA in the total sample was 14.8 %, where 10.5 % of individuals reported having knee OA and 8.5 % reported having hip OA. Differences in prevalence were found for males and females across age categories for both knee and hip OA. In terms of modifiable factors, being obese (BMI >30 kg/m2) was significantly associated with the prevalence of knee (OR: 4.37; 95 % CI: 2.08,9.20) and hip (OR: 2.52; 95 % CI: 1.17,5.43) OA. Individuals who stand or walk a lot, but do not carry or lift things during their occupational activities were 2.0 times less likely to have hip OA (OR: 0.50; 95 % CI: 0.26,0.96). Individuals who usually lift or carry light loads or have to climb stairs or hills were 2.2 times less likely to have hip OA (OR: 0.45; 95 % CI: 0.21,0.95). The odds of having hip OA were 1.9 times lower in individuals consuming recommended or higher vitamin C intake (OR: 0.52; 95 % CI: 0.29,0.96). Significant differences in prevalence were found for both males and females across age categories. CONCLUSION: The prevalence of knee and hip OA obtained in this study is comparable to other studies. Females have greater knee OA prevalence and a greater proportion of women have mobility limitations as well as hip and knee pain; it is important to target this sub-group.

Examining the Promotion of Healthy Eating among Exercise Specialists: A Cross-sectional Study.

The aim of this cross-sectional study was to survey exercise specialists about nutrition counselling practices, their own dietary practices, and to identify potential relationships. An electronic survey was used to examine characteristics and strategies used for assessing and promoting healthy eating to clients. Exercise specialists (n = 94) were recruited through a public registry and through targeted advertising on 2 professional websites in Alberta, Canada. Eighty-five percent of respondents promoted healthy eating to clients. Confidence in assessing and promoting healthy eating was moderate to low. Those with more than 6 years of professional experience reported higher confidence compared with those with less than 1 year of experience in assessing healthy eating (P < 0.05) and promoting healthy eating (P < 0.01). Confidence was higher among those with more professional experience but who did not meet Canada's Food Guide recommendations (P < 0.05). Professional experience, personal dietary practices, and confidence are important characteristics when considering the assessment and promotion of healthy eating by exercise specialists. Promoting collaborative relationships between registered dietitians and exercise specialists would likely benefit exercise specialists when they are assessing and promoting healthy eating among their clients.

Utility of telephone survey methods in population-based health studies of older adults: an example from the Alberta Older Adult Health Behavior (ALERT) study.

BACKGROUND: Random digit dialing is often used in public health research initiatives to accrue and establish a study sample; however few studies have fully described the utility of this approach. The primary objective of this paper was to describe the implementation and utility of using random digit dialing and Computer Assisted Telephone Interviewing (CATI) for sampling, recruitment and data collection in a large population-based study of older adults [Alberta Older Adult Health Behavior (ALERT) study]. METHODS: Using random digit dialing, older adults (> = 55 years) completed health behavior and outcome and demographic measures via CATI. After completing the CATI, participants were invited to receive a step pedometer and waist circumference tape measure via mail to gather objectively derived ambulatory activity and waist circumference assessments. RESULTS: Overall, 36,000 telephone numbers were called of which 7,013 were deemed eligible for the study. Of those, 4,913 (70.1%) refused to participate in the study and 804 (11.4%) participants were not included due to a variety of call dispositions (e.g., difficult to reach, full quota for region). A total of 1,296 participants completed telephone interviews (18.5% of those eligible and 3.6% of all individuals approached). Overall, 22.8% of households did not have an age 55+ resident and 13.6% of individuals refused to participate, Average age was 66.5 years, and 43% were male. A total of 1,081 participants (83.4%) also submitted self-measured ambulatory activity (i.e., via step pedometer) and anthropometric data (i.e., waist circumference). With the exception of income (18.7%), the rate of missing data for demographics, health behaviors, and health measures was minimal (<1%). CONCLUSIONS: Older adults are willing to participate in telephone-based health surveys when randomly contacted. Researchers can use this information to evaluate the feasibility and the logistics of planned studies using a similar population and study design.

Registered nurse lactation consultants' experiences supporting maternal mental health: A qualitative descriptive study.

BACKGROUND: The province of Nova Scotia has the highest rates of perinatal mental health disorders in Canada, and rates of exclusive breastfeeding fall below the Canadian national average. Exclusive breastfeeding is identified as a protective factor against the development of perinatal mental health disorders. Lactation consultant support is associated with increased rates of exclusive breastfeeding and decreased rates of perinatal mental health disorders. Despite this, little is known regarding the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health. OBJECTIVE: To understand the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health. DESIGN: A qualitative descriptive design using online semi-structured interviews. SETTING & PARTICIPANTS: Ten Registered Nurse Lactation Consultants employed in the publicly funded healthcare system in Nova Scotia, Canada, were recruited via purposive sampling. FINDINGS: Three themes emerged regarding the relational experiences of Registered Nurse Lactation Consultants while supporting maternal mental health; these included (1) Experiences supporting maternal mental health, (2) Providing maternal mental health care, and (3) Mothers need support. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Registered Nurse Lactation Consultants described positive experiences supporting maternal mental health and indicated that lactation consultant appointments were an opportune time to provide screening and support for maternal mental health. Enhancing support for maternal mental health requires collaborative and integrated approaches throughout the perinatal period. Healthcare providers, including Registered Nurse Lactation Consultants, must be provided with the support and resources to provide timely and appropriate support for maternal mental health throughout the perinatal period.

Determinants of lifestyle behavior in type 2 diabetes: results of the 2011 cross-sectional survey on living with chronic diseases in Canada.

BACKGROUND: Lifestyle behavior modification is an essential component of self-management of type 2 diabetes. We evaluated the prevalence of engagement in lifestyle behaviors for management of the disease, as well as the impact of healthcare professional support on these behaviors. METHODS: Self-reported data were available from 2682 adult respondents, age 20 years or older, to the 2011 Survey on Living with Chronic Diseases in Canada's diabetes component. Associations with never engaging in and not sustaining self-management behaviors (of dietary change, weight control, exercise, and smoking cessation) were evaluated using binomial regression models. RESULTS: The prevalence of reported dietary change, weight control/loss, increased exercise and smoking cessation (among those who smoked since being diagnosed) were 89.7%, 72.1%, 69.5%, and 30.6%, respectively. Those who reported not receiving health professional advice in the previous 12 months were more likely to report never engaging in dietary change (RR = 2.7, 95% CI 1.8 - 4.2), exercise (RR = 1.7, 95% CI 1.3 - 2.1), or weight control/loss (RR = 2.2, 95% CI 1.3 - 3.6), but not smoking cessation (RR = 1.0; 95% CI: 0.7 - 1.5). Also, living with diabetes for more than six years was associated with not sustaining dietary change, weight loss and smoking cessation. CONCLUSION: Health professional advice for lifestyle behaviors for type 2 diabetes self-management may support individual actions. Patients living with the disease for more than 6 years may require additional support in sustaining recommended behaviors.

Physical activity and health-related quality of life among older men: an examination of current physical activity recommendations.

OBJECTIVE: To determine differences in health-related quality of life (HRQoL) between older men achieving versus not achieving American College of Sports Medicine (ACSM) and the United States Department of Health and Human Services recommendations (USDHHS) physical activity (PA) recommendations. METHOD: Older-aged men (≥ 55 years) completed a mailed survey that assessed self-reported PA and HRQoL. Data were collected between September and October of 2010. RESULTS: 387 older men (Mean age=65) completed the survey. Under half (48%) reported achieving the ACSM recommendation while 64% reported achieving the USDHHS recommendation. Older men achieving the ACSM recommendation reported significantly higher scores in physical health (Δ=3.5, p<0.001), mental health (Δ=4.4, p<0.001), and global health (Δ=4.3, p<0.001) component scores compared to those not achieving the recommendation. Those achieving the higher dose recommended by the USDHHS (≥ 300 min per week of moderate-intensity activity) reported significantly higher scores on the PHC (Δ=2.1, p=0.029) and GHC (Δ=2.3, p=0.027) scales compared to those achieving the USDHHS base recommendation (150-299.9 min per week of moderate-intensity activity). CONCLUSIONS: Self-reported PA was significantly and positively associated with higher HRQoL scores among older men. Associations were stronger for those achieving a higher volume of PA.

Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes.

BACKGROUND: While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. METHOD: Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. DISCUSSION: The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier: NCT00991380.

Canada's Physical Activity Guide: examining print-based material for motivating physical activity in the workplace.

The authors conducted a secondary analysis on 202 adults from the Physical Activity Workplace Study. The aim of this analysis was to examine demographic characteristics associated with reading Canada's Physical Activity Guide (CPAG), being motivated by the guide, and whether participants in the Physical Activity Workplace Study who read the CPAG increased their physical activity levels over 1 year. Results revealed that less than 50% of participants read the full version of CPAG, and less than 10% were motivated by it. The CPAG also appears to be more appealing to and effective for women than for men. Although the CPAG had some influence in increasing mild physical activity levels in a workplace sample, there was also a decrease in physical activity levels among some members of the group. Overall, the effectiveness of CPAG was not substantial, and the findings of this analysis could help guide future targeted intervention materials and programs.