Government, governance, and place-based approaches: lessons from and for public policy.

BACKGROUND: Place-based approaches are increasingly applied to address the determinants of health, many of which are complex problems, to ultimately improve population health outcomes. Through public policy, government actions can affect the effectiveness of place-based approaches by influencing the conceptualisation, development, implementation, governance, and/or evaluation of place-based approaches. Despite the important role of public policy, there has been limited examination of public policy related to place-based approaches. We add to the limited knowledge base by analysing Australian national public policy, to explore: (1) the definitions, conceptualisations, and characteristics of place-based approaches in public policy; (2) the government's perception and communication of its role in place-based approaches; and (3) the extent to which government policy reflects the necessary conditions for successful place-based governance developed by Marsh and colleagues, namely localised context, embedded learning, and reciprocal accountability. METHODS: This research was underpinned by the Theory of Systems Change and methodologically informed by the READ approach to document analysis. Ritchie and Spencer's framework method was utilised to analyse the data. RESULTS: We identified and reviewed 67 policy documents. In terms of conceptualisation, common characteristics of place-based approaches related to collaboration, including community in decision-making, responsiveness to community needs, and suitability of place-based approaches to address complex problems and socio-economic determinants of health. Three roles of government were identified: funder, partner, and creator of a supportive policy environment. From the three criteria for successful place-based governance, localised context was the most dominant across the documents and reciprocal accountability the least. CONCLUSIONS: Based on our findings, we drew key implications for public policy and research. There was a disproportionate emphasis on the bottom-up approach across the documents, which presents the risk of diminishing government interest in place-based approaches, potentially burdening communities experiencing disadvantage beyond their capacities. Governments engaged in place-based approaches should work towards a more balanced hybrid approach to place-based approaches that maintain the central functions of government while allowing for successful place-based governance. This could be achieved by promoting consistency in conceptualisations of 'place-based', employing an active role in trust building, advancing the creation of a supportive policy environment, and embedding 'learning' across place-based approaches.

The C-CAP Process: A Comprehensive Approach to Community Resource Mapping.

INTRODUCTION: Place-based systems change approaches are gaining popularity to address the complex problems associated with locational disadvantage. An important stage of place-based systems change involves understanding the context that surrounds (re)produces a target problem. Community resource mapping can be used to establish the context and identify the strengths of a community that might be leveraged through systems change efforts. Approaches to community resource mapping draw on a range of philosophical assumptions and methodological frameworks. However, comprehensive, practical guidance for researchers and practitioners to conduct community resource mapping is scarce. METHOD: Drawing on the learnings from a literature review, scoping workshops, and reflective practice sessions, we developed a flexible, methodologically robust process called the Contextualize, Collect, Analyze, and Present (C-CAP) process: a four-phase approach to preparing for, conducting, and reporting on community resource mapping. The C-CAP process was co-developed by researchers and practitioners and was tested and refined in two different communities. RESULTS: The C-CAP process provides robust guidance for conducting and reporting on a community resource mapping project. The C-CAP process can be applied by public health practitioners and researchers and adapted for use across different communities, problems, and target groups. We encourage others guided by differing theoretical perspectives to apply C-CAP and share the learnings. CONCLUSION: Application of the C-CAP process has the potential to improve the comparability and comprehensiveness of findings from community resource mapping projects and avoids duplication of effort by reducing the need to design new processes for each new community resource mapping activity.

Scoping review of practice-focused resources to support the implementation of place-based approaches.

ISSUE ADDRESSED: There is increasing interest across public health research, policy, and practice in place-based approaches to improve health outcomes. Practice-focused resources, such as grey literature, courses and websites, are utilised by practitioners to support the implementation of place-based approaches. METHODS: A detailed search of two search engines: Google and DuckDuckGo to identify free practice-focused resources was conducted. RESULTS: Forty-one resources met inclusion criteria, including 26 publications, 13 web-based resources and two courses. They were mainly focused on collaboration, developed by not-for-profit organisations, focused on a broad target audience, and supported people living with disadvantage. The publications we reviewed generally: clearly stated important information, such as the author of the publication; used their own evaluations, professional experience and other grey literature as supporting evidence; included specific, practical implementation strategies; and were easy to read. CONCLUSIONS: Based on findings, we recommend that: (1) the development of resources to support evidence-informed practice and governance be prioritised; (2) resources clearly state their target audience and tailor communication to this audience; (3) resources draw on evidence from a range of sources; (4) resources continue to include practical implementation strategies supported by examples and (5) resource content be adaptable to different contexts (e.g., different settings and/or target populations). SO WHAT?: This is the first review of practice-focused resources to support the implementation of place-based approaches and the findings can be used to reduce duplication of efforts and inform future research, policy, and practice, particularly the refinement of existing resources and the development of future resources.

Associations between pre-COVID-19 physical activity profiles and mental wellbeing and quality of life during COVID-19 lockdown among adults.

The COVID-19 pandemic has been detrimental to the physical and mental health and wellbeing of people across the globe. Regular physical activity has consistently demonstrated an array of health benefits, but the impact of regular physical activity habits pre-pandemic on health and wellbeing during the pandemic is largely unknown. The purpose of this study was to identify distinct pre-COVID-19 lockdown physical activity profiles [i.e., walking, leisure-time moderate-vigorous physical activity (MVPA), domestic MVPA and muscle strengthening exercise] and assess whether these profiles were associated with mental wellbeing and quality of life during COVID-19 lockdown. A total of 442 adults (Mage = 43.97 ± 13.85; 75.6% female) from Melbourne, Australia completed an online questionnaire measuring pre-COVID-19 physical activity, including walking habits, leisure-time MVPA, domestic MVPA, and muscle strengthening exercise - and completed measures of mental wellbeing and health related quality of life. Latent profile analysis identified five distinct profiles that differed in terms of levels of walking, leisure-time MVPA, domestic MVPA and muscle strengthening exercise. Based on the observed pre-COVID-19 lockdown profiles, it appears that high levels of MVPA and muscle strengthening exercise may serve as a protective factor against the potential negative impact of a global pandemic lockdown on mental wellbeing and quality of life.

Contextual influences on the within-person association between physical activity and affect in adolescents: an ecological momentary assessment study.

There is limited research on how the context in which moderate-to-vigorous physical activity (MVPA) occurs influences the relationship between physical activity and affect. This study aimed to investigate how the social context and physical environment enhance the relationship between MVPA and affect in daily life. Overall, 119 adolescents (mean age = 14.7 years) provided information about their core affect, physical environment and social context on multiple occasions over a 4-day period using ecological momentary assessment. Additionally, participants' level of MVPA was objectively measured using accelerometers. Level of MVPA was positively associated with energetic arousal, being outdoors was positively associated with valence and energetic arousal, and being with someone else was also positively associated with energetic arousal. Additionally, being outdoors moderated the association between MVPA and tense arousal so that MVPA was only inversely related to tense arousal when outdoors. These findings showed that young people experience more positive valence, greater levels of energetic arousal and less tense arousal when physically active outdoors compared to when indoors and highlight the importance of encouraging young people to participate in physical activity outdoors. Further research is warranted to understand how social contexts may influence the association between MVPA and affect in young people.

Blending an implementation science framework with principles of proportionate universalism to support physical activity promotion in primary healthcare while addressing health inequities.

Globally, insufficient physical activity (PA) is one of the main risk factors for premature mortality. Although insufficient PA is prevalent in nearly every demographic, people with socio-economic disadvantage participate in lower levels of PA than those who are more affluent, and this contributes to widening health inequities. PA promotion interventions in primary healthcare are effective and cost effective, however they are not widely implemented in practice. Further, current approaches that adopt a 'universal' approach to PA promotion do not consider or address the additional barriers experienced by people who experience socioeconomic disadvantages. To address the research to policy and practice gap, and taking Australia as a case study, this commentary proposes a novel model which blends an implementation science framework with the principles of proportionate universalism. Proportionate universalism is a principle suggesting that health interventions and policies need to be universal, not targeted, but with intensity and scale proportionate to the level of social need and/or disadvantage. Within this model, we propose interrelated and multi-level evidence-based policies and strategies to support PA promotion in primary healthcare while addressing health inequities. The principles outlined in the new model which blends proportionate (Pro) universalism principles and Practical, Robust Implementation and Sustainability Model (PRISM), 'ProPRISM' can be applied to the implementation of PA promotion interventions in health care settings in other high-income countries. Future studies should test the model and provide evidence of its effectiveness in improving implementation and patient health outcomes and cost-effectiveness. There is potential to expand the proposed model to other health sectors (e.g., secondary and tertiary care) and to address other chronic disease risk factors such as unhealthy diet, smoking, and alcohol consumption. Therefore, this approach has the potential to transform the delivery of health care to a prevention-focused health service model, which could reduce the prevalence and burden of chronic disease and health care costs in high-income countries.

Trends and correlates of meeting 24-hour movement guidelines: a 15-year study among 167,577 Thai adults.

BACKGROUND: Time spent in physical activity (PA), sedentary behaviour (SB), and sleep always takes up the whole day. New public health guidelines combining recommendations for PA, SB, and sleep have been issued in several countries. Thailand was the first country to release the 24-h guidelines for adults. Currently, there is no evidence on the population prevalence of meeting 24-h movement guidelines in Thailand. This study, therefore, aimed to determine 15-year trends and associations of meeting 24-h movement guidelines among Thai adults. METHOD: We analysed cross-sectional data from 2001, 2004, 2009, and 2015 Thai Time-Use Surveys, coded using the International Classification of Activities for Time-Use Statistics (ICATUS). All ICATUS-based activities were categorised into moderate-to-vigorous PA (MVPA), light PA (LPA), SB, and sleep based on a previously developed classification system. A total of 167,577 adult participants were included. The participants were classified according to the Thai 24-h movement guidelines into meeting or not meeting the following criteria: 1) ≥150 min/week of MVPA; 2) interrupting SB every 2 h; 3) sleeping 7-9 h per day; and 4) adhering to all three guidelines. RESULTS: In 2015, the prevalence of adults who met the MVPA, SB, sleep, and overall recommendations was 81.7, 44.6, 56.4, and 21.3%, respectively. A significant linear increase was found for the prevalence of meeting the SB recommendation, while the prevalence meeting the MVPA, sleep, and overall recommendations was lowest in 2001, peaked in 2004 or 2009, and declined in 2015. The lowest odds for meeting the 24-h guidelines were found among males, those living in urban areas, inhabitants of Bangkok and South Thailand, unemployed, and those with low education level. CONCLUSIONS: Despite promising trends in the prevalence of meeting PA, SB, and sleep recommendations, a majority of Thai adults still do not meet the overall 24-h movement guidelines. Further actions are needed to promote more MVPA, less SB, and adequate sleep in Thai adults, particularly among males, those living in urban areas, inhabitants of Bangkok and South Thailand, unemployed, and those with low education level.

Standardised criteria for classifying the International Classification of Activities for Time-use Statistics (ICATUS) activity groups into sleep, sedentary behaviour, and physical activity.

BACKGROUND: Globally, the International Classification of Activities for Time-Use Statistics (ICATUS) is one of the most widely used time-use classifications to identify time spent in various activities. Comprehensive 24-h activities that can be extracted from ICATUS provide possible implications for the use of time-use data in relation to activity-health associations; however, these activities are not classified in a way that makes such analysis feasible. This study, therefore, aimed to develop criteria for classifying ICATUS activities into sleep, sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), based on expert assessment. METHOD: We classified activities from the Trial ICATUS 2005 and final ICATUS 2016. One author assigned METs and codes for wakefulness status and posture, to all subclass activities in the Trial ICATUS 2005. Once coded, one author matched the most detailed level of activities from the ICATUS 2016 with the corresponding activities in the Trial ICATUS 2005, where applicable. The assessment and harmonisation of each ICATUS activity were reviewed independently and anonymously by four experts, as part of a Delphi process. Given a large number of ICATUS activities, four separate Delphi panels were formed for this purpose. A series of Delphi survey rounds were repeated until a consensus among all experts was reached. RESULTS: Consensus about harmonisation and classification of ICATUS activities was reached by the third round of the Delphi survey in all four panels. A total of 542 activities were classified into sleep, SB, LPA, and MVPA categories. Of these, 390 activities were from the Trial ICATUS 2005 and 152 activities were from the final ICATUS 2016. The majority of ICATUS 2016 activities were harmonised into the ICATUS activity groups (n = 143). CONCLUSIONS: Based on expert consensus, we developed a classification system that enables ICATUS-based time-use data to be classified into sleep, SB, LPA, and MVPA categories. Adoption and consistent use of this classification system will facilitate standardisation of time-use data processing for the purpose of sleep, SB and physical activity research, and improve between-study comparability. Future studies should test the applicability of the classification system by applying it to empirical data.

Correlates of physical activity and sedentary behaviour in the Thai population: a systematic review.

BACKGROUND: Given the importance of knowing the potential impediments and enablers for physical activity (PA) and sedentary behaviour (SB) in a specific population, the aim of this study was to systematically review and summarise evidence on individual, social, environmental, and policy correlates of PA and SB in the Thai population. METHODS: A systematic review of articles written in Thai and English was conducted. Studies that reported at least one correlate for PA and/or SB in a healthy Thai population were selected independently by two authors. Data on 21 variables were extracted. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 25,007 records were screened and 167 studies were included. The studies reported associations with PA for a total of 261 variables, mostly for adults and older adults. For most of the variables, evidence was available from a limited number of studies. Consistent evidence was found for individual-level and social correlates of PA in children/adolescents and adults and for individual-level correlates of PA in older adults. Self-efficacy and perceived barriers were consistently associated with PA in all age groups. Other consistently identified individual-level correlates in adults and older adults included self-rated general health, mental health, perceived benefits, and attitudes towards PA. Consistent evidence was also found for social correlates of PA in adults, including social support, interpersonal influences, parent/family influences, and information support. The influence of friendship/companionship was identified as a correlate of PA only in children/adolescents. A limited number of studies examined SB correlates, especially in older adults. The studies reported associations with SB for a total of 41 variables. Consistent evidence of association with SB was only found for obesity in adults. Some evidence suggests that male adults engage more in SB than females. CONCLUSIONS: More Thai studies are needed on (i) PA correlates, particularly among children/adolescents, and that focus on environment- and policy-related factors and (ii) SB correlates, particularly among older adults. Researchers are also encouraged to conduct longitudinal studies to provide evidence on prospective and causal relationships, and subject to feasibility, use device-based measures of PA and SB.

Mechanisms of Physical Activity Behavior Change for Prostate Cancer Survivors: A Cluster Randomized Controlled Trial.

Background: Exercise is beneficial for prostate cancer survivors. Therefore, understanding the mechanisms of physical activity (PA) behavior change is imperative. Purpose: The ENGAGE study was an exercise intervention for prostate cancer survivors, which improved vigorous physical activity (VPA) at postintervention and follow-up. The purpose of this study was to assess (a) whether the intervention improved social cognitive determinants of behavior and (b) the extent to which social cognitive determinants mediated the effect of the exercise intervention on VPA. Methods: Overall, 147 men consented to be involved in the study (intervention = 54, usual care = 93). Data from baseline, postintervention (12 weeks) and follow-up (6 months) were used in this analysis. Social cognitive determinants were measured using appropriate measures. VPA was measured using an adapted version of the Leisure-Time Exercise Questionnaire. Results: Compared with the control condition, men in the intervention condition had higher task self-efficacy postintervention (+16.23; 95% confidence interval [CI] +9.19 to +23.31; effect size [d] = 0.85, p < .001) and at follow-up (+12.58; 95% CI = +4.45 to +20.71, d = 0.50, p = .002). Task self-efficacy partially mediated the effect of the exercise intervention on VPA (indirect effect: B = 19.90; 95% CI 1.56 to 38.25, p = .033). Conclusion: The intervention improved the belief among prostate cancer survivors that they could perform challenging exercises for longer periods of time, which partially explained the positive effect of the intervention on VPA. Australia and New Zealand Clinical Trials Registration: ACTRN12610000609055.

Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review.

BACKGROUND: People from socioeconomically disadvantaged population groups are less likely to be physically active and more likely to experience adverse health outcomes than those who are less disadvantaged. In this umbrella review we examined across all age groups, (1) the effectiveness of interventions to improve physical activity among socioeconomically disadvantaged groups, (2) the characteristics of effective interventions, and (3) directions for future research. METHODS: PubMed/MEDLINE and Scopus were searched up to May 2017 to identify systematic reviews reporting physical activity interventions in socioeconomically disadvantaged populations or sub-groups. Two authors independently conducted study screening and selection, data extraction (one author, with data checked by two others) and assessment of methodological quality using the 'Assessment of Multiple Systematic Reviews' scale. Results were synthesized narratively. RESULTS: Seventeen reviews met our inclusion criteria, with only 5 (30%) reviews being assessed as high quality. Seven (41%) reviews focused on obesity prevention and an additional four focused on multiple behavioural outcomes. For pre school children, parent-focused, group-based interventions were effective in improving physical activity. For children, school-based interventions and policies were effective; few studies focused on adolescents and those that did were generally not effective; for adults, there was mixed evidence of effectiveness but characteristics such as group-based interventions and those that focused on physical activity only were associated with effectiveness. Few studies focused on older adults. Across all ages, interventions that were more intensive tended to be more effective. Most studies reported short-term, rather than longer-term, outcomes and common methodological limitations included high probability of selection bias, low response rates, and high attrition. CONCLUSIONS: Interventions can be successful at improving physical activity among children from socioeconomically disadvantaged groups, with evidence for other age groups weak or inconclusive. More high-quality studies in this population group are needed, which adopt strategies to increase recruitment rates and reduce attrition, report longer term outcomes, and provide adequate intervention details, to allow determination of the characteristics of effective interventions. We recommend that the benefits of physical activity be recognised more broadly than obesity prevention in future studies, as this may have implications for the design and appeal of interventions.

An exploratory analysis of the interactions between social norms and the built environment on cycling for recreation and transport.

BACKGROUND: There is growing evidence of the public health benefits of promoting cycling. The ways that the built environment and perceived social norms independently influence cycling participation is well established. However, whether these factors interact to influence cycling participation has not been examined. Such research is important because understanding the effect of multiple socio-ecological factors and the interactions between them is needed to guide the development of interventions and strategies to increase cycling participation. Therefore, the aim of this study is to explore the interactive effects of the built environment and perceived social norms on transport and recreational cycling. METHODS: Data was collected using a self-administered online questionnaire from 228 office workers in Metropolitan Melbourne, Australia. Measures used in previous research were employed to assess self-reported transport and recreation cycling in the last week, perceptions of neighbourhood built environment, perceived social norms towards cycling, and objective land-use mix, residential density and street connectivity of the suburbs in which participants lived and work. Multiple binary logistic regression analyses were conducted to explore the interactive effects of the built environment and perceived social norms on transport and recreation cycling. All interactive effects were considered significant at p < 0.10. RESULTS: There was a significant interactive effect between the workplace built environment and perceived group norm on transport cycling (p = 0.06). There were no other significant interactive effects observed between components of the built environment and perceived social norms on transport or recreational cycling. CONCLUSIONS: The interactive effect found in this study provides some evidence that the workplace built environment interacts with perceived group norms to influence cycling for transport. Positive perceptions of the workplace built environment, such as showers and secure bike racks, can somewhat compensate for the negative influence of when cycling is considered less of a norm among, family, friend or colleagues. However, the findings of this study did not support that the neighbourhood built environment and perceived social norms interact to influence cycling for recreation or transport. These findings contribute to the knowledge of how multiple factors may reciprocate to influence individual's decision to cycle. More research into the interactive effects of socio-ecological factors is warranted.

Physical activity and sedentary behaviour research in Thailand: a systematic scoping review.

BACKGROUND: The number of deaths per year attributed to non-communicable diseases is increasing in low- and middle-income countries, including Thailand. To facilitate the development of evidence-based public health programs and policies in Thailand, research on physical activity (PA) and sedentary behaviour (SB) is needed. The aims of this scoping review were to: (i) map all available evidence on PA and SB in Thailand; (ii) identify research gaps; and (iii) suggest directions for future research. METHODS: A systematic literature search was conducted through 10 bibliographic databases. Additional articles were identified through secondary searches of reference lists, websites of relevant Thai health organisations, Google, and Google Scholar. Studies written in Thai or English were screened independently by two authors and included if they presented quantitative or qualitative data relevant to public health research on PA and/or SB. RESULTS: Out of 25,007 screened articles, a total of 564 studies were included in the review. Most studies included PA only (80%), 6.7% included SB only, and 13.3% included both PA and SB. The most common research focus was correlates (58.9%), followed by outcomes of PA/SB (22.2%), prevalence of PA/SB (12.4%), and instrument validation (3.2%). Most PA/SB research was cross-sectional (69.3%), while interventions (19.7%) and longitudinal studies (2.8%) were less represented. Most studies (94%) used self-reports of PA/SB, and few (2.5%) used device-based measures. Both sexes were examined in most studies (82.5%). Adults were the main target population group (51.1%), followed by older adults (26.9%), adolescents (15.7%), and children (6.3%). Clinical populations were investigated in the context of PA/SB in a relatively large number of studies (15.3%), most frequently those with cardiovascular disease, diabetes, and hypertension (22%, 21%, and 21% respectively). CONCLUSIONS: The number of Thai papers on PA published per year has been increasing, indicating a growing interest in this research area. More studies using population-representative samples are needed, particularly among children and adolescents, and investigating SB as a health risk factor. To provide stronger evidence on determinants and outcomes of PA/SB, longitudinal studies using standardised measures of PA and SB are required.

Associations of objectively measured moderate-to-vigorous physical activity and sedentary behavior with quality of life and psychological well-being in prostate cancer survivors.

PURPOSE: Although evidence is building on the positive effects of physical activity for prostate cancer survivors, less is known about the possible independent effects of sedentary behavior on quality of life and psychological well-being in this population. We determined the extent to which objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary behavior were independently associated with quality of life, anxiety, and depressive symptoms in prostate cancer survivors. METHODS: An exploratory cross-sectional analysis was undertaken on baseline data from a multicenter, cluster randomized controlled trial on the efficacy of a clinician referral and 12-week exercise program for men who had completed active treatment for prostate cancer. Multiple regression analyses were performed using data from 98 prostate cancer survivors who wore hip-mounted accelerometers (time spent sedentary defined as <100 counts per minute [CPM]; MVPA defined as >1,951 CPM) and completed self-report instruments on their quality of life, anxiety, and depressive symptoms. Results were compared with minimal clinically important differences for the quality of life scales. RESULTS: Independent of sedentary behavior, increases in MVPA of between 15 and 33 min/day were associated with clinically important (but not statistically significant) improvements in three quality of life scales (insomnia, diarrhea, and financial difficulties). Independent of MVPA, decreases in sedentary behavior of 119 and 107 min/day were associated with clinically important (but not statistically significant) improvements in physical functioning and role functioning, respectively. CONCLUSION: Within our exploratory study, modest increases in MVPA and more substantive decreases in sedentary behavior were independently associated with clinically important improvements in several quality of life scales. Further research, including prospective studies, is required to understand sedentary behavior across larger and more representative samples (in terms of their physical, psychological, and social functioning and their engagement in physical activity) of prostate cancer survivors. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055.

Changes in sport and physical activity participation for adolescent females: a longitudinal study.

BACKGROUND: Participation in sport and physical activity is reported to decline during adolescence, particularly for females. However we do not have a clear understanding of changes in the context (i.e., modes and settings) of participation throughout adolescence. This study investigated longitudinal changes in physical activity participation and the specific modes and settings of physical activity, together with cross-sectional comparisons, for two age cohorts of female adolescents. METHODS: Survey of 729 adolescent girls (489 recruited in Year 7 and 243 in Year 11). Participation in eight different modes/settings was reported. PA was measured using 24-h recall diary and metabolic equivalent weighted energy expenditure (MET-min) in Leisure Time Moderate and Vigorous Physical Activity (LTMVPA) on the previous day was calculated. RESULTS: There were no significant changes in duration or total MET-min of LTMVPA on previous day. However, there were significant changes in the modes/settings of participation across time. Participation in school physical education rose during early adolescence before decreasing significantly, and participation in competitive sport and club sport significantly decreased over time; however there were increases in non-competitive forms of physical activity. CONCLUSIONS: Overall levels of physical activity did not significantly decrease over adolescence, which is positive for physical health. However, the transition from structured sport to non-organised physical activity may effect social and psychological health, which needs to be further examined.

Effects of a clinician referral and exercise program for men who have completed active treatment for prostate cancer: A multicenter cluster randomized controlled trial (ENGAGE).

BACKGROUND: The purpose of this study was to determine the efficacy of a clinician referral and exercise program in improving exercise levels and quality of life for men with prostate cancer. METHODS: This was a multicenter cluster randomized controlled trial in Melbourne, Australia comprising 15 clinicians: 8 clinicians were randomized to refer eligible participants (n = 54) to a 12-week exercise program comprising 2 supervised gym sessions and 1 home-based session per week, and 7 clinicians were randomized to follow usual care (n = 93). The primary outcome was self-reported physical activity; the secondary outcomes were quality of life, anxiety, and symptoms of depression. RESULTS: A significant intervention effect was observed for vigorous-intensity exercise (effect size: Cohen's d, 0.46; 95% confidence interval [CI], 0.09-0.82; P = .010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, -0.28 to 0.45; P = .48). Significant intervention effects were also observed for meeting exercise guidelines (≥150 min/wk; odds ratio, 3.9; 95% CI, 1.9-7.8; P = .002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, -0.02 to 0.70; P = .06) and depression symptoms (effect size: d, -0.35; 95% CI, -0.71 to 0.02; P = .06). Eighty percent of participants reported that the clinician's referral influenced their decision to participate in the exercise program. CONCLUSIONS: The clinician referral and 12-week exercise program significantly improved vigorous exercise levels and had a positive impact on mental health outcomes for men living with prostate cancer. Further research is needed to determine the sustainability of the exercise program and its generalizability to other cancer populations.

Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report.

BACKGROUND: Several studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting. METHODS: Reported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12-25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy. RESULTS: Implementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%). CONCLUSIONS: Results indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science.

Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study.

BACKGROUND: Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM. METHODS: This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored. RESULTS: Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients treated with other therapies (e.g., chemotherapy, radiotherapy) were more likely to report pain as a barrier. CONCLUSIONS: Patients with MM experience debilitating effects of their condition and therapy, which influences their level and intensity of physical activity participation. Physical activity programs should be individualised; take into consideration gender differences and the impact of different types of therapy on physical activity; and focus on meeting the psychological, coping and recovery needs of patients.

Family support and ease of access link socio-economic status and sports club membership in adolescent girls: a mediation study.

BACKGROUND: Much research has been conducted into the determinants of physical activity (PA) participation among adolescent girls. However, the more specific question of what are the determinants of particular forms of PA participation, such as the link between participation through a sports club, has not been investigated. Accordingly, the aim of this study was to investigate the relationships between participation in a sports club and socio-economic status (SES), access to facilities, and family and peer support, for female adolescents. METHODS: A survey of 732 female adolescent school students (521 metropolitan, 211 non-metropolitan; 489 Year 7, 243 Year 11) was conducted. The survey included demographic information (living arrangements, ethnicity indicators, and indicators of SES such as parental education and employment status and locality); access to facilities; and family and peer support (travel, encouragement, watching, praise, joint participation). For each characteristic, sports club participants and non-participants were compared using chi-square tests. Multiple mediation analyses were used to investigate the role of access, family and peer support in the link between SES and sport participation. RESULTS: There were significant associations (p<0.05) between sports club participation and: all demographic characteristics; all measures of family and peer support; and access to sport-related facilities. Highest levels of participation were associated with monolingual Australian-born families, with two parents, at least one of whom was well-educated, with both parents employed, and high levels of parental assistance, engagement and support. Participation in club sport among both younger and older adolescent girls was significantly positively associated with the SES of both their neighbourhoods and their households, particularly in metropolitan areas. These associations were most strongly mediated by family support and by access to facilities. CONCLUSIONS: To facilitate and promote greater participation in club sport among adolescent girls from low SES neighbourhoods and households, strategies should target modifiable determinants such as facility access and parental support. This will involve improving access to sports facilities and promoting, encouraging and assisting parents to provide support for their daughters' participation in sport clubs.