Effects of online support and social media communities on gestational diabetes: A systematic review.

BACKGROUND: Gestational diabetes mellitus (GDM) is a common complication in pregnancy that can lead to negative maternal and fetal outcomes. Online support interventions have been suggested as a potential tool to improve the management of GDM. OBJECTIVE: This systematic review aimed to summarize the effectiveness of social media and online support interventions for the management of GDM. METHODS: We conducted a thorough systematic search across Web of Science, Scopus, and PubMed, following PRISMA guidelines, and supplemented it with a manual search. Our results included both qualitative and quantitative research. We rigorously assessed quantitative studies for bias using ROBINS-I and RoB 2 tools, ensuring the reliability of our findings. RESULTS: We incorporated a total of 22 studies, which were comprised of ten qualitative and twelve quantitative studies. Online support interventions were found to have a positive impact on promoting self-care and improving healthcare outcomes for women with GDM. Individualized diet and exercise interventions resulted in lower odds of weight gain and GDM diagnosis, while online prenatal education increased breastfeeding rates. In addition, telemedicine options reduced the need for in-person clinical visits and improved patient satisfaction. CONCLUSIONS: Online support interventions show potential to improve outcomes in patients with GDM in this small literature review. Future research is also necessary to determine the effectiveness of different types of online interventions and identify strategies to improve engagement and the quality of the information provided through online resources.

The effects of multi-nutrient formulas containing a combination of n-3 PUFA and B vitamins on cognition in the older adult: a systematic review and meta-analysis.

There is now evidence to suggest that there may be an interaction between B vitamins and n-3 PUFA, with suggestions that increasing intake of both nutrients simultaneously may benefit cognition in older adults. The aim of this systematic review was to investigate whether supplementation with a combination of n-3 PUFA and B vitamins can prevent cognitive decline in older adults. Randomised controlled trials conducted in older adults that measured cognitive function were retrieved. The included trials provided a combination of n-3 PUFA and B vitamins alone, or in combination with other nutrients. Trials that provided n-3 PUFA alone and also measured B vitamin status or provided B vitamin supplementation alone and measured n-3 PUFA status were also included. The databases searched were The Cochrane Library, EMBASE, CINAHL, Scopus and MEDLINE. A total of 14 papers were included in the analysis (n 4913; age: 60-70 years; follow-up 24 weeks to 4 years). The meta-analysis results found a significant benefit of nutrient formulas, which included both n-3 PUFA and B vitamins alongside other nutrients, v. placebo on global cognition assessed using composite scores from a neuropsychological test battery (G = 0·23, P = 0·002), global cognition using single measures of cognition (G = 0·28, P = 0·004) and episodic memory (G = 0·32, P = 0·001). The results indicate that providing a combination of n-3 PUFA and B vitamins as part of a multi-nutrient formula benefits cognition in older adults v. a placebo, and the potential for an interaction between these key nutrients should be considered in future experimental work.

Barriers and Facilitators Associated with the Adoption of and Adherence to a Mediterranean Style Diet in Adults: A Systematic Review of Published Observational and Qualitative Studies.

The Mediterranean diet (MedDiet) has been linked with physical and mental health benefits. Previous research, however, suggests that adoption and adherence to a Mediterranean diet might be difficult for people who live outside of the Mediterranean region. The aim of this systematic review was to investigate the factors that influence adoption and adherence to a Mediterranean style diet in adults aged 18 years old and over, as identified in published observational and qualitative studies. Following registration of our protocol on PROSPERO (ID: CRD42018116515), observational and qualitative studies of adults' perceptions and experiences relevant to following a Mediterranean style diet were identified using systematic searches of databases: MEDLINE, the Cochane Library, CINAHL, Web of Science and Scopus, over all years of records until February 2022. A narrative synthesis was then undertaken. Of 4559 retrieved articles, 18 studies fulfilled our inclusion criteria and were included. Factors influencing adoption and adherence to a MedDiet were identified and categorized as: financial, cognitive, socio-cultural, motivational, lifestyle, accessibility & availability, sensory & hedonic and demographic. Similar barriers and facilitators are often reported in relation to healthy eating or the consumption of specific healthy foods, with a few exceptions. These exceptions detailed concerns with specific components of the MedDiet; considerations due to culture and traditions, and concerns over a cooler climate. Suggestions for overcoming these barriers and facilitators specific to adoption and adherence to the Mediterranean diet are offered. These data will inform the development of future studies of robust methodology in eating behaviour change which offer pragmatic approaches for people to consume and maintain healthy diets.

Diet and longevity in the Blue Zones: A set-and-forget issue?

The Blue Zones (BZs) are areas of the globe inhabited by exceptionally long-lived populations. They include the island of Okinawa in Japan, the island of Ikaria in Greece, the mountain area of the island of Sardinia in Italy, and the peninsula of Nicoya in Costa Rica. Their longevity is a relatively recent phenomenon that has been progressively investigated since the dawn of this century. Research efforts over the past two decades have sought to shed light on the factors associated with this longevity, as well as explore the possibility of lessons transferable to the general population. Among the features of BZ inhabitants, described in the literature, their eating habits hold a prominent place, as these have the advantage of being easily quantifiable and applicable on a larger scale. However, it is too often taken for granted that the mere fact of being documented in a long-lived population makes the diet a causal factor of that population's longevity; this is a claim which should be proven. Furthermore, it is implicitly assumed that a specific BZ diet is homogeneous and remains stable over time, whereas some evidence suggests the opposite. Therefore, this review summarizes our current knowledge of the BZ diets and discusses whether they can be considered as a paradigmatic example of healthy nutrition valid for anyone or, rather, a set of evolving food patterns that has offered benefits to a few specific communities in recent decades.

'Everyone's so kind and jolly it boosts my spirits, if you know what I mean': A humanising perspective on exercise programme participation.

BACKGROUND: Maintaining a physically active lifestyle across the life course can add to an individual's health and well-being. Many people are insufficiently active to achieve these gains with a trend towards further decreases in activity as people age. Community-based group exercise programmes have been shown to be one means of increasing sustained activity levels for older people. AIM: To understand how and why older people sustain participation to community-based group exercise programmes from a humanising perspective. METHODS: A multiple-case study approach was employed to study three exercise programmes in the South-West of England. Data were collected through participant observation, focus groups and documentation. Data were analysed with deductive thematic analysis and mapped against the humanisation framework. RESULTS: Findings suggest that the humanising nature of these particular exercise programmes supported sustained participation. In these programmes, agency was evidenced in the way participants self-selected their level of exertion with exercises. There was freedom to be their unique selves and exercise within the limits of their insider challenges of an ageing body. Through this non-judgemental exercise environment, there was an embodied understanding of who they were as people. The exercise programme became part of their personal journey. This journey helped inform their future by enabling them to keep active and maintain independence, allowing them to continue engaging in the world. There was a sense of togetherness and belonging which led to feelings of homeliness as they found a sense of place within the group. The friendships they formed helped them make sense and add meaning to their experiences and personal health challenges. CONCLUSIONS: When planning exercise environments to support the long-term adoption of a sustained behaviour change, in the form of physical activity for older people, it is helpful to consider dimensions that make an individual feel human.

Poor Dietary Quality and Patterns Are Associated with Higher Perceived Stress among Women of Reproductive Age in the UK.

The aim of this study was to investigate the association between stress and diet quality/patterns among women of reproductive age in UK. In total, 244 reproductive aged women participated in an online survey consisting of the European Prospective into Cancer and Nutrition food frequency questionnaire in addition to stress, depression, physical-activity, adiposity, and socioeconomic questions. An a-priori diet quality index was derived by assessing the adherence to Alternate Mediterranean Diet (aMD). A-posteriori dietary-patterns (DPs) were explored through factor analysis. Regression models were used to assess the predictors of the DPs. Participants mainly had medium (n = 113) aMD adherence. Higher stress levels were reported by participants with low aMD adherence. Participants with high aMD adherence were of normal BMI. Factor analysis revealed three DPs: fats and oils, sugars, snacks, alcoholic-beverages, red/processed meat, and cereals (DP-1), fish and seafood, eggs, milk and milk-products (DP-2), and fruits, vegetables, nuts and seeds (DP-3). Regression models showed that DP-1 was positively associated with stress (p = 0.005) and negatively with age (p = 0.004) and smoking (p = 0.005). DP-2 was negatively associated with maternal educational-level (p = 0.01) while DP-3 was negatively associated with stress (p < 0.001), BMI (p = 0.001), and white ethnicity (p = 0.01). Stress was negatively associated with healthy diet quality/patterns among reproductive aged women.

Validation of the European Prospective Investigation into Cancer (EPIC) FFQ for use among adults in Lebanon.

OBJECTIVE: To validate the European Prospective Investigation into Cancer (EPIC) FFQ in Lebanon. DESIGN: Validation of the EPIC FFQ was done against three 24-h recalls (24-HR). Unadjusted and energy-adjusted correlations, Bland-Altman plots and weighed kappa statistics were used to assess the agreement between the two methods. SETTING: Lebanon. PARTICIPANTS: 119 adults (staff and students) at a Lebanese University. RESULTS: Good unadjusted and energy-adjusted correlation coefficients were found between data from the two methods which ranged from -0·002 (vitamin A) to 0·337 (carbohydrates) and were all statistically significant except for vitamin D, vitamin E, vitamin A, Se and niacin. Slight/fair agreement was reported through weighed kappa estimates for unadjusted data ranging from -0·05 (vitamin C) to 0·248 (Mg) and for energy-adjusted data ranging from -0·034 (vitamin A) to 0·203 (P). Individuals were categorised into exact and adjacent quartiles with an average of 78 % for unadjusted data and 70 % for energy-adjusted data, indicating a very good agreement between the EPIC FFQ and the average of the 24-HR data. The visual inspection of the Bland-Altman plots revealed an overestimation of energy, carbohydrates, protein and fat intakes by the FFQ method. CONCLUSION: Overall, when all tests were taken into consideration, the current study demonstrated an acceptable agreement of the EPIC FFQ with the 24-h dietary recall method and significantly good correlations between dietary intakes. Therefore, the EPIC FFQ can be considered a valid tool for assessing diet in epidemiological studies among Lebanese adults.

Effectiveness and Usability of Digital Tools to Support Dietary Self-Management of Gestational Diabetes Mellitus: A Systematic Review.

Advice on dietary intake is an essential first line intervention for the management of gestational diabetes mellitus (GDM). Digital tools such as web-based and smartphone apps have been suggested to provide a novel way of providing information on diet for optimal glucose regulation in women with GDM. This systematic review explores the effectiveness and usability of digital tools designed to support dietary self-management of GDM. A systematic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Scopus using key search terms identified 1476 papers reporting research studies, of which 16 met the specified inclusion criteria. The quality of the included studies was assessed using the ErasmusAGE Quality Score or the Mixed Methods Appraisal Tool (MMAT) version 2018. The findings show that the adoption of digital tools may be an effective approach to support self-management relating to healthy diet, health behaviour, and adherence to therapy in women with GDM as a usable intervention. However, there is a lack of evidence concerning the effectiveness of tools to support the dietary management of GDM. Consideration for ethnic specific dietary advice and evidence-based frameworks in the development of effective digital tools for dietary management of GDM should be considered as these aspects have been limited in the studies reviewed.

A Priori and a Posteriori Dietary Patterns in Women of Childbearing Age in the UK.

Poor diet quality is a major cause of maternal obesity. We aimed to investigate a priori and a-posteriori derived dietary patterns in childbearing-aged women in UK. An online survey assessed food intake, physical activity (PA), anthropometry and socio-demographics. An a priori defined diet quality was determined via Mediterranean diet (MD) adherence score and Exploratory Factor Analysis (EFA) derived dietary patterns (DPs). Multiple linear regression explored associations between DPs with anthropometric measures, PA and socio-demographics. Participants (n = 123) had low-to-medium MD adherence (average MD-score: 4.0 (2.0)). Age was positively associated with higher MD adherence (X2 (2) = 13.14, p = 0.01). EFA revealed three DPs: 'fruits, nuts, vegetables and legumes' ("Vegetarian-style" DP); 'sweets, cereals, dairy products and potatoes' ("Dairy, sweets and starchy foods" DP); and 'eggs, seafood and meats' ("Protein-rich" DP). "Vegetarian-style" DP was positively associated with higher maternal educational level (p < 0.01) and PA (p = 0.01), but negatively with white ethnicity (p < 0.01). "Dairy, sweets and starchy foods" DP was positively associated with white ethnicity (p = 0.03) and negatively with age (p = 0.03). "Protein-rich" DP was positively associated with age (p < 0.001) and negatively with PA (p = 0.01). A poor diet quality was found among childbearing-aged women; notably in the younger age category, those of white ethnicity, that were more physically inactive and with a lower socioeconomic background.

Perceived stress and diet quality in women of reproductive age: a systematic review and meta-analysis.

BACKGROUND: Poor diet quality is associated with obesity-related morbidity and mortality. Psychological stress can increase unhealthy dietary choices, but evidence pertinent to women of reproductive age remains unclear. This paper systematically reviewed the literature to determine the association between psychological stress and diet quality in women of reproductive age. METHODS: Medline, CINAHL, Scopus, Cochrane Library, Web of Science, and Sciencedirect were searched. Data extraction was determined by the PEO. Inclusion criteria consisted of: English language, stress (exposure) measured in combination with diet quality (outcome), healthy women of reproductive age (18-49 years old (population)). Observational studies, due to the nature of the PEO, were included. Quality assessment used the Risk of Bias in Non-randomised Studies from the Cochrane Handbook of Systematic Reviews of Interventions. Meta-analysis was conducted using random-effect model to estimate the Fisher's z transformed correlation between stress and diet quality with 95% confidence interval (CI). RESULTS: From 139,552 hits, 471 papers were screened; 24 studies met the inclusion criteria and were conducted in different countries: 8 studies on diet quality and 16 on food intake and frequency of consumption. Studies of diet quality consisted of six cross-sectional and two longitudinal designs with a total of 3982 participants. Diet quality was measured with diverse indices; Alternate Healthy Eating Index (n = 2), Healthy Eating Index (n = 2), Dietary Approach to Stop Hypertension (DASH) Diet Index (n = 2), Dietary Quality Index- Pregnancy (n = 2), and Dietary Guideline Adherence Index (n = 1). Most studies used Cohen's perceived stress scale and no study measured biological stress response. After sensitivity analysis, only 5 studies (3471 participants) were included in the meta-analysis. Meta-analysis revealed a significant negative association between stress and diet quality with substantial heterogeneity between studies (r = - 0.35, 95% CI [- 0.56; - 0.15], p value < 0.001, Cochran Q test P < 0.0001, I2 = 93%). The 16 studies of food intake and frequency of consumption were very heterogeneous in the outcome measure and were not included in the meta-analysis. These studies showed that stress was significantly associated with unhealthy dietary patterns (high in fat, sweets, salt, and fast food and low in fruits, vegetables, fish, and unsaturated fats). CONCLUSION: Future studies that explore diet quality/patterns should include both diet indices and factor analysis and measure biological markers of stress and dietary patterns simultaneously.

The effects of moderate alterations in adrenergic activity on acute appetite regulation in obese women: A randomised crossover trial.

BACKGROUND: Previous evidence has demonstrated that serum leptin is correlated with appetite in combination with, but not without, modest exercise. AIM: The present experiments investigated the effects of exogenous adrenaline and α/ß adrenoceptor blockade in combination with moderate exercise on serum leptin concentrations, appetite/satiety sensations and subsequent food intake in obese women. METHODS: A total of 10 obese women ((mean ± SEM), age: 50 (1.9) years, body mass index 36 (4.1) kg/m2, waist 104.8 (4.1) cm) participated in two separate, double-blind randomised experimental trials. Experiment 1: moderate exercise after α/ß adrenergic blocker (labetalol, 100 mg orally) versus moderate exercise plus placebo; experiment 2: adrenaline infusion for 20 minutes versus saline infusion. Appetite/satiety and biochemistry were measured at baseline, pre- and immediately post-intervention, then 1 hour post-intervention (i.e., before dinner). Food intake was assessed via ad libitum buffet-style dinner. RESULTS: No differences were found in appetite/satiety, subsequent food intake or serum leptin in any of the studies (experiment 1 or experiment 2). In experiment 1, blood glucose was higher (p < 0.01) and plasma free fatty acids lower (p = 0.04) versus placebo. In experiment 2, plasma free fatty acids (p < 0.05) increased after adrenaline versus saline infusion. CONCLUSIONS: Neither inhibition of exercise-induced adrenergic activity by combined α/ß adrenergic blockade nor moderate increases in adrenergic activity induced by intravenous adrenaline infusion affected acute appetite regulation.

Effects of lunch club attendance on the dietary intake of older adults in the UK: A pilot cross-sectional study.

BACKGROUND: Lunch clubs are community-based projects where meals are offered with opportunities for social interaction, and a unique dining experience of dual commercial and communal nature. AIM: The aim of the present cross-sectional study was to assess differences in the dietary intake between lunch club and non-lunch club days among community-dwelling elderly, living in Dorset, UK. METHODS: A total of 39 elderly individuals attending local lunch clubs were recruited. Socioeconomic factors were recorded, anthropometric measurements were taken and the dietary intake was assessed in lunch club and non-lunch club days via 24 hour dietary recalls. RESULTS: For the majority of participants, having a hot meal (74.4%), meeting with friends (92.3%), dining outside home (76.9%), having a home-styled cooked meal (71.8%) and skipping cooking (43.6%) were considered as important factors for lunch club dining. Absolute energy intake, protein, fat, carbohydrate, saturated fatty acids, fibre, potassium, calcium, iron, vitamins A, C and folate and water from drinks were significantly greater on lunch club days. When intake was expressed as a percentage of the dietary reference values, all examined nutrients were consumed in greater adequacy during lunch club days, except potassium and vitamin D. CONCLUSIONS: Lunch clubs appear to be an effective means for ameliorating nutrient intake among older adults, while in parallel, offer the opportunity for socializing and sharing a hot meal with peers.

Effects of a high-DHA multi-nutrient supplement and exercise on mobility and cognition in older women (MOBILE): a randomised semi-blinded placebo-controlled study.

There is a complex interplay between mobility and cognition in older adults. We have previously shown that a high-DHA multi-nutrient supplement improves habitual walking speed, verbal memory and psychomotor response latency in older women. Exercise also improves mobility and cognition in older adults, and n-3 fatty acids and exercise share a range of overlapping biological effects. This study examined for the first time the effects of the high-DHA multi-nutrient supplement and aerobic exercise on mobility and cognition in older women. Women (mean age 67 (sd 8) years) were assigned to the following groups: multi-nutrient (1 g DHA, 160 mg EPA, 240 mg Ginkgo biloba, 60 mg phosphatidylserine, 20 mg d-α tocopherol, 1 mg folic acid and 20 µg vitamin B12 per d, n 13), multi-nutrient and exercise (spin class twice per week, n 14), exercise and placebo (n 12) or placebo (n 12). The multi-nutrient was given for 24 weeks and exercise for 12 weeks. No treatment effects were observed for the primary outcome, habitual walking speed. Improvements in verbal memory and executive function were seen for all treatments groups v. placebo (all, P < 0·05). Significant improvements in self-reported emotional well-being were seen with multi-nutrient and exercise groups v. placebo (P = 0·03). The results suggest that the high-DHA multi-nutrient supplement produces similar improvements in cognitive function to aerobic exercise, offering the intriguing prospect that supplementation may be able to mitigate some of the effects of low physical activity on cognitive function in the elderly.

Combining a high DHA multi-nutrient supplement with aerobic exercise: Protocol for a randomised controlled study assessing mobility and cognitive function in older women.

There is a complex interplay between cognition and gait in older people, with declines in gait speed coexisting with, or preceding cognitive decline. Omega-3 fatty acids, B vitamins, vitamin E, phosphatidylserine, and Ginkgo Biloba show promise in preserving mobility and cognitive function in older adults. Exercise benefits mobility and there is evidence suggesting positive interactions between exercise and omega-3 fatty acids on physical and cognitive function in older adults. Non-frail or pre-frail females aged ≥60 years are included in a randomized placebo controlled study. Intervention groups are: high DHA multi-nutrient supplement and exercise, placebo supplement and exercise, high DHA multi-nutrient supplement, and placebo supplement. Dietary supplementation is 24 weeks. The exercise intervention, two cycle ergometer classes per week, is for the final 12 weeks. The primary outcome is habitual walking speed, secondary outcomes include gait variables under single and dual task, five times sit to stand, verbal and spatial memory, executive function, interference control and health related quality of life. Blood fatty acids, serum homocysteine, dietary intake, physical activity, and verbal intelligence are measured to assess compliance and control for confounding factors. The study is registered at www.clinicaltrials.gov (NCT03228550).

Exploring the Perceived Barriers to Following a Mediterranean Style Diet in Childbearing Age: A Qualitative Study.

A considerable amount of research has focused on interventions in pregnancy to promote health in current and future generations. This has yielded inconsistent results and focus has turned towards improving health in the preconception period. Promotion of healthy dietary patterns similar to a Mediterranean diet in the preconception years has been suggested as a dietary strategy to prevent maternal obesity and optimize offspring health. However, it is uncertain whether adoption is acceptable in women of childbearing age. This qualitative study aims to investigate the perceived barriers to following a Mediterranean diet in women of childbearing age. Semi-structured focus groups were used to generate deep insights to be used to guide the development of a future intervention. Nulliparous women aged between 20 and 47 years were recruited (n = 20). Six focus groups were digitally audio recorded and transcribed verbatim by the researcher. Thematic analysis was used to analyze data, which occurred in parallel with data collection to ascertain when data saturation was reached. Five core themes were identified: Mediterranean diet features, perceived benefits, existing dietary behavior and knowledge, practical factors, and information source. The present study highlights that a Mediterranean diet is acceptable to childbearing-aged women, and the insights generated will be helpful in developing an intervention to promote Mediterranean diet adoption.

Diet quality, overweight and daily monetary allowance of Greek adolescents.

Objective To investigate cross-correlates of pocket-money on diet quality and weight status of Greek adolescents. Methods A total of 172 adolescents (55.2% boys), aged between 10 and 15 years old were recruited. Body weight and height were measured, body mass index (BMI) was computed. Weight status was assessed according to the International Obesity Task Force criteria and diet quality was evaluated via the Healthy Eating Index (HEI) - 2010. Results Adolescents were allowed a mean allowance of €4.63 ± 3.66 daily. Among boys participants, BMI correlated with pocket money (r = 0.311, p ≤ 0.002) and normoweight boys received statistically less money than their overweight peers (p ≤ 0.019). In both sexes, normoweight was more prevalent in the lowest monetary quartiles. Pocket money was not associated with HEI. Among boys, moderate HEI was more prevalent in the third quartile of pocket money, significantly higher compared to all others (p ≤ 0.01 for all). For girls, the prevalence of moderate HEI declined by each ascending pocket money quartile (p ≤ 0.05 for all). Conclusion In our sample, adolescents exhibited high rates of pooled overweight including obesity. The majority of the participants followed a diet of moderate quality. Pocket money was associated with BMI only among boys. As pocket money was not associated with diet quality, it is highly possible that adolescents might choose to spend their money on items other than foods. Our study shows that pocket money should be controlled during adolescence and teenagers should be educated on spending their money on healthier food choices.

Older people's adherence to community-based group exercise programmes: a multiple-case study.

BACKGROUND: Physical inactivity is a global phenomenon, with estimates of one in four adults not being active enough to achieve health benefits, thus heightening the risk of developing non-communicable diseases. In order to realise the health and wellbeing gains associated with physical activity the behaviour must be sustained. Community-based group exercise programmes (CBGEP) utilising social supports have been shown to be one means of not only increasing activity levels for older people, but sustaining physical activity. A gap in the literature was identified around older people's long-term adherence to real-life CBGEP within a UK context. This study therefore sought to address this gap by understanding older people's ongoing adherence to CBGEP with a view to gaining further insight about which factors contribute to enabling people to sustain their physical activity levels. METHODS: A multiple case study research design was employed to understand older people's (≥60 years, n = 27) adherence (≥ 69%, for ≥ 1 year) to three current CBGEP in the South- West of England. Qualitative data (participant observation, focus groups, documents, and interviews) were collected and analysed using inductive thematic analysis followed by the analytic technique of explanation building. Quantitative data were analysed using descriptive statistics and used to set the context of the study. RESULTS: The current study offers five unique insights into real-life programmes which have been successful in helping older people maintain adherence for a year or longer. These included: factors relating to the individual, the instructor (particularly their personality, professionalism and humanised approach), programme design (including location, affordability, the use of music, and adaptable exercise content), social features which supported a sense of belonging, and participant perceived benefits (physical and psycho-social). These all served to explain older people's adherence to CBGEP. CONCLUSIONS: These factors related to participant adherence of CBGEP must be considered if we wish to support older people in sustaining a physically active lifestyle as they age. These findings are of interest to practitioners and policy makers in how CBGEP serve to aid older people in maintaining a physically active lifestyle with a view to preventing non-communicable diseases and in maintaining social connectivity.

Adherence to community based group exercise interventions for older people: A mixed-methods systematic review.

OBJECTIVE: Lifelong physical activity provides some of the best prospects for ageing well. Nevertheless, people tend to become less physically active as they age. This systematic review assessed the views and adherence of participants attending community based exercise programmes of ≥6month's duration. METHOD: Searches were carried out in eight online scientific databases (January 1995-May 2014) to identify relevant primary studies. Studies were assessed for quality and data extracted. Results were synthesised thematically and narratively. Qualitative findings were compared against quantitative studies. RESULTS: A total of 2958 studies were identified and screened against the inclusion/exclusion criteria. Ten studies met the inclusion criteria (five quantitative, three qualitative and two mixed-methods study designs). None were excluded on the basis of quality. Six key themes were identified from the qualitative studies as important for adherence to group exercise programmes: social connectedness, participant perceived benefits, programme design, empowering/energising effects, instructor and individual behaviour. The mean adherence rate of studies with comparable measures was (69.1% SD 14.6). When the views of participants from the qualitative synthesis were juxtaposed against the quantitative studies, programme design was a common feature across all studies. CONCLUSION: Evidence surrounding these programmes is limited both in terms of long-term adherence measures and the views of participants. However, based on limited findings there is some indication that community based group exercise programmes have long-term adherence rates of almost 70%. Incorporating the views of older people into programme designs may provide guidance for innovative interventions leading to sustained adherence.

Prevalence of overweight and obesity in preschool children in Thessaloniki, Greece.

OBJECTIVE: Data on obesity in preschoolers are scarce in Greece, a country particularly affected by the obesity epidemic. The present study aimed to assess overweight and obesity prevalence of preschoolers in Thessaloniki, Greece, by using three different standards for defining childhood overweight and obesity. DESIGN: One thousand two hundred and fifty (1250) preschool children (657 boys and 593 girls) aged 2.0-6.0 years old from all public municipality kindergartens of Thessaloniki, Greece, participated in this cross-sectional survey conducted from 2009 to 2010.Body weight and height were measured and detailed anthropometry measurement was undertaken. BMI was classified to weight categories based on the CDC (US Centers for Disease Control and Prevention), IOTF (the International Obesity Task Force) and WHO (the World Health Organization) references. RESULTS: Rates of excess body weight varied significantly according to the different international criteria: IOTF: overweight (including obesity) 21.2%, obesity 5.8%;CDC: overweight (including obesity) 30.5%, obesity 13.5%; and WHO: overweight (including obesity) 32.6%, obesity 5%. Boys and older children were particularly affected. CONCLUSIONS: Overweight prevalence is high in Greek preschoolers and varies significantly according to the different criteria used, from 21.2% (IOTF reference) to 32.6% (CDC reference).