Health promotion expectations and perceptions of sport club participants.

To develop health promotion (HP) in sports clubs (SCs), stakeholders need to know the HP expectations of sports participants. However, the literature does not provide information on these aspects, which exacerbates the difficulty for SCs to provide an environment, activities and organization that promote health and to play the role entrusted to them in the integration of vulnerable populations. To fill this gap, this study explores the HP expectations and perceptions of sports participants, with a particular focus on ethnocultural characteristics, and documents participants' understanding of HP. A descriptive qualitative study comprising semi-structured interviews was carried out with 22 French and Quebec sports participants. Because they have little experience with HP in their SC, participants do not seem to have many expectations of their SC in terms of HP. Nevertheless, they felt that SCs can play an important role in health and suggested several themes and types of action, such as seminars on nutrition, activities outside the SC to develop cohesion or health monitoring. Sports participants from ethnocultural minorities seem to appreciate the programs designed to integrate them. There is a predominantly physical conception of health and the contribution of SCs to health, and the relationship between the types of health determinants (economic, environmental, organizational and social) and health is not clear. This study shows that the idea of a health-promoting SC appeals to SC participants, but this approach has not yet taken root in this setting or in society as a whole.

Pilot study of a health promotion intervention in sports clubs / Étude pilote d'une intervention de promotion de la santé au sein de clubs de sport.

Sports clubs (SCs) are an ideal setting for promoting health. However existing health promotion (HP) interventions in SCs mainly target a single health behavior and men who do sports, and evaluations of such interventions provides little information about their deployment. To overcome these limitations, the PROSCeSS intervention was co-constructed based on the theoretical model of the health-promoting SC and multi-level, multi-determinant health strategies. The aim of this pilot study was to evaluate the deployment of the PROSCeSS intervention and identify the factors influencing its deployment. A qualitative study, using recordings of meetings, email and telephone exchanges, and interviews with project leaders of fourteen SC, was carried out. Although a low number of SCs had completed the intervention, they all considered that they have a role to play in helping their members maintain good health. Their ability to develop HP activities and to implement the intervention was influenced by the resources available, the support they received from their sports federation, and the ability of each project leader to get involved in the intervention. The SCs that deployed the intervention implemented several strategies enabling them to integrate health into the organizational, social, economic, and environmental habits of the SCs and to develop new HP activities, such as adapted sports activity sessions and activities to teach members about first aid, nutrition, and good practices for warming up. This study highlights the importance of understanding the specificities of the contexts in which HP interventions are deployed. Having led to a reworking of the intervention steps and the development of an appropriate evaluation design, it also highlights the essential role of pilot studies in the development and evaluation of interventions.

Le club de sport (CS) est un milieu de vie privilégié pour promouvoir la santé. Cependant, les interventions de promotion de la santé (PS) existantes dans les CS ciblent majoritairement un seul comportement de santé et des pratiquants sportifs masculins, et leurs évaluations renseignent peu leurs déploiements. Pour dépasser ces limites, l'intervention PROSCeSS a été co-construite à partir du modèle théorique du CS promoteur de santé et de stratégies multi-niveaux et multi-déterminants de santé. L'objectif de cette étude pilote était d'évaluer le déploiement de l'intervention PROSCeSS et d'identifier les facteurs influençant son déploiement. Une étude qualitative comprenant des enregistrements de réunions, des échanges par e-mails et par téléphone, et des entretiens avec les référents de 14 CS a été réalisée. Même si le nombre de CS qui sont allés au bout de l'intervention est faible, ceux-ci considèrent qu'ils ont un rôle à jouer dans la santé de leurs membres. Leur capacité à développer des activités de PS et à déployer les étapes de l'intervention est influencée par les ressources disponibles, le soutien qu'ils reçoivent de leur fédération sportive et la capacité d'un porteur de projet (référent) à s'impliquer. Les CS qui ont déployé l'intervention ont mis en place plusieurs stratégies qui leur permettent d'intégrer la santé dans les habitudes organisationnelles, sociales, économiques et environnementales du CS et de développer de nouvelles activités de PS, telles que des sessions d'activités sportives adaptées et des activités de sensibilisation à l'échauffement, à l'alimentation et aux gestes de premier secours. Cette étude montre qu'il est important de comprendre les spécificités des contextes dans lesquels les interventions de PS sont déployées. Parce qu'elle a conduit à retravailler les étapes de l'intervention et à développer un nouveau design d'évaluation, elle met en évidence le rôle essentiel des études pilotes pour le développement et l'évaluation des interventions.

Evaluating the feasibility and acceptability of an adapted fencing intervention in breast cancer surgery post-operative care: the RIPOSTE pilot randomized trial.

Background: Adapted physical activity programs have shown promising results in reducing the physical, social and psychological side effects associated with breast cancer, but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the framework to guide the planning and evaluation of programs according to the 5 following keys: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing). This program is an innovative intervention focused on improving the quality of life (QoL) of breast cancer surgery patients through fencing. Methods: A convergent mixed methods pilot study was conducted to preliminary evaluate the different RE-AIM dimension of the pilot program. Twenty-four participants who have just undergone surgery for invasive breast cancer were randomly allocated in two groups: one group started immediately after their inclusion (Early RIPOSTE group) and the other started 3 months following their inclusion (Delayed RIPOSTE group). Participants answered a questionnaire at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and physical activity. Results: RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of QoL, shoulder functional capacity, fatigue and anxiety-depression state, even without any significant differences between the Early RIPOSTE group and the Delayed RIPOSTE group. Discussions: The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during school vacations were the main barriers. The intervention was moderately well implemented and adherence to the protocol was suitable. Conclusion: RIPOSTE is an acceptable and effective program for involving breast cancer survivors in physical activity, that needs to be tested at a larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide.

A health promoting sports club framework: strategies from the field.

The application of the settings-based approach to sports clubs requires a context-specific framework to develop and operationalize health promotion interventions. Incorporating top-down and bottom-up perspectives into interventions increases their efficiency, success and sustainability. In 2020, the health promoting sports club (HPSC) model and intervention framework were created, including strategies and intervention components. A subsequent concept mapping study generated 35 statements from sports club stakeholders highlighting their needs when developing health promotion initiatives. This commentary integrates the concept mapping results into the HPSC model and intervention framework. The process added new sports club levels, updated existing and developed new intervention components, then classified them into the framework. The revised HPSC model has seven levels while the revised intervention framework includes 13 strategies and 69 intervention components. This revised HPSC framework provides sports club stakeholders, public health experts and researchers a means to develop and implement targeted health promotion interventions.

Capitalization of experience of physical activity resumption programs: Lessons learned for adherence and post-program referral.

The benefits of physical activity (PA) in managing chronic diseases are largely demonstrated. To encourage a sustainable PA practice for inactive patients with chronic diseases, France has recently implemented PA resumption programs, in which patients can participate with a medical prescription but which are time-limited. In the literature, the effectiveness of those exercise referral schemes to foster sustainable PA practice is still mixed. The present study aims at capitalizing the experience of eight resumption programs to understand what makes the programs work, adherence mechanisms and the post-program referral scheme. Questionnaires and semi-structured interviews informed those intervention mechanisms analysed using thematic analysis. This study provides insights into expertize in patient management among these programs, currently due to key findings as the employment of adapted PA teachers, their training and the use of mechanisms for program adherence (practice conditions, emphasize progress and feelings generated by exercise, the relational and social aspect of practice). Other key findings are a lack of clarity in program objectives which is an area of improvement, and a broad diversity of referral (transmitting contact details, contacting the club, intervention of a third-party association or physical presence) that need further exploration.

A RE-AIM framework analysis of a sports club health promotion MOOC: the PROSCeSS MOOC.

Acquisition of health promotion (HP) skills and knowledge is essential for interventions development in this field. In sports clubs (SC), little HP training exists even though it was requested by SC actors. In response, the PROSCeSS (PROmotion de la Santé au sein du Clubs SportifS) MOOC (Massive Open Online Course) was developed to support actors of HP in the SC in the development of HP interventions. The present study evaluates the MOOC's effectiveness and learning process. The RE-AIM framework, measuring reach, effectiveness, adoption, implementation and maintenance was used to structure this study. Surveys were sent before and after the MOOC to the 2814 learners. Among the 502 (18%) respondents to the pre-survey, 80% reported belonging to a SC as a coach (35%) or manager (25%). The 14% of pre-survey respondents who completed the post-survey increased their HP knowledge score by 42% and their confidence to implement HP actions by 6%. Results present the strategies considered most important and feasible by the learners and the main barriers to the implementation of HP actions in the SC. This study shows that MOOC appears to be an appealing (93% of learners were satisfied) and effective solution (as long as it is followed) to develop HP knowledge and skills of SC actors in HP, meeting their needs and constraints. Although improvements should be made (especially in terms of promoting adoption), this type of educational format should be encouraged to support the HP potential of SC.

Health promoting sports federations: theoretical foundations and guidelines.

Background: Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP). Methods: A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework. Results: Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club's intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP. Conclusion: The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI).

BACKGROUND: Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA. METHODS: This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps. RESULTS: Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed. CONCLUSIONS: This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

Health promoting sports clubs: from theoretical model to logic model.

A recent literature review indicated that the settings-based approach, as it is applied to sports clubs, is poorly understood and not well implemented. The current study builds on the health promoting sports clubs (HPSC) theoretical model as a basis for a settings-based approach in the sports setting and proposes a logic model to develop and evaluate HPSC in practice. The logic model was established through qualitative, iterative methods in the form of six meetings with eight experts in the field. Qualitative thematic coding was conducted on notes taken and contributions during and between meetings. The results describe a best-practice logic model of HPSC, including inputs, activities, outcomes and impacts at each HPSC level, while case studies illustrate the interactions between levels. Results indicate that a HPSC can have an impact at each level, from individual health to social and community capital. For a sports club, the logic model helps to define how the club's board or management committee can set the conditions for club managers and coaches to support members' health. External stakeholders to clubs are also recognized for their key responsibility in providing different types of resources to support sports clubs to be health promoting. Future research should focus on monitoring and evaluating at each level, including empirical testing system interactions as a whole and interactions across levels.

This article describes a logic model for health promoting sports clubs (HPSC), informed by a settings-based approach. It demonstrates how each of the seven levels of the HPSC model can request resources, implement activities to generate outcomes and impact at their level, as well as how these levels interact. This logic model offers explicit descriptions of the resources needed by stakeholders to develop health promotion (HP) activities. It also highlights the relationships between activities and outcomes, which are often made implicitly by sports club stakeholders, supporting the understanding about how HP can enhance a sports club's core business. This logic model can be used to develop interventions, and to support monitoring and evaluation of processes, activities and results to investigate how sports clubs promote health.

Health promoting sports clubs: from theory to intervention.

INTRODUCTION: Beyond the contribution of sports clubs to physical activity, an important health determinant, sports clubs can embrace the settings-based approach to health promotion, acting as health promoting sports clubs (HPSC). Limited research links the HPSC concept with evidence-driven strategies to provide guidance to develop HPSC interventions. METHODS: An intervention building a research system of the development of an HPSC intervention will be presented, including seven different studies, from literature review to intervention co-construction and evaluation. The different steps and their results will be presented as lessons learnt for settings-based intervention development. RESULTS: First, the evidence base showed a poorly defined HPSC concept, but 14 evidence-driven strategies. Second, concept mapping identified 35 sports clubs needs in regard to HPSC. Third, the HPSC model and intervention framework were designed using a participative research approach. Fourth, a measurement tool for HPSC was validated psychometrically. Fifth, capitalization of experience from eight exemplar HPSC projects was realized to test the intervention theory. Sixth, program co-construction was realized by involving sports club actors. Seventh, intervention evaluation was built by the research team. DISCUSSION: This HPSC intervention development is an example of building a health promotion program, implicating different types of stakeholders, and provide a HPSC theoretical model, HPSC intervention strategies, a program and toolkit, for sports clubs to implement health promotion and fully endorse their role in the community.

French validation of the e-PROSCeSS questionnaire: stakeholder perceptions of the health promoting sports club.

The health promoting sports club describes the development of the settings-based approach in sports clubs. Based on this model, a questionnaire was developed to measure health promotion perceptions in sports clubs (e-PROSCeSS). The objective of this study was to assess the psychometric properties of a French version of the e-PROSCeSS measurement tool. The questionnaire includes three scales measuring stakeholder's perceptions of club (macro), managers (meso) and coaches (micro) activities toward promoting health. Five steps were undertaken to assess perceptions. First, scales were translated into French. Second, each item's content clarity was tested in three populations: managers, coaches, sports participants. Third, descriptive statistics were analyzed for each scale. Fourth, confirmatory factorial analysis was used to select items for each level. Predictive validity found positive relationships between health promotion perceptions and managing/coaching positions, and negative relationships with drop-out intentions. Positive relationships were found between sports participants' perceptions of health promotion and their self-rated performance and quality of life, while negative relationships were detected with drop-out intentions. The French e-PROSCeSS subscales showed good psychometric properties in measuring health determinants at multiple levels. However, the tool did not measure health promotion as an overarching concept that questions its applicability in the sports club setting.

Effect of Elite Sport on Physical Activity Practice in the General Population: A Systematic Review.

BACKGROUND: Our study investigated the effect of elite sport on physical activity (PA) practice in the general population. METHODS: Structured Boolean searches were conducted across 5 electronic databases (PubMed, JSTOR, Web of Science, SPORTDiscus, and PsycInfo) from January 2000 to August 2021. Peer-reviewed studies in English were included if the effects of hosting elite sport events, elite sport success, and elite sport role modeling on PA/sport practice in the general population were measured. RESULTS: We identified 12,563 articles and included 36 articles. Most studies investigated the effect of hosting elite sport events (n = 27), followed by elite sport success (n = 16) and elite sport role modeling (n = 3). Most studies did not observe a positive effect of hosting elite sport events, elite sport success, or elite sport role modeling on PA/sport practice in the general population. No evidence of a lagged effect of elite sport was observed. No evidence of elite sport effects was observed according to age range and geographical scale. CONCLUSION: There is no evidence supporting the effect of elite sport in increasing PA or sport participation in the general population. Decision makers and policymakers should be aware of this and invest in strategies such as those recommended by the World Health Organization.

Development of a health-promoting sports club's intervention in France applying participatory action research.

The recognition of sports clubs (SC) as health-promoting settings is increasing, as well as the number of health promotion (HP) interventions implemented in this setting. However, minimal understanding of their development process and the persistent gap between theoretical knowledge and real-life practice is a major limitation to their implementation. This article describes a participatory research approach, implicating 29 stakeholders in sports and HP (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations and 8 representatives from SC), leading to the co-construction of a health-promoting SC intervention. Stakeholders were mobilized through four stages: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (iv) beta-testing of a massive open online course (MOOC). A qualitative analysis was carried out on data collected through notetaking, recordings, transcripts, email exchanges and produced documents. This work led to the development of an HP intervention, including an MOOC, as well as a seven-step SC-tailored program. The convergence of theoretical knowledge and contextual real-life practice made it possible to respond to the specific needs and implementation problems encountered by SC actors and to develop acceptable strategies and tools.

Sports clubs (SC) can promote health beyond the offer of physical activity and sport by acting on health determinants (economic, social, environmental and organizational). To this end, interventions can be implemented. This study presents the way in which researchers and field actors can collaborate to develop adapted interventions. Involving 29 sport and health promotion (HP) actors (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations, and 8 representatives from SC), four stages were set up to develop a Massive Open Online Course (MOOC) and an SC-tailored program: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (4) beta-testing of the MOOC. The results of these stages were qualitatively analyzed and allowed for the development of content, tools and planning consistent with the realities faced by SC. This work presents ways in which field actors and researchers can collaborate to develop acceptable strategies and tools to promote health.

Oncology health professionals' perspectives of determinants of exercise by cancer patients: A socio-ecological approach.

PURPOSE: Scientific evidence has shown that practicing exercise reduced the risk of overall and cancer-specific mortality for cancer patients. Numerous studies have shown limited support has been provided by cancer and general health professionals. This present study identifies determinants of suggesting of exercise from the oncology health professionals' perspective by using a socio-ecological approach. METHOD: Health professionals from two oncology services in France were contacted, which resulted in 36 semi-structured interviews questioning elements of support for exercise, from individual to political determinants. RESULTS: intrapersonal-level findings revealed that exercise is considered complementary to treatment, not recommended at all times of the disease duration and not to all patients. For interpersonal determinants, health professionals discuss exercise based on their own sport practice and their exercise knowledge. Health professionals interchangeably use exercise, sport, or exercise. Examination of institutional determinants showed that the oncology services did not use tools to evaluate or follow up on exercise. Only one of the services had an exercise referral scheme. Examination of community determinants showed that health professionals identified a diversity of exercise providers, without the ability to differentiate exercise program quality. Public policy findings have shown that despite an exercise prescription law, health professionals do not prescribe exercise, do not know how to prescribe it, and consider that the exercise useless because of no refund system for patients. CONCLUSIONS: The results provide a systemic understanding of the determinants helping cancer patients and health professionals improve adherence to exercise.

Evaluation of implementation and effects of a health-promoting sports club intervention using a mixed-method design: PROSCeSS protocol.

Public authorities and academics have advocated for applying been advocating for the application of the setting-based approach to sports clubs. However, studies have shown that existing health promotion (HP) interventions in sports clubs poorly understand and apply this approach. Moreover, methods used to evaluate these interventions do not inform their implementation process, limiting the generation effectiveness' proofs. This study aims at evaluating the implementation process and effectiveness of an HP intervention in sports clubs (PROmotion de la Santé dans les ClubS de Spor; PROSCeSS), based on the health-promoting sports club (HPSC) model. A type 3 hybrid design, using a multiphase mixed-method: QUAN→QUAL→ QUAN+QUAL (qual)→QUAL (quan+qual), will be used. Phase A will be a pre-post-quantitative study with one HP officer, five managers and five coaches from 30 sports clubs exploring the effects of the PROSCeSS intervention on HP perceptions and health literacy. Phase B will be focus groups with participants from HP initiatives that the 30 sports clubs will have previously put in place to detect changes in health. Phase C will explain the results of phases A and B by choice of strategies and adherence to standardised steps, measured through semistructured interviews and implementation data collection. Phase D will cross-reference the semistructured interviews, the sports club characteristics questionnaire and the implementation data collection to study the relationships between the context and the implementation process. This protocol will identify 'what works', 'for whom', in 'what context' in terms of HPSC and clarify which intervention components are more effective at improving HP. This evaluation design will help to develop appropriate approaches to evaluate HP interventions.

Development of the health promoting sports club-national audit tool.

BACKGROUND: Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs. METHODS: A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus. RESULTS: Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders. CONCLUSION: To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Adapted Fencing for Patients With Invasive Breast Cancer: The RIPOSTE Pilot Randomized Controlled Trial.

Introduction: Even if indications for mastectomy have been progressively reduced in loco-regional breast cancer (BC) treatment, the harmful effects of surgery are still numerous and can impact physical and psychological wellbeing of women. The RIPOSTE (Reconstruction, self-Image, Posture, Oncology, "Santé"-Health, Therapy, "Escrime"-Fencing) program aimed to propose adapted fencing to patients with BC. This study aims to investigate the effect and conditions of effectiveness of the RIPOSTE program. Methods and analysis: This is a prospective randomized controlled trial including 24 patients with invasive BC who have just undergone surgery. The study will be proposed to the patient and if interested, the patient will be referred to a sports physician for a medico-sportive evaluation. At the end the evaluation, if the patient meets the inclusion criteria, she will be randomly assigned to one of the 2 groups based on a 1:1 principle: Early RIPOSTE group (receive one fencing session per week for 3 months immediately after their inclusion), Delayed RIPOSTE group (receive one fencing session per week for 3 months but within the 3 months following their inclusion). Patients will be included for 6 months with 3 follow-up times (0, 3, and 6 months) by a sport physician. The primary outcome is the evolution of quality of life score. Secondary outcomes are disability score, fatigue, anxiety-depression, cost-effectiveness and process evaluation. Ethics and dissemination: The study protocol has been approved by a French ethics committee (CPP Sud Méditerranée IV, N°ID-RCB: 2020-A01916-33). Results will be submitted for publication, at scientific conferences and through press releases. Trial Registration: NCT04627714.

PERSISTE: a mixed methods protocol to identify barriers and levers to a sustainable physical activity practice among patients with chronic disease after physical activity resumption programs.

Physical activity (PA) has evidence-based benefits for physical, social and mental health, but investigation of how PA interventions for patients with chronic disease affects their PA practice up to 1 year after programmes are rare. Moreover, few studies document how the context and intervention mechanisms of PA programmes affect sustainable PA practice and its determinants. The present protocol describes a mixed methods study comparing the effectiveness and conditions for the effectiveness of two PA resumption programmes (a hospital-led and a community-based programme). Using a comparative longitudinal study, 60 patients (3-month duration) will be followed for 1 year though four data collections: before (T0) and at the end (T1) of the intervention, 6 months (T2) and 1 year (T3) after the start of the programme. The primary outcome will be PA practice in min/week and categorised as light, moderate or vigorous (using International Physical Activity Questionnaire (IPAQ)), and secondary outcomes will include sedentary time in min/week (IPAQ), quality of life evaluated though the physical and mental composite scores ('Medical Outcome Study Short Form 12'), and enjoyment using four statements rated from 1 to 5, a high score being synonymous of enjoyment (Intrinsic Motivation Inventory). Qualitative data on further determinants of PA practice and intervention mechanisms will be collected. The expected results will offer the opportunity to understand how the intervention context contributes to a more effective, sustainable PA practice. Trial registration number: NCT04954209.

Health Promotion in Sport, through Sport, as an Outcome of Sport, or Health-Promoting Sport-What Is the Difference?

What do we currently know about the relationship between health promotion and sport in research [...].

Capitalization of Health Promotion Initiatives within French Sports Clubs.

The settings-based approach to health promotion within sports clubs is a growing field of research. Evidence of health promotion intervention effectiveness in scientific literature is scarce, and little is known about their implementation mechanisms. The present study explores how promising health promotion interventions in eight French sports clubs are developed, and how the health promoting sports club's intervention planning framework is applied. A method to collect Experiential Knowledge in health promotion was used, based on two iterative interviews to analyze intervention mechanisms and completed with document analysis. A deductive analysis using the health promoting sports club intervention planning framework was then undertaken. Among the 14 evidence-driven strategies, 13 were implemented in sports clubs (min = 9; max = 13). Policies were not targeted by any of the interventions. Key competencies of the managers of these health promotion interventions were identified: (1) having a deep understanding of the public and environment, (2) acquiring a high capacity to mobilize internal and external human resources, (3) possessing communication skills and (4) having an ability to write grant applications. By using evidence-driven strategies and intervention components, sports professionals can use this experiential knowledge to create successful and sustainable interventions.