RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review.

BACKGROUND: Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. OBJECTIVE: The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. METHODS: A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. RESULTS: The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. CONCLUSIONS: Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. TRIAL REGISTRATION: PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635.

Artificial Intelligence (AI) in pediatric endocrinology.

Artificial Intelligence (AI) is integrating itself throughout the medical community. AI's ability to analyze complex patterns and interpret large amounts of data will have considerable impact on all areas of medicine, including pediatric endocrinology. In this paper, we review and update the current studies of AI in pediatric endocrinology. Specific topics that are addressed include: diabetes management, bone growth, metabolism, obesity, and puberty. Becoming knowledgeable and comfortable with AI will assist pediatric endocrinologists, the goal of the paper.

A Comparison of Objectively Measured Free-Living Physical Behaviour in Adults with and without Lower Limb Amputation.

Objectively monitored free-living physical behaviours of adults with and without lower limb amputation (LLA) were compared. METHODS: 57 adults with LLA wore an activPAL3™ for 8 days. A comparison data set (n = 57) matched on gender, age and employment status was used. Variables included: time sitting; standing; stepping; sit-to-stand transitions; step count and cadence. Comparisons were made between adults with and without LLA and between gender, level and cause of amputation. RESULTS: Participants with LLA due to trauma versus circulatory causes were less sedentary and more active; however, no difference in physical behaviour was recorded across gender or level of amputation. Participants with LLA spent more time sitting (p < 0.001), less time standing and stepping (p < 0.001) and had a lower step count (p < 0.001). Participants with LLA took more steps in cadence bands less than 100 steps·min-1 and fewer steps in cadence bands greater than 100 steps·min-1 compared to participants without LLA. CONCLUSIONS: People with LLA were less active and more sedentary than people without LLA and participated in less activity at a moderate or higher intensity when matched on age, gender and employment. Interventions are needed to promote active lifestyles in this population.

24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies.

Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I2 = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I2 = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I2 = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.

Supporting Physical Activity for Informal Caregivers during and beyond COVID-19: Exploring the Feasibility, Usability and Acceptability of a Digital Health Smartphone Application, 'CareFit'.

The COVID-19 pandemic has exposed how our global societies rely upon the care and support of informal (unpaid) caregivers: in the UK alone, there are an estimated 6.5 million informal carers. The caring role is not just precarious, it is often associated with high levels of stress, poor/deteriorating health and crisis points (hospitalisations, worsening of health). Fittingly, there has been much research in recent years focusing on mental health supports. A lesser explored area is physical health and physical activity. To address this, we conducted a real-world feasibility, usability and acceptability study of a novel codesigned digital health app for caregivers to improve levels of physical activity. Our study was designed to test the prototype app use for three weeks, following participants across questionnaires/in app data/qualitative data. Our findings (from 27 caregivers) highlights key knowledge gaps around physical activity-national guidelines were not reaching populations studies and behavioural change techniques hold promise to help support caregivers in the longer term. Our collective results support the acceptability, usability and feasibility of the Carefit app and warrant further investigation.

Letting the World See through Your Eyes: Using Photovoice to Explore the Role of Technology in Physical Activity for Adolescents Living with Type 1 Diabetes.

This paper qualitatively explores how technologies and physical activity are experienced by adolescents with type 1 diabetes. Type 1 diabetes is a life-threatening autoimmune condition, which is highly prevalent in young children. Physical activity is underutilised as part of treatment goals due to multifactorial challenges and lack of education in both the family setting and across society as a whole. Using photovoice methodology, 29 participants (parents and adolescents), individually or as dyads, shared and described in reflective journal format examples of technology and physical activity in their lives. In total, 120 personal photographs with accompanying narratives were provided. The data were thematically coded by the researcher and then collaboratively with participants. Four key themes (and 12 subthemes) were generated including: (i) benefits of technology; (ii) complexity and difficulty; (iii) emotional impact; (iv) reliance and risk. Findings demonstrate that current technology does not address the complex needs of adolescents with type 1 diabetes to enable participation in physical activity without life risk. We conclude from our findings that future technologies for supporting engagement in physical activity as part of diabetes management need to be: more interoperable, personalised and integrated better with ongoing education and support.

Sharing positive behavior change made during COVID-19 lockdown: A mixed-methods coproduction study.

OBJECTIVE: The negative consequences of coronavirus disease 2019 (COVID-19) national lockdowns have been well documented, including the worsening of mental health for many and the amplification of preexisting inequalities. As a counterpoint, the current study uses a mixed-methods coproduction approach to share psychosocial insights into the adoption of positive changes made during national lockdown in Scotland. This study examines the psychosocial patterning of positive behavior changes and the psychosocial processes by which positive change was realized and shared these insights with partner organizations. METHOD: A sequential mixed-methods design included an online survey (N = 2,445) assessing positive changes in sleep and physical activity patterns and the role of sociodemographics, mood, social support, coping, and resilience using multivariate logistic regression analysis. Interviews were performed with a purposive diverse subsample of people self-reporting high levels of positive change (n = 48) and used thematic analysis. RESULTS: The survey identified that positive behavior change was significantly patterned by age, gender, and vulnerability to COVID-19. Higher levels of positive reframing and active coping in relation to stress were associated with higher levels of positive behavior change. Higher symptoms of depression, planning, and self-distraction were associated with less positive behavior change. Thematic analysis showed the centrality of perceptions of time, opportunities to self-reflect and engage with the natural world, access support in diverse ways, actively build routine, and purposefully build self-efficacy and a sense of control were key to initiating positive change. CONCLUSIONS: The current study yields insights into achieving positive behavior change at a time of international crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exploring the Use of Fitbit Consumer Activity Trackers to Support Active Lifestyles in Adults with Type 2 Diabetes: A Mixed-Methods Study.

BACKGROUND: People with type 2 diabetes are less active than those without the condition. Physical activity promotion within diabetes health care is limited. This project explored the use of Fitbit activity trackers (Fitbit, San Francisco, CA, USA) to support active lifestyles in adults with type 2 diabetes through a mixed-methods study. METHODS: Two stages were conducted. In stage 1, adults with type 2 diabetes used a Fitbit Charge 4 (Fitbit, San Francisco, CA, USA) for 4 weeks. Fitbit and self-reported physical activity data was examined through quantitative analysis. Qualitative analysis was conducted to explore the experiences of participants. In stage 2, health professionals were interviewed to examine their views on using Fitbit activity trackers within type 2 diabetes care. RESULTS: Adults with type 2 diabetes were recruited for stage 1 and adult health care and fitness professionals were recruited for stage 2. Stage 1 participants' self-reported increases in physical activity (mean weekly minutes of walking increased from 358.75 to 507.50 min, p = 0.046) and a decrease in sedentary behaviour (mean daily hours of sedentary behaviour decreased from 10.65 to 10.05 h, p = 0.575). Fitbit activity data ranges identified individuals who led inactive and sedentary lifestyles below levels recommended and in need of physical activity support to reduce the risk to their health. During interviews, participants stated that the Fitbit activity tracker motivated them to be more active. Stage 2 participants intimated that Fitbit activity trackers could improve the promotion of physical activity within type 2 diabetes care. Interventions involving the Fitbit premium service, community prescription and combined use of Fitbits with physical activity behaviour change models were recommended by stage 2 participants. CONCLUSIONS: This study found that there is future scope for using Fitbit activity trackers to support active lifestyles in adults diagnosed with type 2 diabetes.

A Novel Mobile App ("CareFit") to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study.

BACKGROUND: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. OBJECTIVE: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. METHODS: We co-designed a mobile app, "CareFit," by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. RESULTS: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. CONCLUSIONS: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings.

What have we learned about positive changes experienced during COVID-19 lockdown? Evidence of the social patterning of change.

BACKGROUND: Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. METHODS: The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. RESULTS: There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. CONCLUSION: Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.

A novel research method for workshops and co-production of interventions: using a secret Facebook group.

BACKGROUND: Co-production of interventions is reliant on good communication and consensus between participants and researchers, but attending in-person meetings and workshops is hard for time-constrained groups such as new mums, who may be geographically dispersed without reliable transport. Discussions with a lay advisory group resulted in the decision to hold a workshop over a secret Facebook group. The aim of this study was to test the feasibility of a secret Facebook group for co-production activities. In the example presented, the population was women with previous gestational diabetes, the topic was physical inactivity, and the purpose was to develop an acceptable physical activity intervention. METHODS: The researchers created a secret Facebook group with content similar to an in-person workshop that sequentially progressed to develop a programme theory for an intervention. The researcher posted 1-2 times per day for 14 days, and members of the group were invited to comment and discuss the content. Feasibility and acceptability of the group were analysed using Facebook analytics and a post-workshop survey. RESULTS: Twenty-one participants took part. In total, 521 comments were provided in response to 18 posts of varying types (average = 28.9 comments per post). The total word count of participant comments was 21,142 words. The workshop was viewed positively, with 20 of 21 participants saying they liked the workshop "somewhat" or "a great deal", and felt the group was a safe and open environment to share opinions. When asked if they would take part in something like this again, 15 of 21 said "Yes". Participants mentioned the format was convenient; it allowed them to reflect on their experiences, and they liked helping research progress. Those who say "maybe" said it was difficult finding time and depended on what else was going on. CONCLUSION: Using a secret Facebook group as a method of co-production or as a workshop in the research process is a feasible and acceptable method. Social media holds significant potential for co-production and involvement in research for populations who are geographically dispersed or time-constrained, with an uncommon condition or other circumstances where in-person meetings are either not appropriate or not possible.

Changes in Physical Activity, Sitting and Sleep across the COVID-19 National Lockdown Period in Scotland.

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.

Pilot Testing of a Nudge-Based Digital Intervention (Welbot) to Improve Sedentary Behaviour and Wellbeing in the Workplace.

Welbot is a nudge-based digital intervention that aims to reduce sedentary behaviour and improve physical and mental wellbeing at work. The purpose of this study was to pilot test the Welbot intervention. Forty-one (6M/35F) University staff (M age = 43-years) participated in this study, which was a single arm repeated measures trial conducted over three weeks of intervention. The primary outcome was sedentary behaviour (measured subjectively and objectively) and secondary outcomes included: mental wellbeing, procrastination, depression, anxiety and stress, and work engagement. A subset of participants (n = 6) wore an ActivPAL to objectively measure activity data, while another subset of participants (n = 6) completed a qualitative semi-structured interview to ascertain experiences of using Welbot. Following the intervention, a Friedman non-parametric test revealed that participants self-reported significantly less time sitting and more time standing and objectively recorded more steps at the week-1 follow-up. A series of paired t-tests exhibited that changes in all secondary outcomes were in the expected direction. However, only improvements in depression, anxiety, and stress were significant. After using Welbot, thematic analysis demonstrated that participants perceived they had a positive behaviour change, increased awareness of unhealthy behaviours at work, and provided suggestions for intervention improvement. Overall, findings provided indications of the potential positive impact Welbot may have on employees' wellbeing, however, limitations are noted. Recommendations for intervention improvement including personalisation (e.g., individual preferences for nudges and the option to sync Welbot with online calendars) and further research into how users engage with Welbot are provided.

Diurnal patterns of objectively measured sedentary time and interruptions to sedentary time are associated with glycaemic indices in type 2 diabetes.

OBJECTIVES: To investigate diurnal patterns of sedentary time and interruptions to sedentary time and their associations with achievement of pre-meal glucose, post-meal glucose, bedtime glucose and the dawn phenomenon targets and with duration of hypoglycaemia, euglycaemia, hyperglycaemia and above target range. DESIGN: Intensive longitudinal study. METHODS: In 37 adults with type 2 diabetes, the FreeStyle Libre and activPAL3 were used to monitor glucose and sedentary time and interruptions to sedentary time in the morning (07:00-12:00), afternoon (12:00-17:00) and evening (17:00-23:00) for 14 days. Diurnal patterns of sedentary behaviour and associations with glycaemic indices were assessed using repeated measures ANOVA and linear regressions. RESULTS: Sedentary time was significantly higher in the evening (43.47±7.37min/h) than the morning (33.34±8.44min/h) and afternoon (37.26±8.28min/h). Interruptions to sedentary time were significantly lower in the evening (2.64±0.74n/h) than the morning (3.69±1.08n/h) and afternoon (3.06±0.87n/h). Sedentary time in the morning and afternoon was associated with lower achievement of the dawn phenomenon target. Sedentary time in the evening was associated with lower achievement of post-lunch glucose target. Interruptions to sedentary time in the morning and afternoon were associated with higher achievement of pre-dinner glucose target. Interruptions to sedentary time in the evening showed beneficial associations with achievement of post-dinner glucose and bedtime glucose targets and euglycaemia. CONCLUSIONS: Prolonged sedentary behaviour is high in the evening. Interruptions to sedentary time, particularly in the evening, have beneficial associations with glycaemic indices. Interventions targeting interruptions to sedentary time in the evening may be more clinically relevant.

A Mixed Methods Evaluation of a Digital Intervention to Improve Sedentary Behaviour Across Multiple Workplace Settings.

BACKGROUND: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digital interventions in SB require mixed method evaluations to understand potential for impact in real-world settings. In this study, the RE-AIM QuEST evaluation framework will be used to understand the potential of a digital health promotion application which targets reducing and breaking up SB across multiple workplace settings. METHODS: Four companies and 80 employees were recruited to use a digital application. Questionnaires were used to measure SB, and additional health and work-related outcomes at baseline, one month, three month and six month follow-up. Qualitative data was collected through focus groups with employees and interviews with stakeholders. Questionnaire data was analysed using Wilcoxon Sign Rank tests and qualitative data was thematically analysed. RESULTS: The digital application significantly increased standing time at one month for the total group and transitions per hour in one of the companies. Facilitators and barriers were identified across RE-AIM. CONCLUSIONS: Addressing the barriers which have been identified, while maintaining the positive attributes will be critical to producing an effective digital application which also has the potential for impact in the real world.

Physical activity guidelines and promotion: An online survey of United Kingdom's prosthetic rehabilitation healthcare professionals.

BACKGROUND: Healthcare professionals play a key role in supporting physical activity participation for people with lower limb absence. OBJECTIVES: The objectives of this study were to survey healthcare professionals' views of people with lower limb absence in the United Kingdom, explore their awareness and knowledge of physical activity recommendations and investigate their current and desirable practice towards physical activity promotion. STUDY DESIGN: Cross-sectional study. METHODS: Potential participants were identified from open-access health-related databases, educational institution databases, and the authors' professional networks. An online 40-item questionnaire was distributed electronically and by post. Survey items were multiple choice, Likert-type scale or open-ended questions to explore the characteristics of healthcare professionals, awareness/knowledge of physical activity guidelines, current and desired practice and views on physical activity promotion. RESULTS: In total, 106 people responded. Physiotherapists had greater awareness/knowledge of physical activity guidelines compared to prosthetists/orthotists and other respondents. Awareness/knowledge of guidelines decreased as age, experience and time since qualification increased. The most common source of knowledge was self-directed learning. CONCLUSION: Continuing and improving education on the content of physical activity guidelines may be helpful for healthcare professionals in promoting physical activity to those with lower limb absence. CLINICAL RELEVANCE: This research aims to inform prosthetic rehabilitation professionals and academics about an under-researched area within physical activity for health. This knowledge could help develop interventions with the aim of improving physical activity promotion and participation, and ultimately the health and well-being of people with limb absence.

Impact of free-living pattern of sedentary behaviour on intra-day glucose regulation in type 2 diabetes.

PURPOSE: To investigate how the pattern of sedentary behaviour affects intra-day glucose regulation in type 2 diabetes. METHODS: This intensive longitudinal study was conducted in 37 participants with type 2 diabetes (age, 62.8 ± 10.5 years). Glucose and sedentary behaviour/physical activity were assessed with a continuous glucose monitoring (Abbott FreeStyle Libre) and an activity monitor (activPAL3) for 14 days. Multiple regression models with generalised estimating equations (GEEs) approach were used to assess the associations of sedentary time and breaks in sedentary time with pre-breakfast glucose, pre-lunch glucose, pre-dinner glucose, post-breakfast glucose, post-lunch glucose, post-dinner glucose, bedtime glucose, the dawn phenomenon, time in target glucose range (TIR, glucose 3.9-10 mmol/L) and time above target glucose range (TAR, glucose > 10 mmol/L). RESULTS: Sedentary time was associated with higher pre-breakfast glucose (p = 0.001), pre-dinner glucose (p < 0.001), post-lunch glucose (p = 0.005), post-dinner glucose (p = 0.013) and the dawn phenomenon (p < 0.001). Breaks in sedentary time were associated with lower pre-breakfast glucose (p = 0.023), pre-dinner glucose (p = 0.023), post-breakfast glucose (p < 0.001) and the dawn phenomenon (p = 0.004). The association between sedentary time and less TIR (p = 0.022) and the association between breaks in sedentary time and more TIR (p = 0.001) were also observed. CONCLUSIONS: Reducing sedentary time and promoting breaks in sedentary time could be clinically relevant to improve intra-day glucose regulation in type 2 diabetes.

Effect of home-based strength training program on IGF-I, IGFBP-1 and IGFBP-3 in obese Latino boys participating in a 16-week randomized controlled trial.

Introduction Growing evidence indicates that circulating concentrations of insulin-like growth factor 1 (IGF-I), along with IGF-I relative to IGF-binding proteins (IGFBP), are associated with an increased risk of cancer. In accord, regular exercise is linked with a lower risk of cancer. Purpose To assess the effects of a 16-week home-based strength training (HBST) program on serum IGF-I, IGFBP-1 and IGFBP-3. Methods A total of 32 obese Latino adolescent males (aged 14-18 years) were randomized into a twice-weekly HBST (n = 16) or a control group (C, n = 16) for 16 weeks. The following were measured at pre- and post-intervention: IGF-I, IGFBP-1 and IGFBP-3, glucose/insulin indices by oral and/or intravenous (IV) glucose tolerance tests, strength by one-repetition maximum (1RM), dietary intake by 3-d records, body composition by DEXA and physical activity using the Actigraph GT1X. The generalized linear model (GLM) was used to assess differences in changes among outcome measures between the HBST and C groups. Results Exercise adherence in the HBST group was 89%. IGF-1 showed a trend for significant within-subject improvements (p = 0.078) but no significant within-subject or between-subject differences for IGFBP-1, IGFBP-3 two-glucose, fasting glucose or 2-h glucose (p > 0.05). There was a significant decrease (p > 0.05) in fasting glucose in the C group (p = 0.02) and also in the intervention group (p = 0.03) between baseline and follow-up testing. A significant difference was also found in the C group for 2-h glucose with an increase at follow-up testing (p = 0.04). Conclusions Though not statistically significant (p < 0.05), the results indicated that a 16-week HBST program decreased IGF-I and increased IGFBP-1, along with IGFBP-3, concentrations among overweight/obese Latino boys. However, further studies should consider increasing either the dose or the duration of the intervention to elicit greater improvements in this at-risk pediatric population.

Dose-response between frequency of breaks in sedentary time and glucose control in type 2 diabetes: A proof of concept study.

OBJECTIVES: This study aimed to investigate dose-response between frequency of breaks in sedentary time and glucose control. DESIGN: Randomised three-treatment, two-period balanced incomplete block trial. METHODS: Twelve adults with type 2 diabetes (age, 60±11years; body mass index, 30.2±4.7kg/m2) participated in two of the following treatment conditions: sitting for 7h interrupted by 3min light-intensity walking breaks every (1) 60min (Condition 1), (2) 30min (Condition 2), and (3) 15min (Condition 3). Postprandial glucose incremental area under the curves (iAUCs) and 21-h glucose total area under the curve (AUC) were measured using continuous glucose monitoring. Standardised meals were provided. RESULTS: Compared with Condition 1 (6.7±0.8mmolL-1×3.5h-1), post-breakfast glucose iAUC was reduced for Condition 3 (3.5±0.9 mmolL-1×3.5h-1, p˂0.04). Post-lunch glucose iAUC was lower in Condition 3 (1.3±0.9mmolL-1×3.5h-1, p˂0.03) and Condition 2 (2.1±0.7mmolL-1×3.5h-1, p˂0.05) relative to Condition 1 (4.6±0.8mmolL-1×3.5h-1). Condition 3 (1.0±0.7mmolL-1×3.5h-1, p=0.02) and Condition 2 (1.6±0.6mmolL-1×3.5h-1, p˂0.04) attenuated post-dinner glucose iAUC compared with Condition 1 (4.0±0.7mmolL-1×3.5h-1). Cumulative 10.5-h postprandial glucose iAUC was lower in Condition 3 than Condition 1 (p=0.02). Condition 3 reduced 21-h glucose AUC compared with Condition 1 (p<0.001) and Condition 2 (p=0.002). However, post-breakfast glucose iAUC, cumulative 10.5-h postprandial glucose iAUC and 21-h glucose AUC were not different between Condition 2 and Condition 1 (p˃0.05). CONCLUSIONS: There could be dose-response between frequency of breaks in sedentary time and glucose. Interrupting sedentary time every 15min could produce better glucose control.

Should We Scale-Up? A Mixed Methods Process Evaluation of an Intervention Targeting Sedentary Office Workers Using the RE-AIM QuEST Framework.

Background: Interventions targeting a reduction in sedentary behaviour in office workers need to be scaled-up to have impact. In this study, the RE-AIM QuEST framework was used to evaluate the potential for further implementation and scale-up of a consultation based workplace intervention which targeted both the reduction, and breaking up of sitting time. Methods: To evaluate the Springfield College sedentary behaviour intervention across multiple RE-AIM QuEST indicators; intervention participant, non-participant (employees who did not participate) and key informant (consultation delivery team; members of the research team and stakeholders in workplace health promotion) data were collected using interviews, focus groups and questionnaires. Questionnaires were summarized using descriptive statistics and interviews and focus groups were transcribed verbatim, and thematically analysed. Results: Barriers to scale-up were: participant burden of activity monitoring; lack of management support; influence of policy; flexibility (scheduling/locations); time and cost. Facilitators to scale up were: visible leadership; social and cultural changes in the workplace; high acceptability; existing health and wellbeing programmes; culture and philosophy of the participating college. Conclusions: There is potential for scale-up, however adaptations will need to be made to address the barriers to scale-up. Future interventions in office workers should evaluate for scalability during the pilot phases of research.