Barriers to physical activity in prostate cancer survivors.

AIMS: Despite the benefits of regular physical activity (PA), many prostate cancer (PCa) survivors are not engaging in sufficient PA to achieve health-related gain. This qualitative study sought to gain further insight regarding barriers to PA in older-aged PCa survivors. METHODS: Sixteen participants were individually interviewed, and data were analysed using an inductive thematic approach. RESULTS: Six main themes affecting perceived barriers for PA post diagnosis were identified: the effects of the PCa and PCa treatments on PA, urinary incontinence and bowel control, pre-existing comorbid conditions, increased age, time constraints and lack of proximity to PA or exercise venues. CONCLUSIONS: Only two of the six barriers identified directly related to having had PCa. With an increase in PCa survivorship, an active focus needs to be placed on the role that PA can have in helping maintain and improve both the physical and psychological health-related outcomes of PCa survivors.

International Physical Activity and Built Environment Study of adolescents: IPEN Adolescent design, protocol and measures.

INTRODUCTION: Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese). METHODS AND ANALYSIS: The IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11-19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status. ETHICS AND DISSEMINATION: Ethical approval was received from each study site's Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

Older adults' evaluations of the standard and modified pedometer-based Green Prescription.

INTRODUCTION The Green Prescription is a primary care programme designed to increase physical activity in individuals with low activity levels. Older adults tend to engage in insufficient physical activity to obtain health-related gain. AIM To examine participants' ratings of the Healthy Steps intervention and to assess how participants rated the use of a pedometer-based Green Prescription in aiding their physical activity. METHODS In total, 330 community-dwelling older adults who have low levels of activity were randomised to receive either a standard time-based Green Prescription or a modified pedometer-based Green Prescription. Post-intervention, 259 participants completed the participant evaluation questionnaire via postal survey. Data were analysed using descriptive statistics and Chi-squared analyses. RESULTS The standard components of the Green Prescription (general practitioner consultations and telephone counselling) received similar and higher ratings across both allocation groups than the use of print materials. A pedometer-based Green Prescription was rated as being helpful in aiding physical activity. DISCUSSION This study supports the importance of general practitioners' initial role in prescribing physical activity for older adults and of ongoing telephone support for longer-term adherence. Incorporating a pedometer can be effective in helping low-active older adults initiate and maintain regular physical activity.

Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial.

BACKGROUND: Low-carbohydrate, high-fat (LCHF) diets are useful for treating a range of health conditions, but there is little research evaluating the degree of carbohydrate restriction on outcome measures. This study compares anthropometric and cardiometabolic outcomes between differing carbohydrate-restricted diets. OBJECTIVE: Our hypothesis was that moderate carbohydrate restriction is easier to maintain and more effective for improving cardiometabolic health markers than greater restriction. DESIGN: A total of 77 healthy participants were randomised to a very low-carbohydrate ketogenic diet (VLCKD), low-carbohydrate diet (LCD), or moderate-low carbohydrate diet (MCD), containing 5%, 15% and 25% total energy from carbohydrate, respectively, for 12-weeks. Anthropometric and metabolic health measures were taken at baseline and at 12 weeks. Using ANOVA, both within and between-group outcomes were analysed. RESULTS: Of 77 participants, 39 (51%) completed the study. In these completers overall, significant reductions in weight and body mass index occurred ((mean change) 3.7 kg/m2; 95% confidence limits (CL): 3.8, 1.8), along with increases in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, (0.49 mmol/L; 95% CL; 0.06, 0.92; p = 0.03), and total cholesterol concentrations (0.11 mmol/L; 95% CL; 0.00, 0.23; p = 0.05). Triglyceride (TG) levels were reduced by 0.12 mmol/L (95% CL; -0.20, 0.02; p = 0.02). No significant changes occurred between groups. The largest improvements in high density lipoprotein cholesterol (HDL-c) and TG and anthropometric changes occurred for the VLCKD group. CONCLUSIONS: Low-carbohydrate, high-fat diets have a positive effect on markers of health. Adherence to the allocation of carbohydrate was more easily achieved in MCD, and LCD groups compared to VLCKD and there were comparable improvements in weight loss and waist circumference and greater improvements in HDL-c and TG with greater carbohydrate restriction.

Effects of differing levels of carbohydrate restriction on mood achievement of nutritional ketosis, and symptoms of carbohydrate withdrawal in healthy adults: A randomized clinical trial.

OBJECTIVES: To our knowledge, minimal research exists on the effects of diets differing in carbohydrate restriction on symptoms of carbohydrate withdrawal and mood, and the achievement of nutritional ketosis (NK). The aim of this study was to compare ketonaemia, symptoms of carbohydrate withdrawal, and mood. We hypothesized that a moderate carbohydrate restriction would result in fewer symptoms and a reduced effect on mood. METHODS: Seventy-seven healthy participants (25 men and 52 women; mean age: 39 y, range: 25-49; mean body mass index 27 kg/m2, range: 20-39) were randomized to receive either a very-low-carbohydrate ketogenic diet (VLCKD), low-carbohydrate diet (LCD), or moderately low-carbohydrate diet (MCD), containing 5%, 15%, and 25% total energy (TE) from carbohydrate, respectively, for 3 wk. Fasting blood ketone measures were recorded daily upon waking along with a data from symptom questionnaire and a 5-point mood-state scale. Using analysis of variance and a 5% two-sided α level to determine statistical significance, between-group outcomes were analyzed. Additional association and analyses were conducted by multiple linear regression. RESULTS: In 75 of 77 initial participants included for analysis, mean serum levels of ß-hydroxybutyrate (ßOHB) were increased by 0.27 ± 0.32, 0.41 ± 0.38, and 0.62 ± 0.49 mmol/L for MCD, LCD, and VLCKD, respectively (P = 0.013). The achievement of NK was consistent for both VLCKD and LCD groups and sporadic for the MCD group. Only the VLCKD group exhibited 95% confidence interval levels that were consistently ≥0.5 mmol/L. The overall mean change in sum of symptoms scores (SOSS) from baseline was 0.81 ± 2.84 (P < 0.001). Changes in SOSS were highest in the VLCKD group (1.49 ± 2.47), followed by LCD (0.65 ± 2.70) and MCD (0.18 ± 3.3; P = 0.264). Small, statistically significant increases were seen for headache severity, constipation, diarrhea, halitosis, muscle cramps and muscle weakness, and light-headedness, whereas intestinal bloating and craving for sugar and starch improved from baseline. Only halitosis (P = 0.039) and muscle weakness (P = 0.005) differed significantly between the groups. Mood improved significantly from baseline overall, but there was no significant difference between groups (P = 0.181) CONCLUSIONS: Diets containing 5% TE from carbohydrates are ketogenic, but diets containing between 15% and 25% TE from carbohydrates can also result in mean ßOHB ≥0.5 mmol/L. There was no meaningful difference in symptoms of carbohydrate withdrawal between diets that contain 5% to 25% TE from carbohydrate, and mood was improved overall, with no significant difference between interventions. Our conclusion, therefore, is that reduced carbohydrate diets should be prescribed by need rather than the desire to mitigate symptoms of carbohydrate withdrawal.

The Effect of Medium Chain Triglycerides on Time to Nutritional Ketosis and Symptoms of Keto-Induction in Healthy Adults: A Randomised Controlled Clinical Trial.

Medium chain triglycerides (MCTs) are ketogenic and might reduce adverse effects of keto-induction and improve time to ketosis and the tolerability of very low carbohydrate diets. This study investigates whether MCT supplementation improves time to nutritional ketosis (NK), mood, and symptoms of keto-induction. We compared changes in beta-hydroxybutyrate (BOHB), blood glucose, symptoms of keto-induction, and mood disturbance, in 28 healthy adults prescribed a ketogenic diet, randomised to receive either 30 ml of MCT, or sunflower oil as a control, three times per day, for 20 days. The primary outcome measured was the achievement of NK (≥0.5 mmol·L-1 BOHB). Participants also completed a daily Profile of Mood States and keto-induction symptom questionnaire. MCT resulted in higher BOHB at all time points and faster time to NK, a result that failed to reach significance. Symptoms of keto-induction resulted from both diets, with a greater magnitude in the control group, except for abdominal pain, which occurred with greater frequency and severity in the MCT-supplemented diet. There was a possibly beneficial effect on symptoms by MCT, but the effect on mood was unclear. Based on these results, MCTs increase BOHB compared with LCT and reduce symptoms of keto-induction. It is unclear whether MCTs significantly improve mood or time to NK. The trial was registered by the Australia New Zealand Clinical Trial Registry ACTRN12616001099415.

The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review.

BACKGROUND: Adaptation to a ketogenic diet (keto-induction) can cause unpleasant symptoms, and this can reduce tolerability of the diet. Several methods have been suggested as useful for encouraging entry into nutritional ketosis (NK) and reducing symptoms of keto-induction. This paper reviews the scientific literature on the effects of these methods on time-to-NK and on symptoms during the keto-induction phase. METHODS: PubMed, Science Direct, CINAHL, MEDLINE, Alt Health Watch, Food Science Source and EBSCO Psychology and Behavioural Sciences Collection electronic databases were searched online. Various purported ketogenic supplements were searched along with the terms "ketogenic diet", "ketogenic", "ketosis" and ketonaemia (/ ketonemia). Additionally, author names and reference lists were used for further search of the selected papers for related references. RESULTS: Evidence, from one mouse study, suggests that leucine doesn't significantly increase beta-hydroxybutyrate (BOHB) but the addition of leucine to a ketogenic diet in humans, while increasing the protein-to-fat ratio of the diet, doesn't reduce ketosis. Animal studies indicate that the short chain fatty acids acetic acid and butyric acid, increase ketone body concentrations. However, only one study has been performed in humans. This demonstrated that butyric acid is more ketogenic than either leucine or an 8-chain monoglyceride. Medium-chain triglycerides (MCTs) increase BOHB in a linear, dose-dependent manner, and promote both ketonaemia and ketogenesis. Exogenous ketones promote ketonaemia but may inhibit ketogenesis. CONCLUSIONS: There is a clear ketogenic effect of supplemental MCTs; however, it is unclear whether they independently improve time to NK and reduce symptoms of keto-induction. There is limited research on the potential for other supplements to improve time to NK and reduce symptoms of keto-induction. Few studies have specifically evaluated symptoms and adverse effects of a ketogenic diet during the induction phase. Those that have typically were not designed to evaluate these variables as primary outcomes, and thus, more research is required to elucidate the role that supplementation might play in encouraging ketogenesis, improve time to NK, and reduce symptoms associated with keto-induction.

The Clustering of Lifestyle Behaviours in New Zealand and their Relationship with Optimal Wellbeing.

PURPOSE: The purpose of this research was to determine (1) associations between multiple lifestyle behaviours and optimal wellbeing and (2) the extent to which five lifestyle behaviours-sleep, physical activity, sedentary behaviour, sugary drink consumption, and fruit and vegetable intake-cluster in a national sample. METHOD: A national sample of New Zealand adults participated in a web-based wellbeing survey. Five lifestyle behaviours-sleep, physical activity, sedentary behaviour, sugary drink consumption, and fruit and vegetable intake-were dichotomised into healthy (meets recommendations) and unhealthy (does not meet recommendations) categories. Optimal wellbeing was calculated using a multi-dimensional flourishing scale, and binary logistic regression analysis was used to calculate the relationship between multiple healthy behaviours and optimal wellbeing. Clustering was examined by comparing the observed and expected prevalence rates (O/E) of healthy and unhealthy two-, three-, four-, and five-behaviour combinations. RESULTS: Data from 9425 participants show those engaging in four to five healthy behaviours (23 %) were 4.7 (95 % confidence interval (CI) 3.8-5.7) times more likely to achieve optimal wellbeing compared to those engaging in zero to one healthy behaviour (21 %). Clustering was observed for healthy (5 %, O/E 2.0, 95 % CI 1.8-2.2) and unhealthy (5 %, O/E 2.1, 95 % CI 1.9-2.3) five-behaviour combinations and for four- and three-behaviour combinations. At the two-behaviour level, healthy fruit and vegetable intake clustered with all behaviours, except sleep which did not cluster with any behaviour. CONCLUSION: Multiple lifestyle behaviours were positively associated with optimal wellbeing. The results show lifestyle behaviours cluster, providing support for multiple behaviour lifestyle-based interventions for optimising wellbeing.

Associations between lifestyle behaviours and optimal wellbeing in a diverse sample of New Zealand adults.

BACKGROUND: In positive psychology optimal wellbeing is considered a broad, multi-dimensional construct encompassing both feelings and functioning. Yet, this notion of wellbeing has not been translated into public health. The purpose of this study is to integrate public health and positive psychology to determine associations between lifestyle behaviours and optimal wellbeing in a diverse sample of New Zealand adults. METHODS: A web-based survey design was employed to collect data. Participants reported on their wellbeing and lifestyle behaviours including nutrition, exercise, sedentary behaviour, and sleep. Optimal wellbeing was calculated using a multi-dimensional scale designed to mirror the internationally recognised diagnostic criteria for mental disorders. Binary logistic regression was used to calculate associations between 10 lifestyle behaviours and optimal wellbeing. RESULTS: Of the total sample (n = 9514), 24 % met the criteria for optimal wellbeing. Compared to reference groups, the association with optimal wellbeing was greater for those who reported exercising ≥ 7 times/week (odds ratio: 1.61, 95 % confidence interval: 1.22-2.13, p < 0.01) and sitting "almost none of the time" (1.87, 1.01-3.29, p < 0.01). Optimal wellbeing was lower for those reporting restless sleep "almost all of the time" (0.24, 95 % CI: 0.17-0.32 p < 0.01) and consuming sugary drinks 5-6 times/week (0.73, 95 % CI: 0.53-0.95, p < 0.05). CONCLUSIONS: Public health and positive psychology were integrated to provide support for a relationship between lifestyle behaviours and a multi-dimensional measure of optimal wellbeing. It is likely this relationship between lifestyle behaviours and optimal wellbeing is bidirectional giving rise to the debate that holistic approaches are needed to promote positive health.

Flourishing in New Zealand Workers: Associations With Lifestyle Behaviors, Physical Health, Psychosocial, and Work-Related Indicators.

OBJECTIVE: To investigate the prevalence and associations of flourishing among a large sample of New Zealand workers. METHODS: A categorical diagnosis of flourishing was applied to data from the Sovereign Wellbeing Index, a nationally representative sample of adults in paid employment (n = 5549) containing various lifestyle, physical, psychosocial, and work-related indicators. RESULTS: One in four New Zealand workers were categorized as flourishing. Being older and married, reporting greater income, financial security, physical health, autonomy, strengths awareness and use, work-life balance, job satisfaction, participation in the Five Ways to Well-being, volunteering, and feeling appreciated by others were all positively associated with worker flourishing independent of sociodemographics. CONCLUSIONS: Flourishing is a useful additional indicator for evaluating the prevalence, and identifying the drivers, of employee well-being. Employers may benefit from promoting these indicators among staff.

General practitioners' views on the role of pedometers in health promotion.

INTRODUCTION: Regular pedometer use can help initiate and maintain regular walking activity that can lead to a number of health-related benefits. The primary health care setting has been found to be an ideal venue in which to counsel low-active individuals for physical activity. AIM: To examine general practitioners' (GPs) views on the role of pedometers in health promotion. METHODS: Fifteen GPs working in urban, primary care practices in Auckland, New Zealand were individually interviewed. The interview schedule focused on physical activity counselling and the Green Prescription programme. For this sub-study, the focus was on questions relating to pedometer use. An inductive thematic approach was used to analyse the data. FINDINGS: Four main themes were identified. Pedometers were viewed as motivational devices that could be used to encourage low-active patients to become more active, as they provided feedback on step counts. A pedometer was also viewed as a self-management tool, whereby the individual could set daily step count goals, which in turn could help increase their physical activity engagement. GPs who currently wore a pedometer discussed the practicalities of being able to show a patient how to use a pedometer. Also discussed was how cost could restrict pedometer access for some patients. CONCLUSIONS: Pedometers were viewed by GPs as being helpful devices that could help motivate and support low-active patients in becoming more active. Information regarding step counts was seen as important because it could make people aware how little physical activity they were engaging in.

The long-term effects of a primary care physical activity intervention on mental health in low-active, community-dwelling older adults.

OBJECTIVES: To examine the effect that physical activity delivered via two different versions of the Green Prescription (a primary care physical activity scripting program) had on depressive symptomatology and general mental health functioning over a 12-month period in non-depressed, low-active, community-dwelling older adults. METHOD: Two hundred and twenty-five participants from the Healthy Steps study took part in the present study. Healthy Steps participants were randomized to receive either the standard time-based or a modified pedometer-based Green Prescription. Depression, mental health functioning and physical activity were measured at baseline, post-intervention (3 months post-baseline) and at the 9-month follow-up period. RESULTS: At post-intervention, a positive association was found between increases in leisure-time physical activity and total walking physical activity and a decrease in depressive symptomatology (within the non-depressed range of the GDS-15) and an increase in perceived mental health functioning, regardless of intervention allocation. These improvements were also evident at the follow-up period for participants in both intervention allocation groups. CONCLUSION: Our findings suggest that the standard time-based Green Prescription and a modified pedometer-based Green Prescription are both effective in maintaining and improving mental health in non-depressed, previously low-active older adults.

Perceived barriers, benefits, and motives for physical activity: two primary-care physical activity prescription programs.

This study examined whether perceived barriers, benefits, and motives for physical activity differed based on allocation to 2 different types of primary-care activity-prescription programs (pedometer-based vs. time-based Green Prescription). Eighty participants from the Healthy Steps study completed a questionnaire that assessed their perceived barriers, benefits, and motives for physical activity. Factor analysis was carried out to identify common themes of barriers, benefits, and motives for physical activity. Factor scores were then used to explore between-groups differences for perceived barriers, benefits, and motives based on group allocation and demographic variables. No significant differences were found in factor scores based on allocation. Demographic variables relating to the existence of chronic health conditions, weight status, and older age were found to significantly influence perceived barriers, benefits, and motives for physical activity. Findings suggest that the addition of a pedometer to the standard Green Prescription does not appear to increase perceived motives or benefits or decrease perceived barriers for physical activity in low-active older adults.

Cost-effectiveness of pedometer-based versus time-based Green Prescriptions: the Healthy Steps Study.

This paper reports on the cost-effectiveness of pedometer-based versus time-based Green Prescriptions in improving physical activity and health-related quality of life (EQ-5D) in a randomised controlled trial of 330 low-active, community-based adults aged 65 years and over. Costs, measured in $NZ (NZ$1=A$0.83, December 2008), comprised public and private health care costs plus exercise-related personal expenditure. Based on intention-to-treat data at 12-month follow up, the pedometer group showed a greater increase in weekly leisure walking (50.6 versus 28.1min for the time-based group, adjusted means, P=0.03). There were no significant between-group differences in costs. The incremental cost-effectiveness ratios, for the pedometer-based versus time-based Green Prescription, per 30min of weekly leisure walking and per quality-adjusted life year were, (i) when including only community care costs, $115 and $3105, (ii) when including only exercise and community care costs, $130 and $3500, and (iii) for all costs, -$185 and -$4999, respectively. The cost-effectiveness acceptability curves showed that the pedometer-based compared with the time-based Green Prescription was statistically cost-effective, for the above cost categories, at the following quality-adjusted life year thresholds: (i) $30000; (ii) $30500; and (iii) $16500. The additional program cost of converting one sedentary adult to an active state over a 12-month period was $667. The outcomes suggest the pedometer-based Green Prescription may be cost-effective in increasing physical activity and health-related quality of life over 12 months in previously low-active older adults.

Efficacy of a "small-changes" workplace weight loss initiative on weight and productivity outcomes.

OBJECTIVE: The effect of weight reduction on workplace productivity is unknown. We have investigated a "small-changes" workplace weight loss intervention on weight and productivity outcomes. METHODS: Overweight/obese employees at two New Zealand worksites (n = 102) received the 12-week intervention. One site received an extra 9-month weight-maintenance component. Magnitudes of effects on weight and productivity were assessed via standardization. RESULTS: Both groups reduced weight at 12 weeks and maintained lost weight at 12 months. There were small possible improvements in productivity at one worksite and trivial reductions at the other by 12 weeks, with little subsequent change during maintenance in either group. At an individual level, weight change was associated with at most only small improvements or small reductions in productivity. CONCLUSION: Workplace weight loss initiatives may need to be more intensive or multidimensional to enhance productivity.

A "small-changes" workplace weight loss and maintenance program: examination of weight and health outcomes.

OBJECTIVE: To compare the effect of "small-changes" and "usual care" workplace interventions on weight loss and to investigate the effect of small changes with or without maintenance on weight and health outcomes. METHODS: Overweight/obese employees at two New Zealand worksites received a 12-month usual-care intervention (n = 53), followed by a 12-month small-changes intervention (n = 102). Small changes comprised a 12-week component, followed by 9 months of maintenance, implemented at only one worksite. Magnitudes of effects were assessed via a threshold of -5% (weight loss) and standardization (health outcomes). RESULTS: Small changes showed beneficial weight loss relative to usual care in both worksites. For small-changes interventions, worksites reduced weight (12 weeks) and maintained lost weight (12 months). One in every three participants lost 5% or more weight. Some improvements in health outcomes were shown. CONCLUSION: Regardless of maintenance, the small-changes intervention was successful in sustaining weight loss.

Healthy Steps trial: pedometer-based advice and physical activity for low-active older adults.

PURPOSE: We compared the effectiveness of 2 physical activity prescriptions delivered in primary care--the standard time-based Green Prescription and a pedometer step-based Green Prescription--on physical activity, body mass index (BMI), blood pressure, and quality of life in low-active older adults. METHODS: We undertook a randomized controlled trial involving 330 low-active older adults (aged =65 years) recruited through their primary care physicians' patient databases. Participants were randomized to either the pedometer step-based Green Prescription group (n = 165) or the standard Green Prescription group (n = 165). Both groups had a visit with the primary care practitioner and 3 telephone counseling sessions over 12 weeks aimed at increasing physical activity. Outcomes were the changes in physical activity (assessed with the Auckland Heart Study Physical Activity Questionnaire), blood pressure, BMI, quality of life (assessed with the 36-Item Short Form Health Survey), physical function status (assessed with the Short Physical Performance Battery), and falls over a 12-month period. RESULTS: Of the patients invited to participate, 57% responded. At 12 months, leisure walking increased by 49.6 min/wk for the pedometer Green Prescription compared with 28.1 min/wk for the standard Green Prescription (P=.03). For both groups, there were significant increases across all physical activity domains at 3 months (end of intervention) that were largely maintained after 12 months of follow-up. BMI did not change in either group. Significant improvements in blood pressure were observed for both groups without any differences between them. CONCLUSIONS: Pedometer use resulted in a greater increase in leisure walking without any impact on overall activity level. All participants increased physical activity, and on average, their blood pressure decreased over 12 months, although the clinical relevance is unknown.

General practitioners' views and experiences of counselling for physical activity through the New Zealand Green Prescription program.

BACKGROUND: Regular physical activity is beneficial in both the prevention and management of chronic health conditions. A large proportion of adult New Zealanders, however, are insufficiently active. To help increase population levels of physical activity in New Zealand the Green Prescription, a primary care physical activity scripting program, was developed. The primary aim of this study was to identify why general practitioners (GPs) counsel for physical activity and administer Green Prescriptions. A secondary aim was to examine GPs' views and experiences of Green Prescription counselling for the management of depression. METHODS: Individual face-to-face interviews were conducted with 15 GPs. All interviews were audio-taped and transcribed. Data were analysed using an inductive thematic approach. RESULTS: Several themes and sub-themes emerged from the data. Notably, GPs counselled for physical activity and prescribed Green Prescriptions for both primary preventive (e.g., weight control) and secondary management (e.g., diabetes management) purposes. GPs reported the benefits of the Green Prescription centred around two main themes: (i) a non-medication approach to a healthier lifestyle and (ii) the support benefits of physical activity. Time constraints within the consultation was the only main theme that emerged regarding the barriers GPs perceived to Green Prescription use. Physical activity in general, and physical activity prescribed through the Green Prescription, were also viewed by GPs as beneficial for the management of depression. CONCLUSIONS: The results of this study suggest that New Zealand GPs view the Green Prescription program as beneficial for their patients with pre-existing conditions and/or weight problems. While this is encouraging, the Green Prescription may also be used to promote physical activity in currently healthy but low-active and sedentary individuals. Such individuals are currently disease free, but are at risk for future health-related problems because of their inactive lifestyle. It is recommended that time constraints of the consultation in regard to administering Green Prescriptions could be dealt with by delegating the more time consuming tasks to the patient support counsellors that support the Green Prescription program, and having practice nurses assist in the administration of Green Prescriptions. Green Prescription counselling in conjunction with antidepressant medication may be beneficial for the management of depression and warrants further research.

How many steps/day are enough? For adults.

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day.

Physical activity, sedentariness, and body fatness in a sample of 6-year-old Pacific children.

OBJECTIVE: Pacific children living in New Zealand exhibit considerably higher rates of overweight and obesity than their non-Pacific peers. The study aim was to identify physical activity and sedentary behaviors related to increased body size in Pacific children, to inform future intervention development for improved activity profiles and body size outcomes in this population. METHODS: Three hundred and ninety-three 6-year-old Pacific children and their mothers living in Auckland, New Zealand were invited to participate. Activity was assessed over 8 days using accelerometry and mothers reported on their child's sedentary behaviours. Children's height, weight, and body fatness was assessed and body mass index (BMI) and body fat z-scores calculated. Maternal height, weight, and waist circumference were assessed and BMI calculated. Associations between children's body fat z-scores and potential related factors were determined using regression analyses. RESULTS: Of the 254 children who registered, 102 (27% overweight, 32% obese) were included in analyses. Almost all mothers were overweight or obese. On average, children's body fat z-scores were 1.75 standard deviations above the reference group (range -0.6, 3.14). After accounting for all other factors, watching television every day and having a mother with a high waist circumference were associated with increased body fat z-scores. CONCLUSIONS: Strategies for obesity reduction in Pacific children and their mothers living in New Zealand are urgently required. Multifaceted, family based interventions that include the promotion of healthy nutritional practices and television free days may be efficacious in improving activity profiles and body size outcomes for Pacific children.