Benefits, risks, barriers, and facilitators to cycling: a narrative review.

There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.

Development and optimisation of a multi-component workplace intervention to increase cycling for the Cycle Nation Project.

The Cycle Nation Project (CNP) aimed to develop, test the feasibility of and optimize a multi-component individual-/social-level workplace-based intervention to increase cycling among office staff at a multinational bank (HSBC UK). To do this, we first explored barriers to cycling in a nationally-representative survey of UK adults, then undertook focus groups with bank employees to understand any context-specific barriers and ways in which these might be overcome. These activities led to identification of 10 individual-level, two social-level, and five organizational-level modifiable factors, which were mapped to candidate intervention components previously identified in a scoping review of cycling initiatives. Interviews with HSBC UK managers then explored the practicality of implementing the candidate intervention components in bank offices. The resultant pilot CNP intervention included 32 core components across six intervention functions (education, persuasion, incentivisation, training, environmental restructuring, enablement). Participants received a loan bike for 12-weeks (or their own bike serviced), and a 9-week cycle training course (condensed to 6 weeks for those already confident in basic cycling skills), including interactive information sharing activities, behavior change techniques (e.g., weekly goal setting), bike maintenance training, practical off-road cycling skill games and on-road group rides. Sessions were delivered by trained bank staff members who were experienced cyclists. The CNP pilot intervention was delivered across three sites with 68 participants. It was completed in two sites (the third site was stopped due to COVID-19) and was feasible and acceptable to both women and men and across different ethnicities. In addition, the CNP intervention was successful (at least in the short term) in increasing cycling by 3 rides/week on average, and improving perceptions of safety, vitality, confidence, and motivation to cycle. Following minor modifications, the long-term effectiveness and cost-effectiveness of the CNP intervention should be tested in a full-scale randomized controlled trial.

Beyond cycle lanes and large-scale infrastructure: a scoping review of initiatives that groups and organisations can implement to promote cycling for the Cycle Nation Project.

BACKGROUND/OBJECTIVES: Cycling has well-established positive relationships with health. Evidence suggests that large-scale infrastructure and built-environment initiatives to promote cycling are likely to be necessary but not sufficient to maximise cycling participation. Smaller-scale initiatives that can be implemented by organisations (eg, employers) and groups (eg, community groups) are therefore also important, but the full range of feasible activities to promote cycling is not known. We aimed to scope the literature and map organisational, social and individual level activities to increase cycling. METHODS: Design: Scoping review following an established five-stage process.Eligibility criteria: Studies or publicly available reports describing cycling promotion initiatives deemed feasible for organisations or groups to implement.Sources of evidence and selection: (i) online databases (Ovid (Medline), Ovid (Embase), SportDISCUS (Ebscohost), ProQuest, Web of Science), (ii) existing systematic reviews, (iii) expert stakeholder consultation. RESULTS: We extracted data from 129 studies and reports, from 20 different countries, identifying 145 cycling promotion initiatives. From these initiatives we identified 484 actions within 93 action types within 33 action categories under the nine intervention functions described by Michie et al. Environmental restructuring (micro-level), enablement, education and persuasion were the functions with the most action types, while coercion, modelling and restriction had the fewest action types. CONCLUSION: This is the first comprehensive map to summarise the broad range of action types feasible for implementation within organisation/group-based cycling promotion initiatives. The map will be a critical tool for communities, employers, practitioners and researchers in designing interventions to increase cycling.

Views of prison staff in Scotland on the potential benefits and risks of e-cigarettes in smoke-free prisons: a qualitative focus group study.

OBJECTIVE: Electronic cigarettes (e-cigarettes) were introduced into all Scottish prisons in February 2018, some months after prisons began preparing in 2017 for a smoking ban implemented in November 2018. In 2016/2017, prison staff views on the potential benefits and risks of e-cigarettes were explored in advance of the introduction of: (1) a smoking ban and (2) e-cigarettes. SETTING: Fourteen prisons in Scotland. PARTICIPANTS: Seventeen focus groups and two paired interviews were conducted with 132 staff in 14 Scottish prisons 4-9 months before plans for a smoking ban were announced in July 2017. Both smoking and non-smoking staff were invited to participate. RESULTS: Prison staff highlighted three potential risks of e-cigarettes in smoke-free prisons: staff health risks from e-cigarette vapour; prisoner health risks from vaping; and risks to both groups from e-cigarette misuse, defects or accidents. Conversely, potential benefits of e-cigarettes in smoke-free prisons centred on: reducing smoking-related health harms to staff and prisoners; helping prisoners to manage without tobacco; and supporting staff to maintain safety and discipline in prison. Staff who participated in focus groups had limited experience of vaping and expressed some uncertainty and misunderstandings about e-cigarettes. CONCLUSION: Our findings highlight that scientific uncertainty, misunderstanding about vaping, the complexity of prisons as workplaces and prison tobacco control policy all have implications for staff perceptions of the potential place of e-cigarettes in smoke-free prisons. To alleviate staff concerns, there is a need for reliable information on e-cigarettes. Staff may also require reassurances on whether products are 'tamper proof', and rules about vaping indoors.

Prison Staff and Prisoner Views on a Prison Smoking Ban: Evidence From the Tobacco in Prisons Study.

INTRODUCTION: In jurisdictions permitting prisoner smoking, rates are high (c75%), with smoking embedded in prison culture, leading to secondhand smoke exposures among staff and prisoners and challenges for smoking cessation. Momentum is building to ban smoking in prisons, but research on staff and prisoner views is lacking. We address this gap, providing evidence on staff and prisoner views throughout all Scottish prisons. METHODS: Data were collected prior to the announcement of a (November 2018) prison smoking ban throughout Scotland. Mixed methods were used: surveys of staff (online, N = 1271, ~27%) and prisoners (questionnaire, N = 2512, ~34%); 17 focus groups and two paired interviews with staff in 14 prisons. RESULTS: Staff were more positive than prisoners about bans and increased smoking restrictions, although prisoner views were more favorable should e-cigarettes be permitted. Nonsmokers were more positive than smokers. Whilst 74% staff and 22% prisoners agreed bans were a good idea, both groups acknowledged implementation and enforcement challenges. Staff views were influenced by beliefs about: acceptability of the policy in principle and whether/how bans could be achieved. Although some voiced doubts about smoke-free policies, staff likened a ban to other operational challenges. Staff raised concerns around needs for appropriate measures, resources and support, adequate lead-in time, and effective communication prior to a ban. CONCLUSION: We recommend that regular and open opportunities for dialogue within and between different stakeholder groups are created when preparing for prison smoking bans and that specific measures to address staff and prisoner concerns are incorporated into plans to create and maintain smoke-free environments. IMPLICATIONS: To our knowledge, this study is the first to research staff and prisoner views across a whole prison system prior to implementation of smoke-free policies. The results highlight potential challenges and suggest measures, which might help to maximize the success of bans. Our results are relevant for prison service managers responsible for the forthcoming introduction of a ban in Scottish prisons (November 2018) and for other prison systems and comparable institutions planning smoke-free initiatives. Given that prison smoking bans may be contentious, we recommend creating regular and open opportunities for dialogue between stakeholders when preparing for and maintaining smoke-free environments.

Characterising the Exposure of Prison Staff to Second-Hand Tobacco Smoke.

Second-hand tobacco smoke (SHS) is an avoidable and harmful exposure in the workplace but >25000 prison staff continue to be exposed on a daily basis in the UK and many more worldwide. SHS exposures in prisons are incompletely understood but may be considerable given the large proportion of smoking prisoners and limited ventilation. This study characterized the exposure of prison staff to SHS in all 15 prisons in Scotland using multiple methods. Exposure assessment strategies included 6-day area measurement of fine Particulate Matter (PM2.5) and airborne nicotine in each prison together with short (30-minute) measurements of PM2.5 covering a range of locations/activities. Pre- and post-shift saliva samples were also gathered from non-smoking staff and analysed for cotinine to estimate exposure. There was evidence of exposure to SHS in all prisons from the results of PM2.5 and nicotine measurements. The salivary cotinine results from a sub-sample of non-smoking workers indicated SHS exposures of similar magnitude to those provided by the 6-day area measurements of PM2.5. There was a high degree of exposure variability with some locations/activities involving exposure to SHS concentrations that were comparable to those measured in bars in Scotland prior to smoke-free legislation in 2006. The median shift exposure to SHS-PM2.5 was ~20 to 30 µg m-3 and is broadly similar to that experienced by someone living in a typical smoking home in Scotland. This is the most comprehensive assessment of prison workers' exposure to SHS in the world. The results are highly relevant to the development of smoke-free policies in prisons and should be considered when deciding on the best approach to provide prison staff with a safe and healthy working environment.

Acute Responses to Resistance and High-Intensity Interval Training in Early Adolescents.

Harris, NK, Dulson, DK, Logan, GRM, Warbrick, IB, Merien, FLR, and Lubans, DR. Acute responses to resistance and high-intensity interval training in early adolescents. J Strength Cond Res 31(5): 1177-1186, 2017-The purpose of this study was to compare the acute physiological responses within and between resistance training (RT) and high-intensity interval training (HIIT) matched for time and with comparable effort, in a school setting. Seventeen early adolescents (12.9 ± 0.3 years) performed both RT (2-5 repetitions perceived short of failure at the end of each set) and HIIT (90% of age-predicted maximum heart rate), equated for total work set and recovery period durations comprising of 12 "sets" of 30-second work followed by 30-second recovery (total session time 12 minutes). Variables of interest included oxygen consumption, set and session heart rate (HR), and rate of perceived exertion, and change in salivary cortisol (SC), salivary alpha amylase, and blood lactate (BL) from presession to postsession. Analyses were conducted to determine responses within and between the 2 different protocols. For both RT and HIIT, there were very large increases pretrial to posttrial for SC and BL, and only BL increased greater in HIIT (9.1 ± 2.6 mmol·L) than RT (6.8 ± 3.3 mmol·L). Mean set HR for both RT (170 ± 9.1 b·min) and HIIT (179 ± 5.6 b·min) was at least 85% of HRmax. V[Combining Dot Above]O2 over all 12 sets was greater for HIIT (33.8 ± 5.21 ml·kg·min) than RT (24.9 ± 3.23 ml·kg·min). Brief, repetitive, intermittent forays into high but not supramaximal intensity exercise using RT or HIIT seemed to be a potent physiological stimulus in adolescents.

Adolescent physical activity levels: discrepancies with accelerometer data analysis.

This study investigated the effects of epoch length and cut point selection on adolescent physical activity intensity quantification using vertical axis and vector magnitude (VM) measurement with the ActiGraph GT3X+ accelerometer. Four hundred and nine adolescents (211 males; 198 females) aged 12-16 years of age wore accelerometers during waking hours. The GT3X+ acceleration counts were reintegrated into 1, 5, 15, 30 and 60 s epoch lengths for both vertical axis and VM counts. One cut point was applied to vertical axis counts and three different cut points were applied to VM counts for each epoch length. Significant differences (P < 0.01) in mean total counts per day were observed between vertical axis and VM counts, and between epoch lengths for VM only. Differences in physical activity levels were observed between vertical and VM cut points, and between epoch lengths across all activity intensities. Our findings illustrate the magnitude of differences in physical activity outcomes that occur between axis measurement, cut points and epoch length. The magnitude of difference across epoch length must be considered in the interpretation of accelerometer data and seen as a confounding variable when comparing physical activity levels between studies.

Low-Active Male Adolescents: A Dose Response to High-Intensity Interval Training.

PURPOSE: High-intensity interval training (HIIT) is a potential alternative to traditionally recommended steady state exercise for providing health benefits in adolescents, yet its dose-response relationship in this cohort remains unclear, as does its translatability to real-world, nonclinical settings. The present study adopts a novel dose-response design to investigate the effects of undertaking 8 wk of HIIT on the cardiometabolic health of low-active male adolescents. METHODS: Twenty-six male adolescents (age 16 ± 1 yr), identified as low active by nonparticipation in structured sport and physical education classes, were randomly assigned to one of five treatment groups. Corresponding with their group numbers (1-5), participants completed a number of HIIT "sets," which consisted of 4 repeated bouts of 20-s near-maximal exertion interspersed with 10-s passive recovery. Participants performed two HIIT sessions and one resistance training session each week for 8 wk. Baseline and follow-up health measures consisted of peak oxygen uptake (V˙O2peak) with an incremental ramp test to volitional exhaustion; body composition (including visceral fat mass, body fat, and lean tissue mass) with dual-energy x-ray absorptiometry; and lipid profile, glucose, insulin, and interleukin-6 from blood analysis. All health outcomes were analyzed as percentage changes, and data were modeled using a quadratic function to explore dose-response relationships. RESULTS: Significant improvements were observed for V˙O2peak (∼6%), body fat percentage (∼4%), visceral fat mass (∼10%), and waist circumference-to-height ratio (∼3%), but there was no clear effect of dose across groups. CONCLUSIONS: Low-active adolescent males performing a single HIIT set twice weekly, in addition to one resistance training session, gained meaningful improvements in fitness and body composition. Performing additional HIIT sets provided no additional improvements to those of the lowest dose in this study.

An investigation of two-dimensional ultrasound carotid plaque presence and intima media thickness in middle-aged South Asian and European men living in the United kingdom.

OBJECTIVES: Ultrasound studies of carotid intima media thickness (cIMT) and plaques are limited in South Asians, a group at elevated cardiovascular disease (CVD) risk. We determined whether South Asians have a difference in these ultrasound markers compared to Europeans living in the United Kingdom and whether measured risk factor(s) could account for any such differences. METHODS: One hundred South Asian men, aged 40 to 70 years and 100 European men of similar age and BMI, without diagnosed CVD or diabetes, underwent carotid ultrasound for measurement of cIMT and carotid plaque presence. Physical activity, cardiorespiratory fitness, anthropometry and blood pressure were assessed, fasted blood taken for measurement of cardiometabolic risk factors and demographic and lifestyle factors recorded. RESULTS: Age-adjusted mean (SD) cIMT was similar in South Asians and Europeans (0.64 (0.16) mm v 0.65 (0.12) mm, p = 0.64). Plaque was present in 48 South Asians and 37 Europeans and overall, there was no age-adjusted difference between South Asian and Europeans for plaque score(odds ratio 1.49, 95% CI, 0.86-2.80, p = 0.16), however, South Asians appeared to have more plaques at a younger age than Europeans; at age 40-50 years the odds of South Asians having plaques was 2.63 (95% CI, 1.16-5.93) times that for Europeans. CONCLUSIONS: cIMT is similar between healthy South Asian and European men. Whilst there was no overall difference in plaque presence in South Asians, there is an indication of greater plaque prevalence at younger ages--an observation requiring further investigation. Prospective studies linking plaques to CVD outcomes in South Asians are needed to investigate whether these measures help improve CVD risk prediction.

A review of adolescent high-intensity interval training.

Despite the promising evidence supporting positive effects of high-intensity interval training (HIIT) on the metabolic profile in adults, there is limited research targeting adolescents. Given the rising burden of chronic disease, it is essential to implement strategies to improve the cardiometabolic health in adolescence, as this is a key stage in the development of healthy lifestyle behaviours. This narrative review summarises evidence of the relative efficacy of HIIT regarding the metabolic health of adolescents. Methodological inconsistencies confound our ability to draw conclusions; however, there is meaningful evidence supporting HIIT as a potentially efficacious exercise modality for use in the adolescent cohort. Future research must examine the effects of various HIIT protocols to determine the optimum strategy to deliver cardiometabolic health benefits. Researchers should explicitly show between-group differences for HIIT intervention and steady-state exercise or control groups, as the magnitude of difference between HIIT and other exercise modalities is of key interest to public health. There is scope for research to examine the palatability of HIIT as an exercise modality for adolescents through investigating perceived enjoyment during and after HIIT, and consequent long-term exercise adherence.