Improving physical activity and screen time in Australian Outside School Hours Care: Study protocol.

BACKGROUND: Children's physical activity and screen time behaviours impact their physical health and well-being. In Australia, less than half of children meet daily physical activity recommendations and only one-third meet daily screen time recommendations. Nearly half a million Australian school children aged 5-12 attend Outside School Hours Care (OSHC) weekly, activities undertaken at OSHC play a key role in meeting these recommendations. Currently, physical activity and screen time practices in OSHC vary and lack policy guidance. The Activated OSHC program is a policy-based intervention that supports OSHC services to implement the physical activity and screen time guidelines. METHODS: 192 OSHC services across Australia will be recruited. 96 services will be randomly allocated to receive the Activated OSHC program. OSHC coordinators will complete online surveys examining physical activity and screen time scheduling, cost, acceptability, and feasibility. Primary outcome; changes in the proportion of intervention and control services meeting OSHC sector physical activity and screen time guidelines, and secondary outcomes; changes in children's physical activity and screen time behaviours; changes in staff behaviour will be assessed using mixed-effects regression models. DISCUSSION: The aim of this study is to examine the impact of the Activated OSHC program on children's physical activity and screen time. IMPACT: Recent Australian research in Outside School Hours Care (OSHC) has identified significant inconsistency in practices related to physical activity and screen time, compounded by an absence of explicit policy guidance. The Activated OSHC program is a policy-based intervention that supports OSHC services to implement the Australian OSHC physical activity and screen time guidelines. This study will assess the implementation and effectiveness of the Activated OSHC program in an effectiveness-implementation hybrid type 2 trial design. Implementation of outside school hours care sector physical activity and screen time guidelines may improve children's physical activity and screen time behaviours.

Effectiveness of interventions to prevent or reverse pre-frailty and frailty in middle-aged community dwelling adults: A systematic review.

INTRODUCTION: Frailty, marked by diminished physiological capacity and higher health risks, is less understood in middle-aged individuals (40-65 years) than older adults. This review synthesises intervention studies for pre-frailty and frailty in this demographic, assessing effectiveness, feasibility, and implementation factors including participant experience and cost-effectiveness. METHOD: Registered on the Open Science Framework and adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the template for intervention description and replication (TIDieR) guidelines, this review searched six databases for interventions targeting middle-aged adults. Dual screening, data extraction, risk assessment, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) certainty evaluation were conducted. Findings were narratively synthesized due to heterogeneity. RESULTS: Eight studies (2018-2023) with 2838 participants were included. Resistance training and multicomponent exercise reduced frailty; though, not always significantly. Low-intensity exercises and education-based interventions yielded mixed results, suggesting a need for further research. Positive participant experiences and cost-effectiveness of interventions such as resistance training and educational interventions supports their feasibility. Varying quality, methodologies and levels of bias indicated a need for more rigorous future research. DISCUSSION: This review reveals an evidence gap in middle-aged frailty interventions. Multicomponent interventions and resistance training showed promise, but their comparative effectiveness remains uncertain. Educational and low-intensity interventions need further research to establish their effectiveness. The findings diverge from those in older adults, emphasising the need for age-specific approaches. Future studies should employ higher-quality methods and explore emerging technologies to enhance intervention effectiveness for pre-frailty and frailty in middle-aged adults.

Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach.

BACKGROUND: With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. METHODS: This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. RESULTS: Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. CONCLUSION: During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities   , considering their capacities and preferences, to facilitate community participation are required.

Self-management by older people living with cancer and multi-morbidity: a qualitative study.

PURPOSE: Over half of individuals diagnosed with cancer are aged over 70 years, and more than 75% of those with cancer report at least one other medical condition. Having multiple conditions alongside cancer in old age may lower functional status, greater likelihood of treatment complications and less favourable prognoses. This qualitative study explored how older people with long-term chronic conditions manage their health and meet their health-related goals after they have completed treatment for cancer. METHODS: One-to-one face-to-face qualitative interviews were conducted with 8 older people and 2 informal caregivers based in the UK. Older adults were eligible to participate if they were over 70 and had completed primary cancer treatment with curative intent and had at least one other chronic health condition. A semi-structured interview schedule developed a priori based on Shippee's cumulative complexity model was used. We aimed to explore experiences that could influence self-management, utilisation of healthcare services and health outcomes. A framework analysis was used to describe and interpret the data. RESULTS: Four overarching themes were identified in the analysis. These themes related to factors that influenced the everyday health-related workload and capacity of the participants. These factors included their health, resources, and opportunities, as well their motivation and sense of perceived control over their lives. CONCLUSIONS: Fragmented healthcare systems and relationships with healthcare professionals also influenced the participants' self-management of their health. Our findings highlight the interaction between an individuals' needs, capacity, treatment burden, and the services and resources available to them. These findings support calls to promote person-centred care to better support older adults to manage their health.

Prevalence and determinants of physical frailty among people living in residential aged care facilities: a large-scale retrospective audit.

BACKGROUND: Physical frailty is associated with increased risk of falls, hospitalisation and mortality. There is a dearth of information on physical frailty of older adults living in residential aged care. This study aimed to describe physical frailty in aged care residents and investigate possible determinants of frailty. METHOD: A retrospective audit of resident records was undertaken across 14 residential aged care facilities. Data were extracted on all consenting residents who had completed measures relating to frailty (Short Physical Performance Battery SPPB; grip strength). All data of the first record of measures were extracted, resident characteristics, and the time from admission to assessment. Summary statistics were completed. Differences between sub-groups were explored (Mann-Whitney U, Kruskall-Wallis Ranked tests). Associations between variables were explored with Chi-squared and Pearson correlations. Determinants of physical frailty were determined with linear regression analyses. Alpha (2-sided) was 0.05. RESULTS: Data were extracted for 1241 residents (67% female), with a mean age of 86.0 (7.6) years. Males had a significantly lower time from admission to assessment of frailty (p ≤ 0.001). The average SPPB score was 4.1 (3.3), 75% of residents were frail and 19% pre-frail. Bivariate analyses indicated no significant relationships between grip strength and SPPB score, but significant differences for grip strength, where males were significantly stronger (males 20.2 ± 8.3 kg; females 12.4 ± 5.4 kg; p ≤ 0.001). There was a significant positive relationship between SPPB total score and grip strength, gender (p ≤ 0.001), and marital status (p = 0.049) and a negative relationship between time from admission to assessment and SPPB total score (p ≤ 0.001). There were significant negative relationships between gender (p ≤ 0.001) and age (p ≤ 0.001), and time from admission to assessment (p ≤ 0.001) with grip strength. CONCLUSION: Older adults living in residential aged care have a high level of physical frailty which may lead to increased risk of adverse outcomes. Time in the residential aged care setting and age appear to predict physical frailty. There is a need for a consistent battery of measures to continually monitor frailty and programs to address the high levels of frailty in residential aged care.

Physical activity and screen time in outside school hours care services across Australia: current versus best practice.

BACKGROUND: Outside school hours care (OSHC) is accessed by millions of children internationally. Recently, physical activity and screen time guidelines in OSHC were developed. This study described the current physical activity and screen time scheduling in Australian OSHC, obtained sector feedback on the guidelines and compared current- with best-practice. METHODS: A cross-sectional online survey was administered to n = 3551 Australian OSHC directors. Participants reported scheduling for physical activity and screen time opportunities in before- and after-school care. Feedback was sought on the new guidelines, including barriers and enablers for implementation. Scheduling data were used to evaluate whether services were currently meeting the new guidelines; that is if time allocated matched with time recommended. RESULTS: Five hundred and sixty-six directors participated (response rate 16%). Physical activity and screen time practices varied widely (e.g., after-school physical activity opportunity ranged from 15 to 150 min, mean 74, SD 28; after-school screen time opportunity ranged from 15 to 195 min, mean 89, SD 43), with state (p = 0.002) and socioeconomic (based on postcode; p < 0.001) differences. Most participants (54-81%) agreed that the guideline's recommended physical activity and screen time durations were appropriate, however, only 40% of participants' OSHC services' programs actually met the guidelines. CONCLUSIONS: Physical activity and screen time scheduling in OSHC is highly variable. Despite support for the guidelines, current scheduling practice in the majority of OSHC services surveyed do not meet best practice guidelines.

Schedules of standing and sitting directed by musculoskeletal discomfort in workers transitioning to sit-stand workstations: a cross-sectional study.

Sit-stand workstations are growing in popularity, however limited guidelines exist regarding optimal schedules of sitting and standing. This was the first known study to observe sit-stand workstation schedules when postural change is based on maintaining musculoskeletal discomfort within 'acceptable' levels. Fourteen healthy adults new to sit-stand workstations completed computer-based work at a sit-stand desk for half a workday. Participants changed between standing and sitting postures each time discomfort reached the maximum acceptable threshold. On average, the amount of standing and sitting was greatest in the first standing (median 40 minutes, interquartile range 40 minutes) and sitting (median 30 minutes, interquartile range 115 minutes) bouts. Average durations spent standing and sitting were lower in all consecutive bouts. Stand-sit ratios indicated an equal amount of standing to sitting or somewhat less standing. The schedules had substantial inter-participant variability. Future studies should consider that optimal schedules may vary with regard to time and be individual-specific.

Refined guidelines are needed regarding effective use of sit-stand workstations. This study proposed a novel method of investigating potentially optimal schedules, in which postural change was based on reaching a threshold of musculoskeletal discomfort. The findings suggest that an optimal schedule may vary with time and be individual-specific. Abbreviations: BMI: body mass index; Borg CR-10 scale: Borg Category Ratio-10 scale; IQR: interquartile range; LMD questionnaire: the localised musculoskeletal discomfort questionnaire; MHT: maximum holding time; SD: standard deviation.

Development of Australian physical activity and screen time guidelines for outside school hours care: an international Delphi study.

BACKGROUND: Children's activity patterns in the periods before and after school make a key contribution to achieving 24-h movement guidelines. There are currently no national-level guidelines informing physical activity and screen time practices in Outside School Hours Care (OSHC) programs anywhere in the world. This study aimed to work with industry, government and academic stakeholders to develop draft physical activity and screen time guidelines for use in Australian OSHC. METHODS: A 4-round online Delphi survey was conducted from May 2019 to January 2020. The Delphi participants included national and international experts and stakeholders from academia, education, government, health and the OSHC sectors. Round 1 consisted of open-ended questions exploring physical activity, screen time and sedentary behaviour in various periods of OSHC (before school, after school and vacation care). In rounds 2 and 3, participants rated the importance of items generated from the first round for inclusion in national guidelines using a Likert scale (1-9). Consensus was defined a priori as ≥80% of respondents rating an item as "critically important" (score 7-9). Between rounds 3 and 4, the guideline development panel used the consensus items, systematic review evidence, and followed the GRADE process, to draft the guidelines. In round 4, participants were invited to provide feedback on the draft guidelines and comment on barriers and enablers to implementation. RESULTS: Sixty-seven stakeholders agreed to participate, with response rates 61, 81, 54 and 72% for the four rounds respectively. Of the 123 items generated across the three rounds, 48 statements achieved consensus agreement as critically important for inclusion in the guidelines. These included offering a variety of physical activities (free play, playground and equipment) and restriction of screen time. The final round provided feedback on the draft guidelines. The wording of the guidelines was found to be appropriate and preliminary enablers and barriers to implementation were identified. CONCLUSIONS: This world-first expert and stakeholder consultation has underpinned the development of the draft Australian guidelines for physical activity and screen time in OSHC. Ongoing work is needed to further refine the guidelines, determine current rates of compliance with the guidelines and implement the guidelines into practice.

Interventions in outside-school hours childcare settings for promoting physical activity amongst schoolchildren aged 4 to 12 years.

BACKGROUND: Insufficient physical activity is one of four primary risk factors for non-communicable diseases such as stroke, heart disease, type 2 diabetes, cancer and chronic lung disease. As few as one in five children aged 5 to 17 years have the physical activity recommended for health benefits. The outside-school hours period contributes around 30% of children's daily physical activity and presents a key opportunity for children to increase their physical activity. Testing the effects of interventions in outside-school hours childcare settings is required to assess the potential to increase physical activity and reduce disease burden. OBJECTIVES: To assess the effectiveness, cost-effectiveness and associated adverse events of interventions designed to increase physical activity in children aged 4 to 12 years in outside-school hours childcare settings. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ERIC and SportsDISCUS to identify eligible trials on 18 August 2020. We searched two databases, three trial registries, reference lists of included trials and handsearched two physical activity journals in August 2020. We contacted first and senior authors on articles identified for inclusion for ongoing or unpublished potentially relevant trials in August 2020. SELECTION CRITERIA: We included randomised controlled trials, including cluster-randomised controlled trials, of any intervention primarily aimed at increasing physical activity in children aged 4 to 12 years in outside-school hours childcare settings compared to usual care. To be eligible, the interventions must have been delivered in the context of an existing outside-school hours childcare setting (i.e. childcare that was available consistently throughout the school week/year), and not set up in the after-school period for the purpose of research. Two review authors independently screened titles and abstracts of identified papers with discrepancies resolved via a consensus discussion. A third review author was not required to resolve disagreements. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of included trials with discrepancies resolved via a consensus discussion; a third review author was not required to resolve disagreements. For continuous measures of physical activity, we reported the mean difference (MD) with 95% confidence intervals (CIs) in random-effects models using the generic inverse variance method for each outcome. For continuous measures, when studies used different scales to measure the same outcome, we used standardised mean differences (SMDs). We conducted assessments of risk of bias of all outcomes and evaluated the certainty of evidence (GRADE approach) using standard Cochrane procedures. MAIN RESULTS: We included nine trials with 4458 participants. Five trials examined the effectiveness of staff-based interventions to change practice in the outside-school hours childcare setting (e.g. change in programming, activities offered by staff, staff facilitation/training). Two trials examined the effectiveness of staff- and parent-based interventions (e.g. parent newsletters/telephone calls/messages or parent tool-kits in addition to staff-based interventions), one trial assessed staff- and child-based intervention (e.g. children had home activities to emphasise physical activity education learnt during outside-school hours childcare sessions in addition to staff-based interventions) and one trial assessed child-only based intervention (i.e. only children were targeted).  We judged two trials as free from high risk of bias across all domains. Of those studies at high risk of bias, it was across domains of randomisation process, missing outcome data and measurement of the outcome. There was low-certainty evidence that physical activity interventions may have little to no effect on total daily moderate-to-vigorous physical activity compared to no intervention (MD 1.7 minutes, 95% CI -0.42 to 3.82; P = 0.12; 6 trials; 3042 children). We were unable to pool data on proportion of the OSHC session spent in moderate-to-vigorous physical activity in a meta-analysis. Both trials showed an increase in proportion of session spent in moderate-to-vigorous physical activity (moderate-certainty evidence) from 4% to 7.3% of session time; however, only one trial was statistically significant. There was low-certainty evidence that physical activity interventions may lead to little to no reduction in body mass index (BMI) as a measure of cardiovascular health, compared to no intervention (SMD -0.17, 95% CI -0.44 to 0.10; P = 0.22; 4 trials, 1684 children). Physical activity interventions that were delivered online were more cost-effective than in person. Combined results suggest that staff-and-parent and staff-and-child-based interventions may lead to a small increase in overall daily physical activity and a small reduction or no difference in BMI. Process evaluation was assessed differently by four of the included studies, with two studies reporting improvements in physical activity practices, one reporting high programme satisfaction and one high programme fidelity. The certainty of the evidence for these outcomes was low to moderate. Finally, there was very low-certainty evidence that physical activity interventions in outside-school hours childcare settings may increase cardiovascular fitness. No trials reported on quality of life or adverse outcomes. Trials reported funding from local government health grants or charitable funds; no trials reported industry funding. AUTHORS' CONCLUSIONS: Although the review included nine trials, the evidence for how to increase children's physical activity in outside-school hours care settings remains limited, both in terms of certainty of evidence and magnitude of the effect. Of the types of interventions identified, when assessed using GRADE there was low-certainty evidence that multi-component interventions, with a specific physical activity goal may have a small increase in daily moderate-to-vigorous physical activity and a slight reduction in BMI. There was very low-certainty evidence that interventions increase cardiovascular fitness. By contrast there was moderate-certainty evidence that interventions were effective for increasing proportion of time spent in moderate-to-vigorous physical activity, and online training is cost-effective.

Core Domains for Research on Hospital Inactivity in Acutely Ill Older Adults: A Delphi Consensus Study.

OBJECTIVE: To identify core domains for research studies of physical activity and sedentary behavior during hospitalization for older adults with an acute medical illness. DESIGN: A 4-Round Delphi consensus process. Round 1 invited responses to open-ended questions to generate items for the core domains research. In rounds 2-4, participants were invited to use a Likert scale (1-9) to rate the importance of each core domain for research studies of physical activity and/or sedentary behavior in hospitalized older adults with an acute medical illness. SETTING: Online surveys. PARTICIPANTS: A total of 49 participants were invited to each round (international researchers, clinicians, policy makers and patients). Response rates across rounds 1-4 were 94%, 88%, 83% and 81%, respectively. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Consensus was defined a priori as ≥70% of respondents rating an item as "critical" (score≥7) and ≤15% of respondents rating an item as "not important" (score≤3). RESULTS: In round 2, a total of 9 of 25 core domains reached consensus agreement (physical functioning, general, role functioning, emotional functioning, global quality of life, hospital, psychiatric, cognitive functioning, carer burden). In round 3, an additional 8 reached consensus (adverse events, perceived health status, musculoskeletal, social functioning, vascular, cardiac, mortality, economic). Round 4 participants provided further review and a final rating of all 17 core domains that met consensus in previous rounds. Four core domains were rated as "critically important" to evaluate: physical functioning, social functioning, emotional functioning, and hospital outcomes. CONCLUSIONS: This preliminary work provides international and expert consensus-based core domains for development toward a core-outcome set for research, with the ultimate goal of fostering consistency in outcomes and reporting to accelerate research on effective strategies to address physical activity and/or sedentary behavior in older adults while hospitalized.

Mental health problems and fear of childbirth: A cohort study of women in an inner-city maternity service.

OBJECTIVES: To estimate the population prevalence of severe fear of childbirth (FOC) during pregnancy and investigate its association with: (a) antenatal common mental disorders (depression and anxiety disorder) and (b) elective cesarean birth. METHODS: 545 participants from an inner-city London maternity population were interviewed soon after their first antenatal appointment (mean gestation: 14 weeks). Current mental disorders were assessed using the Structured Clinical Interview DSM-IV. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) at approximately 28 weeks gestation (n = 377), with severe FOC defined using a cutoff of WDEQ-A ≥ 85. Birth mode information was collected at 3 months post-delivery using an adapted Adult Service Use Schedule. Linear regressions were used to model associations, adjusting for the effects of covariates (age, parity, relationship status, education, and planned pregnancy). Sampling weights were used to adjust for bias introduced by the stratified sampling. We also accounted for missing data within the analysis. RESULTS: The estimated population prevalence of severe FOC was 3% (95% CI: 2%-6%) (n = 377). Depression and anxiety were significantly associated with severe FOC after adjustment for covariates (45% vs 11%; coefficient: 15.75, 95% CI: 8.08-23.42, P < .001). There was a weak association between severe FOC and elective cesarean birth. CONCLUSIONS: Severe FOC occurs in around 3% of the population. Depression and anxiety are associated with FOC. Pregnant people with depression and anxiety may be at increased risk of experiencing severe FOC. Attitudes toward childbirth should be assessed as part of routine clinical assessment of pregnant people in contact with mental health services.

Re-thinking reablement strategies for older adults in residential aged care: a scoping review.

BACKGROUND: The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD: This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS: Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS: There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION: Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).

Community participation of community dwelling older adults: a cross-sectional study.

BACKGROUND: With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation. METHODS: This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored. RESULTS: Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48). CONCLUSION: Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity. TRIAL REGISTRATION: Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).

Promoting physical activity during the COVID-19 lockdown in Australia: The roles of psychological predictors and commercial physical activity apps.

Purpose: Physical activity confers many physical and mental health benefits. Thus, it is of great concern that the COVID-19 lockdown has adversely impacted engagement in physical activity. There is a need to understand the factors linked to physical activity during COVID-19 as this will be fundamental to the development of innovative approaches to support engagement in physical activity during a pandemic. This study aimed to ascertain the psychological and mental health predictors of physical activity during the COVID-19 lockdown. We also examined the value of harnessing commercial physical activity apps to facilitate physical activity during a pandemic. Method: A nationwide online survey was completed by 408 Australian adults (Mage = 35.7 ± 13.9 years, 86.0% female) following the initial COVID-19 lockdown (April/May 2020). The survey incorporated measures that retrospectively assessed physical activity (and perceived changes in physical activity behaviour), psychological constructs (social support, self-efficacy, self-determined motivations), mental health, and engagement with commercial physical activity apps during the lockdown. Results: Over half of participants (53.4%) reported a reduction in physical activity during the initial COVID-19 lockdown, with markedly fewer (23.8%) reporting an increase in physical activity. App use (ß = .09, p = .027), social support (ß = .10, p = .021), self-efficacy (ß = .42, p < .001), and identified regulation (ß = .25, p < .001) emerged as important predictors of physical activity engagement (min/week). Self-efficacy (OR = 4.2, p < .001) was also associated with a greater likelihood of perceived positive changes (increases) in physical activity. The relationship between app use and physical activity was mediated by self-efficacy (ß = 0.10 [0.06, 0.15]) and identified regulation (ß = 0.09 [0.04, 0.15]); self-efficacy (ß = 0.15, [0.09, 0.21]) also mediated the relationship between app use and positive changes in physical activity. Conclusions: It is imperative that interventions targeted at increasing social support, self-efficacy, and autonomous motivations are developed and utilised to support engagement in physical activity during a pandemic. Commercial physical activity apps demonstrate the potential to mitigate reductions in physical activity during a pandemic, and thus the use of these apps should be encouraged.

Lower Dietary and Circulating Vitamin C in Middle- and Older-Aged Men and Women Are Associated with Lower Estimated Skeletal Muscle Mass.

BACKGROUND: Age-related loss of skeletal muscle mass contributes to poor outcomes including sarcopenia, physical disability, frailty, type 2 diabetes, and mortality. Vitamin C has physiological relevance to skeletal muscle and may protect it during aging, but few studies have investigated its importance in older populations. OBJECTIVES: We aimed to investigate cross-sectional associations of dietary and plasma vitamin C with proxy measures of skeletal muscle mass in a large cohort of middle- and older-aged individuals. METHODS: We analyzed data from >13,000 men and women in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, aged 42-82 y. Fat-free mass (FFM), as a proxy for skeletal muscle mass, was estimated using bioelectrical impedance analysis and expressed as a percentage of total mass (FFM%) or standardized by BMI (FFMBMI). Dietary vitamin C intakes were calculated from 7-d food diary data, and plasma vitamin C was measured in peripheral blood. Multivariable regression models, including relevant lifestyle, dietary, and biological covariates, were used to determine associations between FFM measures and quintiles of dietary vitamin C or insufficient compared with sufficient plasma vitamin C (<50 µmol/L and ≥50 µmol/L). RESULTS: Positive trends were found across quintiles of dietary vitamin C and FFM measures for both sexes, with interquintile differences in FFM% and FFMBMI of 1.0% and 2.3% for men and 1.9% and 2.9% for women, respectively (all P < 0.001). Similarly, FFM% and FFMBMI measures were higher in participants with sufficient than with insufficient plasma vitamin C: by 1.6% and 2.0% in men, and 3.4% and 3.9% in women, respectively (all P < 0.001). Associations were also evident in analyses stratified into <65-y and ≥65-y age groups. CONCLUSIONS: Our findings of positive associations, of both dietary and circulating vitamin C with measures of skeletal muscle mass in middle- and older-aged men and women, suggest that dietary vitamin C intake may be useful for reducing age-related muscle loss.

Recommendations for older adults' physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study.

BACKGROUND: Immobility is major contributor to poor outcomes for older people during hospitalisation with an acute medical illness. Yet currently there is no specific mobility guidance for this population, to facilitate sustainable changes in practice. This study aimed to generate draft physical activity (PA) and sedentary behaviour (SB) recommendations for older adults' during hospitalisation for an acute medical illness. METHODS: A 4-Round online Delphi consensus survey was conducted. International researchers, medical/nursing/physiotherapy clinicians, academics from national PA/SB guideline development teams, and patients were invited to participate. Round 1 sought responses to open-ended questions. In Rounds 2-3, participants rated the importance of items using a Likert scale (1-9); consensus was defined a priori as: ≥70% of respondents rating an item as "critical" (score ≥ 7) and ≤ 15% of respondents rating an item as "not important" (score ≤ 3). Round 4 invited participants to comment on draft statements derived from responses to Rounds 1-3; Round 4 responses subsequently informed final drafting of recommendations. RESULTS: Forty-nine people from nine countries were invited to each Round; response rates were 94, 90, 85 and 81% from Rounds 1-4 respectively. 43 concepts (items) from Rounds 2 and 3 were incorporated into 29 statements under themes of PA, SB, people and organisational factors in Round 4. Examples of the final draft recommendations (being the revised version of statements with highest participant endorsement under each theme) were: "some PA is better than none", "older adults should aim to minimise long periods of uninterrupted SB during waking hours while hospitalised", "when encouraging PA and minimising SB, people should be culturally responsive and mindful of older adults' physical and mental capabilities" and "opportunities for PA and minimising SB should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living". CONCLUSIONS: These world-first consensus-based statements from expert and stakeholder consultation provide the starting point for recommendations to address PA and SB for older adults hospitalised with an acute medical illness. Further consultation and evidence review will enable validation of these draft recommendations with examples to improve their specificity and translation to clinical practice.

Office-based physical activity: mapping a social ecological model approach against COM-B.

BACKGROUND: There are growing concerns over the health impacts of occupational sedentary behaviour on office-based workers and increasing workplace recognition of the need to increase physical activity at work. Social ecological models provide a holistic framework for increasing opportunities for physical activity at work. In this paper we propose a social ecological model of office-based physical activity and map it against the Capability Motivation Opportunity (COM-B) framework to highlight the mechanisms of behaviour change that can increase levels of physical activity of office-based workers. DISCUSSION: The paper proposes a social ecological model of physical activity associated with office-based settings. The model considers opportunities for both incidental and discretionary activities, as well as macro and micro factors on both socio-cultural and physical dimensions. The COM-B framework for characterising behaviour change interventions is used to highlight the underlying mechanisms of behaviour change inherent in the model. The broad framework provided by social ecological models is important for understanding physical activity in office-based settings because of the non-discretionary nature of sedentary behaviour of office-based work. It is important for interventions not to rely on individual motivation for behaviour change alone but to incorporate changes to the broader social ecological and physical context to build capability and create opportunities for more sustainable change.

A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization.

OBJECTIVE: To identify interventions using wearable accelerometers to measure physical activity and/or sedentary behaviour in adults during hospitalization for an acute medical/surgical condition. DATA SOURCES: Four databases were searched in August 2019 (MEDLINE, CINAHL, Scopus, EMBASE). REVIEW METHODS: Studies were selected if they described an intervention in adults with a medical/surgical condition, and concurrently reported an accelerometer-derived measure of physical activity and/or sedentary behaviour while participants were admitted. Items were screened for eligibility in duplicate. Included studies were synthesized to describe intervention types, feasibility and potential effectiveness. RESULTS: Twenty-two studies were included, reporting on 3357 participants (2040 with accelerometer data). Identified types of interventions were: pre-habilitation (n = 2) exercise (n = 3), patient behaviour change with self-monitoring (n = 6), models of care (n = 5), implementing system change (n = 2), surgical technique (n = 2) patients wearing day clothes (n = 1) and education about activity in hospital (n = 1). Of 16 studies that reported intervention effects on physical activity, 11 reported a favourable impact including studies of: pre-habilitation, self-monitoring (accelerometry or an activity whiteboard), physiotherapy, an early mobility bundle, minimally invasive surgery, an education booklet and by implementing system change. Of the six studies that reported intervention effects on sedentary behaviour, there was a favourable impact with an activity whiteboard, models of care and an education booklet. CONCLUSION: Accelerometer-derived measures of physical activity and/or sedentary behaviour have been used to describe sample characteristics and intervention effects in studies of hospitalized adults. Interventions may involve a range of health professionals, but less is known about sedentary behaviour in this setting.

A scoping review of physical activity and screen time guidelines for use in Outside School Hours Care.

BACKGROUND: Globally, millions of children attend Outside School Hours Care. Children's activity in this setting is critical to meeting daily physical activity recommendations. Guidelines are evidence-based statements intended to optimise practice. This study aimed to identify guidelines used in Outside School Hours Care for physical activity and screen time and summarise their content and methods of development. METHODS: Outside School Hours Care guidelines for children aged 5 to 12 years were identified by systematically searching Medline, Emcare, Embase, Scopus, ERIC, Sportsdiscus, TROVE, ProQuest, UpToDate, NICE, SIGN and Google in accordance with PRISMA-ScR guidelines. The search was conducted in March 2019 and results screened independently by two authors. Data were synthesized narratively. RESULTS: Nine guideline documents were identified from grey literature only (n = 8 USA, n = 1 Canada). The included guidelines focused predominantly on the after school care period (n = 9 vs n = 2 for the before school period). All had recommendations for physical activity, whilst 7 included screen time recommendations. There was considerable variability across the physical activity and screen time recommendations, though taken together, they recommended 30-60 min of moderate- to- vigorous physical activity and less than 60 min of recreational screen time per session. All guidelines were developed by expert/stakeholder panels, but none followed rigorous guideline development methods. CONCLUSIONS: Limited published guidelines for physical activity and screen time in Outside School Hours Care exist. There is a variation in duration and intensity of physical activity recommended, whilst screen time recommendations are more consistent. Guidelines designed with rigorous tools and for other world regions are warranted.

Associations Between Commercial App Use and Physical Activity: Cross-Sectional Study.

BACKGROUND: In today's society, commercial physical activity apps (eg, Fitbit and Strava) are ubiquitous and hold considerable potential to increase physical activity behavior. Many commercial physical activity apps incorporate social components, in particular app-specific communities (allowing users to interact with other app users) or the capacity to connect to existing social networking platforms (eg, Facebook or Instagram). There is a growing need to gain greater insights into whether commercial physical activity apps and specific components of these apps (social components) are beneficial in facilitating physical activity. OBJECTIVE: This study aimed to examine the relationship between the use of commercial physical activity apps and engagement in physical activity. The social components of commercial physical activity apps (app-specific communities and existing social networking platforms) were also explored. This involved isolating specific features (eg, sharing, providing, and receiving encouragement, comparisons, and competitions) of app-specific communities and existing social networking platforms that were most valuable in facilitating physical activity. METHODS: A cross-sectional web-based survey was conducted. Participants were 1432 adults (mean age 34.1 years, 1256/1432, 88.00% female) who completed measures assessing physical activity, the use of commercial physical activity apps, and engagement with app-specific communities and existing social networking platforms. RESULTS: Overall, 53.14% (761/1432) of the sample reported engaging with a commercial physical activity app. The most commonly used apps were Fitbit (171/761, 22.5%), Strava (130/761, 17.1%), and Garmin (102/761, 13.4%). The use of physical activity apps was significantly associated with physical activity. Notably, the use of app-specific communities and existing social networking platforms facilitated significantly greater engagement in physical activity. The features of app-specific communities that were most beneficial in promoting engagement in physical activity were providing encouragement to a partner, receiving encouragement from close friends and family, and engaging in competitions with members of public app-specific communities. In relation to existing social networking platforms, sharing physical activity posts predicted engagement in physical activity. CONCLUSIONS: The findings indicate that app-specific communities and existing social networking platforms are components of apps that are fundamental in facilitating physical activity. They further suggest that commercial physical activity apps afford high population level reach and hold great potential to promote engagement in physical activity, an important public health consideration.