Psychological distress and health behaviours in people living with and beyond cancer: a cross-sectional study.

This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (< 500 g/week), processed meat (0 g/day), high calorie food (fat ≤ 33% of total daily energy intake and free sugar ≤ 5% of total daily energy intake), alcohol (≤ 14 units/week) and smoking (non-smoking). A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0-9). Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI 0.55, 0.97), but not for any other health behaviour. Psychological distress is associated with lower adherence to WCRF recommendations for physical activity in people living with and beyond cancer. Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.

Perceiving a need for dietary change in adults living with and beyond cancer: A cross-sectional study.

BACKGROUND: Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet. METHODS: Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations. RESULTS: The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio [OR] 0.95, 95% confidence interval [CI] = 94-0.95), female (OR = 1.33, 95% CI = 1.15-1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48-2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16-1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43-1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09-1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41-0.55), fat (OR = 0.67, 95% CI = 0.58-0.77), and sugar (OR = 0.86, 95% CI = 0.75-0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32-1.77) in the BMI model. CONCLUSIONS: Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.

The feasibility and acceptability of an app-based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK.

INTRODUCTION: Increased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory-driven app-based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH). METHODS: Participants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device-measured brisk walking (activPAL accelerometer) and self-reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non-cancer-specific app to promote brisk walking (National Health Service 'Active 10') augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted. RESULTS: Of those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost-effectiveness of the intervention. CONCLUSIONS: This pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost-effectiveness of the intervention.

Prevalence of loneliness and associations with health behaviours and body mass index in 5835 people living with and beyond cancer: a cross-sectional study.

BACKGROUND: A cancer diagnosis and its treatment may be an especially isolating experience. Despite evidence that positive health behaviours can improve outcomes for people living with and beyond cancer (LWBC), no studies have examined associations between loneliness and different health behaviours in this population. This study aimed to describe the prevalence of loneliness in a large sample of UK adults LWBC and to explore whether loneliness was associated with multiple health behaviours. METHODS: Participants were adults (aged ≥ 18 years) diagnosed with breast, prostate or colorectal cancer who completed the Health and Lifestyle After Cancer Survey. Loneliness was reported using the UCLA loneliness score, dichotomised into higher (≥ 6) versus lower (< 6) loneliness. Engagement in moderate-to-vigorous physical activity, dietary intake, smoking status, alcohol use, and self-reported height and weight were recorded. Behaviours were coded to reflect meeting or not meeting the World Cancer Research Fund recommendations for people LWBC. Logistic regression analyses explored associations between loneliness and health behaviours. Covariates were age, sex, ethnicity, education, marital status, living situation, cancer type, spread and treatment, time since treatment, time since diagnosis and number of comorbid conditions. Multiple imputation was used to account for missing data. RESULTS: 5835 participants, mean age 67.4 (standard deviation = 11.8) years, completed the survey. 56% were female (n = 3266) and 44% (n = 2553) male, and 48% (n = 2786) were living with or beyond breast cancer, 32% (n = 1839) prostate, and 21% (n = 1210) colorectal. Of 5485 who completed the loneliness scale, 81% (n = 4423) of participants reported lower and 19% (n = 1035) higher loneliness. After adjustment for confounders, those reporting higher levels of loneliness had lower odds of meeting the WCRF recommendations for moderate-to-vigorous physical activity (Odds Ratio [OR] 0.78, 95% Confidence Internal [CI], 0.67, 0.97, p =.028), fruit and vegetable intake (OR 0.81, CI 0.67, 1.00, p =.046), and smoking (OR 0.62, 0.46, 0.84, p =.003). No association was observed between loneliness and the other dietary behaviours, alcohol, or body mass index. CONCLUSIONS: Loneliness is relatively common in people LWBC and may represent an unmet need. People LWBC who experience higher levels of loneliness may need additional support to improve their health behaviours.

Association between neighbourhood cohesion and physical activity trajectories during the COVID-19 pandemic using data from Understanding Society: The UK Household Longitudinal Study & COVID-19 sub-study.

Neighbourhood cohesion is increasingly recognised as a key determinant of health and health-related behaviours. Positive association between social support and physical activity have been demonstrated on an interpersonal level, there is less evidence at group-level. This study aimed to examine the association between neighbourhood cohesion and physical activity trajectories during the COVID-19 pandemic. Hypothesizing that higher neighbourhood cohesion was a protective factor against reduced physical activity during the pandemic. Data from Understand Society (wave 9, Jan 2017-Dec 2019), and the COVID-19 sub-study (waves 1, 5, 7) was used. Participants (N = 14,475) had baseline data and at least one Covid physical activity measure. We used linear mixed models with a random intercept and slope at the individual level and an unstructured correlation matrix to examine the association between neighbourhood cohesion and physical activity during the follow-up period. We found a significant reduction in physical activity (-441 MET-min/wk, (CI 374.51 - 507.65, p < 0.001) through the COVID-19 pandemic, and that higher neighbourhood cohesion was related to higher physical activity after control for covariates. There was a significant difference between neighbourhood cohesion categories and change seen in PA during the 39-month follow-up period (difference in change between lowest and highest neighbourhood cohesion categories = 373 MET-min/wk, p = 0.036), higher neighbourhood cohesion had a protective effect. Strong relationships between public health and urban planning sectors are needed to build communities with structures in place to support a sense of community, social interaction and attraction to the neighbourhood. This will help long-term neighbourhood cohesion and support increased physical activity.

Did the COVID-19 pandemic impact the dietary intake of individuals living with and beyond breast, prostate, and colorectal cancer and who were most likely to experience change?

PURPOSE: The present work investigated dietary changes amongst individuals living with and beyond cancer (LWBC) from before to during the pandemic. To identify those at greatest risk of unhealthy changes, it was further examined whether patterns varied by sociodemographic, health-related, and COVID-19-related characteristics. METHODS: This longitudinal cohort study analysed data from 716 individuals LWBC participating in the Advancing Survivorship Cancer Outcomes Trial (ASCOT). Using data provided before and during the pandemic, changes in fruit and vegetable, snack, and alcohol intake were tested using mixed-effect regression models. RESULTS: Fruit and vegetable (95%CI: - 0.30; - 0.04) and alcohol consumption (95%CI: - 1.25; - 0.31) decreased, whilst snacking increased (95%CI: 0.19; 0.53). Women and individuals with limited social contact were more likely to reduce fruit and vegetable intake during the pandemic. Women and individuals with poorer sleep quality, limited social contact, and shielding requirements and without higher education were more likely to increase snacking during the pandemic. Individuals with poorer sleep quality, poorer mental health, and regular social contact were more likely to decrease alcohol consumption during the pandemic. CONCLUSIONS: Findings suggest decreased intake for fruit, vegetable, and alcohol consumption and increased snack intake in response to the pandemic amongst individuals LWBC. These changes appear to differ across various characteristics, suggesting the pandemic has not equally impacted everyone in this population. Findings highlight the need for targeted post-COVID strategies to support individuals LWBC most adversely affected by the pandemic, including women and socially isolated individuals. This encourages resources to be prioritised amongst these groups to prevent further negative impact of the pandemic. Whilst the findings are statistically significant, practically they appear less important. This is necessary to acknowledge when considering interventions and next steps.

Perceived Social Support and Sustained Physical Activity During the COVID-19 Pandemic.

BACKGROUND: COVID-19 lockdown introduced substantial barriers to physical activity, providing a unique 'natural experiment' to understand the social factors associated with sustained physical activity. The objectives of this study were to identify the proportion of people who successfully sustained physical activity during lockdown and to explore whether social support, loneliness and social isolation were associated with maintenance of physical activity during COVID-19 lockdown. METHOD: Longitudinal data from 16,980 participants, mean age 51.3 years (SD = 14.3) from the COVID-19 Social Study was used to identify a sample of participants who maintained their physical activity despite lockdown. RESULTS: Seventeen percent were consistently active whilst 42% were completely inactive. After adjustment for multiple confounders, high social support was associated with a 64% (95% CI 50-80%) increased odds of sustaining physical activity and medium social support was associated with 32% (95% CI 20-44%) increased odds. Associations between physical activity and loneliness and social isolation were not found. CONCLUSION: This study supports previous research showing the importance of social support for the long-term maintenance of physical activity behaviour but shows that such effects extend to contexts of social restrictions.

Myeloma patients' experiences of a supervised physical activity programme: a qualitative study.

PURPOSE: The Myeloma: Advancing Survival Cancer Outcomes Trial (MASCOT) tested the impact of a supervised exercise programme on fatigue, clinical, and patient-reported outcomes in multiple myeloma [MM] patients. The current study explored MM patients' experiences of the programme to guide future interventions. METHODS: Purposive sampling was used to recruit stable MM patients participating in MASCOT. Semi-structured, face-to-face interviews were conducted, transcribed verbatim, and analysed using thematic analysis. RESULTS: Six themes were identified. Key drivers for participation in MASCOT were "Altruism and extended cancer care"; participants wanted to give something back and assist in improving post-treatment care for MM patients, especially as after treatment "Barriers to being physically active" were a fear of damage and lack of health professional guidance. "Influences fostering change within the intervention" included physiotherapy supervision and tailored exercises, which gave participants confidence to push themselves in a safe environment and broke down misconceptions about their body. "Social support", from both family and peers in the programme, promoted motivation and adherence. Participants expressed concerns about "Maintaining things going forward" but had identified mechanisms to aid continuation. "Physical and mental benefits" of the programme were highlighted; participants were able to do things they couldn't before and described feeling free from the constraints of MM. CONCLUSIONS: A post-treatment exercise intervention for MM patients was a positive experience, which enhanced participants' physical and psychological wellbeing. Tailored gym and home-based exercises, a specialist cancer physiotherapist, and sustained support were perceived to be important for success. IMPLICATIONS FOR CANCER SURVIVORS: Exercise support for MM patients, ideally with physiotherapist supervision, should be incorporated into survivorship care to qualitatively improve patients' quality of life, self-efficacy, and mental wellbeing.

Dietary supplement use by individuals living with and beyond breast, prostate, and colorectal cancer: A cross-sectional survey.

BACKGROUND: Dietary supplements (DSs) are not recommended for the prevention of cancer recurrence. Although DS use is common in individuals living with and beyond cancer, its associations with beliefs about reduced cancer recurrence risk and demographic and health behaviors are unclear. METHODS: Adults (18 years old or older) who had been diagnosed with breast, prostate, or colorectal cancer were recruited through National Health Service sites in Essex and London. Participants completed a mailed survey and telephone or online 24-hour dietary recalls (MyFood24). Supplement use was collected during the dietary recalls. Associations between DS use and demographics, health behaviors, and beliefs about DSs and cancer were explored. RESULTS: Nineteen percent of 1049 individuals believed that DSs were important for the reduction of cancer recurrence risk, and 40% of individuals reported DS use. DS use was positively associated with being female (odds ratio [OR], 2.48; confidence interval [CI], 1.72-3.56), meeting 5-a-day fruit and vegetable recommendations (OR, 1.36; CI, 1.02-1.82), and believing that DSs were important for reducing cancer recurrence risk (OR, 3.13; CI, 2.35-4.18). DS use was negatively associated with having obesity (OR, 0.58; CI, 0.38-0.87). The most commonly taken DSs overall were fish oils (taken by 13%). Calcium with or without vitamin D was the most common DS taken by individuals with breast cancer (15%). CONCLUSIONS: DS use by individuals living with and beyond cancer is associated with demographic factors and health behaviors. A belief that DSs reduce the risk of cancer recurrence is common and positively associated with DS use. There is a need for health care professionals to provide advice about DS use and cancer recurrence risk.

Running App "Zombies, Run!" Users' Engagement with Physical Activity: A Qualitative Study.

Introduction: Sufficient physical activity (PA) is important for all aspects of health. Smartphone apps and the use of gamification, such as narrative-based augmented reality (AR), have a great potential to engage a variety of people in more PA. Zombies, Run! (ZR) is the world's most popular running exergame app and therefore a suitable model to understand what users find engaging. Objective: To understand people's motivation and experience of using a narrative-based AR exergame app ZR for PA. Materials and Methods: ZR users were randomly selected for interview from a quantitative ZR user's survey. Interviews which were guided by a semistructured topic guide were audio-recorded, transcribed, and analyzed using inductive and deductive thematic analysis. Results: Participants were 15 males and 15 females aged 16-53 years (mean = 36, SD = 10), from 13 countries, with the largest proportions from the United States (30%) and United Kingdom (23%). The majority (73%) used ZR while running, followed by cycling and walking. Four overarching themes that emerged were: "Reasons for starting and staying with ZR," "Preferred features," "Perceived effects of ZR," and "Pros and cons of the app." Sixteen subthemes included the attraction of gamification and narrative appeal, desire to add something fun to PA, or to distract from the negative physiological effects of PA. Users' favorite features were the feelings of immersion and presence through narrative, story line, and characters. The narrative motivated participants to engage in PA for longer sessions and encouraged long-term use. Conclusions: This study identified a number of factors that users found attractive in an AR running exergame, particularly narrative. Our findings suggest that ZR may engage people in exercise by modifying their perception of PA through a story line or narrative, dissociating the players from the effort of exertion. AR narrative-based apps may be an effective way of engaging people with health-related behaviors or habit-forming activities.

A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process.

BACKGROUND: Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity. OBJECTIVE: The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration. METHODS: The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group. RESULTS: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback. CONCLUSIONS: This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial.

Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study.

BACKGROUND: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity. Since parental support is a consistent determinant of physical activity in adolescents, it is crucial to gather the views of parents of adolescents about this type of intervention. OBJECTIVE: This study aimed to interview parents of younger adolescents (13-17 years old) about physical activity, gaming, and VR as part of the larger vEngage study. METHODS: Semistructured interviews were conducted with 18 parents of adolescents. Data were synthesized using framework analysis. RESULTS: Parents believed that encouraging physical activity in adolescents was important, particularly for mental health. Most parents felt that their children were not active enough. Parents reported their adolescents regularly gamed, with mostly negative perceptions of gaming due to violent content and becoming addicted. Parents discussed an inability to relate to gaming due to "generational differences," but an exception was exergaming, which they had played with their children in the past (eg, Wii Fit). Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. CONCLUSIONS: The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that addresses parental concerns, particularly around addiction, violence, and safety, without actively involving their participation. While parents would rather their children performed "real-world" physical activity, they believed the key to engagement was through technology. Overall, there was the perception that harnessing gaming and sedentary screen time for a positive purpose would be strongly supported.

Illness Risk Representation beliefs underlying adolescents' cardiovascular disease risk appraisals and the preventative role of physical activity.

OBJECTIVES: The primary aim was to explore adolescents' cardiovascular disease risk appraisals and establish whether they understood the preventative role of physical activity (PA). The secondary aim was to examine whether adolescents' cardiovascular disease risk appraisal fitted with the Illness Risk Representations (IRR) framework. DESIGN: Qualitative. METHODS: Thirty-one adolescents aged between 13 and 15 years participated in semi-structured interviews. Data were analysed using Framework Analysis. RESULTS: Knowledge of lifestyle behaviours contributing to cardiovascular disease was good. Participants reflected on their current (or expected future) patterns of these behaviours when making judgements about lifetime risk. They struggled however to explain how different health behaviours, including PA, affected the development of the disease. Cardiovascular disease was viewed as potentially fatal, but participants had only a superficial understanding of the consequences of, or treatments for, the disease. The IRR framework, as proposed by Cameron (2003, https://cancercontrol.cancer.gov/brp/research/theories_project/cameron.pdf), largely captured the way in which adolescents' made judgements about their risk of cardiovascular disease. CONCLUSIONS: The findings suggest that adolescents are underestimating their risk of cardiovascular disease due to unhelpful beliefs. Interventions should: provide clear and simple explanations of how different health behaviours contribute to cardiovascular risk, highlight discrepancies that exist between current levels of preventative behaviour and that required to confer a protective effect, expose the false belief that a lack of PA in early life can be compensated for in later adulthood, and aid understanding of the true impact that the disease and its treatment could have of health and quality of life outcomes. Statement of contribution What is already known on this subject? Physical activity (PA) throughout one's lifetime can reduce the risk of developing cardiovascular disease. The majority of adolescents' do not meet the recommended levels of PA. Changing beliefs about the risk of cardiovascular disease might be a useful strategy to motivate engagement in PA. What does this study add? An increased understanding of adolescents' knowledge of cardiovascular disease and the link with PA. Identification of strategies to change adolescents' risk perceptions of cardiovascular disease in ways that could motivate PA. Evidence to support the Illness Risk Representation framework.

What Players of Virtual Reality Exercise Games Want: Thematic Analysis of Web-Based Reviews.

BACKGROUND: Physical activity (PA) is associated with a variety of physical and psychosocial health benefits, but levels of moderate-to-vigorous intensity PA remain low worldwide. Virtual reality (VR) gaming systems involving movement (VR exergames) could be used to engage people in more PA. OBJECTIVE: This study aimed to synthesize public reviews of popular VR exergames to identify common features that players liked or disliked to inform future VR exergame design. METHODS: We conducted a thematic analysis of 498 reviews of the 29 most popular exergames sold in the top 3 VR marketplaces: Steam (Valve Corporation), Viveport (Valve Corporation), and Oculus (Oculus VR). We categorized reviews as positive and negative as they appeared in the marketplaces and identified the most common themes using an inductive thematic analysis. RESULTS: The reviews were often mixed, reporting a wide variety of expectations, preferences, and gaming experiences. Players preferred highly realistic games (eg, closely simulated real-world sport), games that were intuitive (in terms of body movement and controls), and games that provided gradual increases in skill acquisition. Players reported feeling that they reached a high level of exertion when playing and that the immersion distracted them from the intensity of the exercise. Some preferred features included music and social aspects of the games, with multiplayer options to include friends or receive help from experienced players. There were 3 main themes in negative reviews. The first concerned bugs that rendered games frustrating. Second, the quality of graphics had a particularly strong impact on perceived enjoyment. Finally, reviewers disliked when games had overly complex controls and display functions that evoked motion sickness. CONCLUSIONS: Exergames prove to be a stimulating avenue for players to engage in PA and distract themselves from the negative perceptions of performing exercise. The common negative aspects of VR exergames should be addressed for increased uptake and continued engagement.

Digital behavior change interventions to promote physical activity and/or reduce sedentary behavior in older adults: A systematic review and meta-analysis.

BACKGROUND: Physical activity and sedentary behavior are modifiable risk factors for non-communicable disease and healthy ageing, however the majority of older adults remain insufficiently active. Digital behavior change interventions (DBCI) have the potential to reach many older adults to promote physical activity and reduce sedentary time. This study aims to assess the efficacy of DBCI interventions in older adults (≥50 years) on physical activity and sedentary behavior. METHODS: A systematic review of major databases from inception to 03/2018 was undertaken. Randomized controlled trials (RCT) or pre-post interventions assessing effects of DBCI on physical activity and/or sedentary behavior in older adults (≥50 years) were included. Random effects meta-analyses were carried out. RESULTS: Twenty-two studies were included, including 1757 older adults (mean age = 67 years, %male = 41), 68% showed moderate-high risk of bias. Meta-analyses suggested that DBCI increased total physical activity among RCT studies (n = 8) (SMD = 0.28; 95%CI 0.01, 0.56; p = 0.04) and pre-post studies (n = 6) (SMD = 0.25; 95%CI 0.09, 0.41; p = 0.002), increased moderate-to-vigorous physical activity (SMD = 0.47; 95%CI 0.32, 0.62, p < 0.001; MD = 52 min/week) and reduced sedentary time (SMD = -0.45; 95%CI -0.69, -0.19; p < 0.001; MD = 58 min/day). Reductions in systolic blood pressure (-11 bpm; p = 0.04) and improvements in physical functioning (p = 0.03) were also observed. CONCLUSIONS: DBCI may increase physical activity and physical functioning, and reduce sedentary time and systolic blood pressure in older adults, however more high-quality studies are required.

Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation.

BACKGROUND: Physical activity (PA) programmes effective under 'research' conditions may not be effective under 'real-world' conditions. A potential solution is to refer patients to existing PA community-based PA services. METHODS: A process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-delivered PA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD. RESULTS: In Phase I, 30% (n = 20) of eligible patients (n = 20) consented, 85% (n = 17) chose referral to leisure centre, and 15% (n = 3) chose cardiac rehabilitation. In Phase II, 32% (n = 12) consented, 25% (n = 3) chose leisure centre and 75% (n = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends. CONCLUSIONS: The current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity. TRIAL REGISTRATION: ISRCTN11183372.

Occupational Physical Activity Habits of UK Office Workers: Cross-Sectional Data from the Active Buildings Study.

Habitual behaviours are learned responses that are triggered automatically by associated environmental cues. The unvarying nature of most workplace settings makes workplace physical activity a prime candidate for a habitual behaviour, yet the role of habit strength in occupational physical activity has not been investigated. Aims of the present study were to: (i) document occupational physical activity habit strength; and (ii) investigate associations between occupational activity habit strength and occupational physical activity levels. A sample of UK office-based workers (n = 116; 53% female, median age 40 years, SD 10.52) was fitted with activPAL accelerometers worn for 24 h on five consecutive days, providing an objective measure of occupational step counts, stepping time, sitting time, standing time and sit-to-stand transitions. A self-report index measured the automaticity of two occupational physical activities (“being active” (e.g., walking to printers and coffee machines) and “stair climbing”). Adjusted linear regression models investigated the association between occupational activity habit strength and objectively-measured occupational step counts, stepping time, sitting time, standing time and sit-to-stand transitions. Eighty-one per cent of the sample reported habits for “being active”, and 62% reported habits for “stair climbing”. In adjusted models, reported habit strength for “being active” were positively associated with average occupational sit-to-stand transitions per hour (B = 0.340, 95% CI: 0.053 to 0.627, p = 0.021). “Stair climbing” habit strength was unexpectedly negatively associated with average hourly stepping time (B = −0.01, 95% CI: −0.01 to −0.00, p = 0.006) and average hourly occupational step count (B = −38.34, 95% CI: −72.81 to −3.88, p = 0.030), which may reflect that people with stronger stair-climbing habits compensate by walking fewer steps overall. Results suggest that stair-climbing and office-based occupational activity can be habitual. Interventions might fruitfully promote habitual workplace activity, although, in light of potential compensation effects, such interventions should perhaps focus on promoting moderate-intensity activity.

Associations between the Objectively Measured Office Environment and Workplace Step Count and Sitting Time: Cross-Sectional Analyses from the Active Buildings Study.

Office-based workers spend a large proportion of the day sitting and tend to have low overall activity levels. Despite some evidence that features of the external physical environment are associated with physical activity, little is known about the influence of the spatial layout of the internal environment on movement, and the majority of data use self-report. This study investigated associations between objectively-measured sitting time and activity levels and the spatial layout of office floors in a sample of UK office-based workers. Participants wore activPAL accelerometers for at least three consecutive workdays. Primary outcomes were steps and proportion of sitting time per working hour. Primary exposures were office spatial layout, which was objectively-measured by deriving key spatial variables: 'distance from each workstation to key office destinations', 'distance from participant's workstation to all other workstations', 'visibility of co-workers', and workstation 'closeness'. 131 participants from 10 organisations were included. Fifty-four per cent were female, 81% were white, and the majority had a managerial or professional role (72%) in their organisation. The average proportion of the working hour spent sitting was 0.7 (SD 0.15); participants took on average 444 (SD 210) steps per working hour. Models adjusted for confounders revealed significant negative associations between step count and distance from each workstation to all other office destinations (e.g., B = -4.66, 95% CI: -8.12, -1.12, p < 0.01) and nearest office destinations (e.g., B = -6.45, 95% CI: -11.88, -0.41, p < 0.05) and visibility of workstations when standing (B = -2.35, 95% CI: -3.53, -1.18, p < 0.001). The magnitude of these associations was small. There were no associations between spatial variables and sitting time per work hour. Contrary to our hypothesis, the further participants were from office destinations the less they walked, suggesting that changing the relative distance between workstations and other destinations on the same floor may not be the most fruitful target for promoting walking and reducing sitting in the workplace. However, reported effect sizes were very small and based on cross-sectional analyses. The approaches developed in this study could be applied to other office buildings to establish whether a specific office typology may yield more promising results.

Supportive environments for physical activity in deprived communities in the United Kingdom: A qualitative study using photo elicitation.

The health benefits of regular physical activity are substantial and well-established. However, population activity levels are insufficient to obtain health benefits in the United Kingdom (UK), and strategies to increase activity, particularly in income-deprived communities, are sought. Socioecological models of physical activity posit that activity levels are influenced by social, physical and wider environmental factors. In line with a growing evidence base, there is a need to understand the factors that contribute to an activity-supportive neighbourhood within deprived settings within the UK. This study used photo-elicitation qualitative interviews to explore environmental facilitators and barriers to neighbourhood-based, outdoor physical activity in 23 adults living in two income-deprived neighbourhoods in Glasgow, UK. Data were collected between June and October 2015, and were explored using thematic analysis. Five themes were identified: 'diversity of destinations in the neighbourhood', 'provision of services to support healthy environments', 'ownership of public space and facilities to encourage physical activity', 'collective control of public space to prevent disorder' and 'perceived value of the neighbourhood'. Findings highlighted the close interaction between these themes and more broadly between social and physical facets of neighbourhood environments that were unsupportive of physical activity. Discourse about economic aspects was pervasive and emerged as deeply affecting characteristics of the social and physical environment and upstream influences on physical activity. This study supports evidence that multi-faceted interventions addressing aspects of the social, physical and economic environment may be needed to support outdoor physical activity in deprived communities.

Cross-sectional interactions between quality of the physical and social environment and self-reported physical activity in adults living in income-deprived communities.

BACKGROUND: Understanding the environmental determinants of physical activity in populations at high risk of inactivity could contribute to the development of effective interventions. Socioecological models of activity propose that environmental factors have independent and interactive effects of physical activity but there is a lack of research into interactive effects. OBJECTIVES: This study aimed to explore independent and interactive effects of social and physical environmental factors on self-reported physical activity in income-deprived communities. METHODS: Participants were 5,923 adults in Glasgow, United Kingdom. Features of the social environment were self-reported. Quality of the physical environment was objectively-measured. Neighbourhood walking and participation in moderate physical activity [MPA] on ≥5 days/week was self-reported. Multilevel multivariate logistic regression models tested independent and interactive effects of environmental factors on activity. RESULTS: 'Social support' (walking: OR:1.22,95%CI = 1.06-1.41,p<0.01; MPA: OR:0.79,95%CI = 0.67-0.94,p<0.01), 'social interaction' (walking: OR:1.25,95%CI = 1.10-1.42,p<0.01; MPA: OR:6.16,95%CI = 5.14-7.37,p<0.001) and 'cohesion and safety' (walking: OR:1.78,95%CI = 1.56-2.03,p<0.001; MPA: OR:1.93,95%CI = 1.65-2.27,p<0.001), but not 'trust and empowerment', had independent effects on physical activity. 'Aesthetics of built form' (OR:1.47,95%CI = 1.22-1.77,p<0.001) and 'aesthetics and maintenance of open space' (OR:1.32, 95%CI = 1.13-1.54,p<0.01) were related to walking. 'Physical disorder' (OR:1.63,95%CI = 1.31-2.03,p<0.001) had an independent effect on MPA. Interactive effects of social and physical factors on walking and MPA were revealed. CONCLUSIONS: Findings suggest that intervening to create activity-supportive environments in deprived communities may be most effective when simultaneously targeting the social and physical neighbourhood environment.