Developing a theory-driven framework for a football intervention for men with severe, moderate or enduring mental health problems: a participatory realist synthesis.

Background: Physical activity interventions are an important adjunct therapy for people with severe to moderate and/or enduring mental health problems. Football is particularly popular for men in this group. Several interventions have emerged over the past decade and there is a need to clearly articulate how they are intended to work, for whom and in what circumstances.Aims: To develop a theory-driven framework for a football intervention for men with severe, moderate and/or enduring mental health problems using a participatory realist approach.Methods: A participatory literature review on playing football as a means of promoting mental health recovery with a realist synthesis. It included the accounts and input of 12 mental health service users and the contributions of other stakeholders including football coaches and occupational therapists.Results: Fourteen papers were included in the review. Analysis revealed that interventional mechanisms were social connectedness, identity security, normalising experiences and positive affectivity. These supported mental health recovery. Outcomes were moderated by social stigma and several interventional factors such as over-competitiveness.Conclusions: The context mechanism outcome configuration framework for these interventions map well onto social models of mental health recovery and provide insight into how they work. This now requires testing.

Participant experiences in a feasibility trial of supervised exercise training in adults with venous leg ulcers: A qualitative study.

Exercise training can improve lower-limb cutaneous microvascular reactivity in adults with venous leg ulceration; however, there is a lack of research on patients' views about the acceptability and feasibility of exercise interventions. The aim of this study was to explore participants' experiences of the trial "Exploring the Feasibility of Implementing a Supervised Exercise Training and Compression Hosiery Intervention in Patients with Venous Ulceration" (FISCU). Semi-structured face-to-face and telephone interviews were used to investigate participants' experiences (n = 16) of taking part in the FISCU trial. Data were analysed using thematic analysis. Three overarching themes were identified, along with 11 sub-themes: (a) sedentary cautious living (because of pain and reduced mobility, treatment and perceived control, and advice to rest and be careful), (b) key components of the exercise trial (including motivation, an individualised intervention supervised by a specialist exercise professional, and satisfaction with the intervention), and (c) benefits of exercise (physical benefits and healing, psychological well-being, positive impact on comorbidities, and an improved self-management strategy). This study found that an exercise intervention was viewed by participants as positive, acceptable, and feasible while living with a venous leg ulcer. An individualised and supervised exercise programme was key to build confidence to exercise.

Effects of supervised exercise training on lower-limb cutaneous microvascular reactivity in adults with venous ulcers.

PURPOSE: To investigate the effects of a 12-week supervised exercise programme on lower-limb cutaneous microvascular reactivity in adults with venous leg ulceration. METHODS: Thirty-eight adults with unilateral venous ulceration who were being treated with lower-limb compression therapy (58% male; mean age 65 years; median ulcer size 5 cm2) were randomly allocated to exercise or control groups. Exercise participants (n = 18) were invited to attend thrice weekly sessions of lower-limb aerobic and resistance exercise for 12 weeks. Cutaneous microvascular reactivity was assessed in the gaiter region of ulcerated and non-ulcerated legs at baseline and 3 months using laser Doppler fluxmetry coupled with iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). Cutaneous vascular conductance (CVC) was calculated as laser Doppler flux (AU)/mean arterial pressure (mmHg). RESULTS: Thirty-seven participants completed follow-up assessments. Median session attendance was 36 (range 2-36). Analyses of covariance revealed greater peak CVC responses to ACh in the exercise group at 3 months in both the ulcerated (adjusted difference = 0.944 AU/mmHg; 95% CI 0.504-1.384) and non-ulcerated (adjusted difference = 0.596 AU/mmHg; 95% CI 0.028-1.164) legs. Peak CVC responses to SNP were also greater in the exercise group at 3 months in the ulcerated leg (adjusted difference = 0.882 AU/mmHg; 95% CI 0.274-1.491), but not the non-ulcerated leg (adjusted difference = 0.392 AU/mmHg; 95% CI - 0.377 to 1.161). CONCLUSION: Supervised exercise training improves lower-limb cutaneous microvascular reactivity in adults with venous leg ulceration.

Sheffield Hallam Staff Wellness service: Four-year follow-up of the impact on health indicators.

AIMS: Alongside the increasing prevalence of chronic health conditions such as cardiovascular disease and diabetes has been an increase in interventions to reverse these ill-health trends. The aim of this study was to examine the longitudinal impact of the Sheffield Hallam University Staff Wellness Service on health indicators over a five-year period. METHODS: The Sheffield Hallam Staff Wellness Service was advertised to university employees. Of 2651 employees who have attended the service, 427 respondents (male = 162, female = 265) aged 49.86 ± 12.26 years attended for five years (4 years follow-up). Each year, participants were assessed on a range of health measures (i.e. cardio-respiratory fitness, body mass index, blood pressure, total cholesterol, high-density lipoproteins, lung function and percentage body fat). Participants also received lifestyle advice (based on motivational interviewing) as part of the intervention to either improve, or in some cases maintain, their current health behaviours (e.g. increased physical activity and diet change). RESULTS: The wellness service improved staff health for those with an 'at risk' health profile from baseline. These improvements were maintained in subsequent follow-up assessments. Improvement from baseline to 1-year follow-up was observed for all health indicators as was the maintenance of this improvement in years 2, 3 and 4. CONCLUSIONS: The service demonstrates that a university-based wellness service using a combination of motivational interviewing and health screening to elicit behaviour change (and subsequent improvements in health-related outcomes) was successful in improving the health of employees with an 'at risk' profile.

A randomised controlled trial and cost-effectiveness evaluation of 'booster' interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods.

BACKGROUND: More evidence is needed on the potential role of 'booster' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary populations. OBJECTIVES: To determine whether objectively measured physical activity, 6 months after a brief intervention, is increased in those receiving physical activity 'booster' consultations delivered in a motivational interviewing (MI) style, either face to face or by telephone. DESIGN: Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with nested qualitative research fidelity and geographical information systems and health economic substudies. Treatment allocation was carried out using a web-based simple randomisation procedure with equal allocation probabilities. Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only. SETTING: Deprived areas of Sheffield, UK. PARTICIPANTS: Previously sedentary people, aged 40-64 years, living in deprived areas of Sheffield, UK, who had increased their physical activity levels after receiving a brief intervention. INTERVENTIONS: Participants were randomised to the control group (no further intervention) or to two sessions of MI, either face to face ('full booster') or by telephone ('mini booster'). Sessions were delivered 1 and 2 months post-randomisation. MAIN OUTCOME MEASURES: The primary outcome was total energy expenditure (TEE) per day in kcal from 7-day accelerometry, measured using an Actiheart device (CamNtech Ltd, Cambridge, UK). Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment. An estimate of the per-participant intervention costs, resource use data collected by questionnaire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective. An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness. RESULTS: In total, 282 people were randomised (control = 96; mini booster = 92, full booster = 94) of whom 160 had a minimum of 4 out of 7 days' accelerometry data at 3 months (control = 61, mini booster = 47, full booster = 52). The mean difference in TEE per day between baseline and 3 months favoured the control arm over the combined booster arm but this was not statistically significant (-39 kcal, 95% confidence interval -173 to 95, p = 0.57). The autonomy-enabled MI communication style was generally acceptable, although some participants wanted a more paternalistic approach and most expressed enthusiasm for monitoring and feedback components of the intervention and research. Full boosters were more popular than mini boosters. Practitioners achieved and maintained a consistent level of MI competence. Walking distance to the nearest municipal green space or leisure facilities was not associated with physical activity levels. Two alternative modelling approaches both suggested that neither intervention was likely to be cost-effective. CONCLUSIONS: Although some individuals do find a community-based, brief MI 'booster' intervention supportive, the low levels of recruitment and retention and the lack of impact on objectively measured physical activity levels in those with adequate outcome data suggest that it is unlikely to represent a clinically effective or cost-effective intervention for the maintenance of recently acquired physical activity increases in deprived middle-aged urban populations. Future research with middle-aged and relatively deprived populations should explore interventions to promote physical activity that require less proactive engagement from individuals, including environmental interventions. STUDY REGISTRATION: Current Controlled Trials ISRCTN56495859, ClinicalTrials.gov NCT00836459. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 13. See the NIHR Journals Library website for further project information.

Pragmatic exercise intervention in people with mild to moderate multiple sclerosis: a randomised controlled feasibility study.

BACKGROUND: People with Multiple Sclerosis (PwMS) are less physically active than the general population and pragmatic approaches designed to equip them with the skills and confidence to participate in long-term physical activity are required. OBJECTIVE: The objective of this study was to determine the feasibility of a pragmatic exercise intervention in PwMS. METHODS: A voluntary sample of 30 PwMS (male n = 4, female n = 26; mean age = 40 years; range = 24-49 years), with mild to moderate disability (EDSS ≤ 5.5), were recruited from eligible participants attending outpatient clinics. A total of 28 participants were randomised to a 10 week pragmatic exercise intervention (2× supervised and 1× home-based session per week) or usual care. Clinical, functional and quality of life (MSQoL-54) outcomes were assessed at baseline, immediately and 3 months after the intervention. RESULTS: Attrition was low (2 participants lost to immediate follow-up and 4 participants lost to 3 month follow-up), with high compliance rates (>75% of all sessions). The intervention group achieved progression of exercise volume (24.3 ± 7.0 to 30.9 ± 5.5 min per session), intensity (60.4 ± 8.8 to 67.7 ± 6.9% HR max) and training impulse (min × average HR=training impulse/load [arbitrary units; AU]) (2600 ± 1105 to 3210 ± 1269AU) during the intervention, whilst significantly increasing(P = 0.050) their physical composite score (MSQOL-54) at 10 weeks and readiness to exercise (P = 0.003) at 3 months compared with usual care. CONCLUSION: This pragmatic intervention was feasible for PwMS, but further research is needed to assess its long-term impact on physical activity behaviour.