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A perceived ‘lack of time’ is consistently the most commonly reported barrier to exercise. However, the term fails to capture the multifaceted nature of time-related factors. Recognising the need for a more comprehensive analysis of ‘lack of time’ as a barrier to exercise, the aim of this study was to develop the exercise participation explained in relation to time (EXPERT) model. The model was developed through a sequential process including (1) an umbrella literature review of time as a barrier, determinant, and correlate of physical activity; (2) a targeted review of existing temporal models; (3) drafting the model and refining it via discussions between eight authors; (4) a three-round Delphi process with eight panel members; and (5) consultations with seven experts and potential end-users. The final EXPERT model includes 31 factors within four categories: (1) temporal needs and preferences for exercise (ie, when and how long does an individual need/want to exercise), (2) temporal autonomy for exercise (ie, autonomy in scheduling free time for exercise), (3) temporal conditions for exercise (ie, available time for exercise) and (4) temporal dimensions of exercise (ie, use of time for exercise). Definitions, examples and possible survey questions are presented for each factor. The EXPERT model provides a comprehensive framework for understanding the multi-dimensional nature of ‘time’ as it relates to exercise participation. It moves beyond the simplistic notion of 'lack of time' and delves into the complexity of time allocation in the context of exercise. Empirical and cross-cultural validations of the model are warranted.

ObjectivesTo evaluate the effect of a coaching intervention compared with control on physical activity and falls rate at 12 months in community-dwelling people aged 60+ years.DesignCluster randomised controlled trial.SettingCommunity-dwelling older people.Participants72 clusters (605 participants): 37 clusters (290 participants) randomised to the intervention and 35 (315 participants) to control.InterventionIntervention group received written information, fall risk assessment and prevention advice by a physiotherapist, activity tracker and telephone-based coaching from a physiotherapist focused on safe physical activity. Control group received written information and telephone-based dietary coaching. Both groups received up to 19 sessions of telephone coaching over 12 months.OutcomesThe co-primary outcomes were device-measured physical activity expressed in counts per minute at 12 months and falls rate over 12 months. Secondary outcomes included the proportion of fallers, device-measured daily steps and moderate-to-vigorous physical activity (MVPA), self-reported hours per week of physical activity, body mass index, eating habits, goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being and disability.ResultsThe mean age of participants was 74 (SD 8) years, and 70% (n=425) were women. There was no significant effect of the intervention on device-measured physical activity counts per minute (mean difference 5 counts/min/day, 95% CI −21 to 31), or falls at 12 months (0.71 falls/person/year in intervention group and 0.87 falls/person/year in control group; incidence rate ratio 0.86, 95% CI 0.65 to 1.14). The intervention had a positive significant effect on device-measured daily steps and MVPA, and self-reported hours per week of walking, well-being, quality of life, and disability. No significant between-group differences were identified in other secondary outcomes.ConclusionA physical activity and fall prevention programme including fall risk assessment and prevention advice, plus telephone-based health coaching, did not lead to significant differences in physical activity counts per minute or falls rate at 12 months. However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability.Trial registration numberACTRN12615001190594.

Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts. Data on quitting outcomes were obtained from weekly cross‐sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population‐level potential campaign exposure was measured by time and dose. Using multivariate analyses, a positive association between potential exposure to ‘hope’ campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to ‘sadness’ evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt. This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population‐wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns.

Physical activity is accepted worldwide as a public health priority. A physically active lifestyle has been shown to significantly reduce the risk of developing cardiovascular disease, obesity, type 2 diabetes [...], Background. Physical inactivity is a major risk factor for chronic disease. Primary health care practitioners are well placed to promote a physically active lifestyle. The perceptions and practice of physical therapists on their role in physical activity promotion are not well known. Objective. The objective of this study was to determine the knowledge, confidence, role perception, barriers, feasibility, and counseling practice of physical therapists and physical therapist students regarding the promotion of nontreatment physical activity for better health. Design. A cross-sectional survey was conducted. Methods. In 2008, 321 (54%) of a random sample of all physical therapists registered in New South Wales, Australia, responded to a survey on their knowledge, confidence, role perception, barriers, feasibility, and counseling practice with regard to promoting a physically active lifestyles to their patients. Physical therapist students (n=279) completed the same survey but without the questions on barriers and counseling practice. Results. Physical therapists and physical therapist students consider that it is part of their role to give their patients nontreatment physical activity advice. Overall, they reported having adequate knowledge and skills to undertake this role. Incorporating advice into normal consultations is deemed the most feasible form of lifestyle physical activity promotion in physical therapist practice. Limitations. The cross-sectional nature of this study makes it difficult to determine cause and effect relationships. Some selection bias may have occurred, as the physical therapists who completed the questionnaires may have been those most interested in physical activity promotion. Conclusions. Physical therapist practice appears to be an excellent avenue for promoting a physically active lifestyle and could potentially play an important public health role.

OBJECTIVE--Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for the development of type 2 diabetes in the mother and is responsible for morbidity in the child. To better [...]

OBJECTIVE--In this study, we examined patterns of postpartum physical activity among women with recent gestational diabetes mellitus (GDM) and psychosocial factors related to this behavior that could be addressed in [...]

The importance of a credible source of information in mass media campaigns intended towards promotion of public health is discussed. This is analyzed through the study of a sun protection campaign launched in New South Wales, Australia.

The magnitude of access block and its trend over time in New South Wales hospitals, (NSW) using different definitions of access block, and to explore its association with clinical and non-clinical factors is estimated. The study concluded that access block continues to increase across NSW and that hospitals in NSW and Australia move to the use of one standard definition of access block.

Research shows that the energy expenditure during self-paced physical activities can be reliably determined with precision. The energy expenditure data are expressed as a multiple of measured resting metabolic rate, which gives higher values than those obtained from MET.

ObjectiveTo investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults.DesignSystematic review.Data sourcesMedline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022).Eligibility criteria for study selectionEconomic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes versus no intervention or usual care for older adults living in the community or care facilities, and reporting incremental cost-effectiveness ratio (ICER) for fall-related outcomes or quality-adjusted life years (QALY, expressed as cost/QALY) and/or intervention costs.Results31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$100 000/QALY), most results (17/24) were considered cost-effective (moderate certainty). The greatest value for money (lower ICER/QALY gained and fall prevented) appeared to accrue for older adults and those with high fall risk, but unsupervised exercise appeared to offer poor value for money (higher ICER/QALY). For care facilities (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported.ConclusionsMost economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising.PROSPERO registration numberPROSPERO 2020 CRD42020178023.

ObjectivesTo assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.MethodsA cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.ResultsOverall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001).ConclusionA multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617001265369).

Stressful national and international sporting events are noted to trigger cardiac events or sudden death. A review of whether watching football increases the population cardiac event risk in New South Wales shows that Australians appear to be resistant to acute stressors associated with watching sporting events, possibly due to higher rates of motivational deficiency disorder (MoDeD) than in European populations.

About 40% of households in Australia have a dog for a pet. While some previous studies have shown the beneficial psychological effects of pet ownership, leading to physiological benefits, the current article describes a study focusing on the beneficial health effects of having to walk the dog. Although over half of dog owners in the study admitted to never walking their dogs, the researchers calculate that if all dog owners did walk their dogs, those owners would be healthier, and the result would be a $175 million/year saving in healthcare costs in Australia.

The importance of moderate physical activity in extending the active part of life of elderly people is discussed, with focus on the prevention of disease and preservation of mental health.

The amount of material on physical acitivity, hypercholesterolemia, hypertension, the management of smoking, in journals and magazines frequently read by this group was investigated through qualitative study of the total number of articles and advertisements. Only 6% of the cardiovascular disease (CVD) risk factors articles in the Medline search and 5% in the medical magazine search covered prescribing exercise or ways to start and keep up exercise programs. GPs are less well informed by these sources about physical activity than about other traditional CVD risk factors.

The authors address criticism of the Australian Government's childhood obesity-prevention strategy and its adoption of community-wide preventive measures. They argue that research data on the prevalence of childhood obesity and the associated health issues demonstrates that Australia's growing obesity problem is a major health concern that needs a well-structured policy response.

Patient-centered care is an important and evidence-based concept for improving health outcomes for people with chronic disease in primary-care practice. Four issues, which should be implemented for patient-care to become standard, are described.

This article discusses the merits of the international physical activity questionnaire for using it in population surveys for measuring physical activity. Research reveals that the methodology yields reasonable measurements of physical activity among 18- to 65-year old adults in a diverse population.

ObjectiveTo investigate the association of running participation and the dose of running with the risk of all-cause, cardiovascular and cancer mortality.DesignSystematic review and meta-analysis.Data sourcesJournal articles, conference papers and doctoral theses indexed in Academic Search Ultimate, CINAHL, Health Source: Nursing/Academic Edition, MasterFILE Complete, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus and Web of Science.Eligibility criteria for selecting studiesProspective cohort studies on the association between running or jogging participation and the risk of all-cause, cardiovascular and/or cancer mortality in a non-clinical population of adults were included.ResultsFourteen studies from six prospective cohorts with a pooled sample of 232 149 participants were included. In total, 25 951 deaths were recorded during 5.5–35 year follow-ups. Our meta-analysis showed that running participation is associated with 27%, 30% and 23% lower risk of all-cause (pooled adjusted hazard ratio (HR)=0.73; 95% confidence interval (CI) 0.68 to 0.79), cardiovascular (HR=0.70; 95% CI 0.49 to 0.98) and cancer (HR=0.77; 95% CI 0.68 to 0.87) mortality, respectively, compared with no running. A meta-regression analysis showed no significant dose–response trends for weekly frequency, weekly duration, pace and the total volume of running.ConclusionIncreased rates of participation in running, regardless of its dose, would probably lead to substantial improvements in population health and longevity. Any amount of running, even just once a week, is better than no running, but higher doses of running may not necessarily be associated with greater mortality benefits.

In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancetseries on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancetseries and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an ‘upstream’ public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as ‘roadmaps’ in progress to encourage moving the field of physical activity towards achieving population-level impact globally.

ObjectivesPhysical activity guidelines are evidence-based statements on recommended physical activity levels for good health. Guidelines, in isolation, are unlikely to increase population levels of physical activity; appropriate and effective communication is fundamental to maximising their impact. The aim of this paper is to provide a planning framework for physical activity guideline communication, including an overview of key audiences, aims and approaches.MethodsAll authors considered and agreed on the three broad issues to address by consensus. We identified key sources of evidence through scoping of the literature and our knowledge of the research area.ResultsWhether guidelines are global or national, communication of the physical activity guidelines should be informed by: (1) a situational analysis that considers the context in which the communication will take place and (2) a stakeholder analysis to determine the key target audiences for the communication and their values, needs and preferences. Audiences include policy-makers within and outside the health sector, other key stakeholders, the general public, specific population subgroups, health professionals and non-health professionals with a role in physical activity promotion. The aims and approach to communication will differ depending on the target audience.ConclusionCommunication to raise awareness and knowledge of the physical activity guidelines must be supported by policies, environments and opportunities for physical activity. Besides the intrinsic value of the physical activity guidelines, it is essential that substantial effort is put in to diligently planning, funding and implementing their communication from the outset.

The purpose of this study was to review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults. The conclusion states that the newly reported studies tend to take a broader ecological approach to understanding the correlates of PA.

Sedentary behaviour (SB) has been proposed as an ‘independent’ risk factor for chronic disease risk, attracting much research and media attention. Many countries have included generic, non-quantitative reductions in SB in their public health guidelines and calls for quantitative SB targets are increasing. The aim of this narrative review is to critically evaluate key evidence areas relating to the development of guidance on sitting for adults. We carried out a non-systematic narrative evidence synthesis across seven key areas: (1) definition of SB, (2) independence of sitting from physical activity, (3) use of television viewing as a proxy of sitting, (4) interpretation of SB evidence, (5) evidence on ‘sedentary breaks’, (6) evidence on objectively measured sedentary SB and mortality and (7) dose response of sitting and mortality/cardiovascular disease. Despite research progress, we still know little about the independent detrimental health effects of sitting, and the possibility that sitting is mostly the inverse of physical activity remains. Unresolved issues include an unclear definition, inconsistencies between mechanistic and epidemiological studies, over-reliance on surrogate outcomes, a very weak epidemiological evidence base to support the inclusion of ‘sedentary breaks’ in guidelines, reliance on self-reported sitting measures, and misinterpretation of data whereby methodologically inconsistent associations are claimed to be strong evidence. In conclusion, public health guidance requires a consistent evidence base but this is lacking for SB. The development of quantitative SB guidance, using an underdeveloped evidence base, is premature; any further recommendations for sedentary behaviour require development of the evidence base and refinement of the research paradigms used in the field.

ObjectiveTo examine whether the associations between sedentary behaviours (ie, daily sitting/TV-viewing time) and mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity (PA).DesignHarmonised meta-analysis of prospective cohort studies. Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sedentary behaviours and into quartiles of PA (MET-hour/week).Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus and Scopus.Eligibility criteria for selecting studiesIndividual level data on both sedentary behaviours and PA and reported effect estimates for CVD or cancer mortality.ResultsNine studies (n=850 060; deaths=25 730) and eight studies (n=777 696; deaths=30 851) provided data on sitting time and CVD and cancer mortality, respectively. Five studies had data on TV-viewing time and CVD (n=458 127; deaths=13 230) and cancer (n=458 091; deaths=16 430) mortality. A dose–response association between sitting time (9%–32% higher risk; p for trend <0.001) and TV time (3%–59% higher risk; p for trend <0.001) with CVD mortality was observed in the ‘inactive’, lowest quartile of PA. Associations were less consistent in the second and third quartiles of PA, and there was no increased risk for CVD mortality with increasing sedentary behaviours in the most active quartile. Associations between sedentary behaviours and cancer mortality were generally weaker; 6%–21% higher risk with longer sitting time observed only in the lowest quartile of PA.ConclusionPA modifies the associations between sedentary behaviours and CVD and cancer mortality. These findings emphasise the importance of higher volumes of moderate and vigorous activity to reduce, or even eliminate these risks, especially for those who sit a lot in their daily lives.

Background:The Mamil (middle‐aged man in Lycra) appears to be an emergent cycling‐focused species. Objectives:To explore the nature and distribution of the Mamilian species; to determine whether rates of cycling by middle‐aged men in Australia have changed since the pre‐Mamilian era. Setting:Secondary analysis of representative population‐based datasets. National sport participation data from the Exercise, Recreation and Sport (2002–2004, 2008–2010) and Ausplay surveys (2016) were analysed to assess trends in recreational and exercise‐related cycling, including by middle‐aged men (45–64 years of age). Data from New South Wales Population Health Surveys (2006, 2010, 2014) and Australian censuses (2006, 2011, 2014) were analysed to assess trends in cycling to work. Main outcome measures:Cycling participation rates (at least once or at least once a week in the past 12 months); rates of cycling to work. Results:The proportion of middle‐aged men who cycled for exercise or recreational purposes at least once a week during the previous year increased from 6.2% (95% CI, 5.5–7.0%) during 2002–2004 to 13.2% (95% CI, 11.9–14.6%) in 2016. The prevalence of Mamils in the most affluent residential areas has more than doubled since 2002–2004, and is twice as high as in the least advantaged locations. Media reports of “Mamils” corroborate these temporal trends. Discussion:Mamils in Australia are socially graded, and also grade themselves according to bicycle‐related expenditure and hill gradients overcome. They often form cohesive and supportive groups, but may not reflect a population‐wide social movement to increase physical activity among adult Australians.

The article describes the various health benefits of cycling, which is otherwise used as a regular physical activity in Australia. The results prove that continuous cycling often leads to reduction in mortality and cardiovascular risk among Finnish women and Chinese adults.

ObjectiveTo synthesise the literature on the effects of neighbourhood environmental change through residential relocation on physical activity, walking and travel behaviour.DesignSystematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42017077681).Data sourcesElectronic databases for peer-reviewed and grey literature were systematically searched to March 2017, followed by forward and backward citation tracking.Eligibility criteriaA study was eligible for inclusion if it (1) measured changes in neighbourhood built environment attributes as a result of residential relocation (either prospectively or retrospectively); (2) included a measure of physical activity, walking, cycling or travel modal change as an outcome; (3) was quantitative and (4) included an English abstract or summary.ResultsA total of 23 studies was included in the review. Among the eight retrospective longitudinal studies, there was good evidence for the relationship between relocation and walking (consistency score (CS)>90%). For the 15 prospective longitudinal studies, the evidence for the effects of environmental change/relocation on physical activity or walking was weak to moderate (CS mostly <45%), even weaker for effects on other outcomes, including physical activity, cycling, public transport use and driving. Results from risk of bias analyses support the robustness of the findings.ConclusionThe results are encouraging for the retrospective longitudinal relocation studies, but weaker evidence exists for the methodologically stronger prospective longitudinal relocation studies. The evidence base is currently limited, and continued longitudinal research should extend the plethora of cross-sectional studies to build higher-quality evidence.

Issues concerning the benefits of physical activity as a protection against heart disease are discussed.

Both progress and problems are to be found the the use of asthma management plans in Australia, and in time research on the usefulness, effectiveness and applicability of the Australian Asthma Management Plan will likely improve quality of life for those with asthma. The plan was written as an expert consensus statement for is not evidence-based. The highest rate of possession of an AMP has been seen in those with a specialist and a GP, and once again the benefits of integrated care are seen.

BackgroundAlthough certain types of sedentary behaviour have been linked to metabolic risk, prospective studies describing the links between sitting with incident diabetes are scarce and often do not account for baseline adiposity. We investigate the associations between context-specific sitting and incident diabetes in a cohort of mid-aged to older British civil servants.MethodsUsing data from the Whitehall II study (n=4811), Cox proportional hazards models (adjusted for age, sex, ethnicity, employment grade, smoking, alcohol intake, fruit and vegetable consumption, self-rated health, physical functioning, walking and moderate-to-vigorous physical activity, and body mass index (BMI)) were fitted to examine associations between total sitting and context–specific sitting time (work, television (TV), non-TV leisure time sitting at home) at phase 5 (1997–1999) and fasting glucose-defined incident diabetes up to 2011.ResultsTotal sitting (HR of the top compared with the bottom group: 1.26; 95% CI 1.00 to 1.62; p=0.01) and TV sitting (1.33; 95% CI 1.03 to 1.88; p=0.05) showed associations with incident diabetes; once BMI was included in the model these associations were attenuated for both total sitting (1.19; 95% CI 0.92 to 1.55; p=0.22) and TV sitting (1.31; 95% CI 0.96 to 1.76; p=0.14).ConclusionWe found limited evidence linking sitting and incident diabetes over 13 years in this occupational cohort of civil servants.

IMPORTANCE: Few studies have examined how different proportions of moderate and vigorous physical activity affect health outcomes. OBJECTIVE: To examine whether the proportion of total moderate to vigorous activity (MVPA) that is achieved through vigorous activity is associated with all-cause mortality independently of the total amount of MVPA. DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study with activity data linked to all-cause mortality data from February 1, 2006, through June 15, 2014, in 204 542 adults aged 45 through 75 years from the 45 and Up population-based cohort study from New South Wales, Australia (mean [SD] follow-up, 6.52 [1.23] years). Associations between different contributions of vigorous activity to total MVPA and mortality were examined using Cox proportional hazards models, adjusted for total MVPA and sociodemographic and health covariates. EXPOSURES: Different proportions of total MVPA as vigorous activity. Physical activity was measured with the Active Australia Survey. MAIN OUTCOMES AND MEASURES: All-cause mortality during the follow-up period. RESULTS: During 1 444 927 person-years of follow-up, 7435 deaths were registered. Compared with those who reported no MVPA (crude death rate, 8.34%), the adjusted hazard ratios for all-cause mortality were 0.66 (95% CI, 0.61-0.71; crude death rate, 4.81%), 0.53 (95% CI, 0.48-0.57; crude death rate, 3.17%), and 0.46 (95% CI, 0.43-0.49; crude death rate, 2.64%) for reporting 10 through 149, 150 through 299, and 300 min/wk or more of activity, respectively. Among those who reported any MVPA, the proportion of vigorous activity revealed an inverse dose-response relationship with all-cause mortality: compared with those reporting no vigorous activity (crude death rate, 3.84%) the fully adjusted hazard ratio was 0.91 (95% CI, 0.84-0.98; crude death rate, 2.35%) in those who reported some vigorous activity (but &lt;30% of total activity) and 0.87 (95% CI, 0.81-0.93; crude death rate, 2.08%) among those who reported 30% or more of activity as vigorous. These associations were consistent in men and women, across categories of body mass index and volume of MVPA, and in those with and without existing cardiovascular disease or diabetes mellitus. CONCLUSIONS AND RELEVANCE: Among people reporting any activity, there was an inverse dose-response relationship between proportion of vigorous activity and mortality. Our findings suggest that vigorous activities should be endorsed in clinical and public health activity guidelines to maximize the population benefits of physical activity.

Self-reported rates of participation in sport vary by country. In the UK, about 40% of men and women aged 16 years or older participate in at least one sport every week. Although few data exist to assess trends for participation in sport, there is little evidence of change in the past decade among adults. Large cohort studies suggest that such participation in sport is associated with a 20–40% reduction in all-cause mortality compared with non-participation. Randomised trials and crossover clinical studies suggest that playing sport is associated with specific health benefits. Some sports have relatively high injury risk although neuromuscular training programmes can prevent various lower extremity injuries. Clinicians can influence a large number of patients through brief interventions that promote physical activity, and encouragement toward participation in sport for some physically inactive patients qualifies as evidence-based therapy. Exercise might also be considered as a fifth vital sign and should be recorded in patients' electronic medical records and routine histories.

Physical inactivity is an important contributor to non-communicable diseases in countries of high income, and increasingly so in those of low and middle income. Understanding why people are physically active or inactive contributes to evidence-based planning of public health interventions, because effective programmes will target factors known to cause inactivity. Research into correlates (factors associated with activity) or determinants (those with a causal relationship) has burgeoned in the past two decades, but has mostly focused on individual-level factors in high-income countries. It has shown that age, sex, health status, self-efficacy, and motivation are associated with physical activity. Ecological models take a broad view of health behaviour causation, with the social and physical environment included as contributors to physical inactivity, particularly those outside the health sector, such as urban planning, transportation systems, and parks and trails. New areas of determinants research have identified genetic factors contributing to the propensity to be physically active, and evolutionary factors and obesity that might predispose to inactivity, and have explored the longitudinal tracking of physical activity throughout life. An understanding of correlates and determinants, especially in countries of low and middle income, could reduce the effect of future epidemics of inactivity and contribute to effective global prevention of non-communicable diseases.

This study examined Australian athletes' support for athletes' role in promoting physical activity and obesity prevention, the acceptability of unhealthy products promotion in sport, and their own health behaviours. Surveys were conducted with (n = 1990) elite and sub-elite athletes recruited from 22 sports across Australia. Athletes' perceptions and behaviours were analysed across demographic and sport-related factors (e.g. individual vs team sport) and correlations calculated between perceptions and health behaviours. Most respondents supported a role for athletes in promoting physical activity and obesity prevention, and disagreed that athletes should promote unhealthy foods and alcohol (73.9%). Athletes reported low smoking rates, but high rates of binge drinking. Female, younger, individual and amateur athletes had more health-positive perceptions and healthier behaviours than older, male, team and professional athletes. More sympathy towards junk food and alcohol advertising in sport and less support for athletes as role models were associated with more unhealthy behaviours. Elite athletes are receptive to supporting health promotion through sport and many are not in agreement with the promotion of unhealthy products in sport or by sports people. Improving elite athletes' health behaviours would benefit not only the individual but also health promotion within elite sport. As key stakeholders in the debate, public health advocates and health policy makers could use support for health promotion among elite athletes to challenge the links between (especially male and team) sport and unhealthy behaviours currently reinforced by sponsorship and advertising of unhealthy products.

Purpose. To examine if a mass media campaign influenced walking differently in people in different physical environments.Design. Quasi-experimental study.Setting. Wheeling, West Virginia.Participants. Random sample of adults age 50 to 65 years, response rate: 72.1% (n = 719 in intervention community, n = 753 in comparison community).Intervention. Mass media campaign.Measures. Self-reported measures were used in before and after telephone surveys for walking and the physical environment. Measures included 11 environmental walkability items, from which two subscales (i.e., usable sidewalks/aesthetics and facilities) were extracted.Analysis. Multiple linear regression.Results. Overall, walking increased by 2.7 minutes per week (standard deviation [SD] = 231.1, not significant [NS]). When confined to those insufficiently active at baseline (i.e., <30 minutes per day) the minutes walked increased by 92.1 minutes (SD = 152.9, p < .001). For the insufficiently active at baseline in the top half of the environmental factor of usable sidewalks, walking increased by 19 minutes more than in the bottom half (NS). For the factor of aesthetics and facilities, people in the more walkable environment increased walking by 87 minutes more than those in the bottom half (p < .001).Conclusion. In this community-wide physical activity, intervention changes in walking after the campaign were significantly moderated by some environmental attributes. This contributes to the limited evidence on the impact of the environment in enhancing community physical activity interventions. This finding needs to be replicated in other community interventions with greater environmental variation.

Objective:Social gradients in Aboriginal health are seldom explored. This study describes social gradients and trends in smoking during pregnancy among Aboriginal mothers in NSW.

Organised sport provides an important setting for health promotion. Peak sporting organisations have a role in assisting and overseeing sports clubs, including providing funding opportunities. As such, sponsorship of these organisations may influence the funding of community sport. This study aimed to describe the nature and scope of peak sporting organisations' sponsorship, and particularly food and beverage company sponsors. An analysis of national and state sporting organisations' websites for the nine most popular sports for children and from four Australian states and territories was conducted using a structured survey tool. Information collected included the number and type of sponsors and sponsorship policies. The nature of food and beverage sponsors was defined as more healthy or less healthy using criteria from a Delphi survey. 443 sponsors were identified across 55 websites. Overall, 9% of sponsors were food companies and 3% were alcohol manufacturers. The majority of food companies (63%) and alcohol manufacturers (100%) did not meet criteria as healthy sponsors. Sponsorship of peak sporting organisations is widespread and consists of a relatively high proportion of alcohol manufacturers and food companies, some of which produce products considered to be unhealthy. This sponsorship may influence community sport through sponsored sporting programs or by indicating sponsors' acceptability. Policy interventions to reduce peak sporting organisations' reliance on unhealthy food and alcohol sponsorship may have broader implications on sponsorship at the community level by limiting the promotion of these products at sports clubs.

Introducing a new and free population-wide telephone service to assist adults to be more active, eat healthier and achieve a healthy weight requires large-scale marketing. The challenge is to understand the pattern of advertising that is effective at generating public awareness and interest in using the new service. A mass media campaign, consisting mainly of television advertising, was launched in March 2009 to promote the NSW Get Healthy Information and Coaching Service® (GHS). This included GHS-specific and re-badged National ‘Measure Up’ campaign television advertisements. The number of calls and website visits to the GHS were monitored during the first 10 months of the initiative. GHS participants were also asked where they heard about the service. Paid television advertising shows a dose-response relationship with contacts to the GHS. The 30-second GHS-specific advertising was significantly more effective at generating contacts compared to ‘Measure Up’ advertising, and compared to GHS advertising that involved the 15-second advertising. Participants were significantly more likely to report television advertising as their referral source during periods of GHS advertising when compared to ‘Measure up’ advertising. On-going marketing of state-wide prevention initiatives is necessary to achieve population-wide engagement. On the whole, specific GHS-promoting messages were more effective in recruiting participants than the re-badged national ‘Measure Up’ Campaign advertising. The relevance of the creative execution, the call to action and the length of time a viewer is exposed to the GHS details have an impact on the numbers of calls to the GHS. The implementation of a population-based support service requires sustained and tailored media messaging to promote its use, if higher population-wide use of the service is to be achieved.

Determining children's exposure to food and beverage company sponsorship, and the effect of this exposure, is important in establishing the extent to which there may be health and societal consequences. This paper aimed to provide preliminary evidence on the scope and potential effects on children of unhealthy food and beverage sponsorship. A review of published literature and media and marketing reports was conducted to determine the types of food and beverage sponsorship campaigns that children are exposed to, and the effect of corporate sponsorship (including tobacco and alcohol) on children and adolescents. A large range of food and beverage sponsorship activities, in Australia and internationally, were identified for both school and sport settings. In particular, food and beverage companies have attempted to develop a marketing presence at all levels of professional and community sport. No information was identified measuring the effect of food and beverage company sponsorship on children and adolescents. However, empirical evidence from consumer studies relating to tobacco and alcohol sponsorship has repeatedly demonstrated that sponsorship has an impact on children's product recall and product-related attitudes and behavioural intentions. While there is no available research on the direct effect of food and beverage sponsorship, the demonstrated effects of tobacco and alcohol sponsorship on children's product awareness, preferences and consumption are likely to be applicable to food companies. This paper suggests that sponsorship is a potentially significant marketing tool, and its prevalence and sophistication is increasing and diversifying. A range of policy and structural initiatives are possible to limit this sponsorship, including replacement sponsorship schemes.

Objective:Australian data indicate that 63% of children participated in sport in 2009, a 4% increase since 2000. Children's high participation in sport, and the association between sport and health, means that these settings provide an opportunity to promote other aspects of health, such as healthy eating, to children. This study aimed to determine healthy eating practices and policies at children's sports clubs.

Women with previous gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes; this risk is higher in nonCaucasian women. This study explored the beliefs, attitudes, social support, environmental influences and other factors related to diabetes risk behaviours among Arabic, Cantonese/Mandarin, and English speaking women with recent GDM. Women living in the Sydney metropolitan area (Australia) who had GDM 6–36 months previously were included. Indepth semistructured telephone interviews on women's experiences and perceptions of GDM and the lifestyle risk factors for developing type 2 diabetes were conducted in the language participants spoke at home (n=20 Arabic, 20 Cantonese/Mandarin, 17 English). Data were analysed for underlying themes using NVivo software. Mental distress, role perceptions, social support and cultural expectations were major issues related to women's struggles to find the right balance between the large proportion of household and child care responsibilities and leading a healthy lifestyle. Women's ability to follow a healthy lifestyle is embedded in their psychological wellbeing and the social and cultural context of their lives. The study highlights the need for a holistic approach that ensures personal support and access to services as well as lifestyle specific programs. Practitioners providing lifestyle prescriptions should take into account a woman's psychosocial and cultural context as well as the role played by family members.

This study examined the use of quantitative methods in Australian health promotion research in order to identify methodological trends and priorities for strengthening the evidence base for health promotion. Australian health promotion articles were identified by hand searching publications from 1992–2002 in six journals: Health Promotion Journal of Australia, Australian and New Zealand Journal of Public Health, Health Promotion International, Health Education Research, Health Education and Behavior and the American Journal of Health Promotion. The study designs and statistical methods used in articles presenting quantitative research were recorded. 591 (57.7%) of the 1,025 articles used quantitative methods. Cross-sectional designs were used in the majority (54.3%) of studies with pre- and post-test (14.6%) and post-test only (9.5%) the next most common designs. Bivariate statistical methods were used in 45.9% of papers, multivariate methods in 27.1% and simple numbers and proportions in 25.4%. Few studies used higher-level statistical techniques. While most studies used quantitative methods, the majority were descriptive in nature. The study designs and statistical methods used provided limited scope for demonstrating intervention effects or understanding the determinants of change. The use of more advanced quantitative methods could strengthen the evidence base for health promotion and help to address research questions of importance. The barriers to greater application of these methods need to be identified and overcome.

Purpose. This study examined the broader use of a print-media intervention, which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community, as a strategy suitable for a more diverse statewide population sample.Methods. Participants were randomly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to participate in a randomized controlled trial. Consenters were allocated to either intervention (n = 361) or control (n = 358) conditions. The intervention, a personalized letter plus stage-targeted booklets, was sent 1 week postbaseline. Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance (ANOVA) and χ2statistics.Results. The groups were similar at baseline (mean age 43 ± 3 years; 64% women). Process evaluation showed high intervention recall (76% at 2 months) and high follow-up response rates (>85% at 8 months) were achieved. Nonsignificant increases in physical activity were observed (F 1,719= 2.18, p = .14).Discussion. A single mailing of stage-targeted print materials was not effective in promoting increases in physical activity among participants selected from the statewide population. Future research could examine how the effectiveness of print media might be enhanced, possibly by using supplementary media, community-based prompts, or other incentives.