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In this paper we outline the protocol for an implementation-effectiveness trial of ecofit, a multi-component mHealth intervention aimed at increasing participation in resistance and aerobic physical activity using the outdoor built environment (i.e., outdoor gyms) and social support. We have previously demonstrated the efficacy and effectiveness of the ecofitprogram in insufficiently active people with (or at risk of) type 2 diabetes and community-dwelling adults, respectively. The objective of this trial is to compare the effects of two implementation support models (i.e., ‘Low’ versus ‘Moderate’) on the reach (primary outcome), uptake, dose received, impact and fidelity of the ecofitprogram.

Background: Outdoor gym installations have become a popular initiative by local government agencies globally to increase community-based physical activity. Despite their rapid spread, usage rates and user characteristics are not well described, particularly the mode/type of activity performed. This study aims to investigate the proportion and timing of outdoor gym use, and demographic characteristics of gym users across seven locations. Method: The current study employed a cross-sectional research design with observational measures to examine outdoor gym use across seven locations in a large regional area in New South Wales, Australia. An outdoor gym audit including the number of pieces and names of the equipment, and type of outdoor gym was undertaken in the month prior to data collection. Results: A total of 56 h of observation periods were conducted, during which 2950 individuals were observed moving through the observation target areas. Across all parks, 3.8% of individuals (n= 112) were observed using the outdoor gyms for exercise purposes. Males (65%) were more likely to be observed using the equipment than females (35%) and there were more young-to-middle aged adult (83.9%) users than seniors (6.3%), adolescents (4.5%) and children (3.6%). Conclusion: Outdoor gyms have the potential to influence community-based physical inactivity rates as they appear to be a popular strategy by many government jurisdictions globally. To increase usage, local government agencies would benefit from working collaboratively with researchers to determine effective education and promotion strategies and in developing interventions to increase usage of outdoor gym equipment, particularly among women and older adults.

BackgroundCardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents’ CRF.MethodsTwo-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering.ResultsWe observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol.ConclusionsImplementing HIIT during curricular time improved adolescents’ CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12618000293268).

•Cardiorespiratory fitness was associated with older adolescents’ cognitive control.•Muscular fitness was not associated with older adolescents’ cognitive control.•Cardiorespiratory fitness selectively influences cognition in late adolescence.

ObjectiveTo identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.DesignSystematic review and network meta-analysis.MethodsScreening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool.Data sourcesCochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases.Eligibility criteria for selecting studiesAny randomised trial with exercise arms for participants meeting clinical cut-offs for major depression.Results218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges’ g −0.62, 95% credible interval −0.80 to −0.45), yoga (n=1047, κ=33, g −0.55, −0.73 to −0.36), strength training (n=643, κ=22, g −0.49, −0.69 to −0.29), mixed aerobic exercises (n=1286, κ=51, g −0.43, −0.61 to −0.24), and tai chi or qigong (n=343, κ=12, g −0.42, −0.65 to −0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.ConclusionsExercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.Systematic review registrationPROSPERO CRD42018118040.

Regular physical activity can significantly reduce the risk of numerous chronic diseases, and improve bone density and mental health. Yet, only 50% of Australian adults meet the aerobic physical activity guidelines and 9-19% meet the resistance-based physical activity guidelines. The aim of this study is to enhance community-based aerobic and resistance-based physical activity through the use of publicly available outdoor exercise equipment, social support and smartphone technology.