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Objectives: While outdoor gyms are being rapidly installed around the globe, little is known about their implications on physical activity, and fitness and other health-related outcomes. The primary objective of this systematic review was to examine the effects of outdoor gyms on physical activity, fitness and other health-related outcomes. Secondary objectives were to describe outdoor gym characteristics, user characteristics, and outdoor gym usage., Design: Systematic review., Methods: Peer-reviewed papers published in English were obtained through online database searches of the following databases; EBSCO, SPORTdiscus, Medline, PsycINFO, Web of Science, Scopus and Informit. Searches covered the periods from database inception to January 2019. Studies that reported on the efficacy of outdoor gym use for physical activity, health-related outcomes or descriptive aspects of outdoor gyms and their users were eligible for inclusion., Results: There was some support that outdoor gyms may improve physical activity, fitness and other health-related outcomes, however few experimental studies have been conducted. There was no consistency between outdoor gyms in terms types and number of installed equipment for each facility. Further, this review found discrepancies of whom were the most likely users of outdoor gyms and when they were mainly used., Conclusions: This review contributes to the limited evidence on the impact and characteristics of outdoor gyms on physical activity and fitness and health-related outcomes., (Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Purpose: This study was designed to assess the feasibility and preliminary efficacy of a teacher-facilitated high-intensity interval training intervention for older adolescents (ie, 16-18 y)., Methods: Two secondary schools from New South Wales, Australia were recruited, and participants (ie, grade 11 students; 16.2 [0.4] y) were randomized at the school level to the Burn 2 Learn intervention (n = 38), or a wait-list control group (n = 30). Teachers were trained to facilitate the delivery of the novel high-intensity interval training program, which involved 3 sessions per week (∼12-20 min) for 14 weeks. A range of process measures were used to assess intervention feasibility (ie, recruitment, retention, attendance, and program satisfaction). Primary (cardiorespiratory fitness, determined using the progressive aerobic cardiovascular endurance run shuttle run test) and secondary outcomes were assessed at baseline and posttest (14-wk)., Results: Sixty-eight grade 11 students were recruited at baseline (85% of target sample), 61 participants completed posttest assessments (90% retention) and on average, participants performed 1.9 sessions per week. Overall, teachers (4.0/5) and students (4.0/5) were satisfied with the Burn 2 Learn program. Group by time effects were observed for cardiorespiratory fitness (8.9 laps; 95% confidence intervals, 1.7-16.2) and a selection of secondary outcomes., Conclusion: This study provides evidence for the feasibility and preliminary efficacy of a teacher-facilitated high-intensity interval training intervention for older adolescents.

The risk and prevalence of Type 2 Diabetes (T2D) has dramatically increased over the past decade. The aim of this study was to develop, implement and evaluate a physical activity intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. A 20-week, assessor blinded, parallel-group randomized controlled trial (RCT) was conducted at the University of Newcastle (June-December 2015). Adults were randomized to the intervention (n=42) or wait-list control group (n=42). The theory-based intervention included: Phase 1 (weeks 1-10) integrated group sessions (outdoor physical activity and cognitive mentoring), and the eCoFit smartphone application (app). Phase 2 (weeks 11-20) only included the eCoFit app. Participants were assessed at baseline, 10weeks and 20weeks. Linear mixed models (intention-to-treat) were used to determine group-by-time interactions at 10weeks (primary time-point) and 20weeks for the primary outcomes. Several secondary outcomes were also assessed. After 10weeks, significant group-by-time effects were observed for aerobic fitness (4.5mL/kg/min; 95% CI [1.3, 7.7], d=0.68) and muscular fitness (lower body) (3.4 reps, 95% CI [2.7, 4.2], d=1.45). Intervention effects for secondary outcomes included significant increased physical activity (1330steps/week), improved upper body muscular fitness (5 reps; arm-curl test), improved functionality (-1.8s; timed-up and go test) reduced waist circumference (2.8cm) and systolic blood pressure (-10.4mmHg). After 20weeks, significant effects were observed for lower body muscular fitness and health outcomes. eCoFit is an innovative lifestyle intervention which integrates smartphone technology, social support, and the outdoor environment to improve aerobic and muscular fitness., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To examine whether a gender-tailored weight loss maintenance (WLM) program could reduce men's weight regain following weight loss., Methods: Ninety-two men who lost at least 4 kg during a 3-month weight loss phase were randomized to receive: (i) a 6-month WLM program (WL + WLM; n = 47) or (ii) no resources (WL-only; n = 45). The WLM program included written materials and messages (SMS, video email) plus other resources (e.g., pedometer, Gymstick™). The primary outcome was weight change in the first year post-randomization. Participants were assessed at "-3 months" (preweight loss), "0 months" (randomization into the WLM Phase), "6 months," "1 year," and "3 years.", Results: Before randomization, participants lost a mean (SD) of 7.3 kg (2.5). Retention was 83% at 6 months and 1 year and 71% at 3 years. Intention-to-treat analysis detected a significant group × time difference in weight regain favoring the intervention group at 6 months (-1.9 kg, 95% CI -3.7 to -0.1) but not at 1- or 3-year follow-up. Three years after completing the original weight loss program the WL-only and WL + WLM groups had maintained 59% and 51% of their initial weight loss, respectively., Conclusions: Men with overweight/obesity demonstrated clinically meaningful WLM 3 years after successfully losing weight. An additional WLM program contributed to enhanced WLM effects in the short term only. (ACTRN12612000749808)., (© 2016 The Obesity Society.)

The purpose of this study was to examine the mediating effect of resistance training skill competency on percentage of body fat, muscular fitness and physical activity among a sample of adolescent boys participating in a school-based obesity prevention intervention. Participants were 361 adolescent boys taking part in the Active Teen Leaders Avoiding Screen-time (ATLAS) cluster randomised controlled trial: a school-based program targeting the health behaviours of economically disadvantaged adolescent males considered "at-risk" of obesity. Body fat percentage (bioelectrical impedance), muscular fitness (hand grip dynamometry and push-ups), physical activity (accelerometry) and resistance training skill competency were assessed at baseline and post-intervention (i.e., 8 months). Three separate multi-level mediation models were analysed to investigate the potential mediating effects of resistance training skill competency on each of the study outcomes using a product-of-coefficients test. Analyses followed the intention-to-treat principle. The intervention had a significant impact on the resistance training skill competency of the boys, and improvements in skill competency significantly mediated the effect of the intervention on percentage of body fat and the combined muscular fitness score. No significant mediated effects were found for physical activity. Improving resistance training skill competency may be an effective strategy for achieving improvements in body composition and muscular fitness in adolescent boys.

Numerous studies have identified a positive association between fundamental movement skill (FMS) competency and physical activity in children; however, the causal pathways have not been established. The aim of this study is to determine if changes in FMS competency mediated the effect of the Supporting Children's Outcomes using Rewards, Exercise and Skills (SCORES) intervention on physical activity and cardiorespiratory fitness in children. Eight primary schools (25 classes) and 460 children (aged 8.5 ± 0.6, 54% girls) were randomised to the SCORES intervention or control group for the 12-month study. The outcomes were accelerometer-determined moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness. The hypothesised mediators were actual FMS competency and perceived sport competence. Mediation analyses were conducted using multilevel linear analysis in MPlus. From the original sample, 138 (30.0%) and 370 (80.4%) children provided useable physical activity and cardiorespiratory fitness data at post-test assessments. There were significant treatment effects for locomotor skills and overall FMSs. Changes in MVPA were associated with changes in object-control skills, overall FMSs and perceived competence. The overall FMSs had a significant mediating effect on MVPA (AB = 2.09, CI = 0.01-4.55). Overall FMSs (AB = 1.19, CI = 0.002-2.79) and locomotor skills (AB = 0.74, CI = 0.01-1.69) had a significant mediating effect on cardiorespiratory fitness. The results of this study conclude that actual but not perceived movement skill competency mediated the effect of the SCORES intervention on physical activity and cardiorespiratory fitness.

Background: Evidence suggests that physical self-concept is associated with physical activity in children and adolescents, but no systematic review of this literature has been conducted., Objective: The primary aim of this systematic review and meta-analysis was to determine the strength of associations between physical activity and physical self-concept (general and sub-domains) in children and adolescents. The secondary aim was to examine potential moderators of the association between physical activity and physical self-concept., Methods: A systematic search of six electronic databases (MEDLINE, CINAHL, SPORTDiscus, ERIC, Web of Science and Scopus) with no date restrictions was conducted. Random effects meta-analyses with correction for measurement were employed. The associations between physical activity and general physical self-concept and sub-domains were explored. A risk of bias assessment was conducted by two reviewers., Results: The search identified 64 studies to be included in the meta-analysis. Thirty-three studies addressed multiple outcomes of general physical self-concept: 28 studies examined general physical self-concept, 59 examined perceived competence, 25 examined perceived fitness, and 55 examined perceived appearance. Perceived competence was most strongly associated with physical activity (r = 0.30, 95% CI 0.24-0.35, p < 0.001), followed by perceived fitness (r = 0.26, 95% CI 0.20-0.32, p < 0.001), general physical self-concept (r = 0.25, 95% CI 0.16-0.34, p < 0.001) and perceived physical appearance (r = 0.12, 95% CI 0.08-0.16, p < 0.001). Sex was a significant moderator for general physical self-concept (p < 0.05), and age was a significant moderator for perceived appearance (p ≤ 0.01) and perceived competence (p < 0.05). No significant moderators were found for perceived fitness., Conclusion: Overall, a significant association has been consistently demonstrated between physical activity and physical self-concept and its various sub-domains in children and adolescents. Age and sex are key moderators of the association between physical activity and physical self-concept.

Background: Physical fitness during childhood and adolescence has been identified as an important determinant of current and future health status. While research has traditionally focused on the association between cardio-respiratory fitness and health outcomes, the association between muscular fitness (MF) and health status has recently received increased attention., Objective: The aim of this systematic review and meta-analysis was to evaluate the potential physiological and psychological benefits associated with MF among children and adolescents., Methods: A systematic search of six electronic databases (PubMed, SPORTDiscus, Scopus, EMBASE, PsycINFO and OVID MEDLINE) was performed on the 20th May, 2013. Cross-sectional, longitudinal and experimental studies that quantitatively examined the association between MF and potential health benefits among children and adolescents were included. The search yielded 110 eligible studies, encompassing six health outcomes (i.e., adiposity, bone health, cardiovascular disease [CVD] and metabolic risk factors, musculoskeletal pain, psychological health and cognitive ability). The percentage of studies reporting statistically significant associations between MF and the outcome of interest was used to determine the strength of the evidence for an association and additional coding was conducted to account for risk of bias. Meta-analyses were also performed to determine the pooled effect size if there were at least three studies providing standardised coefficients., Results: Strong evidence was found for an inverse association between MF and total and central adiposity, and CVD and metabolic risk factors. The pooled effect size for the relationship between MF and adiposity was r = -0.25 (95% CI -0.41 to -0.08). Strong evidence was also found for a positive association between MF and bone health and self-esteem. The pooled effect size for the relationship between MF and perceived sports competence was r = 0.39 (95% CI 0.34-0.45). The evidence for an association between MF and musculoskeletal pain and cognitive ability was inconsistent/uncertain. Where evidence of an association was found, the associations were generally low to moderate., Conclusion: The findings of this review highlight the importance of developing MF in youth for a number of health-related benefits.

Objective: To determine whether time spent outdoors was associated with increased moderate-to-vigorous physical activity (MVPA) and related health benefits in youth., Study Design: We performed a cross-sectional study of 306 youth aged 13.6 ± 1.4 years. The exposure of interest was self-reported time spent outdoors after school, stratified into three categories: none, some, and most/all of the time. The main outcome of interest was accelerometer-derived MVPA (Actical: 1500 to >6500 counts/min). Secondary outcomes included sedentary behavior, cardiorespiratory fitness, overweight status, and blood pressure., Results: Among the 306 youth studied, those who reported spending most/all of their after-school time outdoors (n = 120) participated in more MVPA (61.0 ± 24.3 vs 39.9 ± 19.1 min/day; adjusted P < .001), were more likely to achieve the recommended minimum 60 min/day of MVPA (aOR 2.8; 95% CI, 1.3-6.4), spent less time in sedentary activities (539 ± 97 min/day vs 610 ± 146 min/day; adjusted P < .001), and had higher cardiorespiratory fitness (49 ± 5 vs 45 ± 6 mL/kg/min; adjusted P < .001) than youth who reported no time outdoors (n = 52). No differences in overweight/obesity or blood pressure were observed across the groups., Conclusions: Time spent outdoors is positively associated with MVPA and cardiorespiratory fitness in youth and negatively associated with sedentary behavior. Experimental trials are needed to determine whether strategies designed to increase time spent outdoors exert a positive influence on physical activity and fitness levels in youth., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: The negative consequences of unhealthy weight gain and the high likelihood of pediatric obesity tracking into adulthood highlight the importance of targeting youth who are 'at risk' of obesity. The aim of this paper is to report the rationale and study protocol for the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention intervention for adolescent boys living in low-income communities., Methods/design: The ATLAS intervention will be evaluated using a cluster randomized controlled trial in 14 secondary schools in the state of New South Wales (NSW), Australia (2012 to 2014). ATLAS is an 8-month multi-component, school-based program informed by self-determination theory and social cognitive theory. The intervention consists of teacher professional development, enhanced school-sport sessions, researcher-led seminars, lunch-time physical activity mentoring sessions, pedometers for self-monitoring, provision of equipment to schools, parental newsletters, and a smartphone application and website. Assessments were conducted at baseline and will be completed again at 9- and 18-months from baseline. Primary outcomes are body mass index (BMI) and waist circumference. Secondary outcomes include BMI z-scores, body fat (bioelectrical impedance analysis), physical activity (accelerometers), muscular fitness (grip strength and push-ups), screen-time, sugar-sweetened beverage consumption, resistance training skill competency, daytime sleepiness, subjective well-being, physical self-perception, pathological video gaming, and aggression. Hypothesized mediators of behavior change will also be explored., Discussion: ATLAS is an innovative school-based intervention designed to improve the health behaviors and related outcomes of adolescent males in low-income communities., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The main aim of this study was to determine the test-retest reliability of existing tests of health-related fitness. Participants (mean age 14.8 years, s = 0.4) were 42 boys and 26 girls who completed the study assessments on two occasions separated by one week. The following tests were conducted: bioelectrical impedance analysis (BIA) to calculate percent body fat, leg dynamometer, 90° push-up, 7-stage sit-up, and wall squat tests. Intra-class correlation (ICC), paired samples t-tests, and typical error expressed as a coefficient of variation were calculated. The mean percent body fat intra-class correlation coefficient was similar for boys (ICC = 0.95) and girls (ICC = 0.93), but the mean coefficient of variation was considerably higher for boys than girls (22.2% vs. 12.2%). The boys' coefficients of variation for the tests of muscular fitness ranged from 9.0% for the leg dynamometer test to 26.5% for the timed wall squat test. The girls' coefficients of variation ranged from 17.1% for the sit-up test to 21.4% for the push-up test. Although the BIA machine produced reliable estimates of percent body fat, the tests of muscular fitness resulted in high systematic error, suggesting that these measures may require an extensive familiarization phase before the results can be considered reliable.

Physical activity plays a key role in diabetes management, and in reducing the risk factors related to the development of co-morbid conditions. This study examined predictors of physical activity (Static Model) and activity change (Change Model) for individuals with type 1 (T1D) or type 2 diabetes (T2D) in a population sample of 1662 adults (510 type 1; 1152 type 2) using self-reported measures of co-morbidities, perceived difficulties in performing tasks of daily living (TDL), time since diagnosis, and selected demographic factors. Since the motivation for physical activity could be influenced by the initial diagnosis of diabetes, analyses were conducted separately for newly diagnosed individuals (diagnosed with diabetes < or =1 year), and those that have been diagnosed for sometime (diagnosed with diabetes >1 year). In the Static Model, a younger age (beta=-.11, p<.05) and having less perceived difficulties in performing TDL (beta=-.12, p<.05) were associated with a higher physical activity in individuals with type 1 diabetes. The presence of difficulties in TDL (beta=-.08, p<.05) and co-morbidities (beta=-.08, p<.05) were associated with physical activity participation in type 2 individuals diagnosed for >1 year, but not in newly diagnosed individuals. A shorter duration of disease (beta=-.07, p<.05), a higher body mass index (BMI) (beta=.09, p<.05) and female gender (beta=.07, p<.05) was associated with physical activity increase in individuals with type 2 diabetes. A higher BMI predicted physical activity change in both newly diagnosed individuals and those diagnosed for sometime. However, both genders were equally likely to increase their physical activity among newly diagnosed individuals. Although the magnitude of the study results are relatively modest, they could potentially guide and encourage future investigations in this area that could lead to useful insights in designing PA intervention programs for these specific populations.

Purpose: To compare the effects of stage-matched and standard print materials for physical activity (PA) change., Design: Participants were randomized into (1) a stage-matched intervention group (n = 165), (2) a standard intervention group (n = 176), or (3) a no-contact control group (n = 166). The stage-matched and standard intervention groups both received materials at baseline, 3 months, and 6 months. Assessments of all three groups were conducted at baseline, 6, and 12 months., Setting: Canadian worksites., Subjects: Employees (N = 507)., Interventions: Five motivationally targeted booklets were developed for the stage-matched group. The standard group received Canada's Physical Activity Guide and handbook., Measures: The main dependent variable was PA, expressed as metabolic equivalent (MET) minutes and measured using the Godin Leisure-Time Exercise Questionnaire. Demographic characteristics and stages of change for PA were also assessed., Results: At 12 months mean weekly MET minutes for combined moderate and vigorous activity increased from baseline by 223, 67, and 78 for the stage-matched, standard, and control groups, respectively; however, differences were not significant (p > .05). Women in the stage-matched group over the 12-month period significantly increased their activity by 327 weekly MET minutes whereas the standard and control groups declined their activity (F = 3.01, p < .05)., Conclusion: PA stage-matched materials delivered in the workplace are efficacious for women but not men. Future interventions should explore the use of these intervention materials in conjunction with multilevel strategies, and particular attention should be paid to possible gender differences.

Background: Despite the benefits of physical activity (PA), a significant proportion of youth remains inactive. Studies assessing differences in the correlates of PA among urban and rural youth are scarce, and such investigations can help identify subgroups of the population that may need to be targeted for special intervention programs. The purpose of this study was to assess differences in the correlates of PA between Canadian urban and rural youth., Methods: The sample consisted of 1398 adolescents from 4 urban schools and 1290 adolescents from 4 rural schools. Mean age of the participants was 15.6 +/- 1.3 years. Hierarchical regression analyses were used to examine the association between self-reported PA and a number of demographic, psychological, behavioral, and social correlates., Results: Common correlates between the 2 locations included gender (with girls being less active than boys) perceptions of athletic/physical ability, self-efficacy, interest in organized group activities, use of recreation time, and friends' and siblings' frequency of participation in PA. Active commuting to school and taking a physical education class were unique correlates of PA at the multivariate level in urban and rural students, respectively. Variance explained in PA ranged from 43% for urban school students to 38% for rural school students., Conclusions: Although more similarities than discrepancies were found in the correlates of PA between the 2 geographical locations, findings from this study strengthen the policies that argue for a coordinated multisector approach to the promotion of PA in youth, which include the family, school, and community.

Purpose: The purpose of this study was to explore (1) patterns in physical activity behaviors and (2) the meaning and personal significance of social cognitive theory (SCT) constructs on physical activity, across gender and income groups among people with type 2 diabetes (T2DM)., Methods: Albertans, 18 years and older (x- = 63, SD = 12.08) with T2DM (N = 1614) completed self-report measures of demographic characteristics and physical activity. Two-way, between-groups analyses of variance (ANOVAs) assessed main and interaction effects of gender and income on leisure time physical activity (LTPA). A subsample of these participants (n = 20) subsequently completed qualitative telephone interviews to provide contextual understanding of the quantitative data and to explore salient SCT influences on physical activity., Results: Significant findings indicated that men participate in more LTPA than women do, and those from the highest income group participate in more LTPA than low- or middle-income groups (P < .01). Interview results suggested that walking is the most popular form of physical activity; however, gender and income groups differ in other leisure and nonleisure physical activities. Furthermore, patterns for SCT constructs related to physical activity were apparent across gender and income, most noticeably for self-efficacy and environmental and situational influences. Specifically among men, noteworthy differences existed between income groups for self-control and reinforcement strategies., Conclusions: The study highlights the need for more sensitive self-report measures and objective measures of physical activity to help distinguish whether true differences exist between certain demographic groups. Moreover, interventions that promote walking may be beneficial for people with T2DM, provided that appropriate environmental and policy changes occur to accommodate walking and other physical activity behaviors.

Background: Cardiorespiratory 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.Methods: Two-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.Results: We 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.Conclusions: Implementing 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 Number: Australian New Zealand Clinical Trials Registry (ACTRN12618000293268). [ABSTRACT FROM AUTHOR]

Background: The purposes of this study were to determine if a) gender moderated the relationship between self-efficacy and physical activity (PA) among youth in Alberta. Canada, and, alternatively b) if self-efficacy mediated the relationship between gender and PA. Methods: A novel web-based tool was used to survey a regionally diverse sample of 4779 students (boys = 2222, girls = 2557) from I 17 schools in grades 7 to 10 (mean age = 13.64 yrs.). Among other variables, students were asked about their PA and sell-efficacy for participating in PA. Results: Based upon a series of multilevel analyses, self-efficacy was found to be a significantly stronger correlate of PA for girls. But, boys had significantly higher self-efficacy compared with girls, which resulted in significantly more PA. Conclusions: Findings suggest self-efficacy is an important correlate of PA among adolescent girls but that boys are more physically active because they have more self-efficacy for PA. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) cite time as a barrier to physical activity counseling. An alternative for time-poor GPs in Australia is the referral of insufficiently active patients to exercise physiologists (EPs). As data on the predictors of adherence to physical activity counseling interventions are limited, this study aimed to identify the sociodemographic, medical, health, and psychological characteristics of insufficiently active primary care patients who adhered to a physical activity counseling intervention delivered by EPs. Methods: This secondary analysis of data from the NewCOACH randomized trial used logistic regression to identify predictors of adherence, defined as patient participation in at least four of the five physical activity counseling sessions. EPs provided information about the number of sessions, while other potential predictors were obtained from the self-administered baseline questionnaire and medical summary sheets provided by the GPs. Results: Of the 132 patients referred to an EP, 102 (77%) were adherent: 91 (69%) and eleven (8.3%) participated in all, or all but one, of the sessions, respectively. Of the remainder, seven (5.3%) patients participated in three sessions, seven (5.3%) participated in two sessions, five (3.8%) participated in one session, and eleven (8.3%) did not participate in any session. The odds of being adherent were 5.84 (95% CI 1.46–23.4, P≤0.05) times higher among retired participants than in those who were not in paid employment. The odds of being adherent 1) increased as the positive outcome expectation score increased (OR 1.89, 95% CI 1.12–3.18, P≤0.05) and 2) decreased as the duration (days) between referral and the initial counseling session increased (OR 0.95, 95% CI 0.92–0.98, P<0.01). Conclusion: More than three quarters of the patients participated in all, or all but one, of the sessions. Being retired, positive outcome expectations, and having a shorter wait between referral and the initial appointment predicted adherence. [ABSTRACT FROM AUTHOR]

Background: Obesity prevention interventions targeting 'at-risk' adolescents are urgently needed. The aim of this study is to evaluate the sustained impact of the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention program. Methods: Cluster RCT in 14 secondary schools in low-income communities of New South Wales, Australia. Participants were 361 adolescent boys (aged 12-14 years) 'at risk' of obesity. The intervention was based on Self-Determination Theory and Social Cognitive Theory and involved: professional development, fitness equipment for schools, teacher-delivered physical activity sessions, lunch-time activity sessions, researcher-led seminars, a smartphone application, and parental strategies. Assessments for the primary (body mass index [BMI], waist circumference) and secondary outcomes were conducted at baseline, 8- (post-intervention) and 18-months (follow-up). Analyses followed the intention-to-treat principle using linear mixed models. Results: After 18-months, there were no intervention effects for BMI or waist circumference. Sustained effects were found for screen-time, resistance training skill competency, and motivational regulations for school sport. Conclusions: There were no clinically meaningful intervention effects for the adiposity outcomes. However, the intervention resulted in sustained effects for secondary outcomes. Interventions that more intensively target the home environment, as well as other socio-ecological determinants of obesity may be needed to prevent unhealthy weight gain in adolescents from low-income communities. [ABSTRACT FROM AUTHOR]

Objectives: To examine predictors of physical activity (PA) 6 months after a randomized controlled trial. Methods: Breast cancer survivors (N=377) completed assessments at baseline, postintervention, and 6 months after the intervention. Data were collected on demographic, medical, psychosocial, motivational, and behavioral variables at baseline, postintervention, and 6 months. Results: Survivors meeting PA guidelines at baseline (OR=5.54, 95% CI=2.99-9.82, P<0.001) and postintervention (OR = 2.92, 95% CI=1.63-5.23, P<0.001) had a greater likelihood of meeting PA guidelines at 6 months follow-up. Conclusions: Interventions promoting PA maintenance should focus on optimizing PA behavior, psychosocial functioning, and motivation. [ABSTRACT FROM AUTHOR]

Physical activity (PA) plays a key role in the management of Type 1 (T1D) and Type 2 diabetes (T2D) but there are few theory-based, effective programs to promote PA for individuals with diabetes. The purpose of this study was to investigate the utility of the Theory of Planned Behaviour (TPB) in understanding PA in an adult population with T1D or T2D. A total of 2311 individuals (691 T1D; 1614 T2D) completed self-report TPB constructs of attitude, subjective norms, perceived behavioural control (PBC), intention and PA at baseline and 1717 (524 T1D; 1123 T2D) completed the PA measure again at 6-month follow-up. Multi-group Structural Equation Modelling was conducted to: (1) test the fit of the TPB structure (2) determine the TPB structural invariance between the two types of diabetes and (3) to examine the explained variances in PA and compare the strength of associations of the TPB constructs in the two types of diabetes. The TPB constructs explained ≥40% of the variance in intentions for both diabetes groups. In cross-sectional models, the TPB accounted for 23 and 19% of the variance in PA for T1D and T2D, respectively. In prospective models, the TPB explained 13 and 8% of the variance in PA for T1D and T2D, respectively. When adjusting for past PA behaviour, the impact of PBC and intention on behaviour was reduced in both groups. The findings provide evidence for the utility of the TPB for the design of PA promotion interventions for adults with either T1D or T2D. [ABSTRACT FROM AUTHOR]

Abstract: Background: It is well established that both aerobic physical activity (PA) and resistance training are essential in the treatment and management of type 2 diabetes (T2D), but few studies have examined the determinants of both modes of PA in the same sample. Purpose: The main objective was to investigate the utility of the Protection Motivation Theory (PMT) in predicting aerobic PA and resistance training in a population sample of T2D adults. Methods: A total of 244 individuals completed self-report PMT constructs of vulnerability, severity, fear, response efficacy, self-efficacy and intention, and a 3-month follow-up that assessed aerobic PA and resistance training. Results: PMT explained 19% (p <.001) and 20% (p <.001) of the variance respectively for aerobic PA and resistance training behaviour. Significant associations were found between self-efficacy (β =0.45, p <.001) and gender (β =0.15, p <.05) for aerobic PA, and self-efficacy (β =0.48, p <.001) and age (β =0.17, p <.05) for resistance training. PMT accounted for 43% (p <.001) and 56% (p <.001) of the variance respectively for aerobic PA and resistance training intentions. For aerobic PA, response efficacy (β =0.14, p <.05) and self-efficacy (β =0.59, p <.001) were significantly associated with intention, while response efficacy (β =0.23, p <.001), self-efficacy (β =0.64, p <.001) and age (β =0.10, p <.05) were significantly related with resistance training intention. Conclusions: None of the unique constructs of the PMT (i.e., perceived vulnerability, severity and fear) were significant with either aerobic and resistance training intention. These results may guide the development of effective PA interventions in people with T2D. [Copyright &y& Elsevier]

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We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors. To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks. Breast cancer survivors ( N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group. Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = −0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks. Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted. [ABSTRACT FROM AUTHOR]

The article cites a study that identifies key demographic and health factors associated with physical activity (PA) participation in adults diagnosed with type 1 or type 2 diabetes recruited from the Canadian Diabetes Association of Alberta, Canada. The study uses multiple and logistic regression models to identify demographic and health factors related to PA levels, and the analyses were conducted separately for type 1 and type 2 groups. The study shows that a 63.7% of those with type 1 and 71.9% for those with type 2 diabetes were not achieving recommended PA levels.

Purpose. The purpose of this study was to evaluate a 12-week workplace e-mail intervention designed to promote physical activity and nutrition behavior. Design. A pre- and post-test design was conducted to compare the effects of e-mail messages between intervention and control groups. Setting. Five large workplaces in Alberta, Canada. Subjects. Employees with access to a personal e-mail address (N = 2121) were randomly assigned to an intervention (n = 1566) or a control group (n = 555). Intervention. Physical activity and nutrition messages were based on social-cognitive theories. The intervention group received one physical activity and one parallel nutrition message per week for 12 weeks. The control group received no weekly messages. Measures. Each participant completed self-report measures of physical activity and nutrition related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week after (time 2) the intervention. Results. The intervention group was more efficacious at time 2 on measures of self-efficacy, pros, cons, intentions, and behavior related to physical activity. This group also reported more favorable changes in practicing healthy eating, balancing food intake with activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat foods. Effect sizes for all significant differences were small. Conclusion. E-mail is a promising mode of delivery for promoting physical activity and nutrition in the workplace. Further theoretically driven studies are needed. [ABSTRACT FROM AUTHOR]

Abstract: Background: The standard methodological approach for evaluating social cognitive theories when predicting physical activity behavior is the passive prospective/longitudinal survey design. Although this design is logical, a cross-sectional design may be a cost-effective alternative if the relationships between social cognitive constructs and physical activity are relatively stable. The purpose of this study was to evaluate the utility of a concurrent measure of physical activity used in a cross-sectional design in comparison to the standard prospective measure. Methods: This study included two 6-month prediction time-periods, between 1997 and 1998, for the purpose of analysis replication, and the theory of planned behavior, the transtheoretical model, protection motivation theory, and social cognitive theory as the models of interest in a population sample (N = 703). Results: Results showed trivial (69% of tests; q < 0.10) to small (31% of tests; q = 0.11–0.18) differences in the correlations between social cognitive constructs and vigorous physical activity occur when using a cross-sectional or prospective design. The cross-sectional design estimated slightly larger coefficients than the prospective design. Conclusions: It appears that a measure of concurrent physical activity included in a cross-sectional design can act as a reasonable proxy measure of future behavior measured in a passive prospective/longitudinal design. These findings support the use of cross-sectional designs when researchers seek a standard correlational investigation of physical activity and social cognitive constructs with the possibility that coefficients may be slightly biased upwards. [Copyright &y& Elsevier]

Background. The majority of the population is inactive, and strategies to date for promoting regular physical activity have been limited in their effectiveness. Further research is needed to identify correlates of physical activity in different subgroups to design more efficacious interventions. This study sought to identify correlates of physical activity across men and women, urban and rural geographical locations, and four distinct age groups (18–25; 26–45; 46–59; and 60+).Methods. This study employed data from a large provincial household random sample (N = 20,606) of Canadians. Analyses were utilized to examine the amount of variance explained in self-reported physical activity by a number of demographic and/or biological, psychological, behavioral, social, and environmental variables within each subgroup.Results. Proportion of friends who exercise, injury from past physical activity, educational level, perceived health status, and alcohol consumption were among the strongest correlates across subgroups.Conclusions. A number of correlates were identified as being significant across all subgroups examined. Most differences in the correlates of physical activity were found within different age groups rather than among urban and rural residents and gender. [Copyright &y& Elsevier]

The examination of physical environments to explain and promote physical activity is an important yet under-investigated area of research inquiry. This study explored relationships between the perceived availability of physical environmental resources and the perceived importance of these resources in relation to physical activity levels amongst youth. A self-report questionnaire was completed by 610 students (mean age = 15.5 years old; 62% female participants) from four high schools (grades 9-12) in rural Alberta, Canada. Perceived physical environment constructs explained 5% of the variance in physical activity, with home, neighborhood, and school as significant domains. Perceived importance constructs explained 8% of the variance in physical activity with school context showing the only significant relationship with physical activity. A hierarchical regression analysis entered sex, grade, self-efficacy, peer family and physical education teacher relationships, as the first block and eight environmental constructs as the second block The first block variables accounted for 22% of the variance and environmental constructs accounted for an added 4% of the variance in physical activity. Perceived importance of the school environment was the only environment variable significantly associated with physical activity (β = .14; p < .05) after taking into account the impact of these traditional predictors. These findings reinforce the need to provide and support school physical environments related to physical activity. [ABSTRACT FROM AUTHOR]

The aggregation of measured social cognitive beliefs to form scales is a common procedure in physical activity research. In this paper, we propose that specific beliefs may actually have unique associations with physical activity, which are obscured by the practice of aggregation. Further, we point out that beliefs may be related in a more complex manner than the theory behind scale aggregation. Both of these factors are interpreted in terms of limiting physical activity intervention efforts. Therefore, the purpose of this study was to examine alternatives to summative scales of physical activity beliefs using structural equation modeling. Demonstrations were performed using belief-based constructs of self-efficacy, pros and cons with a large Canadian random sample (N = 683) over three, 6-month time points. Results demonstrated that items of belief-based scales are multidimensional and that a correlated belief structure fit the observed data better (P < 0.05) and explained more variance in vigorous physical activity (an additional 6-7%) than aggregated scales. Finally, a causally ordered structure among beliefs was supported, suggesting that items within a scale may be linked causally rather than as indicators of a higher-order latent variable. Implications for future research and physical activity interventions are discussed. [ABSTRACT FROM AUTHOR]

Copyright of AVANTE is the property of PHE Canada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While facility-based resistance training (RT) improves glycemic control for individuals with type 2 diabetes (T2D), studies in home-based settings have been less successful, perhaps because the exercise equipment provided could not provide adequate stimulus for muscle hypertrophy. It has not been established whether home-based resistance training is efficacious and feasible for this population. The purpose of this study was to investigate whether a home-based, RT program could improve strength, clinical markers, and quality of life (QoL) factors in obese T2D adults. 48 individuals were randomly assigned to 16 weeks of either treatment (n=27) or control (n=21). Individuals in the treatment condition received a multi-gym apparatus and free weights, along with supervised home instruction from a qualified trainer. This supervision gradually decreased from 3 times per week to 2 times per month; overall participants were supervised for 18 of 48 sessions. Intention-to-treat ANCOVAs, adjusted for baseline scores, were completed on the pre- and post-study measures at 16 weeks (loss to follow-up was 15%). Significant improvements in strength (24-40% mean increases in bench press, leg press, and upright row), HDL-C, fasting insulin, and dimensions of QoL were observed in the intervention group in comparison to the controls at the p < .05 significance level. Baseline mean Ale was 6.9 and did not change. There were no significant differences in blood pressure, anthropometrics, body composition by DEXA, LDL-C, or c-reactive protein between the two groups. Overall, home-based, resistance training with high quality equipment and supervision is feasible in obese people with T2D and can improve strength, HDL-cholesterol, and quality of life. [ABSTRACT FROM AUTHOR]

The article investigates the long-term effects of pedometers and print materials that focuses on the physical activity (PA) and health-related quality of life undergone by breast cancer survivors under the three month behavior modification intervention. It focuses on the efficiency of the employed pedometers and print materials to monitor the changes in PA and health related quality of life of breast cancer survivors. It also illustrates the strength and limitations of the employed medical intervention program that benefits the greatest number of breast cancer survivors.

Background: Physical inactivity and poor dietary habits in women pose a clear public health burden. Mothers are generally the main female role model for daughters, therefore, targeting intergenerational females simultaneously may be a novel approach. However, the effectiveness of this approach to improve physical activity, fitness, nutrition and adiposity has not been systematically examined.Objectives: To assess the effectiveness of physical activity, fitness and nutrition interventions targeting mothers and their daughters.Data Sources: PubMed, Psychinfo, EMBASE, Ovid Medline, SCOPUS, CINAHL, Sportdiscus and Informit were searched for English language studies (1980-2015).Study Selection: Randomized controlled trials (RCTS), non-randomized experimental trials and pre-post studies of physical activity, fitness, nutrition and adiposity interventions targeting mothers and daughters were eligible if they reported changes in physical activity, fitness, dietary intake or adiposity.Data Extraction: Data were extracted using a standardized template and checked by a second author.Data Synthesis: 3577 articles were screened and 14 unique studies (7 RCTs, 1 pseudo-randomized, 1 non-randomized, 5 pre-post) met the inclusion criteria. The majority of studies were conducted in the US (n=11) and most were limited by methodological concerns. Of the RCTs that targeted each outcome exclusively, ≤20%, ≤20% ≤21% and 0% were successful for improving physical activity, fitness, nutrition and adiposity respectively.Conclusions: Overall, evidence for the effectiveness of mother-daughter interventions to improve physical activity, fitness, nutrition and adiposity is inconclusive. The diversity of study designs, exposures and outcomes used, along with methodological weaknesses means that well-designed and reported RCTs are warranted. [ABSTRACT FROM AUTHOR]

Purpose Guidelines recommend that young people engage in muscle-strengthening activities on at least 3 d⋅wk-1. The purpose of this study was to examine the effect of a school-based intervention focused on resistance training (RT) for adolescents. Methods The "Resistance Training for Teens" intervention was evaluated using a cluster-randomized, controlled trial with 607 adolescents (50.1% girls; 14.1 ± 0.5 yr) from 16 secondary schools. Teachers were trained to deliver the intervention, which included the following: (i) an interactive student seminar; (ii) a structured physical activity program, focused on RT; (iii) lunchtime fitness sessions; and (iv) Web-based smartphone apps. The primary outcome was muscular fitness (MF) and secondary outcomes included body mass index, RT skill competency, flexibility, physical activity, self-efficacy, and motivation. Assessments were conducted at baseline, 6 months (postprogram; primary end point), and 12 months (follow-up). Outcomes were assessed using linear mixed models, with three potential moderators tested using interaction terms (and subgroup analyses where appropriate). Results For the primary outcome (MF), a group-time effect was observed at 6 months for the upper body (2.0 repetitions; 95% confidence interval (CI), 0.8-3.2), but not the lower body (-1.4 cm; 95% CI, -4.7-1.9). At 6 months, there were intervention effects for RT skill competency and self-efficacy, but no other secondary outcomes. Effects for upper body MF and RT skill competency were sustained at 12 months. Despite overall no effect for body mass index, there was a group-time effect at 12 months among students who were overweight/obese at baseline (-0.55 kg⋅m-2; 95% CI, -1.01 to -0.08). Conclusions The school-based RT intervention resulted in immediate and sustained improvements in upper body MF and RT skill competency, demonstrating an effective and scalable approach to delivering RT within secondary schools. [ABSTRACT FROM AUTHOR]

Introduction The prevalence and risk of Type 2 Diabetes (T2D) has dramatically increased over the past decade. Physical activity (PA) has significant benefits for the treatment and prevention of T2D. The aim of this study is to develop, implement and evaluate a community-based PA intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. Research design and methods The eCoFit pilot intervention will be evaluated using a randomized controlled trial (RCT) design. The 20-week (Phases 1 and 2) multi-component intervention was guided by Social Cognitive Theory, Health Action Process Approach Model, and Cognitive Behavior Therapy strategies. Phase 1 (Weeks 1–10) includes: i) 5 group face-to-face sessions consisting of outdoor training and cognitive mentoring; and ii) the use of the eCoFit smartphone application with a description of where and how to use the outdoor environment to be more physically active. Phase 2 (Weeks 11–20) includes the use of the eCoFit smartphone application only. Assessments are to be conducted at baseline, 10-weeks (primary end-point) and 20-weeks (secondary end-point) post-baseline. Primary outcomes are cardio-respiratory fitness and muscular fitness (lower body). Secondary outcomes include physical, behavioral, mental health and quality of life, and social–cognitive outcomes. Discussion eCoFit is an innovative, multi-component intervention, which integrates smartphone technology, social support and the outdoor physical environment to promote aerobic and resistance training PA among adults at risk of, or diagnosed with T2D. The findings will be used to guide future interventions and to develop and implement effective community-based prevention programs. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12615000990527. [ABSTRACT FROM AUTHOR]

Abstract: Objective . : To examine the American–Canadian difference in physical activity and its association with diabetes prevalence. Methods . : We used cross-sectional data from nationally representative samples of adults (8688 persons aged ≥18years) participating in the 2004 Joint Canada/U.S. Survey of Health. Using data on up to 22 activities in the past 3months, we defined 3 physical activity groups (in metabolic equivalents-hours/day) as low (<1.5), moderate (1.5–2.9), and high (≥3.0). We employed logistic regression models in our analyses. Results . : Self-reported diabetes prevalence was 7.6% in the U.S. and 5.4% in Canada. The prevalence of low physical activity was considerably higher in the U.S. (70.9%) than in Canada (52.3%), while levels of moderate and high physical activity were higher in Canada (24.6% and 23.1%, respectively) than in the U.S. (14.3% and 14.8%, respectively). Using nationality (Canada as reference) to predict diabetes status, the adjusted odds ratio was 1.48 (95%CI, 1.22–1.79), and became 1.38 (95%CI, 1.15–1.66) when additionally adjusting for physical activity level. We estimate that 20.8% of the U.S.-Canada difference in diabetes prevalence is associated with physical activity. Conclusions . : The difference in the prevalence of diabetes between U.S. and Canadian adults may be partially explained by differences in physical activity between the two countries. [Copyright &y& Elsevier]

Objectives: Two primary objectives were to examine (a) changes in physical activity (PA) over a 12-month period in people living with cardiac disease who did not attend cardiac rehabilitation (CR), and (b) the role of barrier self-efficacy in explaining these changes from a gender perspective. A secondary objective was to examine whether attending CR (or not) moderated the gender-barrier self-efficacy relationship with PA. Design and Setting: Participants (N = 801) completed a questionnaire in the hospital and at 2, 6, and 12 months after hospitalization, as well as a telephone-administered 7-day PA recall at 2, 6, and 12 months. Main Outcome Measures: PA and barrier self-efficacy. Results: Hierarchical linear modeling showed significant declines in PA over time, which were especially pronounced for women. Moreover, the association between barrier self-efficacy and PA became significantly weaker over time, especially for women. This trend was similar for participants who did and did not attend CR. Conclusion: Interventions that focus on increasing barrier self-efficacy in people living with heart disease after hospitalization will likely equally benefit men and women in the short term but may disproportionately benefit men in the longer term regardless of participation in CR. [ABSTRACT FROM AUTHOR]