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Many sedentary adults have high body fat along with low fitness, strength, and lean body mass (LBM) which are associated with poor health independently of body mass. Physical activity can aid in prevention, management, and treatment of numerous chronic conditions. The potential efficacy of resistance training (RT) in modifying risk factors for cardiovascular and metabolic disease is clear. However, RT is under researched in public health. We report community-based studies of RT in sedentary (Study 1), and overweight and pre-diabetic (Study 2) populations. Study 1 - A semi randomised trial design (48-weeks): Participants choosing either a fitness centre approach, and randomised to structured-exercise (STRUC, n = 107), or free/unstructured gym use (FREE, n = 110), or not, and randomised to physical-activity-counselling (PAC, n = 71) or a measurement only comparator (CONT, n = 76). Study 2 - A randomised wait list controlled trial (12-weeks): Patients were randomly assigned to; traditional-supervised-exercise (STRUC, n = 30), physical-activity-counselling (PAC, n = 23), either combined (COMB, n = 39), or a wait-list comparator (CONT, n = 54). Outcomes for both were BF mass (kg), LBM (kg), BF percentage (%), and strength. Study 1: One-way ANCOVA revealed significant between group effects for BF% and LBM, but not for BF mass or strength. Post hoc paired comparisons revealed significantly greater change in LBM for the STRUC group compared with the CONT group. Within group changes using 95%CIs revealed significant changes only in the STRUC group for both BF% (− 4.1 to − 0.9%) and LBM (0.1 to 4.5 kg), and in FREE (8.2 to 28.5 kg) and STRUC (5.9 to 26.0 kg) for strength. Study 2: One-way ANCOVA did not reveal significant between group effects for strength, BF%, BF mass, or LBM. For strength, 95%CIs revealed significant within group changes for the STRUC (2.4 to 14.1 kg) and COMB (3.7 to 15.0 kg) groups. Strength increased in both studies across all RT treatments compared to controls, yet significant improvements in both strength and body-composition occurred only in programmed and/or supervised RT. As general increases in physical activity have limited impact upon body-composition, public health practitioners should structure interventions to include progressive RT. Study 1: ISRCTN13024854 , retrospectively registered 20/02/2018. Study 2: ISRCTN13509468 , retrospectively registered 20/02/2018).

Aim Insufficient research examines the treatment effectiveness of real-world physical activity (PA) interventions. Purpose We investigated the effects of 3 interventions on directly measured cardiovascular variables. All treatments and measures were administered in community settings by fitness centre staff. Methods Participants were sedentary individuals receiving no medication to reduce cardiovascular disease (CVD) risk (n=369, age 43 ±5 years). In a semirandomised design, participants were allocated to a structured gym exercise programme (STRUC), unstructured gym exercise (FREE), physical activity counselling (PAC) or a measurement-only control condition (CONT). Measures were: predicted aerobic capacity (VO2: mL kg min), mean arterial blood pressure (MAP: mm Hg) and total cholesterol (TC: mmol/L), and were taken at baseline and 48 weeks. Results Data analysis indicated a statistically significant deterioration in TC in CONT (0.8%, SD=0.5, p=0.005), and a statistically significant improvement in MAP in STRUC (2.5%, SD=8.3, p=0.004). Following a median split by baseline VO2, paired-sample t tests indicated significant improvements in VO2 among low-fit participants in STRUC (3.5%, SD=4.8, p=0.003), PAC (3.3%, SD=7.7, p=0.050) and FREE (2.6%, SD=4.8, p=0.006), and significant deterioration of VO2 among high-fit participants in FREE (−2.0%, SD=5.6, p=0.037), and PAC (−3.2%, SD=6.4, p=0.031). Conclusions Several forms of PA may offset increased cholesterol resulting from inactivity. Structured PA (exercise) might be more effective than either unstructured PA or counselling in improving blood pressure, and community-based PA interventions might be more effective in improving VO2 among low-fit than among high-fit participants.

Falls that occur as a result of a slip are one of the leading causes of injuries, particularly in the elderly population. Previous studies have focused on slips that occur on a flat surface. Slips on a laterally sloping surface are important and may be related to different mechanisms of balance recovery. This type of slip might result in different gait adaptations to those previously described on a flat surface, but these adaptations have not been investigated. The aim of this study was to assess whether, when walking on a cross-slope, young adults adapted their gait when made aware of a potential slip, and having experienced a slip. Gait parameters were compared for three conditions--(1) Normal walking; (2) Walking after being made aware of a potential slip (participants were told that a slip may occur); (3) Walking after experiencing a slip (Participants had already experienced at least one slip induced using a soapy contaminant). Gait parameters were only analysed for trials in which there was no slippery contaminant present on the walkway. Stride length and walking velocity were significantly reduced, and stance duration was significantly greater in the awareness and experience conditions compared to normal walking, with no significant differences in any gait parameters between the awareness and experience conditions. In addition, 46.7% of the slip trials resulted in a fall. This is higher than reported for slips induced on a flat surface, suggesting slips on a cross-slope are more hazardous. This would help explain the more cautious gait patterns observed in both the awareness and experience conditions.

that many studies examining the treatment effectiveness of exercise in the real world adopt laboratory style methods and controls that would be impractical and uneconomic in real-world interventions. Data resulting from such studies merely add to the efficacy data set. We argue that despite metaphorically drowning in evidence of efficacy and implementation effectiveness, SEM is yet to provide sufficient evidence of treatment effectiveness. Furthermore, while it is a mistake to confuse efficacy with effectiveness, 9 in lobbying for exercise as a public health tool, we often do just that.

A sedentary lifestyle is associated with cardiovascular disease (CVD). Blood pressure (BP) and blood lipids (cholesterols) are key mediators of CVD. A substantial body of evidence demonstrates reduced CVD risk following systematic physical activity (PA). Despite this evidence, CVD continues to rise, and public health PA initiatives often fail to demonstrate clinically relevant effects. In short, laboratory efficacy often fails to translate into real-world effectiveness.PURPOSE: We investigated the effectiveness of three physical activity interventions. We did so using a Phase-IV clinical trial model, in which all treatments were administered in uncontrolled community settings, and in which all interventions and measures were delivered by, and conducted by, community health centre staff.METHODS: Participants were sedentary individuals receiving no medication to reduce CVD risk (n=238, age 43±5 years). Participants selected a PA or exercise (EX) pathway. Those who selected PA were randomised to either fitness centre based PA counselling delivered by an exercise professional (PAC) or a wait-list control condition (CONT). Those who selected EX were randomised to either a structured exercise program (STRUC) or unstructured fitness centre use (FREE). Measures were mean arterial pressure (MAP: mmHg) estimated using the formula Diastolic Blood Pressure (BP) + (0.33 x (Systolic BP – Diastolic BP)), and total cholesterol (TC: mmol/L). Measures were taken at baseline and 48 weeks. Data were analysed using paired-sample t-tests.RESULTS: Data analysis for cholesterol indicated a small but statistically significant increase in TC in CONT (M=0.8%, SD=0.5, p = .005). TC was however approximately equivalent to baseline in PAC and FREE and reduced, although not significantly, in STRUC. Data for blood pressure indicated a statistically significant decrease in MAP in STRUC (M=2.5%, SD=8.3, P = .004). MAP was reduced, although not significantly, in all other treatments and CONT.CONCLUSIONS: Data suggest that over 48 weeks, all forms of exercise might be effective in offsetting increases in total cholesterol associated with inactivity. Furthermore, a structured exercise programme might be more effective than either unstructured exercise or physical activity counselling in reducing mean arterial blood pressure.

PURPOSE: Evidence for the effectiveness of GP Exercise Referral is weak (1, 2). We examined traditional supervised exercise (TRAD), physical activity counselling (PAC), combined TRAD/PAC (CMB) and wait-list controls (CON) in a community exercise referral programme in South East London, UK.METHODS: PPs (n=141) were identified by their doctors as overweight and at increased risk of Type 2 Diabetes. PPs were randomly assigned to treatment. Measures were blood pressure and body composition at baseline and 12 weeks. RESULTS: One-way ANOVA of absolute change in dependant variables between treatments indicated that body fat mass, body fat % and systolic blood pressure were reduced at 12 weeks for all groups including CONT. No statistically significant between-group effects were observed. Paired sample t-tests indicated that lean mass was significantly increased at 12 weeks for all groups including CON; diastolic blood pressure was significantly decreased for all groups at 12 weeks except PAC. Retention was highest to CMB (75%), followed by CON (68%), with PAC and TRAD both at 55%. CONCLUSIONS: Treatment groups and CON appeared to benefit from the programme, with likely measurement effects partially explaining improvement in CON. High retention to CMB is of significance to future GP Referral programmes.

Purpose. Many sedentary adults possess not only a high body fat percentage (BFP), but also low lean body mass (LBM). The latter may predispose metabolic disease such as Type-2 Diabetes. The majority of public health messaging around physical activity centers on habitual (e.g., walking) or purposeful (e.g., jogging) aerobic activity. However, few positive effects on muscle mass result from such activities. Whilst resistance training (RT) is an obvious solution, its effectiveness in public health settings is not demonstrated. We report two community-based RT studies, Study 1 delivered to a sedentary population, Study 2 to overweight and pre-diabetic patients.METHODS: In Study 1 (48-weeks), participants (n=364) were allocated to either programed-exercise (PROG), un-programmed use of a community gym (FREE), or monthly physical activity counseling (PAC). A wait-list control (CONT) was employed. In Study 2 (12-weeks), overweight and pre-diabetic patients (n=141) were randomly assigned to 12 sessions of either supervised exercise (SUP), PAC, or the two combined (COMB). A wait list control was employed.RESULTS: In Study 1, ANOVA indicated significant differences between treatments. PROG performed significantly better than CONT on strength (p= .048) and LBM (p= .009). FREE performed significantly better than CONT on strength (p= .029). Paired-sample t-tests indicated that PROG improved significantly pre-post on strength (p= .001), LBM (p= .036) and BFP (p= .006), whilst improvements in strength only were observed in FREE (p= .01) and PAC (p= .014). In Study 2 ANOVA indicated no significant differences between treatments. However paired-sample t-tests indicated that SUP improved significantly pre-post on strength (p= .01) and BFP (p= .027), with a clear trend also in LBM (p= .074), whilst significantly improved strength only was observed in COMB (p= .026) and PAC (p= .016).CONCLUSIONS: In both studies, whilst statistically significant increases in strength were observed across all treatments, significant improvements in both strength and body composition were observed only in programmed and/or supervised conditions. Collectively data suggest that the programming and supervision of resistance training is beneficial in community settings when improvements in body composition are desired.

PURPOSE: Ensuring that at-risk groups are sufficiently physically active is a major public health challenge. Physical activity counselling (PAC) has shown some promise. However many programmes require multiple PAC sessions that are resource intensive and costly. We report a study of PAC – in this case the UK-based programme ‘Let’s Get Moving’ – built around just one PAC session and delivered from general medical practitioner (GP) surgeries.METHODS: Participants (n=1601, M±SD age = 41.4±21.8) were identified by their local GP surgeries as meeting one or more of the following: age 18-74, currently sedentary, BMI 28-35, and/or hypertensive, and/or first medication for hypertension in last 6 months, and/or first medication for weight management in last 6 months. Participants attended a PAC session with a local community exercise professional (CEP) who was based at the surgery. At this session participants were encouraged to increase their physical activity and to attend community exercise sessions provided by local authorities. All participants received a telephone call at 6-weeks and attended a follow-up PAC session with the CEP at 12-weeks. Measures at 0 and 12 weeks were self-reported physical activity (MET-min/week) using the International Physical activity Questionnaire short-form (IPAQ) and an additional question regarding sport participation.RESULTS: Paired sample t-tests indicated significant increases in MET-min/week in Walking (M±SD = 404.6±1622.0, p < 0.001), Moderate Activity (M±SD = 151.8±1365.2, p = 0.006), Vigorous Activity (M±SD = 193.8±1439.7, p = 0.001), Total Activity (M±SD = 659.6±2742.3, p < 0.001), and Sport Participation (M±SD = 35.5±105.5, p < 0.001). Repeated measures ANOVA revealed a significant interaction suggesting that Vigorous Activity increased significantly more for females than males (F[1,533] = 3.981, p = .047). Reasons for this are unclear and warrant further investigation.CONCLUSIONS: Whilst the absence of controls and the self-report of physical activity are limitations, data suggest that brief PAC is an effective intervention when delivered to at risk individuals, and might be especially effective in encouraging females to adopt more vigorous activity. We also speculate that PAC’s effectiveness is enhanced through being located at a GP surgery.